Banca de DEFESA: WILDNA SHARON MARTINS DA COSTA

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : WILDNA SHARON MARTINS DA COSTA
DATE: 16/11/2023
TIME: 14:30
LOCAL: Remoto
TITLE:

DISCRIMINATIVE VALIDITY OF ITEMS IN THE DIAGNOSTIC CRITERIA FOR SOMATOSENSORY TINNITUS IN PATIENTS WITH TINNITUS

KEY WORDS:

Keywords: validation study, somatosensory tinnitus, quality of life.

 

PAGES: 67
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Introduction: Tinnitus is defined as the auditory perception of a sound generated in the auditory or para-auditory pathways. When tinnitus is influenced by the cervical spine and/or temporomandibular region, it is referred to as somatosensory tinnitus (SST). The diagnosis of SST is based on standardized criteria established in an international consensus of experts; however, the standardization of the physical examination and the measurement properties of these criteria have not yet been evaluated.

Objective: To propose a physical examination checklist of adapted items from the Diagnostic Criteria for Somatosensory Tinnitus for the diagnosis of SST and determine the discriminative validity of diagnostic criteria items between patients with and without SST.

Methods: A methodological study of known-groups validity was conducted, including individuals aged 18 years or older, of both sexes, with a complaint of tinnitus, recruited from a specialized Otorhinolaryngology outpatient clinic, totaling 100 patients divided into the SST Group (n=46) and the Non-SST Group (n=54). Patients were assessed by a multidisciplinary team to screen for the etiology of tinnitus, and in this context, underwent a physiotherapeutic assessment through a structured physical examination adapted from somatosensory tinnitus diagnostic criteria to detect the influence of the somatosensory system on the cause of tinnitus. The physical examination items assessed were tinnitus modulation by somatic maneuvers (SM), palpation of the temporomandibular joint (TMJ), the jaw and neck muscles; the presence of pain and myofascial trigger points (MTrPs). Patients were also asked about the intensity of tinnitus-related distress using the Numerical Rating Scale (NRS) and the impact of the symptom on their quality of life using the Tinnitus Handicap Inventory (THI). The known-groups validity of the physical examination checklist for the Diagnostic Criteria for Somatosensory Tinnitus (DC/SST) was evaluated using the chi-square test, Fisher's exact test, and the Fi coefficient. THI scores were compared between groups using Student's t-test with effect size measured by Cohen's d.

Results: The SST Group reported greater tinnitus distress (p<0.01); stress and sleep impairment were self-reported as worsening factors of tinnitus that affect the quality of life in 82.6% and 63% of these patients, respectively (p<0.01 and p=0.04) with associations ranging from strong to very strong (0.20-0.28), and patients in this group had a greater impact on the quality of life in the functional domain and total THI score 

(p=0.03 and p=0.05, respectively) when compared to the Non-SST Group. As for the physical examination items for the diagnosis of SST, associations were found for modulation by SM in all cervical and mandibular movements (p<0.05) and gaze-evoked (p<0.01), all with a very strong effect size (Fi 0.32-0.54) for the SST Group. Regarding the criteria related to TMJ palpation, the SST Group showed a higher frequency of palpation modulation in the left TMJ (p=0.05) and self-reported pain in the right TMJ (p<0.01), with strong to very strong associations (Fi 0.19 and 0.29, respectively). The presence of crepitation in the TMJ did not show a statistically significant difference. There was also an association for modulation upon palpation in all cervical and masticatory muscles assessed (p<0.01) with a very strong effect size (Fi 0.27-0.47). Regarding the presence of pain during active cervical and mandibular movements, there was statistical significance for flexion (p=0.05 and Fi=0.19), protrusion (p=0.01 and Fi=0.24), and retraction (p=0.02 and Fi=0.22) of the cervical spine and the right lateralization (p=0.01 and Fi=0.24) and clenching (p<0.01 and Fi=0.29) movements of the TMJ. The presence of pain upon muscle palpation showed significance for most muscles (p=0.01 to 0.04), with a strong to very strong association (Fi 0.19-0.31). Regarding the presence of MTrPs, there was a greater difference for the SST Group in the suboccipital muscles (p=0.01), right sternocleidomastoid muscle (p=0.04), right and left upper trapezius (p<0.01 and p=0.05, respectively), and bilateral rhomboid muscles (p=0.04) with a very strong association (Fi 0.18-0.27).

Conclusion: The checklist of items adapted from the diagnostic criteria for SST was able to discriminate differences between the groups with and without SST, showing strong to very strong associations for patients with SST. It is expected that the checklist may aiding in the standardized identification of patients with probable somatosensory tinnitus be easily implemented both in the clinical practice of professionals assisting patients with tinnitus and in scientific research field.

 

COMMITTEE MEMBERS:
Presidente - 4374835 - KARYNA MYRELLY OLIVEIRA BEZERRA DE FIGUEIREDO RIBEIRO
Externo à Instituição - CARINA ANDREA COSTA BEZERRA ROCHA - USP
Externa à Instituição - THAIS CRISTINA CHAVES - UFSCAR