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Berger JI, Billig AJ, Sedley W, Kumar S, Griffiths TD, Gander PE. What is the role of the hippocampus and parahippocampal gyrus in the persistence of tinnitus? Hum Brain Mapp 2024; 45:e26627. [PMID: 38376166 PMCID: PMC10878198 DOI: 10.1002/hbm.26627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 02/21/2024] Open
Abstract
The hippocampus and parahippocampal gyrus have been implicated as part of a tinnitus network by a number of studies. These structures are usually considered in the context of a "limbic system," a concept typically invoked to explain the emotional response to tinnitus. Despite this common framing, it is not apparent from current literature that this is necessarily the main functional role of these structures in persistent tinnitus. Here, we highlight a different role that encompasses their most commonly implicated functional position within the brain-that is, as a memory system. We consider tinnitus as an auditory object that is held in memory, which may be made persistent by associated activity from the hippocampus and parahippocampal gyrus. Evidence from animal and human studies implicating these structures in tinnitus is reviewed and used as an anchor for this hypothesis. We highlight the potential for the hippocampus/parahippocampal gyrus to facilitate maintenance of the memory of the tinnitus percept via communication with auditory cortex, rather than (or in addition to) mediating emotional responses to this percept.
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Affiliation(s)
- Joel I. Berger
- Department of NeurosurgeryUniversity of IowaIowa CityIowaUSA
| | | | | | | | | | - Phillip E. Gander
- Department of NeurosurgeryUniversity of IowaIowa CityIowaUSA
- Department of RadiologyUniversity of IowaIowa CityIowaUSA
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Gasparre D, Pepe I, Laera D, Abbatantuono C, De Caro MF, Taurino A, D’Erasmo D, Fanizzi P, Antonucci LA, Pantaleo A, Cavallaro G, Pontillo V, Taurisano P, Quaranta N. Cognitive functioning and psychosomatic syndromes in a subjective tinnitus sample. Front Psychol 2023; 14:1256291. [PMID: 38192387 PMCID: PMC10773809 DOI: 10.3389/fpsyg.2023.1256291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and psychosomatic symptoms and the occurrence or maintenance of chronic tinnitus. This study aimed to detect the prevalence and role of psychosomatic conditions, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), and cognitive functioning in a group of patients with tinnitus. Methods Sixty-two patients with subjective tinnitus and 62 non-tinnitus controls were recruited from the Otorhinolaryngology Unit of the University of Bari. Pure-tone audiometry was performed in all tinnitus subjects, and sound level tolerance was evaluated. Additionally, tinnitus handicap (Tinnitus Handicap Inventory [THI]), psychopathological symptoms (Symptom Checklist-90, Revised [SCL-90-R]), anxiety (State-Trait Anxiety Inventory [STAI-Y1/2]), depression (Beck Depression Inventory [BDI]), cognitive impairment (Mini-Mental State Examination [MMSE]), executive functions (Frontal Assessment Battery [FAB]), and psychosomatic syndromes (DCPR) were evaluated. Parametric and non-parametric tests were used to detect cognitive and symptomatological differences between patients and controls. The predictivity of these factors for tinnitus severity was studied using multiple regression (Backward Elimination). All tests were considered significant at p < 0.05 (family wise error corrected for each comparison). Results 69.4% tinnitus patients met multiple DCPR criteria, compared to 32.3% of controls. Tinnitus patients exhibited elevated rates of illness denial (ꭓ2 = 9.02; p < 0.009), demoralization (ꭓ2 = 8.05; p < 0.018), somatization (ꭓ2 = 4.92; p < 0.063) and functional symptoms (ꭓ2 = 5.21; p < 0.06) scoring significantly higher on the BDI, STAI-Y1, and STAI-Y2, and SCL-90-R compared to controls. Patients with tinnitus showed lower MMSE scores, compared to controls (t = -2.282; p < 0.001). No association between tinnitus severity and global cognitive impairment emerged. Conversely, executive function deficits were associated to tinnitus severity. Among the cognitive and psychological factors, only trait anxiety, one or more psychosomatic syndromes, and somatization clusters were strongly correlated with tinnitus severity. Discussion Our findings suggest a relationship between tinnitus severity, psychological, psychosomatic symptoms, and frontal impairment. Additionally, the influence of tinnitus on cognitive functions paves the way for integrated, multidisciplinary diagnostic and treatment options for patients. Although preliminary, our findings highlight the importance of early cognitive and psychological screening to improve patients' quality of life.
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Affiliation(s)
- Daphne Gasparre
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Ilaria Pepe
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Domenico Laera
- Clinical Psychology Service, Mental Health Department, ASL Taranto, Taranto, Italy
| | - Chiara Abbatantuono
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Fara De Caro
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Alessandro Taurino
- Department of Education, Psychology, Communication, University of Bari, Palazzo Chiaia-Napolitano, Bari, Italy
| | - Daniele D’Erasmo
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Piero Fanizzi
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Linda A. Antonucci
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Alessandra Pantaleo
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giada Cavallaro
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Vito Pontillo
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Taurisano
- Department of Translational Biomedicine and Neuroscience “DiBraiN”, University of Bari “Aldo Moro”, Bari, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, Department of Biomedical Sciences, Neuroscience and Sensory Organs, University of Bari Aldo Moro, Bari, Italy
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Hamed SA, Attiah FA, Fawzy M, Azzam M. Evaluation of chronic idiopathic tinnitus and its psychosocial triggers. World J Clin Cases 2023; 11:3211-3223. [PMID: 37274028 PMCID: PMC10237132 DOI: 10.12998/wjcc.v11.i14.3211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/18/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The tinnitus susceptibility patterns in relation to different psychological and life stressors are unknown in different cultures.
AIM To determine the comorbid psychosocial factors and behaviors associated with tinnitus and the predictors for the increase in its severity.
METHODS Participants were 230 adults (males = 70; females = 160; mean age = 38.6 ± 3.3). They underwent audiograms, speech discrimination and masking testing, and neuropsychiatric evaluation. Measures used for assessment included tinnitus handicap inventory, depression anxiety stress scale 21 (DASS-21), perceived stress scale (PSS), and insomnia severity index (ISI).
RESULTS Patients had mean duration of tinnitus of 11.5 ± 2.5 mo. They had intact hearing perception at 250-8000 Hz and 95 (41.3%) had aggravation of tinnitus loudness by masking noise. Decompensated tinnitus was reported in 77% (n = 177). The majority had clinically significant insomnia (81.3%), somatic symptoms (75%) other than tinnitus and perceived moderate (46.1%) and high (44.3%) stress to tinnitus. The severe/extremely severe symptoms of depression, anxiety and stress were reported in 17.4%, 35.7% and 44.3%, respectively. Patients with decom-pensated type had significantly higher scores for ISI (P = 0.001) and DASS-21 (depression = 0.02, anxiety = 0.01, stress = 0.001) compared to those with compensated tinnitus. Psychiatric interviewing showed that 35.7% had non-specific anxiety disorder, 17.4% had major depression, and 19.6% fulfilled the criteria of somatization disorder. Multivariate analysis showed that the only independent predictors for tinnitus severity were the duration of tinnitus [odd ratios (OR) = 0.832, 95%CI: 0.640-1.158; P = 0.001] and PSS (OR = 0.835, 95%CI: 0.540-1.125; P = 0.001) scores.
CONCLUSION To the best of our knowledge, this is the first study in our culture to evaluate the causal relationship between psychological factors and tinnitus onset, severity and persistence. Tinnitus could be the earliest and dominant somatic symptom induced by life stressors and psychological vulnerabilities. Therefore, multidisciplinary consultation (psychologists, psychiatrists, and neurologists) is important to acknowledge among the audiologists and otolaryngologists who primarily consult patients.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University, Faculty of Medicine, Assiut 71516, Egypt
| | - Fadia Ahmed Attiah
- Department of Neurology and Psychiatry, Assiut University, Faculty of Medicine, Assiut 71516, Egypt
| | - Mohamed Fawzy
- Department of Neurology and Psychiatry, Assiut University, Faculty of Medicine, Assiut 71516, Egypt
| | - Mohamed Azzam
- Department of Otolaryngology, Assiut University, Faculty of Medicine, Assiut 71516, Egypt
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Mazurek B, Böcking B, Dobel C, Rose M, Brüggemann P. Tinnitus and Influencing Comorbidities. Laryngorhinootologie 2023; 102:S50-S58. [PMID: 37130530 PMCID: PMC10184670 DOI: 10.1055/a-1950-6149] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Numerous studies show that impairments in chronic tinnitus are closely connected with psychosomatic and other concomitant symptoms. This overview summarizes some of these studies. Beyond hearing loss, individual interactions of medical and psychosocial stress factors as well as resources are of central importance. Tinnitus related distress reflects a large number of intercorrelated, psychosomatic influences - such as personality traits, stress reactivity and depression or anxiety - which can be accompanied by cognitive difficulties and should be conceptualized and assessed within a vulnerability-stress-reaction model. Superordinate factors such as age, gender or education level can increase vulnerability to stress. Therefore, diagnosis and therapy of chronic tinnitus be individualised, multidimensional and interdisciplinary. Multimodal psychosomatic therapy approaches aim to address individually constellated medical, audiological and psychological influences in order to sustainably increase the quality of life of those affected. Counselling in the first contact is also indispensable for diagnosis and therapy.
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Affiliation(s)
- Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Berlin
| | | | - Christian Dobel
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Jena, Jena
| | - Matthias Rose
- Medizinische Klinik m. S. Psychosomatik, Charité - Universitätsmedizin Berlin, Berlin
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Factors Associated With the Development of Tinnitus and With the Degree of Annoyance Caused by Newly Developed Tinnitus. Ear Hear 2022; 43:1807-1815. [PMID: 35729718 PMCID: PMC9592178 DOI: 10.1097/aud.0000000000001250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Tinnitus is highly prevalent, but only a few risk factors for developing tinnitus are known and little is known about factors associated with the degree of annoyance of new-onset tinnitus. Longitudinal analysis can reveal risk factors associated with the development of tinnitus and might lead to targeted prevention. The aim of this study is twofold. (1) To identify risk factors that are longitudinally associated with the odds of developing tinnitus 5 years later. (2) To identify factors that are cross-sectionally associated with tinnitus annoyance in adults with new-onset tinnitus. METHODS Baseline, 5-year, and 10-year follow-up data of participants in the Netherlands Longitudinal Study on Hearing (NL-SH) were used. The NL-SH is a web-based prospective cohort study, which started in 2006 and includes both normal hearing and hearing-impaired adults aged 18 to 70 years at baseline. The NL-SH uses an online digit-triplet speech-in-noise test to asses speech recognition ability in noise, and online questionnaires on various aspects of life. At follow-up, participants are asked (1) if they suffer from tinnitus and (2) to rate tinnitus annoyance on a 0 to 100 numeric rating scale. We investigated whether demographic (age, sex, living arrangement, educational level), lifestyle (history of tobacco smoking, alcohol use), health (asthma, severe heart disease, hypertension, history of stroke, osteoarthritis, rheumatoid arthritis, epilepsy, multiple sclerosis, and migraine), hearing (speech recognition ability in noise, hyperacusis, and occupational noise exposure), and psychological variables (distress, somatization, depression, and anxiety) were potential risk factors for new-onset tinnitus, or associated with annoyance caused by new-onset tinnitus. Generalized estimating equations were used to longitudinally analyze the association between potential risk factors and new-onset tinnitus measured 5 years later. A multivariable association model was constructed using a forward selection procedure with p < 0.05 for model entry. Linear regression analysis was used to cross-sectionally analyze the association between potential factors and tinnitus annoyance in new-onset tinnitus. For this purpose, a multivariable association model was constructed using a forward selection procedure with p <0.05 for model entry. RESULTS In total, 734 participants without tinnitus at baseline were included, from which 137 participants reported to suffer from new-onset tinnitus 5 or 10 years later. Risk factors for new-onset tinnitus were history of smoking (odds ratio 1.5, 95% confidence interval [CI] 1.0 to 2.2, p = 0.027) and higher levels of somatization (odds ratio 2.0, 95% CI 1.2 to 3.3, overall p = 0.024). Factors associated with the degree of tinnitus annoyance were increased levels of anxiety (β = 11.6, 95% CI 2.3-20.8, overall p = 0.035) and poor speech recognition ability in noise (β = 13.5, 95% CI, 4.4 to 22.6, overall p = 0.014). CONCLUSIONS Higher levels of somatization and a history of smoking were found to be risk factors for new-onset tinnitus 5 years later. Anxiety and poor speech recognition ability in noise were associated with higher degrees of tinnitus annoyance in new-onset tinnitus. Somatization deserves to be addressed in future research and clinical practice as it might provide part of a model for the development of chronic tinnitus.
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Demopoulos C, Duong X, Hinkley LB, Ranasinghe KG, Mizuiri D, Garrett C, Honma S, Henderson-Sabes J, Findlay A, Racine-Belkoura C, Cheung SW, Nagarajan SS. Global resting-state functional connectivity of neural oscillations in tinnitus with and without hearing loss. Hum Brain Mapp 2020; 41:2846-2861. [PMID: 32243040 PMCID: PMC7294064 DOI: 10.1002/hbm.24981] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 12/11/2022] Open
Abstract
This study examined global resting-state functional connectivity of neural oscillations in individuals with chronic tinnitus and normal and impaired hearing. We tested the hypothesis that distinct neural oscillatory networks are engaged in tinnitus with and without hearing loss. In both tinnitus groups, with and without hearing loss, we identified multiple frequency band-dependent regions of increased and decreased global functional connectivity. We also found that the auditory domain of tinnitus severity, assayed by the Tinnitus Functional Index, was associated with global functional connectivity in both auditory and nonauditory regions. These findings provide candidate biomarkers to target and monitor treatments for tinnitus with and without hearing loss.
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Affiliation(s)
- Carly Demopoulos
- Department of Psychiatry, University of California San Francisco, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Xuan Duong
- Department of Psychology, Palo Alto University, Palo Alto, California
| | - Leighton B Hinkley
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Kamalini G Ranasinghe
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Coleman Garrett
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Susanne Honma
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Jennifer Henderson-Sabes
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Anne Findlay
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Caroline Racine-Belkoura
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
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Lee SY, Lee JY, Han SY, Seo Y, Shim YJ, Kim YH. Neurocognition of Aged Patients With Chronic Tinnitus: Focus on Mild Cognitive Impairment. Clin Exp Otorhinolaryngol 2019; 13:8-14. [PMID: 31079444 PMCID: PMC7010500 DOI: 10.21053/ceo.2018.01914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/04/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate the neurocognition of aged patients with chronic tinnitus and reveal the possible association between tinnitus severity and cognitive function, with attention to mild cognitive impairment (MCI). METHODS Fifty-eight elderly patients (≥65 years old) with chronic tinnitus (≥6 months) were prospectively enrolled in this study. All patients assessed the neurocognitive batteries including the Korean version of the patient health questionnaire-9 (K-PHQ-9), the Lawton instrumental activities of daily living scale (K-IADL), and the Montreal cognitive assessment (MoCA-K). After initial evaluation to exclude moderate or severe cognitive impairment by a psychiatrist, the patients were classified into two groups: MCI and non-MCI, according to the MoCA-K scores (cutoff value, 22/23). All patients underwent audiological examinations including psychoacoustic tests of tinnitus. RESULTS Of 58 patients, 10 (17.2%) met the MCI criteria. The tinnitus handicap inventory (THI) score in the MCI group was significantly higher than that in the non-MCI group. Based on multivariate regression analysis, a significant association between tinnitus severity and MoCA-K score was also detected. Specifically, bothersome tinnitus (THI score ≥30) was closely linked to the presence of MCI. Meanwhile, the impact of MCI on both K-PHQ-9 and K-IADL scores was not evident in patients with chronic tinnitus. CONCLUSION Tinnitus severity appears to be a potential independent determinant for predicting the MCI, suggesting the underlying mechanism between chronic tinnitus and cognitive deficit. Given that MCI highly links to dementia, the evaluation of cognitive functions in aged patients with chronic tinnitus need to be considered at the initial assessment of tinnitus.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Yoon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yuju Seo
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ye Ji Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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9
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Prevalence of and Risk Factors for Tinnitus and Tinnitus-Related Handicap in a College-Aged Population. Ear Hear 2018; 39:517-526. [DOI: 10.1097/aud.0000000000000503] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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A systematic review and meta-analysis of psychological functioning in chronic tinnitus. Clin Psychol Rev 2018; 60:62-86. [DOI: 10.1016/j.cpr.2017.12.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 10/31/2017] [Accepted: 12/28/2017] [Indexed: 11/19/2022]
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Patients' and Clinicians' Views of the Psychological Components of Tinnitus Treatment That Could Inform Audiologists' Usual Care: A Delphi Survey. Ear Hear 2017; 39:367-377. [PMID: 28930785 PMCID: PMC5839700 DOI: 10.1097/aud.0000000000000492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine which components of psychological therapies are most important and appropriate to inform audiologists' usual care for people with tinnitus. DESIGN A 39-member panel of patients, audiologists, hearing therapists, and psychologists completed a three-round Delphi survey to reach consensus on essential components of audiologist-delivered psychologically informed care for tinnitus. RESULTS Consensus (≥80% agreement) was reached on including 76 of 160 components. No components reached consensus for exclusion. The components reaching consensus were predominantly common therapeutic skills such as Socratic questioning and active listening, rather than specific techniques, for example, graded exposure therapy or cognitive restructuring. Consensus on educational components to include largely concerned psychological models of tinnitus rather than neurophysiological information. CONCLUSIONS The results of this Delphi survey provide a tool to develop audiologists' usual tinnitus care using components that both patients and clinicians agree are important and appropriate to be delivered by an audiologist for adults with tinnitus-related distress. Research is now necessary to test the added effects of these components when delivered by audiologists.
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Khan M, Gross J, Haupt H, Jainz A, Niklowitz P, Scherer H, Schmidt FP, Klapp BF, Reisshauer A, Mazurek B. A pilot clinical trial of the effects of coenzyme Q10 on chronic tinnitus aurium. Otolaryngol Head Neck Surg 2016; 136:72-7. [PMID: 17210337 DOI: 10.1016/j.otohns.2006.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 07/07/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE: To determine the short-term effects of coenzyme Q10 (CoQ10) on the antioxidative status and tinnitus expression in patients with chronic tinnitus aurium. STUDY DESIGN: A 16-week prospective nonrandomized clinical trial (n = 20). Tinnitus and Short Form-36 Questionnaires (TQ/SF-36) were evaluated together with the plasma concentrations of CoQ10, malondialdehyde, and the total antioxidant status. RESULTS: The mean plasma CoQ10 concentration rose under external CoQ10 supply and remained elevated after medication stopped without overall effects on the tinnitus score. However, in a subgroup of 7 patients with low initial plasma CoQ10 concentration and significant increase in the plasma CoQ10 level, a clear decrease in the TQ score was observed. CONCLUSION: In patients with a low plasma CoQ10 concentration, CoQ10 supply may decrease the tinnitus expression. SIGNIFICANCE: This is the first study to examine the effect of CoQ10 in chronic tinnitus aurium. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- Martin Khan
- Department of Otorhinolaryngology, Charité-University Medicine Berlin, Berlin, Germany
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Georgiewa P, Szczepek AJ, Rose M, Klapp BF, Mazurek B. Cerebral Processing of Emotionally Loaded Acoustic Signals by Tinnitus Patients. Audiol Neurootol 2016; 21:80-7. [DOI: 10.1159/000443364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022] Open
Abstract
This exploratory study determined the activation pattern in nonauditory brain areas in response to acoustic, emotionally positive, negative or neutral stimuli presented to tinnitus patients and control subjects. Ten patients with chronic tinnitus and without measurable hearing loss and 13 matched control subjects were included in the study and subjected to fMRI with a 1.5-tesla scanner. During the scanning procedure, acoustic stimuli of different emotional value were presented to the subjects. Statistical analyses were performed using statistical parametric mapping (SPM 99). The activation pattern induced by emotionally loaded acoustic stimuli differed significantly within and between both groups tested, depending on the kind of stimuli used. Within-group differences included the limbic system, prefrontal regions, temporal association cortices and striatal regions. Tinnitus patients had a pronounced involvement of limbic regions involved in the processing of chimes (positive stimulus) and neutral words (neutral stimulus), strongly suggesting improperly functioning inhibitory mechanisms that were functioning well in the control subjects. This study supports the hypothesis about the existence of a tinnitus-specific brain network. Such a network could respond to any acoustic stimuli by activating limbic areas involved in stress reactivity and emotional processing and by reducing activation of areas responsible for attention and acoustic filtering (thalamus, frontal regions), possibly reinforcing negative effects of tinnitus.
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The Correlation of the Tinnitus Handicap Inventory with Depression and Anxiety in Veterans with Tinnitus. Int J Otolaryngol 2015; 2015:689375. [PMID: 26697070 PMCID: PMC4677242 DOI: 10.1155/2015/689375] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 12/02/2022] Open
Abstract
Objective. The mechanisms of tinnitus are known to alter neuronal circuits in the brainstem and cortex, which are common to several comorbid conditions. This study examines the relationship between tinnitus and anxiety/depression. Subjects and Methods. Ninety-one male veterans with subjective tinnitus were enrolled in a Veterans Affairs Tinnitus Clinic. The Tinnitus Handicap Inventory (THI) was used to assess tinnitus severity. ICD-9 codes for anxiety/depression were used to determine their prevalence. Pure tone averages (PTA) were used to assess hearing status. Results. Descriptive analyses revealed that 79.1% of the 91 tinnitus sufferers had a diagnosis of anxiety, 59.3% had depression, and 58.2% suffered from both anxiety/depression. Patients with anxiety had elevated total THI scores as compared to patients without anxiety (p < 0.05). Patients with anxiety or depression had significantly increased Functional and Emotional THI scores, but not Catastrophic THI score. Significant positive correlations were illustrated between the degree of tinnitus and anxiety/depression (p < 0.05). There were no differences in PTA among groups. Conclusions. A majority of patients with tinnitus exhibited anxiety and depression. These patients suffered more severe tinnitus than did patients without anxiety and depression. The data support the need for multidisciplinary intervention of veterans with tinnitus.
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Associations of Organizational Justice with Tinnitus and the Mediating Role of Depressive Symptoms and Burnout—Findings from a Cross-Sectional Study. Int J Behav Med 2015; 23:190-7. [DOI: 10.1007/s12529-015-9505-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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A brain centred view of psychiatric comorbidity in tinnitus: from otology to hodology. Neural Plast 2014; 2014:817852. [PMID: 25018882 PMCID: PMC4074975 DOI: 10.1155/2014/817852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/18/2014] [Accepted: 05/05/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Comorbid psychiatric disorders are frequent among patients affected by tinnitus. There are mutual clinical influences between tinnitus and psychiatric disorders, as well as neurobiological relations based on partially overlapping hodological and neuroplastic phenomena. The aim of the present paper is to review the evidence of alterations in brain networks underlying tinnitus physiopathology and to discuss them in light of the current knowledge of the neurobiology of psychiatric disorders. Methods. Relevant literature was identified through a search on Medline and PubMed; search terms included tinnitus, brain, plasticity, cortex, network, and pathways. Results. Tinnitus phenomenon results from systemic-neurootological triggers followed by neuronal remapping within several auditory and nonauditory pathways. Plastic reorganization and white matter alterations within limbic system, arcuate fasciculus, insula, salience network, dorsolateral prefrontal cortex, auditory pathways, ffrontocortical, and thalamocortical networks are discussed. Discussion. Several overlapping brain network alterations do exist between tinnitus and psychiatric disorders. Tinnitus, initially related to a clinicoanatomical approach based on a cortical localizationism, could be better explained by an holistic or associationist approach considering psychic functions and tinnitus as emergent properties of partially overlapping large-scale neural networks.
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Salviati M, Bersani FS, Terlizzi S, Melcore C, Panico R, Romano GF, Valeriani G, Macrì F, Altissimi G, Mazzei F, Testugini V, Latini L, Delle Chiaie R, Biondi M, Cianfrone G. Tinnitus: clinical experience of the psychosomatic connection. Neuropsychiatr Dis Treat 2014; 10:267-75. [PMID: 24550676 PMCID: PMC3925227 DOI: 10.2147/ndt.s49425] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The connection between psychopathology and tinnitus is complex and not adequately studied. The aim of this study is to investigate the relationship between tinnitus and psychiatric comorbidities from different points of view: categorical, dimensional, temperamental, and perceived stress level. METHODS Two hundred and thirty-nine patients affected by tinnitus were recruited between January and October 2012. Patients underwent a preliminary battery of tests including the Tinnitus Handicap Inventory (THI), Symptom Check List (SCL90-R), Temperament and Character Inventory (TCI), and Stress-Related Vulnerability Scale (VRS), and eventually a full psychiatric evaluation. RESULTS One hundred and fourteen patients (48% of the total sample) presented psychiatric comorbidity. Among these, a higher prevalence of depression, somatization, obsession, and anxiety was found. More than 41% of patients affected by decompensated tinnitus reported a family history of psychiatric disorders. Significant positive correlations between the psychopathological screening tools (SCL90-R and VRS) and THI were found. Patients affected by comorbid psychiatric disorder showed specific temperamental and characterial predispositions. CONCLUSION Psychiatric comorbidity in subjects affected by tinnitus is frequent. Stress can be considered as a factor leading to damage and dysfunction of the auditory apparatus. The vulnerability to neurotic disorders and the lack of coping capabilities can play a critical role in the clinical history of patients affected by severe tinnitus.
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Affiliation(s)
- Massimo Salviati
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Francesco Saverio Bersani
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Samira Terlizzi
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Claudia Melcore
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Roberta Panico
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Graziella Francesca Romano
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Guiseppe Valeriani
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Francesco Macrì
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | | | - Filippo Mazzei
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Valeria Testugini
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Luca Latini
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Roberto Delle Chiaie
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
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Mahmoudian S, Farhadi M, Najafi-Koopaie M, Darestani-Farahani E, Mohebbi M, Dengler R, Esser KH, Sadjedi H, Salamat B, Danesh AA, Lenarz T. Central auditory processing during chronic tinnitus as indexed by topographical maps of the mismatch negativity obtained with the multi-feature paradigm. Brain Res 2013; 1527:161-73. [DOI: 10.1016/j.brainres.2013.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 06/09/2013] [Accepted: 06/14/2013] [Indexed: 11/16/2022]
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Zenner HP, Vonthein R, Zenner B, Leuchtweis R, Plontke SK, Torka W, Pogge S, Birbaumer N. Standardized tinnitus-specific individual cognitive-behavioral therapy: A controlled outcome study with 286 tinnitus patients. Hear Res 2013; 298:117-25. [DOI: 10.1016/j.heares.2012.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 10/13/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022]
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Das SK, Wineland A, Kallogjeri D, Piccirillo JF. Cognitive speed as an objective measure of tinnitus. Laryngoscope 2013; 122:2533-8. [PMID: 23108884 DOI: 10.1002/lary.23555] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Subjective, chronic tinnitus is a common but poorly understood condition. The heterogeneity within tinnitus has hindered the development of functional severity measures and effective treatment. Tinnitus at least partially results from maladaptive cortical processes that are associated with cognitive deficits. This study examined whether cognitive processing speed might serve as a novel objective measure of tinnitus severity, and whether the psychiatric comorbidities of depression and somatization are predictive of self-reported tinnitus severity. STUDY DESIGN Cross-sectional study of 92 chronic tinnitus participants. METHODS The Tinnitus Handicap Inventory (THI) captured the self-reported severity of tinnitus. Cognitive processing speed was objectively measured by the Brain Speed Test (BST), a short computerized test from Posit Science. Somatization and depression were captured by the Whiteley-7 and Patient Health Questionnaire-9 scales. The results of these tests were combined into a Composite Psychiatric State (CPS) variable. The ability of BST z score and CPS level to predict THI was assessed. RESULTS There was a significant correlation (r = 0.54, P < .001) between BST z scores and THI in those with bothersome tinnitus (THI ≥ 30). Additionally, BST z score was correlated with the validated neurocognitive tests. Multivariate analysis identified BST z score and CPS level as independent predictors of THI. CONCLUSIONS In severe tinnitus, BST provides an objective measure of the functional impact of tinnitus. Cognitive processing speed and psychiatric state are independent predictors of self-reported tinnitus severity. These measures help define clinical subgroups within tinnitus: one subgroup whose functional impact is primarily cognitive and another whose functional impact is primarily psychiatric.
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Affiliation(s)
- Sunil K Das
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Hanley PJ, Davis PB. Treatment of tinnitus with a customized, dynamic acoustic neural stimulus: underlying principles and clinical efficacy. Trends Amplif 2008; 12:210-22. [PMID: 18614554 DOI: 10.1177/1084713808319942] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tinnitus has been challenging to treat with consistently positive results. The Neuromonics Tinnitus Treatment is a newly available approach to the treatment of clinically significant, problematic tinnitus (and reduced sound tolerance) that was developed with the intention of simultaneously addressing the auditory, attentional, and emotional processes underlying the condition. It uses a prescribed acoustic stimulus, customized for each patient's individual audiometric profile, which provides a broad frequency stimulus to address the effects of auditory deprivation, promotes relief and relaxation with the intention of reducing engagement of the limbic system/amygdala and autonomic nervous system, and applies the principles of systematic desensitization to address the attentional processes. This article describes the underlying principles behind this approach. It also summarizes evidence for clinical efficacy from controlled clinical studies and from a private practice clinical setting, where it has been shown to provide consistently positive outcomes for patients meeting suitability criteria.
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Affiliation(s)
- Peter J Hanley
- Neuromonics Pty Limited, Chatswood, New South Wales, Australia.
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Abstract
OBJECTIVE To investigate cochlear outer hair cell function based on distortion product otoacoustic emission (DPOAE) in patients with tinnitus. STUDY DESIGN This is a case control study. SUBJECTS AND METHODS The subjects are patients who attended the Otorhinolaryngology Clinic in Hospital Universiti Kebangsaan Malaysia over a period of 19 months from April 2005 until October 2006. All patients underwent a full ENT assessment and had tympanometry, pure tone audiometry, and DPOAE tests. The UKM Research and Ethics Committee reviewed and approved the study proposal prior to commencement of this study. RESULTS The study population included 49 patients. They consisted of 16 patients (32 ears) with tinnitus and reduced hearing, 13 patients (26 ears) with tinnitus and normal hearing, 7 patients (13 ears) without tinnitus with reduced hearing, and 13 patients (26 ears) without tinnitus with normal hearing. Statistical analysis showed significant differences (P = .00) of mean DPOAE levels between the four groups of patients. CONCLUSION Our results suggest that reduced outer hair cell activity, as detected by reduced DPOAE levels, may manifest as tinnitus even before there is a shift on hearing threshold. We also postulate that further reduction of cochlear outer hair cell activity, as shown by further reduced DPOAE levels, may actually terminate the source of tinnitus.
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Caffier PP, Haupt H, Scherer H, Mazurek B. Outcomes of Long-Term Outpatient Tinnitus-Coping Therapy: Psychometric Changes and Value of Tinnitus-Control Instruments. Ear Hear 2006; 27:619-27. [PMID: 17086074 DOI: 10.1097/01.aud.0000240504.77861.1a] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Increasing tinnitus compliance and coping are desirable aims of successful treatment in chronic tinnitus. However, application of established procedures such as tinnitus retraining therapy (TRT) is often relatively short. In addition, the value of tinnitus control instruments (TCI) is questionable, especially for minor severity levels of tinnitus, and the comparability of treatment results is low. To evaluate long-term changes of tinnitus-related distress, defined psychometric data were collected in patients with compensated tinnitus (cT) or decompensated tinnitus (dT) during a standardized 2-yr outpatient tinnitus-coping therapy (TCT). DESIGN In a prospective clinical investigation, the data of 70 tinnitus patients were recorded at the beginning and at 6-mo intervals, with a final investigation after 24 mo. The first group consisted of 40 patients with cT and dT who were randomly assigned to a treatment group and a waiting-list control group. After a period of 12 mo without treatment, the control group was treated similarly. The tinnitus questionnaire (TQ) of Goebel and Hiller, visual analog scales (VAS), and a severity questionnaire for tinnitus-associated complaints were used as psychodiagnostic instruments. Therapy components consisted of counseling, fitting patients with TCIs (TCI provision), auditory and relaxation training, and psychosomatic care if necessary. A second group of 30 patients with cT receiving TCT without TCI devices was investigated to evaluate the additive efficacy of TCI in cT. RESULTS The initial TQ score did not differ between the treatment group and the waiting-list control group. After 12 mo, the control group did not show any significant changes, but the treatment group had improved significantly. During TCT, the combined data of both groups showed a statistically significant decrease of the TQ score in dT (59.1 to 34.8) and cT (32.8 to 24.0). These changes were especially reflected by the subscales of cognitive and emotional distress and also by the VAS and the severity questionnaire. dT patients benefitted without dependence on age or duration of pre-existing tinnitus; for cT patients, this was true mainly of the younger and older subjects and for tinnitus lasting for less than 1 yr. TCI provision improved the efficacy of TCT in patients with cT. CONCLUSIONS The psychometric changes demonstrate a clear decrease of tinnitus-related distress in all severity levels of sufficiently treated chronic tinnitus. Long-term TCT induces improvement even up to the time of 24 mo. With TCIs established particularly in patients with dT, our results suggest that a supporting adjustment of TCI devices is helpful in cT to foster quicker rehabilitation. The outpatient interdisciplinary TCT, consisting of cognitive tinnitus desensitization, TCI provision, and psychosomatic support if required, represents a successful treatment strategy for both dT and cT patients.
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Affiliation(s)
- Philipp P Caffier
- Department of Otorhinolaryngology, Charité-University Medicine Berlin, Joint Facility of Free University and Humboldt-University, Campus Charité Mitte, Berlin, Germany.
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Cummings M, Lundeberg T. Acupuncture for tinnitus. Complement Ther Med 2006; 14:290-1. [PMID: 17105701 DOI: 10.1016/j.ctim.2006.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 04/21/2006] [Accepted: 06/09/2006] [Indexed: 10/24/2022] Open
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