Early identification and prompt clinical and surgical intervention with mandatory drainage of the middle ear (primary disease), was essential for better outcome.

The THI was translated and culturally adapted in order to be used with the Brazilian population, demonstrating to be a reliable instrument to verify the damage caused by tinnitus in the quality of life of individuals.

The treatment of tinnitus, which is defined as conscientious perception of a sound originated in the ears or nervous system, represents until the current days a great challenge. The use of Acupuncture (ACP) is based on the stimulation with needles of specific points on the human anatomy. A prospective, randomized and double-blinded study was carried through in 76 patients taken care of in the Clinic of Tinnitus of the Department of Otorhinolaryngology and Head and Neck Surgery of the UNIFESP-EPM in the period understood between April and June of 2005. All the patients had humming complaint and had been submitted to clinical anamnese, physical examination and subsidiary exams in order to investigate its etiology. The patients then were directed to a first researcher that determined an initial numeric value of the humming through Visual Analoge Scale(VAS), varying from 0 to 10 points. After this, had been directed for another room in which an acupuncturist doctor, who did not have access to the initial evaluation, separated the patients in Group Control and Group Study according to the attendance order, in alternating way. The ACP point used in patients of the Group Study places 6,5 cm above of the apex of the auditory pavilion in the parietal region. The point used in the Group Control places 3 cm above of the previous point, in the same vertical line. Then they had been sent back to the initial room for a new evaluation by the first researcher, where they had been guided to redefine the subjective score of the humming. Among the 76 studied patients, 29 were male (38,2%) and 47 female (61,8%), with average age 56,9 + 12,0 years. The Groups Study and Control had counted on 38 patients each. Through the Anova test it was evidenced that it had significant difference (p<0,001) between the moments pre and post needling and that in the group Study this improvement is more evident (p=0,0127). The t-independent test showed that it had a significant difference (p=0,017) between the two moments in the groups Study and Control. We conclude that there was significant reduction of the counting of the moments pre and post needling in both the groups, and in the group study the reduction is greater that in the group control.

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.

No abstract

Tinnitus is characterized by the perception of sound in the absence of an external auditory stimulus. The network connectivity of auditory and non-auditory brain structures associated with emotion, memory and attention are functionally altered in debilitating tinnitus. Current studies suggest that tinnitus results from neuroplastic changes in the frontal and limbic temporal regions. The objective of this study was to use Single-Photon Emission Computed Tomography (SPECT) to evaluate changes in the cerebral blood flow in tinnitus patients with normal hearing compared with healthy controls. Methods: Twenty tinnitus patients with normal hearing and 17 healthy controls, matched for sex, age and years of education, were subjected to Single Photon Emission Computed Tomography using the radiotracer ethylenedicysteine diethyl ester, labeled with Technetium 99 m (99 mTc-ECD SPECT). The severity of tinnitus was assessed using the “Tinnitus Handicap Inventory” (THI). The images were processed and analyzed using “Statistical Parametric Mapping” (SPM8). Results: A significant increase in cerebral perfusion in the left parahippocampal gyrus (pFWE <0.05) was observed in patients with tinnitus compared with healthy controls. The average total THI score was 50.8+18.24, classified as moderate tinnitus. Conclusion: It was possible to identify significant changes in the limbic system of the brain perfusion in tinnitus patients with normal hearing, suggesting that central mechanisms, not specific to the auditory pathway, are involved in the pathophysiology of symptoms, even in the absence of clinically diagnosed peripheral changes.

• Efficacy of acupuncture on brain perfusion and symptoms of tinnitus patients. • Acupuncture improved the Tinnitus Handicap Inventory scores in tinnitus patients. • No significant changes in brain perfusion were observed after 12 twice-weekly sessions. • Perfusion changes would reflect changes in neuronal function.

Classifying persistent tinnitus as pure tone or noise, present in high or low frequency and establishing its different characteristics allow us to know its peculiarities and the effects of this symptom in patients' lives.