Ten Years Follow Up of Patients with Tinnitus and Normal Hearing.

OBJECTIVE: To describe the natural history of tinnitus in normal hearing patients. STUDY DESIGN: This is a prospective longitudinal observational study. SETTING: Tertiary University Hospital. METHODS: In 2009 we studied 68 patients with significant tinnitus and normal hearing (Study Group-SG) compared to 46 patients with normal hearing and no tinnitus (Control Group-CG). We have been able to contact and recruit 24 patients from SG (35.3 %) and ten patients from CG) (21.74%) in 2019. Both groups were submitted to conventional audiometry, Distortion Product Otoacoustic Emissions (DPOAE), Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) and Beck`S Depression and Anxiety Scales (BDS, BAS). These measures were compared with the same ones performed ten years ago in the same groups of patients. The software SPSS for windows version 21 was used. P values <0.05 were considered significant. Student t test was used to compare SG and CG results in 2019 and to compare 2009 and 2019 outcomes.. RESULTS: Hearing loss, especially in the higher frequencies, were significantly worse in SG compared to GC in 2019. DPOAE were significantly worse in SG and CG in 2019 however CG had more abnormal results than SG. These results suggest that outer hair cells lesions are not the only determinant for tinnitus and hearing loss development. CONCLUSIONS: These results suggest that outer hair cells lesions are not the only determinant for tinnitus and hearing loss development.

Impact of mass-screening on tuberculosis incidence in a prospective cohort of Brazilian prisoners.

BACKGROUND: Globally, prison inmates are a high-risk population for tuberculosis (TB), but the specific drivers of disease and impact of mass screening interventions are poorly understood. METHODS: We performed a prospective cohort study to characterize the incidence and risk factors for tuberculosis infection and disease in 12 Brazilian prisons, and to investigate the effect of mass screening on subsequent disease risk. After recruiting a stratified random sample of inmates, we administered a questionnaire to ascertain symptoms and potential risk factors for tuberculosis; performed tuberculin skin testing (TST); collected sera for HIV testing; and obtained two sputum samples for smear microscopy and culture, from participants reporting a cough of any duration. We repeated the questionnaire and all tests for inmates who remained incarcerated after 1 year. TST conversion was defined as TST ≥10 mm and an induration increase of at least 6 mm in an individual with a baseline TST <10 mm. Cox proportional hazard models were performed to identify risk factors associated with active TB. To evaluate the impact of screening on subsequent risk of disease, we compared TB notifications over one year among individuals randomized to screening for active TB with those not randomized to screening. RESULTS: Among 3,771 inmates recruited, 3,380 (89.6 %) were enrolled in the study, and 1,422 remained incarcerated after one year. Among 1,350 inmates (94.9 %) with paired TSTs at baseline and one-year follow-up, 25.7 % (272/1060) converted to positive. Among those incarcerated for the year, 10 (0.7 %) had TB at baseline and 25 (1.8 %) were diagnosed with TB over the subsequent year. Cases identified through active screening were less likely to be smear-positive than passively detected cases (10.0 % vs 50.9 %; p < 0.01), suggesting early case detection. However, there was no reduction in subsequent disease among individuals actively screened versus those not screened (1.3 % vs 1.7 %; p = 0.88). Drug use during the year (AHR 3.22; 95 % CI 1.05-9.89) and knows somebody with TB were (AHR 2.86; 95 % CI 1.01-8.10) associated with active TB during one year of follow up CONCLUSIONS: Mass screening in twelve Brazilian prisons did not reduce risk of subsequent disease in twelve Brazilian prisons, likely due to an extremely high force of infection. New approaches are needed to control TB in this high-transmission setting.