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Korkut S, Altıntaş M. The Frequency of Health Anxiety, Coronavirus Anxiety and Anxiety Disorder in Patients With Tinnitus During the COVID-19 Pandemic and the Impact of Pandemic on Tinnitus. Clin Otolaryngol 2024. [PMID: 38940211 DOI: 10.1111/coa.14196] [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: 12/20/2023] [Revised: 06/04/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES This study aimed to examine the frequency of anxiety disorder, coronavirus anxiety and health anxiety in tinnitus patients during the pandemic and also, determined the psychophysiological impact of COVID-19 on tinnitus. METHODS This cross-sectional study was conducted in a tertiary central pandemic hospital from 15 July 2021 to 15 December 2022. In total, 124 patients with tinnitus and 77 healthy controls participated in the study. The sociodemographic data, a set of valid and reliable assessment instruments were used to measure outcomes of anxiety disorder, coronavirus anxiety, health anxiety and severity of tinnitus. RESULTS Patients with tinnitus were found to experience higher levels of coronavirus anxiety, health anxiety and anxiety disorder than controls (p < 0.05). In tinnitus patients, the frequency of coronavirus anxiety was 22.6% and anxiety disorder was 18.5%. Notably, the levels of tinnitus severity were moderate to severe in more than half of the patients (51.6%) and also most of them (81.3%) reported that the severity of tinnitus during the pandemic was higher compared with the pre-pandemic. CONCLUSION Tinnitus patients had high levels of anxiety disorder, coronavirus anxiety and health anxiety. In line with these findings, it was evaluated that there was a relationship between the COVID-19 pandemic with psychological problems and tinnitus. Therefore, the predominance of tinnitus symptoms at presentation should not lead the clinician to neglect the underlying psychopathological problems in these patients.
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Affiliation(s)
- Süleyman Korkut
- Department of Psychiatry, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mustafa Altıntaş
- Department of Otorhinolaryngology, Antalya Training and Research Hospital, Antalya, Turkey
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Demoen S, Cardon E, Jacquemin L, Timmermans A, Van Rompaey V, Gilles A, Michiels S. Health-Related Quality of Life in Subjective, Chronic Tinnitus Patients: A Scoping Review. J Assoc Res Otolaryngol 2024; 25:103-129. [PMID: 38253898 PMCID: PMC11018725 DOI: 10.1007/s10162-024-00926-5] [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: 08/07/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE This scoping review aims to assess whether the severity or distress of subjective tinnitus is negatively associated or correlated with the level of health-related quality of life (HRQoL). A second objective is to examine whether tinnitus patients score differently on HRQoL questionnaires in comparison to subjects without tinnitus and whether HRQoL differs between specific subgroups of tinnitus. METHODS This scoping review adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA guidelines): the statement and extension for scoping reviews (PRISMA-ScR). The following databases were consulted (on the 20th of October 2023): PubMed, Cochrane Library, Web of Science, and Scopus. The search string was composed of the terms tinnitus, HRQoL, and synonyms. A double-blinded screening for eligibility was performed, first on the title and abstract and subsequently on the full-text articles. Studies were considered eligible if they looked at HRQoL questionnaire results for adult patients (> 18 years) reporting chronic (> 3 months), subjective tinnitus as a primary complaint. RESULTS In total, 37 studies with a total sample size of 33,900 participants were included in this scoping review, with some studies answering multiple study objectives. Seventeen studies demonstrated the presence of a significant negative correlation between tinnitus-related distress and HRQoL. Two studies indicated that HRQoL is mediated by tinnitus-related distress. Eighteen studies found that, in general, patients with tinnitus scored significantly lower on HRQoL questionnaires in comparison to subjects without tinnitus. Nineteen studies demonstrated that subgroups of patients with more severe tinnitus complaints or specific additional complaints scored worse on HRQoL questionnaires. CONCLUSION Based on the current literature, chronic subjective tinnitus-related distress has a significant impact on health-related quality of life. In addition, subjects without tinnitus generally score significantly higher on HRQoL questionnaires than patients with tinnitus. The heterogeneity in outcome measures between studies precludes meta-analysis. Increased homogeneity in the choice of HRQoL questionnaires would make a comparison between studies possible, which would give valuable information on both a clinical and an economic level, guiding future tinnitus treatment. REGISTRATION The protocol for the scoping review is registered at Open Science Framework: https://doi.org/10.17605/OSF.IO/F5S9C .
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Affiliation(s)
- Sara Demoen
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium.
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Emilie Cardon
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laure Jacquemin
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annick Timmermans
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Sarah Michiels
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
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Jin IK, Tyler RS. Measuring tinnitus in pharmaceutical clinical trials. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:3843. [PMID: 36586833 DOI: 10.1121/10.0014699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/21/2022] [Indexed: 06/17/2023]
Abstract
This paper reviews methods and considerations for measuring tinnitus in clinical trials designed to evaluate treatment options using investigational medicinal products. Tests applied in tinnitus-related research and clinical practice have their own measurement purposes, advantages, and limitations. If the characteristics of each test method are well understood, the test can be effectively used in clinical trials. For the accuracy of clinical trial results, it is necessary to use a test tool with verified validity, reliability, and sensitivity. If a test tool that is likely to have high variability in the same individual is required in the clinical trial, strategies to increase the reliability of the test, such as repeat measurements, may also be needed. In addition, a test tool that meets the purpose of the clinical trial should be selected. For example, the tinnitus questionnaire is appropriate to assess reactions to tinnitus, and measurements of tinnitus loudness or pitch are appropriate to evaluate the psychoacoustic characteristics of tinnitus. In conclusion, the use of validated test tools that meet the purpose of the trial will help with the accuracy of the clinical trial results.
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Affiliation(s)
- In-Ki Jin
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, Hallym University, Chuncheon-si, Gangwon-do 24252, South Korea
| | - Richard S Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242, USA
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Tarnowska KA, Ras ZW, Jastreboff PJ. A data-driven approach to clinical decision support in tinnitus retraining therapy. Front Neuroinform 2022; 16:934433. [PMID: 36246392 PMCID: PMC9555793 DOI: 10.3389/fninf.2022.934433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background Tinnitus, known as “ringing in the ears”, is a widespread and frequently disabling hearing disorder. No pharmacological treatment exists, but clinical management techniques, such as tinnitus retraining therapy (TRT), prove effective in helping patients. Although effective, TRT is not widely offered, due to scarcity of expertise and complexity because of a high level of personalization. Within this study, a data-driven clinical decision support tool is proposed to guide clinicians in the delivery of TRT. Methods This research proposes the formulation of data analytics models, based on supervised machine learning (ML) techniques, such as classification models and decision rules for diagnosis, and action rules for treatment to support the delivery of TRT. A knowledge-based framework for clinical decision support system (CDSS) is proposed as a UI-based Java application with embedded WEKA predictive models and Java Expert System Shell (JESS) rule engine with a pattern-matching algorithm for inference (Rete). The knowledge base is evaluated by the accuracy, coverage, and explainability of diagnostics predictions and treatment recommendations. Results The ML methods were applied to a clinical dataset of tinnitus patients from the Tinnitus and Hyperacusis Center at Emory University School of Medicine, which describes 555 patients and 3,000 visits. The validated ML classification models for diagnosis and rules: association and actionable treatment patterns were embedded into the knowledge base of CDSS. The CDSS prototype was tested for accuracy and explainability of the decision support, with preliminary testing resulting in an average of 80% accuracy, satisfactory coverage, and explainability. Conclusions The outcome is a validated prototype CDS system that is expected to facilitate the TRT practice.
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Affiliation(s)
- Katarzyna A. Tarnowska
- School of Computing, University of North Florida, Jacksonville, FL, United States
- *Correspondence: Katarzyna A. Tarnowska
| | - Zbigniew W. Ras
- Computer Science Department, University of North Carolina, Charlotte, NC, United States
- Polish-Japanese Academy of Information Technology, Warsaw, Poland
| | - Pawel J. Jastreboff
- Department of Otolaryngology—Head & Neck Surgery, School of Medicine Emory University, Atlanta, GA, United States
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Le Prell CG. Prevention of Noise-Induced Hearing Loss Using Investigational Medicines for the Inner Ear: Previous Trial Outcomes Should Inform Future Trial Design. Antioxid Redox Signal 2022; 36:1171-1202. [PMID: 34346254 PMCID: PMC9221155 DOI: 10.1089/ars.2021.0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/13/2022]
Abstract
Significance: Noise-induced hearing loss (NIHL) is an important public health issue resulting in decreased quality of life for affected individuals, and significant costs to employers and governmental agencies. Recent Advances: Advances in the mechanistic understanding of NIHL have prompted a growing number of proposed, in-progress, and completed clinical trials for possible protections against NIHL via antioxidants and other drug agents. Thirty-one clinical trials evaluating prevention of either temporary or permanent NIHL were identified and are reviewed. Critical Issues: This review revealed little consistency in the noise-exposed populations in which drugs are evaluated or the primary outcomes used to measure NIHL prevention. Changes in pure-tone thresholds were the most common primary outcomes; specific threshold metrics included both average hearing loss and incidence of significant hearing loss. Changes in otoacoustic emission (OAE) amplitude were relatively common secondary outcomes. Extended high-frequency (EHF) hearing and speech-in-noise perception are commonly adversely affected by noise exposure but are not consistently included in clinical trials assessing prevention of NIHL. Future Directions: Multiple criteria are available for monitoring NIHL, but the specific criterion to be used to define clinically significant otoprotection remains a topic of discussion. Audiogram-based primary outcome measures can be combined with secondary outcomes, including OAE amplitude, EHF hearing, speech-in-noise testing, tinnitus surveys, and patient-reported outcomes. Standardization of test protocols for the above primary and secondary outcomes, and associated reporting criterion for each, would facilitate clinical trial design and comparison of results across investigational drug agents. Antioxid. Redox Signal. 36, 1171-1202.
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Affiliation(s)
- Colleen G. Le Prell
- Department of Speech, Language, and Hearing Science, University of Texas at Dallas, Richardson, Texas, USA
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Tyler RS, Stocking C, Ji H, Witt S, Mancini PC. Tinnitus Activities Treatment with Total and Partial Masking. J Am Acad Audiol 2021; 32:501-509. [DOI: 10.1055/s-0041-1731698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background There are many counseling and sound therapy approaches to treat tinnitus. Counseling approaches range from providing information using directive or collaborative approaches. Sound therapies include strategies that use background sounds to totally or partially mask tinnitus to reduce the prominence of or decrease the loudness or annoyance of the tinnitus.
Purpose We evaluated the effectiveness of tinnitus activities treatment (TAT) in two groups, those without hearing aids (HA) and those who were provided with HA. In both groups, comparisons were made among those receiving (1) counseling only, (2) counseling and partial masking, and (3) counseling and total masking.
Research Design Participants were provided with HA or not, based on their choice, and then randomly assigned to one of the three groups. The Tinnitus Handicap Questionnaire (THQ) was used as the primary measure.
Results For those without HA, significant benefits were obtained for 8 out of 22 participants in the counseling group, 8 of 13 in the total masking group, and 8 of 24 in the partial mask group. The average decrease in the THQ was 15% for the counseling group, 25% for the total mask, and 14% for the partial masking group. For those with HA; significant benefits were obtained for 5 of 16 in the counseling group, 3 of 14 in the total mask group, and 6 of 13 in the partial mask group. The average decrease in the THQ score was 12% for counseling, 13% for total masking, and 16% for partial masking. No significant differences among groups were observed.
Conclusion Individual differences were large. Many benefited from their treatment, but some did not. We believe this was likely influenced by their expectations.
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Affiliation(s)
- Richard S. Tyler
- Department of Otolaryngology - Head and Neck Surgery, The University of Iowa, Iowa City, Iowa
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City, Iowa
| | - Christina Stocking
- Speech-Language and Hearing Clinic, University at Buffalo, Buffalo, New York
| | - Haihong Ji
- Department of Otolaryngology - Head and Neck Surgery, The University of Iowa, Iowa City, Iowa
| | - Shelley Witt
- Department of Otolaryngology - Head and Neck Surgery, The University of Iowa, Iowa City, Iowa
| | - Patricia C. Mancini
- Department of Otolaryngology - Head and Neck Surgery, The University of Iowa, Iowa City, Iowa
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Chen Z, Zheng Y, Fei Y, Wu D, Yang X. Validation of the mandarin tinnitus evaluation questionnaire: A clinician-administered tool for tinnitus management. Medicine (Baltimore) 2021; 100:e26490. [PMID: 34232181 PMCID: PMC8270615 DOI: 10.1097/md.0000000000026490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023] Open
Abstract
This study sought to validate the applicability of the mandarin Tinnitus Evaluation Questionnaire (TEQ), a brief score method administered by clinicians to quantify the tinnitus severity.A descriptive observational questionnaire study in regard to psychometric properties and practicability was conducted with a total of 414 primary tinnitus outpatients, in which 173 of 414 patients completed the follow-up after receiving an intervention based on the tinnitus educational counseling and the life-style adjustment guidance. For quantifying the tinnitus severity, the TEQ and other 2 self-report questionnaires, Tinnitus Handicap Inventory and visual analog scale, were administered on patients' first-visit and follow-up. With the psychometric analysis, we evaluated the performance of TEQ in tinnitus management, including distinguishing patients with varying severity and detecting the treatment-related outcome.At the first visit, the TEQ showed an excellent inter-rater reliability (Pearson correlation, 0.97, P < .01), a good internal consistency reliability (Cronbach's α, 0.79), and an acceptable convergent validity (Pearson correlation, 0.78 with the Tinnitus Handicap Inventory; 0.62 with a single-question visual analog scale, P < .01). In detecting the treatment-related change, a large effect size of TEQ verified a sensitive responsiveness. After estimating the test-error, a 2-point reduction (2/21) of the TEQ was recommend to be considered a reference outcome indicator for the effective intervention.Even though the TEQ is scored by clinician, it can reflect the clinical features of tinnitus patient. Flexible and simple assessing process makes it a practical tool for patient intake, intervention selection, and outcome measurement.
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de Azevedo AA, Penido NDO, Figueiredo RR. Event related potentials (ERPs) to assess the tinnitus complaint during drug treatment. PROGRESS IN BRAIN RESEARCH 2021; 262:175-187. [PMID: 33931178 DOI: 10.1016/bs.pbr.2020.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Previous studies have shown that the attention given to tinnitus can be a determinant of tinnitus severity. Some of these studies have shown changes in the amplitude and/or latency parameters of the event-related auditory potentials (ERPs). One of the tools previously employed to investigate an individual's attention is the Event Related Potential (ERP), which reflects the amount of attention from the patient to the provided auditory stimuli. OBJECTIVE To verify if the use of central and peripheral drugs tested for the treatment of tinnitus present changes in the measurable parameters of event-related potentials when compared to Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS). METHOD Eighty-eight tinnitus patients were randomly sorted into two drug groups: (1) drugs with a central action mechanism and (2) drug with peripheral action mechanism. Their effects upon the negative aspects caused by tinnitus symptoms were evaluated by the ERPs during three periods: Premedication (T1), at Termination of the drug treatment (T2), and following the Washout period (T3), and then compared with the results from the THI questionnaire and VAS. RESULTS ERP waves in both groups did not demonstrate significant differences during the three evaluated periods (P=0.53), despite the significant improvement seen through the evaluation by the THI questionnaire and VAS for tinnitus annoyance and intensity (P<0.0001). CONCLUSION The use of ERPs with patients of chronic tinnitus who have been submitted to treatment using drugs having actions on both the CNS and peripheral auditory system did not present changes in either latency or amplitude of the waves throughout the treatment when compared to the THI questionnaire and VAS. The ERPs cannot be considered as criterion to evaluate the evolution of drug treatment in patients complaining of tinnitus. The statistically significant reduction in THI and VAS scores among all drugs used occurred with dopamine antagonists. Considering the possible antipsychotic effects, we can conclude that the concomitance of a variety of psychopathological conditions such as obsessive-compulsive disorder may be associated with tinnitus in some patients and may be responsible for the severity of the symptom.
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Affiliation(s)
- Andréia Aparecida de Azevedo
- Universidade Federal de São Paulo, São Paulo, Brazil; Otorrinolaringologia sul fluminense (Otosul), Volta Redonda, Brazil.
| | | | - Ricardo Rodrigues Figueiredo
- Otorrinolaringologia sul fluminense (Otosul), Volta Redonda, Brazil; Faculdade de Medicina de Valença, Volta Redonda, Volta Redonda, RJ, Brazil
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Mancini PC, Tyler RS, Jun HJ, Wang TC, Ji H, Stocking C, Secor C, Rojas-Roncancio E, Witt S. Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research. Am J Audiol 2020; 29:429-435. [PMID: 32717149 DOI: 10.1044/2020_aja-20-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2-3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation (r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.
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Affiliation(s)
- Patricia C. Mancini
- Department of Otolaryngology—Head and Neck Surgery, The University of Iowa, Iowa City
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Richard S. Tyler
- Department of Otolaryngology—Head and Neck Surgery, The University of Iowa, Iowa City
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Hyung Jin Jun
- Department of Otolaryngology—Head and Neck Surgery, The University of Iowa, Iowa City
| | - Tang-Chuan Wang
- Department of Otolaryngology—Head and Neck Surgery, The University of Iowa, Iowa City
| | - Helena Ji
- Department of Otolaryngology—Head and Neck Surgery, The University of Iowa, Iowa City
| | | | - Carrie Secor
- University at Buffalo Speech-Language and Hearing Clinic,NY
| | | | - Shelley Witt
- Department of Otolaryngology—Head and Neck Surgery, The University of Iowa, Iowa City
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Vijayasingam A, Frost E, Wilkins J, Gillen L, Premachandra P, Mclaren K, Gilmartin D, Picinali L, Vidal-Diez A, Borsci S, Ni MZ, Tang WY, Morris-Rosendahl D, Harcourt J, Elston C, Simmonds NJ, Shah A. Tablet and web-based audiometry to screen for hearing loss in adults with cystic fibrosis. Thorax 2020; 75:632-639. [PMID: 32409613 DOI: 10.1136/thoraxjnl-2019-214177] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Individuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry in a sound-booth is costly, time-consuming and requires a trained audiologist. This cross-sectional study analysed tablet-based audiometry (Shoebox MD) performed by non-audiologists in an outpatient setting, alongside home web-based audiometry (3D Tune-In) to screen for hearing loss in adults with CF. METHODS Hearing was analysed in 126 CF adults using validated questionnaires, a web self-hearing test (0.5 to 4 kHz), tablet (0.25 to 12 kHz) and sound-booth audiometry (0.25 to 12 kHz). A threshold of ≥25 dB hearing loss at ≥1 audiometric frequency was considered abnormal. Demographics and mitochondrial DNA sequencing were used to analyse risk factors, and accuracy and usability of hearing tests determined. RESULTS Prevalence of hearing loss within any frequency band tested was 48%. Multivariate analysis showed age (OR 1.127; (95% CI: 1.07 to 1.18; p value<0.0001) per year older) and total intravenous antibiotic days over 10 years (OR 1.006; (95% CI: 1.002 to 1.010; p value=0.004) per further intravenous day) were significantly associated with increased risk of hearing loss. Tablet audiometry had good usability, was 93% sensitive, 88% specific with 94% negative predictive value to screen for hearing loss compared with web self-test audiometry and questionnaires which had poor sensitivity (17% and 13%, respectively). Intraclass correlation (ICC) of tablet versus sound-booth audiometry showed high correlation (ICC >0.9) at all frequencies ≥4 kHz. CONCLUSIONS Adults with CF have a high prevalence of drug-related hearing loss and tablet-based audiometry can be a practical, accurate screening tool within integrated ototoxicity monitoring programmes for early detection.
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Affiliation(s)
- Anitha Vijayasingam
- Adult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Emily Frost
- Department of Audiology, Imperial College Healthcare NHS Trust, London, UK
| | - Julie Wilkins
- Department of Audiology, Imperial College Healthcare NHS Trust, London, UK
| | - Lise Gillen
- Department of Audiology, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | | | - Kate Mclaren
- Adult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Desmond Gilmartin
- Adult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lorenzo Picinali
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Alberto Vidal-Diez
- London In Vitro Diagnostics Collaborative, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Simone Borsci
- London In Vitro Diagnostics Collaborative, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Cognitive Psychology and Ergonomics, Faculty of Behavioural Management and Social sciences, University of Twente, Enschede, Overijssel, Netherlands
| | - Melody Zhifang Ni
- London In Vitro Diagnostics Collaborative, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Wai Y Tang
- Clinical Genetics and Genomics, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Deborah Morris-Rosendahl
- Clinical Genetics and Genomics, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Jonny Harcourt
- Department of Ear, Nose and Throat, Imperial College Healthcare NHS Trust, London, UK
| | - Caroline Elston
- Department of Cystic Fibrosis, King's College Hospital NHS Foundation Trust, London, London, UK
| | - N J Simmonds
- Adult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Anand Shah
- Adult Cystic Fibrosis Centre, Royal Brompton and Harefield NHS Foundation Trust, London, UK .,National Heart and Lung Institute, Imperial College London, London, UK
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Husain FT, Schmidt SA, Tai Y, Granato EC, Ramos P, Sherman P, Esquivel C. Replicability of Neural and Behavioral Measures of Tinnitus Handicap in Civilian and Military Populations: Preliminary Results. Am J Audiol 2019; 28:191-208. [PMID: 31022364 DOI: 10.1044/2019_aja-ttr17-18-0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose In the past decade, resting-state functional connectivity, acquired using functional magnetic resonance imaging (fMRI), has emerged as a popular measure of tinnitus, especially as related to self-reported handicap or psychological reaction. The goal of this study was to assess replicability of neural correlates of tinnitus, namely, resting-state functional connectivity, in the same individuals acquired over 2 sessions. Method Data were collected at 2 different sites (University of Illinois at Urbana-Champaign and Joint Base San Antonio Wilford Hall Ambulatory Surgical Center) using similar 3T magnets and similar data acquisition paradigms. Thirty-six patients (all civilians) were scanned using resting-state fMRI at the University of Illinois at Urbana-Champaign. Ten patients, active-duty Service members and Veterans, were scanned at the Wilford Hall Ambulatory Surgical Center and the Department of Defense Hearing Center of Excellence. Each participant was scanned twice, a week apart, using identical protocols of 10 min resting-state fMRI. Results Tinnitus handicap scores using the Tinnitus Functional Index and the Tinnitus Primary Function Questionnaire ranged between no or mild handicap to moderately severe handicap but did not significantly differ between visits. We examined the default mode, dorsal attention, and auditory resting-state networks and found that the strength of the within-network functional connections across visit was similar for the attention and default mode networks but not for the auditory network. In addition, the functional connection between the attention network and precuneus, a region of the default mode network, was also replicable across visits. Conclusions Our results show that resting-state fMRI measures are replicable and reliable in patients with a subjective condition, although some networks and functional connections may be more stable than others. This paves the way for using resting-state fMRI to measure the efficacy of tinnitus interventions and as a tool to help propose better management options.
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Affiliation(s)
- Fatima T. Husain
- Department of Speech and Hearing Science, University of Illinois at Urbana–Champaign
- The Neuroscience Program, University of Illinois at Urbana–Champaign
- The Beckman Institute for Advance Science and Technology, University of Illinois at Urbana–Champaign
| | - Sara A. Schmidt
- The Neuroscience Program, University of Illinois at Urbana–Champaign
- The Beckman Institute for Advance Science and Technology, University of Illinois at Urbana–Champaign
| | - Yihsin Tai
- Department of Speech and Hearing Science, University of Illinois at Urbana–Champaign
- The Beckman Institute for Advance Science and Technology, University of Illinois at Urbana–Champaign
| | - Elsa C. Granato
- Department of Defense Hearing Center of Excellence, San Antonio, TX
- zCore Business Solutions, Inc., Round Rock, TX
| | - Pedro Ramos
- Decypher Technologies, San Antonio, TX
- 711th Human Performance Wing (HPW)/USAF School of Aerospace Medicine, Dayton, OH
| | - Paul Sherman
- 711th Human Performance Wing (HPW)/USAF School of Aerospace Medicine, Dayton, OH
- 59th Medical Wing, Department of Radiology, San Antonio, TX
| | - Carlos Esquivel
- Department of Defense Hearing Center of Excellence, San Antonio, TX
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Cacace AT, Hu J, Romero S, Xuan Y, Burkard RF, Tyler RS. Glutamate is down-regulated and tinnitus loudness-levels decreased following rTMS over auditory cortex of the left hemisphere: A prospective randomized single-blinded sham-controlled cross-over study. Hear Res 2018; 358:59-73. [DOI: 10.1016/j.heares.2017.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 10/25/2017] [Accepted: 10/31/2017] [Indexed: 12/14/2022]
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Tyler RS, Deshpande AK, Lau CC, Kuk F. The Effectiveness of the Progression of Widex Zen Tinnitus Therapy: A Pilot Study. Am J Audiol 2017; 26:283-292. [PMID: 28614844 DOI: 10.1044/2017_aja-16-0009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/20/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study was to measure the progression of benefits to individuals with tinnitus from providing informational counseling, hearing aids, a brief tinnitus activities treatment and Zen therapy. METHOD Several magnitude estimation scales and tinnitus handicap scales were administered for the duration of the study to 20 participants. RESULTS Results indicated that all participants benefited from this sequential approach of providing different components of this tinnitus treatment. Large benefits were observed following the tinnitus activities treatment and the Zen treatments. CONCLUSION We conclude that the progressive approach of treatment demonstrated here should be of benefit to most individuals with tinnitus and that the Widex Zen sound therapy is a worthwhile treatment for many tinnitus sufferers.
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Affiliation(s)
- Richard S. Tyler
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa, Iowa City
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City
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Bauer CA, Berry J, Brozoski TJ. Clinical trials supported by the Tinnitus Research Consortium: Lessons learned, the Southern Illinois University experience. Hear Res 2016; 334:65-71. [DOI: 10.1016/j.heares.2015.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/03/2015] [Accepted: 05/05/2015] [Indexed: 11/16/2022]
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Stein A, Wunderlich R, Lau P, Engell A, Wollbrink A, Shaykevich A, Kuhn JT, Holling H, Rudack C, Pantev C. Clinical trial on tonal tinnitus with tailor-made notched music training. BMC Neurol 2016; 16:38. [PMID: 26987755 PMCID: PMC4797223 DOI: 10.1186/s12883-016-0558-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/10/2016] [Indexed: 11/26/2022] Open
Abstract
Background Tinnitus is a result of hyper-activity/hyper-synchrony of auditory neurons coding the tinnitus frequency, which has developed due to synchronous mass activity owing to the lack of inhibition. We assume that removal of exactly these frequencies from a complex auditory stimulus will cause the brain to reorganize around tonotopic regions coding the tinnitus frequency through inhibition-induced plasticity. Based on this assumption, a novel treatment for tonal tinnitus - tailor-made notched music training (TMNMT) - has been introduced and was tested in this clinical trial. Methods A randomized controlled trial in parallel group design was performed in a double-blinded manner. We included 100 participants with chronic, tonal tinnitus who listened to tailor-made notched music for two hours a day for three consecutive months. Our primary outcome measures were the Tinnitus Handicap Questionnaire and Visual Analog Scales measuring perceived tinnitus loudness, awareness, distress and handicap. Participants rated their tinnitus before and after the training as well as one month after cessation of the training. Results While no effect was found for the primary outcome measures, tinnitus distress, as measured by the Tinnitus Questionnaire, a secondary outcome measure, developed differently in the two groups. The treatment group showed higher distress scores while the placebo group revealed lower distress scores after the training. However, this effect did not reach significance in post-hoc analysis and disappeared at follow-up measurements. At follow-up, tinnitus loudness in the treatment group was significantly reduced as compared to the control group. Post hoc analysis, accounting for low reliability scores in the Visual Analog Scales, showed a significant reduction of the overall Visual Analog Scale mean score in the treatment group even at the post measurement. Conclusion This is the first study on TMNMT that was planned and conducted following the CONSORT statement standards for clinical trials. The current work is one more step towards a final evaluation of TMNMT. Already after three months the effect of training with tailor-made notched music is observable in the most direct rating of tinnitus perception – the tinnitus loudness, while more global measures of tinnitus distress do not show relevant changes. Trial registration Current Controlled Trials ISRCTN04840953; Trial registration date: 17.07.2013
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Affiliation(s)
- Alwina Stein
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany
| | - Robert Wunderlich
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany.,Institute for Physiological Psychology, University of Bielefeld, Bielefeld, Germany
| | - Pia Lau
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany
| | - Alva Engell
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany
| | | | - Jörg-Tobias Kuhn
- Institute for Psychology, University of Münster, Fliednerstraße 21, 48149, Münster, Germany
| | - Heinz Holling
- Institute for Psychology, University of Münster, Fliednerstraße 21, 48149, Münster, Germany
| | - Claudia Rudack
- Department of ENT, University Clinic Münster, University of Münster, Cardinal-von-Galen Ring 10, 48149, Münster, Germany
| | - Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany.
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Fackrell K, Hall DA, Barry JG, Hoare DJ. Psychometric properties of the Tinnitus Functional Index (TFI): Assessment in a UK research volunteer population. Hear Res 2015; 335:220-235. [PMID: 26415998 PMCID: PMC5708524 DOI: 10.1016/j.heares.2015.09.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022]
Abstract
Objectives Questionnaires are essential for measuring tinnitus severity and intervention-related change but there is no standard instrument used routinely in research settings. Most tinnitus questionnaires are optimised for measuring severity but not change. However, the Tinnitus Functional Index (TFI) claims to be optimised for both. It has not however been fully validated for research purposes. Here we evaluate the relevant psychometric properties of the TFI, specifically the questionnaire factor structure, reproducibility, validity and responsiveness guided by quality criteria for the measurement properties of health-related questionnaires. Methods The study involved a retrospective analysis of data collected for 294 members of the general public who participated in a randomised controlled trial of a novel tinnitus device (ClinicalTrials.gov Identifier: NCT01541969). Participants completed up to eight commonly used assessment questionnaires including the TFI, Tinnitus Handicap Inventory (THI), Tinnitus Handicap Questionnaire (THQ), a Visual Analogue Scale of loudness (VAS-Loudness), Percentage Annoyance question, the Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI), and the World Health Organisation Quality of Life-Bref (WHOQOL-BREF). A series of analyses assessed the study objectives. Forty four participants completed the TFI at a second visit (within 7–21 days and before receiving any intervention) providing data for reproducibility assessments. Results The 8-factor structure was not fully confirmed for this general (non-clinical) population. Whilst it was acceptable standalone subscale, the ‘auditory’ factor showed poor loading with the higher order factor ‘functional impact of tinnitus’. Reproducibility assessments for the overall TFI indicate high internal consistency (α = 0.80) and extremely high reliability (ICC: 0.91), whilst agreement was borderline acceptable (93%). Construct validity was demonstrated by high correlations between scores on the TFI and THI (r = 0.82) and THQ (r = 0.82), moderate correlations with VAS-L (r = 0.46), PR-A (r = 0.58), BDI (r = 0.57), BAI (r = 0.39) and WHOQOL (r = −0.48). Floor effects were observed for more than 50% of the items. A smallest detectable change score of 22.4 is proposed for the TFI global score. Conclusion Even though the proposed 8-factor structure was not fully confirmed for this population, the TFI appears to cover multiple symptom domains, and to measure the construct of tinnitus with an excellent reliability in distinguishing between patients. While the TFI may discriminate those whose tinnitus is not a problem, floor effects in many items means it is less appropriate as a measure of change in this subgroup. Further investigation is needed to determine whether these effects are relevant in other populations.
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Affiliation(s)
- Kathryn Fackrell
- NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, NG7 2RD, UK.
| | - Deborah A Hall
- NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, NG7 2RD, UK
| | - Johanna G Barry
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK; Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - Derek J Hoare
- NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, NG7 2RD, UK
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Wunderlich R, Lau P, Stein A, Engell A, Wollbrink A, Rudack C, Pantev C. Impact of Spectral Notch Width on Neurophysiological Plasticity and Clinical Effectiveness of the Tailor-Made Notched Music Training. PLoS One 2015; 10:e0138595. [PMID: 26406446 PMCID: PMC4583393 DOI: 10.1371/journal.pone.0138595] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/01/2015] [Indexed: 11/19/2022] Open
Abstract
Tinnitus, the ringing in the ears that is unrelated to any external source, causes a significant loss in quality of life, involving sleep disturbance and depression for 1 to 3% of the general population. While in the first place tinnitus may be triggered by damage to the inner ear cells, the neural generators of subjective tinnitus are located in central regions of the nervous system. A loss of lateral inhibition, tonotopical reorganization and a gain-increase in response to the sensory deprivation result in hypersensitivity and hyperactivity in certain regions of the auditory cortex. In the tailor-made notched music training (TMNMT) patients listen to music from which the frequency spectrum of the tinnitus has been removed. This evokes strong lateral inhibition from neurons tuned to adjacent frequencies onto the neurons involved in the tinnitus percept. A reduction of tinnitus loudness and tinnitus-related neural activity was achieved with TMNMT in previous studies. As the effect of lateral inhibition depends on the bandwidth of the notch, in the current study we altered the notch width to find the most effective notch width for TMNMT. We compared 1-octave notch width with ½-octave and ¼-octave. Participants chose their favorite music for the training that included three month of two hours daily listening. The outcome was measured by means of standardized questionnaires and magnetoencephalography. We found a general reduction of tinnitus distress in all administered tinnitus questionnaires after the training. Additionally, tinnitus-related neural activity was reduced after the training. Nevertheless, notch width did not have an influence on the behavioral or neural effects of TMNMT. This could be due to a non-linear resolution of lateral inhibition in high frequencies.
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Affiliation(s)
- Robert Wunderlich
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
- Institute for Physiological Psychology, University of Bielefeld, Bielefeld, Germany
| | - Pia Lau
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Alwina Stein
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Alva Engell
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Claudia Rudack
- Department of Otolaryngology, University Hospital of Münster, Münster, Germany
| | - Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
- * E-mail:
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Ward J, Vella C, Hoare DJ, Hall DA. Subtyping Somatic Tinnitus: A Cross-Sectional UK Cohort Study of Demographic, Clinical and Audiological Characteristics. PLoS One 2015; 10:e0126254. [PMID: 25996779 PMCID: PMC4440784 DOI: 10.1371/journal.pone.0126254] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/31/2015] [Indexed: 11/23/2022] Open
Abstract
Somatic tinnitus is the ability to modulate the psychoacoustic features of tinnitus by somatic manoeuvres. The condition is still not fully understood and further identification of this subtype is essential, particularly for the purpose of establishing protocols for both its diagnosis and treatment. This study aimed to investigate the characteristics of somatic tinnitus within a large UK cohort using a largely unselected sample. We believe this to be relatively unique in comparison to current literature on the topic. This was investigated by using a total of 608 participant assessments from a set of recognised tinnitus and audiology measures. Results from a set of chi-square tests of association found that amongst the individuals with somatic tinnitus, a higher proportion had pulsatile tinnitus (different from heartbeat), were under the age of 40, reported variation in the loudness of their tinnitus and reported temporomandibular joint (TMJ) disorder. The same pattern of results was confirmed using a multivariate analysis of the data based on logistic regression. These findings have strong implications towards the profiling of somatic tinnitus as a distinct subtype of general tinnitus.
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Affiliation(s)
- Jamie Ward
- School of Psychology, University of Sussex, Brighton, BNI 9RH, United Kingdom
- * E-mail:
| | - Claire Vella
- School of Psychology, University of Sussex, Brighton, BNI 9RH, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
| | - Deborah A. Hall
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
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Kleinstäuber M, Frank I, Weise C. A confirmatory factor analytic validation of the Tinnitus Handicap Inventory. J Psychosom Res 2015; 78:277-84. [PMID: 25582803 DOI: 10.1016/j.jpsychores.2014.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Because the postulated three-factor structure of the internationally widely used Tinnitus Handicap Inventory (THI) has not been confirmed yet by a confirmatory factor analytic approach this was the central aim of the current study. METHODS From a clinical setting, N=373 patients with chronic tinnitus completed the THI and further questionnaires assessing tinnitus-related and psychological variables. In order to analyze the psychometric properties of the THI, confirmatory factor analysis (CFA) and correlational analyses were conducted. RESULTS CFA provided a statistically significant support for a better fit of the data to the hypothesized three-factor structure (RMSEA=.049, WRMR=1.062, CFI=.965, TLI=.961) than to a general factor model (RMSEA=.062, WRMR=1.258, CFI=.942, TLI=.937). The calculation of Cronbach's alpha as indicator of internal consistency revealed satisfactory values (.80-.91) with the exception of the catastrophic subscale (.65). High positive correlations of the THI and its subscales with other measures of tinnitus distress, anxiety, and depression, high negative correlations with tinnitus acceptance, moderate positive correlations with anxiety sensitivity, sleeping difficulties, tinnitus loudness, and small correlations with the Big Five personality dimensions confirmed construct validity. CONCLUSION Results show that the THI is a highly reliable and valid measure of tinnitus-related handicap. In contrast to results of previous exploratory analyses the current findings speak for a three-factor in contrast to a unifactorial structure. Future research is needed to replicate this result in different tinnitus populations.
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Affiliation(s)
- Maria Kleinstäuber
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Germany.
| | - Ina Frank
- Johannes Gutenberg-University Mainz, Department of Clinical Psychology and Psychotherapy, Germany
| | - Cornelia Weise
- Philipps-University Marburg, Department of Clinical Psychology and Psychotherapy, Germany; Linköping University, Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research and Linnaeus Centre HEAD, Linköping, Sweden
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Tyler R, Ji H, Perreau A, Witt S, Noble W, Coelho C. Development and validation of the tinnitus primary function questionnaire. Am J Audiol 2014; 23:260-72. [PMID: 24811293 DOI: 10.1044/2014_aja-13-0014] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 04/05/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To create a questionnaire focused on the primary activities impaired by tinnitus and therefore more sensitive to treatments. METHOD Questions were developed on (a) emotions, (b) hearing, (c) sleep, and (d) concentration. A 20-item questionnaire was administered to 158 patients. First, confirmatory factor analysis was used to select 3 questions per domain. Second, factor analysis was used to evaluate the appropriateness of the 12-item questionnaire. RESULTS The analysis indicated that the selected questions successfully represented 4 independent domains. Scores were correlated with the Tinnitus Handicap Questionnaire ( r = .77, p < .01) and loudness ( r = .40, p < .01). The Sleep subscale correlated with the Pittsburgh Sleep Index ( r = .68, p < .01); the Emotion subscale correlated with the Beck Inventory ( r = .66, p < .01) and the Trait Anxiety questionnaire ( r = .67, p < .01). The average scores went from 51% to 38% following treatment. CONCLUSION The Tinnitus Primary Function Questionnaire is valid, reliable, and sensitive and can be used to determine the efficacy of clinical trials.
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Effects of frequency discrimination training on tinnitus: results from two randomised controlled trials. J Assoc Res Otolaryngol 2012; 13:543-59. [PMID: 22476724 PMCID: PMC3387303 DOI: 10.1007/s10162-012-0323-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/15/2012] [Indexed: 12/30/2022] Open
Abstract
That auditory perceptual training may alleviate tinnitus draws on two observations: (1) tinnitus probably arises from altered activity within the central auditory system following hearing loss and (2) sound-based training can change central auditory activity. Training that provides sound enrichment across hearing loss frequencies has therefore been hypothesised to alleviate tinnitus. We tested this prediction with two randomised trials of frequency discrimination training involving a total of 70 participants with chronic subjective tinnitus. Participants trained on either (1) a pure-tone standard at a frequency within their region of normal hearing, (2) a pure-tone standard within the region of hearing loss or (3) a high-pass harmonic complex tone spanning a region of hearing loss. Analysis of the primary outcome measure revealed an overall reduction in self-reported tinnitus handicap after training that was maintained at a 1-month follow-up assessment, but there were no significant differences between groups. Secondary analyses also report the effects of different domains of tinnitus handicap on the psychoacoustical characteristics of the tinnitus percept (sensation level, bandwidth and pitch) and on duration of training. Our overall findings and conclusions cast doubt on the superiority of a purely acoustic mechanism to underpin tinnitus remediation. Rather, the nonspecific patterns of improvement are more suggestive that auditory perceptual training affects impact on a contributory mechanism such as selective attention or emotional state.
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Moon IS, Park SY, Park HJ, Yang HS, Hong SJ, Lee WS. Clinical characteristics of acoustic trauma caused by gunshot noise in mass rifle drills without ear protection. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2011; 8:618-23. [PMID: 21936701 DOI: 10.1080/15459624.2011.609013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
One of the major occupational hazards of working in military service is being subjected to intense impulse noise. We analyzed the clinical presentation of acoustic traumas, induced by mass rifle gunshot noise during military training, in unprotected patients. We evaluated 189 soldiers who had otologic symptoms after rifle shooting exercises without using any hearing protection. All soldiers had been training on the K2 rifle. We took medical histories; conducted physical examinations and hearing evaluations (pure-tone audiometry, speech audiometry, and impedence audiometry); and distributed the Newmann's Tinnitus Handicap Inventory (THI) survey. In addition, we evaluated a normal control group of 64 subjects of similar age who had never fired a rifle. In the patient group, the most common and irritating reported symptom was tinnitus (94.2%), and the average THI score in the patient group was 39.51 ± 14.87, which was significantly higher than the control group score (0.56 ± 3.94) (p < 0.001). Average outcomes of post-exposure air conduction thresholds were 21.33 ± 13.25 dB HL in the affected ears. These levels also were significantly higher than those of the control group (9.16 ± 4.07dB HL) (p < 0.001). Hearing loss was most prominent at high frequencies. An asymmetry of hearing loss related to head position during shooting was not observed. Acoustic trauma induced by gunshot noise can cause permanent tinnitus and hearing loss. Hearing protection (bilateral earplugs) and environmental reform are necessary.
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Affiliation(s)
- In Seok Moon
- Department of Otorhinolaryngology- Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Molini E, Faralli M, Calenti C, Ricci G, Longari F, Frenguelli A. Personal experience with tinnitus retraining therapy. Eur Arch Otorhinolaryngol 2011; 267:51-6. [PMID: 19543742 DOI: 10.1007/s00405-009-1015-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 06/05/2009] [Indexed: 10/20/2022]
Abstract
We present the results of tinnitus retraining therapy (TRT) in a group of patients suffering from tinnitus and/or hyperacusia. Based on the scores from a specific questionnaire and the Tinnitus Handicap Inventory (THI), the patients were classified into five categories and began therapy according to Jastreboff's criteria. Depending on the individual case, therapy envisaged counselling sessions, ambient sound enrichment, sound generators and hearing aids. At the end of the 18-month period, therapeutic success was observed in 79% of the patients. The initial numerical values of the scale of the symptoms and the THI seem predictive of treatment outcome. The use of instruments (sound generators) increases the success rate, but the study also demonstrates the effectiveness of counselling and ambient sound enrichment. Failures mainly involved patients with hypacusia who refused to wear hearing aids, as this influenced the effectiveness of ambient sound enrichment and counselling. Paralleling the data in the literature, the results demonstrate the effectiveness of TRT, which cannot be attributed to a placebo effect given the extended duration of treatment.
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Affiliation(s)
- Egisto Molini
- Otolaryngology and Cervicofacial Surgery Clinic, University of Perugia, Perugia, Italy
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Hesser H, Weise C, Westin VZ, Andersson G. A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress. Clin Psychol Rev 2011; 31:545-53. [DOI: 10.1016/j.cpr.2010.12.006] [Citation(s) in RCA: 197] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 10/27/2010] [Accepted: 12/14/2010] [Indexed: 11/24/2022]
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Searchfield GD, Kaur M, Martin WH. Hearing aids as an adjunct to counseling: Tinnitus patients who choose amplification do better than those that don't. Int J Audiol 2010; 49:574-9. [DOI: 10.3109/14992021003777267] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pan T, Tyler RS, Ji H, Coelho C, Gehringer AK, Gogel SA. Changes in the tinnitus handicap questionnaire after cochlear implantation. Am J Audiol 2010; 18:144-51. [PMID: 19949236 DOI: 10.1044/1059-0889(2009/07-0042)] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine (a) changes in the Tinnitus Handicap Questionnaire (THQ) for patients using cochlear implants, (b) differences between patients who receive total or partial relief, and (c) identifiable characteristics of those who report tinnitus after implantation. METHOD Pre- and postoperatively, 244 adults were administered the THQ when they reported tinnitus. RESULTS Of the 153 patients who had tinnitus preoperatively, 94 (61%) patients reported total suppression and 59 (39%) reported a partial reduction. In 91 patients who did not have tinnitus before implantation, 11 (12%) reported tinnitus postimplantation. The THQ score decreased from 41% preimplant to 30% postimplant. The largest reductions involved social handicap and hearing. Patients with a more severe hearing loss might be more likely to experience an exacerbation of their tinnitus. We were not able to clearly identify differences between patients who received total or partial relief and the characteristics of patients who reported tinnitus after implantation. Those who acquired tinnitus had the shortest duration hearing loss (5.6 years) and were the oldest (63 years). The average THQ score of patients getting tinnitus was 29%. CONCLUSIONS Most tinnitus patients benefit from receiving a cochlear implant.
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Affiliation(s)
- Tao Pan
- University of Iowa, Iowa City, and Peking University Third Hospital, Beijing, People’s Republic of China
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Pan T, Tyler RS, Ji H, Coelho C, Gehringer AK, Gogel SA. The relationship between tinnitus pitch and the audiogram. Int J Audiol 2009; 48:277-94. [PMID: 19842803 DOI: 10.1080/14992020802581974] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Miguel Ramirez Aristeguieta L, Pablo Sandoval Ortiz G, Ernesto Ballesteros L, Leonardo González A, Muñoz G. Treatment and follow-up of referred otic symptomatology in 23 patients with diagnosed temporomandibular disorders. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/16513860600836715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Baracca GN, Forti S, Crocetti A, Fagnani E, Scotti A, Del Bo L, Ambrosetti U. Results of TRT after eighteen months: Our experience. Int J Audiol 2009; 46:217-22. [PMID: 17487669 DOI: 10.1080/14992020601175945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to evaluate the efficacy of TRT in patients suffering from tinnitus. The tinnitus disorder affects about 10-15% of the population and, in one person out of a hundred, it is a disabling disorder. TRT treatment is based on Jastreboff's neurophysiological model. TRT consists of two parts: counselling, and sound therapy by means of dedicated hearing aids and sound generators. It proved to be useful to reduce the symptoms related to tinnitus. Jastreboff's structured interviews were proposed to a sample of 51 patients with tinnitus belonging to the I-II-III-IV classes according to Jastreboff. These patients were treated for 18 months. Sixty-eight percent of patients reported a reduction in the symptoms related to tinnitus, such as sleep disturbance, problems in concentration, and inability to relax. A percentage (64.7%) of patients thought that their quality of life was improved. Patients who had suffered from tinnitus for less than one year achieved significantly better results than patients who had suffered for a longer period of time. TRT is an effective tool in the treatment of tinnitus.
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Affiliation(s)
- Giovanna N Baracca
- U.O. Complessa di Orl-Audiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
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The Additive Effect of Co-Occurring Anxiety and Depression on Health Status, Quality of Life and Coping Strategies in Help-Seeking Tinnitus Sufferers. Ear Hear 2008; 29:947-56. [DOI: 10.1097/aud.0b013e3181888f83] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tyler RS, Oleson J, Noble W, Coelho C, Ji H. Clinical trials for tinnitus: study populations, designs, measurement variables, and data analysis. PROGRESS IN BRAIN RESEARCH 2007; 166:499-509. [DOI: 10.1016/s0079-6123(07)66048-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Henry JA, Schechter MA, Zaugg TL, Griest S, Jastreboff PJ, Vernon JA, Kaelin C, Meikle MB, Lyons KS, Stewart BJ. Clinical trial to compare tinnitus masking and tinnitus retraining therapy. Acta Otolaryngol 2006:64-9. [PMID: 17114146 DOI: 10.1080/03655230600895556] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONCLUSION Both tinnitus masking (TM) and tinnitus retraining therapy (TRT) can be effective therapies for amelioration of tinnitus. TM may be more effective for patients in the short term, but with continued treatment TRT may produce the greatest effects. OBJECTIVES Although TM and TRT have been used for many years, research has not documented definitively the efficacy of these methods. The present study was a controlled clinical trial to prospectively evaluate the clinical efficacy of these two methods for US military veterans with severe tinnitus. SUBJECTS AND METHODS Over 800 veterans were screened to ensure that enrolled patients had tinnitus of sufficient severity to justify 18 months of individualized treatment. Qualifying patients (n=123) were placed quasi-randomly (alternating placement) into treatment with either TM or TRT. Treatment was administered at 0, 3, 6, 12, and 18 months. Outcomes of treatment were evaluated primarily using three self-administered tinnitus questionnaires (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index). RESULTS Findings are presented from the three written questionnaires with respect to three categories of patients: describing tinnitus as a 'moderate,' 'big,' and 'very big' problem at baseline. Based on effect sizes, both groups showed considerable improvement overall. In general, TM effects remained fairly constant over time while TRT effects improved incrementally. For the patients with a 'moderate' and 'big' problem, TM provided the greatest benefit at 3 and 6 months; benefit to these TRT patients was slightly greater at 12 months, and much greater at 18 months. For patients with a 'very big' problem, TM provided the greatest benefit at 3 months. For these latter patients, results were about the same between groups at 6 months, and improvement for TRT was much greater at 12 months, with further gains at 18 months.
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Affiliation(s)
- J A Henry
- VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center (VAMC), Portland, OR, USA.
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Sobhy OA, Koutb AR, Abdel-Baki FA, Ali TM, El Raffa IZ, Khater AH. Evaluation of aural manifestations in temporo-mandibular joint dysfunction. ACTA ACUST UNITED AC 2004; 29:382-5. [PMID: 15270827 DOI: 10.1111/j.1365-2273.2004.00842.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Thirty patients with temporo-mandibular joint dysfunction were selected to investigate the changes in otoacoustic emissions before and after conservative treatment of their temporo-mandibular joints. Pure tone audiometry, transient-evoked otoacoustic emissions (TEOAE), distortion-product otoacoustic emissions (DPOAE) as well as a tinnitus questionnaire were administered to all patients before and after therapy. Therapy was conservative in the form of counselling, physiotherapy, anti-inflammatory agents, muscle relaxants, and occlusal splints. Results indicated insignificant changes in the TEOAEs, whereas there were significant increases in distortion product levels at most of the frequency bands. These results were paralleled to subjective improvement of tinnitus.
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Affiliation(s)
- O A Sobhy
- Audiology Unit, ORL Department, Faculty of Medicine, Alexandira University, Alexandria, Egypt.
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Rubinstein JT, Tyler RS, Johnson A, Brown CJ. Electrical suppression of tinnitus with high-rate pulse trains. Otol Neurotol 2003; 24:478-85. [PMID: 12806303 DOI: 10.1097/00129492-200305000-00021] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Application of high-rate pulse trains (e.g., 4800 pps) to the cochlea may represent an effective treatment of tinnitus. BACKGROUND Tinnitus is a widespread clinical problem with multiple treatments but no cure. A cure for tinnitus would restore the perception of silence. One plausible hypothesis for the origin of tinnitus associated with sensorineural hearing loss is that it is due to loss or alteration of the normal spontaneous activity in the deafferented regions of the cochlea. Electrical stimulation of the cochlea with 5000-pps pulse trains can produce spontaneous-like patterns of spike activity in the auditory nerve. METHODS Eleven volunteer human subjects with bothersome tinnitus and high-frequency sensorineural hearing loss underwent myringotomy and temporary placement of a round window electrode. High-rate pulse train stimuli were presented at various stimulus intensities and tinnitus, and stimulus perception were scaled by the subject. Three cochlear implant recipients with tinnitus in the implanted ear underwent similar stimulation. RESULTS Five of 11 (45%) of transtympanic subjects showed substantial or complete tinnitus suppression with either no perception or only a transient perception of the stimulus. Three showed tinnitus suppression only in association with the perception of the stimulus. Three showed no effects on tinnitus. A similar pattern of responses was seen in the cochlear implant subjects. CONCLUSIONS Although the study lacked an ideal placebo control, the results are promising and support further research to develop a clinically useful intervention for this troubling disorder.
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Affiliation(s)
- Jay T Rubinstein
- Department of Otolaryngology, University of Iowa, Iowa City, Iowa 52242, USA.
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Bouscau-Faure F, Keller P, Dauman R. Further validation of the Iowa tinnitus handicap questionnaire. Acta Otolaryngol 2003; 123:227-31. [PMID: 12701746 DOI: 10.1080/00016480310001051] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The ease of use of the French version of the Tinnitus Handicap Questionnaire was assessed in a group of 100 unselected individuals with tinnitus, 57 of whom agreed to take part in the survey. In addition to the instructions commonly used with this inventory, participants were invited to make any comments they wished about each item and to give their opinion of the content and presentation of the questionnaire. Nineteen subjects (33.3%) experienced difficulties with assigning a score to at least one item and one particular item was largely responsible for this problem. Increased systematic use of quantitative and qualitative data with this type of questionnaire is advocated.
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Affiliation(s)
- Frederic Bouscau-Faure
- Audiology Unit, Department of Otolaryngology-Head and Neck Surgery, University Hospital of Bordeaux, Bordeaux, France
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Andersson G, Lyttkens L, Larsen HC. Distinguishing levels of tinnitus distress. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 1999; 24:404-10. [PMID: 10542919 DOI: 10.1046/j.1365-2273.1999.00278.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Degrees of tinnitus distress were explored in a sample of 216 patients who completed audiological measures and were assessed in a structured interview conducted by a clinical psychologist. The Klockhoff and Lindblom grading system was used and its inter-rater reliability assessed in a subsample showing a high degree of correspondence. Results from the interview are reported in terms of variability of tinnitus, characteristics of problematic situations, distress caused by tinnitus, possibilities to cope, and other influencing factors. Finally, a set of discriminant analyses were conducted on the data set resulting in a final model which included pitch, minimal masking level (MML), tolerance in relation to onset, and avoidance of situations because of tinnitus. This model correctly classified 73% of the subjects into the two levels of distress (grade II and III). There may be a potential role for MML as an outcome variable in tinnitus treatment research.
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Affiliation(s)
- G Andersson
- Department of Audiology, University Hospital, Uppsala, Sweden.
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