Braz. j. . vol.82 número3

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www.bjorl.org

Brazilian

Journal

of

OTORHINOLARYNGOLOGY

ORIGINAL

ARTICLE

Effects

of

sound

amplification

in

self-perception

of

tinnitus

and

hearing

loss

in

the

elderly

夽

,

夽夽

Tiago

de

Melo

Araujo

a,∗

,

Maria

Cecília

Martinelli

Iório

b

a_{Post-graduate}_in_Human_{Communication}_Disorders,_Department_of_{Phonoaudiology,}_Escola_Paulista_de_Medicina,

UniversidadeFederaldeSãoPaulo(UNIFESP),SãoPaulo,SP,Brazil

b_Department_of_{Phonoaudiology,}_Escola_Paulista_de_Medicina,_Universidade_Federal_de_São_Paulo_(UNIFESP),_São_Paulo,_SP,_Brazil

Received14April2015;accepted12May2015 Availableonline16October2015

KEYWORDS Questionnaires; Scales;

Elderly; Tinnitus; Hearingaids

Abstract

Objective: Todeterminetheeffectoftheuseofhearingaidsinself-perceptionoftinnitusand hearinglossintheelderly.

Methods:Atotalof24elderlypatientsbetween60and70yearsofagewithmoderate-grade sensorineuralhearinglosswereevaluatedanddividedintotwogroupsaccordingtothepresence orabsenceoftinnitus.Allvolunteerswerefittedwithbinauralmicro-channelhearingaidsof thesamebrandandmodelandsubmittedtotests,scales,andquestionnairesrelevanttothis topic.Theevaluationswereperformedbeforeandafteroneandthreemonthsofeffectiveuse ofthesehearingaids.

Results:Acousticstimulationthroughtheeffectiveuseofhearingaidscausedareductionin theperceptionoftinnitussoundintensity(especiallyinevaluationswiththeprosthesison)and innuisanceassociatedwiththissymptomandwithhearingloss.In addition,allparticipants weresatisfiedwiththeuseofhearingaids.

Conclusion: Thecontinuoususeofhearingaidsisbeneficialforthetreatmentoftinnitusand hearingloss,bringingsatisfactiontousers.

夽 _Please_cite_this_article_as:_Araujo_TM,_Iório_MCM._Effects_of_sound_{amplification}_in_{self-perception}_of_tinnitus_and_hearing_loss_in_the elderly.BrazJOtorhinolaryngol.2016;82:289---96.

夽夽_Study_conducted_in_the

NúcleoIntegradodeAssistência,PesquisaeEnsinodaAudic¸ão(NIAPEA),DepartmentofPhonoaudiology,Escola PaulistadeMedicina,UniversidadeFederaldeSãoPaulo(UNIFESP),SãoPaulo,SP,Brazil.

∗_{Corresponding}_author.

E-mail:tiagoaraujofono@yahoo.com.br(T.M.Araujo). http://dx.doi.org/10.1016/j.bjorl.2015.05.010

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PALAVRAS-CHAVE Questionários; Escalas; Idoso; Zumbido;

Auxiliaresdeaudic¸ão

Efeitosdaamplificac¸ãosonoranaautopercepc¸ãodozumbidoedaperdaauditivaem idosos

Resumo

Objetivo:Verificar oefeitodousodeprótesesauditivasnaautopercepc¸ãodozumbidoeda perdaauditivaemidosos.

Método: Foramavaliados24 idososcomperdaauditivaneurossensorialdegraumoderadoe idadesentre60e70 anosdivididosemdoisgruposconformeapresenc¸aounãodezumbido. Todososvoluntáriosforamadaptadosbinauralmentecomprótesesauditivasmicrocanaisde mesmofabricanteemodeloesubmetidosatestes,escalasequestionáriospertinentesaotema. Asavaliac¸õesocorrerampré,eapósumetrêsmesesdeusoefetivodasprótesesauditivas.

Resultados: Aestimulaçãoacústicapormeiodouso efetivodepróteses auditivaspropiciou reduçãonaautopercepçãodaintensidadesonoradozumbido(principalmentenasavaliações comaspróteses)enodesconfortocomestesintomaecomaperdaauditiva.Alémdisso,todos osparticipantesmostraram-sesatisfeitoscomousodosdispositivosdeamplificação.

Conclusão:Ousocontínuodasprótesesauditivasébenéficoaotratamentodozumbidoeda perdaauditiva,alémdeimplicarnasatisfac¸ãodosusuários.

Introduction

AccordingtotheWorldHealthOrganization,tinnitus,i.e., soundperceptionby aperson in theabsenceof an exter-nalgeneratingsource,1_is_a_symptom_that_affects_about₂₇₈

millionpeopleworldwide,andabout 28millionin Brazil.2

Internationaldataindicatethattheprevalenceoftinnitus in thegeneral population increased from15% to25.3% in only15years,andthesenumbersgrowwiththeincreasing ageofthepopulation.3

Approximately20%ofpatientswithchronictinnitus (tinn-ituspresentforoverthreemonths)experienceasignificant nuisance effect,4 _and _among _other _complaints _describe

flaws in reasoning, memory, and concentration; impair-ment of speech discrimination and ability to maintain selectiveattention; and decreased pleasure derived from leisure activities, resting, and conviviality in their social environment.5---7

Atemporaryorpermanentdecreaseinauditorystimuli (sensorydeficit)increasesthesensitivityofsubcortical neu-rons,resultingintheplasticreorganizationoftheauditory cortex,withsubsequentsustainedawarenessoftinnitus.8,9

The literature suggests that feelings of intensity with respecttotinnitusmayberelatedtothenuisance caused bythiscondition,10,11 _and_that_there_are_several_tools12---15

which can be used to assess and monitor the treatment ofpatientssufferingfromthissymptom, amongwhichthe authors emphasize the acuphenometry test, the visual-analoguescale (VAS),andthe TinnitusHandicapInventory (THI)questionnaire.Inpatientswithtinnitusassociatedwith hearingloss, the IOI-HA (International OutcomeInventory for Hearing Aids) is also of value when rehabilitation is throughtheuseofhearingaids.

Studies of plasticity have suggested that an increase of the auditory stimulus provided by sound amplification through the use of hearing aids can induce secondary

plasticity,helpingtodecreasethenuisanceassociatedwith tinnitus.16,17

Fromthisperspective,thehypothesesthatguidedusto initiatethisresearchwerethattheuseofsound amplifica-tionwouldreducethesensationofintensityoftinnitusinthe elderlywithhearingimpairmentanddecreasethenuisance associatedwithbothsymptoms(tinnitusandhearingloss), determiningthesuccessofpatient’sadaptationtohearing aids.

Consideringthatthepresenceoftinnitusalsointerferes inhealthself-perceptionintheelderly,18_the_present_study

aimed to verify the effect of the use of hearing aids in self-perceptionoftinnitusintheelderlywithhearing impair-ment.

Methods

This research was conducted in the Integrated Cen-ter for Assistance, Research, and Education in Hearing (Núcleo Integrado de Assistência, Pesquisa e Ensino em Audic¸ão [NIAPEA]),Department of Phonoaudiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP) during the years 2013 and 2014, after approval by the Ethics Committee in Research, UNIFESP, underPresentationCertificateforEthicsAssessment(CAAE) No.09876112.1.0000.5505.

This study consisted of an interventional prospective study andof a non-probabilisticsample, which monitored andevaluated24elderlypatientsaged60---70years,divided intotwogroupsaccordingtothepresenceorabsenceof tinn-itus symptoms. The subjects’ participation was voluntary andconfirmedbysigningtheinformedconsent.

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were3580medicalrecordsanalyzed,withtheexclusionof thosesubjectsoutsidetheintendedagegroupofthisstudy, resultingin658medicalrecords.Ofthese,itwasfoundthat 512(78%)patientsreportedthepresenceoftinnitus(with orwithoutnuisance)and146(22%)reportednothavingthe symptom.

Accordingly, eligibility criteria were defined for the compositionofthesampleandformationofstudy(TG---with tinnitus)andcontrol(TGw/o---withouttinnitus)groups.

Thus,for both groups,inclusion criteriawerepresence ofmoderate-gradebilateralacquiredsensorineuralhearing loss(meanofpuretoneauditorythresholds41---60dBHLat 500, 1000, 2000, and 4000Hz), flat or slightly downward audiometric configuration, speech recognition percentage scores of ≥76%, andtype-A tympanometrycurvesin both ears. Furthermore, Brazilian Portuguese was required to be their mother tongue; finally, subjects needed to be candidates for the use of binaural microchannel hearing aids.

Forthe TG:afterthisfirstselection, patientswhomet thesecriteriaweresubmittedtotheVASandtheTHI ques-tionnaire,becauseonlypatientswithaconstantawareness ofannoyingtinnitusremainedinthegroup,accordingtothe following criteria defined for this study: VAS≥5 (at least moderategrade)andTHI≥38(atleastmoderategrade).19

FortheTGw/o:itwasrequirednottohavethesymptom understudy.

Subjectswithobviousneurological,articulatory,and/or verbalfluencydisordersandthosewithpreviousexperience withtheuseofhearingaidsalsowereexcluded.

Given theeligibility criterialisted aboveandafter the investigationconductedthroughanalysisofmedicalrecords andtelephoneand/orface-to-facecontact,thefinal sam-ple consisted of 24 subjects (18 females and six males) distributedintwogroups:TG=12andTGw/o=12.

Procedures

TG seniorswho met eligibilitycriteria weresubmitted to anacuphenometrytest(perceptionoffrequencyandsound intensity level of tinnitusmeasurements), VAS(subjective degreeofnuisancecausedbyhearinglossandtinnitus),THI (subjectivedegreeofnuisancecausedbytinnitus),and IQ-ISAD (success of the patient’s adaptation tohearing aids) questionnaires.TGw/oseniorsweresubmittedtoVAS (sub-jective degree of nuisance caused by hearing loss) and IQ-ISAD.

Inthisstudy,effectiveuseofhearingaidsmandatedthat thesubjectusedthedeviceforatleasteighthours/day.All seniorswere fitted withmicrochannel hearingaids of the samebrandandmodel,whosefrequencyrangedescribedin thetechnicalsheetrangesfrom150to7000Hz.

Theacuphenometrytest,usedtomeasuredata,suchas perception offrequency andintensity of tinnitus,isquite useful in assessing and monitoring treatment of patients withthissymptom,14_and_was_implemented_at_three_points

in time:beforethe fitting of hearingaids (T1),after one month(T2),andafterthreemonthsofeffective use(T3). InT2andT3,thetestswereappliedwithandwithout the device, utilizinga Grason-Stadler GSI 61 audiometer with supra-auralTDH50Pphones.

The VASis an easy-to-usescale that ismost commonly usedinstudiesonthissubject,14_and_provides_{self-assigned}

scoresbetween0and10reflectingthenuisanceassociated withthe assessed symptom (tinnitus or hearing loss) in a simpleandobjectiveway.

The THI questionnaire, developed20 _in ₁₉₉₆ _and

adapted12_and_validated21_for_Brazilian_Portuguese,_assesses

emotional,functional,andcatastrophicaspectsoftinnitus patients.

The IQ-ISADquestionnaire,proposed22 _in₂₀₀₂_and_also

translated and adapted into Portuguese,15 _reflects _the

successofthepatient’sadaptationtohearingaids,by evalu-atingeachofthefollowingareas:use,benefit,limitationof activities,satisfaction,participationrestriction,impactof hearinglossincontactwithotherpeople,andqualityoflife. Thesedomainsareonlyevaluatedinpatientswithhearing aids,afterexperiencewiththeuseofamplification.

Statistics

Inthestatisticalanalysis,SPSSv.17,Minitabv.16,andExcel 2010softwarewereused.Wilcoxon(evolutionof the indi-vidualswithin the group) and Mann---Whitney (comparison betweengroups)testsalsowereused.Thisstudy adopted the0.05significancelevel(5%)forstatisticalanalysis.Inthe tables,thestatisticallysignificantvaluesweremarkedwith anasterisk[*];however,thosevaluesthat,duetotheir prox-imitytotheacceptancelimit,tendedtobesignificant(up to5%abovethevalueof ˛adopted), weremarked witha hashcharacter(#).

Results

This study evaluated24 elderly patients: 12 women aged 61---70 years (mean 66.9) in the TG, and six men and six womenaged61---69years(mean64.5)intheTGw/o.

The range,inyears,of educationforthe TGwas5---10 yearsandfortheTGw/owas6---10years.

Thedurationoftimefromtheonsetofhearinglossuntil theinterventionwithhearingaidsforbothgroupsexhibited avariation of 2---30 years of hearing deprivation,with an averageof8.7yearsfortheTGand8.2yearsfortheTGw/o. The lengthoftimefromthe onsetoftinnitusuntilthe adaptationofhearingaidsaveraged10.5yearsfortheTG, rangingfromfourto30years.

Comparingthetypeoftinnitusreportedbythepatient andthemeasureoftheperceptionofpitchfrequencyofthis symptom(acuphenometry),100%‘‘puretone’’tinnituswas observed,withdescriptionssuch aswhistle,cricket,bell, hissing,andbuzzer,atfrequenciesofsensationaround2000 and8000Hz,withameanof5300Hzfortheright earand 5100Hzfortheleftear.

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Table1 Descriptivestatisticsandcomparativestudyamongtimepointsofevaluationforthefeelingofsoundintensity(dBSL) oftinnitusintherightear(TG).

Measures T1 T2w/o T3w/o T2 T3

Mean 6.66 6 5.28 4.47 3.78

Median 6.3 5.8 5 4.5 3.2

Standarddeviation 1.3 1.23 0.99 1.24 1.18

Q1 5.7 5 4.8 3.5 3

Q3 7.7 6.8 6.2 5 5

n 12 12 12 12 12

CI 0.74 0.7 0.56 0.7 0.67

n,numberofsubjects;Q1,firstquartile;Q3,thirdquartile;CI,confidenceinterval;TG,tinnitusgroup;T1,firstevaluation;T2w/o, secondevaluationwithoutprosthesis;T2,secondevaluation withprosthesis;T3w/o,thirdevaluationwithout prosthesis;T3,third evaluationwithprosthesis.

Statisticaltestused:Wilcoxon.

p-Valuesobtainedinthecomparisonbetweentimepoints:T2w/o×T1:0.022*;T3w/o×T1:0.002*;T2×T1:0.002*;T3×T1:0.002*.

Table2 Descriptivestatisticsandcomparativestudyamongtimepointsofevaluationfortheperceptionofsoundintensity (dBSL)oftinnitusintheleftear(TG).

Measures T1 T2w/o T3w/o T2 T3

Mean 6.66 6.19 5.47 4.61 3.61

Median 6.3 5.8 5.3 4.7 3.5

Standarddeviation 1.38 1.29 1.17 1.59 1.06

Q1 6 5.5 5 4.1 3.2

Q3 7.6 7 6.2 5.1 4

n 12 12 12 12 12

CI 0.78 0.73 0.66 0.9 0.6

n,numberofsubjects;Q1,firstquartile;Q3,thirdquartile;CI,confidenceinterval;TG,tinnitusgroup;T1,firstevaluation;T2w/o, secondevaluationwithoutprosthesis;T2,secondevaluation withprosthesis;T3w/o,thirdevaluationwithout prosthesis;T3,third evaluationwithprosthesis.

Statisticaltestused:Wilcoxon.

p-Valuesobtainedinthecomparisonbetweentimepoints:T2w/o×T1:0.022*;T3w/o×T1:0.002*;T2×T1:0.002*;T3×T1:0.002*.

Thenuisancefromtinnitus,asmeasuredbyVAS,showed asignificant reductioninthe perceptionof intensity from tinnitusintheTGat timepointsT2andT3relativetoT1 (Table4).

Forthe total score of THI across evaluations, a signif-icantreduction in nuisance complaintsrelatedtotinnitus wasobserved.AtT1,thenuisancewasmoderate,atT2,it becamelight,andatT3,itwasnegligible(Table5).

Regarding the IQ-ISAD questionnaire, the groups were homogeneous in comparisons between T2 and T3 vs. T1,

bothbytotalscoreandbyquestion(withoutstatistical sig-nificance)(Table6).

Discussion

Becausetheagingprocessbringsorganicandphysiological changestotheauditorysystem,we chosetostudyelderly patientsinarestrictedagegroup.23_Thus,_this_study_avoided

comparing the performance of elderly patients with very

Table3 Descriptivestatisticsandcomparativestudyamonggroups,bytimepoint,forVAS(uncomfortablewithhearingloss).

Times/groups Mean Median Standarddeviation Q1 Q3 n CI p-Value

T1 TG 7 7 1.21 6.8 8 12 0.68 0.295

TGw/o 7.67 7.5 1.5 7 8.3 12 0.85

T2 TG 4.33 4.5 1.3 4 5 12 0.74 0.370

TGw/o 4.75 5 1.29 4 6 12 0.73

T3 TG 3.08 3 1.08 2.8 4 12 0.61 0.040

TGw/o 2.08 2 1.31 1 3 12 0.74

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Table 4 Descriptive statistics and comparative study amongevaluationtimepointsforVAS(uncomfortablewith tinnitus)(TG).

Measures T1 T2 T3

Mean 8.75 4.67 2.25

Median 9.5 4 2

Standarddeviation 1.48 1.3 1.14

Q1 7.8 4 2

Q3 10 5.3 3

n 12 12 12

CI 0.84 0.74 0.64

VAS, visual analogue scale; n, number of subjects; Q1, first quartile;Q3,thirdquartile;CI,confidenceinterval;TG, tinni-tusgroup;TGw/o,groupwithouttinnitus;T1,firstevaluation (unaided);T2, second evaluation(with prosthesis); T3, third evaluation(withprosthesis).

Statisticaltestused:Mann---Whitney.

p-Values obtained in the comparison between time points: T2×T1:0.002*;T3×T1:0.002*.

differentages. The occurrenceof tinnitus in peopleaged 55---75yearsissubstantial.24

A higher proportion of female elderly patients were observedinthisstudy (18women;12intheTG).Thereis agreateroccurrenceofsymptomsinfemales24,25_;_however,

itisnotablethatwomenhavealwaysshownmoreconcern about the deterioration of hearing, aswell as with their generalhealth.26

Studies ofplasticityhavesuggestedthat anincreasein theauditorystimulusprovidedbythehearingaidcaninduce secondaryplasticity,16,17 _also_diminishing_the_nuisance _and

the change of attentional focus with respect to tinnitus, becausedecreased hyperactivitywouldoccurinregionsof the auditory pathway and also in non-auditory pathways, suchasthoseassociatedwithperception,attention, mem-ory,andemotionalreactions.27

Inlinewiththisstudy,ahigherincidenceof‘‘puretone’’ tinnitus wasobserved (66%), but withfrequencies around 6000and8000Hz.28 _In_the_current_survey,_the_mean_value

Table 5 Descriptive statistics and comparative study among evaluationtime pointsfor totalscore ofTHI ques-tionnaire(TG).

Measures T1 T2 T3

Mean 45 21.33 9.17

Median 41 20 8

Standarddeviation 7.36 8.24 2.89

Q1 39.5 16 7.5

Q3 51 25 10.5

n 12 12 12

CI 4.16 4.66 1.63

THI, TinnitusHandicapInventory;n, numberofsubjects;Q1, firstquartile; Q3,thirdquartile;CI, confidenceinterval;TG, tinnitusgroup;T1,firstevaluation(unaided);T2,second evalu-ation(withprosthesis);T3,thirdevaluation(withprosthesis). Statisticaltestused:Wilcoxon.

p-Values obtained in the comparison between time points: T2×T1:0.002*;T3×T1:0.002*.

foundforperception oftinnitusfrequencyfallswithinthe rangeof amplificationfrequencies of hearing aids, which couldexplainthegoodprognosisforadecreaseinthe nui-sanceassociatedwiththesymptom.Anotherstudyfounda similarmean(5333Hz)andmentionedtheimportanceofthe choiceofthehearingaidaccordingtoitsfrequencyband.29

Adifferentstudyfoundasignificantdecreaseofsound inten-sityoftinnitusinsubjectswhosefrequencyofthesymptom wasbelow 6000Hz, and concludedthat the frequency of tinnitusshouldbeconsideredasanimportantfactorinthe successofamplification.30

Asignificantdecreaseintheperceptionofsoundintensity caused by tinnitus was observed throughout the evalua-tionsfor both ears(Tables 1and2). Itis noteworthythat in the assessments with hearing aids this perception of intensity was lower, when compared to the assessments carriedoutwithout thesedevices.Thisfactdemonstrated thebeneficialeffectofasustainedacousticstimulationon theperceptionof tinnitusby thepatient.Similarlytothe describedresults,perceptionofintensityoftinnituslevels wasobservedbetween5and10dBSL.31

Otherauthors32 _found_no_effect_with_the_use_of_hearing

aidsintheperceptionoftinnitussoundintensityinanyof thegroupstheystudied;thus,thoseauthorsconcludedthat onemonthoftreatmentwasnotsufficienttodemonstrate theeffectsofamplificationinbrainplasticity.However,they alsodidnotreportthetimeofeffectiveuseofhearingaids bythesubjectstheystudied,andinthepresentstudy, pos-itiveresultswereobservedfromthefirstmonthofuse.

Regardingthe nuisance causedby hearingloss as mea-suredbyVAS,asignificantreductionwasobservedfromthe evaluationsinbothgroups(Table3),withstatistical differ-enceonly at T3, when theTGw/o reported less nuisance comparedtotheTG. The literature25 _states _that_the

nui-sancecausedbytinnitusisaddedtothatfromthehearing loss;thus,itcanbeadifficulttaskforthepatienttoisolate symptoms,inordertodefinethequantificationofnuisance. Again, comparing the TG results for the nuisance due to hearing loss and to tinnitus (Table 4), a greater nui-sanceassociatedwithtinnitusvs. hearinglossinT1could beperceived.AtT3,themeanthatexpressesthenuisance withtinnituswaslowerthanthemeanthatreflectsthe nui-sanceduetohearingloss,i.e.,thesymptomthatbothered themostexhibitedthegreatestimprovement.In the spe-cializedliterature,33,34_the_nuisance_associated_with_tinnitus

canceaseimmediatelywiththeuseofhearingaids,butthis doesnotoccurwithhearinglosswithrespecttoperception andunderstandingofspeech.

Wherehearinglossandtinnitusoccurtogether,an inves-tigationintowhich of thesesymptomscauses the greater nuisanceiswarranted,35 _in_order_to_target_the_therapeutic

approach.In thisstudy,TGshowedgreater nuisance from tinnitus;thus,inadditiontotheuseofamplification,itwas necessaryfortheparticipantstounderstandthe pathophysi-ologyofthesymptomandtheroleofrehabilitation,helping themtoreduceanxietyandcontroltheirexpectations.

Thefindingsofthisstudycorroborateresults36 _in_which

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Table6 Descriptivestatisticsandcomparativestudyamonggroups,bytimepoint,fortotalscoreandbytheIQ-ISADtool.

Times/groups Mean Median Standarddeviation Q1 Q3 n CI p-Value

Total T2 TG 31.42 31.5 1.16 31 32 12 0.66 0.788

TGw/o 31.58 31 1.83 30.8 32.5 12 1.04

T3 TG 34.25 34.5 0.87 33.8 35 12 0.49 0.780

TGw/o 34.17 34 0.83 33.8 35 12 0.47

(Qu1) T2 TG 4.92 5 0.29 5 5 12 0.16 0.546

TGw/o 4.83 5 0.39 5 5 12 0.22

T3 TG 5 5 0 5 5 12 --- 1.000

TGw/o 5 5 0 5 5 12

---(Qu2) T2 TG 4.08 4 0.67 4 4.3 12 0.38 0.527

TGw/o 4.25 4 0.75 4 5 12 0.43

T3 TG 4.83 5 0.39 5 5 12 0.22 1.000

TGw/o 4.83 5 0.39 5 5 12 0.22

(Qu3) T2 TG 3.92 4 0.79 3 4.3 12 0.45 0.975

TGw/o 3.92 4 0.67 3.8 4 12 0.38

T3 TG 4.67 5 0.49 4 5 12 0.28 0.660

TGw/o 4.75 5 0.45 4.8 5 12 0.26

(Qu4) T2 TG 4.42 4 0.51 4 5 12 0.29 0.527

TGw/o 4.25 4 0.62 4 5 12 0.35

T3 TG 5 5 0 5 5 12 --- 0.070

TGw/o 4.75 5 0.45 4.8 5 12 0.26

(Qu5) T2 TG 4.67 5 0.49 4 5 12 0.28 0.660

TGw/o 4.75 5 0.45 4.8 5 12 0.26

T3 TG 4.92 5 0.29 5 5 12 0.16 1.000

TGw/o 4.92 5 0.29 5 5 12 0.16

(Qu6) T2 TG 4.92 5 0.29 5 5 12 0.16 0.284

TGw/o 4.75 5 0.45 4.8 5 12 0.26

T3 TG 5 5 0 5 5 12 --- 0.148

TGw/o 4.83 5 0.39 5 5 12 0.22

(Qu7) T2 TG 4.50 4.5 0.52 4 5 12 0.30 0.090

TGw/o 4.83 5 0.39 5 5 12 0.22

T3 TG 4.83 5 0.39 5 5 12 0.22 0.148

TGw/o 5 5 0 5 5 12

---IQ-ISAD,InternationalQuestionnaire---IndividualSoundAmplificationDevice;n,numberofsubjects;Q1,firstquartile,Q3,thirdquartile; CI,confidenceinterval;TG,tinnitusgroup;TGw/o,groupwithouttinnitus;T2,secondevaluation;T3,thirdevaluation;Qu1,question 1;Qu2,question2;Qu3,question3;Qu4,question4;Qu5,question5;Qu6,question6;Qu7,question7.

Statisticaltestused:Mann---Whitney.

Inthepresentstudy,allvolunteerssuffered sensorineu-ral hearing loss, i.e., the nuisance from tinnitus could result from the permanent decrease in auditory stimuli withincreasedsensitivityofneuronsinthesubcortical cen-ters, and the treatment with hearing aids decreases the peripheraldeficit,causingtheacousticsignaltobebetter expressedinthecentralauditorynervoussystem(CANS).37

Current research also showed that the mechanisms underlyingplasticityalsofunctionduringoldage;therefore cliniciansshouldnotavoidtherapeuticinterventionsinthe elderly.

Still, withrespect to the nuisance caused by tinnitus, theTHI questionnaire results (Table 6) demonstrate that, duringthe evaluations, a significant decrease in nuisance complaintsrelatedtotinnitusoccurred,eitherbytotalscore orbytheuseofthescale.AtT1,thenuisancewasmoderate; atT2,itbecamelight;andatT3,negligible.

Thereisadirectrelationshipbetweenthescoreofthis questionnaireandthenuisanceassociatedwithtinnitus,38,39

thatis,itisclearthattherewasareductioninnuisanceover time.

As tothe result of applyingthe IQ-ISAD (Table 6), the groupswerehomogeneousincomparisonsbetweenT2and T3vs.T1,both bytotalscore andbyquestion; therewas nostatisticalsignificance.Onestudy40 _mentioned_that_the

reductionoftinnituswiththeuseofhearingaidscan influ-encetheusers’satisfactionwiththeamplificationdevice. Inthecurrentstudy,itwasfoundthatbothgroupsalready hadhigh scoresat T2,reaching34pointsatT3--- positive resultsalsofoundinotherstudies.41,42

In the TG, whose participants reported a decrease in the perception of and nuisance associated with tinnitus, the level of satisfaction with the use of hearing aids is understandable. In some cases,patients with tinnitusare moreconcernedwithrelievingthatsymptomthanactually reducing their hearing difficulties with the use of hear-ing aids, and use the device only if it produces tinnitus masking.40

Withthe IQ-ISAD,wefound43 _no_correlation_among_the

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Thus,thesevariables wouldnotinterferewiththe results obtainedfromthequestionnaire.

Theresultsofthisstudyrevealedasignificantreduction inself-perceptionoftinnitusintermsofsoundintensity,and inthediscomfortcausedbythissymptomandbythe hear-ingloss.Itisimportanttoemphasizethattheperformance of the TG volunteers in acuphenometry test revaluations wasevenbetterwhenthesesubjectswereevaluatedwith thedeviceson,whichreinforcestheimportanceofpatient educationregardingthecontinueduseofhearingaids.

Conclusion

Fromthedataobtained,itwasconcludedthat,duringthe evaluationsinboth groups,adecreasein nuisancecaused by hearing loss was observed, and also that the percep-tionofsoundintensityandthenuisancecausedbytinnitus were reduced after intervention with acoustic stimula-tionthroughsoundamplification.Therewasnodifference betweengroupswithrespecttosuccessofadaptingto hear-ingaids.

Funding

ThisstudywasfundedbyCoordenac¸ãodeAperfeic¸oamento dePessoaldeNívelSuperior(CAPES).

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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