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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2020.tde-11032020-095221
Document
Author
Full name
Carla Alexandra Campagna
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Ramalho, Jeanne da Rosa Oiticica (President)
Medeiros, Ítalo Roberto Tôrres de
Stefanelli, Vinicius Cobos
Tsuji, Robinson Koji
Title in Portuguese
Eficácia do agulhamento a seco no incômodo do zumbido crônico em portadores de pontos gatilhos miofasciais
Keywords in Portuguese
Agulhamento a seco
Agulhamento terapêutico
Placebo
Pontos gatilho
Tono muscular
Zumbido
Zumbido somatossensorial
Abstract in Portuguese
O zumbido pode ser definido como percepção de som nas orelhas ou na cabeça na ausência de fonte sonora externa. Estudo recente feito na cidade de São Paulo detectou que a prevalência de zumbido é de 22% da população. É um sintoma comum decorrente de várias etiologias. A suspeita de zumbido do tipo somatossensorial ocorre toda vez que a contração ativa ou a passiva da musculatura da cabeça e ou do pescoço for capaz de modular as características psicoacústicas (intensidade, frequência, localização) deste sintoma. O fenômeno decorre de disfunção na rede de conexões neurais entre as vias auditivas e proprioceptivas. O tratamento do zumbido somatossensorial pode ser realizado de diversas formas, incluindo a melhora dos pontos gatilhos miofasciais (PGM). O agulhamento a seco (AS) é uma das estratégias terapêuticas que podem ser usadas, ainda que não tenha sido testado para o tratamento do zumbido. OBJETIVO: Avaliar a eficácia do AS no tratamento do zumbido crônico somatossensorial em portadores de PGM. MÉTODOS: O AS foi feito com a inserção de uma agulha longa e fina via intramuscular, após avaliação física e determinação dos músculos a serem tratados. O estímulo mecânico da agulha foi usado como um agente físico para desfazer os PGM. Todos os pacientes foram submetidos a 1 sessão semanal, por 4 semanas consecutivas, de AS placebo, seguida de intervalo de 15 dias ("washout") e de 1 sessão semanal, por 4 semanas consecutivas, de AS terapêutico. As variáveis de mensuração usadas para medir o grau de incômodo do zumbido foram: Escala Visual Analógica do zumbido (EVAz) e questionário THI ("Tinnitus Handcap Inventory"). Para avaliar a dor muscular, foram utilizados Escala Visual Analógica da dor (EVAd) e NDI-BR. O dispositivo Neutone® foi usado para medir a tensão muscular. RESULTADOS: Pacientes com zumbido somatossensorial e PGM apresentaram redução significantemente maior no escore total do THI e no domínio emocional do THI, após AS terapêutico do que AS placebo. A EVAz reduziu-se significantemente ao analisarmos o pré e o pós-procedimento do grupo AS terapêutico. Apesar de não ter havido diferença estatística entre AS terapêutico comparado ao AS placebo, observou-se tendência para tal. CONCLUSÃO: A técnica de AS terapêutico para PGM em pacientes com zumbido crônico de origem somatossensorial foi eficaz na redução do THI (escore total e domínio emocional) e da EVAz
Title in English
Effectiveness of dry needling in the annoyance of chronic tinnitus in patients with myofascial trigger points
Keywords in English
Dry needling
Muscle tonus
Placebo
Somatosensory tinnitus
Therapeutic needling
Tinnitus
Trigger points
Abstract in English
Introduction: Tinnitus can be defined as the perception of sound in the ears or in the head in the absence of an external sound source. A recent study in the city of São Paulo found that the prevalence of tinnitus in this population is of 22%. It is a common symptom that may arises from several different etiologies. The suspicion of somatosensory tinnitus occurs whenever an active or passive contraction of the head's and/or neck's muscles is able to modulate its psychoacoustic characteristics (loudness, pitch, location). The phenomenon arises from a dysfunction in the network of neural connections between the auditory and proprioceptive pathways. The treatment of somatosensory tinnitus can be approached in several ways, including the deactivation of myofascial trigger points (MTP). Dry needling (DN) is one of the therapeutic strategies used to deactivate MTP, even though it hasn't been tested before for tinnitus's treatment. Objective: To evaluate the efficacy of DN in the treatment of chronic somatosensory tinnitus patients with MTP. Methods: After the patients' physical evaluation and determination of the muscles that needed to be treated, the DN was done by the insertion of a long and fine intramuscular needle in the affected area. The needle's mechanical stimulation was used as a physical agent for deactivation of MTP. All patients underwent one weekly session of placebo DN for 4 consecutive weeks, followed by a 15-day washout, and then one weekly session of therapeutic DN for 4 consecutive weeks. The measurement variables used to assess the degree of tinnitus annoyance included the Visual Analogue Scale for tinnitus (VASt) and the THI questionnaire ("Tinnitus Handicap Inventory"). The Visual Analogue Scale for pain (VASp) and the Neck Disability Index (NDI) were used to evaluate muscle pain. The Neutone® device was used to measure muscle tension. Results: Patients with somatosensory tinnitus and MTP presented a significantly greater decrease in the total THI score and in THI's emotional domain after therapeutic DN when compared with placebo DN. The VASt showed a significantly decrease comparing after with before therapeutic DN; although no difference were observed between placebo and therapeutic DN, there was a tendency of statistical significance for the second. Conclusion: The DN therapy technique for MTP in patients with somatosensory tinnitus was effective to reduce THI (total score and emotional domain), as well as VASt
 
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Publishing Date
2020-03-11
 
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