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Author: admin, 14.04.2015. Category: Is There A Cure For Tinnitus

Our objective was to compare quality of life, high-frequency audiometry, and loudness-pitch match in individuals with tinnitus with and without hearing loss. Tinnitus is defined as a sensation of sound perceived by an individual in the absence of an external sound source, and it affects approximately 15% of the population worldwide [1-3]. This study received approval from the ethics committee of the Universidade Federal de Sao Paulo-Brazil (process no.
Nonparametric statistical tests and methods were used in order to compare the results of all procedures between the groups (NL and HI). Reporting on tinnitus assessed using high-frequency audiometry, a number of authors posit a difference in the threshold between individuals with and without tinnitus [11]. Only the younger individuals (up to 28 years of age) in the HI group perceived frequencies of 10 and 12 kHz.
Regarding the loudness-pitch match, a statistically significant difference was evident between age groups among NL individuals, with older individuals exhibiting loudness that was 78.40% more intense than younger individuals (Fig.
Greater tinnitus intensity in the HI group denoted a worse hearing threshold, which is in agreement with findings from previous studies [16].
Regarding the THI, a previous study found mild handicap (18-36 points) among the group with normal hearing [7].
Analysis of the WHOQOL questionnaire in the general comparison between groups revealed that the HI individuals scored lower on all the subscales in the NL group (Fig. The pitch of the tinnitus is higher among individuals without hearing loss, whereas the opposite is true with regard to loudness. How to cite this article Passi S, Ralli G, Capparelli E, Mammone A, Scacciatelli D, Cianfrone G.
The main objective of this study was to determine reliability, validity, and reproducibility of the Italian version of the Tinnitus Handicap Inventory (THI) self-administered questionnaire aimed at evaluating the impact of tinnitus on the quality of life of subjects affected by this symptom. Over time, different authors have made various attempts at defining and classifying tinnitus; however, that none of their proposals has proved to be exhaustively descriptive suggests the great level of complexity of the pathogenesis and phenomenology associated with tinnitus. One of the first definitions was coined by Itard (1774-1838), who described tinnitus as "an extremely irksome discomfort, which leads to a profound sadness in affected individuals." He advised several therapeutic approaches to gain relief, among which was the use of environmental noise [1,2]. Our opinion is that no single theory, model, or hypothesis will be exhaustive in all the affected patients [21]. Tinnitus may be continuous or intermittent and it can be localized at the ear level, bilaterally or unilaterally, or at various points in the head [24]. Therefore, because the tinnitus symptom is not always associated with a specific and easily detectable pathogenic factor and varies greatly in both qualitative and quantitative terms, it escapes instrumental evaluation. Further studies showed that the level of distress is not related to type, assumed cause, or features (such as pitch and loudness) of tinnitus [30-32]. In the course of the last two decades, several selfadministration questionnaires for the investigation of the disabling aspects of tinnitus have been reported in the literature [37,38], using various evaluation systems and presenting different features.
On the occasion of the Fourth International Tinnitus Seminar in Bordeaux in 1991, Halford and Anderson [42] introduced the Subjective Tinnitus Severity Scale (STSS), composed of 16 items and a single factor evaluating severity of tinnitus in terms of intrusiveness and interference with sleep, relaxing capacity, and distress level. The two instruments discussed in the following paragraphs focus mainly on psychological reactions to tinnitus, a further confirmation of a trend in the most recent literature that takes into account tinnitus-coping strategies more than symptom severity. Normally, the tinnitus sufferer turns, in the first place, to specialists, such as an otolaryngologist or an audiologist. One of the criticisms leveled at the THI in the past was that, compared with other self-assessment scales (Tinnitus Questionnaire [TQ], THQ, TRQ), its factorial structure had not been validated [52-54]. The THI has been adopted as either a primary outcome measure or in association with other evaluation scales and has been used in double-blind trials with a control group to assess the effect of pharmacological treatments administered to tinnitus sufferers. In light of our Italian clinical experience, we chose to evaluate reliability, validity, and psychometric properties of the THI, for we believe that among all tests described in this study, its questions are the most easily understood and provide an exhaustive framework for tinnitus impact on the sufferers' everyday life and function. It is interesting to note that item 24, relating to the effect of stress on tinnitus, turns out to be the least correlated to the total score of the scale. High total scores are always suggestive of high scores in the catastrophic scale, in support of the findings of McCombe et al. These definitions based on grading are very useful in clinical practice and help doctors to quickly identify the most appropriate therapeutic choices.
From the Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
Iron deficiency anemia is extremely common, particularly in the developing world, reaching a state of global epidemic. Anemia is generally defined according to hemoglobin levels, which may vary according to many factors most importantly age, gender, and ethnicity. A recent study9 found that most pregnant women were not receiving adequate amounts of iron, despite taking fortified food and supplementation. Lowered iron stores of the newborn child may persist for up to one year and result in iron deficiency anemia.26 Such a state should be identified and treated promptly because of the possible long term consequences. Iron treatment should be started once iron deficiency anemia is recognized in infants and young children.
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Impact of Tinnitus on Quality of Life, Loudness and Pitch Match, and High-Frequency Audiometry. A study carried out on a random sample (45% men and 55% women) in a large Brazilian city found that 25% of the interviewees complained of tinnitus [4]. WHOQOL [9,10] questionnaire: Investigation of quality of life, addressing mental health, motor skills, and cognitive and social aspects. We used the Mann-Whitney test for the analysis of the questionnaires, high-frequency audiometry, and loudness-pitch match. Although we did not include any individuals without tinnitus in the present study, the NL group demonstrated a frequency difference of 18 kHz, as those up to 28 years of age perceived this frequency, whereas older individuals did not (Fig. Mean high-frequency audiometry values comparing individuals with and without hearing loss according to age group.
Mean loudness values of tinnitus comparing individuals with and without hearing loss according to age group. Mean pitch values of tinnitus comparing individuals with and without hearing loss according to age group.
A statistically significant difference was evident between NL and HI groups with regard to loudness (see Fig. Mean handicap values on Tinnitus Handicap Inventory comparing individuals with and without hearing loss according to age group. Comparison of mean World Health Organization Quality of Life (Abbreviated) values comparing individuals with and without hearing loss according to questionnaire subscales.
Individuals with tinnitus and hearing impairment have higher high-frequency thresholds, with complete hearing loss at some frequencies, as compared to those without hearing loss. The handicap caused by tinnitus is moderate among individuals with hearing impairment and in older individuals with normal hearing, whereas this handicap is mild among younger individuals with normal hearing. The THI Questionnaire: Psychometric Data for Reliability and Validity of the Italian Version. Shulman [1] defined tinnitus as "the aberrant perception of sound reported by a patient that is unrelated to an external source of stimulation," whereas Jastreboff [2] mainly referred to the most recent neurophysiological acquisitions regarding the auditory function and described tinnitus as "the perception of sound that results exclusively from activity within the nervous system without any corresponding mechanical, vibratory activity within the cochlea and not related to external stimulation of any kind" [3]. Among the various pathologies that may cause or accompany tinnitus are otitis media, otosclerosis, Meniere's disease, presbycusis, exposure to noise and ototoxic drugs, sudden deafness, head trauma, acoustic neuroma, meningitis, and temporomandibular joint disorders [6-10]. Tinnitus is a very frequent symptom among the population and, indeed, some epidemiological studies report that temporary tinnitus can be commonly perceived by individuals of any age [22,23].
It can manifest suddenly or gradually, and sufferers describe it in a broad variety of qualitative features, from hissing to tinkling, from buzzing to steaming, or as a pool of undefined sound components, all descriptions that, unfortunately, do not provide the clinician with helpful indications for therapy or pathogenesis.
As a matter of fact, no currently available methods are able to ascertain the presence of tinnitus or its severity in audiological terms: hence the necessity of alternative assessment instruments ranging beyond the audiology area and focusing instead on the impact of tinnitus on affected subjects' activities of daily living [25]. To account for the differences between tinnitus sufferers and nonsufferers, many authors considered the cognitive factor, thus identifying cognitive reactions to tinnitus as crucial to the development of habituation [33-35].
Some of these were formulated by audiologists, some others by psychologists and multidisciplinary teams. Such a change of focus is researchers' answer to the growing evidence that tinnitus responds more readily to a global and multidisciplinary approach than to medical treatments. Such specialists make a clinical evaluation of the auditory apparatus to exclude or detect the presence of pathological situations causing tinnitus. It should provide indications for a multidisciplinary therapeutic approach and also serve for the assessment of therapeutic outcomes.
Such validation was later provided by a Danish working group [47] and by Baguley and Andersson [52], who defined it as a distress-specific monofactorial scale.
The THI was employed to evaluate the efficacy of baclofen, melatonin, and glycopyrrolate in the treatment of Meniere's disease and of Ginkgo biloba, botulinum toxin type A, gabapentin, and melatonin on tinnitus and, in the case of melatonin, on sleep [57-63]. The Centre is located at the University of Rome Sapienza, Department of Otorhinolaryngology, Audiology, and Phoniatrics, G. This indicates the extent to which stress is a fundamental element in determining the degree of distress, independent of severity of tinnitus. National Research Council Working Group 89 Committee on Hearing, Bioacoustics, and Biomechanics.
Iron deficiency during pregnancy is one of the leading causes of anemia in infants and young children. Typical features of iron deficiency anemia are caused by lowered oxygen delivery to the tissues, and include pallor, fatigue, apathy, fainting, and breathlessness.2,9 Additional features include headaches, palpitation, hair loss, and tinnitus. Even in developed countries, such as the United Kingdom (UK), up to 50% of women during their reproductive age have poor iron residual supplies, and are at risk of developing anemia if they conceive.9 Another UK study11 found that 40% of women aged between 19-34 years had iron levels below the recommended doses. Throughout pregnancy, iron deficiency anemia adversely affects the maternal and fetal well-being, and is linked to increased morbidity and fetal death. Routine maternal iron supplementation is a vital mean in correcting the global problem of iron deficiency and preventing its negative effects.31 Whilst oral supplementation is most prevalent, it is also possible to provide iron parentally (intramuscular or intravenous). Prevalence of iron-deficiency anaemia among university students in Noakhali region, Bangladesh. Prevalence and risk factors for iron deficiency anemia in the Korean population: Results of the Fifth Korea National Health and Nutrition Examination Survey. Iron deficiency anemia among kindergarten children living in the marginalized areas of Gaza Strip, Palestine.
Dietary determinants of and possible solutions to iron deficiency for young women living in industrialized countries: a review.

Maternal iron - infection interactions and neonatal mortality, with an emphasis on developing countries. Anemia among pregnant women in Southeast Ethiopia: prevalence, severity and associated risk factors. Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron.
Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: A review of the evidence. Iron and copper interactions in development and the effect on pregnancy outcome, metal-binding proteins and trace element metabolism. Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy.
The effects of oral iron supplementation on cognition in older children and adults: A systematic review and meta-analysis. Brain iron and behavior of rats are not normalized by treatment of iron deficiency anemia during early development. Higher prevalence of iron deficiency as strong predictor of attention deficit hyperactivity disorder in children.
Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia.
Associations of maternal and neonatal serum trace element concentrations with neonatal birth weight. Effect of iron supplementation on mental and motor development in children: Systematic review of randomised controlled trials. Effect of iron supplementation on physical growth in children: Systematic review of randomised controlled trials. Effects of daily iron supplementation in primary-school-aged children: systematic review and meta-analysis of randomized controlled trials. Institute of Medicine (US) Committee on the Prevention, Detection, and Management of Iron Deficiency Anemia Among U.S. Authors have no conflict of interests, and the work was not supported or funded by any drug company. All participants underwent loudness-pitch match and highfrequency audiometry and responded to the Tinnitus Handicap Inventory (THI) and World Health Organization Quality of Life (WHOQOL) questionnaires. Comparing the HI and NL groups showed statistically significant differences up to 16,000 Hz, with the NL group requiring less intensity to perceive the frequencies than those in the HI group (see Fig. We found statistically significant differences between those with and without hearing loss on the physical and psychological subscales, which corroborates a previous study that compared individuals with noiseinduced hearing loss to those with normal hearing [18]. Among individuals with normal hearing, age affects the thresholds of highfrequency audiometry.
Individuals with hearing loss have a poorer quality of life than individuals without hearing loss, especially in the physical and psychological domains.
Adaptacao para lingua portuguesa do questionario Tinnitus Handicap Inventory: Validade e reprodutibilidade.
Desenvolvimento da versao em Portugues do instrumento de avaliacao de qualidade de vida da OMS (WHOQOL-100). Aplicacao da versao em Portugues do instrumento abreviado de avaliacao de qualidade de vida WHOQOL-bref.
Acufenometria: O resgate de um instrumento de avaliacao do zumbido e sua correlacao com perdas sensorias.
Emissoes otoacusticas e audiometria de altas frequencias: Eestudo em pacientes com zumbido sem perda auditiva [tese].
Alteracoes auditivas relacionadas ao zumbido nos disturbios otologicos e da articulacao temporo-mandibular. All subjects reported as their main problem a tinnitus that had persisted for at least 6 months. In our view, the most exhaustive definition, including the numerous aspects of this symptom, is McFadden's: "Tinnitus is the conscious experience of a sound that originates in the head or neck, and without voluntary origin obvious to that person" [3]. Recent hypotheses refer to sensorineural hearing loss of autoimmune and neuroendocrine origin and metabolic disease. The reported prevalence of continuous tinnitus is 6-30%, of which only a portion (0.5-2%) of the population turns out to be significantly affected. Even from a quantitative viewpoint, descriptions given by tinnitus sufferers do not provide useful clinical correlates, as numerous factors can affect the patients, such as environmental noise and the level of attention that the subject pays to the symptom. In this regard, the observations of Tyler and Baker [25] of 72 patients-members of a tinnitus self-help group-are a starting point for the formulation of some specific tests. In addition, a psychological predisposition that was hypothesized can affect tinnitus-coping abilities. In 1990, Sweetow and Levy [40] introduced the Tinnitus Severity Scale (TSS), with 15 items and five relevant factors: symptom intrusiveness, distress, hearing loss, sleep disorders, and drug use. The widely known Tinnitus Reaction Questionnaire (TRQ), proposed by Wilson et al [45], is made up of 26 items investigating four factors: general distress, level of interference in work performance, severe distress, and avoidance strategies. As previously stated, specialists who normally see tinnitus sufferers know well that the symptom's severity is not directly related to the triggering pathology or to psychoacoustic characteristics of the symptom. Specifically, 11 items are included in the functional scale, 9 in the emotional scale, and 5 in the catastrophic scale. These authors found the reliability of the test-retest to be high and reported a high validity correlating with other distressmeasuring scales, specifically the TQ, as shown by Baguley et al.
The use of the THI in association with other instruments, such as the Tinnitus Coping Style Questionnaire, has been reported in assessing the efficacy of low-power laser on tinnitus [64]. Its validity was confirmed as an outcome-measuring instrument determining the efficacy of tinnitus retraining therapy as compared to acoustical masking [68].
The first version of the questionnaire (the alpha version) constituted 45 items, some based on interviews with patients and others adapted from both the Hearing Handicap Inventory for the Elderly and the Dizziness Handicap Inventory and others based on the symptomatic categories defined by Tyler and Baker [25]. Specifically, the THI devotes 11 items to the functional scale, 9 to the emotional scale, and 5 to the catastrophic scale. These properties provide clinicians or health operators with an instrument that completes the audiology diagnosis, thus indicating the necessity for involving other professionals who are not directly related to audiology, such as psychologists and neuropsychiatrists.
In that interesting and very useful study, the authors provide a characterization of the type of impact that tinnitus causes in connection with the subject's ratings. Development of tinnitus-related neuronal hyperactivity through homeostatitic plasticity after hearing loss: A computational model. Etanercept therapy for immune-mediated cochleovestibular disorders: A multicenter, open-label, pilot study. Sudden hearing loss as a first complication of long-standing Type 1 diabetes mellitus: A case report.
The inner hair cell synaptic complex: Physiology, pharmacology and new therapeutic strategies. Increases in spontaneous neural activity in the hamster dorsal cochlear nucleus following cisplatin treatment: A possible basis for cisplatin-induced tinnitus. Cisplatininduced hyperactivity in the dorsal nucleus and its relations to outer hair cell loss: relevance to tinnitus.
Elevated fusiform cell activity in the dorsal nucleus of chinchillas with psychophysical evidence of tinnitus.
In vivo optical imaging of toneevoked activity in the dorsal cochlear nucleus with a voltage sensitive dye. Evidence of decreased GABAergic influence on temporal integration in the inferior colliculus following acute noise exposure: A study of evoked potentials in the rats. Lateralized tinnitus studied with functional magnetic resonance imaging: Abnormal inferior colliculus activation.
The perceived severity of tinnitus: Some observations concerning a large population of tinnitus patients. Psychological characteristics of individuals high and low in their ability to cope with tinnitus. Psychological dimensions in patients with disabling tinnitus and craniomandibular disorders. Tinnitus Reaction Questionnaire: Psychometric properties of a measure of distress associated with tinnitus. Brazilian Portuguese language version of the Tinnitus Handicap Inventory: Validity and reproducibility. Validation of the German-version Tinnitus Handicap Inventory (THI) Psychiatr Prax 34(1):140-142, 2007. Ginkgo biloba does not benefit patients with tinnitus: A randomized placebocontrolled double-blind trial and meta-analysis of randomized trials. An investigation of the audiological handicap associated with unilateral sudden sensorineural hearing loss.
Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy. Many women go through the entire pregnancy without attaining the minimum required intake of iron.
Up to 52% of pregnant women in the developing world are affected.8 Lowered iron stores in their newborn baby will increase the risk of subsequent iron deficiency anemia. Chronic iron deficiency anemia lowers work tolerance, productivity, and the quality of life.
Therefore, enhanced physical activity should be combined with nutritious food that does not promote excessive weight gain, which is also a risk factor for iron deficiency. Affected mothers frequently experience breathing difficulties, fainting, tiredness, palpitations, and sleep difficulties.16 They also have an increased risk of developing perinatal infection, pre-eclampsia, and bleeding. Prophylactic oral iron supplementation can be associated with some side effects, such as nausea and constipation, which are normally more common during pregnancy. Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). On high-frequency audiometry, older individuals required 77.15% more intensity than did young individuals. The degree of discomfort, intolerance, or incapacity caused to the individual is often not related to the loudness (sensation of intensity) of the tinnitus.
When the pitch of the tinnitus was considered higher then the conventional range, high-frequency stimuli were presented.

The maximum score on the questionnaire is 100 points, with higher scores denoting a greater degree of handicap that the individuals attribute to tinnitus in their lives.
This demonstrates that the older individuals had a greater sensation of intensity than younger individuals. In previous studies, the frequency found among individuals with normal hearing was 6,000 Hz [13,14]. The HI group required double the loudness of the NL group, which is explained by the increase in tonal threshold in this group. The authors of the study cited found no significant handicap in the group with hearing loss, whereas in our study, we found moderate handicap (38-56 points) among the HI patients in both age groups, demonstrating that the coexistence of hearing impairment and tinnitus has a greater impact on the life of affected individuals (see Fig. Of the 72 patients, 93% (67) reported consequent changes in their lifestyle, 56% (40) reported effects on their general health, and 70% (50) reported emotional difficulties [26-29]. House [36] stated, in this regard, that the perception of tinnitus could be determined by specific personality characteristics, a viewpoint shared by other authors as well. The TRQ is based primarily on data provided by Tyler and Baker [25] and on that from the aforementioned TEQ, THQ, and TSS. Each item is made up of a statement that the subject can rate on a Likert scale with three alternative assessments: 0 (no), 2 (sometimes), and 4 (yes).
The THI was also the main instrument employed in the study of the effects of an acoustic prosthesis on tinnitus, which evaluated 34 patients affected by tinnitus and hyperacusis and using a hearing aid for the first time [65]. The THI beta version is the one currently being used and is the object of our work (Table 1).
Each item is made up of a statement that affected subjects can rate on a Likert scale with three gradations: 0 (no), 2 (sometimes), and 4 (yes). We also computed Pearson's product-moment correlations between the THI and the three subscales (Table 3). Each question is easily and precisely formulated and allows time for the responders to reflect on the actual impact of the symptom on their everyday life situations, unlike a standard interview.
The scale that appears to be most independent of the others is the catastrophic scale; however, the low number of items in this scale should be taken into account. In Aran JM, Dauman R (eds), Tinnitus 91-Proceedings of the Fourth International Tinnitus Seminar. In Aran JM, Dauman R (eds), Tinnitus91- Proceedings of the Fourth International Tinnitus Seminar. Jan, Professor and Consultant, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. This review aims to determine the impact of maternal iron deficiency and iron deficiency anemia on infants and young children.
Once iron stores are completely depleted, iron accessibility to the tissues decline leading to symptomatic anemia. Prematurity and early weaning off breastfeeding increases the risk further, because of reduced iron stores. A healthy varied diet can be routinely supplemented by prophylactic doses of iron to prevent depletion of iron stores.
There is an increasing need for public health strategies to educate the population as to the need for a healthy diet and iron supplementation before conception, or at least at the beginning of the pregnancy.
Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work.
On the THI questionnaire, individuals in the NL group exhibited mild handicap, whereas those in the HI group exhibited moderate handicap. In 15-20% of cases, tinnitus affects quality of life, with repercussions involving sleep habits, concentration, emotional stability, and social activities [6]. The sample was made up of 52 individuals divided into two groups (28 with normal hearing [NL group] and 24 with moderate to severe neurosensory hearing loss [HI group]. Loudness was obtained immediately after the obtainment of the pitch using a caparison method, beginning with an intensity of 10 dB above the average of 500, 1,000, and 2,000 Hz, varying in intervals of 5 dB on the basis of patients' sensation. Our study corroborates this, as older individuals had higher high-frequency thresholds, especially in the HI group.
This may be explained by both the characteristic increase in tonal threshold that accompanies hearing loss and the descending hearing impairment among the individuals selected for the study. In our study, mean tinnitus pitch for the HI group was 6,000 Hz, which is similar to results in a study carried out on individuals with acoustic trauma, whose pitch ranged from 6,000 to 8,000 Hz [15]. Furthermore, we observed a statistically significant difference between groups regarding pitch, for which higher frequencies (10,000 Hz) were achieved among the HI group.
In any case, it is necessary to have an initial basic measurement backing up the clinical audiological evaluation and indicating the degree of tinnitus impact on the sufferers' quality of life. Each of the instruments described are meant to evaluate the direct effects of tinnitus on hearing and on function in terms of disability level. The Tinnitus Handicap Inventory (THI) [46] is a questionnaire made up of 25 items divided into three subscales: functional, emotional, and catastrophic. The score of each scale is the sum of the answers to the items that constitute the scale itself. The author stated that both questionnaires are easily used and can be completed quickly -in about 5-15 minutes for the TQ and 10 minutes for the THI-and that directions for operator's use are rather simple, though the THI shows some advantages in terms of reproducibility because it is not subject to copyright. It consists of 25 items, as a result of a selection made from the previous 45, item selection being unaffected by age, gender, and hearing level. For our purposes, we considered audiological data gathered by means of half-octave tonal liminal audiometry and impedanciometry.
Subjects were told to read each question carefully and to answer by choosing one of the three possible answers-yes, no, and sometimes- without skipping any question. A Student's t-test for independent samples was used to detect differences between women and men regarding the perception of tinnitus distress (Table 4).
Our choice is supported by the results of the test-retest performed on the questionnaire, which corroborated its validity and solidity as a measuring instrument. Extensive literature review revealed that iron deficiency is a global nutritional problem affecting up to 52% of pregnant women.
The objective of this review is to outline the impact of maternal iron deficiency, and iron deficiency anemia on infants and young children.
The acidic environment aids iron absorption, which takes place in the first, and second parts of the small intestine. Any successful public prevention or treatment program should put into consideration all these contributing and correlating factors. It has been noted that iron levels in breast milk fall as lactation progresses over time.30 Careful monitoring and adequate supplementation is therefore needed for infants at risk. Integrating this information into educational curricula, pre-marital counselling, and prenatal care is needed. On the WHOQOL questionnaires, the HI group demonstrated greater impairment on the physical and psychological domains than did the NL group. The aim of our study was to compare quality of life, high-frequency audiometry, and loudness-pitch match in individuals with tinnitus with and without hearing loss, according to age group. These groups were subdivided according to age: one subgroup up to 28 years and the other older than 28 years. Statistically significant differences were found between age groups at frequencies of 10, 12, 14, and 16 kHz (see Fig.
Among the HI group, pitch was 6,000 Hz, which is a frequency encountered within the conventional range.
A number of authors believe that the THI questionnaire may be used as a measure for quantifying the impact of tinnitus on daily living [7,8]. The THI has been widely employed at an international level in clinical contexts, both to evaluate the subjective perception of handicap level and to measure the outcomes of treatments [47-51]. Perhaps this is the reason for the frequent choice of the THI by several work teams in recent years.
We had the questionnaire translated a first time by a bilingual translator; since then, the translated test has been back-translated into the original language to guarantee that the author's scope was respected for each question. Iron absorption is therefore enhanced by the co-administration of acidic compounds, such as ascorbic acid.
Mothers should receive appropriate nutritional advice and supplementation at their first point of contact with healthcare professionals. In a study involving a group with hearing conditions and temporomandibular disorders, the pitch most often encountered was high [9]. The main factor is relevant to the social and emotional spheres and to problems of sleep and rest. This scale refers to the reactions of people interacting daily with tinnitus sufferers; therefore, rather than assessing the sufferers themselves, it is an additional instrument for the evaluation of how relatives, friends, and colleagues support or interact with sufferers. The test has, indeed, been translated and validated into Danish, Spanish, Korean, Brazilian Portuguese, and German.
According to Dobie [54] as well, both the TQ and the THI are likely to become common instruments for any work team involved in the diagnosis and treatment of tinnitus [55,56]. On high-frequency audiometry, individuals with tinnitus and HI exhibited higher thresholds, with complete hearing loss at some frequencies.
The second factor refers to hearing capacity, and the third covers patients' opinions on tinnitus.
Considering the growing interest in tinnitus in Italy, our study objective was to work at the cultural adaptation of the questionnaire to the Italian language and to its validation. Unfortunately, neither of the two questionnaires takes into consideration the presence of hyperacusis as an accessory phenomenon, though the relevant literature states that some 40% of tinnitus sufferers report this symptom as well. The final score obtained is directly proportional to the impact of tinnitus on the sufferer's life. Tinnitus is perceived even in the presence of environmental sound; however, daily activities are not impaired. After absorption, protein-bound iron is transported into the bone marrow for incorporation in the production of red blood cells.4 Excess iron is stored as ferritin, a labile, and easily available provider of iron. The WHOQOL and THI questionnaires revealed that individuals with HI experienced a poorer quality of life than did those with normal hearing.

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