Tinnitus prevalence in the city of São Paulo

Non-invasive treatments improve patient outcomes in chronic tinnitus: a systematic review and network meta-analysis

OBJECTIVE

To investigate the relative effectiveness of various Non-Invasive Treatment Techniques (NITs) in chronic tinnitus management.

METHODS

We searched PubMed, Embase and Cochrane Library databases from the time of data construction to December 31, 2022. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, NITs were evaluated, including Aacceptance and commitment therapy (A), Cognitive behavioral therapy (C), Sound therapy (S), Transcranial magnetic stimulation (T), Electrical stimulation therapy (E), Virtual reality therapy (V), tinnitus Retraining therapy (R), general psychotherapy (D), and Placebo (P). The outcome indicators included the Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire (TQ), Hospital Anxiety and Depression Scale-anxiety-Depression (HADS-D), Insomnia Severity Index (ISI), Visual Analogue Scales-Loudness (VAS-L), and Visual Analogue Scales-Distress (VAS-D). Statistical analysis was performed using Stata 14.0 for NMA.

RESULTS

This systematic review and meta-analysis included 22 randomized controlled trials comprising 2,354 patients. The treatment effects varied on each scale. For THI, S (86.9%) was the most effective, whereas P (6.5%) was the worst. For TQ, C (89.5%) was the most effective, whereas D (25.4%) was the worst. For HADS-D, A (82.4%) was the most effective, whereas D (9.47%) was the worst. For ISI, A (83.2%) was the most effective, whereas R (20.6%) was the worst. For VAS-L, S (73.5%) was the most effective, whereas E (18.9%) was the worst. For VAS-D, C (84.7%) was the most effective, whereas P (18.1%) was the worst.

CONCLUSIONS

The combination of acoustics and cognitive behavioral therapy may be an effectively treat patients with chronic tinnitus.

LEVEL OF EVIDENCE

How common is the problem? Level 2. Is this diagnostic or monitoring test accurate? (Diagnosis) Level 1. What will happen if we do not add a therapy? (Prognosis) Level 1. Does this intervention help? (Treatment Benefits) Level 1. What are the COMMON harms? (Treatment Harms) Level 1. What are the RARE harms? (Treatment Harms) Level 1. Is this (early detection) test worthwhile? (Screening) Level 1I.

In Silico Study in MPO and Molecular Docking of the Synthetic Drynaran Analogues Against the Chronic Tinnitus: Modulation of the M1 Muscarinic Acetylcholine Receptor

Tinnitus is a syndrome that affects the human auditory system and is characterized by a perception of sounds in the absence of acoustic stimuli, or in total silence. Research indicates that muscarinic acetylcholine receptors (mAChRs), especially the M1 type, have a fundamental role in the alterations of auditory perceptions of tinnitus. Here, a series of computer-aided tools were used, from molecular surface analysis software to services available on the web for estimating pharmacokinetics and pharmacodynamics. The results infer that the low lipophilicity ligands, that is, the 1a-d alkyl furans, present the best pharmacokinetic profile, as compounds with an optimal alignment between permeability and clearance. However, only ligands 1a and 1b have properties that are safe for the central nervous system, the site of cholinergic modulation. These ligands showed similarity with compounds deposited in the European Molecular Biology Laboratory chemical (ChEMBL) database acting on the mAChRs M1 type, the target selected for the molecular docking test. The simulations suggest that the 1 g ligand can form the ligand-receptor complex with the best affinity energy order and that, together with the 1b ligand, they are competitive agonists in relation to the antagonist Tiotropium, in addition to acting in synergism with the drug Bromazepam in the treatment of chronic tinnitus.

Auditory training for tinnitus treatment: a scoping review

OBJECTIVES

Our study aimed to verify the evidence of auditory training employed in the audiological treatment of tinnitus in adults and older adults.

METHODS

Scoping review based on a search for articles in journals available in MEDLINE (PubMed), Embase (Elsevier), LILACS (BVS), and Cochrane Library. Titles and abstracts of the retrieved articles were assessed by peers, following the eligibility criteria; they were afterward read in full text, and the references were hand searched in the results found. Studies' level of evidence was classified into very high (Level A+), high (Level A), moderate (Level B), limited (Level C), low (Level D), or very low (Level D-) based on the Critically Appraised Topics.

RESULTS

2160 records were identified in the searching stage and 15 studies were eligible for data extraction. Study design, sample characterization, auditory training tasks, sound stimuli, outcome measures, and results were extracted. Frequency discrimination training was the most frequent strategy, followed by auditory attentional skills training and multisensory training. Almost all studies with daily auditory training sessions reported significant benefits demonstrated in at least one outcome measure. Studies that used auditory discrimination training and attentional auditory skill stimulation to treat tinnitus obtained quality evidence levels ranging from limited to high (C‒A) and studies that applied multisensory training or attentional training combined with counseling and passive listening in tinnitus patients reached a high-quality evidence level (A).

CONCLUSION

Recent studies had higher levels of evidence and considered attentional factors and multisensory pathways in auditory training strategies.

EEG spectral and microstate analysis originating residual inhibition of tinnitus induced by tailor-made notched music training

Tailor-made notched music training (TMNMT) is a promising therapy for tinnitus. Residual inhibition (RI) is one of the few interventions that can temporarily inhibit tinnitus, which is a useful technique that can be applied to tinnitus research and explore tinnitus mechanisms. In this study, RI effect of TMNMT in tinnitus was investigated mainly using behavioral tests, EEG spectral and microstate analysis. To our knowledge, this study is the first to investigate RI effect of TMNMT. A total of 44 participants with tinnitus were divided into TMNMT group (22 participants; ECnm, NMnm, RInm represent that EEG recordings with eyes closed stimuli-pre, stimuli-ing, stimuli-post by TMNMT music, respectively) and Placebo control group (22 participants; ECpb, PBpb, RIpb represent that EEG recordings with eyes closed stimuli-pre, stimuli-ing, stimuli-post by Placebo music, respectively) in a single-blind manner. Behavioral tests, EEG spectral analysis (covering delta, theta, alpha, beta, gamma frequency bands) and microstate analysis (involving four microstate classes, A to D) were employed to evaluate RI effect of TMNMT. The results of the study showed that TMNMT had a stronger inhibition ability and longer inhibition time according to the behavioral tests compared to Placebo. Spectral analysis showed that RI effect of TMNMT increased significantly the power spectral density (PSD) of delta, theta bands and decreased significantly the PSD of alpha2 band, and microstate analysis showed that RI effect of TMNMT had shorter duration (microstate B, microstate C), higher Occurrence (microstate A, microstate C, microstate D), Coverage (microstate A) and transition probabilities (microstate A to microstate B, microstate A to microstate D and microstate D to microstate A). Meanwhile, RI effect of Placebo decreased significantly the PSD of alpha2 band, and microstate analysis showed that RI effect of Placebo had shorter duration (microstate C, microstate D), higher occurrence (microstate B, microstate C), lower coverage (microstate C, microstate D), higher transition probabilities (microstate A to microstate B, microstate B to microstate A). It was also found that the intensity of tinnitus symptoms was significant positively correlated with the duration of microstate B in five subgroups (ECnm, NMnm, RInm, ECpb, PBpb). Our study provided valuable experimental evidence and practical applications for the effectiveness of TMNMT as a novel music therapy for tinnitus. The observed stronger residual inhibition (RI) ability of TMNMT supported its potential applications in tinnitus treatment. Furthermore, the temporal dynamics of EEG microstates serve as novel functional and trait markers of synchronous brain activity that contribute to a deep understanding of the neural mechanism underlying TMNMT treatment for tinnitus.

Influence of Bone Conduction Hearing Device Implantation on Health-Related Quality of Life for Patients with and without Tinnitus

(1) Background: Tinnitus, often related to hearing loss, is an addressable public health concern affecting health-related quality of life (HRQoL). This study aimed to explore the influence of bone conduction hearing aid (BCHA) implantation on HRQoL and hearing disability in patients with hearing loss suffering from tinnitus. (2) Methods: Data were collected from an international hearing implant registry. Health Utilities Index Mark 3 (HUI-3), Spatial and Qualities of Hearing- 49 Questionnaire (SSQ) and self-reported tinnitus burden data for adult patients implanted with a BCHA (n = 42) who provided baseline as well as follow-up data 1-year post-implantation were extracted from the registry. Wilcoxon signed rank tests and paired samples t-tests were used to analyse outcomes data. (3) Results: Patients, with or without tinnitus, demonstrated clinically important mean improvements in HUI-3 multi-attribute utility scores, HUI-3 hearing attribute and SSQ scores. Hearing loss patients with tinnitus presented with a lower HRQoL than patients without tinnitus. (4) Conclusions: These findings demonstrate the importance of hearing rehabilitation in improving the quality of life and hearing disability of patients with or without tinnitus and in providing tinnitus relief in some patients with hearing loss and tinnitus.

Tinnitus Prevalence in the Adult Population-Results from the Gutenberg Health Study

Background and Objectives: Tinnitus is a common symptom in medical practice, although data on its prevalence vary. As the underlying pathophysiological mechanism is still not fully understood, hearing loss is thought to be an important risk factor for the occurrence of tinnitus. The aim of this study was to assess tinnitus prevalence in a large German cohort and to determine its dependence on hearing impairment. Materials and Methods: The Gutenberg Health Study (GHS) is a population-based cohort study and representative for the population of Mainz and its district. Participants were asked whether they suffer from tinnitus and how much they are burdened by it. Extensive audiological examinations using bone- and air-conduction were also performed. Results: 4942 participants (mean age: 61.0, 2550 men and 2392 women) were included in the study. The overall prevalence of tinnitus was 26.1%. Men were affected significantly more often than women. The prevalence of tinnitus increased with age, peaking at ages 75 to 79 years. Considering only annoying tinnitus, the prevalence was 9.8%. Logistic regression showed that participants with severe to complete hearing loss (>65 dB) were more likely to have tinnitus. Conclusions: Tinnitus is a common symptom, and given demographic changes, its prevalence is expected to increase.

Tinnitus Prevalence and Associated Factors among Dental Clinicians in the United Arab Emirates

Dental clinicians are at increased risk for developing tinnitus due to exposure to high levels of occupational noise. This study aimed to determine tinnitus prevalence and associated factors among dental clinicians. Interviews were conducted with 150 randomly selected dental clinicians using a questionnaire. Noise levels were measured at three points of time at the operating area. Tinnitus was reported in 19.33% of the participants. The average noise level was significantly higher among participants with tinnitus compared to those without the condition. More participants complained of intermittent tinnitus and the rest had the constant type, with the latter being significantly more bothersome. The weekly average time of using high-speed handpieces, suction and electric handpieces, age and experience had a significant effect on the presence of tinnitus. Only 2.7% of the participants reported the use of a hearing protection device. Tinnitus is a common finding among dental clinicians especially those with higher levels of occupational noise and more frequent use of noise-generating equipment. Knowledge of tinnitus prevalence aids in realizing the extent of its impact and making informed decisions. These results call for improved awareness of the negative impact of clinically-generated noise and emphasize the importance of preventive measures and periodic audiometry exams.

Prevalence and associated risk factors of tinnitus among adult Palestinians: a cross-sectional study

Tinnitus is a common complaint with potentially negative impact on quality of life. Prevalence of tinnitus ranges from 5 to 43% worldwide. This variation could be due to the heterogeneity of tinnitus assessment. This has limited the progress in understanding tinnitus. Therefore, we employed a standardized and a validated assessment method to determine the prevalence and related risk factors of tinnitus among Palestinians for the first time. This is a cross-sectional study in which we questioned a representative sample of 618 subjects in one-to-one interviews. The prevalence of any tinnitus was 30.6% among adult Palestinians. Participants from the oldest age group were almost five times more likely to have tinnitus. Moreover, participants with head and neck pain syndrome, severe hearing impairment, sleeping disorders or frequent complaints of vertigo were approximately two times more likely to have tinnitus. Our study provides novel information regarding tinnitus in Palestine and improves our understanding of tinnitus. This will improve the diagnosis and consequently will contribute in reducing the prevalence and perhaps in preventing tinnitus. As tinnitus still has no known cure, further investigations of modifiable risk factors and causes of tinnitus are crucial to prevent it in the future.

Association of tinnitus and self-reported systemic arterial hypertension: a retrospective study

PURPOSE

To describe data on hearing loss, systemic arterial hypertension and tinnitus of individuals, and to verify the association between self-reported systemic arterial hypertension and tinnitus, as well as to correlate other variables present in the sample: hearing loss and tinnitus, age and tinnitus and age and systemic arterial hypertension.

METHODS

Quantitative, descriptive and inferential, retrospective research with data collection from 473 medical records of adults and elderly people treated between 2008 and 2018. Selected were information on age, gender, result of pure tone audiometry, tinnitus, tinnitus type and frequency, presence of SAH and use of medication to control the disease.

RESULTS

No association was found between systemic arterial hypertension and tinnitus or between hearing loss and tinnitus and between age and tinnitus, however, an association was observed between age and systemic arterial hypertension using the Chi - Square test. The most common type of tinnitus was wheezing and most individuals who reported feeling more than one type of tinnitus were hypertensive.

CONCLUSION

The results found and the literature suggest that systemic arterial hypertension may be an additional factor or an aggravating factor of preexisting factors in the generation of tinnitus, but not the primary cause.

Translation and validation of the Tinnitus Primary Function Questionnaire into Brazilian Portuguese

OBJECTIVE

In this study, the Tinnitus Primary Function Questionnaire was translated, culturally adapted and validated for Brazilian Portuguese.

METHODS

This study was carried out in two stages. First, a prospective study of translation and cultural adaptation was carried out with a group of 20 patients. The questionnaire was translated, revised and back-translated from Portuguese into English. Subsequently, a retrospective study was carried out with 1,095 patients, 18 months after the first stage. The validation and reliability of the Tinnitus Primary Function Questionnaire was verified by comparing its results with the results of the Tinnitus Handicap Inventory.

RESULTS

The interclass correlation coefficient of the behavioral aspects ranged from 0.82 to 0.90 and the total score was 0.93, while Cronbach's alpha was >0.94 for the total score during the test-retest application. To validate the questionnaire, a database was used, which consisted of 1,095 patients submitted to tinnitus assessment using the Tinnitus Primary Function Questionnaire and Tinnitus Handicap Inventory simultaneously. Patients were enrolled from 14 Brazilian states (46% female), with a mean age of 58 years. The reliability of the Tinnitus Primary Function Questionnaire was tested during validation for the four different evaluated behavioral aspects, and the results were significantly high for all aspects and the total score. To validate the Tinnitus Primary Function Questionnaire, the results of the total Tinnitus Primary Function Questionnaire and Tinnitus Handicap Inventory scores were compared using Pearson's product-moment correlation test. The results indicate a high correlation between the two questionnaires (r=0.84; p<0.001; 95% CI 0.82-0.85).

CONCLUSION

The data from the Tinnitus Primary Function Questionnaire showed a high correlation with those of the Tinnitus Handicap Inventory. This indicates that the Portuguese version of the Tinnitus Primary Function Questionnaire can be adopted as a valuable tool in the clinical evaluation of patients with tinnitus.

LEVEL OF EVIDENCE

2C.

Hearing aid effectiveness on patients with chronic tinnitus and associated hearing loss

OBJECTIVE

Our study aimed to measure the effectiveness of using HA in reducing the disturbance caused by tinnitus.

METHODS

Study was designed as a within-subjects clinical trial. Nineteen patients with chronic tinnitus and untreated sensorineural hearing loss were under counseling, HA fitting and 6 months follow-up. Tinnitus assessment was performed with Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), pitch and loudness matching, and Minimum Masking Level measurements (MML).

RESULTS

following 6 months of HA use, a reduction in reported tinnitus and hearing handicap scales scores was observed both statistically and clinically. The pitch and loudness matching, as well as MML at the baseline and final evaluation were compared. MML's thresholds reduced significantly after 6 months of HA use.

CONCLUSION

Our study has provided evidence that HA fitting is a valuable treatment strategy for chronic tinnitus relief and associated hearing loss subtype of patient.

LEVEL OF EVIDENCE: 3

Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta-analysis

Importance

To date, no systematic review has taken a meta-analytic approach to estimating the prevalence and incidence of tinnitus in the general population.

Objective

To provide frequency estimates of tinnitus worldwide.

Data Sources

An umbrella review followed by a traditional systematic review was performed by searching PubMed-MEDLINE and Embase from inception through November 19, 2021.

Study Selection

Research data from the general population were selected, and studies based on patients or on subgroups of the population with selected lifestyle habits were excluded. No restrictions were applied according to date, age, sex, and country.

Data Extraction and Synthesis

Relevant extracted information included type of study, time and location, end point, population characteristics, and tinnitus definition. The study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.

Main Outcomes and Measures

Pooled prevalence estimates of any tinnitus, severe tinnitus, chronic tinnitus, and diagnosed tinnitus as well as incidence of tinnitus were obtained using random-effects meta-analytic models; heterogeneity between studies was controlled using the χ2 test, and inconsistency was measured using the I2 statistic.

Results

Among 767 publications, 113 eligible articles published between 1972 and 2021 were identified, and prevalence estimates from 83 articles and incidence estimates from 12 articles were extracted. The pooled prevalence of any tinnitus among adults was 14.4% (95% CI, 12.6%-16.5%) and ranged from 4.1% (95% CI, 3.7%-4.4%) to 37.2% (95% CI, 34.6%-39.9%). Prevalence estimates did not significantly differ by sex (14.1% [95% CI, 11.6%-17.0%] among male individuals; 13.1% [95% CI, 10.5%-16.2%] among female individuals), but increased prevalence was associated with age (9.7% [95% CI, 7.4%-12.5%] among adults aged 18-44 years; 13.7% [95% CI, 11.0%-17.0%] among those aged 45-64 years; and 23.6% [95% CI, 19.4%-28.5%] among those aged ≥65 years; P < .001 among age groups). The pooled prevalence of severe tinnitus was 2.3% (95% CI, 1.7%-3.1%), ranging from 0.5% (95% CI, 0.3%-0.7%) to 12.6% (95% CI, 11.1%-14.1%). The pooled prevalence of chronic tinnitus was 9.8% (95% CI, 4.7%-19.3%) and the pooled prevalence of diagnosed tinnitus was 3.4% (95% CI, 2.1%-5.5%). The pooled incidence rate of any tinnitus was 1164 per 100 000 person-years (95% CI, 479-2828 per 100 000 person-years).

Conclusions and Relevance

Despite the substantial heterogeneity among studies, this comprehensive systematic review on the prevalence and incidence of tinnitus suggests that tinnitus affects more than 740 million adults globally and is perceived as a major problem by more than 120 million people, mostly aged 65 years or older. Health policy makers should consider the global burden of tinnitus, and greater effort should be devoted to boost research on tinnitus.

The effects of photobiomodulation therapy in individuals with tinnitus and without hearing loss

To verify the effect of photobiomodulation therapy (PBMT) in individuals with chronic tinnitus without hearing loss, 20 patients who met the inclusion criteria were randomly divided into group 1: active low-level laser (LLL) and group 2: equipment without laser (placebo). Upon anamnesis, data collection, and audiological exams, the Tinnitus Handicap Inventory (THI) and the Visual-Analog Scale (EVA) were applied to measure the level of discomfort with tinnitus and the level of discomfort before and after laser treatment. The protocol used included 12 active LLL sessions for group 1 and not active for group 2, varying red and infrared wavelengths. There was a reduction in the disadvantage of individuals with tinnitus after the intervention and between the initial and final sessions, regardless of the intervention, although group 1 showed a greater reduction than group 2, regardless of point in time of assessment and number of session. There was no statistical difference as to group and point in time for the high-frequency audiometry and acuphenometry outcomes. Individuals with chronic tinnitus reduced the complaint, regardless of point in time and group of intervention; however, the group that received PBMT improved the level of satisfaction, regardless of point in time of assessment and number of session.

Evaluating the efficacy of hearing aids for tinnitus therapy - A Positron emission tomography study

Brain imaging studies have revealed neural changes in chronic tinnitus patients that are not restricted to auditory brain areas; rather, the engagement of limbic system structures, attention and memory networks are has been noted. Hearing aids (HA) provide compensation for comorbid hearing loss and may decrease tinnitus-related perception and annoyance. Using resting state positron emission tomography our goal was to analyze metabolic and functional brain changes after six months of effective HA use by patients with chronic tinnitus and associated sensorineural hearing loss. 33 age and hearing loss matched participants with mild/moderate hearing loss were enrolled in this study: 19 with tinnitus, and 14 without tinnitus. Participants with tinnitus of more than 6 months with moderate/severe Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores composed the tinnitus group. A full factorial 2X2 ANOVA was conducted for imaging analysis, with group (tinnitus and controls) and time point (pre-intervention and post-intervention) as factors. Six months after HA fitting, tinnitus scores reduced statistically and clinically. Analysis revealed increased glycolytic metabolism in the left orbitofrontal cortex, right temporal lobe and right hippocampus, and reduced glycolytic metabolism in the left cerebellum and inferior parietal lobe within the tinnitus group. The hearing loss control group showed no significant metabolic changes in the analysis. Parsing out the contribution of tinnitus independent of hearing loss, allowed us to identify areas implicated in declines in tinnitus handicap as a result of the intervention. Brain regions implicated in the present study may be part of chronic tinnitus-specific network.

Association of tinnitus and self-reported systemic arterial hypertension: a retrospective study

ABSTRACT Purpose To describe data on hearing loss, systemic arterial hypertension and tinnitus of individuals, and to verify the association between self-reported systemic arterial hypertension and tinnitus, as well as to correlate other variables present in the sample: hearing loss and tinnitus, age and tinnitus and age and systemic arterial hypertension. Methods Quantitative, descriptive and inferential, retrospective research with data collection from 473 medical records of adults and elderly people treated between 2008 and 2018. Selected were information on age, gender, result of pure tone audiometry, tinnitus, tinnitus type and frequency, presence of SAH and use of medication to control the disease. Results No association was found between systemic arterial hypertension and tinnitus or between hearing loss and tinnitus and between age and tinnitus, however, an association was observed between age and systemic arterial hypertension using the Chi - Square test. The most common type of tinnitus was wheezing and most individuals who reported feeling more than one type of tinnitus were hypertensive. Conclusion The results found and the literature suggest that systemic arterial hypertension may be an additional factor or an aggravating factor of preexisting factors in the generation of tinnitus, but not the primary cause.

Profile and prevalence of people with tinnitus: a health survey

PURPOSE

To estimate the prevalence and characterize the health profile, and tinnitus complaint, of the adult population of a health district in Campinas, in the State of São Paulo.

METHODS

A in-service survey was conducted in all health centers in the district with a random approach to the adult population seeking care at the unit. The sample consisted of 1,720 people, including 1,569 subjects who agreed to participate in the survey and answered a questionnaire including questions on general health and tinnitus. Two regression models were performed according to the variables and a 5% significance level was was adopted for the statistical analysis.

RESULTS

496 people reported tinnitus, representing a prevalence of 31.6%. Most of the sample was female, had at least one chronic disease and made continuous use of some medication. Respondents reported hearing complaints and the most common type of tinnitus was reported as unilateral, intermittent and acute. The regression models performed showed a higher chance of tinnitus with advancing age and with the occurrence of diabetes and thyroid disorder.

CONCLUSION

Tinnitus is related to the occurrence of chronic diseases and advancing age, may cause discomfort and is a reason for seeking treatment. Further population studies are required in different contexts in the Brazilian scenario.

Evaluation of Tp-e interval, Tp-e/QT ratio and index of cardiac-electrophysiological balance in patients with tinnitus

Background

Tinnitus is a common auditory symptom. Dysfunction in the autonomic nervous system (ANS) is an essential part of the etiopathogenesis of tinnitus. ANS regulates heart rate and heart rhythm and can lead to ventricular repolarization changes, which can cause malignant ventricular arrhythmias. T wave peak-to-end T(p-e) interval and T(p-e)/QT ratio are known ventricular arrhythmia indexes, and the index of cardiac-electrophysiological balance (iCEB) is a novel index that can be used to predict the risk of malignant ventricular arrhythmia. The goal of the study was to investigate these ventricular arrhythmia indexes in patients with tinnitus.

Methods

The study population consisted of 240 patients with tinnitus and 240 healthy subjects. A standard 12-channel surface electrocardiogram was applied to both groups. T(p-e) interval, QT interval and QRS duration were determined. Corrected QT (QTc) was determined via Bazett’s formula. To predict ventricular arrhythmia, iCEB (QT/QRS), T(p-e)/QT, corrected iCEB (QTc/QRS) and T(p-e)/QTc values were determined and compared between groups.

Results

Compared to the control group, QT (376.46 ± 36.54 vs 346.52 ± 24.51 ms), QTc (426.68 ± 24.68 vs 390.42 ± 24.04 ms), T(p-e) (75.86 ± 14.68 vs 62.42 ± 8.64 ms), T(p-e)/QT (0.201 ± 0.06 vs 0.180 ± 0.01) and T(p-e)/QTc (0.177 ± 0.06 vs 0.159 ± 0.02) were significantly higher in patients with tinnitus (p < 0.001 for all). QT/QRS (3.92 ± 0.68 vs 3.56 ± 0.32) and QTc/QRS (4.44 ± 1.03 vs 4.01 ± 0.64) were also significantly higher in patients with tinnitus (p = 0.018 and p = 0.008, respectively). In addition, significant positive correlations were found between T(p-e), T(p-e)/QTc ratio and disease duration (r = 0.792, p < 0.001; r = 0.500, p < 0.001, respectively).

Conclusion

As a result, patients with tinnitus may have an increased risk of malignant ventricular arrhythmia.

Effectiveness of Dry Needling in Bothersome Chronic Tinnitus in Patients with Myofascial Trigger Points

Introduction  Therapeutic dry needling (DN) is effective in reducing the discomfort of chronic somatosensory tinnitus in patients with myofascial trigger points (MTP)s.

Objective  To evaluate the efficacy of DN in chronic somatosensory tinnitus discomfort in patients with MTP.

Methods  Placebo-controlled paired trial that included 16 patients with a diagnosis of somatosensory chronic tinnitus and with the presence of at least one active or latent MTP. Treatment was performed in two phases: (1) four sessions (one session per week for four consecutive weeks) of placebo DN and (2) four sessions of therapeutic DN with a gap (washout) of 15 days between these phases.

Results  The Tinnitus Handicap Inventory (THI) variable and its emotional domain had a statistically significant reduction in therapeutic DN when compared with placebo DN ( p  = 0.024 and p = 0.011, respectively).

The tinnitus visual analogic scale (VAS) signaled a reduction in tinnitus discomfort when compared with moments before and after therapeutic DN ( p  < 0.05).

Conclusion  The therapeutic DN technique for MTP in patients with chronic tinnitus of somatosensory origin proved effective in reducing symptom discomfort, as measured by the THI (total score) and its emotional domain when compared with placebo DN.

Translation, Cultural Adaptation and Validation to Brazilian Portuguese of the Tinnitus Functional Index Questionnaire

Introduction  Tinnitus affects a large portion of the world's population. There are several questionnaires being used for the evaluation of the severity of tinnitus and its impact in quality of life; however, they do not measure treatment-related changes. So, a new self-reported questionnaire was developed, the Tinnitus Functional Index (TFI), which has been translated into several languages.

Objective  To perform the translation, cultural adaptation and validation of the TFI questionnaire for Brazilian Portuguese.

Method  This is a multicenter project divided into two stages: translation and cultural adaptation; and validation and reliability. For the validation, the Brazilian Portuguese version of the TFI was correlated with the Tinnitus Handicap Inventory (THI) domains for tinnitus and quality of life and was evaluated by the Spearman ρ test. The reliability and internal consistency were evaluated by the Cronbach α test.

Result  The Brazilian version of the TFI was obtained through an initial translation process, synthesis of translations, backtranslation and evaluation by a committee of experts. This version was then applied in 88 patients complaining of tinnitus from speech therapy and otorhinolaryngology outpatient clinics of the three school clinics. The Brazilian version presented high reliability, as evidenced by the Cronbach α value (α = 0.870), and strong correlation (rho = 0.760 and p  = 0.000).

Conclusion  The high reliability found in the results demonstrates that the Brazilian Portuguese version of the TFI is a valid and reliable instrument to evaluate the severity and impact of tinnitus on quality of life and changes related to its treatment.

The balance between Bayesian inference and default mode determines the generation of tinnitus from decreased auditory input: A volume entropy-based study

Along with phantom pain, tinnitus, a phantom auditory perception occurring in the absence of an external acoustic stimulus, is one of the most representative phantom perceptions that develops in subjects with decreased peripheral sensory input. Although tinnitus is closely associated with peripheral hearing loss (HL), it remains unclear why only some individuals with HL develop tinnitus. In this study, we investigated the differences between 65 HL with tinnitus (HL‐T) and 104 HL with no tinnitus (HL‐NT) using a resting‐state electroencephalography data‐based volume entropy model of the brain network, by comparing the afferent node capacities, that quantify the contribution of each node to the spread of information, of all Brodmann areas. While the HL‐T group showed increased information flow in areas involved in Bayesian inference (the left orbitofrontal cortex, the left subgenual anterior cingulate cortex, and the left ventrolateral prefrontal cortex) and auditory memory storage (the right hippocampus/parahippocampus), the HL‐NT group showed increased afferent node capacity in hub areas of the default mode network (DMN; the right posterior cingulate cortex and the right medial temporal gyrus). These results suggest that the balance of activity between the Bayesian inferential network (updating missing auditory information by retrieving auditory memories from the hippocampus/parahippocampus) and DMN (maintaining the “silent status quo”) determines whether phantom auditory perception occurs in a brain with decreased peripheral auditory input.

The effects of diet and physical activity induced weight loss on the severity of tinnitus and quality of life: A randomized controlled trial

BACKGROUND & AIMS

Subjective tinnitus is the most common and manifest auditory symptom of an existing pathology in the auditory system. Although the effect of obesity on tinnitus is still uncertain, it is known that increased fat tissue increases the severity and symptoms of tinnitus. In this study, it was aimed to evaluate the effect of weight loss through diet and physical activity on tinnitus.

METHODS

Forty-six obese subjects diagnosed with tinnitus were randomized into the diet + physical activity (PA) (n = 13), diet (n = 16) and the control groups (n = 17). The anthropometric measurements, tinnitus severity scores, tinnitus handicap inventory (THI) scores and short form quality of life (SF-36) scores of the individuals were recorded and compared at the beginning and at the end of the study.

RESULTS

In the diet + PA and diet groups; body weight (diet + PA:-6.5 ± 2.6; diet: -4.1 ± 1) tinnitus severity (diet + PA:-11.0 ± 7.0; diet: -9.0 ± 8.7) and THI scores (diet + FA:-15.0 ± 9.5; diet: -14.0 ± 10.0) significantly decreased compared to the control group (p < 0.01). This decline was more in those with weight loss of ≥5.0% than those with <5.0%. SF-36 score was significantly increased in the diet + PA and diet groups (respectively 10.0 ± 5.5 and 6.0 ± 2.7) compared to the control group (p < 0.05).

CONCLUSIONS

Diet and physical activity intervention ameliorated the tinnitus severity and quality of life in obese patients with tinnitus. However to generalize this findings further studies are needed. REGISTERED UNDER CLINICALTRIALS.

GOV IDENTIFIER NO

NCT00123456.

Noise Damage Accelerates Auditory Aging and Tinnitus: A Canadian Population-Based Study

OBJECTIVE

Age-related hearing loss (ARHL) is the third most challenging disability in older adults. Noise is a known modifiable risk factor of ARHL, which can drive adverse health effects. Few large-scale studies, however, have shown how chronic noise exposure (CNE) impacts the progression of ARHL and tinnitus.

STUDY DESIGN

Retrospective large-scale study.

SETTING

Audiology clinical practice.

PATIENTS

In this study, 928 individuals aged 30-100 years without (n=497) or with the experience of CNE (n=431) were compared in their hearing assessments and tinnitus. In order to only investigate the impact of CNE on ARHL and tinnitus, people with other risk factors of hearing loss were excluded from the study.

INTERVENTION

Diagnostic.

MAIN OUTCOME MEASURES

Noise damage was associated with a greater ARHL per age decades (pure-tone average(PTA)0.5-4kHz alterations 19.6-70.8 dB vs. 8.0-63.2 dB, ≤0.001), an acceleration of developing a significant ARHL at least by two decades (PTA0.5-4kHz 33.4 dB at 50-59yr vs. 28.2 dB at 30-39yr, ≤0.001), and an increased loss of word recognition scores (total average 84.7% vs. 80.0%, ≤0.001). Significant noise-associated growth in the prevalence of tinnitus also was shown, including more than a triple prevalence for constant tinnitus (28.10% vs. 8.85%, ≤0.001) and near to a double prevalence for intermittent tinnitus (19.10% vs. 11.10%, ≤0.001). Noise also resulted in the elevation of the static compliance of the tympanic membrane throughout age (total average 0.61 vs. 0.85 mmho, ≤0.001).

CONCLUSIONS

Our findings emphasize the significant contribution of CNE in auditory aging and the precipitation of both ARHL and tinnitus.

A contribution to the debate on tinnitus definition

Tinnitus is generally defined as an auditory perception in the absence of environmental sound stimulation. However, this definition is quite incomplete as it omits an essential aspect, the patient's point of view. This point of view constitutes, first and foremost, a global and unified lived experience, which is not only sensory (localization, loudness, pitch and tone), but also cognitive (thoughts, attentiveness, behaviors) and emotional (discomfort, suffering). This experience can be lived in a very unpleasant way and consequently have a very negative impact on quality of life. This article proposes and justifies a new definition for tinnitus elaborated by a group of French clinicians and researchers, which is more in line with its phenomenology. It also provides a minimum knowledge base, including possibilities for clinical care, hoping to eradicate all misinformation, misconceptions and inappropriate attitudes or practices toward this condition. Here is the short version of our definition: Tinnitus is an auditory sensation without an external sound stimulation or meaning, which can be lived as an unpleasant experience, possibly impacting quality of life.

Exposure to leisure noise and intermittent tinnitus among young adults in Bavaria: longitudinal data from a prospective cohort study

OBJECTIVES

To investigate the association between total leisure noise exposure and intermittent tinnitus among young adults.

DESIGN

Data were obtained from the Ohrkan study, an ongoing prospective cohort study conducted in South Germany since 2009. Information about exposure to impulse and leisure noise, tinnitus occurrences, sociodemographic variables, and self-rated hearing ability were analysed at four time points over a period of seven and a half years.

STUDY SAMPLE

Participants of the Ohrkan cohort study, who provided data about the occurrence of tinnitus for all surveys (n = 1028).

RESULTS

Intermittent tinnitus was reported in the majority of the sample (60%). The risk for intermittent tinnitus increased with higher sound pressure levels from exposure to leisure noise (full model (Odds Ratio, 95%CI): 80-<85dB(A): 1.41 [1.13-1.78], 85-<90dB(A): 1.73 [1.38-2.16], >90dB(A): 2.04 [1.59-2.61]). Visiting nightclubs was a major contributor to this relationship. Of the considered covariables, self-rated hearing as "poor", and growing up in a single-parent household were significantly associated with intermittent tinnitus.

CONCLUSION

Intermittent tinnitus is very frequent among young adults and is associated with high levels of leisure noise exposure. To prevent intermittent tinnitus, reduced sound pressure levels and the use of hearing protection are necessary.

Event related potentials (ERPs) to assess the tinnitus complaint during drug treatment

INTRODUCTION

Previous studies have shown that the attention given to tinnitus can be a determinant of tinnitus severity. Some of these studies have shown changes in the amplitude and/or latency parameters of the event-related auditory potentials (ERPs). One of the tools previously employed to investigate an individual's attention is the Event Related Potential (ERP), which reflects the amount of attention from the patient to the provided auditory stimuli.

OBJECTIVE

To verify if the use of central and peripheral drugs tested for the treatment of tinnitus present changes in the measurable parameters of event-related potentials when compared to Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS).

METHOD

Eighty-eight tinnitus patients were randomly sorted into two drug groups: (1) drugs with a central action mechanism and (2) drug with peripheral action mechanism. Their effects upon the negative aspects caused by tinnitus symptoms were evaluated by the ERPs during three periods: Premedication (T1), at Termination of the drug treatment (T2), and following the Washout period (T3), and then compared with the results from the THI questionnaire and VAS.

RESULTS

ERP waves in both groups did not demonstrate significant differences during the three evaluated periods (P=0.53), despite the significant improvement seen through the evaluation by the THI questionnaire and VAS for tinnitus annoyance and intensity (P<0.0001).

CONCLUSION

The use of ERPs with patients of chronic tinnitus who have been submitted to treatment using drugs having actions on both the CNS and peripheral auditory system did not present changes in either latency or amplitude of the waves throughout the treatment when compared to the THI questionnaire and VAS. The ERPs cannot be considered as criterion to evaluate the evolution of drug treatment in patients complaining of tinnitus. The statistically significant reduction in THI and VAS scores among all drugs used occurred with dopamine antagonists. Considering the possible antipsychotic effects, we can conclude that the concomitance of a variety of psychopathological conditions such as obsessive-compulsive disorder may be associated with tinnitus in some patients and may be responsible for the severity of the symptom.

Auditory attention in individuals with tinnitus

Introduction

Tinnitus is characterized by the presence of a sound in the absence of external sound stimulus. In individuals with normal audiometry, it may be associated with auditory attention difficulty, especially in those who report high tinnitus annoyance.

Objective

To investigate auditory attention ability in individuals with tinnitus complaint.

Methods

Cross-sectional analytical observational study. We evaluated 30 volunteers with normal hearing (up to 25 dBHL): 15 with tinnitus (test group) and 15 with no complaints (control group), aged between 18-40 years. The volunteers answered the tinnitus handicap inventory questionnaire and a visual analogue scale. Subsequently, a basic audiological evaluation (meatoscopy, tonal and vocal audiometry, and imittanciometry) and psychoacoustic measures of tinnitus (loudness and pitch) were performed. To evaluate auditory attention, the following tests were performed: auditory cognitive evoked potential (P300), central auditory processing tests (dichotic digits test and speech-in-noise test) and sustained auditory attention ability test.

Results

In the tinnitus handicap inventory, individuals with tinnitus had a mean score of 37.78 (±27.05), characterized as moderate degree. In the dichotic digits test (binaural separation), a difference was observed between the groups in both ears. Moreover, there was a difference in the speech-in-noise test in both ears (RE: p = 0.044; LE: p = 0.019), in P300 (p = 0.049) and in total sustained auditory attention ability test (p = 0.032). Also, there is a negative correlation between sustained auditory attention ability test, decrease in attentiveness and binaural integration (RE: p = 0.044; LE: p = 0.048).

Conclusions

Individuals with tinnitus had a poorer performance compared to the control group regarding auditory attention ability. Therefore, it is inferred that tinnitus is associated with poor performance in selective and sustained auditory attention in the assessed volunteers. These aspects should be considered for the management of patients with tinnitus.

Development of an educational tool on tinnitus in a website format

ABSTRACT Objective: to develop an educational tool in a Virtual Learning Environment (VLE), in a website format, to supply information on tinnitus, additional content on hearing and to provide access links to other websites related to speech therapy and audiology, so as to promote public health. Methods: an experimental, descriptive study, involving, in its construction, 6 stages elaborated as follows: planning, adaptation, collection of testimonies, inclusion of content, review and dissemination. Results: the site was titled "Do you have tinnitus?" It was subdivided into others: "Home", "Tinnitus?" "Types of tinnitus," "Main causes," "What to do?" "Main forms of treatment," "Tips to relieve tinnitus," "Prevention," "News," "Testimonials," "About your hearing," "What is hearing loss?" "What are speech therapy and audiology?" "Other sites," "Contact" and "About." Illustrations and videos were inserted, and the information contained in any material was classified with easy readability. Conclusion: it was possible to develop a website entitled “Do you have tinnitus?” available at the electronic address: https://vocetemzumbido.wixsite.com/home, providing general information about tinnitus, in addition to additional information on hearing.

Prevalence, Incidence, and Risk Factors for Tinnitus

How many people are affected by tinnitus? Is the risk of developing tinnitus on the rise or has it been declining over time? What modifiable lifestyle factors could help to prevent tinnitus? These population-based questions can be addressed through epidemiological research. Epidemiology refers to the underlying and basic science of public health. It describes the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems. There are two key concepts in epidemiology: (1) measures of frequency and (2) measures of effect. In this chapter, we introduce the two main measures of frequency, prevalence and incidence. We also introduce the notion of risk factors, critical for understanding measures of effect concerning the risk of developing a health condition. In both sections, we provide illustrative examples from the published literature on tinnitus. We end by offering a critical evaluation of the current status of epidemiological research on tinnitus and point to some promising future directions.

Applicability of the real ear measurement for audiological intervention of tinnitus

INTRODUCTION

Tinnitus is present in a large part of chronic health complaints, and it is considered a public health problem injurious to the individual's quality of life. Considering the increase of the world population associated with an increase of life expectancy, tinnitus remains a cause for medical concern, since during aging the occurrence of auditory impairments due to the deterioration of the peripheral auditory structures and central impairs the quality of life.

OBJECTIVE

The aim of the present study was to analyze the applicability of real ear measurements for audiological intervention of tinnitus through specific evaluation, selection, verification and validation of the hearing aids combined with the sound generator.

METHODS

Forty individuals of both genders with hearing loss and tinnitus complaints were deemed eligible to compose the sample. They were enrolled according to clinical symptoms and submitted to the following procedures: anamnesis and previous complaint history, high frequency audiometry, immittanciometry and acuphenometry with the research of psychoacoustic thresholds of pitch, loudness and minimum masking threshold, sound generator, in addition to the application of the Tinnitus Handicap Inventory and Visual Analog Scale tools. The entire sample was adapted with Siemens hearing aids and a sound generator, participated in a counseling session with support of digital material and evaluated in two situations: Initial Assessment (before the hearing aids and sound generator adaptation) and Final Assessment (6 months, after adaptation). The statistical analyzes were descriptive and inferential, adopted a significance level of 5% and the T-Paired Test and the Spearman Correlation test were performed.

RESULTS

The results showed that there was a benefit with the use of hearing aids combined with a sound generator from the statistically significant values and strong correlations between the sound generator verification data regarding acuphenometry and the nuisance/severity questionnaires. Regarding the verification of the sound generator, it is important to highlight that the entire sample selected the effective acoustic stimulation based on the comfort levels, which was proved in the present study to be a sufficient intensity for positive prognosis, whereas the users' noises were found below the psychoacoustic thresholds of acuphenometry.

CONCLUSION

The present study concluded that the audiological intervention with any level of sound stimulus is enough to obtain a positive prognosis in the medium term. Data that specifies that the verification of sound generator was effective at the real ear measurements are important in the evaluation and intervention of the complaint. In addition, it points out that the greater the tinnitus perception, the greater its severity, and the greater the nuisance, the higher the psychoacoustics thresholds of frequency and the minimum threshold of masking.

Age-related hearing loss and tinnitus, dementia risk, and auditory amplification outcomes

Age-related hearing loss (ARHL) or presbycusis, as the third leading cause of chronic disability in older adults, has been shown to be associated with predisposing cognitive impairment and dementia. Tinnitus is also a chronic auditory disorder demonstrating a growth rate with increasing age. Recent evidence stands for the link between bothersome tinnitus and impairments in various aspects of cognitive function. Both ARHL and age-related tinnitus affect mental health and contribute to developing anxiety, stress, and depression. The present review is a comprehensive multidisciplinary study on diverse interactions among ARHL, tinnitus, and cognitive decline in older adults. This review incorporates the latest evidence in prevalence and risk factors of ARHL and tinnitus, the neural substrates of tinnitus-related cognitive impairments, hypothesized mechanisms concerning the association between ARHL and increased risk of dementia, hearing amplification outcomes in cases with ARHL and cognitive decline, and preliminary findings on the link between ARHL and cognitive impairment in animal studies. Given extensive evidence that demonstrates advantages of using auditory amplification in the alleviation of hearing handicap, depression, and tinnitus, and the improvement of cognition, social communication, and quality of life, regular hearing screening programs for identification and management of midlife hearing loss and tinnitus is strongly recommended.

Tinnitus evaluation: relationship between pitch matching and loudness, visual analog scale and tinnitus handicap inventory

Introduction

Tinnitus is a subjective auditory symptom usually associated with a sound, even in the absence of external sound sources. Its diagnosis is complex, and some of the forms of measurement alone or in combination, include self-assessment questionnaires, such as the tinnitus handicap inventory, the visual analog scale and/or pitch and loudness matching.

Objective

To analyze the correlation among three tinnitus measurement methods: tinnitus handicap inventory, visual analog scale and pitch and loudness matching.

Methods

The study consisted of 148 patients complaining of chronic tinnitus. An otorhinolaryngological evaluation, anamnesis directed to tinnitus, audiometry (pure tone and speech), imitanciometry, tinnitus handicap inventory, visual analog scale, and pitch and loudness matching were performed. The study was registered in the Ethics Committee of the Institution with no. 0129/12.

Results

Regarding the frequency of tinnitus handicap inventory responses, a higher occurrence of the mild degree was observed. An average of 6 points was observed on the visual analog scale. The mean loudness matching in the right ear was 20 dBNS, and in the left ear was 17 dBNS. As for the type of stimulus, the most found was continuous pure tone. The frequency of the pitch sensation was 6000 Hz in the largest number of cases. Regarding the measures of tinnitus handicap inventory and the visual analogical scale, a significant correlation was observed, and as one value increases the other also increases. Pitch and loudness matching and the visual analogical scale results are also significant.

Conclusion

There was a significant correlation between the values measured by the tinnitus handicap inventory, visual analogical scale (annoyance) and loudness matching in the evaluation of tinnitus. The selection of any one of the three evaluative methods for tinnitus investigation provides different dimensions of the tinnitus and complements the others.

Tinnitus and hearing survey: cultural adaptation to Brazilian Portuguese

Introduction

Hearing loss is associated with several comorbidities and may be frequently associated with tinnitus. When patients complain of both tinnitus and hearing difficulties in audiology and otolaryngology clinics, there, is often great difficulty separating the two complaints. The tinnitus and hearing survey was specially developed for this purpose to identify the main complaint and help direct the choice of appropriate intervention.

Objective

To translate and culturally adapt the tinnitus and hearing survey for the Brazilian-Portuguese.

Methods

Seventy patients who had previously completed a battery of audiological diagnostic exams were invited to complete the tinnitus and hearing survey and were categorized into four groups: normal hearing without tinnitus, normal hearing with tinnitus, hearing loss without tinnitus, and hearing loss with tinnitus. Cultural adaptation of tinnitus and hearing survey followed the steps indicated by Guillemin et al. (1993), including assessment of inter-researchers’ reproducibility, internal consistency, and reliability of the instrument.

Results

There were no substantial changes to the content of the tinnitus and hearing survey questions, although a few adaptations were made to two-item sound tolerance section to facilitate participants’ understanding. Internal consistency and reliability tested by Cronbach’s α was considered good for all domains. The reproducibility of the tinnitus and hearing survey was measured by the Kappa coefficient at two different moments and agreement between evaluators 1 and 2 was considered almost perfect, indicating good reproducibility.

Conclusion

The tinnitus and hearing survey was culturally adapted to Brazilian Portuguese and analyzed for internal consistency, reliability, and reproducibility. Results support this questionnaire as a useful tool to help professionals differentiate the main complaint of the individual, allowing the choice of a more appropriate intervention.

Tinnitus and its relationship with anxiety and depression in the elderly: a systematic review

ABSTRACT Objective: to verify, in the literature, a probable association of tinnitus with anxiety and depression in the elderly. Methods: a systematic review (through a search in the indexed databases - Lilacs, Scielo, Pubmed, Science Direct, The Cochrane Library) of studies published between 2013 and 2018, in Portuguese and in English, involving adults and/or elderly (18 years and older). The descriptors used were: “tinnitus", "depression", "anxiety", "adult", "elderly", interspersed by the Boolean operator AND. Results: 11 studies were selected, from which, 5 compared adults to elderly and only 2 evaluated such relationship in the elderly alone. Studies suggest that, as age increases, tinnitus severity and psychological symptoms also increase, affecting both men and women. Conclusion: few studies compared the relationship between the variables among the elderly. A probable association between the variables for both genders has been found, suggesting that the advancing age contributes to the increase of tinnitus severity and its psychological symptoms, affecting the quality of life of these individuals. Further studies are suggested to confirm the association between tinnitus, anxiety and depression in the elderly. Multi-professional work is important for the evaluation and treatment of these people.

The Cochleural Alternating Acoustic Beam Therapy (CAABT): A pre-clinical trial

PURPOSE

We intend to assess the effectiveness of a novel tinnitus treatment therapy, the Cochleural Alternating Acoustic Beam Therapy (CAABT) using the psychoacoustic measures, the questionnaires and rs-fMRI.

MATERIALS AND METHODS

In this study, we enrolled 11 older than 18 years old Chinese patients with normal hearing who had unilateral, chronic (longer than 6 months), sensorineural tinnitus, of frequencies between 125-8000 Hz, and an average loudness of 31 dB. The patients underwent the treatment with the CAABT method for 12 weeks and the outcomes were evaluated with tinnitus questionnaire scores, a set of psychoacoustic measures, and rs-fMRI testing before treatment and at 3 months. This was an earlier study of the controlled randomized clinical trial which was registered with ClinicalTrials.gov, number NCT02774122.

RESULTS

Almost all the patients reported reduced tinnitus annoyance after the three-month treatment. The THI and VAS scores showed decreased tinnitus severity. The rs-fMRI results indicated that the right middle frontal gyrus and the right superior temporal gyrus displayed noticeable decreases of the ReHo values for the subjects between the before and after treatment, supporting the clinical evidence of significant tinnitus reduction.

CONCLUSION

The therapy seemed effective in patients of varying severities, and no side effects were observed in this trial. The CAABT can be an alternative for those who are suitable for sound therapy once a large scale of and better controlled clinical studies have validated the findings of this experiment.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group

Introduction

Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life.

Objective

To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds.

Methods

Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described.

Results

The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results.

Conclusion

A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.

Quality of life in individuals with tinnitus with and without hearing loss

ABSTRACT Purpose: to evaluate the perception of the level of quality of life in subjects with tinnitus, with and without hearing loss. Methods: a cross-sectional quantitative study. A total of 189 subjects (mean age 53.06 years) divided into four groups. Group 1: subjects with normal auditory thresholds without tinnitus complaint; Group 2: subjects with normal auditory thresholds and tinnitus complaint; Group 3: subjects with sensorineural hearing loss without tinnitus complaint; Group 4: subjects with sensorineural hearing loss and with tinnitus complaint. Levels of quality of life were investigated through the World Health Organization Quality Of Life (WHOQOL) website - brief and psycho-emotional and functional aspects of patients with tinnitus through the Tinnitus Handicap Inventory (THI). Statistical analyzes, comparisons among groups and descriptive analysis were performed, considering a significance level of 5%. Results: the overall mean scores of quality of life in group 4 (56.07) were smaller than those of group 1 (64.67) (p<0.05). The subjects with tinnitus complaint presented a moderate level of disturbance of the symptom. Conclusion: tinnitus interferes in the quality of life of individuals who had preserved or altered auditory thresholds. Therefore, means to reduce the discomfort caused by tinnitus symptom should be developed, in order to improve patients' quality of life.

Clinical characteristics of patients with tinnitus evaluated with the Tinnitus Sample Case History Questionnaire in Japan: A case series

Background

The Tinnitus Sample Case History Questionnaire was determined as a standardized questionnaire for obtaining patient case histories and for characterizing patients into subgroups at the Tinnitus Research Initiative in 2006. In this study, we developed a Japanese version of this questionnaire for evaluating the clinical characteristics of patients with tinnitus. The Japanese version of the questionnaire will be available for evaluating treatments for tinnitus and for comparing data on tinnitus in research centers.

Aims/Objectives

To evaluate the clinical characteristics of patients with tinnitus in Japan using a newly developed Japanese version of Tinnitus Sample Case History Questionnaire.

Study design

This was a prospective study based on patient records.

Setting

University hospitals, general hospitals, and clinics.

Subjects and methods

We collected patient data using a Japanese translated version of the Tinnitus Sample Case History Questionnaire. In total, 584 patients who visited our institutions in Japan between August 2012 and March 2014 were included (280 males and 304 females; age 13–92 years; mean age, 60.8). We examined patients after dividing them into two groups according to the presence or absence of hyperacusis. The collected results were compared with those from the Tinnitus Research Initiative database.

Results

Compared with the TRI database, there were significantly more elderly female patients and fewer patients with trauma-associated tinnitus. There was a statistically lower ratio of patients with hyperacusis. We found that patients with tinnitus in addition to hyperacusis had greater tinnitus severity and exhibited higher rates of various complications.

Conclusion

The Japanese version of the Tinnitus Sample Case History Questionnaire developed in this study can be a useful tool for evaluating patients with tinnitus in Japan. The results of this multicenter study reflect the characteristics of patients with tinnitus who require medical care in Japan. Our data provides a preliminary basis for an international comparison of tinnitus epidemiology.

Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms

OBJECTIVE

To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms.

MATERIALS AND METHODS

We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant.

RESULTS

The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom.

CONCLUSION

Vascular loops do not appear to be associated with otoneurological manifestations.

Prevalence and Determinants of Tinnitus in the Italian Adult Population

Background: Limited, outdated, and poor quality data are available on the prevalence of tinnitus, particularly in Italy. Methods: A face-to-face survey was conducted in 2014 on 2,952 individuals, who represented the Italian population aged 18 or more (50.6 million). Any tinnitus was defined as the presence of ringing or buzzing in the ears lasting for at least 5 min in the previous 12 months. Results: Any tinnitus was reported by 6.2% of Italian adults, chronic tinnitus (i.e. for more than 3 months) by 4.8%, and severe tinnitus (i.e. which constitutes a big or very big problem) by 1.2%. The corresponding estimates for the population aged ≥45 years were 8.7, 7.4 and 2.0%, respectively. Multivariable analysis on population aged ≥45 years revealed that old age (odds ratio (OR) = 4.49 for ≥75 vs. 45-54 years) and obesity (OR = 2.14 compared to normal weight) were directly related to any tinnitus, and high monthly family income (OR = 0.50) and moderate alcohol consumption (OR = 0.59 for <7 drinks/week vs. non-drinking) were inversely related. Conclusions: This is the first study on tinnitus prevalence among the general Italian adult population. It indicates that in Italy tinnitus affects more than 3 million adults and is felt as a major problem by more than 600,000 Italians, mostly aged 45 years or more.