Marine Raquel Diniz da Rosa

Reabilitação vestibular no tratamento da tontura e do zumbido

PURPOSE: To verify the effectiveness of vestibular rehabilitation exercises in the improvement of tinnitus and dizziness through an evaluation carried out before and after the administration of the Dizziness Handicap Inventory (DHI) and the Tinnitus Handicap Inventory (DHI) questionnaires, both adapted to the Brazilian population. METHODS: Six patients (two male and four female), with ages ranging from 43 to 70 years, were evaluated. The patients were submitted to the following procedures: anamnesis, otoscopy, vestibular evaluation through vectoelectronystagmography, and administration of the questionnaires, before and after vestibular rehabilitation, using the Cawthorne and Cooksey protocol. RESULTS: a) regarding the most related complaints, imbalance when walking (83,3%), headache (66,6%) and depression (66,6%), were observed; b) in the vestibular exam all the patients showed alterations in the caloric test, and the most frequent syndrome was the irritative peripheral vestibular (83,3%); c) two cases of irritative peripheral vestibular syndrome, two cases of irritative peripheral unilateral vestibular syndrome, one case of irritative peripheral bilateral vestibular syndrome and one case of peripheral deficient unilateral vestibular syndrome were verified in the vestibular exam; d) in the administration of the DHI, an improvement in the functional and emotional aspects were observed, with the physical aspect remaining unchanged; e) in the administration of the THI, an improvement was observed in all the aspects evaluated. CONCLUSION: The protocol of vestibular rehabilitation used in the study, promoted a decrease in tinnitus and dizziness, hence improving the quality of life of the patients.

Reabilitação vestibular em idosos com Parkinson

ABSTRACTPurpose: to check the effectiveness of vestibular rehabilitation exercises (RV) by means of an evaluationof a pre and post application of the Dizziness Handicap Inventory (DHI) questionnaire (Brazilian version). Methods: eight patients were evaluated (three female and five male), in the age group varying from 48to 71, referred from the Parana Association of Parkinson to the Otoneurological Laboratory of TuiutiUniversity of Parana. The patients were divided in two groups and submitted to the following procedures:anamnesis, otorhinolaryngological evaluation, vestibular evaluation through vectoelectronystagmography(VENG) and an application of DHI questionnaire (Brazilian version) before and after RV, using Cawthorneand Cooksey (group A) and Herdman (group B) protocols. Results : a) regarding the otoneurologicalcomplaints referred to in the anamnesis, the prevalence of dizziness (100.0%), trembling (100.0%) anddeviation during walking (75.0%) were observed; b) In the vestibular exam, all patients (100.0%) presentedalterations, with the largest incidence being the deficient peripheral vestibular syndromes (62.5%); c)There was significant improvement of the functional (p = 0,020470) and emotional (p = 0,013631)aspects after accomplishing the RV exercises using the Cawthorne and Cooksey protocol and of theemotional aspect (p=0,007316) using Herdman protocol.

A relação entre o envelhecimento e a habilidade de escuta dicótica em indivíduos com mais de 50 anos

OBJECTIVE: To study the dichotic listening ability of a group of individuals over 50 years old and to verify the relationship between auditory processing, aging and hearing loss. METHOD: 40 individuals aged from 50 to 83 years were evaluated, subdivided into group A (normal listeners), group B (individuals with normal audition for their age) and group C (individuals with hearing loss). The following procedures were performed: anamnesis, otological inspection, audiological exams and evaluation of auditory processing by the administration of the dichotic tests of alternate disyllables and digits. RESULTS: A disorder of auditory processing was verified in all the groups evaluated; the degree of alteration was more important in group C; in all groups the most affected auditory ability was selective attention. CONCLUSION: It was observed that the aging progress is a susceptible factor for alterations of auditory processing, especially for dichotic listening in view of the fact that this can still receive influences from peripheral auditory losses.

Ocorrência de perda auditiva induzida pelo ruído em carpinteiros

PURPOSE: to investigate the occurrence of noise induced hearing loss in carpenters, characterizing the hearing loss for age group, time of total exposure to noise and regular use of hearing protectors during the total exposure time. METHOD: retrospective and descriptive study in a population of 80 construction carpenters, attended at a private clinic. 60 workers were analyzed, as data on medical history and record of audiometric testing. RESULTS: 49% of the workers shoed normal hearing, being 58% with normal bilaterally hearing thresholds and 35% with audiometric notch in 3 kHz, 4 kHz and/or 6 kHz. 44% showed suggestive audiometric profile of NIHL, of these 74% were classified as bilateral NIHL and 19% as unilateral NIHL. There were significant differences between the NIHL group and normal to the age variables (p=0.001), as well as the total time of exposure to occupational noise (p=0,002). CONCLUSION: the greater the age and length of employment as a carpenter were, the greater their hearing loss, mainly due to exposure to loud noise during the working day, and we also noted that measures taken in order to control the use of the auricular protector are insufficient to prevent hearing loss. Therefore, we suggest active preventive measures in hearing health in this studied population, in the field of civil construction.

Zumbido e ansiedade: uma revisão da literatura

Tinnitus is a sound perceived without external stimulus, and results from the dynamic interaction of the centers in the central nervous system, including non-auditory and auditory ways. The result of this interaction, especially with the limbic system and autonomic nervous system, would be responsible for triggering negative emotional associations and distress in patients with tinnitus. Anxiety, a physiological condition inherent to human beings, when exacerbated, generates a mood disorder, affecting thinking, behavior and physiological activity. If an inner or outer stimulus is interpreted as dangerous or threatening, it may trigger an emotional reaction characterized as a state of anxiety. This work aims to review the relationship between tinnitus and anxiety. The tinnitus sound is perceived can be altered by anxiety, thereby, sharpening the sensitivity in detecting sounds that seem a potential threat, because for many people, tinnitus is synonymous with a serious illness. The etiology for the development of depression and anxiety may be related to tinnitus. Many people acquire this symptom by physical problems and hence develop depression and anxiety. Others with different degrees of distress due to tinnitus acquire emotional problems. Thus, there is a probable link between tinnitus and emotional problems, but it is not always easy to identify which one occurs first. Studies show that patients affected by tinnitus have a greater trend for suicide, depression and anxiety. They also refer to the additive cumulative effects of anxiety and depression on the quality of life of tinnitus sufferers.

Achados vestibulares em usuários de aparelho de amplificação sonora individual

PURPOSE: to check vestibular findings in patients with sensoneural hearing loss, hearing aid users. METHODS: 20 patients (eleven females and nine males) aging from 39 to 85-year-old with bilateral sensorineural hearing loss, from moderate to severe degrees, were attended in a higher education institution evaluated by medical history, otological inspections, complete basic conventional audiological evaluations, acoustic impedance tests and vectoeletronystagmography. RESULTS: a) from the 20 evaluated patients, 18 (90%) showed tinnitus complaint, 15 (75%) dizziness complaint and eight (40%) headache complaint; b) There was a prevalence of alterations in the caloric test and in the peripheral vestibular system; c) the results of the vestibular exam showed alterations in 14 patients (70%) being, eight cases (40%) of peripheral vestibular irritative syndromes and six cases (30%) of peripheral vestibular deficiency syndromes; d) we verified significant difference between the vestibular exam results and how long the patient had use the hearing aid; e) from the five patients that did not related vestibular symptoms four (80%) showed alterations in the vestibular exam. CONCLUSION: the importance and sensibility of the functional study regarding the balance system in this type of population must be emphasized because same disorders may occur in the vestibular exam in spite of symptom presence.

Variation in the Hearing Threshold in Women during the Menstrual Cycle

Introduction  The hormonal changes that occur during the menstrual cycle and their relationship with hearing problems have been studied. However, they have not been well explained. Objective  The objective of our study is to investigate the variation in hearing thresholds in women during the menstrual cycle. Method  We conducted a cohort and longitudinal study. It was composed of 30 volunteers, aged 18–39 years old, of which 20 were women during the phases of the menstrual cycle and 10 were men (control group) who underwent audiometry and impedance exams, to correlate the possible audiological changes in each phase of the menstrual cycle. Results  There were significant changes in hearing thresholds observed during the menstrual cycle phases in the group of women who used hormonal contraceptives and the group who did not use such contraceptives. Improved hearing thresholds were observed in the late follicular phase in the group who did not use hormonal contraceptives and the hearing thresholds at high frequencies were better. Throughout the menstrual cycle phases, the mean variation was 3.6 db HL between weeks in the group who used hormonal contraceptives and 4.09 db HL in the group who did not use them. Conclusions  The present study found that there may be a relationship between hearing changes and hormonal fluctuations during the menstrual cycle based on changes in the hearing thresholds of women. In addition, this study suggests that estrogen has an otoprotective effect on hearing, since the best hearing thresholds were found when estrogen was at its maximum peak.

Linguagem em idosos com doença de Alzheimer: uma revisão sistemática

With increasing life expectancy, dementias have been affecting the population, and Alzheimers disease is the most common. This disease is defined by a gradual disappearance of memory and other cognitive functions, including language. Human language is important to establish interpersonal connections and to promote an individual social inclusion. This article aimed to perform a systematic review regarding scientific studies on the association between Alzheimers disease and language. Articles were researched in three databases: Scielo, Lilacs and Bireme. The main bibliographic search descriptors were: Alzheimers Disease, Language and Communication. The research was conducted from October to December 2013. The final sample was formed by 07 articles, including those that characterized the language in Alzheimers Disease at different stages. Through this study results, it was possible to verify changes in language in all disease stages and the importance of early identification of such changes. This identification can provide time to the patient and their family members to program and organize their future, by seeking support services to the patient, as well as aid in the individual communication process and quality of life. These findings point to the importance of knowledge of the main changes shown by individuals with Alzheimers disease, such as language, cognitive or behavioral changes. The development of studies that address the relation between tests used to identify the main language disorders in individuals with Alzheimers disease is essential.

Avaliação da escuta dicótica em idosos com perda auditiva

OBJECTIVE: To verify the efficiency of dichotic listening in senior citizens with peripheral auditory loss. METHODS: 30 patients were evaluated, all over 60 years and suffering from neurosensory auditory loss, during the period from March to November 2007, in a private institution in the city of Curitiba, state of Parana. The following procedures were carried out: anamnesis, otorhinolaryngologic, audiologic and imitanciometric evaluations and an evaluation of auditory processing by the application of the Staggered Spondaic Word test - (SSW). RESULTS: a) 70% of the patients presented alterations in at least one of the ears in competitive left or right conditions; b) the degree of alteration was from light to severe and the right ear presented a statistically significant advantage in relation to the left; c) the tendencies of answers obtained were: type A - 70%, order effect - 36,6%, auditory effect - 13,3% and inversions 6,6%; d) there was a significant difference in the tendency for EA (auditory effect) answers, comparing the American standard to the findings of the present study. CONCLUSION: The efficiency of dichotic listening in senior citizens can be jeopardized due to peripheral auditory loss, and as such, loss of acoustic information has been observed, which reduces the probability of understanding speech. Therefore, the evaluation of dichotic listening is an important tool in the improvement of the selection and adaptation of individual sound amplification aids so that their use is more meaningful.

Tinnitus evaluation: relation among pitch matching and loudness, visual analog scale and tinnitus handicap inventory

INTRODUCTION Tinnitus 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. OBJECTIVE To analyze the correlation among three tinnitus measurement methods: tinnitus handicap inventory, visual analog scale and pitch and loudness matching. METHODS The 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. RESULTS Regarding 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 20dBNS, and in the left ear was 17dBNS. As for the type of stimulus, the most found was continuous pure tone. The frequency of the pitch sensation was 6000Hz 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. CONCLUSION There 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.