Auditory attention in individuals with tinnitus

IntroductionTinnitus is characterized by the presence of a sound in the absence of external sound stimulus. In individuals with normal audiometry, it may be associated with auditory attention difficulty, especially in those who report high tinnitus annoyance.ObjectiveTo investigate auditory attention ability in individuals with tinnitus complaint.MethodsCross-sectional analytical observational study. We evaluated 30 volunteers with normal hearing (up to 25 dBHL): 15 with tinnitus (test group) and 15 with no complaints (control group), aged between 18-40 years. The volunteers answered the tinnitus handicap inventory questionnaire and a visual analogue scale. Subsequently, a basic audiological evaluation (meatoscopy, tonal and vocal audiometry, and imittanciometry) and psychoacoustic measures of tinnitus (loudness and pitch) were performed. To evaluate auditory attention, the following tests were performed: auditory cognitive evoked potential (P300), central auditory processing tests (dichotic digits test and speech-in-noise test) and sustained auditory attention ability test.ResultsIn the tinnitus handicap inventory, individuals with tinnitus had a mean score of 37.78 (±27.05), characterized as moderate degree. In the dichotic digits test (binaural separation), a difference was observed between the groups in both ears. Moreover, there was a difference in the speech-in-noise test in both ears (RE: p = 0.044; LE: p = 0.019), in P300 (p = 0.049) and in total sustained auditory attention ability test (p = 0.032). Also, there is a negative correlation between sustained auditory attention ability test, decrease in attentiveness and binaural integration (RE: p = 0.044; LE: p = 0.048).ConclusionsIndividuals with tinnitus had a poorer performance compared to the control group regarding auditory attention ability. Therefore, it is inferred that tinnitus is associated with poor performance in selective and sustained auditory attention in the assessed volunteers. These aspects should be considered for the management of patients with tinnitus.     

Familial misophonia or selective sound sensitivity syndrome : evidence for autosomal dominant inheritance?

Introduction

Misophonia is a recently described, poorly understood and neglected condition. It is characterized by strong negative reactions of hatred, anger or fear when subjects have to face some selective and low level repetitive sounds. The most common ones that trigger such aversive reactions are those elicited by the mouth (chewing gum or food, popping lips) or the nose (breathing, sniffing, and blowing) or by the fingers (typing, kneading paper, clicking pen, drumming on the table). Previous articles have cited that such individuals usually know at least one close relative with similar symptoms, suggesting a possible hereditary component.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group

Introduction

Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life.

DPOAE in estimation of the function of the cochlea in tinnitus patients with normal hearing

Objective

The most probable place generating tinnitus in the auditory pathway is the outer hair cells (OHCs) inside the cochlea. Otoacoustic emissions are used to assess their activity. The objective of the investigation was to measure the features of distortion product otoacoustic emissions (DPOAE) in a group of tinnitus patients without hearing loss, estimate the diagnostic value of the parameters for the analysis of cochlear function in the patients, emphasizing those most useful in localizing tinnitus generators, and determine the hypothetical influence of hyperacusis and misophony on DPOAE parameters in tinnitus patients.

Patients and methods

The material consisted of 44 patients with tinnitus and without hearing loss. In the control group were 33 patients without tinnitus with the same state of hearing. The tinnitus patients were divided into three subgroups: those with hyperacusis, those with misophonia, and those with neither. After collecting medical history and performing clinical examination of all the patients, tonal and impedance audiometry, ABR, and discomfort level were evaluated. Then DPOAE were measured using three procedures. First the amplitudes of two points per octave were assessed, second the “fine structure” method with 16–20 points per octave (f2/f1 = 1.22, L1 = L2 = 70 dB), and the third procedure included recording the growth function in three series for input tones of f2 = 2002, 4004, and 6006 Hz (f2/f1 = 1.22) and L1 = L2 levels increasing by increments of 5 dB in each series.

Results and conclusions

Hyperacusis was found in 63% and misophonia in 10% of the tinnitus patients with no hearing loss. DPOAE amplitudes in recordings with two points per octave and the fine structure method are very valuable parameters for estimating cochlear function in tinnitus patients with normal hearing. Function growth rate cannot be the only parameter in measuring DPOAE in tinnitus patients, including subjects with hyperacusis and misophonia. The markedly higher DPOAE amplitudes in the group of tinnitus patients without hearing loss suggest that tinnitus may be caused by increased motility of the OHCs induced by decreasing efferent fiber activity, and not by OHC failure. Hyperacusis significantly increases the amplitude of DPOAE in tinnitus patients with no hearing loss.     

Tinnitus evaluation: relationship between pitch matching and loudness,visual analog scale and tinnitus handicap inventory

IntroductionTinnitus is a subjective auditory symptom usually associated with a sound, even in the absence of external sound sources. Its diagnosis is complex, and some of the forms of measurement alone or in combination, include self-assessment questionnaires, such as the tinnitus handicap inventory, the visual analog scale and/or pitch and loudness matching.ObjectiveTo analyze the correlation among three tinnitus measurement methods: tinnitus handicap inventory, visual analog scale and pitch and loudness matching.MethodsThe study consisted of 148 patients complaining of chronic tinnitus. An otorhinolaryngological evaluation, anamnesis directed to tinnitus, audiometry (pure tone and speech), imitanciometry, tinnitus handicap inventory, visual analog scale, and pitch and loudness matching were performed. The study was registered in the Ethics Committee of the Institution with no. 0129/12.ResultsRegarding the frequency of tinnitus handicap inventory responses, a higher occurrence of the mild degree was observed. An average of 6 points was observed on the visual analog scale. The mean loudness matching in the right ear was 20 dBNS, and in the left ear was 17 dBNS. As for the type of stimulus, the most found was continuous pure tone. The frequency of the pitch sensation was 6000 Hz in the largest number of cases. Regarding the measures of tinnitus handicap inventory and the visual analogical scale, a significant correlation was observed, and as one value increases the other also increases. Pitch and loudness matching and the visual analogical scale results are also significant.ConclusionThere was a significant correlation between the values measured by the tinnitus handicap inventory, visual analogical scale (annoyance) and loudness matching in the evaluation of tinnitus. The selection of any one of the three evaluative methods for tinnitus investigation provides different dimensions of the tinnitus and complements the others.     

Benchmarks for the Dichotic Sentence Identification test in Brazilian Portuguese for ear and age

IntroductionDichotic listening tests should be used in local languages and adapted for the population.ObjectiveStandardize the Brazilian Portuguese version of the Dichotic Sentence Identification test in normal listeners, comparing the performance for age and ear.MethodsThis prospective study included 200 normal listeners divided into four groups according to age: 13–19 years (GI), 20–29 years (GII), 30–39 years (GIII), and 40–49 years (GIV). The Dichotic Sentence Identification was applied in four stages: training, binaural integration and directed sound from right and left.ResultsBetter results for the right ear were observed in the stages of binaural integration in all assessed groups. There was a negative correlation between age and percentage of correct responses in both ears for free report and training. The worst performance in all stages of the test was observed for the age group 40–49 years old.ConclusionsReference values for the Brazilian Portuguese version of the Dichotic Sentence Identification test in normal listeners aged 13–49 years were established according to age, ear, and test stage; they should be used as benchmarks when evaluating individuals with these characteristics.     

The efficacy and safety of multiple sessions of multisite transcranial random noise stimulation in treating chronic tinnitus

IntroductionRandom noise stimulation was reported as the more effective and safer type of electrical stimulation techniques in relieving tinnitus symptoms. The multisite protocol of transcranial random noise stimulation has shown additional favorable effects.ObjectiveHere we will discuss the role of applying eight sessions of multisite transcranial random noise stimulation in decreasing tinnitus loudness and annoyance without exerting additional adverse effects.MethodsTwenty-nine subjects (8 female), the mean age of (45.34 ± 9.57) with chronic tinnitus received transcranial random noise stimulation in the multisite protocol, 10 min of auditory-transcranial random noise stimulation applied over the T3, T4 preceded by 10 min of prefrontal-transcranial random noise stimulation applied over F4, FP1. In the first group, only one session was applied and the multiple-sessions group contained eight repeated sessions. Visual analog scale scores for loudness and distress were recorded before and immediately after the treatment. Multivariate repeated measure ANOVA test was used and minimal detectable change calculated.ResultsThere was a statistically and clinically significant reduction in tinnitus loudness and annoyance in both groups (p < 0.05, effect size (η²) > 0.8), while the amount of annoyance suppression in the multiple-sessions group was significantly greater than the single-session group. The patients of the multiple-sessions transcranial random noise stimulation group reported an improvement in their sleep and lower tinnitus handicap inventory scores without experiencing any additional adverse effects of the intervention.ConclusionsThe results of this study showed a substantial improvement in tinnitus symptoms by using the multiple sessions of transcranial random noise stimulation in the multisite protocol without producing any additional side effects. We suggest further clinical trials with long-term follow-up be investigated.     

Effects of distractors on upright balance performance in school-aged children with attention deficit hyperactivity disorder,preliminary study

Introduction

Attention deficit hyperactivity disorder is a common impairing neuropsychiatric disorder with onset in early childhood. Almost half of the children with attention deficit hyperactivity disorder also experience a variety of motor-related dysfunctions ranging from fine/gross motor control problems to difficulties in maintaining balance.

Burnt sugarcane harvesting is associated with rhinitis symptoms and inflammatory markers

IntroductionBurnt sugarcane harvesting requires intense physical exertion in an environment of high temperature and exposure to particulate matter.ObjectiveTo evaluate the effects of burnt sugarcane harvesting on rhinitis symptoms and inflammatory markers in sugarcane workers.MethodsA total of 32 male sugarcane workers were evaluated with questionnaire for rhinitis symptoms, and for inflammatory markers on peripheral blood and nasal lavage, in the non-harvesting, and 3 and 6 months into the sugarcane harvesting period. Weather data and particulate matter fine concentrations were measured in the same day.ResultsThe particulate matter concentrations in sugarcane harvesting were 27 (23–33 μg/m³), 112 (96–122 μg/m³), and 63 (17–263 μg/m³); 24 h temperatures were 32.6 (25.4–37.4 °C), 32.3 (26.7–36.7 °C) and 29.7 (24.1–34.0 °C) and relative humidities were 45.4 (35.0–59.7%), 47.9 (39.1–63.0%), and 59.9 (34.7–63.2%) in the non-harvesting period, three and 6 months of the harvesting period. The age was 37.4 ± 10.9 years. The prevalence of rhinitis symptoms was significantly higher at 3 months of the harvesting period (53.4%), compared to non-harvesting period (26.7%; p = 0.039) and at 6 months into the harvesting period (20%; p = 0.006). Concentrations of interleukin 6 (IL-6) in nasal lavage increased after 3 months of the harvesting period compared to the non-harvesting period (p = 0.012). The presence of rhinitis symptoms, after 3 months of the harvesting period, was directly associated with blood eosinophils and inversely associated with neutrophils.ConclusionsAfter 3 months of work in burnt sugarcane harvesting the prevalence of rhinitis symptoms and IL-6 in nasal lavage increased. Furthermore, eosinophil counts were directly associated with the rhinitis symptoms in the period of higher concentration of particulate matter.     

A new classification for septal perforation and effects of treatment methods on quality of life

IntroductionSeptal perforation is a condition characterized by loss of cartilage and/or bony structures along with the mucoperichondrium and mucoperiosteum lining them. The etiology includes a history of nasal surgery or trauma, nose picking, bilateral septal cauterization, overuse of nasal sprays, cocaine abuse, vasculitis, and malignancies.ObjectiveComparison of quality of life in patients with septal perforation after conservative or surgical treatment, and a new approach for the determination of the diameter of the perforation from a different point of view.MethodsThe diameter of septal perforation, total vertical diameter of septum, and horizontal diameter of the perforation were measured in a total of 34 patients. Nineteen of the patients underwent surgical septal perforation repair, and 15 of them received septal button application. The patients were asked to complete the Glasgow Benefit Inventory quality of life questionnaire.ResultsThe septal perforation successfully healed in 18 of 19 patients who underwent surgical treatment. The quality of life scores were statistically significantly higher in the surgical treatment group when compared to the button group (p < 0.05).ConclusionThe septal perforation classification we propose would be beneficial for providing realistic dimensions, treatment methods, and surgical techniques.     

Cochlear implantation in autistic children with profound sensorineural hearing loss

Introduction

Cochlear implants have become the method of choice for the treatment of severe-to-profound hearing loss in both children and adults. Its benefits are well documented in the pediatric and adult population. Also deaf children with additional needs, including autism, have been covered by this treatment.

Sequential bilateral cochlear implant: results in children and adolescents

IntroductionThe use of the bilateral cochlear implants can promote the symmetrical development of the central auditory pathways, thus benefiting the development of auditory abilities and improving sound localization and the ability of auditory speech perception in situations of competitive noise.ObjectiveTo evaluate the ability of speech perception in children and adolescents using sequential bilateral cochlear implants, considering the association of these variables: age at surgery, time of device use and interval between surgeries.MethodsA total of 14 individuals between 10 and 16 years of age, who demonstrated surgical indication for the use of sequential bilateral cochlear implants as intervention in the auditory habilitation process, were assessed. The speech perception ability was assessed through sentence lists constructed in the Portuguese language, presented in two situations: in silence, with fixed intensity of 60 dB SPL, and in competitive noise, with a signal-to-noise ratio of +15 dB. The evaluation was performed under the following conditions: unilateral with the first activated cochlear implant, unilateral with the second activated cochlear implant and bilateral with both devices activated.ResultsThe results of the speech perception tests showed better performance in both silence and in noise for the bilateral cochlear implant condition when compared to the 1st cochlear implant and the 2nd cochlear implant alone. A worse result of speech perception was found using the 2nd cochlear implant alone. No statistically significant correlation was found between age at the surgical procedure, interval between surgeries and the time of use of the 2nd cochlear implant, and the auditory speech perception performance for all assessed conditions. The use of a hearing aid prior to the 2nd cochlear implant resulted in benefits for auditory speech perception with the 2nd cochlear implant, both in silence and in noise.ConclusionThe bilateral cochlear implant provided better speech perception in silence and in noise situations when compared to the unilateral cochlear implant, regardless of the interval between surgeries, age at the surgical procedure and the time of use of the 2nd cochlear implant. Speech perception with the 1st cochlear implant was significantly better than with the 2nd cochlear implant, both in silence and in noise. The use of the hearing aid prior to the 2nd cochlear implant influenced speech perception performance with the 2nd cochlear implant, both in silence and in noise.     

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal

IntroductionAfter post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections.ObjectiveThe aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections.MethodsThe study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination.ResultsThe group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients’ assessment (p < 0.001) and by nasal endoscopic examination (p = 0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required.ConclusionThe use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.     

Evaluation of lung function in patients submitted to total laryngectomy

IntroductionThe post-laryngectomy state is characterized by several alterations in lung function. A reliable estimation of lung function can be very useful in laryngectomees to prevent postoperative complications and to evaluate the results of the treatment.ObjectiveCharacterize the presence of respiratory functional disorders and the functional pattern of laryngectomees through the use of an extratracheal device.MethodsThis transversal study included 50 patients submitted to total laryngectomy at least 6 months prior to this investigation, as the treatment of choice for laryngeal cancer.Results56% percent of the participants had altered breathing pattern, distributed as follows: 14 with obstructive pattern with no air trapping, 11 with obstructive pattern with air trapping and only 3 with restrictive pattern. On average, the diffusion decreased (74.3%) and airway resistance increased (121.7%) when compared to the expected average values for the Brazilian individuals.ConclusionMost patients submitted to total laryngectomy present altered lung function, usually the obstructive type, frequently associated to a history of smoking.     

Relative contributions of auditory and cognitive functions on speech recognition in quiet and in noise among older adults

IntroductionHearing acuity, central auditory processing and cognition contribute to the speech recognition difficulty experienced by older adults. Therefore, quantifying the contribution of these factors on speech recognition problem is important in order to formulate a holistic and effective rehabilitation.ObjectiveTo examine the relative contributions of auditory functioning and cognition status to speech recognition in quiet and in noise.MethodsWe measured speech recognition in quiet and in composite noise using the Malay Hearing in noise test on 72 native Malay speakers (60–82 years) older adults with normal to mild hearing loss. Auditory function included pure tone audiogram, gaps-in-noise, and dichotic digit tests. Cognitive function was assessed using the Malay Montreal cognitive assessment.ResultsLinear regression analyses using backward elimination technique revealed that had the better ear four frequency average (0.5–4 kHz) (4FA), high frequency average and Malay Montreal cognitive assessment attributed to speech perception in quiet (total r² = 0.499). On the other hand, high frequency average, Malay Montreal cognitive assessment and dichotic digit tests contributed significantly to speech recognition in noise (total r² = 0.307). Whereas the better ear high frequency average primarily measured the speech recognition in quiet, the speech recognition in noise was mainly measured by cognitive function.ConclusionsThese findings highlight the fact that besides hearing sensitivity, cognition plays an important role in speech recognition ability among older adults, especially in noisy environments. Therefore, in addition to hearing aids, rehabilitation, which trains cognition, may have a role in improving speech recognition in noise ability of older adults.     

Psychoacoustic classification of persistent tinnitus

Introduction

Tinnitus is a difficult to treat symptom, with different responses in patients. It is classified in different ways, according to its origin and associated diseases.

Preservation of residual hearing after cochlear implant surgery: an exploration of residual hearing function in a group of recipients at cochlear implant units

IntroductionThe preservation of residual hearing is becoming increasingly important in cochlear implant surgery. Conserving residual hearing is a positive prognostic indicator for improved hearing abilities.ObjectiveThe primary aim of the study was to explore the preservation of residual hearing following cochlear implantation in a group of recipients at two major cochlear implant centers.MethodsA quantitative paradigm was adopted and exploratory research conducted within a retrospective data review design. The sample consisted of 50 surgical records and 53 audiological records from 60 observations (53 patients, seven of whom were implanted bilaterally). The records were selected using purposive sampling and consisted of records from participants ranging from six to 59 years of age. The average time of when the postoperative audiograms were performed in the current study was 24.7 months (s.d. = ±9.0). Data were analyzed through both qualitative and inferential statistics and a comparative analysis of unaided pre- and postoperative audiological test results was conducted.ResultsResults indicated a high success rate of 92% preservation of residual hearing with half of the sample exhibiting complete preservation in cochlear implant recipients across all frequencies postoperatively. A total postoperative hearing loss was found in only 8% of cochlear implantees across all frequencies. There was no relationship between preoperative hearing thresholds and preservation of hearing postoperatively. The two main surgical techniques used in the current study were the contour on stylet and the advance off-stylet techniques, with the majority of surgeons utilizing a cochleostomy approach. From the findings, it became apparent that the majority of cases did not have any reported intraoperative complications. This is a positive prognostic indicator for the preservation of residual hearing.ConclusionFindings suggest improved cochlear implant surgical outcomes when compared to previous studies implying progress in surgical techniques. The surgical skill and experience of the surgeon are evidenced by the minimal intraoperative complications and the high success rate of hearing preservation. This is a positive prognostic indicator for individuals with preoperative residual hearing as the preserved residual hearing allows for the potential of electro-acoustic stimulation, which in turn has its own hearing benefits.     

Prognostic role of resection margin in open oncologic laryngeal surgery: survival analysis of a cohort of 139 patients affected by squamous cell carcinoma

IntroductionThe treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin.ObjectiveTo evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis.MethodsBetween 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44 ± 28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors.Results45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to pN (HR = 5.043; p = 0.015) and recurrence (HR = 11.586; p = 0.012). Resection margin did not result an independent predictor (HR = 0.757; p = 0.653).ConclusionsOur study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices.     

Central auditory processing in teenagers with non-cholesteatomatous chronic otitis media

IntroductionEvidences of possible effects of early age otitis media with effusion in the central auditory processing, emphasize the need to consider such effects also in subjects with chronic otitis media.AimTo investigate and analyze the impact of non-cholesteatomatous chronic otitis media on central auditory processing in teenagers.MethodsThis is a study in which 68 teenagers were recruited, 34 with a diagnosis of non-cholesteatomatous chronic otitis media (study group) and 34 without otological disease history (control group). The evaluation of the subjects consisted of: anamnesis, pure-tone threshold audiometry, speech audiometry and a behavioral test battery for assessment of central auditory processing.ResultsA statistically significant difference was found between the means observed in the study and control groups in all tests performed. An association was found between the control group and subgroups of the study group with unilateral alterations in all tests. An association was shown between the results for the control group and study group for family income, with a greater impact on subjects with a lower income.ConclusionsNon-cholesteatomatous chronic otitis media affects the central auditory processing in teenagers suffering from the disorder, and monaural low-redundancy hearing is the most affected auditory mechanism. Unilateral conductive changes cause more damage than bilateral ones, and lower family income seems to lead to more changes to the central auditory processing of subjects with non-cholesteatomatous chronic otitis media.