Zumbido e intolerância a sons : evidência e experiência de um grupo brasileiro

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.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

Autoantibody profile in sudden sensorineural hearing loss, rapidly progressive hearing loss and Ménière\'s disease

A surdez neurossensorial imunomediada (SNIM) é uma das formas reversíveis de surdez neurossensorial, justificando a necessidade de identificação de marcadores mais específicos que ajudem na sua abordagem. O Western blot com antígenos de tecidos bovinos detecta um anticorpo contra a proteína de 68kD (hsp-70) em SNIM. Entretanto, anticorpos antihsp- 70 são comumente encontrados em indivíduos sadios. O objetivo do estudo foi determinar a reatividade de soros de pacientes com doenças otológicas freqüentemente relacionadas à etiologia auto-imune contra antígeno celular de linhagem humana (HeLa) através do Western blot, comparando com outros marcadores sorológicos de auto-imunidade. Soros de 81 pacientes com surdez neurossensorial (25 surdez súbita, 35 rapidamente progressiva e 21 doença Ménière) foram testados por Western blot utilizando extrato total de célula HeLa como antígeno alvo. Os pacientes com surdez foram comparados com indivíduos com audição normal e sem queixas otológicas ou história de doença sistêmica auto-imune (n=48). Observou-se reatividade contra célula HeLa principalmente nas regiões de 42, 48 and 62kD no grupo com surdez. O padrão de reatividade foi diferente entre os diferentes subgrupos de surdez. A reatividade contra as bandas de 48 and 62kD foi observada em surdez súbita e surdez rapidamente progressiva. A proteína de 48kD proveniente da surdez rapidamente progressiva parece ser diferente daquela encontrada em surdez súbita devido a sua resistência à tripsina. Este estudo demonstrou a existência de autorreatividade contra células HeLa na surdez súbita, surdez rapidamente progressiva e doença de Ménière, sugerindo a presença de novos autoanticorpos. O seu papel é ainda desconhecido. Estudos detalhados são necessários para avaliar a real relevância clínica desta autorreatividade na patologia de orelha interna ou como marcador prognóstico ou diagnósticoImmune-mediated sensorineural hearing loss (SNHL) is one of few forms of reversible SNHL, justifying the need to define more specific markers to help clinical approach. Western blot with bovine tissues detect an autoantibody against the 68kD protein (hsp70) in immune-mediated SNHL. However, antihsp70 antibodies are also common in healthy individuals. The objective of this study was to determinate the reactivity of serum from patients with otologic entities often related to autoimmune etiology against human cell line antigen (HeLa) by Western blot, comparing to other serological markers. Sera of 81 patients with SNHL (25 sudden SNHL, 35 rapidly progressive SNHL and 21 Ménière\'s disease patients) were tested by Western blot using HeLa cell total extract as target. Western blot outcome was compared with detection of other current autoimmune markers. Experimental group data were compared to normal-hearing subjects (n=48) without otologic or systemic autoimmune disease. Reactivity to HeLa cells was observed mostly at 42, 48 and 62kD region which pattern was different among different groups. Binding to 48 and 62kD HeLa cell antigen was observed in sudden SNHL and rapidly progressive SNHL. The 48kD protein from rapidly progressive SNHL seems to be different from sudden SNHL\'s according to resistance to trypsin. This study detected autoreactivity to HeLa cells in sudden SNHL, rapidly progressive SNHL and Ménière\'s disease, suggesting the presence of new autoantibodies. Their role is still unknown and further studies should evaluate their relevance on pathology in the inner ear or as diagnostic or prognostic marke

Autoantibody profile in sudden sensorineural hearing loss, rapidly progressive hearing loss and Ménière\'s disease

A surdez neurossensorial imunomediada (SNIM) é uma das formas reversíveis de surdez neurossensorial, justificando a necessidade de identificação de marcadores mais específicos que ajudem na sua abordagem. O Western blot com antígenos de tecidos bovinos detecta um anticorpo contra a proteína de 68kD (hsp-70) em SNIM. Entretanto, anticorpos antihsp- 70 são comumente encontrados em indivíduos sadios. O objetivo do estudo foi determinar a reatividade de soros de pacientes com doenças otológicas freqüentemente relacionadas à etiologia auto-imune contra antígeno celular de linhagem humana (HeLa) através do Western blot, comparando com outros marcadores sorológicos de auto-imunidade. Soros de 81 pacientes com surdez neurossensorial (25 surdez súbita, 35 rapidamente progressiva e 21 doença Ménière) foram testados por Western blot utilizando extrato total de célula HeLa como antígeno alvo. Os pacientes com surdez foram comparados com indivíduos com audição normal e sem queixas otológicas ou história de doença sistêmica auto-imune (n=48). Observou-se reatividade contra célula HeLa principalmente nas regiões de 42, 48 and 62kD no grupo com surdez. O padrão de reatividade foi diferente entre os diferentes subgrupos de surdez. A reatividade contra as bandas de 48 and 62kD foi observada em surdez súbita e surdez rapidamente progressiva. A proteína de 48kD proveniente da surdez rapidamente progressiva parece ser diferente daquela encontrada em surdez súbita devido a sua resistência à tripsina. Este estudo demonstrou a existência de autorreatividade contra células HeLa na surdez súbita, surdez rapidamente progressiva e doença de Ménière, sugerindo a presença de novos autoanticorpos. O seu papel é ainda desconhecido. Estudos detalhados são necessários para avaliar a real relevância clínica desta autorreatividade na patologia de orelha interna ou como marcador prognóstico ou diagnósticoImmune-mediated sensorineural hearing loss (SNHL) is one of few forms of reversible SNHL, justifying the need to define more specific markers to help clinical approach. Western blot with bovine tissues detect an autoantibody against the 68kD protein (hsp70) in immune-mediated SNHL. However, antihsp70 antibodies are also common in healthy individuals. The objective of this study was to determinate the reactivity of serum from patients with otologic entities often related to autoimmune etiology against human cell line antigen (HeLa) by Western blot, comparing to other serological markers. Sera of 81 patients with SNHL (25 sudden SNHL, 35 rapidly progressive SNHL and 21 Ménière\'s disease patients) were tested by Western blot using HeLa cell total extract as target. Western blot outcome was compared with detection of other current autoimmune markers. Experimental group data were compared to normal-hearing subjects (n=48) without otologic or systemic autoimmune disease. Reactivity to HeLa cells was observed mostly at 42, 48 and 62kD region which pattern was different among different groups. Binding to 48 and 62kD HeLa cell antigen was observed in sudden SNHL and rapidly progressive SNHL. The 48kD protein from rapidly progressive SNHL seems to be different from sudden SNHL\'s according to resistance to trypsin. This study detected autoreactivity to HeLa cells in sudden SNHL, rapidly progressive SNHL and Ménière\'s disease, suggesting the presence of new autoantibodies. Their role is still unknown and further studies should evaluate their relevance on pathology in the inner ear or as diagnostic or prognostic marke

Autoantibody profile in sudden sensorineural hearing loss, rapidly progressive hearing loss and Ménière\'s disease

A surdez neurossensorial imunomediada (SNIM) é uma das formas reversíveis de surdez neurossensorial, justificando a necessidade de identificação de marcadores mais específicos que ajudem na sua abordagem. O Western blot com antígenos de tecidos bovinos detecta um anticorpo contra a proteína de 68kD (hsp-70) em SNIM. Entretanto, anticorpos antihsp- 70 são comumente encontrados em indivíduos sadios. O objetivo do estudo foi determinar a reatividade de soros de pacientes com doenças otológicas freqüentemente relacionadas à etiologia auto-imune contra antígeno celular de linhagem humana (HeLa) através do Western blot, comparando com outros marcadores sorológicos de auto-imunidade. Soros de 81 pacientes com surdez neurossensorial (25 surdez súbita, 35 rapidamente progressiva e 21 doença Ménière) foram testados por Western blot utilizando extrato total de célula HeLa como antígeno alvo. Os pacientes com surdez foram comparados com indivíduos com audição normal e sem queixas otológicas ou história de doença sistêmica auto-imune (n=48). Observou-se reatividade contra célula HeLa principalmente nas regiões de 42, 48 and 62kD no grupo com surdez. O padrão de reatividade foi diferente entre os diferentes subgrupos de surdez. A reatividade contra as bandas de 48 and 62kD foi observada em surdez súbita e surdez rapidamente progressiva. A proteína de 48kD proveniente da surdez rapidamente progressiva parece ser diferente daquela encontrada em surdez súbita devido a sua resistência à tripsina. Este estudo demonstrou a existência de autorreatividade contra células HeLa na surdez súbita, surdez rapidamente progressiva e doença de Ménière, sugerindo a presença de novos autoanticorpos. O seu papel é ainda desconhecido. Estudos detalhados são necessários para avaliar a real relevância clínica desta autorreatividade na patologia de orelha interna ou como marcador prognóstico ou diagnósticoImmune-mediated sensorineural hearing loss (SNHL) is one of few forms of reversible SNHL, justifying the need to define more specific markers to help clinical approach. Western blot with bovine tissues detect an autoantibody against the 68kD protein (hsp70) in immune-mediated SNHL. However, antihsp70 antibodies are also common in healthy individuals. The objective of this study was to determinate the reactivity of serum from patients with otologic entities often related to autoimmune etiology against human cell line antigen (HeLa) by Western blot, comparing to other serological markers. Sera of 81 patients with SNHL (25 sudden SNHL, 35 rapidly progressive SNHL and 21 Ménière\'s disease patients) were tested by Western blot using HeLa cell total extract as target. Western blot outcome was compared with detection of other current autoimmune markers. Experimental group data were compared to normal-hearing subjects (n=48) without otologic or systemic autoimmune disease. Reactivity to HeLa cells was observed mostly at 42, 48 and 62kD region which pattern was different among different groups. Binding to 48 and 62kD HeLa cell antigen was observed in sudden SNHL and rapidly progressive SNHL. The 48kD protein from rapidly progressive SNHL seems to be different from sudden SNHL\'s according to resistance to trypsin. This study detected autoreactivity to HeLa cells in sudden SNHL, rapidly progressive SNHL and Ménière\'s disease, suggesting the presence of new autoantibodies. Their role is still unknown and further studies should evaluate their relevance on pathology in the inner ear or as diagnostic or prognostic marke

Tinnitus in adolescents: the start of the vulnerability of the auditory pathways

INTRODUCTION: Although tinnitus is an increasingly common symptom, few studies have assessed its prevalence or incidence among adolescents.PURPOSE: To assess whether the presence of tinnitus in adolescents is associated with minimal hearing damage, evaluated through high-frequency audiometry (HFA), otoacoustic emission (OAE), and loudness discomfort level (LDL).METHODS: The sample comprised 168 adolescents of a private school (61.3% boys; mean age 14.1 years old; standard deviation=2). All of them completed a questionnaire about tinnitus and hypersensitivity to sounds (sound intolerance), and then underwent otoscopy, pure-tone audiometry, HFA, LDL, transient and distortion product otoacoustic emissions (TOAE and DPOAE), and tinnitus pitch/loudness matching (the latter only in those with tinnitus). Participants were later divided into three groups: with no tinnitus (n=73, 43.4%), with sporadic tinnitus (n=47, 28%), and with constant tinnitus (n=48, 28.6%).RESULTS: No significant difference was observed between the groups regarding audiometry thresholds in frequencies from 0.25 to 16 kHz, or TOAE and DPOAE. However, the LDL in adolescents with constant tinnitus was significantly lower than that in other groups, suggesting hypersensitivity to sounds.CONCLUSION: There was no evidence of minimal hearing damage in the audiometry and OAE. Nonetheless, the decreased LDL in adolescents with constant tinnitus suggests that their auditory system is more sensitive. Therefore, this may be the first sign of vulnerability to sounds. Future medium- to long-term monitoring of these students may show whether they will begin a process of functional impairment, altering hearing thresholds, and OAE

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

<div><p>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.</p></div