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Kothari DS, Nieri CA, Tanenbaum ZG, Linker LA, Rangarajan SV. Mind-Body Therapies in the Management of Otolaryngologic Disease: A State-of-the-Art Review of Randomized Controlled Trials. Otolaryngol Head Neck Surg 2024; 170:45-60. [PMID: 37712305 DOI: 10.1002/ohn.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 08/18/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To review and assess the peer-reviewed literature on the utility of mind-body therapy (MBT) as an adjunct treatment in the management of otolaryngologic disease. DATA SOURCES PubMed, Embase, and Cochrane. REVIEW METHODS Randomized control trials (RCTs) of MBTs in the management of otolaryngologic disease from 2002 to 2022 were identified and included according to predefined criteria. Interventions requiring expensive equipment were excluded because the goal of MBT is to be cost-conscious. All studies were subjected to a two-stage blinded screening, extraction, and appraisal process. The outcomes of the intervention and control groups were compared. CONCLUSION RCTs of MBTs, including breathing exercises (4), aromatherapy (2), biofeedback (2), meditation, (2), and yoga (2), have been studied in several otolaryngologic conditions, including septoplasty/rhinoplasty (3), head and neck cancer (2), facial palsy (2), and tinnitus (2). Most studies were of moderate risk of bias on appraisal, and each MBT studied was found to significantly reduce subjective and objective distress associated with the otolaryngologic condition in question. IMPLICATIONS FOR PRACTICE Despite a paucity of strong evidence supporting the universal use of MBTs, our review suggests that MBTs are cost-effective and easily deployable complementary tools in the management of otolaryngologic disease. Future large, methodologically rigorous RCTs are needed to address the limitations of the included studies, such as improper blinding and inappropriate statistical analysis. As MBTs are studied further, a case for their current use can be made because of their low cost and minimal risk to patients.
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Affiliation(s)
- Dhruv S Kothari
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Chad A Nieri
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Zachary G Tanenbaum
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Lauren A Linker
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sanjeet V Rangarajan
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Beukes EW, Andersson G, Fagelson MA, Manchaiah V. Dismantling internet-based cognitive behavioral therapy for tinnitus. The contribution of applied relaxation: A randomized controlled trial. Internet Interv 2021; 25:100402. [PMID: 34040997 PMCID: PMC8141772 DOI: 10.1016/j.invent.2021.100402] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT. AIMS This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression. METHODS A parallel randomized controlled trial design (n = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken. RESULTS Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes d = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group d = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group. CONCLUSION Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.
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Key Words
- Applied relaxation
- CBT, Cognitive Behavioral Therapy
- CONSORT, Consolidated Standards of Reporting Trials
- Cognitive behavioral therapy
- Digital therapeutics
- GAD-7, Generalized Anxiety Disorder
- HHIA-S, Hearing Handicap Inventory for Adults - Screening
- ICBT, Internet-based Cognitive Behavioral Therapy Intervention
- ISI, Insomnia Severity Index
- Internet intervention
- PHQ-9, Patient Health Questionnaire
- RCI, Reliable Change Index
- TFI, Tinnitus Functional Index
- Telehealth
- Tinnitus
- US, United States
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Affiliation(s)
- Eldré W. Beukes
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Vision and Hearing Sciences Research Group, School of Psychology and Sports Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden
| | - Marc A. Fagelson
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, USA
- Audiological Rehabilitation Laboratory, Auditory Vestibular Research Enhancement Award Program, Veterans Affairs Medical Center, Mountain Home, TN, USA
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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Kikidis D, Vassou E, Schlee W, Iliadou E, Markatos N, Triantafyllou A, Langguth B. Methodological Aspects of Randomized Controlled Trials for Tinnitus: A Systematic Review and How a Decision Support System Could Overcome Barriers. J Clin Med 2021; 10:1737. [PMID: 33923778 PMCID: PMC8074073 DOI: 10.3390/jcm10081737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/05/2022] Open
Abstract
Although a wide range of tinnitus management interventions is currently under research and a variety of therapeutic interventions have already been applied in clinical practice, no optimal and universal tinnitus treatment has been reached yet. This fact is to some extent a consequence of the high heterogeneity of the methodologies used in tinnitus related clinical studies. In this manuscript, we have identified, summarized, and critically appraised tinnitus-related randomized clinical trials since 2010, aiming at systematically mapping the research conducted in this area. The results of our analysis of the 73 included randomized clinical trials provide important insight on the identification of limitations of previous works, methodological pitfalls or gaps in current knowledge, a prerequisite for the adequate interpretation of current literature and execution of future studies.
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Affiliation(s)
- Dimitrios Kikidis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Evgenia Vassou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, Universität Regensburg, 93053 Regensburg, Germany; (W.S.); (B.L.)
| | - Eleftheria Iliadou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Nikolaos Markatos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Aikaterini Triantafyllou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, Universität Regensburg, 93053 Regensburg, Germany; (W.S.); (B.L.)
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Toneti BF, Barbosa RFM, Mano LY, Sawada LO, Oliveira IGD, Sawada NO. Benefits of Qigong as an integrative and complementary practice for health: a systematic review. Rev Lat Am Enfermagem 2020; 28:e3317. [PMID: 32696918 PMCID: PMC7365612 DOI: 10.1590/1518-8345.3718.3317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/06/2020] [Indexed: 02/07/2023] Open
Abstract
Objective: to analyze, in the literature, evidence about the benefits of the integrative
and complementary practice of Qigong with regard to the
health of adults and the elderly. Method: a systematic review by searching for studies in the PubMed, CINAHL, LILACS,
EMBASE and Cochrane Library databases. Randomized and non-randomized
clinical trials were included; in Portuguese, English and Spanish; from 2008
to 2018. The Preferred Reporting Items for Systematic Reviews and
Meta-Analyses strategy was adopted, as well as the recommendation of the
Cochrane Collaboration for assessing the risk of bias in the clinical trials
analyzed. Results: 28 studies were selected that indicated the benefit of the practice to the
target audience, which can be used for numerous health conditions, such as:
cancer; fibromyalgia; Parkinson’s disease; Chronic Obstructive Pulmonary
Disease; Burnout; stress; social isolation; chronic low back pain; cervical
pain; buzz; osteoarthritis; fatigue; depression; and cardiovascular
diseases. However, there was a great risk of bias in terms of the blinding
of the research studies. Conclusion: the practice of Qigong produces positive results on health,
mainly in the medium and long term. This study contributes to the
advancement in the use of integrative and complementary practices in
nursing, since it brings together the scientific production in the area from
the best research results available.
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Affiliation(s)
- Bruna Francielle Toneti
- PAHO/WHO Collaborating Centre at the Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Rafael Fernando Mendes Barbosa
- PAHO/WHO Collaborating Centre at the Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Leandro Yukio Mano
- Instituto de Ciências Matemáticas e de Computação, Universidade de São Paulo, São Carlos, SP, Brazil
| | - Luana Okino Sawada
- School of Computing and Information Science, Florida International University, Miami, FL, United States of America
| | - Igor Goulart de Oliveira
- Centro de Ciências Tecnológicas, Universidade Estadual do Norte do Paraná, Bandeirantes, PR, Brazil
| | - Namie Okino Sawada
- Escola de Enfermagem, Universidade Federal de Alfenas, Alfenas, MG, Brazil
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Abstract
Tinnitus is a common symptom. Standard therapies aim at improving the quality of life and reducing the psychological stress associated with tinnitus. Most interventions have little or no effect on the main symptom. Those affected subjects, however, want such a change and prefer a specific solution, such as pharmacologic therapy to other modalities. Scientific efforts have not yet led to significant improvement in the range of therapies. This article outlines existing efforts and develops ideas on how research for improved tinnitus therapy might look in the future.
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Affiliation(s)
- Tobias Kleinjung
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, Zurich CH 8091, Switzerland.
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Center, University of Regensburg, Universitätsstrasse 84, Regensburg D 93053, Germany
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6
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Effect of yoga training on the tinnitus induced distress. Complement Ther Clin Pract 2019; 36:7-11. [DOI: 10.1016/j.ctcp.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/15/2019] [Accepted: 04/10/2019] [Indexed: 11/22/2022]
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Procházková K, Šejna I, Skutil J, Hahn A. Ginkgo biloba extract EGb 761 ® versus pentoxifylline in chronic tinnitus: a randomized, double-blind clinical trial. Int J Clin Pharm 2018; 40:1335-1341. [PMID: 29855986 PMCID: PMC6208604 DOI: 10.1007/s11096-018-0654-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 05/08/2018] [Indexed: 02/05/2023]
Abstract
Background Ginkgo biloba extract EGb 761® and pentoxifylline are frequently prescribed for the treatment of tinnitus. Objective To compare the treatment effects of Ginkgo biloba extract EGb 761R and pentoxifylline. Setting The study was performed at Department of Otorhinolaryngology of University Hospital Královské Vinohrady and 3rd Medical Faculty, Charles University in Prague. Method Patients with sub-chronic or chronic tinnitus were enrolled in double-blind trial and randomized to receive 120 mg EGb 761® or 600 mg pentoxifylline, each twice a day and in double-dummy fashion over a 12-week period. Main outcome measure changes in 11-Point Box Scales for tinnitus loudness and annoyance, the abridged Tinnitus Questionnaire (Mini-TQ), the Hospital Anxiety and Depression Scale (HADS), and the Sheehan Disability Scale (SDS). Results Full analysis set for efficacy analysis comprised 197 patients (EGb 761®, 99; pentoxifylline 98). For both treatment groups, significant improvements were observed in the Mini-TQ, the 11-Point Box Scales for tinnitus loudness and annoyance, the HADS anxiety score and the SDS. There was no relevant difference with regard to tinnitus-related outcomes between the two treatment groups. 20 adverse events were documented in EGb 761® group and 36 adverse events were reported for pentoxifylline group. No serious adverse event was reported during the study. Conclusion EGb 761® and pentoxifylline were similarly effective in reducing the loudness and annoyance of tinnitus as well as overall suffering of the patients. The incidence of adverse events was lower in the EGb 761® group.
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Affiliation(s)
- Klára Procházková
- Department of Otorhinolaryngology, University Hospital Kralovske Vinohrady, Šrobárova 50, 10034, Prague, Czech Republic. .,Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Ivan Šejna
- Department of Otorhinolaryngology, University Hospital Kralovske Vinohrady, Šrobárova 50, 10034, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Skutil
- Department of Otorhinolaryngology, University Hospital Kralovske Vinohrady, Šrobárova 50, 10034, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aleš Hahn
- Department of Otorhinolaryngology, University Hospital Kralovske Vinohrady, Šrobárova 50, 10034, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
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8
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Vielsmeier V, Schecklmann M, Schlee W, Kreuzer PM, Poeppl TB, Rupprecht R, Langguth B, Lehner A. A Pilot Study of Peripheral Muscle Magnetic Stimulation as Add-on Treatment to Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus. Front Neurosci 2018. [PMID: 29515350 PMCID: PMC5826218 DOI: 10.3389/fnins.2018.00068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While brain stimulation techniques have been examined as treatment options for chronic tinnitus for many years, they have recently been extended to multimodal treatment approaches. As chronic tinnitus is often accompanied by comorbid muscular tension in the neck and back, we performed a one-arm pilot study to explore the feasibility of a new multimodal treatment approach. In detail, repetitive peripheral magnetic stimulation (rPMS) of the back was performed before and after each session of repetitive transcranial magnetic stimulation (rTMS) of the brain. Data of 41 patients were analyzed, all of which were treated with ten sessions of rTMS of the left prefrontal and left temporoparietal cortex followed by rPMS of the neck and back muscles. Tinnitus severity was measured using the tinnitus questionnaire (TQ). Neck pain was assessed using the neck pain and disability scale (NPAD). The new treatment approach was feasible and well accepted by the majority of patients. However, the overall patient group did not improve significantly in either of the questionnaires. If patients were divided in different subgroups depending on whether they were suffering from neck pain or somatosensory tinnitus, explorative post-hoc tests suggested differential effects: patients with both neck pain and somatosensory tinnitus had better outcomes than patients without those conditions or with neck pain only. This was true for both the TQ and the NPAD. This effect was of transient nature though: the TQ score went back to its baseline level after a follow-up period of 12 weeks. Based on our results we recommend that in studies that investigate tinnitus treatments targeting somatosensory afferents patients should be stratified according to somatic co-morbidities and somatosensory influence on the tinnitus percept. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT02306447.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Timm B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Henz D, Schöllhorn WI. Temporal Courses in EEG Theta and Alpha Activity in the Dynamic Health Qigong Techniques Wu Qin Xi and Liu Zi Jue. Front Psychol 2018; 8:2291. [PMID: 29358924 PMCID: PMC5766674 DOI: 10.3389/fpsyg.2017.02291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 12/18/2017] [Indexed: 12/24/2022] Open
Abstract
Health Qigong is a common technique of Traditional Chinese Medicine applied to strengthen mental and physical health. Several studies report increases in EEG theta and alpha activity after meditative Qigong techniques indicating a relaxed state of mind. To date, little is known on the effects of dynamic Health Qigong techniques that comprise bodily movements on brain activity. In the current study, we compared effects of two dynamic Health Qigong techniques on EEG brain activity. Subjects performed the techniques Wu Qin Xi (five animals play) and Liu Zi Jue (six healing sounds) in a within-subjects design. Eyes-open and eyes-closed resting EEG was recorded before and immediately after each 15-min practice block. Additionally, the Profile of Mood States (POMS) questionnaire was administered at pretest, and after each 15-min practice block. Results show a decrease in alpha activity after 15 min, followed by an increase after 30 min in the Health Qigong technique Liu Zi Jue. Theta activity was decreased after 15 min, followed by an increase after 30 min in the technique Wu Qin Xi. Results of the POMS indicated an increased vigor-activity level with decreased fatigue and tension-anxiety levels in both techniques after 30 min of practice. Our results demonstrate different temporal dynamics in EEG theta and alpha activity for the Health Qigong techniques Wu Qin Xi and Liu Zi Jue. We hypothesize that the found brain activation patterns result from different attentional focusing styles and breathing techniques performed during the investigated Health Qigong techniques.
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Affiliation(s)
- Diana Henz
- Institute of Sport Science, University of Mainz, Mainz, Germany
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10
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Phillips JS, McFerran DJ, Hall DA, Hoare DJ. The natural history of subjective tinnitus in adults: A systematic review and meta-analysis of no-intervention periods in controlled trials. Laryngoscope 2017; 128:217-227. [PMID: 28425615 DOI: 10.1002/lary.26607] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Tinnitus is a prevalent condition, but little has been published regarding the natural history of the condition. One technique for evaluating the long-term progression of the disease is to examine what happens to participants in the no-intervention control arm of a clinical trial. The aim of this study was to examine no-intervention or waiting-list data reported in trials, in which participants on the active arm received any form of tinnitus intervention. DATA SOURCES CINAHL, PsychINFO, EMBASE, ASSIA, PubMed, Web of Science, Science Direct, EBSCO Host, and Cochrane. METHODS Inclusion criteria followed the PICOS principles: Participants, adults with tinnitus; Intervention, none; Control, any intervention for alleviating tinnitus; Outcomes, a measure assessing tinnitus symptoms using a multi-item patient-reported tinnitus questionnaire. Secondary outcome measures included multi-item patient-reported questionnaires of mood and health-related quality of life and measures that quantified change in tinnitus loudness; Study design, randomized controlled trials or observational studies utilizing a no-intervention or waiting-list control group. Data were extracted and standardized mean difference was calculated for each study to enable meta-analysis. RESULTS The evidence strongly favored a statistically significant decrease in the impact of tinnitus over time, though there was significant heterogeneity and clinical significance cannot be interpreted. Outcome data regarding secondary measures did not demonstrate any clinically significant change. CONCLUSIONS Participants allocated to the no-intervention or waiting-list control arm of clinical trials for a tinnitus intervention show a small but significant improvement in self-reported measures of tinnitus with time; the clinical significance of this finding is unknown. There is, however, considerable variation across individuals. These findings support previous work and can cautiously be used when counseling patients. Laryngoscope, 128:217-227, 2018.
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Affiliation(s)
- John S Phillips
- Department of Otolaryngology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Don J McFerran
- Colchester Hospital University National Health Service Foundation Trust, Colchester, United Kingdom
| | - Deborah A Hall
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research, Nottingham, United Kingdom.,Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Derek J Hoare
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research, Nottingham, United Kingdom.,Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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11
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Henz D, Schöllhorn WI. EEG Brain Activity in Dynamic Health Qigong Training: Same Effects for Mental Practice and Physical Training? Front Psychol 2017; 8:154. [PMID: 28223957 PMCID: PMC5293832 DOI: 10.3389/fpsyg.2017.00154] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/23/2017] [Indexed: 11/13/2022] Open
Abstract
In recent years, there has been significant uptake of meditation and related relaxation techniques, as a means of alleviating stress and fostering an attentive mind. Several electroencephalogram (EEG) studies have reported changes in spectral band frequencies during Qigong meditation indicating a relaxed state. Much less is reported on effects of brain activation patterns induced by Qigong techniques involving bodily movement. In this study, we tested whether (1) physical Qigong training alters EEG theta and alpha activation, and (2) mental practice induces the same effect as a physical Qigong training. Subjects performed the dynamic Health Qigong technique Wu Qin Xi (five animals) physically and by mental practice in a within-subjects design. Experimental conditions were randomized. Two 2-min (eyes-open, eyes-closed) EEG sequences under resting conditions were recorded before and immediately after each 15-min exercise. Analyses of variance were performed for spectral power density data. Increased alpha power was found in posterior regions in mental practice and physical training for eyes-open and eyes-closed conditions. Theta power was increased after mental practice in central areas in eyes-open conditions, decreased in fronto-central areas in eyes-closed conditions. Results suggest that mental, as well as physical Qigong training, increases alpha activity and therefore induces a relaxed state of mind. The observed differences in theta activity indicate different attentional processes in physical and mental Qigong training. No difference in theta activity was obtained in physical and mental Qigong training for eyes-open and eyes-closed resting state. In contrast, mental practice of Qigong entails a high degree of internalized attention that correlates with theta activity, and that is dependent on eyes-open and eyes-closed resting state.
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Affiliation(s)
- Diana Henz
- Institute of Sports Science, University of MainzMainz, Germany
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12
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A proof-of-concept study on the combination of repetitive transcranial magnetic stimulation and relaxation techniques in chronic tinnitus. J Neural Transm (Vienna) 2016; 123:1147-57. [DOI: 10.1007/s00702-016-1588-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/12/2016] [Indexed: 01/24/2023]
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13
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Plein CT, Harounian J, Floyd E, Irizarry R, Ferzli G, Kidwai S, Rosenfeld RM. A Systematic Review of Eligibility and Outcomes in Tinnitus Trials. Otolaryngol Head Neck Surg 2015; 154:24-32. [DOI: 10.1177/0194599815608160] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/03/2015] [Indexed: 11/16/2022]
Abstract
Objective To analyze existing tinnitus treatment trials with regard to eligibility criteria, outcome measures, study quality, and external validity and to recognize the effect of patient demographics, symptom duration, severity, and otologic comorbidity on research findings to help practitioners apply them to patient encounters. Data Sources Systematic literature search conducted by an information specialist for development of the American Academy of Otolaryngology—Head and Neck Surgery Foundation’s tinnitus clinical practice guideline. Review Methods Articles were assessed for eligibility with the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-analyses) and data extracted by 2 independent investigators. Studies were assessed for methodological quality, inclusion and exclusion criteria, patient demographics, and outcome measures. Results A total of 147 randomized trials met inclusion criteria. Nearly all studies took place in a specialist setting. More than 50% did not explicitly define tinnitus, and 44% used a subjective severity threshold, such as “severely disturbing.” Fifty-four percent required symptom duration of at least 6 months for study eligibility, and up to 33% excluded patients with “organic” hearing loss or otologic conditions. Mean age was 52.2 years, and median follow-up was 3 months. Only 20% had a low risk of bias. Conclusion Randomized trials of tinnitus interventions are most applicable to older adults with tinnitus lasting ≥6 months who are evaluated in specialty settings. High risk of bias, short follow-up, and outcome reporting raise concerns about the validity of findings and may influence how clinicians apply trial results to individual patients and establish treatment expectations, thus demonstrating the need for further quality research in this field.
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Affiliation(s)
- Colleen T. Plein
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jonathan Harounian
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Elizabeth Floyd
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Rachel Irizarry
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - George Ferzli
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Sarah Kidwai
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
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Abstract
The purpose of this review was to evaluate the efficacy and safety of qigong for hypertension.A systematic literature search was performed in 7 databases from their respective inceptions until April 2014, including the Cochrane Library, EMBASE, PubMed, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, Wanfang database, and Chinese National Knowledge Infrastructure. Randomized controlled trials of qigong as either monotherapy or adjunctive therapy with antihypertensive drugs versus no intervention, exercise, or antihypertensive drugs for hypertension were identified. The risk of bias was assessed using the tool described in Cochrane Handbook for Systematic Review of Interventions, version 5.1.0.Twenty trials containing 2349 hypertensive patients were included in the meta-analysis. The risk of bias was generally high. Compared with no intervention, qigong significantly reduced systolic blood pressure (SBP) (weighted mean difference [WMD] = -17.40 mm Hg, 95% confidence interval [CI] -21.06 to -13.74, P < 0.00001) and diastolic blood pressure (DBP) (WMD = -10.15 mm Hg, 95% CI -13.99 to -6.30, P < 0.00001). Qigong was inferior to exercise in decreasing SBP (WMD = 6.51 mm Hg, 95% CI 2.81 to 10.21, P = 0.0006), but no significant difference between the effects of qigong and exercise on DBP (WMD = 0.67 mm Hg, 95% CI -1.39 to 2.73, P = 0.52) was identified. Compared with antihypertensive drugs, qigong produced a clinically meaningful but not statistically significant reduction in SBP (WMD = -7.91 mm Hg, 95% CI -16.81 to 1.00, P = 0.08), but appeared to be more effective in lowering DBP (WMD = -6.08 mm Hg, 95% CI -9.58 to -2.58, P = 0.0007). Qigong plus antihypertensive drugs significantly lowered both SBP (WMD = -11.99 mm Hg, 95% CI -15.59 to -8.39, P < 0.00001) and DBP (WMD = -5.28 mm Hg, 95% CI, -8.13 to -2.42, P = 0.0003) compared with antihypertensive drugs alone. No serious adverse events were reported.The meta-analysis suggests that qigong is an effective therapy for hypertension. However, more rigorously designed randomized controlled trials with long-term follow-up focusing on hard clinical outcomes are required to confirm the results.
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Affiliation(s)
- Xingjiang Xiong
- From the Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences (XX); Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA, USA (XL); Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences (PW), Beijing, China; Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA; and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada (YZ)
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Kreuzer PM, Landgrebe M, Resch M, Husser O, Schecklmann M, Geisreiter F, Poeppl TB, Prasser SJ, Hajak G, Rupprecht R, Langguth B. Feasibility, safety and efficacy of transcutaneous vagus nerve stimulation in chronic tinnitus: an open pilot study. Brain Stimul 2014; 7:740-7. [PMID: 24996510 DOI: 10.1016/j.brs.2014.05.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/07/2014] [Accepted: 05/11/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Vagus nerve stimulation represents an established treatment strategy for epilepsy and affective disorders. Recently, positive effects were also shown in animals and humans with tinnitus. Here we report the results of an open pilot study exploring feasibility, safety and efficacy of tVNS in the treatment of chronic tinnitus. STUDY DESIGN Fifty patients with chronic tinnitus underwent tVNS in an open single-armed pilot study which was conducted in two phases applying two different stimulating devices (Cerbomed CM02 and NEMOS). Clinical assessment was based on Tinnitus Questionnaire (TQ), Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), WHO Quality of Life, and various numeric rating scales. Primary outcome was defined as change in TQ (baseline vs. final visit in week 24). The study has been registered with clinicaltrials.gov (NCT01176734). RESULTS Primary analysis indicated mean TQ reductions of 3.7 points (phase 1) and 2.8 points (phase 2) significant for the first study phase. Secondary analyses indicated a significant BDI reduction for phase 1 (uncorrected for multiple testing), but no further systematic or significant effects. Adverse events included twitching and pressure at electrode placement site. The occurrence of one hospitalization because of palpations and the development of a left bundle branch block were considered as unrelated to the intervention. Cognitive testing revealed no significant changes. CONCLUSION Our data demonstrate the feasibility of tVNS over a period of 6 months. There was no clinically relevant improvement of tinnitus complaints. Our data suggest tVNS to be considered safe in patients without a history of cardiac disease.
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Affiliation(s)
- Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053 Regensburg, Germany.
| | - Michael Landgrebe
- Department of Psychiatry, Psychosomatics and Psychotherapy, kbo Lech-Mangfall-Klinik Agatharied, Germany
| | - Markus Resch
- Department of Cardiology, Internal Medicine II, University of Regensburg, Regensburg, Germany
| | - Oliver Husser
- Department of Cardiology, Internal Medicine II, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053 Regensburg, Germany
| | - Florian Geisreiter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053 Regensburg, Germany
| | - Timm B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053 Regensburg, Germany
| | - Sarah J Prasser
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053 Regensburg, Germany
| | - Goeran Hajak
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053 Regensburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Bezirksklinikum Bamberg, Bamberg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053 Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053 Regensburg, Germany
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Kreuzer PM, Goetz M, Holl M, Schecklmann M, Landgrebe M, Staudinger S, Langguth B. Mindfulness-and body-psychotherapy-based group treatment of chronic tinnitus: a randomized controlled pilot study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012. [PMID: 23186556 PMCID: PMC3517771 DOI: 10.1186/1472-6882-12-235] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Tinnitus, the perception of sound in absence of an external acoustic source, impairs the quality of life in 2% of the population. Since in most cases causal treatment is not possible, the majority of therapeutic attempts aim at developing and strengthening individual coping and habituation strategies. Therapeutic interventions that incorporate training in mindfulness meditation have become increasingly popular in the treatment of stress-related disorders. Here we conducted a randomized, controlled clinical study to investigate the efficacy of a specific mindfulness- and body-psychotherapy based program in patients suffering from chronic tinnitus. Methods Thirty-six patients were enrolled in this pilot study. The treatment was specifically developed for tinnitus patients and is based on mindfulness and body psychotherapy. Treatment was performed as group therapy at two training weekends that were separated by an interval of 7 weeks (eleven hours/weekend) and in four further two-hour sessions (week 2, 9, 18 and 22). Patients were randomized to receive treatment either immediately or after waiting time, which served as a control condition. The primary study outcome was the change in tinnitus complaints as measured by the German Version of the Tinnitus Questionnaire (TQ). Results ANOVA testing for the primary outcome showed a significant interaction effect time by group (F = 7.4; df = 1,33; p = 0.010). Post hoc t-tests indicated an amelioration of TQ scores from baseline to week 9 in both groups (intervention group: t = 6.2; df = 17; p < 0.001; control group: t = 2.5; df = 16; p = 0.023), but the intervention group improved more than the control group. Groups differed at week 7 and 9, but not at week 24 as far as the TQ score was concerned. Conclusions Our results suggest that this mindfulness- and body-psychotherapy-based approach is feasible in the treatment of tinnitus and merits further evaluation in clinical studies with larger sample sizes. The study is registered with clinicaltrials.gov (NCT01540357).
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Landgrebe M, Azevedo A, Baguley D, Bauer C, Cacace A, Coelho C, Dornhoffer J, Figueiredo R, Flor H, Hajak G, van de Heyning P, Hiller W, Khedr E, Kleinjung T, Koller M, Lainez JM, Londero A, Martin WH, Mennemeier M, Piccirillo J, De Ridder D, Rupprecht R, Searchfield G, Vanneste S, Zeman F, Langguth B. Methodological aspects of clinical trials in tinnitus: a proposal for an international standard. J Psychosom Res 2012; 73:112-21. [PMID: 22789414 PMCID: PMC3897200 DOI: 10.1016/j.jpsychores.2012.05.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/05/2012] [Accepted: 05/09/2012] [Indexed: 11/15/2022]
Abstract
Chronic tinnitus is a common condition with a high burden of disease. While many different treatments are used in clinical practice, the evidence for the efficacy of these treatments is low and the variance of treatment response between individuals is high. This is most likely due to the great heterogeneity of tinnitus with respect to clinical features as well as underlying pathophysiological mechanisms. There is a clear need to find effective treatment options in tinnitus, however, clinical trials differ substantially with respect to methodological quality and design. Consequently, the conclusions that can be derived from these studies are limited and jeopardize comparison between studies. Here, we discuss our view of the most important aspects of trial design in clinical studies in tinnitus and make suggestions for an international methodological standard in tinnitus trials. We hope that the proposed methodological standard will stimulate scientific discussion and will help to improve the quality of trials in tinnitus.
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Affiliation(s)
- Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany.
| | - Andréia Azevedo
- Department of Otolaryngology, Otosul-Otorrinolaringologia Sul-Fluminense, Volta Redonda, Brasil
| | - David Baguley
- Audiology Department, Cambridge University Hospitals, Cambridge, UK
| | - Carol Bauer
- Division of Otolaryngology Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Anthony Cacace
- Department of Communications Sciences & Disorders, Wayne State University, Detroit, Michigan, USA
| | - Claudia Coelho
- Instituto de Avaliação de Tecnologia em Saúde and Grupo de Pesquisa em Neurotologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - John Dornhoffer
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ricardo Figueiredo
- Department of Otolaryngology, Otosul-Otorrinolaringologia Sul-Fluminense, Volta Redonda, Brasil
| | - Herta Flor
- Institute of Neuropsychology, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Goeran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Germany
| | - Paul van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Belgium
| | - Wolfgang Hiller
- Clinical Psychology and Psychotherapy, Psychological Institute, University of Mainz, Germany
| | - Eman Khedr
- Department of Neurology, Assiut University Hospital, Assiut, Egypt
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Zurich, Switzerland
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Germany
| | | | - Alain Londero
- Service ORL et CCF, Hôpital Européen G. Pompidou, Paris, France
| | - William H. Martin
- Department of Otolaryngology, Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark Mennemeier
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, USA
| | - Jay Piccirillo
- Department of Otolaryngology-Head and Neck and Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Dirk De Ridder
- TRI Tinnitus Clinic Antwerp, University Hospital Antwerp, Belgium
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Grant Searchfield
- Section of Audiology, School of Population Health, The University of Auckland, New Zealand
| | - Sven Vanneste
- TRI Tinnitus Clinic Antwerp, University Hospital Antwerp, Belgium
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany,Interdisciplinary Tinnitus Clinic, University of Regensburg, Germany
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Vielsmeier V, Strutz J, Kleinjung T, Schecklmann M, Kreuzer PM, Landgrebe M, Langguth B. Temporomandibular joint disorder complaints in tinnitus: further hints for a putative tinnitus subtype. PLoS One 2012; 7:e38887. [PMID: 22723902 PMCID: PMC3378537 DOI: 10.1371/journal.pone.0038887] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 05/15/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Tinnitus is considered to be highly heterogeneous with respect to its etiology, its comorbidities and the response to specific interventions. Subtyping is recommended, but it remains to be determined which criteria are useful, since it has not yet been clearly demonstrated whether and to which extent etiologic factors, comorbid states and interventional response are related to each other and are thus applicable for subtyping tinnitus. Analyzing the Tinnitus Research Initiative Database we differentiated patients according to presence or absence of comorbid temporomandibular joint (TMJ) disorder complaints and compared the two groups with respect to etiologic factors. METHODS 1204 Tinnitus patients from the Tinnitus Research Initiative (TRI) Database with and without subjective TMJ complaints were compared with respect to demographic, tinnitus and audiological characteristics, questionnaires, and numeric ratings. Data were analysed according to a predefined statistical analysis plan. RESULTS Tinnitus patients with TMJ complaints (22% of the whole group) were significantly younger, had a lower age at tinnitus onset, and were more frequently female. They could modulate or mask their tinnitus more frequently by somatic maneuvers and by music or sound stimulation. Groups did not significantly differ for tinnitus duration, type of onset (gradual/abrupt), onset related events (whiplash etc.), character (pulsatile or not), hyperacusis, hearing impairment, tinnitus distress, depression, quality of life and subjective ratings (loudness etc.). CONCLUSION Replicating previous work in tinnitus patients with TMJ complaints, classical risk factors for tinnitus like older age and male gender are less relevant in tinnitus patients with TMJ complaints. By demonstrating group differences for modulation of tinnitus by movements and sounds our data further support the notion that tinnitus with TMJ complaints represents a subgroup of tinnitus with clinical features that are highly relevant for specific therapeutic management.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany.
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Robins JLW, Elswick RK, McCain NL. The story of the evolution of a unique tai chi form: origins, philosophy, and research. J Holist Nurs 2012; 30:134-46. [PMID: 22228833 DOI: 10.1177/0898010111429850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this article is to introduce a unique tai chi form that has been successfully implemented in two large randomized clinical trials. The intervention is composed of a series of tai chi movements chosen for their particular meanings, thus adding a cognitive component to the practice of a moving meditation. Over the last decade, the intervention has continued to evolve as it has been used in different populations. Most recently, medical qigong has been integrated to strengthen its potential impact on a variety of biobehavioral measures associated with cardiometabolic risk in women. Following an appraisal of the authors' process as well as the philosophy, practice, and research of tai chi and qigong, the authors share the story of their intervention to contribute to the evolving research of these safe, well-received, low-cost, and beneficial practices.
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Human Energetic Therapies. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vielsmeier V, Kleinjung T, Strutz J, Bürgers R, Kreuzer PM, Langguth B. Tinnitus with temporomandibular joint disorders: a specific entity of tinnitus patients? Otolaryngol Head Neck Surg 2011; 145:748-52. [PMID: 21705788 DOI: 10.1177/0194599811413376] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Tinnitus is frequently associated with temporomandibular joint (TMJ) dysfunction. However, the nature of the relationship is not fully understood. Here the authors compared 30 patients with a confirmed diagnosis of temporomandibular joint dysfunction and tinnitus to a group of 61 patients with tinnitus but without any subjective complaints of TMJ dysfunction with respect to clinical and demographic characteristics. STUDY DESIGN Case-control study. SETTING Tertiary referral center. SUBJECTS Tinnitus patients with and without TMJ dysfunction presenting at the Department of Prosthetic Dentistry and th: Tinnitus Clinic at the University of Regensburg. RESULTS Tinnitus patients with TMJ disorder had better hearing function (P < .0005), lower age (P = .001), and lower age at tinnitus onset (P = .002) and were more frequently female (P = .003). Their subjectively perceived tinnitus loudness was lower (P = .01), and more of them could modulate their tinnitus by jaw or neck movements (P = .001). CONCLUSION Classical risk factors for tinnitus (age, male gender, hearing loss) are less relevant in tinnitus patients with TMJ disorder, suggesting a causal role of TMJ pathology in the generation and maintenance of tinnitus. Based on this finding, treatment of TMJ disorder may represent a causally oriented treatment strategy for tinnitus.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany.
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Hoare DJ, Kowalkowski VL, Kang S, Hall DA. Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. Laryngoscope 2011; 121:1555-64. [PMID: 21671234 PMCID: PMC3477633 DOI: 10.1002/lary.21825] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 03/14/2011] [Accepted: 03/18/2011] [Indexed: 01/19/2023]
Abstract
Objectives/Hypothesis To evaluate the existing level of evidence for tinnitus management strategies identified in the UK Department of Health's Good Practice Guideline. Study Design Systematic review of peer-reviewed literature and meta-analyses. Methods Searches were conducted in PubMed, Cambridge Scientific Abstracts, Web of Science, and EMBASE (earliest to August 2010), supplemented by hand searches in October 2010. Only randomized controlled trials that used validated questionnaire measures of symptoms (i.e., measures of tinnitus distress, anxiety, depression) were included. Results Twenty-eight randomized controlled trials met our inclusion criteria, most of which provide moderate levels of evidence for the effects they reported. Levels of evidence were generally limited by the lack of blinding, lack of power calculations, and incomplete data reporting in these studies. Only studies examining cognitive behavioral therapy were numerous and similar enough to perform meta-analysis, from which the efficacy of cognitive behavioral therapy (moderate effect size) appears to be reasonably established. Antidepressants were the only drug class to show any evidence of potential benefit. Conclusions The efficacy of most interventions for tinnitus benefit remains to be demonstrated conclusively. In particular, high-level assessment of the benefit derived from those interventions most commonly used in practice, namely hearing aids, maskers, and tinnitus retraining therapy needs to be performed.
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Affiliation(s)
- Derek J Hoare
- National Institute for Health Research National Biomedical Research Unit in Hearing, Nottingham, United Kingdom.
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