Logistic regression analysis of factors influencing the effectiveness of intensive sound masking therapy in patients with tinnitus

Efficacy of Tailor-Made Notched Music Training Versus Tinnitus Retraining Therapy in Adults With Chronic Subjective Tinnitus: A Randomized Controlled Clinical Trial

OBJECTIVES

Chronic subjective tinnitus can have a serious effect on daily life, even causing serious psychological disorders. Currently there are no specific effective solutions or cures. Tailor-made notched music training (TMNMT) is a recently proposed sound therapy that has simpler processes and a higher compliance rate than tinnitus retraining therapy (TRT), a widely used treatment for chronic subjective tinnitus. This study explores the therapeutic effect of TMNMT in comparison to TRT to highlight its clinical value.

DESIGN

The study was a randomized controlled, single-blinded clinical trial. One hundred twenty eligible participants were randomly assigned to receive TMNMT (n = 60) or TRT (n = 60) for 3 mo with concurrent follow-up. It should be noted that the duration of sound treatment in TRT was modified to 2 hr per day for better feasibility in practice. The primary outcome was mean change in tinnitus handicap inventory (THI) measured at baseline ( T0 ), 1 mo ( T1 ) and 3 mo ( T2 ) after intervention. Change in visual analog scale (VAS) was measured as a secondary outcome. A comparison of therapeutic effectiveness between TMNMT and TRT was evaluated by repeated measure analysis of variance.

RESULTS

One hundred and twelve (93%) of participants took part in the study, of which 64 were men and 48 women. Mean (SD) age was 42.80 (12.91) years. Fifty-eight were allocated to receive TMNMT and 54 to receive TRT. The between-group difference in primary outcome was -6.90 points (95% confidence interval [CI], -13.53 to -0.27) at T1 and -6.17 points (95% CI, -13.04 to 0.71) at T2 . These results closely reached to clinical significance of tinnitus-related effective relief. For the secondary outcome, the mean value in the TMNMT group was 0.83 points (95% CI, 0.12 to 1.54), significantly lower than the mean value of the TRT group. The differences in THI and VAS between the two groups were statistically significant after intervention. Further analysis showed that age and baseline THI and VAS scores were associated with change in THI and VAS scores after interventions.

CONCLUSIONS

Both TMNMT and TRT were able to alleviate chronic subjective tinnitus effectively after a 3 month intervention. When the two forms of therapy were compared TMNMT appeared to be more effective and consequently potentially superior to TRT for reducing tinnitus loudness and functional and emotional disturbance associated with chronic subjective tinnitus.

Aberrant functional and effective connectivity of the frontostriatal network in unilateral acute tinnitus patients with hearing loss

PURPOSE

The present study combined resting-state functional connectivity (FC) and Granger causality analysis (GCA) to explore frontostriatal network dysfunction in unilateral acute tinnitus (AT) patients with hearing loss.

METHODS

The participants included 42 AT patients and 43 healthy control (HC) subjects who underwent resting-state functional magnetic resonance imaging (fMRI) scans. Based on the seed regions in the frontostriatal network, FC and GCA were conducted between the AT patients and HC subjects. Correlation analyses were used to examine correlations among altered FC values, GCA values, and clinical features in AT patients.

RESULTS

Compared with HCs, AT patients showed a general reduction in FC between the seed regions in the frontostriatal network and nonauditory areas, including the frontal cortices, midcingulate cortex (MCC), supramarginal gyrus, and postcentral gyrus (PoCG). Using the GCA algorithm, we detected abnormal effective connectivity (EC) in the inferior occipital gyrus, MCC, Cerebelum_Crus1, and PoCG. Furthermore, correlations between disrupted FC/EC and clinical characteristics, especially tinnitus distress-related characteristics, were found in AT patients.

CONCLUSIONS

Our work demonstrated abnormal FC and EC between the frontostriatal network and several nonauditory regions in AT patients with hearing loss, suggesting that multiple large-scale network dysfunctions and interactions are involved in the perception of tinnitus. These findings not only enhance the current understanding of the frontostriatal network in tinnitus but also serve as a reminder of the importance of focusing on tinnitus at an early stage.

[Key factors of the severity of chronic subjective tinnitus: a complex network analysis]

Objective:To investigate the key factors related to the severity of chronic subjective tinnitus through a complex network analysis. Methods:A retrospective study about patients with chronic subjective tinnitus presented to Peking Union Medical College Hospital from December 2019 to October 2020 was conducted. The demographic information, audiometric and tinnitus-related tests, and scores of Tinnitus Handicap Inventory（THI）, Hospital Anxiety and Depression Scale（HADS）, Pittsburgh Sleep Quality Index（PSQI） and Visual Analogue Scale（VAS） of tinnitus loudness and annoyance were set as nodes in a complex network which was conducted and analyzed through the R package. Results:A total of 183 patients were enrolled, including 99（54.1%） males and 84（45.9%） females, with an average age of（41.65±1.05） years. The results of the complex network analysis showed that anxiety and sleep disorder were closely related to THI score, and anxiety was more important than sleep disorder. There was a strong correlation between self-reported anxiety and insomnia. Demographic characteristics, audiologic and tinnitus-associated tests were not significantly related to THI score. Conclusion:Anxiety and sleep disturbance were key factors related to tinnitus severity, and anxiety played a more important role. There was an obvious correlation between sleep disorder and anxiety, and they might have a superimposed effect on tinnitus severity. Future therapies of tinnitus should pay more attention on releasing anxiety and insomnia.

Clinical characteristics of subjective idiopathic tinnitus and preliminarily analyses for the effect of tinnitus multielement integration sound therapy

OBJECTIVE

To study the psychoacoustic and audiological characteristics of patients with chronic subjective tinnitus and provide basis for the personalized diagnosis and treatment of tinnitus through a single tinnitus multielement integration sound therapy (T-MIST) and analysis of efficacy preliminarily.

METHODS

145 patients with tinnitus were assessed by systematic medical history collection, professional examination of otolaryngology, audiology examination, full precision test (FPT), residual inhibition test (RIT), tinnitus handicap inventory (THI) and visual analog scale (VAS) annoyance. The correlation among factors was performed.

RESULTS

The frequency of tinnitus was correlated with the frequency of maximum hearing loss (P < 0.05). The loudness of tinnitus was correlated with the loudness of maximum hearing loss (P < 0.05). In this study, T-MIST was used to treat tinnitus. After treatment, tinnitus alleviated VAS annoyance (P < 0.05). The results of RIT were correlated with the effect of T-MIST (P < 0.05).

CONCLUSION

There was a correlation between tinnitus and hearing loss. The RIT may indicate the effectiveness of acoustic therapy in patients. The FPT can find the hidden hearing loss without display on routine pure tone audiometry, so as to provide a clinical reference for the detection of early hearing loss in tinnitus patients.

[Reducing tinnitus intensity : Pilot study to attenuate tonal tinnitus using individually spectrally optimized near-threshold noise]

Hintergrund

Tinnitus betrifft ca. 15 % der Bevölkerung, jedoch existiert noch immer kein echtes Heilverfahren. Ein von uns entwickeltes neuartiges Erklärungsmodell erlaubt nun die Erprobung einer gezielten, an den Ursachen der Tinnitusentstehung ansetzenden Behandlung. Diese basiert auf stochastischen Resonanzphänomenen an bestimmten synaptischen Verbindungen im Hörsystem, welche gezielt durch extern zugeführtes schwellennahes Rauschen induziert werden sollen.

Fragestellung

Die vorliegende Pilotstudie soll zeigen, ob ein spektral individuell angepasstes Rauschen erfolgreich chronischen tonalen/schmalbandigen Tinnitus während der Stimulation abschwächen kann.

Material und Methoden

Bei 22 volljährigen Tinnituspatienten (46.6±16.3 Jahre; 4 Frauen) wurden Hörverlust (HV) sowie Tinnitusfrequenzen (TF) und -lautstärken (TL) audiometrisch bestimmt. Darauf basierend wurden bis zu 8 verschiedene Rauschstimuli (RS) mit je 5 Lautstärken (−20 bis +20 dB SL) erzeugt. Diese wurden über audiologische Kopfhörer in einer Schallkammer für jeweils 40 s präsentiert. Nach jeder Präsentation wurde mithilfe einer 5‑stufigen Bewertungsskala (−2 bis +2) ermittelt, ob sich die TL verändert hat.

Ergebnisse

Es fanden sich Patienten ohne Verbesserung der TL (n = 6) und solche mit Verbesserung (n = 16), wobei hier RS um die TF besonders effektiv waren. Die Gruppen zeigten post hoc deutliche Unterschiede in den Audiogrammen: Offenbar ist das hier getestete Verfahren insbesondere bei normalhörenden Tinnituspatienten und solchen mit geringgradigem HV effektiv.

Schlussfolgerung

Die subjektiv wahrgenommene TL war bei 16 von 22 Probanden für die Dauer der Stimulation reduziert. Für den möglichen Erfolg einer zukünftigen Therapie scheint der HV relevant zu sein.

Sound therapy for cochlear implant users with tinnitus

OBJECTIVE

Despite the positive effect of a cochlear implant (CI) on tinnitus in many patients, tinnitus remains a problem for a significant proportion of CI users. We investigated the acceptability and effect of sound therapy (a combination of natural background sounds and one concise tinnitus counselling session) on tinnitus and speech perception in CI users who still experienced tinnitus during CI use.

DESIGN AND STUDY SAMPLE

Thirty-two CI users (32-78 years) participated in phase 1: a test at the clinic to evaluate six background sounds provided by the sound processor. Eighteen out of the 32 CI users participated in phase 2: an optional take-home evaluation of 2 weeks without sound therapy, followed by 5 weeks with sound therapy, ending with an evaluation visit.

RESULTS

Thirty subjects (93.8%) found at least one background sound acceptable. In phase 2, a small improvement with sound therapy was found for tinnitus loudness, annoyance, and intrusiveness. 50% of the subjects subjectively reported benefit of sound therapy. Especially the sense of control on their tinnitus was highly appreciated. No detrimental effect on speech perception was observed.

CONCLUSION

The background sounds were acceptable and provided tinnitus relief in some CI users with tinnitus during CI use.

Differences in Clinical Characteristics and Brain Activity between Patients with Low- and High-Frequency Tinnitus

This study was aimed at delineating and comparing differences in clinical characteristics and brain activity between patients with low- and high-frequency tinnitus (LFT and HFT, respectively) using high-density electroencephalography (EEG). This study enrolled 3217 patients with subjective tinnitus who were divided into LFT (frequency < 4000 Hz) and HFT (≥4000 Hz) groups. Data regarding medical history, Tinnitus Handicap Inventory, tinnitus matching, and hearing threshold were collected from all patients. Twenty tinnitus patients and 20 volunteers were subjected to 256-channel EEG, and neurophysiological differences were evaluated using standardized low-resolution brain electromagnetic tomography (sLORETA) source-localized EEG recordings. Significant differences in sex (p < 0.001), age (p = 0.022), laterality (p < 0.001), intensity (p < 0.001), tinnitus type (p < 0.001), persistent tinnitus (p = 0.04), average threshold (p < 0.001), and hearing loss (p = 0.028) were observed between LFT and HFT groups. The tinnitus pitch only appeared to be correlated with the threshold of the worst hearing loss in the HFT group. Compared with the controls, the LFT group exhibited increased gamma power (p < 0.05), predominantly in the posterior cingulate cortex (PCC, BA31), whereas the HFT group had significantly decreased alpha1 power (p < 0.05) in the angular gyrus (BA39) and auditory association cortex (BA22). Higher gamma linear connectivity between right BA39 and right BA41 was observed in the HFT group relative to controls (t = 3.637, p = 0.027). Significant changes associated with increased gamma in the LFT group and decreased alpha1 in the HFT group indicate that tinnitus pitch is crucial for matching between the tinnitus and control groups. Differences of band frequency energy in brain activity levels may contribute to the clinical characteristics and internal tinnitus “spectrum” differences.

Aberrant Functional and Causal Connectivity in Acute Tinnitus With Sensorineural Hearing Loss

Purpose

The neural bases in acute tinnitus remains largely undetected. The objective of this study was to identify the alteration of the brain network involved in patients with acute tinnitus and hearing loss.

Methods

Acute tinnitus patients (n = 24) with hearing loss and age-, sex-, education-matched healthy controls (n = 21) participated in the current study and underwent resting-state functional magnetic resonance imaging (fMRI) scanning. Regional homogeneity and amplitude of low-frequency fluctuation were used to investigate the local spontaneous neural activity and functional connectivity (FC), and Granger causality analysis (GCA) was used to analyze the undirected and directed connectivity of brain regions.

Results

Compared with healthy subjects, acute tinnitus patients had a general reduction in FC between auditory and non-auditory brain regions. Based on FC analysis, the superior temporal gyrus (STG) revealed reduced undirected connectivity with non-auditory brain regions including the amygdala (AMYG), nucleus accumbens (NAc), the cerebellum, and postcentral gyrus (PoCG). Using the GCA algorithm, increased effective connectivity from the right AMYG to the right STG, and reduced connectivity from the right PoCG to the left NAc was observed in acute tinnitus patients with hearing loss. The pure-tone threshold was positively correlated with FC between the AMYG and STG, and negatively correlated with FC between the left NAc and the right PoCG. In addition, a negative association between the GCA value from the right PoCG to the left NAc and the THI scores was observed.

Conclusion

Acute tinnitus patients have aberrant FC strength and causal connectivity in both the auditory and non-auditory cortex, especially in the STG, AMYG, and NAc. The current findings will provide a new perspective for understanding the neuropathophysiological mechanism in acute tinnitus.

Reliability and validity of the mandarin version of the tinnitus primary function questionnaire: A preliminary observational study

Tinnitus is a prevalent condition among different populations. As the nature of tinnitus is subjective, self-reported measures have been validated and utilized to assess psychometric properties of tinnitus patients. Without exception, Chinese clinicians have administered these measures to patients in mainland China after cross-cultural adaptation. However, shortcomings of these Mandarin measures limited the widespread use of them. Measures which can be fully adapted to the context of Chinese tinnitus patients are still needed. The objective of this study was to evaluate the reliability and validity of the Mandarin Tinnitus Primary Function Questionnaire (TPFQ-M) in a Chinese population.In this observational questionnaire study, we recruited 350 subjects with primary tinnitus from hearing clinics of West China Hospital and administered the TPFQ-M, Mandarin Tinnitus Handicap Inventory (THI-M), and a systematic hearing test battery.The subjects finished the TPFQ-M within 3 minutes. Exploratory and confirmatory factor analyses demonstrated that a 4-factor model was close to fit. The Cronbach alpha of TPFQ-M was 0.925, and test-retest reliability was reasonable with a 7-day test interval (ICC = 0.857, P < .001; 95% CI: 0.764-0.915). Test-retest reliabilities of subdomains were not parallel to each other, with 0.612 for Emotion, 0.766 for Sleep, 0.860 for Concentration, and 0.897 for Hearing. The convergent validity of TPFQ-M compared to the THI-M was moderate (r = 0.705, P < .001; 95% CI: 0.647-0.754).The TPFQ-M, which shows high internal consistency and good factor structure, is simple and relatively easy to administer in busy clinics. Additional in-depth research involving multiple centers in mainland China is warranted.