Exploring the middle ear function in patients with a cluster of symptoms including tinnitus, hyperacusis, ear fullness and/or pain

New Hyperacusis Therapy Combines Psychoeducation, Sound Exposure, and Counseling

PURPOSE

The aim of this study was to investigate the short- and long-term effects of a new cognitive sound exposure therapy (CSET) in patients with hyperacusis.

METHOD

A new therapy was developed to reduce hyperacusis using sound exposure combined with breathing and relaxation strategies from both acceptance and commitment therapy and cognitive behavioral therapy. Patients who were referred to the Speech and Hearing Centers located in Hengelo and Zwolle in the Netherlands and aged ≥ 18 years with hyperacusis as main complaint and no or mild hearing loss were included in this study. Patients were seen for CSET between June 2020 and August 2022. The sessions took place biweekly. Sessions ended when exposure reached a level with a maximum of 70-80 dB SPL. Short-term effects between the start and the end of therapy were based on tolerable level of sound exposure (dB SPL), subjective-level hinderance of hyperacusis, and sensitivity to sound using the Hyperacusis Questionnaire (HQ). The long-term effect was based on HQ 6 months after the end of therapy. Linear mixed-effects and regression models were applied to study outcomes over time.

RESULTS

In total, 30 patients, 15 men and 15 women, aged between 24 and 76 years were included in this study. The mean number of sessions during therapy was 6 and ranged between 4 and 8. Results showed an increase of exposure level (mean change was +23.7 dB with an SD of 7.9, p < .001), a decrease in sensitivity to daily sounds (mean [SD] change was -1.6 [2.1], p < .001), and a decrease in HQ (mean [SD] change was -9.8 [4.9], p < .001), between the start and the end of therapy. There was no significant change in HQ after the end of therapy and 6 months later; mean (SD) change was 0.2 (4.3), p = .81.

CONCLUSIONS

The evaluation of CSET indicated a decrease in short- and long-term sensitivity to sound in patients with hyperacusis. Additionally, CSET has shown a positive impact, not only for the sounds used in the therapy sessions but also in transferring benefits to everyday sounds. The results of combining psychoeducation, sound exposure, and counseling are promising and warrant further evaluation.

Quality of life and level of physical activity of individuals with temporomandibular disorders with and without otological symptoms: Secondary analysis of a cross-sectional study

BACKGROUND AND PURPOSE

Otological symptoms (OS) are highly prevalent in individuals with temporomandibular disorders (TMD). Individuals with TMD and OS have more neck disability and decreased deep neck muscles endurance when compared to individuals without OS. However, no studies have evaluated whether OS is associated with lower Quality of Life (QoL) and worse levels of physical activity. This study aimed to evaluate the QoL and level of physical activity of individuals with TMD with and without OS.

METHODS

In this cross-sectional study, 62 individuals with TMD were allocated into 2 groups: TMD with OS (n = 36) or TMD without OS (n = 26). Self-reported complaints of dizziness, vertigo, tinnitus, earache, ear fullness, or hypoacusis were considered as OS. QoL was assessed with the WHOQOL-Bref and physical activity with the IPAQ-SF. Independent t-test and chi-squared test were used for analysis between-groups. Effect sizes were reported using Cohen's d. A Pearson correlation was used to compare the number of OS and QoL scores. A significance level of p < 0.05% and 95% confidence intervals were considered statistically significant.

RESULTS

The total generic scores for QoL were not different between-groups (p = 0.076), but individuals with TMD with OS had lower satisfaction (p = 0.015; d: 0.63) and physical domain (p = 0.015; d: 0.64) scores with a moderate effect size. In TMD with OS, 69.4% of individuals were irregularly active and 50% for the TMD without OS, with no statistical significance (p > 0.05). The number of OSs was inversely and weakly associated with the QoL total score.

CONCLUSION

Individuals with TMD and OS are associated with worsened QoL (physical domain and satisfaction) when compared to individuals with TMD without OS. The higher the number of OS, the worse the QoL score. Individuals with TMD with and without OS had similar levels of physical activity, but a high prevalence of irregularly active and sedentary individuals within TMD diagnosed population was found.

Prevalence and management outcomes of tonic tensor tympani syndrome in an ENT audiology tinnitus clinic in Singapore

OBJECTIVE

Tonic tensor tympani syndrome is found in a subset of tinnitus patients who experience intra-aural and peri-aural symptoms, in addition to their tinnitus, in the absence of clinically detectable pathology. As the syndrome has not been widely reported, this study aims to determine its prevalence and evaluate the effectiveness of current management.

METHODS

The tinnitus management clinic records of patients over the past six years were assessed to identify tonic tensor tympani syndrome patients and track their progress based on patient-reported Tinnitus Handicap Index scores. Patients with reversible ear pathology and temporomandibular joint disorder were excluded.

RESULTS

It was found that 13 per cent of the tinnitus management patients fulfilled the criteria for tonic tensor tympani syndrome and 94 per cent of those who returned for follow up showed an improvement in their Tinnitus Handicap Index grades.

CONCLUSION

This study suggests that tonic tensor tympani syndrome is a significant problem among tinnitus patients and current tinnitus management strategies contribute effectively to helping such patients habituate to their symptoms.

Temporal bone marrow of the rat and its connections to the inner ear

Calvarial bone marrow has been found to be central in the brain immune response, being connected to the dura through channels which allow leukocyte trafficking. Temporal bone marrow is thought to play important roles in relation to the inner ear, but is still largely uncharacterized, given this bone complex anatomy. We characterized the geometry and connectivity of rat temporal bone marrow using lightsheet imaging of cleared samples and microCT. Bone marrow was identified in cleared tissue by cellular content (and in particular by the presence of megakaryocytes); since air-filled cavities are absent in rodents, marrow clusters could be recognized in microCT scans by their geometry. In cleared petrosal bone, autofluorescence allowed delineation of the otic capsule layers. Within the endochondral layer, bone marrow was observed in association to the cochlear base and vestibule, and to the cochlear apex. Cochlear apex endochondral marrow (CAEM) was a separated cluster from the remaining endochondral marrow, which was therefore defined as "vestibular endochondral marrow" (VEM). A much larger marrow island (petrosal non-endochondral marrow, PNEM) extended outside the otic capsule surrounding semicircular canal arms. PNEM was mainly connected to the dura, through bone channels similar to those of calvarial bone, and only a few channels were directed toward the canal periosteum. On the contrary, endochondral bone marrow was well connected to the labyrinth through vascular loops (directed to the spiral ligament for CAEM and to the bony labyrinth periosteum for VEM), and to dural sinuses. In addition, CAEM was also connected to the tensor tympani fossa of the middle ear and VEM to the endolymphatic sac. Endochondral marrow was made up of small lobules connected to each other and to other structures by channels lined by elongated macrophages, whereas PNEM displayed larger lobules connected by channels with a sparse macrophage population. Our data suggest that the rat inner ear is surrounded by bone marrow at the junctions with middle ear and brain, most likely with "customs" role, restricting pathogen spread; a second marrow network with different structural features is found within the endochondral bone layer of the otic capsule and may play different functional roles.

Meteorological extremes and their impact on tinnitus-related emergency room visits: a time-series analysis

PURPOSE

Extreme weather events are rising due to the accelerating pace of climate change. These events impact human health and increase emergency room visits (EV) for many morbidities. Tinnitus is a common cause of EVs within otolaryngology in Germany and Austria. The effect of extreme weather conditions on tinnitus-related EVs is unknown.

METHODS

A total of 526 tinnitus-related EVs at a tertiary care hospital in Vienna were identified. A distributed lag non-linear model with a maximum lag period of 14 days was fitted to investigate the immediate and delayed effect of single-day and prolonged (three-day) extreme atmospheric pressure, relative humidity, mean temperature, precipitation and mean wind speed on EV rates. Extreme conditions were defined as the 1st, 5th, 95th, and 99th percentile of the meteorological variables. Relative risk (RR) is defined as risk for tinnitus-related EVs at an extreme condition compared to the risk at the median weather condition. Cumulative RR (cRR) is the total cumulated EV risk for a given time period.

RESULTS

High relative humidity increased same-day RR for tinnitus-related EVs to 1.75. Both low and high atmospheric pressure raised cRR as early as three days after an event to a maximum of 3.24. Low temperatures mitigated cRR within 4 days, while high temperatures tended to increase risk. Prolonged precipitation reduced cRR within one day.

CONCLUSION

Extreme meteorological conditions are associated with tinnitus-related EV rates. Further investigation into potential causative links and underlying pathophysiological mechanisms is warranted.