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Tran N, Zewde N, Spiegel D. Hypnosis facilitates psychosomatic improvement in a patient with treatment-resistant idiopathic tinnitus. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2024:1-6. [PMID: 39051968 DOI: 10.1080/00029157.2024.2379284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Chronic tinnitus, also known as phantom sound perception, is a pervasive and often debilitating condition, affecting 15 to 20% of the population. Due to its idiopathic and persistent nature, chronic tinnitus is frequently associated with co-occurring psychiatric disorders as well as decreased sleep and quality of life. Additionally, heterogeneous presentations of tinnitus create challenges for treatment. In this paper, we present a case study of a 70-year-old female patient who presented with severe bilateral tinnitus over a period of 5 years. After failing multiple treatment trials such as transtympanic electric stimulation, acupuncture, Eye Movement Desensitization and Reprocessing, and medication, the patient found relief only through hypnotherapy. Results may be explained by alterations in interoceptive processing, increased cognitive flexibility, or somatosensory changes, with corresponding changes in functional neural structures. Given the results of this case study, we recommend hypnosis as an alternative or adjunct to current treatment modalities for tinnitus and further investigation in this area.
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D'Andréa G, Giacchero R, Roger C, Vandersteen C, Guevara N. Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:65-71. [PMID: 34229983 DOI: 10.1016/j.anorl.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Tinnitus can induce disabling psychological suffering, requiring an integrative multimodal approach, combining neuromodulation and psychotherapeutic methods. We sought to evaluate the therapeutic efficacy and acceptability of Eye Movement Desensitization and Reprocessing (EMDR) in tinnitus. MATERIALS AND METHODS This was a single-center prospective non-comparative study. Inclusion criteria comprised: adult patient, with chronic tinnitus, Tinnitus Handicap Inventory (THI) score>17, causing psychological distress motivating active treatment after ineffective "classic" treatment (combining advice, sound therapy and first-line drug treatment), and agreement to EMDR therapy. Therapeutic efficacy was defined by a decrease in THI or Visual Analog Scale (VAS) scores. Treatment acceptability was defined by the rate of included patients who completed therapy. RESULTS Thirty-eight patients were included. There was a significant reduction of 53.5% in THI score in 78.9% of patients (P<0.0001; 64.8±20.8 before versus 31.8±24.7 after treatment), and of 51% in VAS score in 76.3% of patients (P<0.0001; 7.24±2.12 before versus 3.58±2.03 after treatment). The treatment acceptability was 86.8%. CONCLUSION EMDR appeared to be an effective alternative that was acceptable to the majority of patients, after failure of "classic" first-line treatment, improving quality of life in tinnitus patients and thus relieving disability.
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Affiliation(s)
- G D'Andréa
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 31, Avenue de Valombrose, 06103 Nice, France.
| | - R Giacchero
- Cabinet de psychothérapie et sophrologie, 40 rue Pastorelli, 06000 Nice, France
| | - C Roger
- Département de Statistiques Médicales, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06100 Nice, France
| | - C Vandersteen
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 31, Avenue de Valombrose, 06103 Nice, France
| | - N Guevara
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Institut Universitaire de la Face et du Cou, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 31, Avenue de Valombrose, 06103 Nice, France
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Abstract
Tinnitus, the perception of sound in the absence of an external sound, usually results from a disorder of: (1) the auditory system (usually peripheral, rarely central); (2) the somatosensory system (head and neck); or (3) a combination of the two. Its cause can be determined through its characteristics. The history must include the tinnitus': (1) quality (including whether it can ever be pulsatile or have a clicking component); (2) location; (3) variability; (4) predominant pitch (low or high); and (5) whether the patient can do something to modulate the percept. In addition to the standard neuro-otologic examination, the exam should include inspection of the teeth for evidence of wear, listening around the ear and neck for sounds similar to the tinnitus, palpation of the craniocervical musculature for trigger points, and probing whether the tinnitus percept can be modulated with "somatic testing." All subjects should have a recent audiogram. Presently the most compelling tinnitus theory is the dorsal cochlear nucleus (DCN) hypothesis: both the auditory and somatosensory systems converge upon and interact within the DCN. If the activity of the DCN's somatosensory-interacting fusiform cells exceeds an individual's tinnitus threshold, then tinnitus results.
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Affiliation(s)
- Robert A Levine
- Department of Ear, Nose and Throat and Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Yahav Oron
- Department of Otolaryngology, Head and Neck Surgery, E. Wolfson Medical Centre, Holon, Israel
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Abstract
BACKGROUND This is an update of a Cochrane Review first published in The Cochrane Library in Issue 12, 2010.Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. Numerous management strategies have been tried for this potentially debilitating, heterogeneous symptom. External noise has been used as a management tool for tinnitus, in different capacities and with different philosophical intent, for over a century. OBJECTIVES To assess the effectiveness of sound-creating devices (including hearing aids) in the management of tinnitus in adults. Primary outcome measures were changes in the loudness or severity of tinnitus and/or impact on quality of life. Secondary outcome measures were change in pure-tone auditory thresholds and adverse effects of treatment. SEARCH METHODS We searched the Cochrane ENT Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 8 February 2012. SELECTION CRITERIA Prospective randomised controlled trials recruiting adults with persistent, distressing, subjective tinnitus of any aetiology in which the management strategy included maskers, noise-generating device and/or hearing aids, used either as the sole management tool or in combination with other strategies, including counselling. DATA COLLECTION AND ANALYSIS Two authors independently examined the 387 search results to identify studies for inclusion in the review, of which 33 were potentially relevant. The update searches in 2012 retrieved no further potentially relevant studies. Both authors extracted data independently. MAIN RESULTS Six trials (553 participants) are included in this review. Studies were varied in design, with significant heterogeneity in the evaluation of subjective tinnitus perception, with different scores, scales, tests and questionnaires as well as variance in the outcome measures used to assess the improvement in tinnitus sensation/quality of life. This precluded meta-analysis of the data. There was no long-term follow-up. We assessed the risk of bias as medium in three and high in three studies. Following analysis of the data, no significant change was seen in the loudness of tinnitus or the overall severity of tinnitus following the use of sound therapy compared to other interventions such as patient education, 'relaxation techniques', 'tinnitus coping strategies', counselling, 'tinnitus retraining' and exposure to environmental sounds. No side effects or significant morbidity were reported from the use of sound-creating devices. AUTHORS' CONCLUSIONS The limited data from the included studies failed to show strong evidence of the efficacy of sound therapy in tinnitus management. The absence of conclusive evidence should not be interpreted as evidence of lack of effectiveness. The lack of quality research in this area, in addition to the common use of combined approaches (hearing therapy plus counselling) in the management of tinnitus are, in part, responsible for the lack of conclusive evidence. Other combined forms of management, such as tinnitus retraining therapy, have been subject to a Cochrane Review. Optimal management may involve multiple strategies.
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Sanchez TG, Rocha CB. Diagnosis and management of somatosensory tinnitus: review article. Clinics (Sao Paulo) 2011; 66:1089-94. [PMID: 21808880 PMCID: PMC3129953 DOI: 10.1590/s1807-59322011000600028] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 02/14/2011] [Accepted: 02/24/2011] [Indexed: 11/22/2022] Open
Abstract
Tinnitus is the perception of sound in the absence of an acoustic external stimulus. It affects 10-17% of the world's population and it a complex symptom with multiple causes, which is influenced by pathways other than the auditory one. Recently, it has been observed that tinnitus may be provoked or modulated by stimulation arising from the somatosensorial system, as well as from the somatomotor and visual-motor systems. This specific subgroup -somatosensory tinnitus - is present in 65% of cases, even though it tends to be underdiagnosed. As a consequence, it is necessary to establish evaluation protocols and specific treatments focusing on both the auditory pathway and the musculoskeletal system.
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Affiliation(s)
- Tanit Ganz Sanchez
- Department of Otolaryngology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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6
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Abstract
BACKGROUND Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. Numerous management strategies have been tried for this potentially debilitating, heterogeneous symptom. External noise has been used as a management tool for tinnitus, in different capacities and with different philosophical intent, for over a century. OBJECTIVES To assess the effectiveness of sound-creating devices (including hearing aids) in the management of tinnitus in adults. Primary outcome measures were changes in the loudness or severity of tinnitus and/or impact on quality of life. Secondary outcome measures were change in pure-tone auditory thresholds and adverse effects of treatment. SEARCH STRATEGY We searched the Cochrane ENT Group Trials Register; CENTRAL (2009, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 11 September 2009. SELECTION CRITERIA Prospective randomised controlled trials recruiting adults with persistent, distressing, subjective tinnitus of any aetiology in which the management strategy included maskers, noise-generating device and/or hearing aids, used either as the sole management tool or in combination with other strategies, including counselling. DATA COLLECTION AND ANALYSIS Two authors independently examined the 362 search results to identify studies for inclusion in the review, of which 33 were potentially relevant. Both authors extracted data independently. MAIN RESULTS Six trials (553 participants) are included in this review. Studies were varied in design, with significant heterogeneity in the evaluation of subjective tinnitus perception, with different scores, scales, tests and questionnaires as well as variance in the outcome measures used to assess the improvement in tinnitus sensation/quality of life. This precluded meta-analysis of the data. There was no long-term follow up. We assessed the risk of bias as medium in three and high in three studies. No side effects or significant morbidity were reported from the use of sound-creating devices. AUTHORS' CONCLUSIONS The limited data from the included studies failed to show strong evidence of the efficacy of sound therapy in tinnitus management. The absence of conclusive evidence should not be interpreted as evidence of lack of effectiveness. The lack of quality research in this area, in addition to the common use of combined approaches (hearing therapy plus counselling) in the management of tinnitus are, in part, responsible for the lack of conclusive evidence. Other combined forms of management, such as Tinnitus Retraining Therapy, have been subject to a Cochrane Review. Optimal management may involve multiple strategies.
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Affiliation(s)
- Jonathan Hobson
- ENT Department, Royal Preston Hospital, Sharoe Green Lane, Fulwood, Preston, UK, PR2 9HT
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Sand PG, Langguth B, Kleinjung T, Eichhammer P. Genetics of chronic tinnitus. PROGRESS IN BRAIN RESEARCH 2008; 166:159-68. [PMID: 17956780 DOI: 10.1016/s0079-6123(07)66014-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Susceptibility to chronic tinnitus is highly variable and of particular interest when it comes to defining strategies for prevention and treatment. While several rare monogenic disorders have been described that are associated with tinnitus, the genetic underpinnings of the more common forms of the syndrome are still poorly understood. The present article incorporates recent advancements in the field, including the epidemiology of tinnitus in subjects with neuropsychiatric illness, and highlights pilot studies of candidate genes.
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Affiliation(s)
- P G Sand
- Department of Psychiatry, University of Regensburg, Regensburg, Germany.
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Robinson SK, Viirre ES, Stein MB. Antidepressant therapy in tinnitus. Hear Res 2007; 226:221-31. [PMID: 16973315 DOI: 10.1016/j.heares.2006.08.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 07/22/2006] [Accepted: 08/01/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Review the literature on the co-morbidity of depression and anxiety with tinnitus. Briefly consider proposed mechanisms by which antidepressants might be helpful for tinnitus, including treatment of co-morbid depression and anxiety and a more direct serotonergic mechanism of tinnitus. Survey the literature on antidepressants and tinnitus including tinnitus reported as a side effect of antidepressants (phenelzine, amitriptyline, protriptyline, doxepin, imipramine, fluoxetine, trazadone, bupropion, venlafaxine), tinnitus associated with withdrawal of antidepressants (venlafaxine and sertraline) and antidepressants as a treatment for tinnitus (case reports--fluoxetine and paroxetine, retrospective reviews--imipramine and selective serotonin reuptake inhibitors, single blind trials of amitriptyline and double blind placebo controlled trials of trimipramine, nortriptyline, paroxetine and sertraline). Provide suggestions on future directions, specifically replication of prior studies and a dose finding study of paroxetine for the treatment of tinnitus.
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Affiliation(s)
- Shannon K Robinson
- Department of Psychiatry, University of California, San Diego School of Medicine, Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Dr., Mail Code 116A, La Jolla, CA 92161, USA.
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Hobson J, Chisholm E, Loveland M. Sound therapy (masking) in the management of tinnitus in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd006371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND Tinnitus is an auditory perception that can be described as the experience of sound, in the ear or in the head, in the absence of external acoustic stimulation (not usually audible to anyone else). At present no specific therapy for tinnitus is acknowledged to be satisfactory in all patients. Cognitive behavioural therapy (CBT) uses relaxation, cognitive restructuring of the thoughts and exposure to exacerbating situations in order to promote habituation and may benefit tinnitus patients, as may the treatment of associated psychological conditions. OBJECTIVES To assess whether cognitive behavioural therapy is effective in the management of patients suffering from tinnitus. SEARCH STRATEGY Our search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE and EMBASE. The last search date was June 2006. SELECTION CRITERIA Randomised controlled trials in which patients with unilateral or bilateral tinnitus as main symptom received cognitive behavioural treatment. DATA COLLECTION AND ANALYSIS One review author (PMD) assessed every report identified by the search strategy. The four review authors assessed the methodological quality, applied inclusion/exclusion criteria and extracted data. MAIN RESULTS Six trials comprising 285 participants were included. 1. PRIMARY OUTCOME subjective tinnitus loudness. CBT compared to a waiting list control group: we found no significant difference (Standardised Mean Difference (SMD) 0.06 (95% CI -0.25 to 0.37)). CBT compared to another intervention (Yoga, Education, Minimal Contact - Education and Education): we found no significant difference (SMD 0.1 (95% CI -0.22 to 0.42)).2. SECONDARY OUTCOMES a) Depression. CBT compared to a waiting list control group: we found no significant difference in either group (SMD 0.29 (95%CI -0.04 to 0.63)). CBT compared to another intervention (Yoga, Education and Minimal Contact - Education): we found no significant difference (SMD 0.01 (95% CI -0.43 to 0.45)). b) Quality of life: CBT compared to a waiting list control group: we found a significant difference in favour of CBT versus the waiting list group (SMD 0.7 (95% CI 0.33 to 1.08)). CBT compared to another intervention (Education, Minimal Contact - Education and Education): we also found a significant difference between CBT and the other intervention control group (SMD 0.64 (95% CI 0.29 to 1.00)). There were no adverse/side effects reported in any trial. AUTHORS' CONCLUSIONS We did not find a significant difference in the subjective loudness of tinnitus, or in the associated depression. However we found a significant improvement in the quality of life (decrease of global tinnitus severity) of the participants, thus suggesting that cognitive behavioural therapy has an effect on the qualitative aspects of tinnitus and contributes positively to the management of tinnitus.
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Affiliation(s)
- P Martinez Devesa
- Great Western Hospital, ENT Department, Marlborough Road, Swindon, Wilts, UK, SN3 6BB.
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Ross UH, Lange O, Unterrainer J, Laszig R. Ericksonian hypnosis in tinnitus therapy: effects of a 28-day inpatient multimodal treatment concept measured by Tinnitus-Questionnaire and Health Survey SF-36. Eur Arch Otorhinolaryngol 2007; 264:483-8. [PMID: 17206402 DOI: 10.1007/s00405-006-0221-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
For the first time, the therapeutic effects on subacute and chronic tinnitus of an inpatient multimodal treatment concept based on principles of Ericksonian hypnosis (EH) were examined by standardized criteria of the Tinnitus Questionnaire (TQ) and Health Survey (SF-36) within a controlled prospective, longitudinal study. A total of 393 patients were treated within an inpatient closed-group 28-day-setting based on a resource-oriented, hypnotherapeutic concept. The severity of tinnitus was assessed by TQ at times of admission, discharge and also at a 6- and 12-month follow-up. Health-related quality of life was evaluated before and after therapy using the SF-36. After therapy, a decrease in TQ score was seen in 90.5% of the patients with subacute tinnitus and in 88,3% of those with chronic tinnitus. Assessment of the TQ score at the end of therapy revealed highly significant improvements of 15.9/14.1 points in mean. Effect sizes in the treatment groups (0.94/0.80) were superior to those in the waiting-list controls (0.14/0.23). The TQ score remained stable in the follow-up controls. Significant improvement in health-related quality of life has been observed within the treatment groups depending on initial level of tinnitus serverity I-IV according to TQ. Using a multimodal treatment concept with emphasis on resource-activating approaches of EH the annoyance of tinnitus can be significantly reduced while health-related quality of life is enhanced within a comparatively short treatment period of 28 days.
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Affiliation(s)
- U H Ross
- Practice for Otorhinolaryngology and Psychotherapy, Freiburg, Germany.
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Abstract
Hypnosis became popular as a treatment for medical conditions in the late 1700s when effective pharmaceutical and surgical treatment options were limited. To determine whether hypnosis has a role in contemporary medicine, relevant trials and a few case reports are reviewed. Despite substantial variation in techniques among the numerous reports, patients treated with hypnosis experienced substantial benefits for many different medical conditions. An expanded role for hypnosis and a larger study of techniques appear to be indicated.
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Affiliation(s)
- James H Stewart
- Department of Internal Medicine and Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Jacksonville, Fla 32224, USA.
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Andersson G. Psychological aspects of tinnitus and the application of cognitive-behavioral therapy. Clin Psychol Rev 2002; 22:977-90. [PMID: 12238249 DOI: 10.1016/s0272-7358(01)00124-6] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article presents an overview of tinnitus (ringing or buzzing in the ears), its psychological effects, and the application of cognitive-behavioral therapy (CBT) for its treatment. Several studies have confirmed an association between psychological factors, such as anxiety and depression, and severe tinnitus and preliminary reports suggest that a proportion of tinnitus patients suffer from mental illness. Assessment strategies used in CBT for tinnitus include structured interviews, daily diary ratings, and validated self-report questionnaires. The treatment approach described in this article includes applied relaxation, imagery and distraction techniques, advice regarding environmental sounds, management of sleep, cognitive restructuring of thoughts and beliefs associated with tinnitus, and relapse prevention. The literature pertinent to CBT approaches to treating tinnitus is reviewed, and it is concluded that CBT shows promise as a treatment of tinnitus-related distress. Future research directions are discussed.
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Affiliation(s)
- Gerhard Andersson
- Department of Psychology, Uppsala University, Box 12 25, SE-751 42 Uppsala, Sweden.
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Attias J, Reshef I, Shemesh Z, Salomon G. Support for the central theory of tinnitus generation: a military epidemiological study. Int J Audiol 2002; 41:301-7. [PMID: 12166690 DOI: 10.3109/14992020209077190] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tinnitus is poorly reflected by audiometric (cochlear) data, indicating that central nervous system (CNS) components are involved in its development. This study aimed to provide support for the neurophysiological theory of tinnitus as a result of combined peripheral and central nervous dysfunctions. Our main findings were the sudden. significant, stepwise increase in tinnitus after 10 years of service, as opposed to the almost linear increase in noise-induced hearing loss (NIHL) with age. Furthermore, the absence of a correlation between the incidence of tinnitus and the severity of tinnitus was linked to the NIHL. We suggest that, in tinnitus, the central screening apparatus which normally inhibits conscious awareness of irrelevant, spurious and non-informative internal and external noise shows a possibly fatigue- or age-related deterioration over time. Further support was provided by low blood levels of vitamin B1 and B12. which are essential to CNS function.
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Affiliation(s)
- Joseph Attias
- Institute for Noise Hazards Research and Evoked Potentials Laboratory, Medical Corps, Petach-Tikva, Israel.
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Abstract
OBJECTIVES Review reports of randomized clinical trials (RCTs) in tinnitus to identify well-established treatments, promising developments, and opportunities for improvement in this area of clinical research. STUDY DESIGN Literature review of RCTs (1964-1998) identified by MEDLINE and OLD MEDLINE searches and personal files. METHODS Studies were compared with the RCT criteria of Guyatt et al. for quality of design, performance, and analysis; "positive" results were critically examined for potential clinical relevance. RESULTS Sixty-nine RCTs evaluated tocainide and related drugs, carbamazepine, benzodiazepines, tricyclic antidepressants, 16 miscellaneous drugs, psychotherapy, electrical/magnetic stimulation, acupuncture, masking, biofeedback, hypnosis, and miscellaneous other nondrug treatments. No treatment can yet be considered well established in terms of providing replicable long-term reduction of tinnitus impact, in excess of placebo effects. CONCLUSIONS Nonspecific support and counseling are probably helpful, as are tricyclic antidepressants in severe cases. Benzodiazepines, newer antidepressants, and electrical stimulation deserve further study. Future tinnitus therapeutic research should emphasize adequate sample size, open trials before RCTs, careful choice of outcome measures, and long-term follow-up.
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Affiliation(s)
- R A Dobie
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Health Science Center at San Antonio, 78284-7777, USA
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Attias J, Furman V, Shemesh Z, Bresloff I. Impaired brain processing in noise-induced tinnitus patients as measured by auditory and visual event-related potentials. Ear Hear 1996; 17:327-33. [PMID: 8862970 DOI: 10.1097/00003446-199608000-00004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aimed to confirm that the brain processing of auditory stimuli in tinnitus patients is impaired (Attias, Urbach, Gold, & Shemesh, 1993). In addition, possible brain processing dysfunction in response to visual stimuli was assessed. DESIGN Auditory and visual event-related potentials (ERPs) and reaction times were recorded in response to a standard oddball target detection paradigm. The subjects consisted of 21 noise-induced chronic tinnitus patients and 21 age- and hearing-matched control subjects without tinnitus. RESULTS The tinnitus patients had significantly prolonged latencies for the auditory nontarget ERP components N1, N2, and P3 and for the auditory target ERP P3 component. The auditory P3 component was also significantly reduced in amplitude for both target and nontarget stimuli for the tinnitus patients. The visual P3 target and nontarget components were similarly significantly prolonged in latency for the tinnitus patients. Reaction times to both target and nontarget stimuli were significantly delayed for the tinnitus patients for both stimulus modalities. CONCLUSIONS These findings point to a cortical information processing dysfunction in chronic tinnitus patients associated primarily with auditory stimuli. ERPs may provide an objective electrophysiologic tinnitus measure.
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Affiliation(s)
- J Attias
- Institute for Noise Hazards Research and Evoked Potentials Laboratory, IDF, Medical Corps, Chaim Sheba-Medical Center, Israel
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Mason JD, Rogerson DR, Butler JD. Client centred hypnotherapy in the management of tinnitus--is it better than counselling? J Laryngol Otol 1996; 110:117-20. [PMID: 8729491 DOI: 10.1017/s002221510013292x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aim of this study was to assess whether client centred hypnotherapy (CCH) which required three sessions with a trained therapist was superior to a single counselling session in reducing the impact of tinnitus. Patients were randomly allocated to receive either counselling (n = 42) or CCH (n = 44). The outcome measures were: tinnitus loudness match, subjective tinnitus symptom severity score, trend of linear analogue scale, request for further therapy and whether the patient had an impression of improvement in their tinnitus after treatment. CCH was no better than counselling in reducing the impact of tinnitus using the three quantative measures of tinnitus, and requests for further follow up. The only significant difference between the two therapies was that 20 (45.5 per cent) of the CCH group reported a general sense of improvement compared to six (14.3 per cent) in the counselling group, this is significant p < 0.01. The study did not demonstrate whether this was a genuine hypnotic effect or simply a response to the additional attention from the therapist.
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Affiliation(s)
- J D Mason
- Department of Otorhinolaryngology, Derbyshire Royal Infirmary, Derby, UK
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Andersson G, Melin L, Hägnebo C, Scott B, Lindberg P. A Review of psychological treatment approaches for patients suffering from tinnitus. Ann Behav Med 1995; 17:357-66. [DOI: 10.1007/bf02888601] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mason J, Rogerson D. Client-centered hypnotherapy for tinnitus: who is likely to benefit? AMERICAN JOURNAL OF CLINICAL HYPNOSIS 1995; 37:294-9. [PMID: 7741085 DOI: 10.1080/00029157.1995.10403158] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In this study we prospectively analyzed 41 patients, 15 females and 26 males with a mean age of 54, who underwent three sessions of client-centered hypnotherapy for their tinnitus. Of these patients, 28 (68%) showed some benefit for their tinnitus 3 months after completing their hypnosis, and 13 (32%) showed no evidence of improvement for their tinnitus. Hearing loss was associated with a nonbeneficial outcome for tinnitus treated with hypnotherapy. Of the nonbeneficial group, 46% had a hearing loss of 30 db or more in their better-hearing ear compared to less than 15% in the beneficial group, a significant difference (X2 = 6.34, df = 1, p < 0.02). Client-centered hypnotherapy can be offered to anyone who wants to have therapy for their tinnitus; in those with significant hearing loss the benefit may be less.
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Affiliation(s)
- J Mason
- Derbyshire Royal Infirmary, United Kingdom
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Attias J, Shemesh Z, Bleich A, Solomon Z, Bar-Or G, Alster J, Sohmer H. Psychological profile of help-seeking and non-help-seeking tinnitus patients. SCANDINAVIAN AUDIOLOGY 1995; 24:13-8. [PMID: 7761793 DOI: 10.3109/01050399509042204] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The psychological profile of tinnitus patients who sought treatment (Help-Seeking, HS) was compared with that of patients who did not seek help (non-help-seeking, NHS) and with normal control subjects. Psychological evaluations as well as hearing, tinnitus loudness, and tinnitus pitch were measured. Overall, the psychiatric symptomatology of HS (n = 50) was more severe with poorer effective coping abilities and externalization of locus of control than NHS (n - 50). However, the psychiatric symptomatology of the NHS was remarkably more severe than that in the normals (n = 73) and more like that in the HS even though they did not turn to treatment. Tinnitus loudness was significantly lower in HS than in NHS subjects. The lower the tinnitus loudness, the higher the psychiatric symptomatology. The trend towards subclinical abnormalities in NHS indicates their vulnerability to pathology and this requires the attention of the therapist in order to increase the patient's self-awareness and to suggest preventive coping strategies or relaxation techniques.
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Affiliation(s)
- J Attias
- Institute for Noise Hazards Research, Medical Corps, Chaim Sheba Medical Center, Ramat-Gan, Israel
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