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Acufenos e disfunção vascular - implicações para a clínica e terapêutica
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Acufenos consistem na perceção de um som que não possui uma fonte externa. A sensação é geralmente de natureza elementar - descrições de assobios, chiados e zumbidos são comuns - embora, em alguns casos, sons mais complexos, como vozes ou música, sejam relatados.
A condição é muito comum, estima-se que a sua prevalência seja de 10 a 25% entre pessoas com mais de 18 anos de idade e, embora muitos doentes não sejam perturbados em demasia, outros consideram o distúrbio capaz de afetar significativamente a sua vida. É necessária uma abordagem multidisciplinar integrada para um diagnóstico abrangente dos acufenos, pois a sua etiologia pode ser diversa.
Sabendo que o seu mecanismo fisiopatológico ainda não está efetivamente compreendido, tentou perceber-se qual o papel que a disfunção vascular pode desempenhar para o desenvolvimento dos acufenos.
A cóclea é considerada um órgão terminal da vascularização, pois o sangue é suprido principalmente por uma única artéria, tal como se verifica na retina, coração e rins. Este tipo de vascularização, torna o órgão particularmente vulnerável a qualquer alteração circulatória. Da mesma forma que a microcirculação da cóclea tem um papel fulcral na manutenção da sua homeostasia, danos nesta podem estar na origem de doenças do foro auditivo. A disfunção vascular pode conduzir ao desenvolvimento de isquémia e stress oxidativo, que vão ser responsáveis por danos cocleares que podem levar à perceção de acufenos. Estas descobertas vão ser relevantes na abordagem terapêutica pois permitem explorar novos alvos terapêuticos. A promoção da circulação coclear e ações antioxidantes estão na base de terapêuticas que se têm mostrado eficazes no combate aos acufenos, como é o caso da melatonina, Ginkgo biloba L. e misoprostol. No entanto, a intervenção ao nível sintomático, maioritariamente recorrendo a terapia cognitivo-comportamental, continua a ser fundamental no sentido de ajudar o doente a lidar com o caráter incomodativo associado aos acufenos.
Tinnitus is the perception of a sound that has no external source. The sensation is usually elemental in nature - descriptions of whistling, squeaking and buzzing are common - although in some cases more complex sounds, such as voices or music, are reported. The condition is very common, its prevalence is estimated to be around 10 to 25% among people over the age of 18, and while many sufferers are not overly disturbed, others find the disorder capable of significantly affecting their lives. An integrated multidisciplinary approach is required for a comprehensive diagnosis of tinnitus, as its causes can be very varied. Knowing that its pathophysiological mechanism is still not effectively understood, attempts have been made to understand what role vascular dysfunction may play in the development of tinnitus. The cochlea is considered a terminal organ, because its blood is supplied mainly by a single artery, as seen in the retina, heart, and the kidneys. This type of vascularization makes the organ particularly vulnerable to any circulatory changes. Just as the microcirculation of the cochlea plays a key role in maintaining homeostasis, damage to the cochlea can cause hearing disorders. Vascular dysfunction can lead to the development of ischemia and oxidative stress, which are responsible for cochlear damage and can result in the perception of tinnitus. These findings will be relevant in the therapeutic approach, as they allow new therapeutic targets to be explored. The promotion of cochlear circulation and antioxidant actions are the basis of therapies that have proven effective in combating tinnitus, such as melatonin, Ginkgo biloba L. and misoprostol. However, the intervention at the symptomatic level, mostly using cognitive-behavioral therapy, remains fundamental in order to help the patient deal with the disturbing character associated with tinnitus.
Tinnitus is the perception of a sound that has no external source. The sensation is usually elemental in nature - descriptions of whistling, squeaking and buzzing are common - although in some cases more complex sounds, such as voices or music, are reported. The condition is very common, its prevalence is estimated to be around 10 to 25% among people over the age of 18, and while many sufferers are not overly disturbed, others find the disorder capable of significantly affecting their lives. An integrated multidisciplinary approach is required for a comprehensive diagnosis of tinnitus, as its causes can be very varied. Knowing that its pathophysiological mechanism is still not effectively understood, attempts have been made to understand what role vascular dysfunction may play in the development of tinnitus. The cochlea is considered a terminal organ, because its blood is supplied mainly by a single artery, as seen in the retina, heart, and the kidneys. This type of vascularization makes the organ particularly vulnerable to any circulatory changes. Just as the microcirculation of the cochlea plays a key role in maintaining homeostasis, damage to the cochlea can cause hearing disorders. Vascular dysfunction can lead to the development of ischemia and oxidative stress, which are responsible for cochlear damage and can result in the perception of tinnitus. These findings will be relevant in the therapeutic approach, as they allow new therapeutic targets to be explored. The promotion of cochlear circulation and antioxidant actions are the basis of therapies that have proven effective in combating tinnitus, such as melatonin, Ginkgo biloba L. and misoprostol. However, the intervention at the symptomatic level, mostly using cognitive-behavioral therapy, remains fundamental in order to help the patient deal with the disturbing character associated with tinnitus.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2021, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Acufenos Disfunção vascular Microcirculação Fisiopatologia Farmacoterapia Mestrado integrado - 2021