Letícia Petersen Schmidt

Brazilian Portuguese Language version of the "Tinnitus Handicap Inventory": validity and reproducibility

UNLABELLED Tinnitus can greatly impact an individuals life quality and it is very difficult to quantify. AIM To determine the reproducibility and validity of a Brazilian Portuguese version of the Tinnitus Handicap Inventory (THI), a self-applicable questionnaire which assesses tinnitus impact on patients life quality. MATERIALS AND METHODS This was a prospective transversal study. The questionnaire was translated into Portuguese and cross-culturally adapted to the Brazilian environment according to internationally recommended methods. The Portuguese version of the THI was answered by 180 patients who complained of tinnitus. Reproducibility was assessed using the Cronbachs Alpha Calculation; and the validity was assessed by means of the Beck Depression Inventory (BDI), calculating the Pearson correlation coefficient. RESULTS The Portuguese version of the THI showed high internal validity, comparable to the original version. A high correlation was observed between the THI and the BDI. CONCLUSION The Brazilian Portuguese version of THI is a valid and reproducible tool used to quantify how tinnitus impacts the life quality of those Brazilian patients who complain of this symptom.

Estudo da orelha contralateral na otite média crônica: "Efeito Orloff ®"

Introducao: A otite media cronica (OMC) representa entidade de alta prevalencia e distribuicao mundial. Apesar da grande quantidade de estudos publicados a respeito, ainda nao ha, na literatura pertinente, consenso sobre a patogenese da OMC. Uma das hipoteses e a do continuum, que apresenta a otite media cronica como uma serie de eventos continuos, onde insultos iniciais desencadeiam uma cascata de alteracoes. Partindo entao da ideia de continuum, pesquisamos a orelha contralateral (OCL) de individuos com diagnostico de OMC, descrevendo as alteracoes encontradas. Forma de estudo: Clinico prospectivo randomizado. Material e Metodos: Foram selecionados 108 pacientes com diagnostico de OMC nao-colesteatomatosa (OMC NC) ou colesteatomatosa (OMC C) acompanhados no ambulatorio do Grupo de Pesquisa em Patologia da Orelha Media do Hospital de Clinicas de Porto Alegre. Nestes, foi realizada otoendoscopia com fibra optica bilateral. A orelha mais estavel foi considerada contralateral (OCL), sendo classificada como normal ou alterada (e as alteracoes descritas). Resultados: Dentre os pacientes avaliados, 59,2% portavam OMC NC e 40,8% OMC C. 46,3% de todos os pacientes apresentaram alteracoes significativas na OCL. Dos pacientes com OMC C, 57% apresentavam alteracao na OCL, sendo que 39% dos pacientes com OMC NC tinham OCL alterada. A alteracao mais frequentemente encontrada foi retracao de MT, em ambos os grupos. Conclusoes: Os dados encontrados sugerem que pacientes que apresentam OMC tem maior probabilidade de apresentarem patologia na OCL, o que corrobora a ideia que a OMC se trata de um evento constitucional e nao isolado da orelha media.

Otoacoustic Emissions in Patients with Tinnitus and Normal Hearing

Objectives: Tinnitus is defined as a sound perception in the absence of a sonorous external stimulus. This symptom is highly associated to hearing loss, although about 10% of the patients with tinnitus have a normal hearing. We studied the otoacoustic emissions (OE) in patients with complaints of tinnitus and normal hearing. Methods: We evaluated 104 patients with tinnitus. Only 10 met the inclusion criterion that was to have thresholds of 20 dB or less in each frequency at tonal audiometry; 5 were men with average age of 36.1 years. OE was performed in each patient. History of occupational noise exposition was evaluated. Results: Sixty percent had OE absent or lowered in one or more frequencies; 60% of them had a positive history of occupational noise exposition (time average of 7.58 years); and 83% of them did not use individual protection equipment. Conclusion: One of the theories that try to explain the pathogenesis of tinnitus is the imbalance between external hairy cells (EHC) and internal hairy cells (IHC). The EHC are more prone to damage and, when it occurs, they fail to perform the inhibition over the ICH function. This lost of IHC inhibition results then in tinnitus. Our results agree with this theory mainly because our patients had alterations in the EHC demonstrated by the OE.

Impact of depression in the quality of life of patients with tinnitus

Objectives: Tinnitus is a very ordinary symptom in the world, although 5% of the population have annoyance because it. Theories point that diagnosis of depression can be a causal factor or can just contribute to tinnitus annoyance. We analyzed if patients with a positive depression screening have a bigger tinnitus repercussion in their quality of life. Methods: We studied 50 patients with tinnitus complaints; 20 were men with an age average of 54.6 years. We used the Beck Inventory (BID II) with a cut point of 15 (sensibility of 0.92 and negative predictive value of 0.99 in a previous study) for depression screening. We used the Tinnitus Handicap Inventory (THI), development by Newman, to quantify the tinnitus repercussion in the patients’ quality of life. Results: Patients with a positive depression screening had an average of 63.05 in the THI and those with a negative screening, 34.06. The difference between the 2 groups was statistically significant (P < 0.001, t student test). Conclusion: Previous studies that had used others methods demonstrated an association between depression and low quality of life because tinnitus. Our results agree with them. The appropriate diagnosis and treatment of depression in patients with chronic tinnitus can minimize the complaints and the impact of the tinnitus in the patients’ quality of life.

Screening of Depression in Patients with Chronic Tinnitus

Abstract Objectives: The tinnitus is a prevalent symptom occurring in about 10% to 20% of the population, but just 5% of them attribute to tinnitus some degree of discomfort. Many hypotheses try to explain why only few patients complain about tinnitus and the majority of them habituate easily to this symptom. The depression’s diagnosis associated with the tinnitus can be one of the factors involved. The objective of this work is to screen depression in patients with chronic tinnitus. Methods: We studied 70 patients with chronic tinnitus of different etiologies; 27 were men and the average age was 55.9 years. We used the Beck Inventory (BID-II) with a cut point of 17 (sensibility of 0.83 and specificity of 0.89 in a previous study with patients with chronic disease)for depression screening. Results: 35.7% of the patients had a positive screening for depression. There were no differences when evaluated sex and age. Conclusion: Previous studies that used others methods had pointed to a higher prevalence of depression in patients with tinnitus than in the general population, estimated in 5 a 15%. Our results agree with them and demonstrate the need of depression investigation in patients with tinnitus to improve their quality of life.

Sensorineural hearing loss in patients with chronic otitis media

Abstract Objectives: Chronic otitis media is currently associated with an increase in air conduction thresholds. However, a few groups reported a decrease in sensorineural function in these patients. This study evaluates the occurrence of sensorineural hearing loss in patients with chronic otitis media. Methods: The records of patients with unilateral chronic otitis media were reviewed. Eighty-four patients met the inclusion criteria that were normal otoscopy and normal hearing in the contra lateral ear. Bone conduction threshold averages were calculated over 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz and 4000 Hz frequencies. We compared the bone conductions threshold averages between the normal ear and the ear with chronic otitis media. Thresholds were examined separately for each frequency. Results: The bone conduction threshold averages in the normal side were smaller than those of the chronic otitis media ear. The threshold shift was statistically significant in each frequency ( P t Student test) but in 500 Hz ( P = 0.16). There were no differences between the groups when we analyzed the role of age or in the role of the cholesteatoma presence in the sensorineural hearing loss. Conclusions: This study shows that chronic otitis media is associated with decrease in cochlear function. Neither the presence of cholesteatoma in the middle ear nor the patients’ age showed any influence in the sensorineural hearing loss.