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When checked, Shutterstock's safe search screens restricted content and excludes it from your search results. The aim of this study was to determine the effects of various treatment modalities employed for patients with sudden sensorineural hearing loss (SHL). Sudden sensorineural hearing loss (SHL) is defined as hearing loss equal to or greater than 30 dB at three or more consecutive frequencies, the onset of which takes place over a period of 3 days or fewer [1]. Treatment is controversial and can involve anti-inflammatory drugs (steroids), vasodilators, antiviral agents, plasma expanders, diuretics, calcium channel antagonists, hyperbaric chamber use, carbogen, anticoagulants and, more recently, intratympanic corticosteroids [6-11]. The aim of this study was to observe the progression of SHL in patients who underwent different treatments at the SHL outpatient facility of our institution and to describe clinical and epidemiological aspects. This retrospective study analyzed the records of patients treated in the sudden hearing loss section of the Otolaryngology Department, Clinic Hospital School of Medicine, University of Sao Paulo, Brazil, between 1996 and 2006.
All patients underwent imaging tests (temporal bone magnetic resonance imaging or computed tomography) and complete blood cell counts. The patients underwent serial audiometric testing at baseline and after 30, 90, 120, and 180 days of treatment.
Considering all the cases, we observed significant posttreatment reductions in low- and high-frequency PTA (Table 3). Estimates have shown that among patients with SHL, the mean age ranges from 43 to 53 years, the gender distribution is equivalent, and the hearing loss is unilateral in more than 95% of cases [2,4,11,13,14], similar to what we observed in our study. Approximately 25-40% of patients with SHL present with concomitant upper-airway infection [11].
According to Rauch [11], vestibular symptoms were identified in 28-57% of cases, as compared with 32-40% reported by Nakashima et al. The most common etiological factors identified for SHL were those that are not the most frequent but can be directly identified through clinical history, blood samples, or imaging studies, including autoimmune diseases, acoustic trauma, ototoxic drugs, Lyme disease, and ear malformations. Theoretically, this anatomical presentation predisposes to hypoxia, spasms, thrombi, and hemorrhage, especially at the cochlear apex, primarily affecting the response to low frequencies [23]. When we analyzed the cases in which PTA normalized, we observed that in most cases baseline PTA was moderate and the etiology was unknown.
Among the five treatment groups, the differences in ΔPTA were not statistically significant at any frequency.
For low-frequency and high-frequency PTA, we observed an inverse linear correlation between time from onset to treatment and audiometric response presented by the patients. On the basis of our analysis, we can infer that plasma expanders do not improve the efficacy of the corticosteroidacyclovir combination used in managing SHL in patients. It is common for ENT physicians to advise tinnitus patients to avoid caffeine in order to minimize tinnitus sounds.
With as many as 85% of adults in the world consuming caffeine on a daily basis, Bristol University researchers wanted to challenge the unproven claim that caffeine can make tinnitus worse.
A better idea, if you’re concerned that caffeine is worsening your tinnitus, might be to cut down on it rather than cut it out completely. There are several other dietary restrictions that are said to alleviate tinnitus, also without the support of real evidence. Despite all the recent findings, the best thing you could do for yourself if you suffer from tinnitus is to learn what triggers or worsens your symptoms. About this SiteOur goal is to provide information about tinnitus treatment options, including the conventional and the holistic. DisclaimerInformation on this site is general in nature and cannot take the place of medical evaluation, diagnoses, and treatment by a health care provider.
PURPOSE: The aim of the study was to determine the effect of tinnitus on psychoacoustic abilities in individuals with normal hearing sensitivity. MATERIALS AND METHODS: The study was conducted on twenty subjects with tinnitus and twenty subjects without tinnitus. RESULTS: Results of the study showed that the clinical group performed poorly in all the tests except for differential limen of intensity.
CONCLUSIONS: Tinnitus affects aspects of auditory perception like temporal resolution, speech perception in noise and frequency discrimination in individuals with normal hearing. Tinnitus is an otologic symptom and it requires detailed audiological evaluation due to its numerous etiological conditions1,2. Studies have shown that tinnitus impairs speech perception in noise6-8 and temporal perception9-12. Sanchez et al.13 compared the results of the gaps in noise test in normal hearing subjects with and without tinnitus. Speech perception abilities in quiet and noise have also been assessed in individuals with tinnitus, with and without hearing loss to find whether tinnitus contributes towards the commonly reported breakdowns in speech understanding. Huang et al.15 conducted Mandarin Speech Perception in Noise Test (MSPIN) on 20 individuals with normal hearing sensitivity but had complaint of tinnitus.
Thus, the majority of the studies cited in the literature reported poorer speech perception abilities in individuals with tinnitus.
Studies have been conducted to investigate the impact of tinnitus on temporal characteristics and speech perception in noise.
The current study was designed to investigate the effect of tinnitus on the temporal characteristics of the auditory system, frequency and intensity discrimination and speech perception ability in noise in persons with normal hearing sensitivity. A cross-sectional descriptive research was used to accomplish the aim of the current study.
The participants of the study had pure tone thresholds within 25 dB HL in octave frequencies from 250-8000 Hz for air conduction and 250-4000 Hz for bone conduction, 'A' Type tympanogram with acoustic reflex thresholds elicited at normal limits (90 dB at 1000 Hz). Written consent was collected from all the subjects for willingly participating in the study. Tests to assess temporal resolution involved gap detection and modulation detection thresholds. The gap detection threshold was assessed by obtaining the participant's ability to detect a temporal gap embedded in the centre of a 500 ms broadband noise. The modulation detection threshold was measured using a 500 ms Gaussian noise which was sinusoidally amplitude modulated at 8 Hz, 20 Hz, 60 Hz and 200 Hz modulation frequencies. Difference limen for frequency for a 1000 Hz pure tone was measured using a three-block forced-choice procedure, through mlp procedure.
Difference limen of intensity for a 1000 Hz pure tone was measured using a three-block, forced-choice procedure. Speech perception in noise testing was done to measure understanding of 50% of the words in sentences (SNR-50). The main aim of the study was to determine the effect of tinnitus on temporal resolution, frequency discrimination, intensity discrimination and speech perception in noise, in individuals with normal hearing sensitivity. The temporal resolution of clinical and control groups was assessed through gap detection test and modulation detection test. Figure 1 shows the mean GDT scores for both the groups along with one standard deviation (SD) bar.
To assess for the significance of GDT scores between control group, mild and moderate tinnitus groups, mixed ANOVA was done where the gap detection threshold was the dependent variable and severity of tinnitus was the independent variable. The MDT test was carried out for four different modulation frequencies (8, 20, 60, 200 Hz). Multivariate analysis of variance (MANOVA) was done to estimate the significant difference in mean thresholds of MDT across the control and clinical groups for the different modulation frequencies.
Boneferroni's pairwise comparison showed that there was a significant difference in MDT thresholds for all the modulation frequencies between control vs. The frequency discrimination ability was assessed using the differential limen of frequency at 1000 Hz. To assess for the significance of difference in DLF between control, mild and moderate tinnitus groups mixed ANOVA was performed keeping DLF threshold as dependent variable and severity of tinnitus as independent variable.
Mixed ANOVA was utilized to assess for statistical significance of DLI between control, mild and moderate tinnitus groups keeping DLI threshold as dependent variable and severity of tinnitus as independent variable. The SNR-50 was calculated to assess the speech perception performance in the presence of noise. Mixed ANOVA was used to determine the significance of difference in SNR-50 values between control, mild and moderate tinnitus groups keepingSNR-50 as dependent variable and severity of tinnitus as independent variable.
The findings of the current study indicate that individuals with moderate tinnitus need larger silent intervals to detect a gap within a noise than individuals with mild tinnitus as well as those without complaints of tinnitus. In a study by Fournier & Hebert21 gap detection in individuals with tinnitus was assessed and they reported that the tinnitus group displayed a deficit in gap processing for both low and high background noise frequencies. In the current study, individuals with tinnitus needed greater modulation depth in comparison to individuals without tinnitus to detect a modulation in the noise in a wide range of modulation frequencies. Thus, the results of both GDT and MDT showed impaired temporal perception in clinical group compared to control group which is in accordance with the literature. The results of the current study suggest that the ability to perceive speech in noise is affected in individuals with tinnitus compared to those without tinnitus. Hennig et al.7 evaluated speech recognition in the presence of competing noise in normal hearing individuals with tinnitus and without tinnitus and hyperacusis. The present study showed that tinnitus had an effect on pitch discrimination ability, but the reduction in performance was similar irrespective of the severity of tinnitus. From the findings of the current study, it is concluded that tinnitus has an effect on certain aspects of auditory perception like temporal resolution, speech perception in noise and frequency discrimination in individuals with normal hearing. Paper submitted to the ITJ-SGP (Publishing Management System) on December 19, 2014; and accepted on March 16, 2015.
INTRODUCTION: Gestational malaria is related to very bad perinatal outcomes and antimalarial drugs used during pregnancy can be ototoxic to the fetus.
OBJECTIVE: To determine the prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy. CONCLUSION: The prevalence of hearing loss in newborns of mothers who had vivax malaria and used chloroquine during pregnancy was 3%. Hearing is one of the noblest of senses since its main function is related to the acquisition and development of oral language1,2. Hearing impairment is considered to be highly disabling due to its consequences on human communication, as well as its impact on cognitive and psychosocial development and the development of oral and written language6. The occurrence of malaria during pregnancy, particularly in the last trimester, can be determinant for infant health, with implications for fetal or neonatal development.
In Brazil, the occurrence of malaria during pregnancy is common in endemic areas such as the states of Roraima, Rondonia, Para, Mato Grosso, Acre, and Amazonas11. In the municipality of Porto Velho (RO) malaria in pregnancy has been shown to be related to poor perinatal outcomes such as preterm birth, extremely low, very low and low birth weight, and death13. In another study, 12 children born to mothers who had been treated with antimalarial drugs during pregnancy had sensorineural hearing loss.
In view of the above considerations, the objective of the present study was to verify the prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy and to characterize the audiologic findings according to newborn gestational age, birth weight, risk factors for hearing loss, type of malaria infection, type of medication used, and gestational period of malaria occurrence and drug treatment. A cross-sectional, quantitative, descriptive-analytical, observational study was conducted using a multifactorial approach.
The number of women with malaria during pregnancy, who were admitted to the hospital during the period of data collection, was taken as the basis for sample size calculation.
The study flow chart contains data regarding infant gender, date of birth, type of malaria infection, gestational period of infection, type of medications used, and presence of risk factors for hearing loss established by the Joint Committee on Infant Hearing (JCIH)16 and by the Multiprofessional Committee on Auditory Health (Comite Multiprofissional em Saude Auditiva - COMUSA)17. The puerperal women were contacted by the researcher while still in the maternity ward in order to investigate the occurrence of malaria during pregnancy.
After signing the informed consent, the interview was conducted with the puerperal participants.
The tests were performed in a quiet room in the presence of the mother or an accompanying person. The step of diagnostic evaluation was performed at the clinic responsible for the NHS program after hospital discharge. After this procedure, the diagnostic ABR test was performed to quantify and identify hearing impairment. Newborns who have had the electrophysiological threshold for tone bursts at 2000 Hz with bilateral 30 dBHL were considered patients with normal hearing and remained in auditory monitoring the NHS program up to 24 months. For data analysis, the distribution of the occurrence of the type of infection and of the gestational period when malaria occurred was first determined, followed by the determination of the distribution of the type of antimalarial medication used for treatment and the gestational period during which the medication was administered, using the test for equality of two proportions. As for the risk factors for hearing loss found in association with the occurrence of malaria and the use of antimalarial drugs in pregnancy, the use of ototoxic medication by the newborn was the most frequent risk factor and this finding was significant when compared to the other risk factors, except for extracorporeal oxygenation (Table 4). No relationship was observed between the NHS result and type of medication, risk factors for hearing loss, gestational period of infection, use of medication, or type of malaria infection (Table 5). The prevalence of hearing loss in our sample was 3% (n = 1), taking into account that two newborns did not undergo the audiological diagnosis. In the present study, Plasmodium vivax was the most frequent species found in women during pregnancy, as also reported in other studies10,13,19-21. The antimalarial drug most frequently used was chloroquine as recommended by the Brazilian Ministry of Health for the treatment of vivax malaria in pregnancy25.
In a study conducted in Porto Velho (RO) on 66 newborns of mothers who used antimalarial drugs during pregnancy, three infants were born to mothers who were treated with primaquine and one was diagnosed with unilateral profound hearing loss21.
As for the gestational period during which the antimalarial drug was used, no difference was observed between trimesters. In the present study, the number of "pass" results in NHS was higher than the number of "failed" results, in agreement with other studies conducted in the same municipality14,21. Two of the four newborns who failed the screening test and who were referred to the clinic responsible for the program for diagnostic evaluation did not attend the assessment. The socioeconomic conditions of the families who participate in the NHS program and the lack of knowledge of the consequences of hearing loss are some factors that could explain the evasion in the population studied, considering that the results of the study showed a low educational level of the women who mainly had incomplete elementary school.
No relationship was found between the NHS results and the variables weight at birth and gestational age, despite having knowledge that gestational malaria is related to very bad perinatal outcomes, including low birth weight13 which could have enhanced the occurrence of hearing loss in newborns. The most frequent risk factor for hearing loss associated with malaria and antimalarial drug use in pregnancy was the use of ototoxic medication by the newborn, in agreement with other studies21,34.
Urinary tract infection is common among young women and is the most frequent complication during pregnancy30, especially among primiparous women35.
The high level of bilirubin requiring blood transfusion was a risk factor for hearing loss in the infant diagnosed in the present study.
Elevated serum levels of bilirubin are considered toxic to the auditory pathways and central nervous system39. Hyperbilirubinemia is one of the risk factors for neonatal deafness and for the development of encephalopathies39, since high levels of bilirubin can damage the auditory system at the peripheral level by altering cochlear hair cells and at the central level in the cochlear, olivary and inferior olivary nuclei41.
In addition to blood transfusion, the infant was exposed to ototoxic medication (gentamicin) which can cause different degrees of damage, with cochlear hair cells damage being typical42.
The prevalence of hearing loss obtained in this study was more than evident in research conducted at the same hospital5, and the value obtained could have been higher, since two newborns did not undergo the audiological diagnosis. In addition, it highlights the need for audiological follow these children in order to evaluate the occurrence of possible progressive alterations as demonstrated in another study which found 12 cases of hearing loss in children born to mothers who had malaria and used antimalarial drugs in pregnancy15.
The main limitation of the present study, which is common in studies involving populations recruited from NHS programs, is failure to attend a visit for diagnostic evaluation. The prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy was 3% (n = 1), the mothers' newborn diagnosed infected with Plasmodium vivax in the first trimester and treated with chloroquine throughout pregnancy. In addition, it was observed that there is no relationship between the NHS findings with the variables weight of the newborn at birth, gestational age, type of medication, IRDA, pregnancy infection, medication use and infection type. Paper submitted to the ITJ-SGP (Publishing Management System) on September 24, 2014; and accepted on July 6, 2015.
This study evaluated the interference of tinnitus on the quality of life for noiseexposed workers enrolled in a hearing conservation program. Most tinnitus research has focused on effective treatments and the mechanisms of the cause, detection, and perception of tinnitus. In addition to its medical and audiological aspects, the psychosocial consequences of tinnitus can be of significance and have also been investigated.
Tinnitus is a common complaint among noise-exposed workers, and in some countries it is even recognized as a work-related condition for compensation purposes.
The objective of our study is to evaluate the impact of tinnitus on the quality of life of workers who are exposed to noise and enrolled in a corporate hearing conservation program.
We enrolled participants from a meat-packing facility in the state of Rio Grande do Sul, Brazil. We administered a questionnaire to all the employees of the company (N = 372) at the beginning of the training sessions of their hearing conservation program. To assess the workers' hearing status, we performed otoscopy and pure-tone audiometry, according to the requirements of the Brazilian legislation [10].
We administered to the 52 participants the Brazilian version of the Tinnitus Handicap Inventory (THI) questionnaire, elaborated by Newman et al.
We calculated Pearson coefficients of linear correlation and tested their significances via the Student's t -test and Fisher's exact test, using a significance level of 5%.
Eighty-two workers (22%) of the total population of 372 workers in the studied company reported tinnitus in the first interview of this study.
Company records also indicated that 15% of the participants who were exposed to noise were also exposed to other hazards.
The results of the relationship between tinnitus and the three THI scales are presented in Figure 2. Table 2 displays the correlations between the functional, emotional, and catastrophic scales and medical history.
Table 3 presents the correlations of the THI results with the health problems described by the participants (n = 52). We separated the participants into two groups: The first was composed of 37 participants with normal hearing (71%), and the second included 6 participants (12%) with a bilateral high-frequency notch. Twenty-two percent of the noise-exposed participants complained of tinnitus, a finding comparable to rates of 25% reported by Sahley and Nodar [14] and 15.5% reported by Zimmermann [15]. Seventy-one percent of the participants with tinnitus complaints presented normal audiometric results, which suggests that tinnitus can be an early indicator of auditory risk from exposure to noise.
The application of the Brazilian version of the THI was both easy and expedient, as indicated by Newman et al. In Table 2, we found significant results involving the functional scale results with the use of prescription drugs and the catastrophic scale results with consumption of coffee. Concerning the degree of severity of tinnitus, 44% presented degree 1 or "slight" tinnitus according to the classification by McCombe et al. We observed a significant correlation between tinnitus severity and exposure to noise and chemical pollutants, predominantly CO. We observed a significant correlation between the duration of noise exposure and the emotional scale for the participants with high-frequency notches, suggesting an extra-auditory effect of noise.
The results of this study demonstrated that the prevalence of tinnitus was high (22%) in this population, despite the fact that study participants were young individuals who had a short duration of noise exposure. The Brazilian version of the THI proved to be an easy instrument to use for evaluating the impact of tinnitus on the quality of life of noise-exposed workers.
We retrospectively evaluated the records of patients treated in the sudden hearing loss section of the Otolaryngology Department at Clinic Hospital, School of Medicine, University of Sao Paulo, Brazil, between 1996 and 2006.
Approximately one-third of affected patients improve spontaneously, most within the first 2 weeks of disease progression [1,3]. The inclusion criterion was SHL of sudden onset over a 72-hour period, equal to or greater than 30 dB at three or more consecutive frequencies.
Group II included patients who had a 0- to 15-day history of SHL and in whom the use of plasma expanders was contraindicated owing to systemic hypertension, cardiopathy, coagulation disorder, or renal failure. The laboratory exams included erythrocyte sedimentation rate, fasting glucose, cholesterol, triglycerides, free thyroxine and thyroid-stimulating hormone, circulating immunocomplex, complement, rheumatoid factor, and antinuclear factor.
The only epidemiological study of SHL published to date was performed in Japan in three different years and different decades [13].
However, other authors [2] observed that, unlike our finding, only 11% of their SHL patients presented with concomitant upper-airway infection. The autoimmune diseases that can lead to SHL are autoimmune inner-ear disease and immunemediated systemic disease leading to a secondary innerear injury. One piece of evidence supporting this hypothesis is the fact that various authors have reported among patients with SHL seropositivity for a number of viruses, including herpes simplex, varicella zoster, cytomegalovirus, influenza, parainfluenza, rubella, and mumps [9, 18-20].
Studies involving patients with SHL have shown evidence of sudden-onset cochlear ischemia and an association between SHL and systemic vascular diseases [23].
In fact, vascular etiology is a very promising theory, but confirming and explaining it is difficult. Despite the lack of a control group, the findings of our study can be compared with those presented in the literature. Among the remaining cases, the most common etiology was diabetes mellitus, followed by viral causes. The improvement in PTA was less pronounced in patients in groups IV and V (who started treatment at least 15 days after the onset of SHL) than in the other patients, although the difference was not statistically significant. This finding is in agreement with those of other studies showing that earlier initiation of treatment improves prognosis [1,4,25]. For one month (30 days) the test group was given their typical caffeine allowance followed by a period of withdrawal, or withdrawal followed by reverting back to their regular caffeine consumption.
A lot of medical professionals today support caffeine withdrawal as a treatment for tinnitus, even with the lack of any associated evidence, and, in fact, severe symptoms of caffeine withdrawal might even lead to intensified tinnitus sounds.
For example, research has shown that CoQ10 as well as Melatonin may be effective tinnitus treatments. If you feel that caffeine is a trigger, then try cutting back on or eliminating it from your diet and see if it lessens the symptoms.
Thomas is an author, researcher, nutritionist and health consultant who dedicated his life to creating the ultimate Tinnitus solution guaranteed to permanently reverse the root of ear ringing and naturally and dramatically improve the overall quality of your life, without the use prescription medication and without any surgical procedures.
We'll cover home remedies, tinnitus diet tips, and general information that will be useful to tinnitus sufferers. The effect of tinnitus on some psychoacoustical abilities in individuals with normal hearing sensitivity. It can affect auditory perception abilities in individuals with normal hearing sensitivity. Tinnitus group was again divided into mild and moderate tinnitus based on the tinnitus handicap inventory. This could be due to subtle changes in the central auditory system which is not reflected in the pure tone audiogram.
The existence of tinnitus could be due to the disrupted neural activity at the level of the auditory system or may be of cochlear origin3,4.


Sanchez et al.10 investigated temporal perception in individuals with tinnitus and normal hearing to find out the possible effect of subtle cochlear changes in the auditory perception. Newman et al.14 investigated the relationship among psychoacoustic judgments, speech understanding ability and self-perceived handicap in subjects with tinnitus and hearing impairment. They reported significantly lower MSPIN score in their clinical group compared to the control group. The underlying basis for such complaints may be attributed to the interference to speech signals by either tinnitus or hearing loss which restricts the spectrum of sound available for higher level interpretation or a combination of the above two. However the effect of tinnitus on other psychoacoustical abilities like frequency and intensity discrimination has not been studied. The clinical group included 20 participants (12 males and 8 females) complaining of tinnitus, having normal hearing sensitivity.
It was ascertained from a structured interview that none of the subjects had any difficulty in understanding speech in daily listening conditions and that they did not have any history of neurologic or otologic disorder. The subjects of both clinical and control groups were assessed for presence of hearing loss and middle ear pathology through pure tone audiometry and immittance audiometry.
Frequency discrimination was assessed through differential limen of frequency and intensity discrimination was assessed through differential limen of intensity.
The noise was designed to have a 0.5 ms cosine ramp at the beginning and the end of the gap. On each trial, two of the three observation blocks contained pure tones at a reference frequency and one block selected at random, had a pure tone of variable frequency, which was always higher than the reference frequency.
The rest of the procedure remained same as mentioned in DLF testing except that the variable in case of DLI was intensity. The subjects were presented with sentence lists developed for the Kannada Quick Speech in Noise test19. In the figure, x-axis represents the various groups and the y-axis represents the gap detection threshold (ms). The mean gap detection thresholds and one-standard-deviation error bars for control & tinnitus (mild and moderate) groups. Figure 2 represents the mean and SD of MDT at all the modulation frequencies for both control and clinical groups. The mean modulation detection thresholds at 8, 20, 60, 200 Hz and one-standard-deviation error bars for control and tinnitus (mild and moderate) groups.
The results of the analysis showed that there was a significant difference between both the groups which is given in Table 2.
The mean differential limen of frequency at 1000 Hz and one-standard-deviation error bars for control and tinnitus (mild and moderate) groups. ANOVA results showed a significant main effect of severity of tinnitus on DLF thresholds [F (2, 37) = 5. The mean differential limen of intensity at 1000 Hz and one-standard-deviation error bars of DLI for control and tinnitus (mild and moderate) groups. The results of the analysis showed that there was no significant main effect of severity of tinnitus on DLI thresholds [F (2, 37) = 1. They postulated that the reason for poor gap detection could be that ongoing tinnitus masks the gap and results in impaired gap detection. The reason for the same could be due to defects in neural structures in the central auditory nervous system which has resulted in the perception of tinnitus, therefore also impairing temporal perception.
They reported that both the groups performed similarly for speech recognition in silence, but poorer performance on speech perception in noise was seen in tinnitus patients when compared with normal-hearing individuals without complaints of tinnitus and hyperacusis.
This could be due to subtle changes in the central auditory system which is not shown in the pure tone audiogram.
Prevalence of hearing loss in newborns of mothers who had malaria and were treated with antimalaric drugs in pregnancy. All underwent neonatal hearing screening with otoacoustic emissions combined with automatic auditory brainstem response.
Auditory sensory deprivation interferes with the ability to interpret speech sounds and results in economic and educational disadvantages2. The malaria parasites can easily cross the placental barrier or are transmitted through maternal-fetal transfusion9. The latest survey regarding the proportion of positive slides in pregnant women from the municipality of Porto Velho, Rondonia (RO), was performed in 2010 and revealed 331 cases of malaria in rural and urban areas, including 48 cases caused by P. In a study conducted in the same municipality, two newborns of mothers who had malaria and used antimalarial drugs in pregnancy were diagnosed with mild unilateral sensorineural hearing loss14. This hearing loss was irreversible in eight of these children, with seven presenting profound hearing loss.
All puerperal women received information about the objectives and methodology of the study and agreed to the procedures by signing the free informed consent form. Transient otoacoustic emissions (TOAE) and automated auditory brainstem responses (AABR) were measured with an Accuscreen instrument (Madsen). The results obtained during hearing screening and diagnostic evaluation were recorded on the study flow chart. Women who confirmed the presence of the disease were invited to participate in the study and received information about the objective and importance of the study and the procedures used.
When necessary, the records of the women and their newborns were accessed to complement the information if the mother could not answer the question or was in doubt.
For electrophysiological assessment of hearing, the infants remained lying in the crib or on the mother's lap during natural non-sedated sleep.
For this test, a probe microphone with a latex bulb was introduced into the external auditory canal of the newborn and emissions were evoked with a broadband click at an intensity of 80 dB SPL.
For this test, the skin in the areas of electrode placement (high forehead and mastoids) was cleaned to permit adequate impedance. Diagnostic evaluation consisted of tympanometry, diagnostic TOAE, diagnostic ABR, and an appointment with the otorhinolaryngologist. The NHS results were correlated with birth weight and gestational age by analysis of variance (ANOVA). Two of the four infants that failed the NHS and that were referred to the clinic responsible for the program for further tests abandoned the program. The audiologic findings of this newborn included the bilateral presence of TOAE; absence of waves I, III and V at 90 dB in the click ABR test accompanied by the presence of cochlear microphonism, and tympanometry revealed normal mobility of the tympano-ossicular system.
In addition to the fact that the mother had malaria and made use of antimalarial drugs during pregnancy, the newborn was exposed to ototoxic medication (gentamicin) for 9 days and required exchange transfusion due to hyperbilirubinemia. This finding was statistically significant when compared to the occurrence of the disease in the third trimester. The use of primaquine is contraindicated for the treatment of pregnant women, irrespective of the Plasmodium species involved and gestational period, and during the breast-feeding period until 6 months25. This infant had no associated risk factor for hearing loss, suggesting that the medication administered possibly caused or potentiated the occurrence of hearing impairment. However, the frequency of antimalarial drug use was higher in the second trimester, although the frequency of malaria occurrence was higher in the first trimester of gestation. Despite an attempt to perform an active search, as routinely done, the mothers could not be contacted by telephone. The infant can be infected at the time of delivery, through hematogenic dissemination, or postpartum36. Neonatal hyperbilirubinemia is toxic to the auditory pathways and central nervous system29 and newborns submitted to exchange transfusion are considered to be at high risk for the development of auditory neuropathy38.
In the latter, the yellow color is more intense in the subthalamic nucleus and globus pallidus and may be present in the hippocampus, geniculate bodies, vestibular, cochlear and oculomotor nuclei, cerebellum and spinal cord40. Other studies have demonstrated a close relationship between hearing impairment and hyperbilirubinemia5,39,40. A close relationship between hearing impairment and use of ototoxic medication has been reported for newborns30,43,44. The chance of these newborns have hearing loss is high, since the NHS was performed with use of combined technical (OAE and AABR), which reduces the chance of false positives. Active search was necessary in various cases of the present sample, but contacting the participants was unsuccessful in two cases. Audiological findings highlighted in this newborn indicate the presence of alteration in retrocochlear auditory pathways that are compatible with the auditory neuropathy spectrum. The IRDA, concomitant with malaria and the use of antimalarial drugs during pregnancy, most common was the use of ototoxic medication by the newborn, but hyperbilirubinemia with exchange transfusion was one of the risk indicators found in newborns diagnosed with hearing loss.
Noise measurements, a questionnaire, a Brazilian version of the Tinnitus Handicap Inventory (THI), and pure-tone audiometry were conducted with 52 participants (mean age, 29 years) who suffered from tinnitus. Among the risk factors for tinnitus, the most prominent are age, gender, various diseases (otological, metabolic, neurological, and vascular alterations and dental factors), hearing loss, and exposure to noise, ototoxic drugs, caffeine, nicotine, and alcohol [1-4].
Tinnitus can alter an individual's ability to function in professional, social, and leisure activities and in family relationships, hence affecting the quality of life [5,6]. In addition to being beneficial for clinical applications, the tinnitus questionnaires are valuable for understanding the relationship between personality and the psychopathology of tinnitus, its impact on the daily life of persons who suffer from tinnitus, the difficulties and the perception of social support in relation to the problem, and the incapacities and the difficulties produced by tinnitus that can seriously affect quality of life [7-9].
Occupational hearing loss prevention initiatives rarely focus on the prevention and management of tinnitus. The company employs 372 workers (120 female, 252 male) working in two fixed 8-hour and 48-minute shifts. The questionnaire gathered information on demographics and occupational and medical histories for each worker.
We also used Spearman's rank correlations to examine the results of exposure information versus the outcome. Because of attrition, we were able to study only 52 workers (14% of total population of the plant). Of those, 62% were exposed to carbon monoxide (CO), 13% to CO and vibration, 12% to hydrochloric acid, and 13% to sodium hydroxide. We observed that of the 52 participants, 71% had normal audiometric results, whereas 12% presented a bilateral high-frequency notch and 17% presented audiometric configurations of hearing loss due to causes other than noise, such as unilateral losses and flat audiometric configuration.
Median of hearing thresholds for the groups with normal hearing (all thresholds 25 dB hearing level [HL]), hearing loss configurations suggestive of noise-induced hearing loss (NIHL), and hearing loss from various causes. The distribution of poorest scores across scales of the Tinnitus Handicap Inventory, in percent (n = 52). We observed a significant correlation between headaches (p = .0458) and the duration of tinnitus. We did not include the remaining 9 individuals (17%), who displayed other audiometric configurations of hearing loss in the statistical analysis. The prevalence of tinnitus complaints in male subjects was 16% and in female subjects was 9%, similar to what has been reported [16-18].
Schleuning [2] explained that caffeine and nicotine could aggravate tinnitus because they are stimulants and can induce the constriction of blood vessels.
The participants of the study who had such combined exposure had a higher degree of tinnitus severity. Moreover, a negative impact of tinnitus on the subjects' quality of life could de detected. The 22% tinnitus rate among workers, most of whom nonetheless had normal hearing, suggests a need to address tinnitus in occupational hearing loss prevention initiatives.
Rick Davis and Robert Randolph (National Institute for Occupational Safety and Health, USA) and Alberto Behar (University of Toronto, Canada) provided helpful critiques of the manuscript. Our study included patients with SHL of sudden onset (occurring over a 72-hour period) at equal to or greater than 30 dB at three consecutive frequencies. Approximately one-third of cases are accompanied by complaints of tinnitus, dizziness, and ear fullness [2,3]. Risk factors associated with poor prognosis include time of disease progression prior to the initiation of treatment, extreme age (being very young or very old), severe initial hearing loss, concomitant vestibular symptoms, and a descending pure-tone audiometry curve [1,4,12]. The treatment regimen was the same as that used in group I patients, minus dextran or minus dextran and acyclovir if the SHL onset was greater than 5 days. Serological tests were also conducted for herpes simplex virus type I, cytomegalovirus, syphilis, rubella, measles, Lyme disease, and the human immunodeficiency virus. Nevertheless, none of those authors compared their results with the prevalence observed in epidemiological studies of upper-airway infection in the corresponding populations. However, those authors found that prevalence of these disorders among patients with SHL was lower than that reported for patients with dizziness [15], which is in agreement with the findings by Cadoni et al. In our study, the etiology was vascular in 4.3% of the cases of SHL, one of which was very severe. We cannot state with confidence that the likelihood of complete recovery is greater in such cases of SHL, as other factors such as gender and age at SHL onset might exert some influence.
In groups I, II, and III, treatment was initiated within the first 15 days after the onset of SHL. We observed a genderbased difference in ΔPTA, with a tendency toward statistical significance, suggesting that the SHL prognosis is poorer for men. Oral steroid treatment of sudden sensorineural hearing loss: A ten year retrospective analysis.
Sudden complete or partial loss of function of the octavus system in apparently normal persons. Antiviral treatment of idiopathic sudden sensorineural hearing loss: A prospective, randomized, double-blind clinical trial.
Treatment of idiopathic sudden sensorineural hearing loss with antiviral therapy: A prospective, randomized, double-blind clinical trial.
Prognosis for sudden sensorineural hearing loss: A retrospective study using logistical regression analysis. Clinicoepidemiologic features of sudden deafness diagnosed and treated at university hospitals in Japan. The implication of viruses in idiopathic sudden hearing loss: Primary infection or reactivation of latent viruses? The relationship of the herpesvirus family to sudden hearing loss: A prospective clinical study and literature review.
On top of that, they found that severe caffeine withdrawal can actually worsen the problem. For reasons that aren’t entirely clear yet, fatigue and stress seem to worsen tinnitus as well. But since diet triggers are so personal, a good strategy is for individual sufferers to keep track of what they consume and when their symptoms are better or worse. If you experience caffeine withdrawal that causes severe side effects, or don’t experience an improvement where your tinnitus is concerned, you can always resume consuming caffeine. Data Collection and Analysis: Differential limen of intensity, differential limen of frequency, gap detection test, modulation detection thresholds were done through the mlp toolbox in Matlab and speech in noise test was done with the help of Quick SIN in Kannada.
Oxenham & Bacon5 reported that even a minute cochlear disorder may affect the cochlear amplification mechanisms.
Results showed that temporal perception and speech perception in noise was impaired in these individuals. Audiometric speech measures were obtained for open set PAL = 50 PB-words in a quiet, closed set synthetic sentence identification, speech perception in noise and dichotic sentence identification.
Another study by Ryu et al.8 similarly reported that tinnitus itself could adversely affect speech perception ability. It can also be hypothesized that subtle cochlear or neutral deficits in tinnitus patients might create deficits in various auditory abilities.
Additionally the effect of severity of tinnitus on these abilities has not been established. Tinnitus Handicap Inventory (THI) was administered to the clinical group to assess the severity of tinnitus and accordingly, the group was divided into a mild (score of 18-36 on THI) and a moderate (score of 38-56 on THI) subgroup for comparison. The subject's participation was voluntary and they were not paid for their participation in the study. This broadband noise was used for the GDT as its spectrum didnot change with the insertion of the gap. Each list contains 7 sentences mixed with 4-talker speech babble noise at different signal to noise ratio (SNR). GDT scores reflect poorer performance by individuals with tinnitus compared to those without tinnitus. In the figure x-axis represents the various groups at different modulation frequencies and the y-axis represents the modulation depth (dB).
In the figure, x-axis represents the various groups and the y-axis represents the DLF in Hz. In the figure x-axis represents the various groups and the y-axis represents the DLF in dB.
However, in these supporting studies effect of degree of tinnitus on temporal resolution was not commented upon. Sanchez et al.13 used the Gap in noise test on normal hearing listeners to evaluate the auditory temporal resolution ability of 18 individuals with tinnitus and 23 individuals without tinnitus. However, temporal processing ability to detect modulation was found to be similar across the different degrees of tinnitus. However, the mild tinnitus group did not show a deficit in the GDT, whereas their MDT was poor.
Furthermore, the speech perception ability in noise was not differing across the range of tinnitus severity. The reason for poorer speech understanding ability in the presence of noise could be attributed to the fact that tinnitus interferes with the speech perception. In the current literature, no other studies have assessed the effect of tinnitus on frequency and intensity discrimination and compared them to normal hearing individuals without tinnitus.
These findings have a clinical significance in designing assessment and rehabilitation protocols for normal hearing individuals with tinnitus.
Cochlear compression: perceptual measures and implications for normal and impaired hearing. Evaluation of masking effects on speech perception in patients with unilateral chronic tinnitus using the hearing in noise test.
Temporal processing evaluation in tinnitus patients: results on analysis of gap in noise and duration pattern test. Relationships among psychoacoustic judgments, speech understanding ability and self-perceived handicap in tinnitus subjects.
Relationships among speech perception, self-rated tinnitus loudness and disability in tinnitus patients with normal pure-tone thresholds of hearing. Frequency discrimination ability and stop-consonant identification in normally hearing and hearing-impaired subjects.
Gap detection deficits in humans with tinnitus as assessed with the acoustic startle paradigm: does tinnitus fill in the gap? Speech recognition index of workers with tinnitus exposed to environmental or occupational noise: a comparative study. Those who failed were referred to audiological diagnosis with evoked otoacoustic emissions and brainstem auditory evoked potential associated with tympanometry (1000 Hz). Furthermore, hearing is essential for interpersonal relationships and relationships with the environment2.
Any type of hearing loss can compromise language, learning, cognitive development and social inclusion of the child7, and it is therefore important that hearing impairment is detected as early as possible. A study demonstrated that pregnant women infected with Plasmodium falciparum present clinical and laboratory alterations, such as altered hemoglobin, hematocrit, creatinine, urea, bilirubin, and glucose.
The treatment indicated for the mothers was chloroquine, chloroquine combined with quinine, and quinine combined with Fansidar.
The study was conducted at the maternity unit of a referral hospital for high-risk pregnancies in the capital of Rondonia.
The following eligibility criteria were established for formation of the sample: newborns of women who had malaria in pregnancy, newborns participating in the NHS Program, and newborns born or hospitalized in the maternity unit of the state referral hospital for high-risk pregnancies in Porto Velho (RO) whose mothers agreed to participate in the study by signing the free informed consent form. Adopting a level of significance of 95% and a sampling error of 6%, the estimated sample size was 35 newborns.
Personal data for subsequent contact were also recorded in case it was necessary to schedule a day and time for a new assessment during both the screening and diagnostic evaluation phases. Mothers who agreed to participate in the study signed two copies of the free informed consent form, one was given to them and the other was kept by the responsible researcher. Infants presenting normal outer hair cell function obtained a "pass" result, which occurs automatically.
Tympanometry, which investigates tympano-ossicular system function, excluding possible middle ear alterations, was performed using a 1000-Hz probe tone since it is more sensitive in identifying these alterations in infants aged 0 to 4 months18.
The frequency of risk factors for hearing loss was analyzed by the test for equality of two proportions and the NHS results were correlated with variables such as type of malaria infection, gestational period when malaria occurred, type of antimalarial agent and gestational period when it was used. The otorhinolaryngologist requested imaging exams to evaluate possible involvement of the central auditory pathway. The Plasmodium species contracted by the mother during the first trimester of gestation was the vivax type. This result differs from that reported in another study21 conducted in the same city, in which the distribution of malaria was homogenous across the three trimesters.
In contrast, the World Health Organization recommends the use of primaquine under medical supervision26. In the present study, the participants reported the use of antimalarial drugs in more than one trimester, as recommended by the Brazilian Ministry of Health that indicate chloroquine as chemoprophylaxis against P. In this respect, it is important for the mother to have a minimum educational level, financial resources and harmony in social and marital relationships to seek the best health measures for her child31. Authors said that the lower the birth weight, the greater the chances of failure in the NHS32,33, which was not observed in this study.
This result highlights the need to develop other studies with this population, but in larger samples. In addition, the rapid discharge of the participants, which is a major obstacle of NHS programs, may have contributed to the small sample size. O conhecimento, a valorizacao da triagem auditiva neonatal e a intervencao precoce da perda auditiva. Hearing aids fitting process in users that are seen in a federal public institution: part I--results and implications with the amplification device.
Avaliacao eletrofisiologica de recem-nascidos de maes que fizeram uso de antimalaricos na gestacao. Estudio de los efectos ototoxicos en 725 pacientes tratados con antimalaricos en el hospital central de Maputo (Mozambique). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs.


Accoustic immitance measures in infants with 226 and 1000 hz probes: correlation with otoacoustic emissions and otoscopy examination. Retardo no crescimento intrauterino, baixo peso ao nascer e prematuridade em recem-nascidos de gravidas com malaria, na Colombia.
Achados audiologicos de recem-nascidos de maes que fizeram uso de antimalaricos no periodo gestacional [Resumo n. Fatores de riscos associados a transmissao de malaria humana, em areas de ressacas, nos bairros Novo Horizonte e Zerao, Macapa, Amapa, Brasil. Determinants of intermittent preventive treatment of malaria during pregnancy (IPTp) utilization in a rural town in Western Nigeria. Indicadores de risco para perda auditiva em neonatos e lactentes atendidos em um programa de triagem auditiva neonatal.
Triagem auditiva em um hospital publico de Belo Horizonte, Minas Gerais, Brasil: deficiencia auditiva e seus fatores de risco em neonatos e lactantes. Analysis of transient otoacoustic emissions and brainstem evoked auditory potentials in neonates with hyperbilirubinemia. Perda auditiva neonatal associada a hiperbilirrubinemia por deficiencia de glicose-6-fosfato desidrogenase: relato de caso. Sequelas auditivas e neuropsicomotoras em recem-nascidos de termo ictericos tratados pelos metodos convencionais. Comparacao das alteracoes auditivas em recem-nascidos da UTI neonatal expostos e nao expostos a antibioticos. Medico do Setor de Saude Auditiva e Implante Coclear Universidade de Brasilia - UnB, Professor Substituto Otorrinolaringologia Universidade de Brasilia - UnB. Professor e orientador do programa de pos-graduacao em Ciencias da Saude e Ciencias Medicas da Universidade de Brasilia - UnB. THI results indicated that tinnitus had the greatest influence in the functional scale (54%).
We used the overall result to identify the degree of severity of tinnitus for each individual and for completing an analysis of the total scores by scales. Of all noise-exposed female workers in the plant, 11 (9%) reported having experienced tinnitus, and 41 (16%) of the noise-exposed male workers reported the condition.
Spearman's rank correlation coefficient results indicated a significant correlation between noise levels and how often workers experience tinnitus (p = .01). We also observed a significant correlation between the duration of noise and the functional scale (p = .039). It is important to notice that the average age of the population of our study (29.2 years) is younger than in other studies, which reported results from groups whose mean ages varied from 40 to 50 years and who had a short duration of noise exposure (average, 7 years)[18-21] . According to that author, doctors believe that 50% of patients with complaints of tinnitus improve significantly when they stop smoking or reduce caffeine intake. In recent decades, studies have demonstrated that simultaneous chronic exposure to CO and noise represents a potential risk to hearing, but reports of tinnitus exist only for cases of intense poisoning from CO [24].
This supports the inclusion of tinnitus prevention initiatives alongside workplace hearing loss prevention initiatives because of shared causal factors. Information on tinnitus prevention and treatment could have a measurable, positive impact on a person's quality of life. The authors thank all those who participated in the study for their time, interest, and cooperation. Guidelines for the grading of tinnitus severity: The results of a working group commissioned by the British Association of Otolaryngologists.
We divided patients into five groups by profile and treated them with dextran, dexamethasone, acyclovir, nicotinic acid, and papaverine hydrochloride (with or without vitamin A). Group III included patients who had a 6- to 15-day history of SHL and who were hospitalized and treated with the same treatment used in group I minus acyclovir.
If no improvement occurred in the auditory threshold after 3 days, treatment was discontinued and the patient was discharged. No statistically significant difference was noted among the treatment groups in terms of audiometric progression determined by calculating the difference between the low- and high-frequency PTAs seen at baseline and after 180 days (Table 7). Owing to differences in design and population, we cannot directly compare our sample with theirs. However, despite advances, serological diagnosis remains difficult, as most tests are nonspecific and have a low accuracy rate [17]. Blood circulation in the inner ear is of the terminal type, the cochlear artery running from the base to the apex of the cochlea. In that case, SHL was detected after an episode of aplastic anemia (severe erythrocytopenia and thrombocytopenia) resulting from prolonged use of a nonsteroidal antiinflammatory drug (potassium diclofenac used daily for more than 1 year to treat acne).
To our knowledge, no previous studies have attempted to identify the etiologies that are most often associated with audiometric normalization in patients with SHL. However, the greatest improvement in PTA was observed in group II patients, who were the only ones not treated by dextran. A recent study demonstrated a statistically significant association between less recovery of hearing loss and male gender [16].
The truth is that there is insufficient evidence to support these theories, which eventually led to Bristol University’s Center for Hearing and Balance Studies in the UK to take a closer look. A brief record was kept of their tinnitus and caffeine withdrawal symptoms twice per day, followed by a questionnaire that was filled out during the study in order to evaluate the effect of withdrawal. Additional research in this area would greatly benefit individuals with tinnitus as well as their physicians. This way, one by one, a sufferer can eliminate foods and substances that worsen the problem, and finally find some relief.
Thus, tinnitus of cochlear origin might involve deformities of both cochlear function and the processing of tinnitus within the nervous system. They attributed this result to the subtle cochlear damage in individuals with tinnitus having normal hearing sensitivity.
They reported in their results that tinnitus may interfere in the perception of speech signals which have reduced linguistic redundancy. Hennig et al.7 evaluated speech recognition in the presence of competitive noise in normal hearing individuals with tinnitus and hyperacusis.
The perception of these psychoacoustic abilities plays an important role in the speech perception in noise.
Ethical clearance was obtained from the relevant ethics committee at the institute prior to commencement of experimentation. The mlp was implemented through Matlab by utilizing a large number of candidate psychometric functions17.
The figure shows that individuals without tinnitus had better MDT compared to those with tinnitus.
The figure shows that individuals without tinnitus had better DLF compared to those with tinnitus. The figure shows that individuals without tinnitus had better DLI compared to those with tinnitus. It is evident from the figure that people with tinnitus had poorer SNR-50 values compared to those without tinnitus.
They reported that individuals without tinnitus detected shorter gaps than individuals with tinnitus. The effect of degree of tinnitus on MDT has not been studied earlier; hence this study adds to the existing literature of effect of tinnitus on psychoacoustic abilities. Thus, it could be postulated that MDT is a more sensitive tool to assess the effect of tinnitus on temporal resolution.
Also the role of the medial olivary cochlear system in the recognition of auditory stimuli in the presence of competitive noise23,24 is well known and a disorder in this system is also hypothesized to cause tinnitus23. The facts that pitch discrimination was poorer in individuals with tinnitus could be attributed to the subtle cochlear changes which is not evidenced in the pure tone thresholds. Data were obtained through interviews with the mothers' and analyzing the patient chart and the newborn, and underwent to statistical tests analysis of variance, equality of two proportions and Chi-square test (p = 0.05).
Therefore, hearing impairment during the first years of life of a child can interfere with the acquisition and development of speech and language3-5.
Newborn hearing screening (NHS) continues to be the only strategy able to detect early hearing alterations that could interfere with the quality of life of an individual5,8. At this hospital, an NHS Program is provided by a private clinic accredited by the National Health System (Sistema Unico de Saude - SUS), where diagnosis and intervention are performed. Excluded were infants born to mothers who were unable to report the occurrence and gestational period of malaria infection and infants born in other maternity units who were therefore not seen at the NHS service of the maternity unit where the study was conducted.
It was not possible to include more subjects because the period scheduled was not sufficient to continue the process.
Disposable insert earphones and electrodes were used for the two instruments, as well as disposable gloves, gauze and 70% alcohol to clean the infant's face and for fixation of the electrodes. Risk factors were analyzed by the chi-squared test in order to determine the relationship between the findings and the variables mentioned. Antimalarial drug use was more frequent in the second trimester of gestation, but most participants reported use of the medication in more than one trimester (Table 2).
The results of these exams indicated the presence of bilateral impairment of the retrocochlear auditory pathways, findings compatible with the spectrum of auditory neuropathy. This divergence may be explained by the difference in the period of data collection between the two studies, since the present study was conducted during the dry season (June to November), with the occurrence of malaria being related to climatic22-24 and environmental factors and an increase in transmission being observed at the end of the rainy season22. However, this indication has become rare as observed in the present study and other studies in which pregnant women had malaria during pregnancy and were treated with chloroquine14,27.
No relationship between the NHS results and gestational age agrees with evidenced by other researchers29.
Even if NHS is performed daily, including weekends and holidays, the large number of births per day in the maternity unit where the study was conducted leads to early discharge and the consequent loss of some newborns.
Ary Pinheiro (Porto Velho- RO) causados pela malaria durante a gestacao no periodo de 2001 a 2003 em usuarias do SUS. Eighty-two individuals (22% of the total population) had experienced tinnitus and were invited to participate in the study. The equipment used was an Interacoustics audiometer, model AD 229, with TDH-39 earphones, calibrated according to ISO 8253.
The average age of the sample was 29.2 years, and the average duration of noise exposure was 7 years. Moreover, significant results were found for the degree of tinnitus and exposure to chemical pollutants (p = .02). The THI indicated that even the degree 1 "slight" tinnitus experienced by most of the participants who reported tinnitus nevertheless had an impact on their quality of life. For instance, lesions in the neck and the middle ear and sinusitis and headaches increase the risk of tinnitus from 28% to 35%. The findings underscore the need for noise control and other effective strategies to mitigate causal factors. The use of an instrument designed to evaluate the impact of tinnitus on a person's life, such as the THI, can contribute to a greater understanding of the needs of a specific person or group (or both). Experiencia do hospital das clinicas da faculdade de medicina da Universidade de Sao Paulo. Worldwide, SHL accounts for approximately 1% of all cases of deafness, and 15,000 new cases occur annually [1,4]. Patients were divided into five treatment groups on the basis of SHL duration and clinical profiles that indicated the use or absence of the current drugs prescribed.
Group IV included patients with a 16- to 30-day history of SHL and who were treated with the group I regimen minus dextran and acyclovir. However, the fact that the time to first medical visit was longer in our study might be attributed to patients' lack of knowledge concerning the symptoms or difficulty in patients' gaining access to treatment. In our sample, tinnitus was much more prevalent (95% of cases) and was often the main reason for the disturbance, leading us to recommend that future clinical trials investigate therapeutic possibilities in preventing and managing this symptom in SHL patients. In our sample, diagnoses were made by determining erythrocyte sedimentation rates and levels of antinuclear factor and rheumatoid factor. Intracochlear hemorrhage can be revealed through the use of magnetic resonance imaging, showing the importance of this procedure in making the diagnosis [24]. The authors estimated that audiometric recovery resulting from treatment translated to an increase in mean PTA of approximately 25 dB, similar to what we observed for low-frequency PTA. However, we agree with Mattox and Simmons [25], who reported a fundamental difference between hearing losses at low frequencies and those affecting high frequencies, stating that low-frequency losses are more easily reversed.
Although some underlying diseases can impair innerear microcirculation and hinder clinical improvement of SHL, the comorbidities presented by patients in group II were not indicators of poor prognosis. The better prognosis in women merits further analyses, given a possible bias that might be related to indicators of good prognosis. The University’s 2010 clinical study was the first of its kind to specifically investigate the relationship between tinnitus and caffeine consumption. This is crucial research because being aware of the chemicals that can make tinnitus worse (or improve it) can provide important clues that will help figure out treatments that could relieve the symptoms. Similar results were obtained by Mehdizade Gilani et al.12 who studied 20 subjects with tinnitus and reported that patients with tinnitus have temporal resolution difficulties in the Gap in Noise test, in spite of normal auditory thresholds. The results showed a similar performance in the speech recognition in silence, but poorer performance on speech perception in noise in tinnitus patients when compared with normal-hearing individuals without complaints of tinnitus and hyperacusis. Frequency discrimination ability helps in the perception of stop consonants and in understanding frequency transition16. Control group included 20 age-matched participants with normal hearing sensitivity and without tinnitus. After every trial, the program estimates the probability (or likelihood) of achieving the listener response to all of the stimuli that have been presented in that trial and determines the subsequent stimulus, considering the psychometric function which gives the highest probability. The modulation depth was varied according to the subject's response to track a 79.4% correct response criterion level.
Moreover, individuals with moderate tinnitus had the poorest MDT values followed by those with mild tinnitus, with the best thresholds obtained by those individuals without tinnitus. Moreover, individuals with moderate tinnitus had poorest DLF values followed by those with mild tinnitus, with the best thresholds obtained by those individuals without tinnitus. Moreover, individuals with moderate tinnitus had poorest DLI values followed by those with mild tinnitus, with the best thresholds obtained by those individuals without tinnitus.
Haas et al.11 also reported of longer GDT in tinnitus subjects compared to non-tinnitus subjects and hypothesized that this could be due to some changes in neural activity in tinnitus patients. Thus, normal hearing individuals who have complaints of tinnitus may have a problem in certain communication situations due to a possible change in the functioning of the efferent fibres of the medial olivary cochlear system. Cochlear damage initially involves the outer hair cells, generally affecting high-frequency hearing. The final sample consisted of 35 mothers who had malaria and used antimalarial drugs in pregnancy and their children. Subjects who needed to complete the diagnostic phase were referred to the clinic responsible for the NHS program. Infants who failed the test were directly referred for diagnostic evaluation, a procedure adopted by the program to prevent abandonment by the mothers, in addition to the fact that ABR is not affected by vernix which would justify retesting within 15 days. Infection occurred more frequently in the first trimester of gestation and this result was significant when compared to the third trimester (Table 1). Twenty (24%) of the 82 were not able to participate because they lost their jobs before collection of data, 5 (6%) declined to participate saying that they no longer had symptoms of tinnitus, and 5 (6%) were on vacation at the time of data collection. We performed puretone audiometry for all subjects at frequencies of 0.5, 1, 2, 3, 4, 6, and 8 kHz.
The functional subscale, composed of 11 questions, evaluates the limitations that tinnitus induces in the mental, social, occupational, and physical areas. Table 1 displays the findings pertaining to the health problems and auditory and medical histories described by the participants.
In the THI, tinnitus was shown to have the greatest relationship to the functional scale (54%), indicating that its impact is more noticeable in social, daily, and reading activities involving concentration, auditory acuity, attention, and rest.
The analysis of the THI results along with the audiometric results indicated that a considerably greater number of significant correlations were verified in the group with altered hearing, which was expected because the two conditions-compromised hearing and tinnitus-are often associated.
Information dissemination on the risks and prevention alternatives is of great importance, as is the management of tinnitus. Finally, it could be used in the design of appropriate strategies to manage tinnitus in the workplace. We determined outcome as the difference between day-0 and day-180 pure-tone averages (PTAs). Since SHL was first described 62 years ago [5], various etiologies have been proposed, including the infectious, traumatic, neoplastic, immune, ototoxic, vascular, ischemic, neurological, and metabolic. Group V included patients with more than a 30-day history of SHL who were treated with nicotinic acid, papaverine hydrochloride, and vitamin A. If audiometric improvement occurred, the treatment regimen was maintained for up to 10 days.
Possibly these discrepancies in the prevalence of upper-airway infection accompanying SHL are the result of geographical differences. In two patients, the diagnoses were made based on a clinical history of vasculitis (Churg-Strauss syndrome) and thrombophilia, respectively. This was also observed in our study in which low-frequency PTA normalized in 28 cases as compared with 15 cases of high-frequency PTA normalization. In our study, dextran was not found to act as an adjuvant to dexamethasone or acyclovir in the treatment of SHL, as the patients presenting the best response to treatment were those in the group not treated by dextran. In another study by Haas et al.11, poorer temporal acuity on gap detection threshold test in nine tinnitus subjects with normal hearing sensitivity was reported.
Intensity discrimination ability is important in understanding just noticeable differences in formants and in the discrimination of peak to valley differences in intensity. The mean age and age range of subjects who participated in the study are depicted in Table 1.
Within about 12 trials, the mlp generally attains a reasonably stable estimate of the most likely psychometric function.
The listener's task was to repeat the sentences presented and each correctly repeated keyword was awarded 1 point for a total possible score of 35 points per list. Therefore, the final sample of the study consisted of 52 participants: 11 females (9% of the total of 120 noiseexposed female workers in the studied plant) and 41 males (16% of the total of 252 noise-exposed male workers in the studied plant). The emotional subscale, composed of 9 questions, includes affective answers for tinnitus (anger, frustration, irritability, and depression). All participants exposed to noise levels greater than 85 dB are required to use ear muffs, and information on their use and maintenance are given when workers are hired.
The emotional scale was the second most affected and is related to manifestations of nervousness, frustration, irritation, depression, anxiety, insecurity, and difficulty in relationships with family and friends.
Estabelece diretrizes e parametros minimos para avaliacao e acompanhamento da audicao dos trabalhadores expostos a niveis de pressao sonora elevados. However, Acrani & Pereira9 in their study of 15 individuals with constant bilateral tinnitus with normal hearing reported of no significant difference in temporal resolution of individuals with and without tinnitus. The role of temporal perception in speech perception is very well known; however, the role of other psychoacoustic abilities in speech perception is still not well understood. The pitch match of the tinnitus was not always at this frequency and this might have had an effect. We also performed daily biological calibration checks on the audiometer immediately before testing subjects. Last, the catastrophic subscale is composed of 5 questions and examines the most severe reactions from tinnitus (desperation, loss of control, inability to face problems, inability to escape tinnitus, and fear of having a serious ailment)[12].
Walkthrough observations suggest that use of the hearing protection is high, but no information exists on the consistency of hearing protection use.
The catastrophic scale demonstrated alterations related to desperation, intolerance to tinnitus, and loss of control in situations when experiencing tinnitus (see Fig.
We observed significant improvements in PTAs after 180 days of treatment and noted a significant linear correlation between time from SHL onset to initial visit and recovery.
The low-frequency PTA was determined by averaging the pure tones of the 250-, 500-, and 1,000-Hz frequencies, and the high-frequency PTA was based on those of the 2,000-, 4,000-, and 8,000-Hz frequencies. Thus, this study incorporates investigating the impact of tinnitus on all of these abilities in individuals with different degrees of tinnitus. In our study, factors such as gender, age, tobacco, and exposure to firearms were not significantly associated with tinnitus. We determined audiometric evolution of the responses in the different treatment groups by subtracting baseline PTA from final PTA (after 180 days of treatment). Pitkaranta and Julkunen [21] investigated the protein MxA (a specific marker of systemic viral infection) in patients with SHL and found evidence of viral etiology in 6.5% of the cases. It will help in understanding the way in which chronic tinnitus disrupts normal temporal characteristics, frequency and intensity discrimination as well as speech perception ability in noise. In the present study a three-interval, alternate forced-choice (3-AFC) method using mlp was used to track a 79.4% correct response criterion. Coles [26], among several authors, reported that the worse the hearing is, the more probable is the occurrence of tinnitus. In the treatment of SHL, dextran provided no more benefit than did dexamethasone or acyclovir.
We found mumps (paramyxovirus) to be the most common etiology, although we did not test for influenza or parainfluenza. For all the tests, the subjects were given 5-6 practice items before the commencement of the test. These discrepancies can be attributed to the difficulty of making the viral diagnosis, given that the time to the first medical visit (interval between the onset of SHL and blood collection) varied from study to study, which can influence seropositivity. The stimuli for the tests were presented using TDH 39 head phones, which was calibrated at 80 dB SPL. Approximately 20% of the patients with hearing loss present complaints of tinnitus, whereas 90% of those with severe tinnitus had hearing loss.
Of note in our study and in a previous study [22] is that some of the patients presented seropositivity for the bacterium that causes Lyme disease.



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