Blood parasites in noddies and boobies from Brazilian offshore islands - differences between species and influence of nesting habitat.

Seabirds are often free from blood parasites, and a recent review suggested that phylogenetic, ecological and life-history parameters can determine the prevalence of blood parasites in seabirds. However, there is a lack of data available from many seabird groups, and a larger database is needed to understand prevalence patterns of blood parasites. We used a molecular screening approach to detect parasites of the genera Plasmodium, Haemoproteus, Leucocytozoon and Babesia in five species of two genera of seabirds that breed on Atlantic Ocean islands off Brazil. The observed patterns differed between the two bird genera. Like other Laridae, brown noddy, Anous stolidus adults were infected with Haemoproteus with low prevalence. Masked boobies, Sula dactylatra and brown boobies, Sula leucogaster were infected with Babesia. Of the latter, mainly juveniles were infected. In all species, intensity of infection (i.e. number of infected erythrocytes) was so low that parasites remained undetected in blood smears. This may explain the absence of major effects on the body condition of birds, although infected juvenile masked boobies were lighter than juveniles that were not infected with Babesia. Two tree-nesting species; black noddy, Anous minutus and red-footed booby, Sula sula did not have blood parasites, suggesting that tree-nesting may reduce the exposure to arthropod vectors compared with ground nesting in these species.

Use of Auditory Feedback Amplifier in Women Without Voice Complaints: A Comparison of Acoustic Measures, Self-Rated Vocal Effort, and Voice Intensity.

OBJECTIVE: To compare the immediate effects of using MindVox in women without voice complaints for 1, 3, 5, and 7 minutes of reading tasks, on acoustic measurements of the vocal signal in low, medium, and strong intensity emissions; on self-rated effort vocal, and on the intensity of voice reception and production. METHODS: Participants read one text using MindVox for 1, 3, 5, and 7 minutes. After each time, measures of self-rated vocal effort were collected (BORG CR10-BR Scale), as well as samples of the vowel /e/ at low (>70 dB), moderate (≥70 dB and ≤80 dB), and high intensities (>80 dB). Acoustic measurements (F0, short-term acoustic measurements, and cepstral peak prominence measurements) were also collected before and after the procedure and subsequently analyzed in the CTS 5.0 Vox-Metria Program. Voice reception and production intensities were captured during the reading task using two decibel meters. One decibel meter was installed near the ear (average intensity received by the ear (EAVG)) and the other near the lips (average intensity captured near the lips (LAVG)), and the data were submitted for analysis. RESULTS: The Cepstral Peak Prominence-Smoothed increased in the first minute, the Cepstral Peak Prominence increased in the third minute, and the jitter decreased from the first minute. All these changes were observed at low intensity and were maintained at the other time points. For every 5 dB of amplification (EAVG), there was a 1 dB decrease in voice production (LAVG). CONCLUSION: Using MindVox in women without voice complaints brings positive immediate effects in cepstral measures and jitter at low intensity. There is a connection between the intensity of the voice received by the ear and the intensity of voice production.

Test for clinical reasoning evaluation in Speech-Language Pathology: content validity. / Teste para avaliação do raciocínio clínico em Fonoaudiologia: validade de conteúdo.

PURPOSE: To validate the content of the Speech-Language Pathology Concordance Test called FonoTCS. METHODS: This is a content validation study of the instrument. Five speech-language pathologists, all with doctoral degrees and teaching experience, averaging 24.8 years of professional practice, participated in the development of FonoTCS and reached a consensus during the process. Thirty questions and 120 items were created, covering seven areas of speech-language pathology expertise across three domains. For content validation, FonoTCS was electronically sent to 15 evaluators to respond to a questionnaire with five questions, rated on a five-point scale, regarding the criteria of clarity, ethics, and relevance of the questions. The Corrected Content Validity Coefficient was calculated for all statements to analyze the responses. Questions with agreement percentages equal to or less than 80% were revised. RESULTS: Thirteen evaluators, all female, with an average age of 39.07 years, including eight with master's degrees and five with doctoral degrees, and an average clinical practice experience of 15.38 years, participated in the analysis. The average Corrected Content Validity Coefficient values for the clarity criterion were 0.93 and 0.95, for the relevance criterion 0.98 and 0.92, and for the ethics criterion 0.99. Two questions received scores of 0.78 and 0.80, both related to the audiology area in the assessment/diagnosis domain, specifically question 2 regarding the relevance criterion. These questions were reviewed and restructured by the judges. CONCLUSION: FonoTCS is a valid instrument from a content perspective.

OBJETIVO: validar o conteúdo do Teste de Concordância de Scripts em Fonoaudiologia, denominado FonoTCS. MÉTODO: Trata-se de estudo de validação de conteúdo de instrumento. Participaram da construção do FonoTCS cinco fonoaudiólogas, doutoras e docentes, com média de 24,8 anos de atuação profissional, que chegaram a um consenso durante o processo de construção do teste. Elaborou-se 30 questões e 120 itens contemplando as áreas de atuação fonoaudiológica. Em seguida, 15 fonoaudiólogas com titulação mínima de mestre, e com, no mínimo, 10 anos de atuação clínica generalista receberam eletronicamente o FonoTCS para validação de conteúdo por meio de questionário sobre critérios de clareza, ética e pertinência do conteúdo das questões. Para a análise das respostas calculou-se o Coeficiente de Validade de Conteúdo Corrigido de todas as afirmativas. Foram revisadas as questões com porcentagem de concordância igual ou inferior a 80%. RESULTADOS: 13 avaliadores responderam a análise, todos do sexo feminino, com média de idade de 39,07 anos, sendo oito mestres e cinco doutoras, com atuação clínica generalista média de 15,38 anos. Os valores médios do Coeficiente de Validade de Conteúdo Corrigido foram 0,93 e 0,95 para o critério de clareza; 0,98 e 0,92 para o critério de pertinência; e 0,99 para o critério de ética. Duas questões apresentaram notas de 0,78 e 0,80, sendo ambas da área de audiologia no domínio de avaliação/diagnóstico, para a questão relacionada ao critério de pertinência, sendo revisadas e reestruturadas pelos juízes. CONCLUSÃO: O FonoTCS é um instrumento válido do ponto de vista do conteúdo.

Evidence of reassortment of avian influenza A (H2) viruses in Brazilian shorebirds.

Influenza A viruses of the H2 subtype represent a zoonotic and pandemic threat to humans due to a lack of widespread specific immunity. Although A(H2) viruses that circulate in wild bird reservoirs are distinct from the 1957 pandemic A(H2N2) viruses, there is concern that they could impact animal and public health. There is limited information on AIVs in Latin America, and next to nothing about H2 subtypes in Brazil. In the present study, we report the occurrence and genomic sequences of two influenza A viruses isolated from wild-caught white-rumped sandpipers (Calidris fuscicollis). One virus, identified as A(H2N1), was isolated from a bird captured in Restinga de Jurubatiba National Park (PNRJ, Rio de Janeiro), while the other, identified as A(H2N2), was isolated from a bird captured in Lagoa do Peixe National Park (PNLP, Rio Grande do Sul). DNA sequencing and phylogenetic analysis of the obtained sequences revealed that each virus belonged to distinct subtypes. Furthermore, the phylogenetic analysis indicated that the genomic sequence of the A(H2N1) virus isolated from PNRJ was most closely related to other A(H2N1) viruses isolated from North American birds. On the other hand, the A(H2N2) virus genome recovered from the PNLP-captured bird exhibited a more diverse origin, with some sequences closely related to viruses from Iceland and North America, and others showing similarity to virus sequences recovered from birds in South America. Viral genes of diverse origins were identified in one of the viruses, indicating local reassortment. This suggests that the extreme South of Brazil may serve as an environment conducive to reassortment between avian influenza virus lineages from North and South America, potentially contributing to an increase in overall viral diversity.

Children with phenylketonuria treated early: basic audiological and electrophysiological evaluation.

OBJECTIVES: Individuals with phenylketonuria (PKU) can exhibit deficits in executive functions, intelligence, attention, visual-spatial processing abilities, and efficiency stemming presumably from deficient neurotransmitter synthesis, even when the disorder is diagnosed and treated early. Basic audiological and electrophysiological evaluations were used to examine the peripheral and central auditory pathways of children with early-treated PKU, who followed adequate versus inadequate diets. Results were compared with those of age-matched children without PKU. DESIGN: The control group included 35 children aged 5 to 16 years, and the experimental group included 25 children with classic PKU, all of whom were diagnosed and treated early. The experimental group comprised children of two subgroups, divided according to their dietary control, as follows: 8 children aged 6 to 13 years with adequate diets (group A); 17 children ages 6 to 15 years demonstrating inadequate diets (group B). All participants underwent auditory evaluations, including otoscopy, pure-tone and speech audiometry, immittance testing (tympanometry and assessment of contralateral stapedial reflex thresholds), and evaluations of auditory brainstem and middle latency responses. The demographic variables and audiological examination results were analyzed for all groups. Results among groups and subgroups were compared using analysis of variance with repeated measures to test statistical significance across factors and measures at the p = 0.05 level. RESULTS: Audiometric evaluation revealed results within normal limits for all groups, except for one child from the inadequate diet group, who showed a mild bilateral conductive hearing loss. Results of speech and immittance audiometry suggested the children in group B as having poorer average speech-discrimination scores and higher stapedial reflex thresholds at 4000 Hz. Auditory brainstem response results revealed longer average latencies for waves III and V and greater interaural differences for wave V in group B, although both groups A and B showed longer average latencies for the interpeak interval I-V, compared with the control group. Middle latency responses showed no significant differences in the latencies of the Na and Pa waves or the Na-Pa amplitude for the experimental group, but electrode or ear effects were present in 87.5% of group A and 58.8% of group B. CONCLUSIONS: Overall, differences observed tended to be small (by clinical diagnostic standards), yet suggest that children with PKU exhibit some effect of this disorder on the pontine auditory pathway, even when diagnosed/treated early and independent of the appropriateness of diet. It thus seems prudent to follow PKU children with auditory processing assessments to evaluate functional implications of these findings.

Prevalence of latent tuberculosis infection and incidence of tuberculin conversion among school contacts older than 5 years in the City of Buenos Aires. / Prevalencia de infección tuberculosa latente e incidencia de viraje tuberculínico en contactos escolares mayores de 5 años en la Ciudad Autónoma de Buenos Aires.

Introduction. Tuberculosis continues to be a common problem in settings of socioeconomic vulnerability. Our primary objective was to establish the prevalence of latent infection and tuberculin conversion among school contacts of tuberculosis cases. Population and methods. In a programmatic area in the south of the City of Buenos Aires, the prevalence of latent infection and tuberculin conversion was assessed in 691 children and adolescents using the tuberculin skin test. The association between loss to follow-up by the health care team and the demographic, school, and baseline care characteristics was studied, and the level of adherence when isoniazid chemoprophylaxis was indicated was described. Results. According to established definitions, the prevalence of latent infection was between 3.4% (95% confidence interval [CI]: 2.3-5.2) and 11.6% (95% CI: 9.3-14.4) in the 610 contacts with at least one skin test. The incidence of tuberculin conversion was between 0.3% and 6.8% in the 294 assessed participants. Age older than 18 years, a higher prevalence of unmet basic needs in the school district, attending the afternoon school shift, negative sputum smear results in the index case, and absence of baseline skin test were associated with contact lost to follow-up. Conclusions. The incidence of tuberculin conversion among school contacts was low. Adherence to isoniazid treatment remains limited. Factors associated with loss of contact tracing were identified, which may guide strategies necessary to improve this process.

Introducción. La tuberculosis continúa siendo un problema frecuente en contextos de vulnerabilidad socioeconómica. El objetivo principal fue establecer la prevalencia de infección latente y viraje tuberculínico en contactos escolares de casos de tuberculosis. Población y métodos. En un área programática del sur de la ciudad, se evaluó la prevalencia de infección y viraje tuberculínico de 691 niñas, niños y adolescentes utilizando la prueba cutánea de tuberculina. Se investigó la asociación entre pérdida de seguimiento por parte del equipo de salud y características demográficas, escolares y asistencia inicial, y se describió el grado de adherencia cuando la quimioprofilaxis con isoniacida fue indicada. Resultados. Según las definiciones consideradas, la prevalencia de infección latente fue entre el 3,4 % (IC95 %: 2,3-5,2) y el 11,6 % (IC95 %: 9,3-14,4) de los 610 contactos con al menos una prueba cutánea aplicada. La incidencia de viraje tuberculínico se encontró entre el 0,3 % y el 6,8 % de los 294 evaluados. La edad mayor de 18 años, la mayor prevalencia de necesidades básicas insatisfechas en la comuna escolar, la pertenencia al turno escolar vespertino, la negatividad en la baciloscopia del caso índice y la ausencia de aplicación de la prueba cutánea inicial se asociaron con pérdida de seguimiento del contacto. Conclusiones. La incidencia de viraje tuberculínico en contactos escolares fue baja. La adherencia a isoniacida continúa siendo limitada. Se identificaron factores asociados con la pérdida de seguimiento de contactos que podrían orientar estrategias necesarias para mejorar este proceso.

Modifications of auditory feedback and its effects on the voice of adult subjects: a scoping review. / Modificações do feedback auditivo e seus efeitos sobre a voz de indivíduos adultos: uma revisão de escopo.

INTRODUCTION: The auditory perception of voice and its production involve auditory feedback, kinesthetic cues and the feedforward system that produce different effects for the voice. The Lombard, Sidetone and Pitch-Shift-Reflex effects are the most studied. The mapping of scientific experiments on changes in auditory feedback for voice motor control makes it possible to examine the existing literature on the phenomenon and may contribute to voice training or therapies. PURPOSE: To map experiments and research results with manipulation of auditory feedback for voice motor control in adults. METHOD: Scope review following the Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) to answer the question: "What are the investigation methods and main research findings on the manipulation of auditory feedback in voice self-monitoring of adults?". The search protocol was based on the Population, Concept, and Context (PCC) mnemonic strategy, in which the population is adult individuals, the concept is the manipulation of auditory feedback and the context is on motor voice control. Articles were searched in the databases: BVS/Virtual Health Library, MEDLINE/Medical Literature Analysis and Retrieval System online, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS and WEB OF SCIENCE. RESULTS: 60 articles were found, 19 on the Lombard Effect, 25 on the Pitch-shift-reflex effect, 12 on the Sidetone effect and four on the Sidetone/Lombard effect. The studies are in agreement that the insertion of a noise that masks the auditory feedback causes an increase in the individual's speech intensity and that the amplification of the auditory feedback promotes the reduction of the sound pressure level in the voice production. A reflex response to the change in pitch is observed in the auditory feedback, however, with particular characteristics in each study. CONCLUSION: The material and method of the experiments are different, there are no standardizations in the tasks, the samples are varied and often reduced. The methodological diversity makes it difficult to generalize the results. The main findings of research on auditory feedback on voice motor control confirm that in the suppression of auditory feedback, the individual tends to increase the intensity of the voice. In auditory feedback amplification, the individual decreases the intensity and has greater control over the fundamental frequency, and in frequency manipulations, the individual tends to correct the manipulation. The few studies with dysphonic individuals show that they behave differently from non-dysphonic individuals.

INTRODUçÃO: A percepção auditiva da voz e sua produção envolvem o feedback auditivo, as pistas cinestésicas e o sistema de feedforward, os quais produzem efeitos distintos para a voz. Os efeitos Lombard, Sidetone e o Pitch-Shift-Reflex são os mais estudados. O mapeamento de experimentos científicos sobre as modificações do feedback auditivo para o controle motor da voz possibilita examinar a literatura existente sobre o fenômeno e pode contribuir para o treinamento ou terapias da voz. OBJETIVO: Mapear os experimentos e resultados das pesquisas com manipulação do feedback auditivo para o controle motor da voz de indivíduos adultos. MÉTODO: Revisão de escopo seguindo o Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) para responder à pergunta: "Quais os métodos de investigação e principais achados das pesquisas sobre a manipulação do feedback auditivo no automonitoramento da voz de indivíduos adultos?". O protocolo de busca foi baseado na estratégia mnemônica População, Conceito e Contexto (PCC). A população são os indivíduos adultos; o conceito é a manipulação do feedback auditivo e o contexto é o controle motor da voz. Os artigos foram pesquisados nas bases de dados: BVS/ Biblioteca Virtual em Saúde, MEDLINE/Medical Literature Analysis and Retrieval Sistem on-line, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS e WEB OF SCIENCE. RESULTADOS: Foram encontrados 60 artigos, sendo 19 da temática do Efeito Lombard, 25 do efeito Pitch-shift-reflex, 12 do efeito Sidetone e quatro sobre o efeito Sidetone/Lombard. Os estudos são concordantes que a inserção de um ruído que mascara o feedback auditivo provoca um aumento na intensidade de fala do indivíduo e que a amplificação do feedback auditivo promove a redução do nível de pressão sonora na produção da voz. Observa-se uma resposta reflexa à mudança de tom no feedback auditivo, porém, com características individuais em cada estudo. CONCLUSÃO: O material e método dos experimentos são distintos, não há padronizações nas tarefas, as amostras são variadas, muitas vezes reduzidas. A diversidade metodológica dificulta a generalização dos resultados. Os principais achados das pesquisas a respeito o feedback auditivo sobre o controle motor da voz confirmam que, na supressão do feedback auditivo, o indivíduo tende a aumentar a intensidade da voz. Na amplificação do feedback auditivo, o indivíduo diminui a intensidade e tem maior controle sobre a frequência fundamental e, nas manipulações da frequência, o indivíduo tende a corrigir a manipulação. Os poucos estudos com sujeitos disfônicos mostram que eles se comportam diferentemente dos não disfônicos.

Comparing photography and collection methods to sample litter in seabird nests in a coastal archipelago in the Southwest Atlantic.

Different methods are used to quantify and classify litter in seabird nests, such as the collection method (CM) and the photography method (PM). We compared the CM and PM in 195 brown booby (Sula leucogaster) nests breeding in a coastal archipelago in the state of Rio de Janeiro, Brazil. Photographs recorded 109 litter items in 44 nests (23% of nests), compared to 416 litter items in 82 nests (42%) by the CM. Pairwise comparison showed a significant difference in the variety and amount of litter items per nest, which was greater for CM (2.1 ± 1.1 categories, 2.13 ± 4.8 items) than for PM (1.5 ± 0.8 categories; 0.56 ± 1.6 items), in addition to a significant difference in the overall litter composition. The CM has been the most often used method to date. Although PM underestimates the amount and frequency of litter, we encourage its use when litter is abundant in nests and for threatened species.

Reliability of Contralateral Suppression in Evoked Distortion Product Otoacoustic Emissions.

Introduction Distortion product otoacoustic emissions (DPOAE) and their suppression may be considered useful in monitoring cochlear function and the efferent auditory pathway inhibitory effect. Nonetheless, the establishment of reliable parameters of response variations is of great importance. Objectives To verify the replicability of test and retest in the research of the inhibitory effect of the efferent pathway using contralateral suppressing stimulus during DPOAE recording for clinical applicability. Methods Cross-sectional study with 48 volunteers, aged 18 to 30 years, with normal audiometric thresholds. The procedures included were audiometric and immittance measures to overrule any conductive or sensorineural conditions and DPOAE recordings without and with contralateral suppression with a 60 dBHL white noise. Distortion product otoacoustic emissions amplitudes were analyzed and compared in both conditions with Wilcoxon test, and the Spearman correlation test was used to assess test-retest reliability. Results The comparative analysis showed differences between amplitudes in test and retest conditions only in 1,500 Hz for DPOAE measures with all other tested frequencies showing no differences, and no difference was observed in all recorded frequencies in the test and retest comparison for DPOAE suppression. The degree of correlation between test and retest of DPOAE amplitude was good at 6,000 Hz and strong (r > 0.880) at the other frequencies. For DPOAE with suppression, all frequencies presented strong correlation between test and retest: 1,500 Hz (r = 0.880), 2,000 Hz (r = 0.882), 3,000 Hz (r = 0.940), and 6,000 Hz (r = 0.957). Conclusions The study found good replicability in contralateral suppression of DPOAE with potential clinical applicability, and we recommend conducting the test from 2000Hz to higher frequencies for more reliable results.

Use of a Smartphone App for Cochlear Implant Patients With Tinnitus.

Purpose Smartphone apps for tinnitus relief are now emerging; however, research supporting their use and effectiveness is lacking. Research has shown that Tinnitus Therapy sounds intended for individuals with acoustic hearing provide relief to some patients using cochlear implants (CIs) with tinnitus. Here, we evaluated the use and acceptability of a smartphone app to help CI patients with tinnitus. Method Participants completed a laboratory trial (n = 19) and an at-home trial (n = 14) using the ReSound Tinnitus Relief app to evaluate its acceptability and effectiveness in reducing their tinnitus. During the laboratory trial, participants selected a sound that was most acceptable in managing their tinnitus (termed chosen sound). Word recognition scores in quiet were obtained before and after sound therapy. Participants were randomly assigned to one of two groups for the at-home trial, that is, AB or BA, using (A) the chosen sound for 2 weeks and (B) the study sound (i.e., broadband noise at hearing threshold) for another 2 weeks. Ratings were collected weekly to determine acceptability and effectiveness of the app in reducing tinnitus loudness and annoyance. Results Results indicated that some, but not all, participants found their chosen sound to be acceptable and/or effective in reducing their tinnitus. A majority of the participants rated the chosen sound or the study sound to be acceptable in reducing their tinnitus. Word recognition scores for most participants were not adversely affected using the chosen sound; however, a significant decrease was observed for three participants. All 14 participants had a positive experience with the app during the at-home trial on tests of sound therapy acceptability, effectiveness, and word recognition. Conclusions Sound therapy using a smartphone app can be effective for many tinnitus patients using CIs. Audiologists should recommend a sound and a level for tinnitus masking that do not interfere with speech perception.

Tinnitus Activities Treatment with Total and Partial Masking.

BACKGROUND: There are many counseling and sound therapy approaches to treat tinnitus. Counseling approaches range from providing information using directive or collaborative approaches. Sound therapies include strategies that use background sounds to totally or partially mask tinnitus to reduce the prominence of or decrease the loudness or annoyance of the tinnitus. PURPOSE: We evaluated the effectiveness of tinnitus activities treatment (TAT) in two groups, those without hearing aids (HA) and those who were provided with HA. In both groups, comparisons were made among those receiving (1) counseling only, (2) counseling and partial masking, and (3) counseling and total masking. RESEARCH DESIGN: Participants were provided with HA or not, based on their choice, and then randomly assigned to one of the three groups. The Tinnitus Handicap Questionnaire (THQ) was used as the primary measure. RESULTS: For those without HA, significant benefits were obtained for 8 out of 22 participants in the counseling group, 8 of 13 in the total masking group, and 8 of 24 in the partial mask group. The average decrease in the THQ was 15% for the counseling group, 25% for the total mask, and 14% for the partial masking group. For those with HA; significant benefits were obtained for 5 of 16 in the counseling group, 3 of 14 in the total mask group, and 6 of 13 in the partial mask group. The average decrease in the THQ score was 12% for counseling, 13% for total masking, and 16% for partial masking. No significant differences among groups were observed. CONCLUSION: Individual differences were large. Many benefited from their treatment, but some did not. We believe this was likely influenced by their expectations.

Effect of Tinnitus Habituation Therapy on Auditory Abilities.

Introduction Research with tinnitus patients presenting with hearing loss and normal hearing subjects have verified that tinnitus interferes with auditory processing. One treatment option for this symptom consists of tinnitus habituation therapy. Objective To determine the influence of tinnitus habituation therapy on auditory abilities, on the self-perception of tinnitus regarding loudness and discomfort, and its impact on the quality of life. Methods A quasi-experimental study was conducted with 19 individuals with tinnitus. Audiological tinnitus and auditory processing evaluations were performed. Subsequently, the volunteers underwent tinnitus habituation therapy for 6 months. Ultimately, all of the individuals were reevaluated. Results A statistically significant reduction in tinnitus self-perception was observed in relation to loudness, discomfort, and its impact on the quality of life ( p = 0.001, 0.001, 0.023, respectively). However, the influence of tinnitus habituation therapy on auditory abilities was not verified. Conclusion Tinnitus habituation therapy was effective in reducing the self-perception of tinnitus loudness and discomfort, as well as the impact of the symptom on the quality of life. However, these factors did not improve the auditory processing skills in tinnitus patients.

Increased Incidence of Tinnitus Following a Hyperthyroidism Diagnosis: A Population-Based Longitudinal Study.

Background: An association between thyroid disease and tinnitus has been described previously but further longitudinal, population-based studies are limited. Objective: To investigate the incidence of tinnitus in patients with hyperthyroidism in a national sample, and to identify risk level and associated factors for tinnitus in hyperthyroidism patients. Design: Retrospective cohort study. Patient data were collected from the Longitudinal Health Insurance Database (LHID 2000), which includes national claims data of patient expenditures for admissions or ambulatory care from 1996 to 2011. Setting: Taiwan hospitals and clinics providing healthcare nationwide. Participants: Patients aged 20 years and older with newly diagnosed hyperthyroidism (ICD-9-CM code 242) between 2000-2010 were selected as the study cohort. Hyperthyroidism patient cohort were identified from the LHID2000. Those with tinnitus history (ICD-9-CM code 388.3) before the index date (first hyperthyroidism diagnosis), younger than 20 years, and with incomplete demographic data were excluded. The non-hyperthyroidism cohort included patients with no history of hyperthyroidism and no documented tinnitus. Main Outcomes and Measures: Incidence of tinnitus was the primary outcome. Baseline demographic factors and comorbidities possibly associated with tinnitus, including age, sex, and comorbidities of hearing loss, vertigo, insomnia and anxiety, were retrieved from the LHID 2000. Patients were followed until end of 2011. Results: During the study period, 780 (4.9%) hyperthyroidism patients and 2007 (3.2%) non-hyperthyroidism controls developed tinnitus. Incidence rate of tinnitus in the hyperthyroidism cohort was significantly higher in hyperthyroidism cohort (7.86 vs. 5.05 per 1000 person-years) than that in non-hyperthyroidism cohort. A higher proportion of patients with hyperthyroidism had comorbid insomnia (45.1% vs. 30.9%) and anxiety (14.0% vs. 5.73%) than those without hyperthyroidism. After adjusting for age, gender and comorbidities (vertigo, insomnia, anxiety, hearing loss), hyperthyroidism patients had 1.38-fold higher risk of tinnitus (95% CI = 1.27-1.50) than those without hyperthyroidism. Conclusions: This large population-based study suggests patients with diagnosed hyperthyroidism was more prone to develop tinnitus. Our findings suggest evaluation for comorbid vertigo, insomnia, anxiety and/or hearing loss may identify patients who are at high risk of developing tinnitus in patients with hyperthyroidism.

Comparison of Speech Recognition in Cochlear Implant Users with Different Speech Processors.

BACKGROUND: Speech recognition in noisy environments is a challenge for both cochlear implant (CI) users and device manufacturers. CI manufacturers have been investing in technological innovations for processors and researching strategies to improve signal processing and signal design for better aesthetic acceptance and everyday use. PURPOSE: This study aimed to compare speech recognition in CI users using off-the-ear (OTE) and behind-the-ear (BTE) processors. DESIGN: A cross-sectional study was conducted with 51 CI recipients, all users of the BTE Nucleus 5 (CP810) sound processor. Speech perception performances were compared in quiet and noisy conditions using the BTE sound processor Nucleus 5 (N5) and OTE sound processor Kanso. Each participant was tested with the Brazilian-Portuguese version of the hearing in noise test using each sound processor in a randomized order. Three test conditions were analyzed with both sound processors: (i) speech level fixed at 65 decibel sound pressure level in a quiet, (ii) speech and noise at fixed levels, and (iii) adaptive speech levels with a fixed noise level. To determine the relative performance of OTE with respect to BTE, paired comparison analyses were performed. RESULTS: The paired t-tests showed no significant difference between the N5 and Kanso in quiet conditions. In all noise conditions, the performance of the OTE (Kanso) sound processor was superior to that of the BTE (N5), regardless of the order in which they were used. With the speech and noise at fixed levels, a significant mean 8.1 percentage point difference was seen between Kanso (78.10%) and N5 (70.7%) in the sentence scores. CONCLUSION: CI users had a lower signal-to-noise ratio and a higher percentage of sentence recognition with the OTE processor than with the BTE processor.

Programming a Cochlear Implant for Tinnitus Suppression.

BACKGROUND: Electrical stimulation of the cochlea to treat tinnitus has been explored for decades. However, few studies have investigated the most salient programming parameters for tinnitus suppression in cochlear implant (CI) patients. PURPOSE: The purpose of this study was to review the available CI programming parameters for tinnitus suppression and to consider possible clinical research designs for selecting the optimal programming parameters for CI patients. RESULTS: Across research studies, the optimal parameters vary significantly and are often based on data fromonly a fewparticipants. Electrical stimulation using lowand high rates, different electrode numbers, and low T-levels were helpful in suppressing tinnitus, although more research is needed from a greater number of CI patients. Possible designs for evaluating these parameters in a clinical setting are presented. CONCLUSIONS: Programming a CI to reduce the prominence of tinnitus is complex, and audiologists should consider adjusting CI parameters systematically for CI patients with bothersome tinnitus.

Complaints of People with Hyperacusis.

BACKGROUND: Hyperacusis is a prevalent auditory disorder that causes significant distress and negatively affects quality of life for many patients. Patients with hyperacusis often have different complaints about the sounds and situations that they experience. Audiologists may have few patients with hyperacusis, and a limited understanding of the sounds and situations that are reported to be challenging by their patients. PURPOSE: To investigate the common complaints reported by hyperacusis patients. RESEARCH DESIGN: A qualitative study was conducted with 11 hyperacusis patients who participated in a group session. RESULTS: All 11 hyperacusis patients experienced negative reactions to specific sounds. In addition, many patients reported physical symptoms such as headaches, balance problems, dysosmia (strong smell problems), and light sensitivity. Sounds that induced discomfort were wide ranging and included low-frequency sounds, high-frequency sounds, wide-band noise, and sudden, high-intensity sounds. Most patients (9/11, 81.8%) reported negative reactions to music in loud rock concerts. Patients reported that stress/tension (90.9%) worsened their hyperacusis, while removing themselves from noise (90.9%) relieved their hyperacusis. CONCLUSION: Loudness is only one of the many factors related to the discomfort of patients with hyperacusis. Across patients, we observed that there were different complaints about the sounds and situations that produced difficulty due to hyperacusis. Physical symptoms following sound exposure were also reported by the patients, suggesting that hyperacusis is a complex disorder and requires intervention that often involves multiple members of the medical team.

An Exploratory Step Toward Measuring the "Meaning of Life" in Patients with Tinnitus and in Cochlear Implant Users.

BACKGROUND: Many questionnaires attempt to quantify the "quality of life." However, we believe understanding the quality of life is complex, and many widely used questionnaires do not capture the broad range of factors that we believe are important. Many do not include questions about communicating. PURPOSE: We developed a preliminary questionnaire designed to measure "The Meaning of Life" from a broader perspective. RESEARCH DESIGN: We reviewed other scales and sought input from individuals with disabilities and developed an initial 23-item questionnaire. STUDY SAMPLE: As a first step, we sampled 116 adults with tinnitus and 196 with cochlear implants (CIs). Individuals who were participating in our CI or tinnitus research programs participated. DATA COLLECTION AND ANALYSIS: To compare differences between the two participant groups, independent sample f-tests were completed for specific items on the questionnaire and for the total score. We compared age and gender differences across all participants using f-tests. Statistical significance was defined as p < 0.05. An exploratory factor analysis was conducted to examine the relationship among the questionnaire items using oblique rotation to produce correlated factors. Extracted factors with an eigenvalue >1.0 were retained according to the Kaiser-Guttman rule. RESULTS: Four factors were prominent in this initial sample, which we labeled (1) friendship and positive outlook, (2) physical health, (3) hearing and mental health, and (4) satisfaction with life. Participants with tinnitus reported more trouble sleeping than participants with CI, whereas both groups had lower scores on hearing. Older patients reported more difficulty with remembering things but were more satisfied with their financial situation. Female participants reportedly had more hobbies and were more satisfied with their sex lives than male participants. CONCLUSIONS: This exploratory study intended to take a broader look at quality of life scales. Further work is needed with a larger sample including younger and older participants with and without disabilities.

Tinnitus Sound Therapy Trial Shows Effectiveness for Those with Tinnitus.

BACKGROUND: It is well accepted among clinicians that maskers and hearing aids combined with counseling are generally helpful to tinnitus patients, but there are few controlled studies exploring the efficacy of maskers alone to decrease the prominence of tinnitus. PURPOSE: We investigated the benefit of maskers for patients with chronic, bothersome tinnitus. RESEARCH DESIGN: Crossover single-participant design, where each participant served as their own control. STUDY SAMPLE: 18 adults with subjective, nonpulsatile, sensorineural tinnitus. INTERVENTION: Participants participated in two six-week trials: one with sound therapy and one without. No counseling was provided in either group. Masking devices were fit with sounds intended to reduce the tinnitus prominence. DATA COLLECTION AND ANALYSIS: Participants rated tinnitus loudness, tinnitus annoyance, and acceptability of the background sounds using a numeric 0-100 interval scale and completed the Tinnitus Primary Functions Questionnaire (TPFQ). RESULTS: Three participants dropped out. On the total score of the TPFQ, 5 of 15 remaining participants (33%) showed a benefit. Using a derived score based on functions showing a handicap before the study, maskers benefit was observed in the areas of sleep (five of nine), hearing (three of eight), thoughts and emotions (three of four), and concentration (four of eight). The TPFQ and annoyance data complemented each other well. CONCLUSIONS: This study demonstrates the benefit of partial masking, encouraging patients to seek help from audiologists interested in providing support for tinnitus patients.

Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research.

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2-3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation (r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

Alterations in early auditory evoked potentials in multiple sclerosis patients.

UNLABELLED: Alterations in early auditory evoked potentials (EAEP) in individuals with demyelinating disease are suggestive of lesions in the brainstem. AIM: this study aims to evaluate the prevalence of hearing disorders and altered EAEP in multiple sclerosis (MS) patients. MATERIALS AND METHOD: sixteen female and nine male patients with a defined diagnosis of multiple sclerosis took part in this study. All individuals underwent hearing and EAEP tests. The wave forms were categorized according to Jerger (1986). RESULTS: fifty EAEP tests were carried out; 70% were classified as type I (normal response) according to Jerger's criteria. Altered EAEP results in at least one ear were classified into types II, III, IV or V according to Jerger. Females accounted for 31.25% of alterations, and males 44.44%, adding up to 36% of all cases. CONCLUSIONS: these findings stress the importance of looking at EAEP in cases where there is suspicion of demyelinating disease and in patients with a defined diagnosis for MS.