Abstract Objectives: Analyze the prevalence of retractions in different areas of the Tympanic Membrane (TM), the correlations between the involvement of the Pars Tensa (PT) and Pars Flaccida (PF), and the air-bone gaps. Methods: A cross-sectional study. Patients with moderate and/or severe TM retraction of 2200 consecutive patients with chronic otitis media between August 2000 and January 2019 were included. Ears with previous surgery were excluded. Ears were classified as isolated PF and PT retractions and association of both. The degrees of severity and presence of effusion were evaluated. The data were analyzed using the SPSS Statistics software program. Results: 661 ears were included. The prevalence of isolated atical retractions was 24.9%, of isolated posterior quadrants was 10.6%, and of association of quadrants was 64%. There was no correlation between the retractions in the different areas of the TM (posterior and attic quadrants: r = 0.13; p = 0.041; anterior and posterior quadrants: r = 0.23; p = 0.013, anterior and attic quadrants: r = 0.06; p = 0.043). Effusion was present in 30.7% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05); 72% of the ears had an ABG ≤ 20dB HL. For severity of the retraction of PF, the ABG was similar across groups. For the PT, there was a global difference in the medians of ABG in terms of the degree of severity, with a moderate correlation. Conclusion: The prevalence of moderate and severe retractions was 24.5%; 64% of the ears had an association of affected regions. There was no correlation between the retraction in the different areas of the TM. We found a significant correlation between the severity of retraction and the worsening of ABG threshold, only for PT. Evidence level: 4.

Abstract Objective: To evaluate the impact of the Universal Neonatal Hearing Screening (UNHS) on the age at diagnosis, beginning of treatment, and first cochlear implant surgery. Methods: A retrospective cohort study with children up to 12 years old with bilateral hearing loss were divided into two groups: patients who underwent UNHS and the ones who didn't. The groups were compared according to their age at the beginning of the evaluation at a specialized center, at the beginning of the intervention, and, for the ones who had indication, at the cochlear implant surgery. The group who underwent UNHS was divided between the ones who passed the screening test and the ones who didn’t. They were compared according to their ages at the same moments as the first two groups. Results: 135 patients were included. The median age at the first appointment in a specialized center was 1.42 (0.50 and 2.50) years, at the beginning of treatment 2.00 (1.00 and 3.52) years, and the cochlear implant surgery 2.83 (1.83 and 4.66) years. Children who underwent UNHS were younger than those who didn't, at the three evaluated moments (p < 0.001). In a subanalysis, children who passed the UNHS but were later diagnosed with hearing loss reached the first appointment with a specialist and started treatment older than those who failed the tests. Conclusion: Performing UNHS interfered with the timing of deafness diagnosis and treatment. However, children who passed the screening but were later diagnosed with hearing loss were the category with the most important delay.

RESUMO Objetivo: verificar o gênero, a idade, a localização do zumbido, a presença ou ausência de perda auditiva e seu grau, assim como as medidas psicoacústicas (pitch, loudness, nível mínimo de mascaramento e inibição residual) de pacientes com zumbido crônico e as suas relações. Métodos: o estudo incluiu sujeitos de ambos os gêneros, com idades entre 25 e 85 anos, com queixa de zumbido crônico e que realizassem acompanhamento em ambulatório especializado do Hospital de Clínicas de Porto Alegre. Foram submetidos a anamnese, avaliação audiológica básica, pesquisa de pitch, loudness, inibição residual (IR) e nível mínimo de mascaramento (NMM). Foram utilizados os seguintes testes estatísticos: Teste Qui-Quadrado, Teste Exato de Fisher, Teste U de Wilcoxon - Mann-Whitney, Teste Kruskal Wallis e Coeficiente de Correlação de Spearman. O nível de significância utilizado foi de 5% (p≤0,05). Resultados: houve associação entre a variável tipo de zumbido e presença ou ausência de perda auditiva (PA), grau de PA, NMM e loudness, assim como, entre idade e presença ou ausência de PA e seu grau. A loudness e o NMM apresentaram fraca correlação diretamente proporcional, ao passo que as correlações entre pitch e loudness, pitch e NMM e IR versus NMM apresentaram-se fracas e inversamente proporcionais. Conclusão: houve heterogeneidade entre as características do zumbido e dos indivíduos acometidos. Conclui-se, de acordo com os resultados expostos, que existe influência de algumas variáveis entre si, da mesma maneira que ocorre entre as medidas psicoacústicas.

ABSTRACT Purpose: to verify the sex, age, tinnitus location, presence or absence of hearing loss, its degree, and the psychoacoustic measurements (pitch, loudness, minimum masking level [MML], and residual inhibition [RI]) of patients with chronic tinnitus and their relationships. Methods: the study included subjects of both sexes, aged 25 to 85 years, with complaints of chronic tinnitus, followed up at the health service where the research was conducted. They were submitted to medical history survey, basic audiological assessment, and pitch, loudness, RI, and MML research. The following statistical tests were used: chi-square test, Fisher’s exact test, Wilcoxon-Mann-Whitney U test, Kruskal-Wallis test, and Spearman’s correlation coefficient. The significance level was set at 5% (p≤0.05). Results: the type of tinnitus was associated with the presence or absence of hearing loss (HL), degree of HL, MML, and loudness; age was associated with the presence or absence of HL and its degree. There was a directly weak proportional correlation between loudness and MML, whereas the correlations between pitch and loudness, pitch and MML, and RI and MML were weak and inversely proportional. Conclusion: both the affected subjects and their tinnitus characteristics were heterogeneous. The results indicate that some variables influence one another, which also happens between psychoacoustic measurements.

Abstract Introduction Hearing loss etiology depends on the population studied as well as on the ethnicity and the socio-economic condition of the analyzed region. Etiological diagnosis contributes to the improvement of preventive measures and to the early identification of this deficiency. Objective To identify the etiological factors of hearing loss and its prevalence in a tertiary hospital in southern Brazil, to verify the frequency of mutations in GJB2 and GJB6 genes, and to correlate the degree of hearing loss with the etiological factors of deafness. Methods This prevalence study involved 140 children with bilateral sensorineural or mixed hearing loss. Medical history, physical examination, audiometry, and evoked auditory brainstem response were conducted. Imaging and genetic examinations were also performed. Results Etiologies and their prevalence were as follows: (a) indeterminate causes, 31.4%; (b) conditions related to neonatal period, 22.1%; (c) genetic, 22.1%; (d) auditory neuropathy, 10%; (e) other factors (cortical malformation, intracranial hemorrhage, and internal ear malformations), 7.9% and (f) congenital infections, 6.4%. Within the genetic cases, ten homozygous and seven heterozygotes of the 35delG mutation were identified, besides two cases of rare variants of GJB2: p.Try172* and p.Arg184Pro. One case with homozygosis of del(GJB6-D13S1830) was found. Regarding severity of hearing loss, in 78.6% of the cases the degree of hearing loss was profound and there were no significant differences when comparing between etiologies. Conclusion The number of indeterminate etiologies is still high and congenital CMV infection may be a possible cause of undiagnosed etiology for hearing loss. The predominance of etiologies related to neonatal conditions and infectious causes are characteristic of developing countries. The most prevalent mutation was 35delG, the main GJB2 gene, probably because of the European influence in the genotype of our population.

Resumo Introdução A etiologia da perda auditiva depende da população estudada, da etnia e da condição socioeconômica da região analisada. O diagnóstico etiológico contribui para o aprimoramento das medidas preventivas e para a identificação precoce dessa deficiência. Objetivos Identificar os fatores etiológicos da perda auditiva e sua prevalência em um hospital terciário do sul do Brasil, verificar a frequência de mutações nos genes GJB2 e GJB6 e correlacionar o grau da perda auditiva com os fatores etiológicos da deficiência auditiva. Método Este estudo de prevalência avaliou 140 crianças com perda auditiva neurossensorial bilateral ou mista. Foram submetidos a anamnese com histórico médico, exame físico, audiometria e potencial evocado auditivo de tronco encefálico. Exames de imagem e genéticos também foram feitos. Resultados As etiologias e sua prevalência foram as seguintes: (a) causas indeterminadas, 31,4%; (b) condições relacionadas ao período neonatal, 22,1%; (c) genética, 22,1%; (d) neuropatia auditiva, 10%; (e) outros fatores (malformação cortical, hemorragia intracraniana e malformações da orelha interna), 7,9% e (f) infecções congênitas, 6,4%. Entre os casos genéticos, foram identificados dez casos homozigotos e sete heterozigotos da mutação 35delG, além de dois casos de variantes raras do GJB2: p.Try172* e p.Arg184Pro. Foi encontrado um caso homozigoto da mutação del (GJB6‐D13S1830). Em relação à gravidade da perda auditiva, em 78,6% dos casos o grau da perda auditiva foi profundo e não houve diferenças significantes na comparação entre as etiologias. Conclusão O número de etiologias indeterminadas ainda é elevado e a infecção congênita por CMV pode ser uma possível causa de etiologia não diagnosticada para perda auditiva. A predominância das etiologias relacionadas às condições neonatais e às causas infecciosas são características de países em desenvolvimento. A mutação mais prevalente foi a 35delG e o principal gene foi o GJB2, provavelmente devido à influência europeia no genótipo de nossa população.

RESUMO Objetivo Verificar benefícios do uso de próteses auditivas na autopercepção do zumbido em adultos e idosos sem experiência prévia de amplificação. Métodos O estudo incluiu indivíduos de ambos os sexos, com queixa de zumbido, acompanhados em hospital público. Aplicaram-se os seguintes exames e instrumentos para mensurar o zumbido e determinar o seu incômodo: pesquisa do pitch e loudness, Escala Visual Analógica (EVA), pesquisa do nível mínimo de mascaramento, inibição residual e Tinnitus Handicap Inventory (THI). As avaliações foram realizadas em duas etapas: antes da adaptação das próteses auditivas e após um mês de uso dos aparelhos. Resultados Dos 20 indivíduos participantes, 60% eram idosos. Verificou-se diferença na autopercepção do zumbido pré e pós-protetização, medido pelas escalas THI e EVA. Também se observaram diferenças nas medidas psicoacústicas, com exceção do pitch, antes e após a amplificação. Além disso, houve correlação entre o tempo de zumbido e a idade com os escores finais do THI. Conclusão O uso de próteses auditivas reduziu o incômodo provocado pelo zumbido, com alteração nas medidas psicoaústicas e no impacto na qualidade de vida.

ABSTRACT Purpose To verify the benefits of using hearing aids in self-perception of tinnitus in adults and elderly without previous experience of amplification. Methods The study included individuals of both gender, with tinnitus complaint, accompanied in public hospital. The following tests and instruments were used to measure tinnitus and determine its discomfort: pitch and loudness, Visual Analogue Scale (VAS), minimum masking level, residual inhibition and Tinnitus Handicap Inventory (THI). The evaluations were performed in two stages: before the adaptation of the hearing aids and after one month of use of the devices. Results Of the 20 participants, 60% were elderly. There was a difference in self-perception of tinnitus before and after hearing aid fitting, as measured by THI and VAS. Differences in psychoacoustic measures were also observed, with the exception of pitch, before and after amplification. In addition, there was a correlation between tinnitus time and age with final THI scores. Conclusion The use of hearing aids was determined to reduce the annoyance caused by tinnitus, with changes in psycho-acoustic measures and impact on quality of life.

Resumo Introdução Zumbido e intolerância a sons são queixas frequentes e subjetivas que podem ter impacto na qualidade de vida do paciente. Objetivo Apresentar uma revisão dos principais pontos, inclusive conceitos, fisiopatologia, diagnóstico e abordagem do paciente com zumbido e sensibilidade a sons. Método Revisão da literatura com levantamento bibliográfico na base de dados da LILACS, SciELO, Pubmed e MEDLINE. Foram selecionados artigos e capítulos de livros sobre zumbido e sensibilidade a sons. Os diversos tópicos foram discutidos por um grupo de profissionais brasileiros e as conclusões, descritas. Resultado A prevalência de zumbido tem aumentado ao longo dos anos, muitas vezes associado a perda auditiva, fatores metabólicos e erros alimentares. A avaliação médica deve ser feita minuciosamente no sentido de orientar a solicitação de exames subsidiários. Os tratamentos disponíveis atualmente variam de medicamentos ao uso de sons com características específicas e técnicas de meditação, com resultados variáveis. Conclusão Foi apresentada uma revisão sobre os temas que permitindo ao leitor uma visão ampla da abordagem dos pacientes com zumbido e sensibilidade auditiva baseada em evidências científicas e experiência nacional.

Abstract Introduction Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life. Objective To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. Methods Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. Results The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. Conclusion A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.

Resumo Introdução: Colesteatoma é uma lesão destrutiva que pode levar a complicações potencialmente letais. Tipicamente, apresenta hipoacusia e otorreia contínua como sintomas. Por ser uma doença rara, existem poucos estudos no Brasil que descrevam as características destes pacientes. Objetivo: O presente estudo teve como objetivos determinar a prevalência de colesteatoma entre os pacientes com otite média crônica (OMC) e descrever as características clínicas, audiológicas e cirúrgicas dos pacientes com colesteatoma adquirido de orelha média atendidos em um hospital de referência do sistema público de saúde. Método: Estudo transversal e de coorte prospectivo, incluindo 1.710 pacientes com OMC, atendidos entre agosto de 2000 e junho de 2015, sem tratamento cirúrgico prévio. Foram feitas anamnese detalhada, videotoscopia e audiometria, além de revisão de prontuários para busca de dados cirúrgicos. Os colesteatomas foram classificados conforme sua via de formação. Resultados: Dos pacientes com otite média crônica, 419 (24,5%) apresentavam colesteatoma. Média de 34,49 anos; 53,5% do sexo feminino e 63,8% adultos. Colesteatoma foi observado bilateralmente em 17,1%. Os epitimpânicos anteriores corresponderam a 1,9%; os epitimpânicos posteriores a 32,9%; os mesotimpânicos posteriores a 33,7%; duas vias a 14,8% e indeterminados a 16,7%. A média tritonal dos gaps aeroósseos foi de 29,84 dB e não diferiu entre os grupos segundo as vias de formação. Não foram observadas correlações entre tamanho do gap e idade do paciente ou duração dos sintomas. Dos pacientes operados, 16,8% foram submetidos a timpanomastoidectomia fechada e 75,2% a timpanomastoidectomia aberta. Conclusão: A prevalência de colesteatoma em pacientes com otite média crônica foi de 24,5% e foi mais frequente em adultos do que em crianças. Os mesotimpânicos posteriores foram mais frequentes, não foi observada diferença na média dos gaps aeroósseos entre diferentes vias de formação. Nos pacientes submetidos a cirurgia, a timpanomastoidectomia aberta foi o procedimento escolhido.

Abstract Introduction: Cholesteatoma is a destructive lesion that can result in life-threatening complications. Typically, it presents with hypoacusis and continuous otorrhea as symptoms. Because it is a rare disease, there are few studies in Brazil describing the characteristics of patients with the disease. Objective: This study aimed to determine the prevalence of cholesteatoma in patients with chronic otitis media and describe clinical, audiological and surgical characteristics of patients with acquired middle ear cholesteatoma treated at a referral hospital in the public health system. Methods: Cross-sectional and prospective cohort study, including 1710 patients with chronic otitis media, treated between August 2000 and June 2015, without prior surgery. Detailed clinical history, videotoscopy, and audiometry were performed, in addition to review of medical records to search for surgical data. Cholesteatomas were classified according to their route of formation. Results: Of the patients with chronic otitis media, 419 (24.5%) had cholesteatoma; mean age of 34.49 years; 53.5% female and 63.8% adults. Bilateral cholesteatoma was observed in 17.1%. Anterior epitympanic cholesteatoma corresponded to 1.9%; posterior epitympanic, 32.9%; posterior mesotympanic, 33.7%; two routes, 14.8%; and indeterminate, 16.7%. The mean air-bone gap was 29.84 dB and did not differ between routes of formation. There were no correlations between gap size and patient age or duration of symptoms. Of the surgical cases, 16.8% underwent closed tympanomastoidectomy and 75.2% open tympanomastoidectomy. Conclusion: The prevalence of cholesteatoma in patients with chronic otitis media was 24.5% and it was more common in adults than in children. Posterior mesotympanic cholesteatoma was more frequent, with no difference in mean air-bone gap between the different routes of formation. In patients undergoing surgery, open tympanomastoidectomy was the procedure most frequently chosen.

Abstract Introduction Tinnitus is a symptom that affects mainly the elderly and can negatively influence their quality of life. Objective The objective of our study is to evaluate the existence of a relationship between the quality of life and the impact caused by tinnitus in elderly individuals, considering the age and gender variables. Method We conducted a cross-sectional study in elderly people of both genders who participate in the extension activities at the university. The evaluation was composed of anamnesis and WHOQOL-OLD instruments, to evaluate the quality of life, and Tinnitus Handicap Inventory (THI) for the evaluation of the tinnitus impact. Result We evaluated 36 elderly individuals with an average age of 68.6 ± 6.8 years old, 72.2 % of them were women. We verified that most of the subjects classified their tinnitus as weak (44.4%) ormedium (36.1%). The score average in the THI was 20 points, with predominant classification of tinnitus impact as negligible (41.7%) or mild (30.6%). In the WHOQOL-OLD, the average score was 15.6 ± 1.6 points (total score). The negative correlation between the THI score and the WHOQOL-OLD score was found in the sensory domain operation and total score. Conclusion The results obtained in the study prove that the quality of life of the elderly individuals evaluated is related to a discomfort caused by the tinnitus.

Resumo Introdução O diagnóstico das disfunções da tuba auditiva é essencial para o melhor entendimento da patogênese da otite média crônica. A literatura descreve uma série de testes que avaliam a função tubária; contudo, tais exames são metodologicamente heterogêneos, com diferenças que variam desde os protocolos de aplicação até a padronização dos exames e seus resultados. Objetivo Avaliar a variação na pressão na orelha média em pacientes com retração da membrana timpânica e em indivíduos normais durante os testes de função tubária e também avaliar a variação intraindividual desses testes. Método Estudo observacional do tipo transversal e contemporâneo, no qual o fator em estudo foi a variação na pressão na orelha média durante os testes de função tubária (manobra de Valsalva, Sniff Test e manobra de Toynbee) em indivíduos normais e em pacientes com retrações timpânicas leves e moderadas/graves. Foram incluídos 38 pacientes (76 orelhas). Os pacientes foram submetidos, em dois momentos diferentes, a testes de função tubária para determinar as medidas de pressão após cada manobra. A análise estatística foi feita com o programa SPSS, versão 18.0, e consideramos como estatisticamente significativos os valores de p < 0,05. Resultados A média ± desvio padrão da idade foi de 11 ± 2,72 anos; 55,3% dos pacientes eram do gênero masculino e 44,7% do feminino. A prevalência de curvas timpanométricas do tipo A foi mais alta entre os participantes com orelhas normais e naqueles com retrações leves, enquanto as curvas timpanométricas do tipo C foram mais frequentes no grupo com retrações moderadas/graves. Observamos pressões aumentadas na orelha média durante a manobra de Valsalva no primeiro momento da avaliação nos três grupos de orelhas (p = 0,012). A variação na pressão não foi significativa para o Sniff Test, nem para a manobra de Toynbee nos dois momentos de avaliação (p ≥ 0,05). Consideramos que a concordância entre as determinações obtidas nos dois momentos diferentes foi fraca a moderada para todos os testes nos três grupos de orelhas e as variações em termos de discrepância entre as medidas foram maiores nas orelhas com retrações timpânicas moderadas/graves. Conclusão Na população estudada, a média das pressões na orelha média apresentou variação significante apenas durante a manobra de Valsalva no primeiro momento de avaliação, nos três grupos de orelhas. As orelhas normais e aquelas que apresentavam retração leve se comportaram de maneira similar nos testes. As manobras testadas exibiram uma variação intraindividual fraca a moderada e a maior variação ocorreu nas orelhas com retrações moderadas/graves.

Abstract Introduction The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results. Objective To evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests. Methods An observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant. Results Mean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p = 0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p ≥ 0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction. Conclusion In this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction.

Abstract Introduction Tinnitus is a symptom that is often associated with presbycusis. Objective This study aims to analyze the existence of association among hearing thresholds, pitch, and loudness of tinnitus in individuals with presbycusis, considering the gender variable. Methods Cross-sectional, descriptive, and prospective study, whose sample consisted of individuals with tinnitus and diagnosis of presbycusis. For the evaluation, we performed anamnesis along with otoscopy, pure tone audiometry, and acuphenometry to analyze the psychoacoustic characteristics of tinnitus individuals. Results The sample consisted of 49 subjects, with a mean age of 69.57 6.53 years, who presented unilateral and bilateral tinnitus, therefore, a sample of 80 ears. In analyzing the results, as for acuphenometry, the loudness of tinnitus was more present at 0dB and the pitch was 6HKz and 8HKz. Regarding the analysis of the association between the frequency of greater hearing threshold and tinnitus pitch, no statistical significance (p= 0.862) was found. As for the association between the intensity of greater hearing threshold and tinnitus loudness, no statistical significance (p= 0.115) was found. Conclusion There is no significant association between the hearing loss of patients with presbycusis and the pitch and loudness of tinnitus.

RESUMO Objetivo: investigar a localização e verificar a influência de fatores e hábitos na percepção do zumbido em pacientes com tal sintoma. Métodos: fizeram parte da amostra 740 indivíduos com queixa de zumbido, atendidos em ambulatório especializado de hospital universitário. Todos relataram a localização do zumbido em resposta a questionário, contendo também informações sobre fatores e hábitos causadores de melhora ou piora na percepção do zumbido. Os dados foram analisados estatisticamente. Resultados: o predomínio da localização foi em ambas as orelhas. A maior parte dos fatores investigados não modifica a percepção do zumbido para os pesquisados. Dentre os fatores que puderam ser relacionados à piora da percepção estão, principalmente, o silêncio e o período da noite, seguidos pela ansiedade. Por outro lado, ruído foi o fator mais referido como causador de diminuição da percepção do zumbido. Não foi verificada influência de idade e gênero. Conclusão: mais da metade dos sujeitos apresentaram queixa de zumbido bilateral e a maior parte das situações pesquisadas não provocam mudança na percepção do zumbido na população estudada. Destaca-se, contudo, que a presença de ruído ambiental auxilia na diminuição da sensação de incômodo ao zumbido, enquanto o silêncio, período da noite e a ansiedade contribuem para acentuá-la.

ABSTRACT Purpose: to investigate the location and to verify the influence of factors and personal habits in the tinnitus perception in patients with the symptom. Methods: 740 individuals with tinnitus, from an outpatient clinic of a university hospital were investigated. All of them reported the location in response to a questionnaire, also containing information about some factors and daily habits that causes improvement or worsening of tinnitus. The data were statistically analyzed. Results: the predominant location was in both ears. Most of the investigated factors does not change the perception of tinnitus for researched subjects. The silence, the nighttime and the anxiety were the factors that might be related to worsening of tinnitus perception. Moreover, the noise was referred as a factor that causes decrease of tinnitus perception. There was no influence of age and gender. Conclusion: more than half of the subjects had bilateral tinnitus and that most situations surveyed do not cause change in the tinnitus perception to the studied people. It is noteworthy, however, that the presence of ambient noise helps to reduce the feeling of tinnitus annoyance, as well as the silence, the period of night and the anxiety contribute to accentuate it.

Abstract Introduction Tinnitus is one of the symptoms that affects individuals suffering from noise induced hearing loss. This condition can be disabling, leading the affected individual to turn away from work. Objective This literature review aims to analyze the possible association between gender and tinnitus pitch and loudness, the degree of hearing loss and the frequencies affected in subjects with noise-induced hearing loss. Methods This contemporary cohort study was conducted through a cross-sectional analysis. The study sample consisted of adults with unilateral or bilateral tinnitus, who had been diagnosed with noise-induced hearing loss. The patients under analysis underwent an otorhinolaryngological evaluation, pure tone audiometry, and acuphenometry. Results The study included 33 subjects with noise-induced hearing loss diagnoses, of which 22 (66.7%) weremen. Authors observed no statistical difference between gender and loudness/pitch tinnitus and loudness/pitch in subjects with bilateral tinnitus. Authors found an inverse relation between tinnitus loudness with intensity greater hearing threshold and the average of the thresholds and the grade of hearing loss. The tinnitus pitch showed no association with higher frequency of hearing threshold. Conclusion Data analysis shows that, among the individuals evaluated, the greater the hearing loss, the lower the loudness of tinnitus. We did not observe an association between hearing loss and tinnitus pitch.

Alguns estudos indicam uma tendência à bilateralidade da otite média crônica. Acredita-se que a orelha contralateral possa fornecer evidências da via de formação da doença da orelha mais afetada, ser um parâmetro da função da tuba auditiva e predizer o sucesso do tratamento. A tomografia computadorizada é um excelente teste para avaliar as estruturas do osso temporal e as alterações decorrentes da da otite média. OBJETIVO: Avaliar tomografias computadorizadas (TC) de osso temporal de pacientes com otite média crônica e descrever anormalidades na orelha contralateral. MÉTODO: Estudo de Prevalências (transversal). Avaliação das TC de 75 pacientes com otite média crônica de um hospital terciário de referência no Brasil por um neurorradiologista. RESULTADOS: A população foi constituída por 50,6% do sexo masculino, com idade média de 36 anos. Encontramos 54,7% de alterações na orelha contralateral claramente relacionadas com otite média crônica. DISCUSSÃO: A prevalência de alterações radiográficas nas orelhas contralaterais de pacientes com otite média crônica corrobora com estudos clínicos, histopatológicos e funcionais desenvolvidos pelo mesmo grupo de pesquisa e sugere que esta doença tem uma característica bilateral.

Some studies indicate a bilateral tendency of chronic otitis media. It is believed that the contralateral ear can provide evidences of the route of formation of ear disease in the most affected, be a parameter of Eustachian tube function and predict successful treatment. The CT scan is an excellent test to evaluate the structures of the temporal bone and the changes resulting from otitis media. OBJECTIVE: To evaluate Temporal Bone Computed Tomography of patients with chronic otitis media and describe abnormalities in the contralateral ear. METHOD: Cross-sectional study. Evaluation of CT scans of 75 patients with chronic otitis media from a tertiary referral hospital in Brazil by a neuroradiologist. RESULTS: Population was consisted of 50.6% males with a mean age of 36 years. We found 54.7% of changes in contralateral ear clearly associated with chronic otitis media. CONCLUSION: The prevalence of radiographic changes in the contralateral ears of patients with chronic otitis media corroborates with clinical, histopathological and functional resources developed by the same group that this disease has a bilateral feature.

A Otite Média Crônica é definida pela presença de alterações teciduais inflamatórias irreversíveis na fenda auditiva. As lesões ossiculares são as mais prevalentes. OBJETIVO: Correlacionar o grau de comprometimento da cadeia ossicular, visualizada no transoperatório, com o grau histológico de inflamação e com a espessura da perimatriz de colesteatomas. TIPO DE ESTUDO: Estudo transversal. MÉTODOS: Descrições cirúrgicas de 71 pacientes foram revisadas. Colesteatomas coletados e fixados em formol 10% e preparadas uma lâmina em Hematoxilina-Eosina e outra em Picrossírios. A leitura foi "cega", através de imagens digitais, no ImageProPlus. A análise estatística foi realizada através do coeficiente de Spearman, sendo considerados como estatisticamente significativos os valores de P<0,05. RESULTADOS: Havia algum envolvimento da cadeia ossicular em 65 casos. O ossículo mais freqüentemente afetado era a bigorna, seguida pelo estribo e pelo martelo. Ao aplicarmos o coeficiente de Spearman entre o grau de comprometimento da cadeia ossicular com a idade do paciente à cirurgia, a espessura da perimatriz e o grau histológico de inflamação não foram detectadas correlações. CONCLUSÃO: Os nossos achados indicam que é praticamente universal o acometimento da cadeia ossicular na presença de colesteatoma. Não foi encontrada correção entre a erosão ossicular e os achados histológicos.

Chronic otitis media is hystopathologycaly defined as the presence of irreversible inflammatory tissue changes in the middle ear. Ossicular lesions represent the most prevalent change. AIM: to correlate the degree of ossicular chain changes seen during surgery with the inflammatory histological degree and the thickness of the cholesteatoma perimatrix. STUDY DESGN: Cross-sectional study. METHODS: Seventy-one descriptions of surgeries done in patients submitted to tympanomastoydectomy were reviewed. Cholesteatoma were collected and fixed in 10% formaldehyde. Two slides were made for each cholesteatoma, one stained with HE and another with picrossirius. Images were obtained from light microscopy and digitally processed and "blindly" analyzed using Image Pro-Plus Software. For statistical analysis we used Spearman's coefficient. Differences were considered statistically significant if P≤0.05. RESULTS: the ossicular chain was involved in 65 cases. The incus was the most frequently affected bone, followed by the stapes and the malleus. When the Spearman's coefficient was employed considering ossicular chain change degree with patient's age by the time of surgery, perimatrix thickness and histological degree of inflammation, correlations were not established. CONCLUSION: Our findings indicate that ossicular chain changes are practically universal when a cholesteatoma is present. We didn't find correlations related with bone erosion and cholesteatoma's histological findings.

O zumbido traz grande repercussões a qualidade de vida dos pacientes, e temos dificuldade em quantificá-los. OBJETIVO: Determinar a reprodutibilidade e validade da tradução para língua portuguesa do Tinnitus Handicap Inventory (THI), um questionário auto-aplicável que avalia a repercussão do zumbido na qualidade de vida dos pacientes. MATERIAL E MÉTODOS: Neste estudo do tipo transversal prospectivo foi traduzido e adaptado culturalmente o questionário THI para a população brasileira de acordo com metodologia internacionalmente aceita e, então, respondido por 180 pacientes com zumbido. A avaliação de reprodutibilidade foi feita através do cálculo do alfa de Cronbach, enquanto que a validade foi testada através da comparação do THI com escala de depressão de Beck, calculando o coeficiente de correlação de Pearson. RESULTADOS: A tradução do THI apresenta boa validade interna, comparável com a demonstrada na versão original. Correlação alta foi observada entre o THI e a escala de Beck. CONCLUSÃO: A versão para a língua portuguesa é um instrumento válido e reprodutível para ser utilizado para quantificar o impacto do zumbido na qualidade de vida dos pacientes brasileiros que nos procuram com esse sintoma.

Tinnitus can greatly impact an individual’s life quality and it is very difficult 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 Cronbach’s 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 impact the life quality of those Brazilian patients who complain of this symptom.