Background Olfactory dysfunction (OD)—including anosmia and hyposmia—is a common symptom of COVID-19. Previous studies have identified olfactory training (OT) as an important treatment for postinfectious OD; however, little is known about its benefits and optimizations after SARS-CoV-2 infection. Objective This study aimed to assess whether olfactory training performance can be optimized using more fragrances over a shorter period of time in patients with persistent OD after COVID-19. In addition, we determined the presence of other variables related to OD and treatment response in this population. Methods This multicenter randomized clinical trial recruited 80 patients with persistent OD and prior COVID-19 infection for less than 3 months. The patients were divided into 2 groups receiving either 4 or 8 essences over 4 weeks. Subjective assessments and the University of Pennsylvania Smell Identification Test (UPSIT) were performed before and after the treatment. Results Significant olfactory improvement was measured subjectively and using the UPSIT in both groups; however, no significant differences between the groups were observed. Additionally, the presence of olfactory fluctuations was associated with higher UPSIT scores. Conclusion These data suggest that training intensification by increasing the number of essences for 4 weeks does not show superiority over the classical method. Moreover, fluctuant olfaction seems to be related to a higher score on the UPSIT.

Conflict of interest: non-existentheadache, physiological changes in heart rate, blood pressure, sleep disorders, several digestive, vestibular, neurological and behavioral disorders such as irritability, tiredness, decreased productivity, noise intolerance, anguish, anxiety, depression, stress, among others 2,3 . In relation to the necessary time exposition for triggering noise-induced hearing loss, the highest number of impairing rates occurs between five and seven years, decreasing loss progression rate until fifteen years when it tends to stabilize as long as exposition conditions and absence of other causative factors are kept 2,4,5 . Noise-induced hearing loss characterized by irreversible cochlear damage, in configuration of high-frequency features one of the most serious, prevalent problems for workers' health. Studies have evidenced that there has not been a reduction in work-related deafness 6 . Occupational noise is also present in hospitals, mainly in hospital laundries where continuous exposition to high levels of sound pressure may bring about permanent changes in workers' hearing INTRODUCTIONAmong all agents that may result in occupational hazard, noise certainly appears as the most frequent one, exposing a larger number of individuals.1 It is known that workers exposed to high levels of noise, above the tolerance threshold, complain about hearing loss and tinnitus, besides NOISE EFFECTS ON HOSPITAL LAUNDRY WORKERS' HEARING Efeitos do ruído na audição de trabalhadores de lavanderia hospitalarFrancisca Pinheiro Fontoura ABSTRACT Purpose: to carry out a characterize the hearing profile of workers from a hospital laundry. Method: crosscut study, with 95 workers, males and females, age averaging 38.23, held at the laundry of a public hospital located in the city of Curitiba, Parana State/Brazil. Documental laundry analysis was carried out (Medical Control and Occupational Health Program and Environmental Risk Prevention Program), noise measurement, anamnesis-applied hearing evaluation, tonal threshold audiometry, acoustic immittance, and transient otoacoustic emission testing. Audiograms were analyzed through clinical and occupational criteria (Labor Ministry/ Regulatory Norm 7). Results: noise levels found were 77.0 to 99.0 dB(A), 37.89% audiograms were altered, among them, 18.94% suggesting noiseinduced hearing loss, mainly among the clothes folders. The test of otoacoustic emissions showed no transient responses in 13 subjects with no emissions in some ears. Conclusion: the laundry is a hazardous place for hearing loss, thus preventive measures, such as Hearing Conservation Programs must be adopted.

Shoot ing is an activity that exposes military personnel to noise impact, which may cause irreversible effects on hearing.Objective: To evaluate impact noise on the hearing of military personnel that practice shooting. Study design:A case-control retrospective study.Methods: 115 military personnel were enrolled; 65 had been exposed to impact noise and 50 were non-exposed. Firearm noise levels were evaluated, subjects answered a questionnaire and underwent threshold tonal audiometry and otoacoustic emissions testing. Results:The average noise level was 125dB(C). Most subjects (78%) believe that noise may cause hearing loss; nearly all (92.3%) used ear noise protectors while shooting, but most (32.3%) had never received guidance for using this equipment. There were significant differences between the two groups in relation to changes suggesting impact noise-induced hearing loss. Conclusion:The differences between groups show that noise-exposed military personnel are more likely to develop hearing loss. The goal of a hearing conservation program for this population should be to preserve hearing and educate these individuals about the importance of using hearing protection correctly. Braz J Otorhinolaryngol. 2011;77(6):747-53. ORIGINAL ARTICLE

Introduction Industry workers are exposed to different environmental risk agents that, when combined, may potentiate risks to hearing. Objective To evaluate the effects of the combined exposure to noise and solvents on hearing in workers. Methods A transversal retrospective cohort study was performed through documentary analysis of an industry. The sample (n = 198) was divided into four groups: the noise group (NG), exposed only to noise; the noise and solvents group (NSG), exposed to noise and solvents; the noise control group and noise and solvents control group (CNS), no exposure. Results The NG showed 16.66% of cases suggestive of bilateral noise-induced hearing loss and NSG showed 5.26%. The NG and NSG had worse thresholds than their respective control groups. Females were less susceptible to noise than males; however, when simultaneously exposed to solvents, hearing was affected in a similar way, resulting in significant differences (p < 0.05). The 40- to 49-year-old age group was significantly worse (p < 0.05) in the auditory thresholds in the NSG compared with the CNS. Conclusion The results observed in this study indicate that simultaneous exposure to noise and solvents can damage the peripheral auditory system.

Introduction: Olfactory dysfunction (OD) is one of the most reported symptoms of COVID -19. Previous studies have identified olfactory training (OT) as an important treatment for postinfectious OD, but little is known about its effect after SARS-CoV-2 infection and how it can be optimized. Objective: To assess whether OT can be optimized if performed intensively, with more fragrances over a shorter period in patients with persistent OD after COVID -19. Also, to determine the presence of other variables related to OD and treatment response in this population. Method: This multicenter randomized clinical trial recruited 80 patients with persistent OD with previous COVID-19 for less than three months. The patients were divided into two groups, who received treatment with 4 and 8 essences over four weeks. Subjective assessments and the University of Pennsylvania Smell Identification Test (UPSIT) were performed before and after treatment. Results: A significant improvement in olfaction was measured subjectively and on UPSIT in both groups, but without significant differences between groups. In addition, the presence of olfactory fluctuation was associated with higher UPSIT scores. Conclusion: These data suggest that intensifying the training by increasing the number of essences for 4 weeks does not show superiority over the classical method. Moreover, a fluctuating olfactory ability seems to be related to a better score in the UPSIT.

Objective The role of high-resolution computed tomography scans in otosclerosis remains uncertain. There is a debate over the relationship between radiological and audiometric findings among patients. Method Pre-operative audiometry and high-resolution computed tomography findings from 40 ears with surgically confirmed otosclerosis were compared. High-resolution computed tomography scan data regarding the characteristics of the disease foci, the endosteal extension and the occurrence of internal auditory canal diverticula were obtained. The influence of each radiological variable on the simple pure tone average, the high-frequency pure tone average and the bone-conduction pure tone average were investigated. Results Cases with endosteal extension (p = 0.047) and a higher number of affected sites within the otic capsule had a worse bone-conduction pure tone average, although it was only significant for the latter (p = 0.006). Those without concomitant retrofenestral disease (p = 0.019) had better simple pure tone average. Conclusion The number of sites of involvement and concomitant retrofenestral disease seem to significantly impact audiometric findings in otosclerosis.

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