Ronaldo Campos Granjeiro

Transient and distortion product evoked oto-acoustic emissions in normal hearing patients with and without tinnitus

Objective To test the hypothesis that tinnitus begins with outer hair cell dysfunction by recording transient (TEOAE) and distortion product evoked (DPOAE) oto-acoustic emissions in patients with normal hearing with (study group, SG) and without tinnitus (control group, CG). Study Design Case control study. Subjects and Methods SG had 32 patients with pure tone thresholds below 25 dB in the 500 to 8000 Hz interval. CG had 37 age- and gender-matched patients with similar thresholds. All patients had normal tympanograms and stapedial reflexes. TEOAE were recorded with wide band click in continuous mode at 80-dB peak SPL. DPOAE were recorded with f1/f2 = 1.22 and intensities of 65 dB (f1) and 55 dB (f2) SPL. Results DPOAE were abnormal in 68.4% of SG and in 50% of CG (P = 0.036). TEOAE were abnormal in 70.2% of SG and in 16.10% of CG (P = 0.0001). Conclusion SG had significantly higher prevalence of abnormal TEOAE and DPOAE than CG.

Comparison of auditory brainstem response results in normal-hearing patients with and without tinnitus.

OBJECTIVE To evaluate electrophysiologically the auditory nerve and the auditory brainstem function of patients with tinnitus and normal-hearing thresholds using the auditory brainstem response (ABR). DESIGN Case-control study. SETTING Ambulatory section of the Department of Otolaryngology, Hospital de Base de Brasília. PATIENTS Thirty-seven individuals with tinnitus and 38 without tinnitus, with ages ranging from 20 to 45 years and pure-tone thresholds of 25 dB or better at frequencies between 500 and 8000 Hz. MAIN OUTCOME MEASURES We compared the latencies of waves I, III, and V; the interpeak intervals I-III, III-V, and I-V; the interaural latency difference (wave V); and the V/I amplitude ratio between the 2 groups. RESULTS Among the 37 patients in the study group, abnormal results were found in 16 (43%) in at least 1 of the 8 parameters evaluated. When we analyzed the latencies, although the values were on average in the normal range used in the present study, the tinnitus group presented a significant prolongation of the latencies of waves I, III, and V when compared with the control group. Furthermore, we found the interpeak I-III, III-V, and I-V values to be within the normal limits, but the interpeak III-V value was significantly (P = .003) enlarged in the study group compared with the control group. The V/I amplitude ratio found in the tinnitus group was within normal limits; however, a significant (P = .004) difference was found when the 2 groups were compared. The averages of the interaural latency difference (wave V) did not show significant differences in relation to the control group. CONCLUSIONS We conclude that, although the averages obtained in several analyzed parameters were within normal limits, the ABR results from the patients with and without tinnitus and normal hearing are different, suggesting that ABR might contribute to the workup of these patients. Our data show that there are changes in the central pathways in the study group. The meaning of these changes must be further investigated.

P099: Otoacoustic Emissions in Patients with Tinnitus

those of conventional stapedotomy. METHODS: The team performed a retrospective investigation on 114 patients who underwent stapedotomy with insertion of a platinum-teflon prosthesis in their department. The question was whether cochlear protection and better sound conduction can be achieved by laser surgery in comparison with conventional technique. Surgery was done conventionally in 72 cases and with Er:YAG laser in 42 cases. Audiometric data were evaluated including preand postoperative bone and air conduction thresholds in compliance with the guidelines of the Committee on Hearing and Equilibrium. The statistical analysis was done with the Mann-Whitney-U-Test. RESULTS: In the lower and middle frequencies, laser technique resulted in a more pronounced improvement of bone conduction thresholds compared with conventional stapedotomy. This was significant at 2 and 3 kHz. The improvement of air conduction and of air-bone-gap was more distinct after laser surgery, too (significant at 0.5 kHz and 4 kHz). CONCLUSIONS: Under clinical conditions, Er:YAG laser in stapedotomy results in cochlear protection and increased improvement of air conduction compared with conventional stapedotomy. These results emphasize the relevance of the application of laser technique in stapes surgery.

Polysomnography Applied to Patients with Tinnitus: A Review

Introduction  Tinnitus has been defined as an “auditory phantom perception,” meaning that tinnitus results from an abnormal activity within the nervous system, in the absence of any internal or external acoustic stimulation. About 10 to 15% of the adult population is affected by tinnitus, and a relevant percentage of tinnitus sufferers experience symptoms severe enough to significantly affect quality of life, including sleep disturbances, work impairment, and, in some cases, psychiatric distress. The self-rated complaints about tinnitus focus on emotional distress, auditory perceptual difficulties, and sleep disturbances. Objectives  To evaluate the works that show sleep disorders in patients with tinnitus, and sleep disorders assessed by polysomnography. Data Synthesis  We found four studies with polysomnography to assess sleep disorders in patients with tinnitus. The first study evaluated 80 patients who were military personnel without major psychiatric disturbances, and their tinnitus was associated with noise-induced permanent hearing. The second study was a prospective, case-control, nonrandomized study of 18 patients affected by chronic tinnitus who were compared with a homogeneous control group consisting of 15 healthy subjects. The last work evaluated questionnaires mailed to patients before their initial appointment at the Oregon Health Sciences University Tinnitus Clinic between 1994 and 1997. These questionnaires requested information pertaining to insomnia, tinnitus severity, and loudness. Follow-up questionnaires were mailed to 350 patients 1 to 4 years (mean 5 ± 2.3 years) after their initial appointment at the clinic. Conclusion  There are few studies with polysomnography for the evaluation of patients with sleep disorders caused by tinnitus. This shows the need for more studies on this subject.

Does Tinnitus Annoyance Correlate to Auditory Brainsteam Responses

Objectives: Tinnitus is more common in patients with some degree of hearing loss, but may be present in approximately 10-20% of people with normal hearing. There is evidence of involvement of the central auditory nervous system and interrelation with various parts of the nervous system, which may be involved in the mechanism of central processing of auditory signals. We aimed to analyze the annoyance of tinnitus in patients without hearing loss and to correlate the findings with auditory brainsteam response (ABR). Methods: We selected 84 patients with tinnitus and 47 patients without tinnitus, with ages ranging from 18 to 48 years old and hearing threshold less than or equal to 25 dB at frequencies between 500 and 8000Hz. We conducted the evaluation of tinnitus annoyance with the Tinnitus Handicap Inventory (THI), and examination of ABR. Results: Among the 84 patients in the study group, we found 35.7% of abnormal tests in at least one of the seven parameters tested, however, only the difference in the interaural wave V latency in patients with unilateral tinnitus was significant difference between the study and control group. Most patients in the study group had mild or very mild tinnitus. The discomfort of tinnitus showed no correlation with the results of ABR results. Conclusions: ABR results did not play a role in tinnitus annoyance in this study. It is important to investigate the role of anxiety and depression in the discomfort of tinnitus.

Effect of hormone replacement therapy on the auditory brainstem response of postmenopausal women.

OBJECTIVE To investigate whether hormone replacement therapy modifies the auditory brainstem response in postmenopausal women. METHODS Nineteen postmenopausal women received hormone replacement therapy (study group) and 25 received no treatment nor placebo (control group). In both groups, age ranged from 45 to 60 years and pure-tone sensitivity was 25 dB or better at frequencies between 500 and 2000 Hz. Auditory brainstem response was evaluated before and after 3 months of hormone use in the study group. The control group was also evaluated at the same periods. The following auditory brainstem response parameters were compared between the two groups: latencies of waves I, III, and V; I-III, III-V, and I-V interpeak intervals. RESULTS Mean age did not differ between groups (study group: 51.5 ± 0.7 years; control: 52.9 ± 0.6 years). No significant differences in wave latencies, or interpeak intervals were observed between the two groups (p > 0.05).

Tinnitus Disturbance in Normal Hearing Patients

Objective: To evaluate the annoyance of tinnitus by means of the Tinnitus Handicap Inventory (THI) in normal hearing patients and to correlate it with outer hair cell function by means of the evoked otoacustic emission tests and with anxiety and depression disorders investigated by the Beck scale. Method: This case-control study was performed in 2 groups of normal hearing patients: study group (SG): 68 patients with tinnitus; and control group (CG): 46 patients without tinnitus. Patients were submitted to otoacoustic emissions tests, to THI evaluation, and to anxiety and depression search by Beck Scale. Results: Seventy-five ears (67.0%) in SG showed abnormal TOAE versus 18 ears (19.6%) in CG (P < .0001). Sixty-eight ears (65.2%) had abnormal DPOAE in SG versus 46 ears (50%) in the CG (P < .029). There was no correlation between THI and the results of TOAE (P = .799) and DPOAE (P > .7) tests. SG had 44.1% (N = 30) individuals with anxiety versus 17.4% (N = 8) in CG (P < .003). There was a statistical difference between the presence and absence of depression and anxiety and the THI (P < .001). The ones with these disturbances showed higher THI scores. Conclusion: There was a correlation between anxiety and depression and the annoyance of tinnitus. Tinnitus annoyance showed no association to the outer hair cells’ function in this study.

P098: ABR in Normal Hearing Patients with and without Tinnitus

those of conventional stapedotomy. METHODS: The team performed a retrospective investigation on 114 patients who underwent stapedotomy with insertion of a platinum-teflon prosthesis in their department. The question was whether cochlear protection and better sound conduction can be achieved by laser surgery in comparison with conventional technique. Surgery was done conventionally in 72 cases and with Er:YAG laser in 42 cases. Audiometric data were evaluated including preand postoperative bone and air conduction thresholds in compliance with the guidelines of the Committee on Hearing and Equilibrium. The statistical analysis was done with the Mann-Whitney-U-Test. RESULTS: In the lower and middle frequencies, laser technique resulted in a more pronounced improvement of bone conduction thresholds compared with conventional stapedotomy. This was significant at 2 and 3 kHz. The improvement of air conduction and of air-bone-gap was more distinct after laser surgery, too (significant at 0.5 kHz and 4 kHz). CONCLUSIONS: Under clinical conditions, Er:YAG laser in stapedotomy results in cochlear protection and increased improvement of air conduction compared with conventional stapedotomy. These results emphasize the relevance of the application of laser technique in stapes surgery.