Reabilitação vestibular e do zumbido em pacientes atendidos em um hospital universitário

• Ano de defesa: 2017
• Autor(a) principal: Najlla Lopes de Oliveira Burle
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Zumbido; Percepção Auditiva; Audição; Tontura; Esclerose Múltipla; Percepção auditiva; Doenças vestibulares/reabilitação; Transtornos de audição; Esclerose múltipla; Esclerose multipla; Transtornos da audição
• Link de acesso: http://hdl.handle.net/1843/BUBD-AXGK6Y

INTRODUCTION: The inner ear is formed by labyrinth that contains the cochlea, organ responsible for the hearing and vestibular apparatus, one of the responsible for balance. Labyrinth changes can manifest with dizziness and tinnitus, symptoms that occupy the second and third position, respectively, among the most prevalent symptoms in the adult population. Along with the view and proprioception, the vestibular apparatus sends informations to the brain stem, where the reflexes integration responsible for balance maintenance occurs. Due to the involvement of the brain stem and cerebellum, patients with Multiple Sclerosis (MS) frequently report imbalance, dizziness or vertigo symptoms, increasing the risk of falls. One way to treat chronic dizziness is Vestibular Rehabilitation (VR). Tinnitus, which is a symptom with high prevalence, is defined as a sound perception in absence of an external stimulus. Studies with hearing loss patients and studies in patients with normal hearing verify that tinnitus can interfere in auditory processing and speech perception in noisy environment. This symptom is difficult to characterize and treat and therefore, many therapeutic possibilities have been described in the literature in order to promote tinnitus relief, among them, Tinnitus Habituation Therapy. The efficacy of this form of treatment is already well described in the literature. However, although proven the benefits of Tinnitus Habituation Therapy and the evidence of possible influence of this symptom on auditory processing abilities, no studies were found to investigate whether tinnitus improvement through habituation therapy influences on auditory processing abilities. OBJECTIVE: To verify the effects of vestibular rehabilitation as a method for dizziness habituation in patients with relapsing-remitting MS, as well as the influence of tinnitus habituation therapy on auditory abilities, regarding the selfperception of tinnitus intensity, discomfort and impact on quality of life. METHOD: Medical records from 24 patients with remitting-relapsing MS and dizziness symptoms were analyzed. The Brazilian version of the Dizziness Handicap Inventory (DHI) was used to compare the effects of VR pre and post treatment. To analyze the influence of tinnitus habituation therapy on auditory processing abilities and self-perception of tinnitus regarding to intensity, discomfort and impact on quality of life, a quasi-experimental study was accomplished with 19 participants. It was performed pure tone, vocal and high frequency audiometry, immitanciometry, acuphenometry, thresholds of discomfort and auditory processing evaluation using the Staggered Spondaic Words (SSW), Pitch Pattern Sequence (PPS), Gap In Noise (GIN), Speech in Noise (SN) e Masking Level Difference (MLD), besides application of Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS). The collected data were inserted into a spreadsheet of the Excel version 2011 software and analyzed statistically considering a level of significance of 5% in the analyzes. RESULTS: The sample was composed of 24 patients with remitting-relapsing MS. All subjects showed improvement in the impact of dizziness on quality of life when compared the scores obtained on Brazilian DHI before and after VR, in all subscales (p-values= FI=0,001, FU= 0,0008, EM= 0,0450 e Total= 0,0002). In relation to tinnitus, there was a statistically significant difference in self-perception of this symptom in relation to intensity, discomfort and impact on quality of life (p-value = 0.001, 0.001 and 0.023, respectively). However, no statistical difference was verified between the results obtained in the auditory processing tests before and after treatment. CONCLUSION: We conclude that vestibular rehabilitation is an effective treatment option to improve the impact of dizziness on quality of life of patients with relapsing-remitting MS. Tinnitus habituation therapy improves the impact of tinnitus on quality of life of patients with this symptom. However, there was no influence of this form of treatment on the auditory processing abilities.