The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey

Effectiveness of bimodal auditory and electrical stimulation in patients with tinnitus: A feasibility study

Background

Tinnitus is a common symptom, affecting about 10–15% of the adult population. When input from the somatosensory system can influence and/or elicit tinnitus, this type of subjective tinnitus is called somatosensory tinnitus. Recently, a new type of bimodal neurostimulation treatment has shown promising results for a specific subgroup within the somatosensory tinnitus population. It is, however, not clear if this bimodal stimulation is also effective in patients with other types of subjective tinnitus.

Aim

The aim of this study was to evaluate the feasibility and efficacy of non-invasive bimodal auditory-somatosensory stimulation in reducing tinnitus severity among a general population of people with subjective tinnitus.

Methods

Chronic subjective tinnitus patients were recruited from the ENT department of the Antwerp University Hospital. Somatosensory stimulation was delivered by Transcutaneous Electrical Nerve Stimulation (TENS), and it was combined with auditory stimulation via headphones. The therapy comprised six sessions of thirty minutes twice a week for a period of 3 consecutive weeks. Follow up measurements were scheduled 9–12 weeks after the last treatment session. The change of the Tinnitus Functional Index (TFI) score, a questionnaire evaluating tinnitus burden and effects on the quality of life, was the primary outcome measure.

Results

Twenty-nine patients were enrolled in the study. A linear mixed-effects model was used to analyze the efficacy of bimodal treatment. The results of this analysis showed a statistically significant decrease (by 6, 9 points) in average TFI score at the follow up visit when compared to baseline. The ability to modulate tinnitus did not have an influence on the treatment results.

Conclusion

Our study showed that bimodal stimulation is a feasible and safe method of tinnitus treatment. The method might be an effective treatment for some participants with tinnitus, especially those who have accompanying neck/temporomandibular problems, although, the evidence from this trial is quite weak. Additional research is needed toward establishing the optimal treatment protocol, as well as selecting the most appropriate inclusion criteria.

Standardized Clinical Profiling in Spanish Patients with Chronic Tinnitus

Background: Tinnitus is a heterogeneous condition. The aim of this study as to compare the online and hospital responses to the Spanish version of European School for Interdisciplinary Tinnitus Research screening-questionnaire (ESIT-SQ) in tinnitus individuals by an unsupervised age clustering. Methods: A cross-sectional study was performed including 434 white Spanish patients with chronic tinnitus to assess the demographic and clinical profile through the ESIT-SQ, with 204 outpatients and 230 individuals from an online survey; a K-means clustering algorithm was used to classify both responses according to age. Results: Online survey showed a high proportion of Meniere’s disease (MD) patients compared to both the general population and the outpatient cohort. The responses showed statistically significant differences between groups regarding education level, tinnitus-related hearing disorders (MD, hyperacusis), sleep difficulties, dyslipidemia, and other tinnitus characteristics, including duration, type of onset, the report of mitigating factors and the use of treatments. However, these differences were partially confirmed after adjusting for age. Conclusions: Self-reported tinnitus surveys are a low confidence source for tinnitus phenotyping. Additional clinical evaluation is needed for tinnitus research to reach the diagnosis. Age-based cluster analysis might help to better define clinical profiles and to compare responses in ESIT-SQ among subgroups of patients with tinnitus.

Somatosensory Tinnitus Diagnosis: Diagnostic Value of Existing Criteria

BACKGROUND

Tinnitus can be influenced by changes in somatosensory afference from the cervical spine or temporomandibular area, then called somatosensory or somatic tinnitus (ST). In 2018, a new set of diagnostic criteria for ST was agreed upon by a large group of ST experts. Currently, however, it still requires extensive and specific expertise to diagnose ST correctly. The next step in the development of easily applicable diagnostic criteria is to assess the diagnostic value of each individual criterion.

OBJECTIVES

The aim of this study was, therefore, to further investigate the diagnostic value of these criteria, validate them empirically, and identify their sensitivity and specificity.

METHODS

An online survey, questioning the presence of 12 diagnostic criteria for ST in a convenience sample of participants with tinnitus, was launched on the online forum Tinnitus Talk, managed by Tinnitus Hub. Participants were divided into three groups: a group with no somatic influence, a group with some somatic influence and a group with large somatic influence on their tinnitus. Chi-square tests were used to calculate differences between these groups. Afterward, sensitivity, specificity, positive and negative likelihood ratios (LR), and pre- and posttest probabilities were calculated for each ST diagnostic criterion. For this analysis, all patients with some and large somatic influence were compared as one group to the group with no somatic influence.

RESULTS

In total, 8221 participants filled out the online survey. As expected, the diagnostic criteria for ST are more prevalent in the groups with somatic influence, but the criterium of tinnitus modulation also often occurs in the group with no somatic influence. The simultaneous onset or increase and decrease of both tinnitus and pain complaints have the highest positive LR (6.29 and 10.72, respectively), next to the influence of certain postures on the tinnitus (+LR: 6.04). To rule out ST, the absence of neck pain or tension in the neck extensor muscles are most suited, as they decrease the posttest probability to 18% and 19%, respectively.

CONCLUSION

The simultaneous onset or increase and decrease of tinnitus and neck or jaw pain and the influence of certain postures are most suited to use as a single criterion for identifying patients with a somatic influence on their tinnitus. On the other hand, the absence of neck pain or tension in the neck extensor muscles is valid criterion to rule out a somatic influence. Additional analysis is needed to identify clusters of symptoms and criteria to further aid ST diagnosis.

From Provider to Advocate: The Complexities of Traumatic Brain Injury Prompt the Evolution of Provider Engagement

Treating a patient with traumatic brain injury requires an interdisciplinary approach because of the pervasive, profound and protean manifestations of this condition. In this review, key aspects of the medical history and review of systems will be described in order to highlight how the role of any provider must evolve to become a better patient advocate. Although this review is written from the vantage point of a vision care provider, it is hoped that patients, caregivers and providers will recognize the need for a team approach.

Web-based discussion forums reveal the person-centered relevance and importance of tinnitus

An increasing number of health researchers are recognizing the benefits of crowdsourcing. Web-based discussion forums are well suited for collecting qualitative research data with tinnitus participants and forum posts can be evaluated using thematic analysis. The present study reports an innovative use of such qualitative data contributed by a group of 148 people with tinnitus and tinnitus professionals through the crowdsourcing platform Tinnitus Talk. While the primary research question was focused on defining symptom concepts, discussions were broad-ranging and extended far beyond this topic. Thematic analysis of the discussion conducted by two analysts identified three novel emerging themes and these were not pre-planned according to the moderator's script. These were (i) the lived experience of tinnitus, (ii) perspectives on interventions for tinnitus, and (iii) the experience of participating in a web discussion forum. These unexpected themes contribute to a richer and more in-depth understanding of tinnitus seen through the eyes of those who experience it on a daily basis. Findings are important since spontaneous themes presumably reflect issues that are of personal relevance and importance to the participants. They therefore give insights into future research directions and have implications for patient-centered counseling strategies that could be effective in clinic.

A Review and a Framework of Variables for Defining and Characterizing Tinnitus Subphenotypes

Tinnitus patients can present with various characteristics, such as those related to the tinnitus perception, symptom severity, and pattern of comorbidities. It is speculated that this phenotypic heterogeneity is associated with differences in the underlying pathophysiology and personal reaction to the condition. However, there is as yet no established protocol for tinnitus profiling or subtyping, hindering progress in treatment development. This review summarizes data on variables that have been used in studies investigating phenotypic differences in subgroups of tinnitus, including variables used to both define and compare subgroups. A PubMed search led to the identification of 64 eligible articles. In most studies, variables for subgrouping were chosen by the researchers (hypothesis-driven approach). Other approaches included application of unsupervised machine-learning techniques for the definition of subgroups (data-driven), and subgroup definition based on the response to a tinnitus treatment (treatment response). A framework of 94 variable concepts was created to summarize variables used across all studies. Frequency statistics for the use of each variable concept are presented, demonstrating those most and least commonly assessed. This review highlights the high dimensionality of tinnitus heterogeneity. The framework of variables can contribute to the design of future studies, helping to decide on tinnitus assessment and subgrouping.

Prognostic Indicators for Positive Treatment Outcome After Multidisciplinary Orofacial Treatment in Patients With Somatosensory Tinnitus

Introduction

Subjective tinnitus that is influenced by the somatosensory system is called somatosensory tinnitus (ST). When ST is related to the temporomandibular area, multidisciplinary orofacial treatment can reduce tinnitus severity. It is, however, unknown if we can predict this positive outcome. The aim of this study is to look for prognostic indicators that can predict a positive outcome after multidisciplinary orofacial treatment in patients with ST.

Methods

Patients were included when they were diagnosed with temporomandibular-related ST and received a maximum of 18 sessions of orofacial treatment during a 9-week program. Predictors for positive treatment outcome were identified using univariate and multiple logistic regression analyses with the Tinnitus Questionnaire (TQ) and the Tinnitus Functional Index (TFI) as dependent variables.

Results

The results of 101 patients were included in the analysis. Immediately after multidisciplinary orofacial treatment, a clinically relevant decrease in TQ score was significantly associated with “shorter duration of tinnitus” [odds ratio (OR) 0.99], “higher initial score on the TQ somatic subscale” (OR 1.52), and “painful palpation of the temporomandibular joint (TMJ)” (OR 2.46). After 9 weeks of follow-up, the “higher initial score on the TQ somatic subscale” remained as the sole predictor (OR 1.44). A clinically relevant decrease on TFI after 9 weeks of follow-up was predicted by “female gender” (OR 2.70), “younger age” (OR 0.96), “shorter duration of the tinnitus” (OR 0.99), “lower pressure pain thresholds (PPT) on TMJ” (OR 0.99), “lower PPT on sternocleidomastoid origin” (OR 0.99), and “better speech in noise perception” (OR 0.88). A multivariate model comprising “shorter duration of tinnitus” and “higher initial score on the somatic subscale of the TQ” correctly predicts the clinically relevant decrease in TQ score after treatment in 68.5%. A second multivariate model comprising “female gender,” “younger age,” and “shorter duration of the tinnitus” correctly predicts a clinically significant decrease on TFI after follow-up in 68.1%.

Conclusion

We were able to identify various prognostic indicators. “Younger female patients” with a “shorter duration of tinnitus” and a “higher initial score on the TQ somatic subscale” appear to have the best prognosis after multimodal orofacial therapy.

Treatment of Somatosensory Tinnitus: A Randomized Controlled Trial Studying the Effect of Orofacial Treatment as Part of a Multidisciplinary Program

Background: Tinnitus, or ringing in the ears, is a perception of sound in the absence of overt acoustic stimulation. In some cases, tinnitus can be influenced by temporomandibular somatosensory input, then called temporomandibular somatosensory tinnitus (TST). It is, however, not entirely known if orofacial treatment can decrease tinnitus severity. The purpose of this study was to evaluate the effect of orofacial treatment on tinnitus complaints in patients with TST. Methods: Adult patients with TST were included, and all patients received information and advice about tinnitus and conservative orofacial treatment consisting of physical therapy, and, in case of grinding, occlusal splints were applied. Included patients were randomly assigned to an early start group and a delayed start group according to our delayed treatment design. Results: In total, 40 patients were included in each group. The treatment effect on tinnitus severity was investigated using the tinnitus questionnaire (TQ) and Tinnitus Functional Index (TFI). Regarding the TQ score, no clinically relevant reductions were observed, and no significant differences in the decrease were observed between the early start group and delayed start group. Contrarily, a significantly higher percentage of patients showed a decrease in the TQ degree in the early start group compared to the delayed start group (30.0% versus 2.8%, p = 0.006). The TFI score did show a significantly greater and clinically relevant reduction in the early start group compared to the delayed start group (p = 0.042). Conclusion: A multidisciplinary non-invasive orofacial treatment was able to reduce tinnitus severity in patients with temporomandibular related somatosensory tinnitus.