Novel grading system of sigmoid sinus dehiscence for radiologic evaluation of pulsatile tinnitus

BackgroundSigmoid sinus dehiscence (SSD) is an important etiology of pulsatile tinnitus (PT) though there is currently no consensus on the prevalence of SSD in non-PT populations. This study establishes a grading system of SSD and analyzes a non-PT cohort for prevalence of SSD.MethodsIn this retrospective study temporal bone CT scans of 91 patients without PT were analyzed for SSD. The dehiscence was divided into three grades: Grade 1 indicating a micro dehiscence of <3.5 mm with an opening to the mastoid air cells, Grade 2 indicating a major dehiscence of >3.5 mm with an opening to the mastoid air cells, and Grade 3 indicating a sigmoid sinus wall dehiscence opening directly to the underlying tissue.ResultsIn patients without PT, SSD occurred in 34% of the cohort. Of these, 75% were Grade 1 and 25% were Grade 2. The range of dehiscence measurements for Grade 1 dehiscences was 0.9–3.4 mm. The range of dehiscence measurements for Grade 2 was 4–7.5 mm. There were no cases of Grade 3 dehiscence among this cohort.ConclusionsSSD occurred in over a third of our non-symptomatic cohort. While all grades of SSD may currently be treated surgically, a large portion of non-PT patients may have these sigmoid sinus anomalies asymptomatically. This grading system allows for the standardization of SSD definition and severity in future studies. Grade 3 dehiscences were completely absent in this cohort of non-PT patients.     

Ictal Tinnitus

Unilateral high pitched tinnitus was the sole epileptic ictal manifestation of a 45-year-old woman. Electrographic seizures originated from the contralateral midtemporal area and consistently correlated with tinnitus. Computed tomography (CT) demonstrated a lesion involving the superior temporal gyrus and inferior portion of the supramarginal gyrus. The case illustrates a cortical origin of tinnitus.     

Selective attentional impairment in chronic tinnitus: Evidence from an event-related potentials study

Objective

Tinnitus is an auditory phantom sensation experienced in the absence of a sound source. Cognitive dysfunctions, especially in working memory and attention, are frequently reported to be associated with tinnitus. The aim of this study was to investigate attentional functioning in a group of subjects with chronic tinnitus using ERPs, and in particular the P300 components.

Microvascular decompression of the cochlear nerve in patients with severe tinnitus. Preoperative findings and operative outcome in 22 patients

Abstract

We evaluated the operative outcome in 22 consecutive patients who underwent microvascular decompression (MVO) of the intracranial portion of the cochlear nerve to relieve incapacitating tinnitus and related it to preoperative findings. The patients were selected for operation from the following criteria: severe tinnitus with sensorineural hearing loss and/or changes in brainstem auditory evoked potentials (BAEPs). Fifty percent had unilateral tinnitus. Before operation, 77 patients (77%) had sensorineural hearing loss in their affected ear. BAEPs were abnormal in 27 patients (95%) and acoustic middle ear reflex response was abnormal in six patients (27%). Vascular compression of the cochlear nerve was found in all patients during the operation. After the operation, 33% had relief of their tinnitus (two patients were totally free of tinnitus and five were markedly improved). Eight patients were slightly improved (38%), and the tinnitus did not change in four patients; two patients (70%) became worse. Of the patients with unilateral tinnitus, 63% had relief oftheir tinnitus. In one patient hearing was noticeably improved after the operation. Five patients (23%) had mild to moderate sensorineural hearing loss due to the operation. No other complications were detected. [Neural Res 1998; 20: 242-248]     

Influence of ethanol on CD2 receptors of lymphocytes in alcohol dependent inpatients and healthy individuals

Tinnitus has been associated with psychiatric disorders and more recently diagnostic tools have been used in a systematic manner. In the present study, we administered the World Health Organisation's Composite International Diagnostic Interview – Short form (CIDI-SF) in a computerized Internet-based version to a self-selected sample of tinnitus patients (n=48). Using the cut-off for ‘probable case’ (12-month prevalence), 69% of the tinnitus patients fulfilled the criteria for depression, 60% for generalized anxiety disorder, 83% for specific phobia, 67% for social phobia, 58% for agoraphobia, 21% panic attack, 83% obsessive–compulsive disorder, 2% alcohol dependence and 0% drug dependence. Decreased percentages were found for depression (4%), specific phobia (62%) and social phobia (27%) when applying a more conservative criteria (maximum case criteria). In conclusion, the findings suggest that the Internet version of CIDI-SF can be used as a screening tool for psychiatric disturbance in somatic patients, but that diagnostic criteria need to be adjusted for Internet use.     

Undetected Metallic Chopstick Stabbed on Neck Resulting Tinnitus and Foreign Body Sensation

Penetrating neck injuries constitute 5-10% of all trauma cases. These injuries may cause life-threatening suppurative or vascular complications, but the severity and extent of damage depends upon the inflicting object and the involved structures. If significant complications are not expected, then it is best to leave the foreign body embedded and avoid surgical risks. We present a rare case of a foreign body embedded in the neck causing tinnitus and foreign body sensation.     

硫辛酸注射液治疗2型糖尿病耳鸣患者的疗效分析

目的探讨硫辛酸注射液治疗2型糖尿病患者耳鸣的临床疗效。方法对照组10例接受腺苷钴胺、血栓通治疗,研究组11例在对照组基础上加用硫辛酸注射液,评价2组治疗效果。结果研究组总有效率（81.8%）明显高于对照组（30%）,治疗过程中未发现不良反应。结论硫辛酸注射液治疗2型糖尿病患者耳鸣临床疗效显著,且具有良好的安全性。     

Botox transient treatment of tinnitus due to stapedius myoclonus: Case report

Object

To explore the feasibility of using botulinum toxin type A (BTXA) to treat tinnitus due to stapedius myoclonus.

Method

A piece of gelfoam containing BTXA (25 U/ml) was placed, through a perforation in tympanic membrane, into the middle ear cavity of a patient suffering from tinnitus due to stapedius myoclonus.

Results

The tinnitus disappeared on the second day after the BTXA treatment. The patient was free of symptoms during a 3-month follow-up period. Tinnitus reappeared at 4 months, and disappeared after second BTXA local treatment.

Conclusion

Local BTXA treatment may be considered as a treatment for tinnitus caused by stapedius myoclonus.     

Anxiety sensitivities,anxiety and depression levels,and personality traits of patients with chronic subjective tinnitus: a case-control study

Abstract

Objectives: Tinnitus is a condition that commonly affects individuals’ daily activities. We aimed to evaluate the anxiety sensitivity, levels of anxiety and depression, and personality traits of patients with chronic subjective tinnitus.

Methods: The study included 42 patients, who visited the Otorhinolaryngology Clinic, complained of having tinnitus for at least 1?year and did not have any previous peripheral vestibular diseases or psychiatric treatment history. Forty-five healthy individuals volunteered to be in the control group. We administered the Tinnitus-Severity-Index (TSI), Anxiety-Sensitivity-Index-3 (ASI-3), Beck-Anxiety Inventory (BAI), Beck-Depression-Inventory (BDI) and Eysenck-Personality- Questionnaire (EPQ) to the study participants.

Results: The BDI score was significantly higher in the patient group. The ASI-3, EPQ, and BAI scores of the patients did not differ statistically. A positive correlation was found between the EPQ neuroticism subscale scores and the ASI-3, BDI, and BAI scores of the patient cases. There was also a positive correlation between the TSI scores and the BAI, ASI-3, and neuroticism scores of the tinnitus group.

Conclusion: To the best of our knowledge, few studies have evaluated anxiety sensitivity, anxiety and depression levels, and personality traits and no studies evaluating patients and controls together. In cases where tinnitus and psychiatric diseases are comorbid, both conditions should be treated to achieve the best outcomes for the patients’ quality of life.

• KEY POINTS

• Although patients with tinnitus were selected among cases without any psychiatric treatment history, we found that depressive symptoms in this group were high.

• The participants’ anxiety sensitivity, anxiety, and neuroticism scores increased as the severity of their tinnitus increased.

• The anxiety sensitivity, anxiety, and depressive scores increased along with the increase in the neuroticism scores of the patients with chronic subjective tinnitus.

     

Tinnitus-provoking salicylate treatment triggers social impairments in mice

Objectives

Tinnitus (perception of sound in silence) strongly affects the quality of life of sufferers. Tinnitus sufferers and their relatives frequently complain about major social impairments. However, it is not known whether this impairment directly results from the occurrence of tinnitus or is the indirect expression of a preexisting psychological vulnerability. Using the well-characterized animal model of salicylate-induced tinnitus, we investigate in mice whether the occurrence of tinnitus can trigger social impairments.

Methods

Experiments were performed on 32 male Balb/C mice. Tinnitus was induced in mice using salicylate treatment. Social behavior was assessed in experimental and control animals using social interaction paradigm. Interaction time, number of social events, and number of nonsocial events were assessed in all animals.

Results

We demonstrate for the first time that treatment known to induce tinnitus triggers complex social impairments in mice. While salicylate-treated animals present a massive decrease in their overall social interactions compared to control untreated animals, they also display a paradoxal increase in the number of conspecific followings.

Conclusion

Tinnitus can thus trigger a complex set of modifications of behavior, which will not only find their expression at the individual level, but also at the social level. Our results suggest that tinnitus can directly be a cause of psychosocial impairment in human and have strong implications for the clinical management of tinnitus sufferers.     

High somatic distress with high long-term stability in selected patients with chronic depression: A 3-year follow-up of ratings with Karolinska Scales of Personality (KSP)

The main aim of the present study was to investigate mean levels and long-term stability of three scales from the Karolinska Scales of Personality (KSP), assessing somatic components of anxiety proneness in selected patients with chronic depressive symptoms. The KSP was filled in by 84 patients (26 men and 58 women) with a history of or ongoing major depression and audiological, or other comorbid somatic, symptoms. Mean scores for the Somatic Anxiety, Muscular Tension and Psychasthenia scales were above two standard deviations compared to a normative group sampled from the population. The KSP was filled in at follow-up by 65 patients. The mean interval between the ratings was 3.5 years. Comparisons between the ratings of the three scales revealed no significant mean score differences, and quite high individual stability. The mean scores were significantly increased in comparisons with depressed patients in primary care suggesting that these patients with chronic depression may comprise a depressive sub-type characterized by high “somatic distress”. A putative origin for the high and stable scores in the presented sub-group of depressed patients, and the concept of “personality trait” in use even for pronounced symptoms, are discussed.     

The relationship between locus of control, tinnitus severity, and emotional distress in a group of tinnitus sufferers

One hundred and nine tinnitus sufferers attending a specialist out-patient clinic completed questionnaires assessing the following: locus of control of behaviour, anxiety (STAI), depression (BDI) and tinnitus severity. Anxiety and depression were found to be correlated with tinnitus severity, as was locus of control, with “internals” reporting their tinnitus to be less severe than “externals.” Partial correlations indicated that locus of control did not directly affect tinnitus severity, but rather, this effect was mediated by the effect of locus of control on anxiety and depression.     

微血管减压术治疗面肌痉挛并耳聋、耳鸣

目的探讨微血管减压术治疗面肌痉挛并耳聋、耳呜的临床疗效。方法我科自2000年6月至2006年6月在局麻下对17例面肌痉挛并耳鸣、耳聋的患者施行了微血管减压术。术中分别松解动脉对第Ⅶ、Ⅷ颅神经的压迫，并以Teflon片分隔神经与血管。结果所有患者面肌痉挛均治愈。9例耳聋症状完全缓解，8例耳聋症状明显改善；15例耳呜症状完全缓解，2例耳鸣症状明显改善。结论微血管减压术对由血管压迫引起的面肌痉挛并耳聋、耳鸣患者疗效明确。     

Meeting the expectations of chronic tinnitus patients: Comparison of a structured group therapy program for tinnitus management with a problem-solving group

Two different group treatments were evaluated in 144 in-patients suffering from impairment due to chronic tinnitus. A tinnitus management therapy (TMT) was developed using principles of cognitive-behavioral therapy and compared with problem solving group therapy. Self-ratings were used to evaluate the help patients found in dealing with life problems and tinnitus as well as the degree to which they felt they were being properly treated and taken seriously. Patients showed significantly more satisfaction with the TMT group and evaluated the help they found in coping with tinnitus and life problems significantly higher. Thus, in the light of unsatisfactory medical solutions and the poor acceptance of some psychological treatments for tinnitus, TMT appears to be an acceptable and helpful treatment program.     

Transcranial direct current stimulation improves tinnitus perception and modulates cortical electrical activity in patients with tinnitus: A randomized clinical trial

ObjectivesThis study aims to determine whether transcranial direct current stimulation (tDCS): a) is effective in the treatment of tinnitus by decreasing its annoyance and severity; b) modulates the cortical electrical activity of such individuals.MethodsA double-blind, placebo-controlled clinical trial was conducted with 24 patients with tinnitus, randomized into two groups: Group 1 (n = 12) received anodal tDCS over the left temporoparietal area (LTA) and cathodal tDCS over the right dorsolateral prefrontal cortex (DLPFC) and Group 2 (n = 12) received placebo intervention. Tinnitus perception using a visual analog scale (VAS) and the Tinnitus Handicap Inventory (THI) questionnaire, in addition to electroencephalogram (EEG) was measured with eyes opened and closed at baseline and after the intervention. For the treatment, patients were subjected to five consecutive sessions of tDCS with the anodal electrode over the LTA and cathodal electrode over the right DLPFC (7 × 5 cm, 2 mA for 20 min). tDCS was turned off after 30 s in the sham group.ResultsActive tDCS significantly improved tinnitus annoyance and severity. It was associated with decreased beta and theta EEG frequency bands with eyes opened and decreased alpha frequency with eyes closed. sLORETA identified changes in frequency bands in the frontal, temporoparietal, and limbic regions. Finally, there were negative correlations between baseline EEG frequency bands and tDCS-induced change in tinnitus annoyance and severity.ConclusionsThese results demonstrate that tDCS modulates the EEG activity and alleviates tinnitus perception. This effect may be related to baseline EEG activity.     

The effectiveness of bibliotherapy in alleviating tinnitus-related distress

Objective

The present study examined the efficacy of bibliotherapy in assisting individuals experiencing distress related to tinnitus.

Methods

One hundred sixty-two tinnitus sufferers from Australia participated in a study designed to examine the effectiveness of a cognitive-behaviorally based self-help book in reducing distress.To maximize the ecological validity of the findings, we excluded no individuals interested in treatment for tinnitus-related distress.

Results

The experimental condition lost 35% of participants at postassessment, compared to 10% in the control group. In an analysis of participants who completed postintervention assessment, those assigned to the intervention condition, who received a tinnitus self-help book, showed significantly less tinnitus-related distress and general distress 2 months later compared to those assigned to the waiting list control condition. The intervention group's reduction in tinnitus-related distress and general distress from preintervention to postintervention 2 months later was significant, and these participants maintained a significant reduction in distress on follow-up 4 months after they received the tinnitus self-help book. A long-term follow-up of all participants, who at that time had received the book at least a year previously, showed a significant reduction in tinnitus distress. Although these group differences and pre-post changes were significant, effect sizes were small. Intention-to-treat analyses showed no significant effect for between-groups analyses, but did show a significant effect for the 1-year follow-up pre-post analysis.

Conclusion

Information on the effectiveness of using a self-help book, without therapist assistance, in alleviating distress is important, as bibliotherapy can provide inexpensive treatment that is not bound by time or place.     

A different view on the link between tinnitus and cognition; is there a reciprocal link?

Abstract

Tinnitus is the conscious perception of sound in the absence of any corresponding acoustic stimulus and is one of common auditory symptoms. There is some evidence that tinnitus patients suffer from difficulties in cognitive function including attention and memory. However, how exactly tinnitus affects the cognitive functions is still under debate. It seems that there is a reciprocal relationship between tinnitus and cognitive functions like auditory selective attention and working memory. In other words, as tinnitus can disrupt attention and memory functions, alterations in cognitive functions would in turn play an important role in tinnitus generation and persistence. This study reviews the literature on the relationship between tinnitus and cognition from a different view (a likely reciprocal link) and discusses its possible mechanisms.