Uma reflexão sobre as conexões entrea fonoaudiologia e Saúde Única / A reflection on the connections betweenspeech therapy and One Health

A Saúde Única é uma crescente abordagem sistêmica para aumentar indissociavelmente os níveis de saúde das pessoas, dos animais e do ambiente no planeta. Por sua característica interdisciplinar e multidisciplinar, a Saúde Única tem arregimentado cada vez mais novos agentes na área de saúde, ampliando novas fronteiras de prática profissional. Objetivo: tendo em vista de que a abordagem sistêmica da Saúde Única (One Health) é holística, objetivou-se descrever e refletir sobre o papel da fonoaudiologia nesse contexto. Métodos: fez-se uma revisão de escopo sobre as ligações da fonoaudiologia com as desordens de saúde que são o foco em Saúde Única. Realizou-se uma procura de artigos nas plataformas PubMed e SciELO, com a combinação booleana dos indexadores "fonoaudiologia" e "Saúde Única", em idioma português; e as palavras "speech-language therapy" e "One Health" em idioma inglês. O operador booleano foi "E" e "AND". Adicionalmente, procurou-se teses e dissertações com esses mesmos operadores e combinações no Catálogo de Teses e Dissertações da CAPES. Analisou-se os dados por uma abordagem qualitativa, por isso os métodos estatísticos não foram aplicados. A partir dessa abordagem, complementou-se a argumentação com uma reflexão crítica sobre a inclusão da fonoaudiologia na estratégia de Saúde Única. Resultados: apenas na plataforma SciELO encontrou-se cinco obras com os descritores e a combinação "Saúde Única AND fonoaudiologia"; esse resultado é fortemente sugestivo de que o profissional em fonoaudiologia não tem sido incluído como um agente na abordagem Saúde Única. Contrariando esse cenário, argumenta--se que a fonoaudiologia pode preencher um nicho de trabalho e atuação acadêmica na abordagem de Saúde Única, cujo foco são desordens de saúde que podem resultar em distúrbios da comunicação nas pessoas. Considerações finais: há um nicho para a fonoaudiologia na abordagem da Saúde Única para a prevenção, o tratamento e a investigação científica das desordens da comunicação humana.

One Health is a growing systemic approach aimed at increasing the health levels of people, animals and the environment on the planet. Due to its inter- and multidisciplinary characteristics, One Health has been recruiting an increasing number of new agents in the health area, expanding new frontiers of professional practice. Objective: considering that the systemic approach of One Health is holistic, the objective is to describe and reflect on the role of speech therapy in this context. Methods: a scoping review was conducted to explore the connections between speech therapy and the health disorders that are the focus of One Health. A search for articles was carried out on the PubMed and SciELO platforms, using the Boolean combination of the terms "fonoaudiologia" (speech therapy) and "Saúde Única" (One Health), in Portuguese; and the words "speech-language therapy" and "One Health" in English using the Boolean operator "E" and "AND". Additionally, we searched for theses and dissertations with these same operators and combinations, in the CAPES Catalog of Theses and Dissertations. The data was analyzed using a qualitative approach, therefore statistical methods were not applied. Based on this approach, the argument was complemented with a critical reflection on the inclusion of speech therapy in the One Health strategy. Results: five works were found on the SciELO platform using the descriptors and combination "Saúde Única AND fonoaudiologia". This result suggests that the speech therapy professional has not been included as an agent in the One Health approach. Contrary to this scenario, it is argued that speech therapy can play a significant professional and academic role in One Health, which focuses on health disorders that may result in communication disorders. Final considerations: there is a niche for speech therapy in the One Health approach to the prevention, treatment and scientific investigation of human communication disorders.

Association between BMI and health-related physical fitness in adolescents with hearing impairment in China: a cross-sectional study.

Background: This cross-sectional study aimed to address a critical gap in the understanding of the association between body mass index (BMI) and physical fitness levels in adolescents with hearing impairment (HI) in China. This study investigated how different BMI levels impact the physical fitness index (PFI) of HI adolescents. Methods: This study employed a physical fitness test for HI adolescents attending special education schools. The test included eight components: height, weight, 50-m sprint, standing long jump, sit and reach, endurance run, bent-knee sit-up (for girls), and pull-up (for boys). Test scores for each student were standardized by age and gender. Individual Z-scores were then calculated, and the sum of these Z-scores constituted the PFI. Logistic regression was used to analyze the relationship between BMI and PFI across different gender and age groups. Statistical significance was set at P < 0.05. Results: The linear regression model showed an inverted U-shaped relationship between BMI and PFI. At the same BMI level, boys exhibited superior physical fitness compared to girls with the same BMI (P < 0.05). Statistically significant differences in PFI levels were observed between normal-weight and obese males, as well as between underweight and obese boys (P < 0.05). In the 13-15 and 16-18 age groups, the increase in BMI has a greater impact on boys PFI than on girls. Conclusions: Adolescents with HI generally demonstrated good physical fitness. Compared to individuals with normal weight, those who were underweight, overweight, or obese exhibited lower levels of physical fitness. Future interventions should focus on adolescents with HI with abnormal BMI.

Occupational health disorders among physical education teachers compared to classroom and subject specialist teachers.

During the course of their work, teachers may be subjected to conditions that cause different health problems. This study examines occupational health disorders in a representative sample of 858 teachers (528 female; age 44.0 ± 9.67 years) divided into three groups of teachers with specific occupational requirements: specialist physical education teachers (specialist PETs), classroom teachers, and specialist teachers. The number of health disorders in the last 12 months was recorded using the Chronic Health Disorders Questionnaire. The differences between the different types of teachers, controlled for sex and age, were analyzed using binary logistic regression. The results showed that 89% of teachers experienced colds as the most frequently reported health problem, followed by 58% for lower back problems, 57% for headaches, 51% for hoarseness, and 43% for neck problems. A binary logistic regression showed that specialist PETs were the group with the highest health risk. They were about twice as likely to have musculoskeletal or hearing disorders than the other two groups of teachers. They were also significantly more likely to suffer from hoarseness. Understanding these different health challenges is critical to developing targeted interventions and robust support systems. These interventions should include initiatives aimed at raising awareness of health risk factors, implementing injury interventions and vocal cord hygiene programs, making ergonomic adjustments, and promoting awareness of self-care (both mental and physical). Given that the teaching profession is currently struggling with an aging workforce and a shortage of teachers, addressing these challenges is critical to the continued well-being of the teaching professionals.

Tinnitus update: what can be done for the ringing?

Physicians will frequently encounter patients who report tinnitus. Tinnitus is a symptom whereby there is the perception of sound or sounds in the ear or head in the absence of an external source of sound. Most individuals experiencing tinnitus will have a neutral reaction to the percept, but in a small proportion of patients, tinnitus can be a debilitating symptom. When it causes burden, patients can be affected in multiple different facets of life, including impairment in sleep, hearing cognition and psychological and psychiatric well-being, often resulting in high healthcare utilisation and societal costs. Hence, chronic, disabling tinnitus is a complex condition with multifactorial causes and multiple perpetuating biopsychosocial factors. Despite efforts to increase knowledge about its pathophysiology and research into treatments, little impact on real-world clinical practice has been seen. There are no proven effective pharmacological treatments or complementary medicines specifically for chronic, disabling tinnitus. Despite this, there is a role for treating this condition through a multidisciplinary approach specifically targeting comorbid active psychiatric conditions, using hearing aids in appropriate clinical settings such as in those with a coassociated confirmed hearing loss, and specialised cognitive behavioural therapy for patients reporting bothersome tinnitus. Cognitive behavioural therapy remains the most valuable evidence-based intervention in this regard. This narrative review attempts to summarise the current understanding in terms of pathophysiology, assessment and treatment of tinnitus for the internal physician who may encounter patients with disabling, chronic tinnitus.

[Rational timepoint of medical rehabilitation in chronic tinnitus : Applying for rehabilitation options for a chronic course]. / Sinnvoller Zeitpunkt medizinischer Rehabilitation bei Tinnitus : Beantragung von Rehabilitationsmöglichkeiten bei chronischem Verlauf.

Chronic tinnitus is a common symptom of the auditory system. A causal therapy does not yet exist. The recommended treatment includes expert counseling, psychotherapeutic interventions, particularly cognitive behavioral therapy, and measures to improve hearing. The treatment modules are multimodal and can be combined individually. Depending on the severity of the different disease dimensions (tinnitus and comorbidities), a rehabilitative approach may be useful for maintaining health and occupational ability. In addition to a thorough and well-founded diagnosis and counseling, specific cognitive behavioral therapy and non-specific psychotherapeutic interventions (mindfulness/relaxation) on an individual or group basis, physiotherapy, and exercise, as well as auditory rehabilitation measures (hearing aids, auditory therapy) in the context of multimodal therapy approaches are necessary.

REVISITING TINNITUS AUDIOLOGICAL REHABILITATION

Current research shows tinnitus as more than an auditory phenomenon, but an emotional and cognitive dimension experience. Besides issues involving tinnitus perception and reaction, there is a third dimension: cognition. Both audiological assessment and rehabilitation need to follow these principles and be more comprehensive. The use of sounds to treat tinnitus is described in several papers and has different purposes. It includes hearing aid fitting if hearing loss is detected and the use of sound generator devices. But there are some cases in that hearing loss rehabilitation is not enough and cases of tinnitus and/or sound intolerance suffering without detectable hearing loss in conventional measures. There is no exclusive way for tinnitus patients' auditory rehabilitation. Based on theoretical proposals and literature, we suggest possibilities of intervention to be even more explored and personally adapted for tinnitus patients: cognitive auditory training and the use of mindfulness-based exercises, sound stimulation during sleep, and restoring the pleasure of listening.

Relationship Between Chloroquine or Hydroxychloroquine Use and Hearing Disorders: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Chloroquine and its analog hydroxychloroquine are derivatives of 4-aminoquinoline and are regularly used in the treatment of malaria and autoimmune diseases. Among the side effects of these drugs, alterations associated with the auditory system are frequently mentioned. Thus, the aim of this systematic review is to systematically review publications on hearing disorders and chloroquine or hydroxychloroquine use. MATERIALS AND METHODS: Inclusion criteria were observational or interventional studies on audiological assessment in participants who were using chloroquine or hydroxychloroquine. The methodological quality was independently assessed by two reviewers using the Meta-Analysis of Statistics: assessment and review Instrument. The certainty of the evidence was assessed using the GRADE tool. RESULTS: A total of 1,372 non-duplicate papers were screened, out of which 17 were included in the final qualitative synthesis, and 5 studies in the meta-analysis. The odds ratio for the two subgroups evaluated did not show significance with no heterogeneity between the effects observed between the different diseases (I2=0%) and obtaining the global estimate of 0.76 (95% confidence interval [CI]=0.41-1.39; p>0.05). Despite the inclusion of papers with different disease samples, the heterogeneity observed in the analysis was low (I2= 0%) and prediction interval (95% PI=0.32-1.80; p>0.05) remained close to that estimated by the CI (95% CI=0.41-1.39; p>0.05). The certainty of the evidence assessed by the GRADE tool was considered very low due to the risk of bias, indirect evidence, and imprecision. CONCLUSIONS: The findings of this study suggest that the use of chloroquine/hydroxychloroquine is not associated with hearing disorders.

Speech perception in modulated noise assessed in bimodal CI users.

BACKGROUND: Although good speech perception in quiet is achievable with cochlear implants (CIs), speech perception in noise is severely impaired compared to normal hearing (NH). In the case of a bimodal CI fitting with a hearing aid (HA) in the opposite ear, the amount of residual acoustic hearing influences speech perception in noise. OBJECTIVE: The aim of this work was to investigate speech perception in noise in a group of bimodal CI users and compare the results to age-matched HA users and people without subjective hearing loss, as well as with a young NH group. MATERIALS AND METHODS: Study participants comprised 19 bimodal CI users, 39 HA users, and 40 subjectively NH subjects in the age group 60-90 years and 14 young NH subjects. Speech reception thresholds (SRTs) in noise were adaptively measured using the Oldenburg Sentence Test for the two spatial test conditions S0N0 (speech and noise from the front) and multisource-noise field (MSNF; speech from the front, four spatially distributed noise sources) in continuous noise of the Oldenburg Sentence Test (Ol-noise) and amplitude-modulated Fastl noise (Fastl-noise). RESULTS: With increasing hearing loss, the median SRT worsened significantly in all conditions. In test condition S0N0, the SRT of the CI group was 5.6 dB worse in Ol-noise than in the young NH group (mean age 26.4 years) and 22.5 dB worse in Fastl-noise; in MSNF, the differences were 6.6 dB (Ol-noise) and 17.3 dB (Fastl-noise), respectively. In the young NH group, median SRT in condition S0N0 improved by 11 dB due to gap listening; in the older NH group, SRTs improved by only 3.1 dB. In the HA and bimodal CI groups there was no gap listening effect and SRTs in Fastl-noise were even worse than in Ol-noise. CONCLUSION: With increasing hearing loss, speech perception in modulated noise is even more impaired than in continuous noise.

Interventions against hearing loss as an integral component of successful tinnitus therapy.

Tinnitus very often develops from acute or chronic hearing loss, mainly inner ear deafness. The frequency of the tinnitus mostly corresponds to the frequency range of the hearing loss and is enhanced by down-regulation of inhibition in the central auditory pathway for these frequencies, in addition to focused attention and enhanced arousal for the disturbing sound. Therefore, interventions to improve hearing such as mid-ear surgery or-more often-electronic devices including hearing aids or cochlear implants (CI) are important for the treatment of tinnitus. In this review, the current German S3 guideline "Chronic tinnitus" and recent literature are discussed.

Does a patient with acquired arbovirus infection have a hearing impairment? A scoping review of hearing changes in an adult with Dengue, Chikungunya, and Zika.

OBJECTIVES: To identify and understand the evidence regarding hearing changes related to acquired Dengue, Chikungunya, and Zika virus infection in adult individuals. METHODS: A scoping review was performed according to the recommendations of The Joanna Briggs Institute and guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in the Embase, PubMed/Medline, ScienceDirect, Scopus, and Web of Science databases without restriction on language and year of publication. Case studies, observational studies, and clinical trials reporting hearing loss in adult subjects (>18-60 years of age) of both sexes with DENV, CHIKV, or ZIKV diagnosed by positive molecular/serological examination by RT-PCR or IgM/IgG by ELISA method were included. RESULTS: Thirteen studies met the inclusion criteria and were selected for review. The occurrence of auditory symptoms caused by arboviroses and the presence of permanent or transient sensorineural hearing loss was variable in adults. CONCLUSIONS: Dengue, Chikungunya, and Zika infections in adults are associated with a variety of auditory symptoms. The frequency of permanent or transient sensorineural hearing loss is low but not negligible.

Influence of depressive disorders, stress, and personality traits on quality of life after cochlear implantation.

PURPOSE: This study aimed to determine whether preoperative depressiveness, stress, and personality influence quality of life (QOL) after cochlear implant (CI) surgery. METHODS: In this prospective study, 79 patients undergoing CI surgery were evaluated preoperatively and 12 months postoperatively. Disease-specific QOL was assessed with the Nijmegen Cochlear Implant Questionnaire (NCIQ) and general QOL with the WHOQOL-BREF. Depressiveness and stress were assessed with the Patient Health Questionnaire (PHQ-D). The Charlson Comorbidity Index (CCI) was used to classify comorbidities. The Big Five Personality Test (B5T) was used to assess the basic personality dimensions. Speech comprehension was evaluated in quiet with the Freiburg monosyllable test and in noise with the Oldenburg sentence test. RESULTS: After CI surgery, the total NCIQ score improved significantly (Δ 17.1 ± 14.7, p < 0.001). General QOL (WHOQOL-BREF, Δ 0.4 ± 9.9, p = 0.357), stress (Δ 0.25 ± 3.21, p = 0.486), and depressiveness (Δ 0.52 ± 3.21, p = 0.121) were unaffected by CI surgery. Patients without elevated depressiveness (p < 0.01) or stress (p < 0.001) had significantly better total NCIQ scores. The results of the multiple regression analyses show that, after adjusting for the CCI, personality, age, and mental health stress (ß = - 0.495, p < 0.001) was significantly associated with postoperative NCIQ outcome scores. Depressiveness and neuroticism had the strongest influence on the generic QOL (ß = - 0.286 and ß = - 0.277, p < 0.05). CONCLUSION: Stress symptoms and personality traits are significant predictive factors for disease-specific QOL, as well as hearing status. This should be considered in the preoperative consultation and in optimizing the rehabilitation process.

Does a patient with acquired arbovirus infection have a hearing impairment? A scoping review of hearing changes in an adult with Dengue, Chikungunya, and Zika

Abstract Objectives To identify and understand the evidence regarding hearing changes related to acquired Dengue, Chikungunya, and Zika virus infection in adult individuals. Methods A scoping review was performed according to the recommendations of The Joanna Briggs Institute and guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews in the Embase, PubMed/Medline, ScienceDirect, Scopus, and Web of Science databases without restriction on language and year of publication. Case studies, observational studies, and clinical trials reporting hearing loss in adult subjects (>18-60 years of age) of both sexes with DENV, CHIKV, or ZIKV diagnosed by positive molecular/serological examination by RT-PCR or IgM/IgG by ELISA method were included. Results Thirteen studies met the inclusion criteria and were selected for review. The occurrence of auditory symptoms caused by arboviroses and the presence of permanent or transient sensorineural hearing loss was variable in adults. Conclusions Dengue, Chikungunya, and Zika infections in adults are associated with a variety of auditory symptoms. The frequency of permanent or transient sensorineural hearing loss is low but not negligible.

Síntomas óticos y síndrome del dolor miofascial en musculatura temporomandibular y esternocleidomastoideo: Estudio de un caso / Otic symptoms and myofascial pain syndrome in temporomandibular and sternocleidomastoid musculature: A case study

Introducción El dolor de oído y la alteración de la audición son motivos de consulta muy frecuentes. El dolor de oído referido puede deberse a alteraciones temporomandibulares y puntos gatillo en la musculatura cervical. La hipoacusia se relaciona con la presencia de puntos gatillo en musculatura cervical y mandibular. Aunque se han observado efectos beneficiosos sobre esta musculatura tras la utilización de terapia manual y punción seca, la literatura al respecto sigue siendo escasa, motivo por que se realizó el actual estudio. Objetivo Conocer los efectos de un tratamiento basado en la técnica suiza y punción seca en la musculatura temporomandibular y esternocleidomastoideo a corto plazo sobre el dolor de oído e hipoacusia, en una paciente de 24 años. Material y métodos Estudio de un caso. Se realizó una valoración previa al tratamiento y otra al finalizar para valorar sus efectos, mediante audiometría y escala visual analógica. Se programó una sesión de 50 min, semanalmente, durante cuatro semanas. Durante el tratamiento se aplicó la técnica suiza y punción seca en cinco músculos de la región mandibular y cervical. Resultados Tras cuatro sesiones de tratamiento se observó una mejora del dolor de la paciente y se evidenció una recuperación de la audición. Conclusiones Una intervención basada en la técnica suiza y punción seca para el tratamiento del síndrome de dolor miofascial de la musculatura temporomandibular y esternocleidomastoideo puede ser útil para mejorar alteraciones de la audición. Se sugiere la realización de ensayos clínicos aleatorizados que evalúen esta técnica (AU)

Introduction Ear pain and hearing impairment is a frequent medical consultation. Referred ear pain may be due to temporomandibular disorders and the presence of trigger points in the cervical musculature. Hearing loss is related to the presence of trigger points in the cervical and mandibular muscles. Although beneficial effects have been observed on this musculature after the use of manual therapy and dry needling, the literature on the matter is still scarce, which is why the current study was carried out. Objective To know the short-term effects of a treatment based on the Swiss technique and dry needling on the temporomandibular and sternocleidomastoid muscles on ear pain and hearing loss, in a female 24-year-old patient. Material and methods Case study. An assessment was carried out before the treatment and another at the end to evaluate its effects. A 50-minute session was held weekly for 4 weeks. During treatment, the Swiss technique was applied to 5 muscles of the mandibular and cervical region. Results After 4 treatment sessions an improvement in the patient's pain was observed and a hearing recovery was evidenced. Conclusions An intervention based on the Swiss technique and dry needling in the treatment of myofascial pain syndrome of the temporomandibular and sternocleidomastoid muscles may be useful in improving hearing disorders and otalgia. Randomized clinical trials evaluating this technique are suggested (AU)

Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation.

Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.

Cochlear-optimized treatment planning in photon and proton radiosurgery for vestibular schwannoma patients.

Objective: To investigate the potential to reduce the cochlear dose with robotic photon radiosurgery or intensity-modulated proton therapy planning for vestibular schwannomas. Materials and Methods: Clinically delivered photon radiosurgery treatment plans were compared to five cochlear-optimized plans: one photon and four proton plans (total of 120). A 1x12 Gy dose was prescribed. Photon plans were generated with Precision (Cyberknife, Accuray) with no PTV margin for set-up errors. Proton plans were generated using an in-house automated multi-criterial planning system with three or nine-beam arrangements, and applying 0 or 3 mm robustness for set-up errors during plan optimization and evaluation (and 3 % range robustness). The sample size was calculated based on a reduction of cochlear Dmean > 1.5 Gy(RBE) from the clinical plans, and resulted in 24 patients. Results: Compared to the clinical photon plans, a reduction of cochlear Dmean > 1.5 Gy(RBE) could be achieved in 11/24 cochlear-optimized photon plans, 4/24 and 6/24 cochlear-optimized proton plans without set-up robustness for three and nine-beam arrangement, respectively, and in 0/24 proton plans with set-up robustness. The cochlea could best be spared in cases with a distance between tumor and cochlea. Using nine proton beams resulted in a reduced dose to most organs at risk. Conclusion: Cochlear dose reduction is possible in vestibular schwannoma radiosurgery while maintaining tumor coverage, especially when the tumor is not adjacent to the cochlea. With current set-up robustness, proton therapy is capable of providing lower dose to organs at risk located distant to the tumor, but not for organs adjacent to it. Consequently, photon plans provided better cochlear sparing than proton plans.

[Noise pollution: what are the health impacts?] / Pollution sonore : quels impacts sur la santé ?

NOISE POLLUTION: WHAT ARE THE HEALTH IMPACTS? Noise pollution resulting from human activities is more and more present and important. It can have deleterious consequences for hearing and health in general, but also for the quality of life. Its economic and societal cost is significant. Active strategies to reduce noise pollution are essential, particularly in urban areas, to prevent the risks of hearing and non-hearing disorders at the source.

POLLUTION SONORE: QUELS IMPACTS SUR LA SANTÉ ? La pollution sonore résultant des activités humaines est de plus en plus présente et importante. Elle peut engendrer des conséquences délétères tant pour l'audition que pour la santé en général, mais aussi pour la qualité de vie. Son coût économique et sociétal est significatif. Des stratégies actives de réduction de la pollution sonore sont indispensables, en particulier en milieu urbain, pour prévenir, à la source, les risques de troubles auditifs et extra-auditifs.

[Chronic tinnitus: An interplay between somatic and psychological factors]. / Chronischer Tinnitus im Wechselspiel somatischer und psychischer Faktoren.

Chronic tinnitus is a common, sometimes highly distressing phenomenon that can be triggered and maintained by an interplay of physical and psychological factors. Partnering with clinical psychology and psychosomatic medicine, modern otolaryngology integrates both medical (e.g., hearing loss) and psychological influences (e.g., interactions between biographical experiences, personality traits, subjective evaluation of intrapsychic and interpersonal stimuli, emotional states, and intrapsychic or interpersonal emotion regulation strategies). Both groups of variables can influence the intensity and course of chronic tinnitus symptomatology both directly and indirectly, whereby the quality and relative degrees of psychological and physical components in a person's self-experience can fluctuate. With this in mind, the present article distinguishes between chronic tinnitus symptomatology with or without hearing loss-and strongly advocates for an integrated understanding of the symptomatology within a holistic psychological frame of reference. After a brief introduction to the principles of psychosomatic medicine and psychotherapy, the article discusses psychological case conceptualization using a vulnerability-stress-coping (VSC) model as an example, outlines clinical aspects and diagnostics of chronic tinnitus symptomatology, and concludes with a conceptualization of chronic tinnitus-related distress as a function of person-centered VSC interactions.

Routine ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years attending primary care: a national consensus statement.

This consensus statement provides new recommendations for primary care assessment of ear health and hearing status of young Aboriginal and Torres Strait Islander children who are not known to have, or are not being actively managed for, ear health and hearing problems. Any child identified with otitis media should be actively managed. This national consensus statement extends existing treatment and management guidelines. MAIN RECOMMENDATIONS: Undertake checks at least 6-monthly, commencing at 6 months until 4 years of age, then at 5 years. Undertake checks more frequently in high risk settings for children under 2 years, when acceptable to families, or in response to parent/carer concerns. Ask parents/carers about concerns, signs, and symptoms; check children's listening and communication skills; and assess middle ear appearance and mobility. Otoacoustic emissions testing is suggested when equipment is available, primary health practitioners have capability and confidence to use the equipment, and there is local preference for its use. Video otoscopy is suggested for health promotion purposes, and/or for sharing images with other health practitioners. Audiometry should be done as per existing guidelines: when there are parent/carer concerns, signs of persistent/recurrent otitis media, or when listening and communication development is not yet on track. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Key practice changes include routine use of tympanometry, and listening and communication skills checklists. Implementation will require access to equipment and training; clear information on immediate, practical actions for families; timely pathways to referral services; and a change management process that shifts perception and tolerance of otitis media and its impacts and raises expectations that Aboriginal and Torres Strait Islander children can have healthy ears and hearing.

Associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros: estudo populacional / Association between self-perceived hearing status and cognitive impairment in the older Brazilian population: a population-based study

Resumo Saúde cognitiva é um fator importante para qualidade de vida e a autonomia dos idosos, sendo influenciada pela capacidade auditiva. O objetivo deste artigo é analisar a associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros. Trata-se de um estudo transversal de base populacional com 4.977 idosos que participaram do ELSI Brasil 2015. Comprometimento cognitivo (desfecho, categorizado como sim e não) e a variável de interesse (autopercepção auditiva, categorizada como boa, regular e ruim), ambos obtidos de forma autorreferida. Para a cognição foram considerados os domínios orientação temporal, memória (curto e longo prazo) e linguagem (recente e tardia). Foi utilizada a regressão de Poisson com estimativa de variância robusta para aferir a associação nas análises bruta e ajustada. Variáveis sociodemográficas, de estilo de vida e de histórico clínico foram utilizadas para ajuste das análises. Dos participantes, 31,8% relataram audição regular ou ruim e 42% apresentaram comprometimento cognitivo. Na análise ajustada, idosos com audição ruim apresentaram maior força de associação com comprometimento cognitivo, em comparação com seus pares com audição boa. Em idosos brasileiros, quanto pior a autopercepção auditiva, maior a associação com o comprometimento cognitivo.

Abstract Cognitive health plays an important role in the quality of life and autonomy of older adults. and it is influenced by hearing ability. This article aims to analyze the association between self-perceived hearing status and cognitive impairment in Brazilian older adults. This cross-sectional population-based study was conducted with 4,977 older adults who participated in ELSI Brazil 2015. The cognitive impairment status (outcome. categorized as "yes" and "no") and variable of interest (self-perceived hearing status. categorized as "good" "fair" and "poor") were obtained using a self-report method. The following domains were considered for cognition: temporal orientation. memory (short and long term). and language (recent and late). Poisson regression with robust variance estimation was used to assess the self-perceived hearing status-cognitive impairment association in the crude and adjusted analyses. Sociodemographic. lifestyle. and medical history variables were used to adjust the analyses. We found that 31.8% of the participants reported fair or poor hearing and 42% had cognitive impairment. In the adjusted analysis. older adults with poor hearing were revealed to have a stronger association with cognitive impairment than their peers with good hearing. Therefore. in older Brazilian adults. lower self-perceived hearing status is associated higher levels of cognitive impairment.

[Stress and suffering from tinnitus-a psychosomatic approach]. / Stress und Leiden am Tinnitus aus psychosomatischer Sicht.

The development and processing of tinnitus is often associated with stress. There are many publications on this subject that have investigated possible connections between stress perception and tinnitus symptoms using different concepts and different test inventories. In this review, we present the development of Selye's concept of stress using the transactional stress model of Lazarus and its transfer to patients suffering from tinnitus. The literature evaluating the influence of stress on tinnitus symptoms with partly very different concepts is critically reviewed. For example, it is suggested that psychosocial stress has the same likelihood of contributing to tinnitus as noise in the workplace. However, what is striking in previous studies is that "stress" as an influencing variable could not be clearly verified with suitable psychometric test procedures or that no significant differences-to very different comparison groups-could be shown. Finally, a possible therapeutic approach to stress management is outlined.