The primary objective of the project was to survey recognized “experts” in the field of neurodiagnostic audiology and practicing audiologists regarding their referral criteria and referral patterns for administering an auditory brainstem response test (ABR). For purposes of this study, “expert” was defined as any recognized audiologist with at least two or more publications and/or seminars in the field of auditory evoked potentials. Responses of experts and practicing audiologists were compared and contrasted to establish: a) if there was a standard referral pattern; b) what, if any, were the apparent critical components of referral patterns; and, c) whether or not current practice reflected the utilization of such critical components. The survey was designed to establish whether the respondent was practicing, in what type of practice setting, and how often ABRs were performed. Specificity and sensitivity of ABR outcomes was also requested. The survey was administered verbally, via telephone, to 3 experts and was sent via e-mail to 178 randomly selected audiologists in the United States. Of the latter 53 returned, 38 reported conducting ABRs. Thus, data analysis was reported on 38 respondents. The survey results did not reveal a consistent standard referral pattern. Critical components for referral were hypothesized based on the “expert” majority response. These include ABR referral based on the presence of: (1) asymmetric sensorineural hearing loss; (2) unilateral tinnitus; (3) positive reflex decay; and, (4) word recognition rollover. The majority of “non-expert” practitioners surveyed reported that these symptoms warranted consideration for referral, thus reflecting utilization of apparent critical components.

<p> Animal studies have shown that the tonotopic organization of the auditory cortex is not statically fixed, but can be remodeled by experience. The purpose of this study was to investigate whether or not frequency discrimination training can induce changes in the cortical representation of a selected frequency in humans. Six human subjects were trained for approximately 3 weeks to detect a change in pitch between two tones (40Hz amplitude modulated) using a standard frequency of 2040 Hz. Each subject was tested on his/her discriminative ability before and after training using three different standards (2040Hz, 1840Hz, and 2240Hz). EEG data were recorded both before and after training and changes in transient and steady-state responses were investigated. Behaviourally, every subject improved at the discrimination task using the trained frequency. However, only three subjects demonstrated transfer to both untrained frequencies. In the EEG data, the P2-Nl amplitude increased in five of the six subjects and the Nllatency decreased in all six for the 2040Hz set. These two findings were statistically significant (p<0.05) for the group. There were no statistically significant findings for the side frequencies. The change in the 40 Hz steady-state response was also not significant, increasing in three subjects and decreasing in the other three. These findings indicate that changes are expressed in the secondary auditory cortex. These findings may also be applicable to the treatment of tinnitus. </p> / Thesis / Master of Science (MSc)

In der vorliegenden Studie wurden zwei Patientenkollektive untersucht, um zum einen die Prävalenz und zum anderen die klinische Bedeutung von Bogengangsdehiszenzen zu erfassen. Des Weiteren wurde bei Patienten, bei denen sowohl eine MRT als auch eine CT des Felsenbeins zur Verfügung standen, die Vergleichbarkeit dieser beiden Bildgebungs- modalitäten bei der Beurteilung von Bogengangsdehiszenzen geprüft. Zur Berechnung der Prävalenz von Bogengangsdehiszenzen wurde ein Kollektiv gewählt, bei dem eine Schnittbildgebung des Felsenbeins vorliegt und von dem kein Zusammenhang mit dem Auftreten von Bogengangsdehiszenzen vermutet werden kann (Patienten mit Akustikusneurinom aus dem Archiv des Klinikums Fulda). Bei 2,1 % der Patienten bzw. 1,1 % der beurteilbaren Felsenbeinen wurde eine Grad 2, d.h. sichere Dehiszenz, bei 11,3 % der Patienten bzw. 7,3 % der Felsenbeine eine Grad 1, d.h. mögliche Dehiszenz festgestellt. Zur Ermittlung der klinischen Relevanz von Bogengangsdehiszenzen wurden 400 CTs und MRTs der Schädelbasis auf das Auftreten von Dehiszenzen hin untersucht. Von den Patienten mit Grad 2 Dehiszenzen wurde die Krankenakte aus dem Archiv angefordert und nach Symptomen gesucht, die in Zusammenhang mit der Bogengangsdehiszenz stehen könnten. Als Kontrolle wurden den 20 Fällen jeweils ein Patient gleichen Geschlechts und etwa gleichen Alters in matched - pair Technik zugeordnet. In 90,9 % der Fälle und bei 82,8% der Patienten aus dem Kontrollkollektiv (jeweils bezogen auf die einzelnen Felsenbeine) trat eine Innenohrschwerhörigkeit auf, bei 8,7 % der Fälle und 7,3 % der Kontrollen trat ein Ohrgeräusch auf. Bei 15 % der Patienten mit Grad 2 Dehiszenz wurde eine Schwindelsymptomatik, bei 10 % eine angeborene Fehlbildung des Ohres festgestellt; beides war bei keiner der Personen in der Vergleichsgruppe der Fall. Vor allen Dingen bei 4 der 20 Fälle sollte auf Grund der Symptomkonstellation differentialdiagnostisch die Grad 2 Dehiszenz als ursächlich für die klinische Symptomatik in Betracht gezogen werden. Bei 80% der Felsenbeine mit Bogengangsdehiszenz, von denen eine Tonschwellenaudiometrie vorlag, wurde eine Schallleitungsstörung festgestellt. Dagegen wurde bei nur 31 % der Felsenbeine ohne Bogengangsdehiszenz eine solche Schallleitungskomponente beschrieben. In der Korrelation der Graduierung der Bogengangsdehiszenzen in der MRT und der CT wurde kein systematischer Unterschied gefunden. Wir sehen daher beide Bildgebungsmodalitäten als gleichwertig in der Diagnosefindung von Bogengangs- dehiszenzen an. Unsere Studie könnte insofern zur Qualitätsverbesserung des ärztlichen Handelns beitragen, als dass sie den Hinweis liefert, dass vor allem beim Vorliegen einer Fistelsymptomatik bzw. eines Tulliophänomens eine Bogengangsdehiszenz als Differentialdiagnose in Betracht zu ziehen und auch als solche im Befund festzuhalten ist. Dies könnte den weiteren Therapieverlauf entscheidend beeinflussen. / In this study imagery of the temporal bone of two different groups of patients were retrospectively explored in order to determine the prevalence and the clinical significance of semicircular canal dehiscence (SCD). Furthermore the value of MRI and CT for delineation of a SCD was compared. In order to evaluate the prevalence of SCD a collective of patients who underwent a high resolution imagery of the temporal bone for a reason that was not related to SCD (patients with acoustic neuroma) were reviewed. SCD was classified in 3 grades (grade 2 – a part of the cross section of the posterior or superior semicircular canal appeared to over the cortical bone of the petrosal bone and no margin was detectable; grade 1 – no margin between the SC and the liquor was visible but the cross section of the SC appeared to be completely situated in the petrosal bone; grade 0 - a margin between SC and liquor was clearly visible). In 2,1 % of the patients and 1,1% of the temporal bones a grade 2 dehiscence was found; in 11,3% of the patients and 7,3% of the temporal bones respectively a grade 1 dehiscence was found. In order to evaluate the clinical significance of SCD 400 CT and MRI of the base of the skull were reviewed. Clinical records of patients with grade 2 dehiscence were reviewed for symptoms related to SCD. As a control group 20 patients of the same age and gender were matched. In 90,9 % of the patients and 82,8% of the control group respectively a labyrinthine hypacusia was found, in 8,7% of the cases and 7,3 % of the control group respectively tinnitus was reported. 15% of the patients with grade 2 SCD suffered from vertigo, 10% had a congenital malformation of the ear; none of the patients of the control group had either. In 4 of the 20 Patients with SCD the symptoms presented could have been related to the dehiscence. In 80% of the temporal bones with SCD a conductive hearing loss was found, whereas only 31% of the control group presented a conductive hearing loss. MRI and CT was found to be of equal value in the delineation of SCD.

Introducción: La evolución y el pronóstico de la sordera brusca ha sido relacionada con diversos factores de pronóstico como la edad, el grado de pérdida auditiva, el retraso diagnóstico, la curva audiométrica, los factores de riesgo cardiovascular, los acúfenos y la clínica vertiginosa. Los potenciales evocados vestibulares miogénicos (PEVM) valoran el sáculo y el nervio vestibular inferior y detectan enfermedades vestibulares periféricas, incluso en ausencia de vértigo. La proximidad anatómica entre la cóclea y el vestíbulo explicaría que un daño coclear severo se asociase a una afectación del sáculo. Así, a mayor daño cocleo-vestibular peor recuperación auditiva. Los PEVM permitirían detectar la afectación vestibular, incluso en ausencia de vértigo, y pronosticar la recuperación auditiva. Hipótesis: La afectación de los potenciales evocados vestibulares miogénicos (PEVM) en la sordera brusca es un factor de mal pronóstico. Diseño del estudio: Prospectivo observacional transversal. Material y método: Durante el período de tiempo comprendido entre agosto de 2008 y julio de 2010 se incluyeron en el estudio 73 pacientes que acudieron al servicio de urgencias de ORL del Hospital Vall d’Hebron con diagnóstico audiométrico de hipoacusia brusca. La pérdida auditiva se obtuvo mediante la 5PTA y se clasificó según la escala cuantitativa de la SEORL. La recuperación auditiva se calculó en valor absoluto, considerando recuperación cuando la ganancia fue mayor de 15 dB, y se distinguieron grados según la clasificación de Siegel. Los PEVM fueron normales o patológicos, clasificándose los patológicos en anomalías de amplitud, anomalías de latencia, ausencia de respuesta o no valorables. Para el análisis estadístico se utilizó la prueba chi-cuadrada para las variables cualitativas y la ANOVA para las cuantitativas. Se realizó un estudio multivariante para las variables relacionadas con la recuperación auditiva mediante un modelo de regresión logística. Resultados: La incidencia de PEVM alterados fue del 43%. Se observó una relación estadísticamente significativa entre la recuperación auditiva y los PEVM (p<0.05). El 70% de los pacientes con PEVM normales recuperó audición. El 60% con recuperación completa presentó PEVM normales. Ningún paciente con recuperación completa o moderada había presentado ausencia de potencial. Por otro lado, los pacientes sin clínica vertiginosa obtuvieron PEVM normales o de menor amplitud y los pacientes con un PEVM ausente habían manifestado vértigo. Discusión: Coincidiendo con otros autores (Iwasaki, Wang, Korres) se observa una relación estadísticamente significativa entre los PEVM y la recuperación auditiva. Así, un PEVM normal o de menor amplitud no es indicativo de recuperación auditiva. Sin embargo, un PEVM ausente o no valorable es signo de mal pronóstico y peor recuperación auditiva. En relación a los PEVM y la clínica vestibular, según algunos autores (Stamatiou, Iwasaki), la presencia de alteraciones vestibulares en la sordera brusca parece correlacionarse mejor con la afectación sacular que con una disfunción aislada de los canales semicirculares. Conclusión: Los PEVM permiten detectar la afectación vestibular, incluso en ausencia de vértigo, y predecir una mayor extensión del daño y una peor recuperación auditiva en los pacientes con sordera brusca. / Introduction: The prognosis and evolution of sudden sensorineural hearing loss (SSHL) have been related to several prognostic factors such as age, the severity of hearing loss, a delayed diagnosis, the shape of the audiometric curve, cardiovascular risk factors, tinnitus and dizzyness. Vestibular evoked myogenic potential testing (VEMP) assesses the neural pathway mediated by the saccule and the inferior branch of the vestibular nerve. The anatomical proximity between the cochlea and vestibule may explain an involvement of the saccule when a cochlear damage. The likelihood of hearing recovery tends to reduce as the degree of labyrinthine involvement increases. VEMP may detect vestibular impairment, even in the absence of vertigo, and predict hearing recovery Hypothesis: The abnormal VEMP response is a factor of poor prognosis in sudden sensorineural hearing loss. Study Design: A prospective observational study. Material and methods: From August 2008 to July 2010, 73 patients with audiometric diagnosis of sudden sensorineural hearing loss were included in the study. All of them were attended at the Vall d’Hebron Hospital Emergency Room of ENT. Hearing loss was defined by 5PTA and was classified according to the quantitative scale established by the Spanish Society of Otorhinolaryngology. Hearing recovery was defined as a gain equal or greater than 15 dB at 5PTA. A subclassification was made using the Siegel classification of hearing recovery. VEMP results were normal or abnormal. Chi-square analysis was peformed to qualitative variables and ANOVA analysis was used for quantitative variables. Logistic regression model was performed in order to assess variables related to hearing recovery. Results: The incidence of abnormal VEMP responses was found in 43 per cent of patients. A statistically significant relationship was reported between VEMP test findings and hearing recovery. 70% of patients with normal VEMP had hearing recovery. 60% of patients with complete recovery showed normal VEMP. No patient with complete or moderate recovery had absent VEMP. Furthermore, patients without dizziness had normal or lower amplitude VEMP response. Patients with vertigo had absent VEMP. Discussion: A statistically significant relationship between hearing recovery and VEMP was found coinciding with other authors (Iwasaki, Wang, Korres). Normal or lower amplitude VEMP responses are not indicative of hearing recovery. However, absent or unreadable VEMP responses are a sign of poor prognosis and worse hearing recovery. In addition, according to some authors (Stamatiou, Iwasaki), the presence of vestibular disorders in sudden sensorineural hearing loss appears to correlate better with saccular involvement than with an isolated dysfunction of the semicircular canals. Conclusion: VEMP testing could be useful to detect vestibular involvement, even in the absence of vertigo. Moreover, VEMP testing could predict a greater extent of damage, which could be associated to a poorer hearing recovery in patients with sudden sensorineural hearing loss.

Introducción: El schwannoma vestibular (SV) es un tumor benigno con origen en el VIII par craneal. La prueba diagnóstica de referencia del SV es la resonancia magnética (RM), si bien existen una serie de pruebas de funcionalidad cócleo-vestibular que, junto con el grado de sospecha dado por determinadas manifestaciones clínicas, pueden poner sobre la pista del SV. Entre éstas pruebas se encuentran los potenciales evocados vestibulares miogénicos de registro cervical (cVEMPs) que ha ganado popularidad en los últimos años como prueba de funcionalidad del sáculo y del nervio vestibular inferior. Los objetivos del presente estudio son determinar cuál es la bondad diagnóstica de los cVEMPs , establecer qué variables demográficas, clínicas (síntomas, signos, inicio) y de resultados en pruebas otoneurológicas (audiometría, pruebas vestibulares calóricas, potenciales auditivos de tronco –PEATC-, cVEMPs) pueden predecir tamaño, grado de penetración y localización tumorales (fundamentales para establecer la modalidad terapéutica adecuada y para la valoración de la funcionalidad auditivo-vestibular residual que, sin duda, marcan la calidad de vida de estos pacientes). Material y métodos: Para establecer la bondad diagnóstica de los cVEMPs se analizó retrospectivamente una cohorte de 585 pacientes visitados consecutivamente en una consulta de otoneurología, en un período de 4 años, con síntomas-signos auditivo-vestibulares (93 con SV, 492 sin SV). A todos ellos se les realizó cVEMPs y RM. Se calculó sensibilidad, especificidad, valores predictivos y razones de verosimilitud; así mismo se usó una cohorte retrospectiva de 157 pacientes con diagnóstico confirmado de SV en el mismo hospital en un período de 10 años, recogiendo datos demográficos, síntomas (hipoacusia, acúfenos, desequilibrio, vértigo, signos no otológicos) y resultados en audiometría, pruebas calóricas, PEATC y cVEMPs, para realizar análisis multivariado referente a la predicción de tamaño, localización –intra o extracanalicular- y grado de penetración en el conducto auditivo interno (CAI) del SV. Resultados: La prueba índice usada en la serie (cVEMPs) para el diagnóstico de SV, cuando fue comparada con la prueba de referencia (RM CAI), presentó una sensibilidad de 81.72% y una especificidad del 37.60%. Mucho más bajas fueron la sensibilidad (58%) y especificidad (52%) de las pruebas vestibulares calóricas. El valor predictivo negativo de los cVEMPs fue del 92%. La afectación de las frecuencias bajas en la audiometría, una alteración del intervalo III-V en el lado sano en los PEATC y presentar signos no otológicos y desequilibrio fueron las variables predictivas que se relacionaron significativamente con el tamaño del SV, en un modelo de regresión lineal múltiple. Los pacientes con afectación en la audiometría de frecuencias graves y penetración del SV más allá de la mitad del CAI tuvieron más probabilidad de presentar SV extracanaliculares. La pérdida en la audiometría de > 40 dB se mostró como la única variable explicativa del mayor grado de penetración de los SV en el CAI. Conclusiones: Los cVEMPs no son una buena herramienta diagnóstica de detección, debido a su baja especificidad, pero sí de exclusión dado su alto valor predictivo negativo. Presentar desequilibrio, signos no otológicos, afectación de las frecuencias bajas en la audiometría y un incremento en el intervalo III-V del lado sano en los PEATC son las variables que predicen mejor el tamaño en mm de los SV. Los cVEMPs no son una buena herramienta para discernir entre un tumor intra o extracanalicular, ni tampoco el grado de penetración tumoral en el CAI. / Introduction: Vestibular schwannoma (VS) is a benign tumor arising from the eighth cranial nerve. The current gold standard for diagnosing SV is magnetic resonance imaging (MRI), although many tests which evaluate cochleovestibular functionality, together with the degree of suspicion given by certain clinical manifestations, can put on the track of the diagnostic of VS. These tests include cervical vestibular evoked myogenic potentials (cVEMPs), that has gained popularity in recent years as a diagnostic tool to evaluate the saccule and the inferior vestibular nerve functionality. The aims of this study are to determine what is the diagnostic accuracy of the cVEMPs, to establish which demographic, clinical (symptoms, signs, onset) and otoneurological tests (audiometry, caloric tests, auditory brainstem potentials -ABR-, cVEMPs) variables can predict size, degree of tumor penetration and location (they are fundamental for establishing the proper therapeutic modality and for the assessment of the residual auditory-vestibular functionality, which undoubtedly predict the quality of life of these patients). Material and methods: A cohort of 585 patients visited consecutively over a period of 4 years, in an otoneurology clinic, suffering from audiovestibular signs and symptoms (93 with VS, 492 without VS) was retrospectively analyzed to establish the diagnostic accuracy of cVEMPs. cVEMPs and MRI was performed in all of them. Sensitivity, specificity, predictive values, and likelihood ratios were calculated; a retrospective cohort of 157 patients with confirmed diagnosis of VS, at the same hospital in a period of 10 years, was also analyzed, collecting demographic data, symptoms (hearing loss, tinnitus, vertigo, imbalance non-otological signs) and results in audiometry, caloric testing, ABR and cVEMPs in order to perform a multivariate analysis to predict the size, location - intra vs. extracanalicular- and degree of penetration into the internal auditory canal (IAC) of the VS. Results: The index test for the diagnosis of SV used in this series (cVEMPs) -when compared to the reference standard test (MRI) - presented a sensitivity of 81.72% and a specificity of 37.60%. The caloric test showed both low sensitivity (58%) and specificity (52%). The negative predictive value of cVEMPs was 92%. The involvement of low frequencies on audiometry, an alteration of the III-V interval in the ipsilateral side in the ABR, non-otological signs and imbalance were predictive variables that were significantly related to the size of the SV in a multiple linear regression model. Patients with involvement of low-frequencies in the audiometric test and penetration of the VS beyond half of the IAC were more likely to have an extracanalicular VS. A loss > 40 dB in the audiometry was established as the single explanatory variable of a higher penetration degree of VS in the IAC. Conclusions: cVEMPs are not a good diagnostic detection tool, due to its low specificity. Conversely, given its high negative predictive value, they are a good diagnostic tool of exclusion. Having imbalance, non-otological signs, involvement of low frequencies in the audiometry and an increased III-V interval in the healthy side in ABR are the variables which best predict the size of VS in millimeters. cVEMPs are not a good tool to discern between intracanalicular and extracanalicular tumors, nor the degree of tumor penetration in the IAC.

<p>Uvod - Etiologija sindroma gornjeg otvora grudnog ko&scaron;a (thoracic outlet syndrome- TOS) je udruženost vi&scaron;e faktora koji su posledica naru&scaron;avanja anatomsko-topografskih odnosa u nivou gornjeg otvora grudnog ko&scaron;a: kostoklavikularnog prostora, prednjeg skalenskog otvora, kao i same mehanike rebarnih zglobova i hrskavica, koji dovode do suženja prostora kroz koje prolaze neurovaskularne strukture, njihove kompresije, a samim tim i iritacije neurovaskularnih struktura. Sindrom gornjeg otvora grudnog ko&scaron;a je kompleks simptoma uzrokovanih kompresijom brahijalnog spleta, vene subklavije, arterije subklavije i simpatičkih vlakana, koji karakteri&scaron;u bol, parestezije, mi&scaron;ićna slabost i osećaj nelagodnosti u ruci/rukama koji se pojačava podizanjem ruke/ruku ili prekomernim pokretima glave i vrata, te dovode do smanjenja funkcionalne sposobnosti ruke/ruku i pote&scaron;koća u obavljanju svakodnevnih aktivnosti. Pored toga imaju često izraženu tahikardiju, osećaj stezanja u grudima, glavobolju, vrtoglavicu, zujanje u u&scaron;ima. Navedene tegobe su izraženije ponekad noću i dovode do poremećaja spavanja (problemi usnivanja, hrkanje, ka&scaron;ljanje, osećaj toplo/hladno, apnea, poremećaj dnevno/noćnog ritma- hronotipizacija, itd). Kao posledica lo&scaron;eg spavanja moguća je pojava depresivnih simptoma. U raspoloživoj literaturi, spavanje i kvalitet spavanja se uglavnom posmatraju kroz prizmu drugih bolesti i stanja. Materijal i metode - Istraživanjem je obuhvaćeno ukupno 181 (sto osam deset jedna) osoba. Od tog broja 53 mu&scaron;karca i 128 žena. Test grupu sačinjavalo je 82 ispitanika sa dijagnostikovanim TOS, a 99 zdravih osoba/osoba oba pola koji nemaju simptomatologiju TOS, je predstavljalo kontrolnu grupu. Grupe su bile ujednačene po polu i starosti (od 18 do 65). Tokom studije ispitanici su podvrgnuti kliničkom pregledu &ndash; fizikalnom i neurolo&scaron;kom pregledu. Pregled je podrazumevao pregled posture obolelog (posmatranje mi&scaron;ića regije vrata, ramena i ruku- trofika, tonus, konzistencija, mobilnost i kontraktilnost), posmatranje promena na koži (sa posebnim osvrtom na promene boje kože, trofičkih promena kože i noktiju i temperature kože ruku - &scaron;aka), testiranje refleksa, ispitivanje senzibiliteta u regijama inervacije odgovarajućih spinalnih korenova brahijalnog spleta. Takođe vr&scaron;ena je analiza stanja uhranjenosti (telesna visina, telesna masa, indeks telesne mase) i izvođenje provokativnih testova (Adson manevar, Rus test, Halsted test, Elvi test i Kostoklavikularni test). Kao deo ispitivanja obavljeno je i radiolo&scaron;ko snimanje vratne kičme kao i pregled oscilografom. Ispitanici su imali za zadatak da ispune sledeće upitnike: Upitnik o nesposobnosti ruke, ramena i &scaron;ake (DASH), Pitsbur&scaron;ki indeks kvaliteta spavanja (PSQI), Upitnik o hronotipizaciji (MEQ), Bekov upitnik o depresiji (BDI II). Na kraju ispitanici su davali odgovore na pitanja iz vodiča za istraživača sastavljenog sa ciljem evaluacije različitih aspekata spavanja. Rezultati - Rezultati su pokazali da su upotrebljene skale dale zadovoljavajuću pouzdanost. Pokazalo se da osobe sa dijagnozom TOS pored bogate simptomatologije imaju jo&scaron; i probleme sa spavanjem. Analizom rezultata do&scaron;lo se do zaključka da osobe sa dijagnozom TOS su starije, imaju vi&scaron;e problema sa spavanjem i veću nesposobnost ruke, ramena i &scaron;ake. Nije se pokazala razlika u hronotipizaciji kod osoba sa TOS u odnosu na kontrolnu grupu. Takođe može se zaključiti da osobe koje imaju izraženu nesposobnost ruku, ramena i &scaron;ake imaju značajno veću &scaron;ansu da imaju sindrom gornjeg otvora grudnog ko&scaron;a. Ove osobe pri tom imaju i veću &scaron;ansu da razviju depresiju i poremećaj spavanja, te se zaključuje da ova dva parametra svoj uticaj na TOS ostvaruju preko problema sa funkcionisanjem ruke, ramena i &scaron;ake. Dobar prediktor za postavljanje dijagnoze TOS može biti testiranje osoba DASH skalom. Zaključak - Rezultati studije mogu biti putokaz daljim istraživanjima, koja bi otvorila vrata formiranju protokola i opservaciji kvaliteta života osoba sa sindroma gornjeg otvora grudnog ko&scaron;a, sa posebnim osvrtom na poremećaje spavanja.</p> / <p>Etiology of thoracic outlet syndrome (TOS) is an association of several factors which are the result of disruption in the anatomical-topographical relations, in the level of superior thoracic aperture: costoclavicular space, anterior scalene aperture, as well as the mechanics of rib joints and cartilage, causing narrowing of space through which the neurovascular structures pass, their compression, and thus the irritation of neurovascular structures. Thoracic outlet syndrome is a complex of symptoms caused by the compression of the brachial plexus, subclavian vein, subclavian artery and sympathetic fibres, which is characterized by pain, parasthesias, muscle weakness and a feeling of discomfort in the arm / arms, which increases with raising the arm/arms or by excessive head and neck movements leading to a reduction of functional capabilities of the hands / arms and difficulties in everyday activities. In addition, patients often have expressed tachycardia, feeling of tightness in the chest, headache, dizziness, tinnitus. These problems are more pronounced at night and sometimes lead to sleep disorders (difficulty in falling asleep, snoring, coughing, feeling hot/cold, apnea, day/night rhythm disorder - Morningness/Eveningness disorder, etc.). As a result of poor sleeping depressive symptoms may occur. In the available bibliography, sleep and quality of sleep are mainly viewed through other diseases and conditions. The study included a total number of 181 (one hundred eighty one) people. Out of that 53 men and 128 women. The test group consisted of 82 patients diagnosed with TOS, and 99 healthy persons of both genders who had no symptoms of TOS, and constitute the control group. Groups were equalled by gender and age (18 to 65). Throughout the study subjects underwent clinical examination - both physical and neurological. This included an assessment of posture of the patient (observation of muscles in region of the neck, shoulders and arms - trophic, muscle tone, consistency, mobility and contractility), observation of changes on the skin (with a special emphasis on skin colour changes, trophic changes of the skin, nails and skin temperature of arms - hands), reflex testing, sensitivity testing in regions of innervations which correspond to spinal roots of the brachial plexus. Moreover, an analysis was conducted on the body composition analysis (body height, body weight, body mass index) as well as provocative tests (Adson manoeuvre, the Roos test, Halstead test, Elvy test and Costoclavicular test). Radiology scan of the cervical spine as well as oscillograph testing was conducted as a part of the test. The subjects were asked to fulfil the following questionnaires: Questionnaire on Disabilities of the Arm, Shoulder and Hand (DASH), Pittsburgh Sleep Quality Index (PSQI), The Morningness / Eveningness Questionnaire (MEQ), Beck Questionnaire on Depression (BDI II). Finally the subjects answered questions that researcher had drawn up in order to evaluate different aspects of sleep. The results showed that the scales used were reliable. It proved that persons diagnosed with TOS in addition to numerous symptoms also had problems with sleep. By analyzing the results it was concluded that people diagnosed with TOS are older, have more problems with sleep and greater disability of arms, shoulders and hands. There was no difference in Morningness/Eveningness type in patients with TOS in comparison to the control group. It can also be concluded that people who have pronounced disability of arms, shoulders and hands have a significantly greater chance of having thoracic outlet syndrome. These persons are more likely to develop depression and sleep disorders therefore those two entities impact TOS through the problems with the functioning of the arms, shoulders and hands. A good predictor in diagnosis of TOS may be testing people with DASH scale. The study findings can serve as a guideline for further research, opening the door into forming protocols and observation of the quality of life of people with the thoracic outlet syndrome, with special emphasis on sleep disorders.</p>

Introdução: A exposição ao ruído ocupacional pode trazer consequências negativas para a saúde auditiva e extra-auditiva dos trabalhadores. Há, na literatura, escassez de estudos que avaliem as condições de trabalho dos operadores de telemarketing, bem como da principal fonte de ruído (headset), que, na maioria dos call centers, é monoaural. Objetivo: Avaliar a exposição ao ruído no trabalho de operadores de telemarketing, buscando relacioná-la aos sintomas auditivos e extra-auditivos referidos, bem como avaliar a aplicabilidade dos headsets mono e binaural. Métodos: Estudo transversal observacional. Participaram 79 operadores de telemarketing, normo-ouvintes, de uma empresa multinacional. Foi realizada medição do ruído, com um audiodosímetro, pela técnica de microfone em ouvido real, por 20 minutos (10 com cada headset), durante ligações diárias dos teleoperadores. Adicionalmente, os participantes responderam a questionário para caracterização dos sintomas auditivos/extraauditivos e relato de preferência entre os headsets. Para a análise dos dados, utilizou-se medidas descritivas e testes de hipótese (Qui-quadrado, Wilcoxon e Mann-Whitney), com nível de significância de 5%. Resultados: Dos 79 participantes (média 22±4,2 anos), 50,64% trabalhavam no período matutino e 49,36% no período vespertino/noturno, sendo a maioria do sexo feminino (78,5%). Mais da metade da amostra relatou: episódios de dor ou infecções de ouvido (55,7%); utilização de estéreo pessoal (70,9%), por mais de uma hora diária, com intensidade acima da metade da capacidade do equipamento; não realizar o controle da intensidade do headset individual (68%). Quanto aos sintomas, 98,7% relataram pelo menos um sintoma auditivo e 88,6% pelo menos um extra-auditivo, sendo os mais frequentes: plenitude auricular (15,2%) e zumbido (13,4%), ansiedade (65,8%), dor de cabeça (34,2%) e estresse (17,7%). Observou-se associação entre as variáveis: intensidade de uso do headset individual e quantidade de sintomas auditivos (p=0,044) e extraauditivos (p=0,026); aumento abrupto de som e zumbido (p=0,020). Os níveis de pressão sonora provenientes do headset monoaural foram maiores que os do binaural para as medidas de pico (p < 0,001), intensidade máxima (p < 0,001) e equivalente (p=0,006). Com relação aos níveis de pressão sonora equivalentes, a média foi de 85,54 dB(A) para o headset monoaural, e de 76,57 dB(A) para o ambiente externo. Quanto à preferência, a maioria dos indivíduos (84,8%) manifestou-se a favor do headset binaural, sendo o principal motivo, proporcionar maior atenção e concentração para as chamadas. Na comparação dos níveis de pressão sonora equivalentes entre os headsets mono e binaurais, de acordo com a preferência de headset dos operadores, para aqueles que preferiram o binaural, verificou-se níveis de pressão sonora dos headsets binaurais significantemente menores quando comparados aos monoaurais (p=0,017), o que não ocorreu para os que preferiram o monoaural (p=0,976). Conclusões: Os níveis de pressão sonora equivalentes produzidos pelo headset monoaural, que é o utilizado neste call center, atingiram valores médios de 85,54 dB(A), com variação de 52,9 a 98,1 dB(A). A quantidade de sintomas auditivos e extra-auditivos referidos pelos operadores de telemarketing, apesar dos limiares auditivos estarem dentro da normalidade, sugere que a exposição a qual estão submetidos pode oferecer riscos para a saúde. O headset binaural, avaliado no presente estudo, demonstrou ser uma alternativa viável para estes trabalhadores e ambiente de trabalho, por produzir menores intensidades sonoras e melhorar a qualidade das chamadas, na perspectiva dos teleoperadores, quando comparado ao headset monoaural / Introduction: Being exposed to occupational noise may result in negative consequences to auditory and extra-auditory health of workers. In the literature, studies that assess the working conditions of telemarketers are scarce, as well as regarding the main source of noise (headset), which, in most call centers, is monaural. Purpose: To assess the exposure to noise of telemarketers, aiming to relate it to the auditory and extra-auditory symptoms mentioned by them, as well as to assess the applicability of mono and binaural headsets. Methods: Crosssectional observational study in which seventy-nine telemarketers from a multinational company participated. Noise measurement was performed with an audiodosimeter using the real ear microphone technique for 20 minutes (10 minutes using each headset) during daily calls to telemarketers. Additionally, the participants answered a questionnaire to characterize auditory / extra-auditory symptoms and reported their most preferably headsets. For the analysis of the data, we used descriptive measures and hypothesis tests (Chi-square, Wilcoxon and Mann-Whitney), with significance level of 5%. Results: Among the 79 participants (mean 22 ± 4.2 years), 50.64% worked in the morning period and 49.36% in the afternoon / evening period, with a majority of females (78.5%). More than half of the sample reported: episodes of pain or ear infections (55.7%); use of personal stereo (70.9%), for more than one hour per day, with intensity above half of the equipment capacity; and lack of monitoring the intensity of the individual headset (68%). Concerning the symptoms, 98.7% reported at least one auditory symptom and 88.6% had at least one extra-auditory one, being the most frequent: auricular fullness (15.2%) and tinnitus (13.4%), anxiety (65.8%), headache (34.2%) and stress (17.7%). We observed an association between the variables: intensity of use of the individual headset and amount of auditory (p = 0.044) and extra-auditory symptoms (p = 0.026); abrupt increase in sound and tinnitus (p = 0.020). The sound pressure levels from the monaural headset were greater than those of the binaural for peak measurements (p < 0.001), maximum intensity (p < 0.001) and equivalent (p = 0.006). Regarding equivalent sound pressure levels, the mean was 85.54 dB (A) for the monaural headset, and 76.57 dB (A) for the external environment. Regarding preference, the majority of individuals (84.8%) expressed support for the binaural headset, being the main reason, the fact that it provides greater attention and concentration capacity for the calls. In comparison to the equivalent sound pressure levels between mono and binaural headsets, according to the headset preference of the telemarketers, for those who preferred binaural, sound pressure levels of binaural headsets were significantly lower when compared to monoaural ones (p = 0.017), which did not occur for those who preferred the monoaural (p = 0.976). Conclusions: Equivalent sound pressure levels produced by the monaural headset, which is the one used in this call center, achieved mean values of 85.54 dB (A), ranging from 52.9 to 98.1 dB (A). The amount of auditory and extra-auditory symptoms reported by telemarketers, even though the hearing thresholds are within normal range, suggests that the noise exposure to which they undergo may jeopardize health. The binaural headset, assessed in the present study, has been shown to be a viable alternative for these workers and work environment, because it produces lower sound intensities and improve the quality of calls, from telemarketers\' perspective, when compared to the monaural headset

Introdução: A exposição ao ruído ocupacional pode trazer consequências negativas para a saúde auditiva e extra-auditiva dos trabalhadores. Há, na literatura, escassez de estudos que avaliem as condições de trabalho dos operadores de telemarketing, bem como da principal fonte de ruído (headset), que, na maioria dos call centers, é monoaural. Objetivo: Avaliar a exposição ao ruído no trabalho de operadores de telemarketing, buscando relacioná-la aos sintomas auditivos e extra-auditivos referidos, bem como avaliar a aplicabilidade dos headsets mono e binaural. Métodos: Estudo transversal observacional. Participaram 79 operadores de telemarketing, normo-ouvintes, de uma empresa multinacional. Foi realizada medição do ruído, com um audiodosímetro, pela técnica de microfone em ouvido real, por 20 minutos (10 com cada headset), durante ligações diárias dos teleoperadores. Adicionalmente, os participantes responderam a questionário para caracterização dos sintomas auditivos/extraauditivos e relato de preferência entre os headsets. Para a análise dos dados, utilizou-se medidas descritivas e testes de hipótese (Qui-quadrado, Wilcoxon e Mann-Whitney), com nível de significância de 5%. Resultados: Dos 79 participantes (média 22±4,2 anos), 50,64% trabalhavam no período matutino e 49,36% no período vespertino/noturno, sendo a maioria do sexo feminino (78,5%). Mais da metade da amostra relatou: episódios de dor ou infecções de ouvido (55,7%); utilização de estéreo pessoal (70,9%), por mais de uma hora diária, com intensidade acima da metade da capacidade do equipamento; não realizar o controle da intensidade do headset individual (68%). Quanto aos sintomas, 98,7% relataram pelo menos um sintoma auditivo e 88,6% pelo menos um extra-auditivo, sendo os mais frequentes: plenitude auricular (15,2%) e zumbido (13,4%), ansiedade (65,8%), dor de cabeça (34,2%) e estresse (17,7%). Observou-se associação entre as variáveis: intensidade de uso do headset individual e quantidade de sintomas auditivos (p=0,044) e extraauditivos (p=0,026); aumento abrupto de som e zumbido (p=0,020). Os níveis de pressão sonora provenientes do headset monoaural foram maiores que os do binaural para as medidas de pico (p < 0,001), intensidade máxima (p < 0,001) e equivalente (p=0,006). Com relação aos níveis de pressão sonora equivalentes, a média foi de 85,54 dB(A) para o headset monoaural, e de 76,57 dB(A) para o ambiente externo. Quanto à preferência, a maioria dos indivíduos (84,8%) manifestou-se a favor do headset binaural, sendo o principal motivo, proporcionar maior atenção e concentração para as chamadas. Na comparação dos níveis de pressão sonora equivalentes entre os headsets mono e binaurais, de acordo com a preferência de headset dos operadores, para aqueles que preferiram o binaural, verificou-se níveis de pressão sonora dos headsets binaurais significantemente menores quando comparados aos monoaurais (p=0,017), o que não ocorreu para os que preferiram o monoaural (p=0,976). Conclusões: Os níveis de pressão sonora equivalentes produzidos pelo headset monoaural, que é o utilizado neste call center, atingiram valores médios de 85,54 dB(A), com variação de 52,9 a 98,1 dB(A). A quantidade de sintomas auditivos e extra-auditivos referidos pelos operadores de telemarketing, apesar dos limiares auditivos estarem dentro da normalidade, sugere que a exposição a qual estão submetidos pode oferecer riscos para a saúde. O headset binaural, avaliado no presente estudo, demonstrou ser uma alternativa viável para estes trabalhadores e ambiente de trabalho, por produzir menores intensidades sonoras e melhorar a qualidade das chamadas, na perspectiva dos teleoperadores, quando comparado ao headset monoaural / Introduction: Being exposed to occupational noise may result in negative consequences to auditory and extra-auditory health of workers. In the literature, studies that assess the working conditions of telemarketers are scarce, as well as regarding the main source of noise (headset), which, in most call centers, is monaural. Purpose: To assess the exposure to noise of telemarketers, aiming to relate it to the auditory and extra-auditory symptoms mentioned by them, as well as to assess the applicability of mono and binaural headsets. Methods: Crosssectional observational study in which seventy-nine telemarketers from a multinational company participated. Noise measurement was performed with an audiodosimeter using the real ear microphone technique for 20 minutes (10 minutes using each headset) during daily calls to telemarketers. Additionally, the participants answered a questionnaire to characterize auditory / extra-auditory symptoms and reported their most preferably headsets. For the analysis of the data, we used descriptive measures and hypothesis tests (Chi-square, Wilcoxon and Mann-Whitney), with significance level of 5%. Results: Among the 79 participants (mean 22 ± 4.2 years), 50.64% worked in the morning period and 49.36% in the afternoon / evening period, with a majority of females (78.5%). More than half of the sample reported: episodes of pain or ear infections (55.7%); use of personal stereo (70.9%), for more than one hour per day, with intensity above half of the equipment capacity; and lack of monitoring the intensity of the individual headset (68%). Concerning the symptoms, 98.7% reported at least one auditory symptom and 88.6% had at least one extra-auditory one, being the most frequent: auricular fullness (15.2%) and tinnitus (13.4%), anxiety (65.8%), headache (34.2%) and stress (17.7%). We observed an association between the variables: intensity of use of the individual headset and amount of auditory (p = 0.044) and extra-auditory symptoms (p = 0.026); abrupt increase in sound and tinnitus (p = 0.020). The sound pressure levels from the monaural headset were greater than those of the binaural for peak measurements (p < 0.001), maximum intensity (p < 0.001) and equivalent (p = 0.006). Regarding equivalent sound pressure levels, the mean was 85.54 dB (A) for the monaural headset, and 76.57 dB (A) for the external environment. Regarding preference, the majority of individuals (84.8%) expressed support for the binaural headset, being the main reason, the fact that it provides greater attention and concentration capacity for the calls. In comparison to the equivalent sound pressure levels between mono and binaural headsets, according to the headset preference of the telemarketers, for those who preferred binaural, sound pressure levels of binaural headsets were significantly lower when compared to monoaural ones (p = 0.017), which did not occur for those who preferred the monoaural (p = 0.976). Conclusions: Equivalent sound pressure levels produced by the monaural headset, which is the one used in this call center, achieved mean values of 85.54 dB (A), ranging from 52.9 to 98.1 dB (A). The amount of auditory and extra-auditory symptoms reported by telemarketers, even though the hearing thresholds are within normal range, suggests that the noise exposure to which they undergo may jeopardize health. The binaural headset, assessed in the present study, has been shown to be a viable alternative for these workers and work environment, because it produces lower sound intensities and improve the quality of calls, from telemarketers\' perspective, when compared to the monaural headset

A música é vista principalmente como arte e lazer e também pode exercer um importante papel na educação de adolescentes, trazendo muitos benefícios. Ela não é apenas agradável para a audição, contribui para o bem estar físico e emocional, desencadeiam sensações que podem afetar o humor, a memória, a função cerebral (córtex pré-frontal, raciocínio), frequência cardíaca, metabolismo e sistema imunológico e percepção da dor. No entanto, além dos benefícios da música, quando o indivíduo se expõe de forma inadequada, o prazer proporcionado pode trazer efeitos desagradáveis para a saúde. A indústria da música amplificada, e principalmente a popularização dos dispositivos sonoros portáteis individuais é crescente entre os jovens, tornando a perda auditiva induzida por elevados níveis de pressão sonora entre crianças e adolescentes uma preocupação evidente. Os riscos, para adquirir a perda auditiva dependem de fatores como número de horas de uso dos fones auriculares ou intensidade. A quantidade de intensidade sonora bem como o tempo que se fica exposto a eles são fatores determinantes da capacidade de prejudicar a audição. Embora estes jovens estejam habituados à exposição à música elevada, não possuem conhecimento sobre os danos auditivos futuros que podem ser causados pela exposição, e quando apresentam esse conhecimento, não sabem exatamente como prevenir estes danos e proteger a sua audição. Dessa forma, o objetivo deste estudo foi: Investigar o nível de informação que os adolescentes têm sobre a música amplificada e a saúde auditiva bem como seus hábitos de escuta, investigar a prevalência de zumbido e alterações auditivas em adolescentes de ambos os sexos, e realizar revisão sistemática sobre os artigos relacionados ao tema. 59 adolescentes participaram deste estudo, responderam a um questionário sobre música amplificada e audição. O THI, foi realizado quando relataram zumbido. Realizaram meatoscopia, imitanciometria, audiometria tonal liminar e de alta frequência e logoaudiometria. Nos resultados, a pergunta formulada na revisão sistemática de literatura foi respondida e evidenciou que embora os jovens tenham uma informação prévia dos riscos da música amplificada e a audição, não é uma informação concreta e não demonstram vontade de mudar seus hábitos de escuta. Nos resultados do estudo clínico, embora não tenha sido encontrada perda auditiva, as curvas audiométricas sugeriram uma futura PAIM, e os questionários mostraram que os adolescentes tem uma informação prévia do assunto, ainda fazem o uso incorreto da música amplificada. Levando a concluir que campanhas efetivas e eficientes com informações completas devem ser feitas, de forma que atinja o interesse dos adolescentes e mude o seu comportamento frente à música amplificada, para que não se crie uma geração de jovens surdos. / The music is mainly seen as art and leisure and can bring many benefits on a teenagers education. It´s not just pleasant for hearing but contributes to the physical and emotional wellbeing, triggering feelings that can affect humor, memory, brain function (prefrontal cortex, reasoning) heart rate, metabolism, immunologic system and pain perception. However, besides of its benefits, when the person is improperly exposed to the music, the pleasure can bring unpleasant health effects. The amplified music industry and mainly by the popularization and by the rise of individual portable sound devices between the young people make the hearing loss, inducted by the exposure on high sound pressure level, an evident concern. The risks to acquire hearing loss are dependent on factors like the number of hours using the earphones and intensity. The quantity of sound intensity as well the period of exposure are determinant factors of the capacity to cause hearing harm. Although young people are accustomed to be exposed to high sound pressure level, they have no knowledge about the future harms that can be caused by exposure, and when they understand the risks, they not exactly know how to prevent those harms and how to protect their hearing. Thus, the objective of this study is to investigate the amount of information young people have about amplified music and hearing health as well to understand their hearing habits, investigate the prevalence of tinnitus and hearing changes on young people of both sexes and perform a systematic review of the studies regarding the theme. 59 teenagers have attended this study, answered a questionnaire about amplified music and hearing. The THI was executed for the subjects that reported tinnitus. They were submitted to meatoscopy, immittanciometry, tonal threshold and high frequency audiometry and logoaudiometry. The question raised during the review of the literature was answered by the results that showed that although young people have knowledge about the risks of amplified music and hearing, the information is not concrete and they show no desire to change their hearing habits. Although no hearing losses were detected, the results of the clinical studies, mainly by the audiometric curves, suggests future PAIM and the questionnaires revealed that the adolescents have prior information about the issue but even so, they still incorrectly use the amplified music which bring us to the conclusion that effectives and efficiency campaigns with complete information should be done to reach teenagers interests with the purpose to change their behavior regarding amplified music to avoid a future generation of deaf adolescents.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2017. / Submitted by Fernanda Percia França (fernandafranca@bce.unb.br) on 2017-04-12T19:35:46Z No. of bitstreams: 1 2017_LilianeBarbosaRodrigues.pdf: 1804791 bytes, checksum: cd2b690a466fad9236cac6b9aa0dad33 (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2017-04-13T15:00:16Z (GMT) No. of bitstreams: 1 2017_LilianeBarbosaRodrigues.pdf: 1804791 bytes, checksum: cd2b690a466fad9236cac6b9aa0dad33 (MD5) / Made available in DSpace on 2017-04-13T15:00:16Z (GMT). No. of bitstreams: 1 2017_LilianeBarbosaRodrigues.pdf: 1804791 bytes, checksum: cd2b690a466fad9236cac6b9aa0dad33 (MD5) / Introdução: A música é considerada um som agradável que dá uma sensação prazerosa ao ouvinte. Porém, pode se tornar uma fonte de poluição sonora, dependendo do nível de intensidade em que é reproduzida. Logo, é importante investigar os hábitos do uso da música amplificada, pois são fatores que podem provocar alteração auditiva. Objetivo: Analisar os hábitos, sintomas auditivos e extra-auditivos, bem como a audição de adolescentes usuários de música amplificada. Métodos: Trata-se de um estudo transversal do qual participaram 250 adolescentes de ambos os sexos, com idade entre 12 e 18 anos, divididos em dois grupos: grupo exposto e não exposto à música amplificada. A coleta de dados ocorreu por meio de um questionário elaborado pela pesquisadora contendo nove perguntas sobre os sintomas auditivos, extra-auditivos e os hábitos de uso da música amplificada (tempo de exposição, volume e ambiente), além da realização da audiometria de altas frequências, que avaliou os limiares das frequências de 6 KHz a 16 KHz, bem como do exame de emissões otoacústicas por produto de distorção, que considerou como critérios de análise a resposta final do exame (passa/falha), a amplitude de reprodução e a relação sinal/ruído. Resultados: Constatou-se que 56% (n=63) da amostra referiu tempo total de exposição à música amplificada entre um e cinco anos; 34% (n=85) referiram fazer uso por trinta minutos diários; 87,3% (n=214) mencionaram utilizar à música amplificada em volume elevado e 96,7% (n=237) referiram utilizar o dispositivo de escuta pessoal em ambiente ruidoso. Dentre os sintomas auditivos, 28,8% (n=72) da amostra mencionou apresentar sensação de orelha tampada; 25,6% (n=64) referiram zumbido e 25,2% (n=63) aludiram dor de ouvido. O sintoma extra-auditivo mais frequente foi à dor de cabeça, mencionada por 36% (n=90) da amostra. Ao comparar a presença ou não dos sintomas auditivos e extra-auditivos dentro de cada grupo, verificou-se a presença de ambos os sintomas no grupo exposto e apenas sintomas auditivos no grupo não exposto. Quando comparados entre os grupos, a frequência de participantes que relataram sintomas extra-auditivos foi significante no grupo exposto. Em contrapartida, não se constatou diferença significante quanto à presença de sintomas auditivos entre ambos os grupos. Ao comparar os limiares das altas frequências e as emissões otoacústicas por produto de distorção, não se observou diferença significativa entre os grupos. Ao relacionar os resultados das emissões otoacústicas por produto de distorção dos participantes expostos e não exposto com os sintomas auditivos e extra-auditivos não foram observadas relações significativas. Conclusão: O tempo de exposição à música amplificada dos adolescentes é de um a cinco anos, com uso diário de 30 minutos, em volume elevado e em ambientes ruidosos. Os adolescentes referiram apresentar sintomas auditivos, sendo a sensação de orelha tampada, seguido de zumbido e dor de ouvido os mais citados. A maior parte da amostra mencionou não apresentar sintomas extra-auditivos, porém dentre os que aludiram estes sintomas, a dor de cabeça é o mais frequente. Os sintomas auditivos ocorrem indistintamente entre adolescentes usuários e não usuários de música amplificada, e os extra-auditivos ocorrem predominantemente em usuários. Os resultados da audiometria de altas frequências e das emissões otoacústicas por produto de distorção são semelhantes entre os grupos, sendo que o resultado das emissões otoacústicas por produto de distorção não tem relação com a presença ou não de sintomas auditivos e extra-auditivos. / Introduction: Music is considered a pleasant sound that gives a pleasant feeling to the listener. However, it can become a source of noise pollution depending on the level of intensity at which it is reproduced. Therefore, it is important to investigate the habits of the use of amplified music, because they are factors that can cause auditory alteration. Objective: To analyze the habits, auditory and extra-auditory symptoms, as well as the hearing of adolescents amplified users. Methods: This was a cross-sectional study involving 250 adolescents of both genders, aged between 12 and 18 years, divided into two groups: exposed and not exposed to amplified music. Data were collected through a questionnaire developed by the researcher containing nine questions about auditory, extra-auditory symptoms and habits of use of amplified music (time of exposure, volume and environment), as well as High frequency audiometry, which evaluate the thresholds of the frequencies from 6 KHz to 16 KHz, as well as the distortion product otoacoustic emissions, which considered as final analysis the test response (pass / fail), reproduction amplitude and signal/noise relation. Results: 56% (n = 63) of the sample referring to the total time of exposure to amplified music between five and five years; 34% (n = 85) of these reported use for thirty minutes daily; 87.3% = 214) used amplification at high volume and 96.7% (n = 237) reported using a personal listening device in a noisy environment. Amongst the auditory symptoms, 28.8% (n = 72) of the sample showed a sensation of earache; 25.6% (n = 64) reported tinnitus and 25.2% (n = 63) reported pain of hearing loss. The most frequent extra-auditory symptom was given to the head, mentioned by 36% (n = 90) of the sample. When comparing a person or not their auditory and extra-auditory examinations within each group, check whether the presence of both symptoms not group exposed and only auditory group symptoms not exposed. When compared between the groups, a frequency of participants who reported extra-auditory symptoms was significant in the exposed group. On the other hand, there was no significant difference in the presence of auditory symptoms between the two groups. When comparing the thresholds of high frequencies and otoacoustic emissions by de distortion product, no significant difference was observed between the groups. When relating distortion product otoacoustic emissions of exposed and unexposed participants with auditory and extra-auditory symptoms did not observe significant relationships. Conclusion: The exposure time to the amplified music of the adolescents is from one to five years, with daily use of 30 minutes, in high volume and in noisy environments. The adolescents reported to present auditory symptoms, being the capped ear sensation, followed by tinnitus and pain most frequently mentioned. The majority of the sample mentioned did not present extra-auditory symptoms, but among those who mentioned these symptoms, headache is the most frequent. Auditory symptoms occur indistinctly among adolescent users and non-users of amplified music, and the extra-auditory ones occur predominantly in users. The results of high frequency audiometry and distortion product otoacoustic emissions are similar between the groups, and the result of the distortion-product-to-noise emissions is not related to the presence or absence of auditory and extra-auditory symptoms.