Reabilitação do sintoma zumbido por meio da estimulação transcraniana por corrente contínua

Abstract

Dissertation organized into two articles. The topic covered was tinnitus, an auditory perception in the absence of an external sound source, which can vary in its impact on quality of life. The technique used is Transcranial Direct Current Stimulation (tDCS), which uses low-intensity electrical current to modulate the activity of the nervous system, with the aim of normalizing neuronal activity. Objective: (1) to verify whether there is a change in the impact and discomfort of the symptom, after neuromodulation with tDCS, in patients with chronic tinnitus. (2) verify the applicability and effectiveness of tDCS as a therapeutic resource in individuals with complaints of chronic tinnitus. Methods: The study was approved by the Research Ethics Committee of the Hospital Universitário Onofre Lopes, nº 5,622,441 and by the Brazilian Clinical Trials Registry (ReBEC), nº RBR-109xh8d6. The articles were designed as (1) uncontrolled clinical trial (pilot study) and (2) single-blind randomized controlled clinical trial. Sample composed of adult patients complaining of chronic tinnitus, referred from the outpatient clinic after otorhinolaryngological evaluation and pure tone audiometry (ATL). Patients with contraindications to neuromodulation were excluded. Anamnesis, high frequency audiometry (AAF) and, to characterize the outcome measures, acuphenometry, Visual Analogue Scale (VAS) and Tinnitus Handicap Inventory (THI) were carried out. The intervention consisted of applying a 2mA current for 20 minutes, anode to the left temporoparietal cortex and cathode to the right dorsolateral prefrontal cortex, for (1) five consecutive sessions, (2) ten alternating sessions; experimental group (GE) received active tDCS and the control group (CG) received simulated tDCS. (1) data analyzed in a descriptive way and, (2) descriptive and inferential for comparison between variables. Results: (1) sample with 5 patients, average age of 45 years, normal ATL and altered AAF. After five sessions, the average loudness reduced from 10.4dBNS to 9.2dBNS; the average total score on the THI varied from 36.8 to 33.2 points and, on the VAS, it went from 5.16 to 4.4 points. (2) sample composed of 31 patients (EG=17 and CG=14), mean age 54 years, predominance of bilateral tinnitus. The majority of patients had altered hearing thresholds (ATL/AAF). A statistical difference was identified in the sensation of intensity and in the minimum level of masking (NMM), pre and post intervention, only for the CG, in the OE and, in the comparison between groups, with an increase in these variables, post intervention, in the CG/ OE. The VAS showed a statistically significant difference in discomfort, pre and post treatment, in both groups, but with no difference between the groups. In the THI, a statistical difference was observed in all subscales, pre and post treatment, only in the EG; and significant difference for Total THI, Functional THI and Emotional THI, when comparing the groups. Conclusion: (1) Results indicate that non-invasive neuromodulation (tDCS) reduced the impact and discomfort caused by tinnitus on the quality of life of the patients studied. (2) Active tDCS was an effective therapy in the treatment of tinnitus, providing notable short-term benefits. It has proven to be safe and practical to reduce intensity, alleviate discomfort and improve patients' quality of life.