1
|
Kleinjung T, Peter N, Schecklmann M, Langguth B. The Current State of Tinnitus Diagnosis and Treatment: a Multidisciplinary Expert Perspective. J Assoc Res Otolaryngol 2024:10.1007/s10162-024-00960-3. [PMID: 39138756 DOI: 10.1007/s10162-024-00960-3] [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: 12/28/2023] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
Tinnitus, the perception of sound without an external source, affects 15% of the population, with 2.4% experiencing significant distress. In this review, we summarize the current state of knowledge about tinnitus management with a particular focus on the translation into clinical practice. In the first section, we analyze shortcomings, knowledge gaps, and challenges in the field of tinnitus research. Then, we highlight the relevance of the diagnostic process to account for tinnitus heterogeneity and to identify all relevant aspects of the tinnitus in an individual patient, such as etiological aspects, pathophysiological mechanisms, factors that contribute most to suffering, and comorbidities. In the next section, we review available treatment options, including counselling, cognitive-behavioral therapy (CBT), hearing aids and cochlear implants for patients with a relevant hearing loss, sound generators, novel auditory stimulation approaches, tinnitus retraining therapy (TRT), pharmacological treatment, neurofeedback, brain stimulation, bimodal stimulation, Internet- and app-based digital approaches, and alternative treatment approaches. The evidence for the effectiveness of the various treatment interventions varies considerably. We also discuss differences in current respective guideline recommendations and close with a discussion of how current pathophysiological knowledge, latest scientific evidence, and patient perspectives can be translated in patient-centered care.
Collapse
Affiliation(s)
- Tobias Kleinjung
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Nicole Peter
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum, Universitätsstr. 84, 93049, Regensburg, Germany
- Multidisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum, Universitätsstr. 84, 93049, Regensburg, Germany.
- Multidisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany.
| |
Collapse
|
2
|
Hoare DJ, Shorter GW, Shekhawat GS, El Refaie A, Labree B, Sereda M. Neuromodulation Treatments Targeting Pathological Synchrony for Tinnitus in Adults: A Systematic Review. Brain Sci 2024; 14:748. [PMID: 39199443 PMCID: PMC11352582 DOI: 10.3390/brainsci14080748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
(1) Background: Tinnitus involves the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source. For many people, tinnitus is a disorder associated with symptoms of emotional distress, cognitive dysfunction, autonomic arousal, behavioural changes, and functional disability. Many symptoms can be addressed effectively using education or cognitive behavioural therapy. However, there is no treatment that effectively reduces or alters tinnitus-related neurophysiological activity and thus the tinnitus percept. In this systematic review, we evaluated the effectiveness of neuromodulation therapies for tinnitus that explicitly target pathological synchronous neural activity. (2) Methods: Multiple databases were searched for randomised controlled trials of neuromodulation interventions for tinnitus in adults, with 24 trials included. The risk of bias was assessed, and where appropriate, meta-analyses were performed. (3) Results: Few trials used acoustic, vagal nerve, or transcranial alternating current stimulation, or bimodal stimulation techniques, with limited evidence of neuromodulation or clinical effectiveness. Multiple trials of transcranial direct current stimulation (tDCS) were identified, and a synthesis demonstrated a significant improvement in tinnitus symptom severity in favour of tDCS versus control, although heterogeneity was high. (4) Discussion: Neuromodulation for tinnitus is an emerging but promising field. Electrical stimulation techniques are particularly interesting, given recent advances in current flow modelling that can be applied to future studies.
Collapse
Affiliation(s)
- Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK; (B.L.); (M.S.)
- Department of Speech and Hearing Sciences, University College Cork, T12 EK59 Cork, Ireland;
| | - Gillian W. Shorter
- Drug and Alcohol Research Network, School of Psychology, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Giriraj S. Shekhawat
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA 5001, Australia;
- Tinnitus Research Initiative, Universitätsstrasse 84, 93053 Regensburg, Germany
| | - Amr El Refaie
- Department of Speech and Hearing Sciences, University College Cork, T12 EK59 Cork, Ireland;
| | - Bas Labree
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK; (B.L.); (M.S.)
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK; (B.L.); (M.S.)
| |
Collapse
|
3
|
Hesse G, Kastellis G, Schaaf H. [S3-Guideline Chronic Tinnitus - Update]. Laryngorhinootologie 2024; 103:452-462. [PMID: 38830358 DOI: 10.1055/a-1994-5307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Chronic tinnitus is a symptom of disturbed auditory perception. More than 90% of tinnitus patients suffer from hearing loss. Many people experience tinnitus and seek for treatment, but suffering and actual burden of tinnitus is individually very different, sometimes it disappears after a certain time even without treatment. This process is called habituation. The actual suffering from tinnitus depends on stress symptoms and other psychosomatic comorbidities like depression, anxiety and sleeping disorders.Up-to-date there is no therapy that can completely switch off tinnitus, mainly because the origin and expression of tinnitus are individual and very different. This educational publication summarizes and evaluates scientific therapeutic approaches for chronic tinnitus, based on the newly elaborated S3-Guideline "Chronic Tinnitus", under the lead management of the German Society of ENT, Head and Neck-Surgery, published in 2021. It focusses on recommendations for counselling, interventions against hearing loss and psychotherapy, mainly cognitive behavioural therapy.
Collapse
|
4
|
Hoare DJ, Smith H, Kennedy V, Fackrell K. Tinnitus in Children. J Assoc Res Otolaryngol 2024; 25:239-247. [PMID: 38709437 PMCID: PMC11150219 DOI: 10.1007/s10162-024-00944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/04/2024] [Indexed: 05/07/2024] Open
Abstract
This perspective reviews the current state of the art and literature on tinnitus in children, prevalence and risk factors, clinical management, and future priorities for healthcare provision and research. Most research in the field to date appears to be prevalence studies, which have reached dramatically different estimates; this reflects the lack of a standard language when asking about the presence of tinnitus, or how bothersome, distressing, or negatively impacting it is for the child. Estimates are also likely affected by a lack of awareness of tinnitus amongst children and parents. Children are less likely to spontaneously report tinnitus than adults, and parents are often unaware their child could even develop tinnitus, considering it a disease of older age for example. It is critical that children are asked and learn about tinnitus. In hearing clinics, clinicians should routinely ask about all children about tinnitus and offer tinnitus care and settings that are child- and family-friendly. As well as asking directly, clinicians should be alert to soft signs of tinnitus such as unexplained listening, speech perception, concentration difficulties, worry or anxiety, or difficulties completing hearing tests or using hearing aids. The recently developed impact of Tinnitus in Children Questionnaire (iTICQ) can then be used to assess problems that are most commonly core to children's experience of tinnitus. Clinical guidelines for tinnitus in children are few but provide recommendations for additional paediatric questionnaires and alternative assessments and for a range of treatment options. Of note, however, is the lack of clinical trials and, therefore, evidence of the effectiveness of any treatment for tinnitus in children. Significant and concerted work is therefore needed to raise awareness of tinnitus in children, understand the scale of clinical need, and standardise and evaluate clinical management options.
Collapse
Affiliation(s)
- Derek J Hoare
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
- School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, T12 EK59, Republic of Ireland.
| | - Harriet Smith
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Kathryn Fackrell
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research (NIHR) Coordinating Centre, School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
| |
Collapse
|
5
|
Slavin KV. Systems Neuroscience's 2022 Top Papers: An Editorial Summary. Brain Sci 2024; 14:315. [PMID: 38671967 PMCID: PMC11048697 DOI: 10.3390/brainsci14040315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the seemingly endless-and sometimes overwhelming-flow of scientific information, there are always some articles that stand out from the crowd, either due to the depth of the covered topic, or due to their unique and unexpected findings [...].
Collapse
Affiliation(s)
- Konstantin V. Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Neurology Service, Jesse Brown Veterans Administration Hospital, Chicago, IL 60612, USA
| |
Collapse
|
6
|
Wallace MN, Palmer AR. Neural Plasticity in Tinnitus Mechanisms. Brain Sci 2023; 13:1615. [PMID: 38137063 PMCID: PMC10741551 DOI: 10.3390/brainsci13121615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 12/24/2023] Open
Abstract
Basic work into neuroplasticity mechanisms in both invertebrate and vertebrate brains, followed by the development of the first animal model of tinnitus, and coupled with clinical studies of tinnitus, meant that, by 1990, Jastreboff [...].
Collapse
Affiliation(s)
- Mark N. Wallace
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK;
| | | |
Collapse
|
7
|
Emadi M, Moossavi A, Akbari M. Combined Bifrontal Transcranial Direct Current Stimulation and Auditory Stroop Training in Chronic Tinnitus. Indian J Otolaryngol Head Neck Surg 2023; 75:8-13. [PMID: 37007882 PMCID: PMC10050537 DOI: 10.1007/s12070-022-03258-z] [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: 09/27/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022] Open
Abstract
Patients with tinnitus experience difficulties in cognitive control and executive functions. Many of which are regarded as the cause of tinnitus rather than its complications. Methods for the improvement of inhibitory and cognitive control seem to be effective in the control of tinnitus. In this study, transcranial direct current stimulation and auditory Stroop exercise were have been to improve inhibitory control and the ability to ignore tinnitus in patients suffering from chronic tinnitus. 34 patients with chronic tinnitus (> 6 months) were randomly divided into two groups. The first group consist of 17 patients who received 6 sessions of tDCS followed by 6 sessions of auditory Stroop training. The second group received 6 sessions of sham tDCS followed by 6 sessions of auditory Stroop training. The initial evaluations including pure tone audiometry, psychoacoustic measurements, tinnitus handicap inventory (THI) survey and visual analog scale (VAS) of annoyance and loudness were performed before, immediately after, and one month after the tDCS, sham, and Stroop training. The results of this study revealed a significant reduction in THI score, VAS of loudness, and annoyance of tinnitus. A significant correlation was detected between the reaction time of incongruent words in the Stroop task and improvement of THI score and VAS of annoyance. Combined tDCS and Stroop training efficiently improve chronic tinnitus.
Collapse
Affiliation(s)
- Maryam Emadi
- Department of Audiology, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Fahmideh Street, Pazhoohesh Square, Hamadan, Iran
| | - Abdollah Moossavi
- Department of Otolaryngology and Head and Neck Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Akbari
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Hesse G, Kastellis G, Mazurek B. S3-Leitlinie zu chronischem Tinnitus überarbeitet. HNO-NACHRICHTEN 2022; 52:32-37. [PMID: 36258690 PMCID: PMC9560716 DOI: 10.1007/s00060-022-8403-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gerhard Hesse
- - Ohr- und Hörinstitut -, Tinnitus-Klinik am KH Bad Arolsen, Große Allee 50, 34454 Bad Arolsen, Deutschland
| | - Georg Kastellis
- - Ohr- und Hörinstitut -, Tinnitus-Klinik am KH Bad Arolsen, Große Allee 50, 34454 Bad Arolsen, Deutschland
| | - Birgit Mazurek
- Tinnituszentrum, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Deutschland
| |
Collapse
|
9
|
Searchfield GD, Sanders PJ. A randomized single-blind controlled trial of a prototype digital polytherapeutic for tinnitus. Front Neurol 2022; 13:958730. [PMID: 35989940 PMCID: PMC9389120 DOI: 10.3389/fneur.2022.958730] [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: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This randomized single-blind controlled trial tested the hypothesis that a prototype digital therapeutic developed to provide goal-based counseling with personalized passive and active game-based sound therapy would provide superior tinnitus outcomes, and similar usability, to a popular passive sound therapy app over a 12 week trial period. Methods The digital therapeutic consisted of an app for iPhone or Android smartphone, Bluetooth bone conduction headphones, neck pillow speaker, and a cloud-based clinician dashboard to enable messaging and app personalization. The control app was a popular self-help passive sound therapy app called White Noise Lite (WN). The primary outcome measure was clinically meaningful change in Tinnitus Functional Index (TFI) between baseline and 12 weeks of therapy. Secondary tinnitus measures were the TFI total score and subscales across sessions, rating scales and the Client Oriented Scale of Improvement in Tinnitus (COSIT). Usability of the US and WN interventions were assessed using the System Usability Scale (SUS) and the mHealth App Usability Questionnaire (MAUQ). Ninety-eight participants who were smartphone app users and had chronic moderate-severe tinnitus (>6 months, TFI score > 40) were enrolled and were randomly allocated to one of the intervention groups. Thirty-one participants in the USL group and 30 in the WN group completed 12 weeks of trial. Results Mean changes in TFI for the USL group at 6 (16.36, SD 17.96) and 12 weeks (17.83 points, SD 19.87) were clinically meaningful (>13 points reduction), the mean change in WN scores were not clinically meaningful (6 weeks 10.77, SD 18.53; 12 weeks 10.12 points, SD 21.36). A statistically higher proportion of USL participants achieved meaningful TFI change at 6 weeks (55%) and 12 weeks (65%) than the WN group at 6 weeks (33%) and 12 weeks (43%). Mean TFI, rating and COSIT scores favored the US group but were not statistically different from WN. Usability measures were similar for both groups. Conclusions The USL group demonstrated a higher proportion of responders than the WN group. The usability of the USL therapeutic was similar to the established WN app. The digital polytherapeutic demonstrated significant benefit for tinnitus reduction supporting further development.
Collapse
Affiliation(s)
- Grant D. Searchfield
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
- *Correspondence: Grant D. Searchfield
| | - Philip J. Sanders
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
| |
Collapse
|