Gabapentin effectiveness on the sensation of subjective idiopathic tinnitus: a pilot study

This prospective, placebo-controlled, double-blind clinical trial evaluated the effectiveness of gabapentin in decreasing subjective features of idiopathic subjective tinnitus in the patients. Pure-tone audiograms, laboratory test and personal histories were used to exclude any particular etiology of tinnitus. Participants were restricted to those with moderate to severe idiopathic subjective tinnitus for at least 6 months. A total of 30 participants received gabapentin in a graduated ascending dose series extending over 4 weeks (peak dose of 900 mg/day). There was not a significant subjective improvement in tinnitus annoyance for the patients (37%) versus controls (42%). Comparison between the results before and after intervention for patients and controls according to subjective response, tinnitus questionnaire, tinnitus severity index and the loudness perception by the patient showed no significant differences (P > 0.05). There is insufficient evidence to support the effectiveness of gabapentin in the treatment of tinnitus up to now.     

Transcutaneous Electric Nerve Stimulation in Chronic Subjective Tinnitus

ObjectiveIt is aimed to determine the therapeutic role of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitus with a randomized and comparative analysis.Method46 individuals with normal hearing, chronic subjective tinnitus, aged 20–65; randomly divided into the study (TENS therapy) and tje control groups. The control group (n = 23) was informed only about tinnitus, while the study group (n = 23) received TENS therapy (20 sessions in 4 weeks). Before TENS therapy, tinnitus-related evaluations of all participants [tinnitus frequency, loudness, minimum masking level (MMS), residual inhibition (RI)] were made and Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), Short Form 36 (SF-36), and The Quality of Life Scale were applied to the participants. These evaluations and questionnaires were repeated after 4 weeks of the therapy.ResultsThere was a significant decrease in the tinnitus severity after TENS therapy in the study group (p = 0.003). Moreover, it was found that VAS (loudness and annoyance), THI (functional, emotional and total score), SF-36 (physical function, physical role, pain, general health, vitality, emotional role and social function) values improved compared to before TENS therapy and the difference was significant (p < 0.05). There was no significant difference between the first and last evaluations of the control group (p > 0.05).ConclusionTENS is an effective, practical and reliable therapy method in reducing severity, loudness, and annoyance of tinnitus, and increasing the quality of life in individuals with chronic subjective tinnitus.     

Efficacy of misoprostol in the treatment of tinnitus in patients with diabetes and/or hypertension

OBJECTIVE: To determine the efficacy of the prostaglandin E1 analogue misoprostol in the treatment of tinnitus in diabetic and/or hypertensive patients. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTINGS: Tertiary care referral center. METHODS: The subjects were 42 patients with hypertension and/or diabetes mellitus who had chronic tinnitus and had experienced tinnitus symptoms for a minimum of 6 months. Twenty-eight patients were randomly assigned to Group I (misoprostol treatment), and 14 patients to the Group II (placebo treatment). Misoprostol therapy was started at 200 microg per day, and was increased 200 microg every 7 days until a dose of 800 microg per day was reached. The same numbers of placebo tablets were given to the control group using the same schedule. Both groups were treated for 1 month. The changes in objective and subjective tinnitus findings from baseline to 1 month were assessed, and the group results were compared. The chi(2)-test, student's t-test and paired-samples t-test were used to analyze the study. RESULTS: At the completion of treatment, objective assessment showed that tinnitus loudness decreased in 13 (46%) of the 28 patients in the experimental group, whereas this was observed in only two (14%) of the 14 subjects in the placebo group. Subjective tinnitus scoring revealed improvement rates of 29 and 14% for the misoprostol and placebo groups, respectively. When t-test relating to difference between rates were performed, the difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant (P = 0.05), but difference between improvement rate based on subjective tinnitus scoring was insignificant (P = 0.22). CONCLUSION: Misoprostol is an effective and safe treatment for chronic tinnitus in hypertensive and/or diabetic patients. Our results are encouraging, but further studies of larger series are needed.     

Efficacy of gabapentin on subjective idiopathic tinnitus: a randomized, double-blind, placebo-controlled trial

Tinnitus can cause extreme morbidity. Despite many attempts to find a treatment for idiopathic cases, they remain difficult to manage. Because nerve injury is one of the suspected etiologies of tinnitus and because gabapentin has been found to be effective in treating nerve injuries, some authors have attempted to determine if gabapentin has a role in treating tinnitus. Although gabapentin was found to be ineffective for tinnitus in these previous studies, to the best of our knowledge no studies have been performed that took into consideration the presence of various accompanying factors and concomitant diseases that might influence its effect. We conducted a prospective, randomized, double-blind, placebo-controlled clinical trial of gabapentin for idiopathic tinnitus. We treated 40 patients with gabapentin and measured its effectiveness by comparing differences between pre- and post-treatment Tinnitus Severity Index (TSI) values and tinnitus loudness scores. We also compared these outcomes with those of a group of 40 matched placebo controls. At study's end, we found no significant differences between the gabapentin and control groups in mean decreases in TSI value and loudness score (p=0.85 and p=0.12, respectively). However, we did find that patients with hypertension, diabetes, and/or dyslipidemia showed a better response to gabapentin than did those with tinnitus alone (p=0.01). We conclude that although there was no statistically significant difference between gabapentin and placebo in treating isolated tinnitus or tinnitus overall, patients with concomitant hypertension, diabetes, and/or dyslipidemia may benefit from gabapentin.     

Multivariate analysis using quantitative methods to evaluate the subjective loudness of tinnitus

Factors affecting the subjective loudness of tinnitus were analyzed using quantitative methods. One hundred and eighty-four patients with unilateral tinnitus were studied. Major factors affecting the subjective loudness of tinnitus were found to be subjective tinnitus pitch, annoyance, diagnosis, pitch-matched frequency, insomnia, age, tinnitus loudness level in dB HL, the duration of tinnitus and the tinnitus loudness level in dB SL at the first axis. Tinnitus pitch and pitch-matched frequency strongly affected the loudness of the tinnitus; high-pitch tinnitus and middle and low frequencies were associated with the subjective loudness of the tinnitus. In contrast, low-pitch tinnitus and a high frequency were associated with the subjective softness of the tinnitus. Thus, tinnitus pitch and pitch-matched frequency are inversely related. Sudden deafness and dizziness were associated with subjective softness of tinnitus, while hearing loss in elderly patients was associated with subjective loudness of tinnitus. Our results suggest that the level of annoyance from tinnitus and the subjective loudness of tinnitus are closely related. The relation between these factors should be considered when evaluating patients with tinnitus.     

倍他司汀联合盐酸氟桂利嗪治疗耳鸣的随机双盲对照初步研究

目的采用前瞻性临床研究方法观察倍他司汀治疗耳鸣的疗效。方法采用随机、双盲、对照临床研究方法探讨倍他司汀对耳鸣的治疗效果。60例以耳鸣为主诉的门诊患者，排除客观性耳鸣、外中耳疾病，随机分为2组，均给予盐酸氟桂利嗪作为基础用药，试验组加用倍他司汀，对照组加用维生素B6，观察治疗1周后的疗效。治疗前患者均填写耳鸣调查表，治疗前后均进行耳鸣匹配、纯音测听检查。结果以耳鸣匹配响度为疗效判定标准，倍他司汀与盐酸氟桂利嗪联合应用治疗耳鸣的疗效优于维生素B6与盐酸氟桂利嗪联合应用的效果。用服从方案完成及意向治疗方法计算倍他司汀组的有效率分别为65．5％、63．3％，对照组的有效率分别为39．3％、36．7％。按照耳鸣主观恢复为疗效判定标准，试验组和对照组的有效率差异无统计学意义。2组均未出现严重药物不良反应，倍他司汀与盐酸氟桂利嗪联合应用并没有增加或加重药物的不良反应，对听力没有帮助。结论倍他司汀可以作为临床上治疗主观性耳鸣药物的一种选择。但是倍他司汀治疗耳鸣的确切疗效还需大样本、安慰剂对照的长期观察研究。     

卡马西平联合盐酸氟桂利嗪治疗耳鸣的随机双盲对照临床研究

目的:对卡马西平治疗主观性耳鸣的疗效进行初步观察。方法:采用前瞻性随机双盲对照方法观察卡马西平治疗主观性耳鸣的疗效。100例以耳鸣为主诉的门诊患者,排除客观性耳鸣和外中耳疾病,随机分为2组,均给予盐酸氟桂利嗪作为基础用药,研究组加用卡马西平,对照组加用维生素B6,观察治疗1周后的疗效。入选者填写耳鸣调查表,治疗前后进行耳鸣匹配、纯音测听检查。结果:以耳鸣匹配响度为疗效判定标准,用意向治疗(intend to treat,ITT)分析及服从方案完成(per protocol,PP)方法计算卡马西平组的有效率分别为26%、28.3%,对照组的有效率分别为26%、27.7%,卡马西平与盐酸氟桂利嗪合用治疗耳鸣与对照组疗效相同。经统计学检验2组疗效差异无统计学意义。以患者耳鸣主观恢复为疗效判定标准,2组药物治疗耳鸣的有效率亦相同。纯音听阈在治疗前后波动在10 dB以内。研究组和对照组不良反应发生率分别为55.3%、16.7%,差异有统计学意义。结论:本研究提示盐酸氟桂利嗪联合卡马西平治疗耳鸣的疗效与对照组相近,对听力无改善作用,联合用药后不良反应增加,故而在临床中不推荐用于治疗主观性耳鸣。     

The low-power laser in the treatment of tinnitus.

The purpose of this study was to evaluate the low-power laser on the treatment of tinnitus. In a randomized, prospective, double-blind, placebo-controlled trial, either active or placebo low-power laser irradiation was given through the external acoustic meatus of the affected ear towards the cochlea. The active laser applied 50 mW (cw, 830 nm) over a period of 10 min per session. Forty-nine patients with severe, chronic uni- or bilateral tinnitus were studied. The main outcome was measured using psychoacoustical match of tinnitus loudness and pitch, Visual Analogue Scale (VAS) ratings of subjective loudness, annoyance and attention involved, scores on the Tinnitus Handicap Inventory (THI), the Tinnitus Coping Style Questionnaire (TCSQ), and a number of psychosocial questionnaires. The results showed only moderate (18%) subjective improvement with no statistically significant differences between the effects of the active laser and placebo treatments. Also, there were no statistically significant differences in prepost measurements of tinnitus loudness, VAS scores, THI scores, or TCSQ scores for patients treated with active laser compared with those treated with placebo. We conclude that low-power laser treatment is not indicated in the treatment of tinnitus. Reports of significant benefits of this treatment in previous, mostly uncontrolled or single-blinded studies may be explained by the placebo effect.     

The low-power laser in the treatment of tinnitus

The purpose of this study was to evaluate the low-power laser on the treatment of tinnitus. In a randomized, prospective, double-blind, placebo-controlled trial, either active or placebo low-power laser irradiation was given through the external acoustic meatus of the affected ear towards the cochlea. The active laser applied 50mW (cw, 830 nm) over a period of 10 min per session. Forty-nine patients with severe, chronic uni- or bilateral tinnitus were studied. The main outcome was measured using psychoacoustical match of tinnitus loudness and pitch, Visual Analogue Scale (VAS) ratings of subjective loudness, annoyance and attention involved, scores on the Tinnitus Handicap Inventory (THI), the Tinnitus Coping Style Questionnaire (TCSQ), and a number of psychosocial questionnaires. The results showed only moderate (18%) subjective improvement with no statistically significant differences between the effects of the active laser and placebo treatments. Also, there were no statistically significant differences in prepost measurements of tinnitus loudness, VAS scores, THI scores, or TCSQ scores for patients treated with active laser compared with those treated with placebo. We conclude that low-power laser treatment is not indicated in the treatment of tinnitus. Reports of significant benefits of this treatment in previous, mostly uncontrolled or single-blinded studies may be explained by the placebo effect.     

Is biofeedback effective for chronic tinnitus? An intensive study with seven subjects.

PURPOSE: This study was developed to test the hypothesis that intensive biofeedback and relaxation training may favorably affect chronic tinnitus. PATIENTS AND METHODS: Seven subjects with chronic tinnitus of moderate to severe intensity engaged in an intensive 5-month program of weekly, individual 90 minute sessions. All individuals attained a high standard of proficiency following training by a biofeedback specialist. A biofeedback unit was provided each subject for daily practice. Audiometric matching of tinnitus pitch and loudness and subjective comparisons of tinnitus loudness were conducted before and after every session. RESULT: Audiometric evaluation showed no changes in tinnitus loudness. Nevertheless, all subjects gained satisfaction from the training. Three reported substantial psychological benefits in coping with tinnitus, two described moderate improvement, and two experienced modest gains. CONCLUSIONS: These results highlight the role of psychological factors in tinnitus management and indicate that biofeedback-relaxation training may be useful therapy for coping with stresses of tinnitus.     

Effective sound therapy using a hearing aid and educational counseling in patients with chronic tinnitus

ObjectiveThis study aimed to assess the effectiveness of our sound therapy with appropriate hearing aid fitting and periodic hearing aid adjustment in patients with chronic tinnitus.MethodsWe conducted a retrospective study. The study included 490 individuals who received treatment with hearing aids for chronic tinnitus at least for 3 months. To determine the effects of tinnitus on patients’ quality of life, the participants completed a series of questionnaires, including the Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS) for loudness and annoyance, and questionnaires of subjective symptom improvement. Data were collected at entry and 3 months and 1 year after treatment initiation.ResultsAll 490 participants completed the questionnaires at 3 months; however, only 312 completed them at 1 year. The mean ± standard deviation THI score before treatment decreased significantly at 3 months (490 participants: 53 ± 25 to 11 ± 16 and 312 participants: 55 ± 24 to 12 ± 16) and 1 year (55 ± 24 to 9 ± 14) (P < 0.01). The mean VAS score for tinnitus loudness before treatment decreased significantly at 3 months (490 participants: 70 ± 22 to 25 ± 27 and 312 participants: 71 ± 22 to 27 ± 26) and 1 year (71 ± 22 to 21 ± 28) (P < 0.01). In addition, the mean VAS score for tinnitus annoyance before treatment decreased significantly at 3 months (490 participants: 75 ± 26 to 20 ± 26 and 312 participants: 75 ± 25 to 23 ± 27) and 1 year (75 ± 25 to 17 ± 26) (P < 0.01). Approximately 80% of patients noticed improvements in their tinnitus annoyance and loudness, as determined by their responses to the questionnaires of subjective symptom improvement.ConclusionThe results of this study suggest that treatment with sound therapy may ameliorate the symptoms of chronic tinnitus associated with hearing loss.     

Multivariate analyses using quantitative method II of annoyance due to tinnitus

Factors affecting annoyance due to tinnitus were analyzed using quantitative method II. Ninety-one patients with unilateral tinnitus of single kind were studied. Major factors affecting annoyance due to tinnitus were found to be subjective loudness of tinnitus, age, degree of hearing loss, tinnitus loudness level in dB HL, pitch matched frequency, puerility and impurity of tinnitus tonality, and subjective tinnitus pitch. Increased annoyance due to tinnitus was associated with an age of 30-49 years, a tinnitus loudness level between 25 and 49 dB HL, a tinnitus loudness level more than 15dB SL, impurity of tinnitus tonality, larger subjective loudness, and high-pitched tones above 4000Hz. Decreased annoyance due to tinnitus was related to the smaller subjective loudness, loudness level below 25dB HL, low-pitched tones below 250Hz, and purity of tinnitus tonality. Our results suggest that these factors are responsible for individual differences in annoyance caused by tinnitus.     

Multivariate analyses by quantitative method II of subjective pitch and tonality of tinnitus]

Factors affecting subjective tinnitus pitch and tinnitus tonality were analyzed with the use of the quantitative method II. Ninety-one patients with unilateral tinnitus of a single kind were studied. Major factors affecting subjective tinnitus pitch were pitch matched frequency, age, puerility and impurity of tinnitus tonality, and loudness of tinnitus. In addition, major factors affecting puerility and impurity of tinnitus tonality were pitch matched frequency, loudness of tinnitus, and nature of the test tone. Furthermore, subjective puerility of tinnitus was associated with middle-pitched frequency and high-pitched frequency, and a loudness level of tinnitus between 25 and 49 dB HL. Whereas impurity of tinnitus was related to low-pitched frequency and noise of the test tone. These results may contribute to the clinical evaluation of tinnitus.     

Clinical randomized trial study of hearing aids effectiveness in association with Ginkgo biloba extract (EGb 761) on tinnitus improvement

IntroductionTinnitus is defined as the perception of sound without its actual presence in the environment. It has been the subject of a great number of studies, especially considering its consequences on patient's quality of life.ObjectiveThis study aimed to investigate the effect of hearing aids and/or Ginkgo biloba extract EGb 761 on tinnitus in patients with hearing loss.MethodsThis is a trial randomized-controlled treatment, parallel, double-blind, with three-arm. Thirty-three adults subjects were divided into three groups: group 1 — subjects undergoing drug therapy with Ginkgo biloba extract EGb 761; group 2 — individuals fitted with digital hearing aids; group 3 — individuals submitted to drug therapy with Ginkgo biloba extract EGb 761 and using hearing aids. The tinnitus handicap inventory and visual analogue scale were used to evaluate self-perception of tinnitus loudness and severity before treatment and 90 days after treatment.ResultsThis study demonstrated a significant correlation between tinnitus handicap inventory and visual analogue scale, before and after treatment. We observed a significant improvement in self-perception of tinnitus loudness and severity after 90 days of treatment with Ginkgo biloba extract EGb 761 and/or hearing aids. No correlation was found between tinnitus onset time and self-perception of tinnitus loudness and severity. Hearing aids were more effective in patients with a shorter tinnitus onset time and Ginkgo biloba extract was effective regardless of tinnitus duration.ConclusionsIt was possible to prove the effectiveness of the hearing aids and/or Ginkgo biloba extract EGb 761 treatment, which shows success in the control of tinnitus contributing to the improvement of this symptom.     

Tinnitus evaluation: relationship between pitch matching and loudness,visual analog scale and tinnitus handicap inventory

IntroductionTinnitus is a subjective auditory symptom usually associated with a sound, even in the absence of external sound sources. Its diagnosis is complex, and some of the forms of measurement alone or in combination, include self-assessment questionnaires, such as the tinnitus handicap inventory, the visual analog scale and/or pitch and loudness matching.ObjectiveTo analyze the correlation among three tinnitus measurement methods: tinnitus handicap inventory, visual analog scale and pitch and loudness matching.MethodsThe study consisted of 148 patients complaining of chronic tinnitus. An otorhinolaryngological evaluation, anamnesis directed to tinnitus, audiometry (pure tone and speech), imitanciometry, tinnitus handicap inventory, visual analog scale, and pitch and loudness matching were performed. The study was registered in the Ethics Committee of the Institution with no. 0129/12.ResultsRegarding the frequency of tinnitus handicap inventory responses, a higher occurrence of the mild degree was observed. An average of 6 points was observed on the visual analog scale. The mean loudness matching in the right ear was 20 dBNS, and in the left ear was 17 dBNS. As for the type of stimulus, the most found was continuous pure tone. The frequency of the pitch sensation was 6000 Hz in the largest number of cases. Regarding the measures of tinnitus handicap inventory and the visual analogical scale, a significant correlation was observed, and as one value increases the other also increases. Pitch and loudness matching and the visual analogical scale results are also significant.ConclusionThere was a significant correlation between the values measured by the tinnitus handicap inventory, visual analogical scale (annoyance) and loudness matching in the evaluation of tinnitus. The selection of any one of the three evaluative methods for tinnitus investigation provides different dimensions of the tinnitus and complements the others.     

Tinnitus perception in patients after vagal nerve stimulator implantation for epilepsy

Purpose

Vagal nerve stimulation in conjunction with sound therapy has been proposed as a treatment for subjective tinnitus. The purpose of this study is to retrospectively review the effect of VNS on perception of tinnitus in epilepsy patients. We explore the incidence of tinnitus and its perceived reduction in patients requiring implantation of VNS for medically refractory seizures.

The efficacy of medication on tinnitus due to acute acoustic trauma

Seventy-two young males suffering from acute acoustic trauma with tinnitus due to gunshots were included prospectively in the study. Forty of the subjects had the left ear affected, four the right ear and the remaining 28 sustained bilateral acoustic traumas. The mean time of admission after onset of symptoms was 28 days (5-88 days). The subjects were randomly categorized into three groups: group A received trimetazidine, prednisolone and complex B vitamins; group B were treated only with trimetazidine; and group C received prednisolone and complex B vitamins. At 3-month follow up, tinnitus had been completely eradicated in only eight subjects and had in 17. No statistically significant difference was found between the three groups concerning improvement of tinnitus. However, it was found that early admission predisposed towards better prognosis. The degree of hearing improvement after medication did not seem to correlate with the relief of tinnitus.     

耳鸣声学特征与中医证型相关性的初步研究

探析耳鸣声学特征与中医证型的相关性。方法:按中医辨证将主观性耳鸣患者分为实证和虚证两组,检测耳鸣的客观声学特征,并进行中医治疗。结果:耳鸣频率:实证组耳鸣频率低于应证组(P<0.05)。耳鸣响度:实证组耳鸣响度高于虚证组(P相似文献   

Temporary Suppression of Tinnitus by Modulated Sounds

Despite high prevalence of tinnitus and its impact on quality life, there is no cure for tinnitus at present. Here, we report an effective means to temporarily suppress tinnitus by amplitude- and frequency-modulated tones. We systematically explored the interaction between subjective tinnitus and 17 external sounds in 20 chronic tinnitus sufferers. The external sounds included traditionally used unmodulated stimuli such as pure tones and white noise and dynamically modulated stimuli known to produce sustained neural synchrony in the central auditory pathway. All external sounds were presented in a random order to all subjects and at a loudness level that was just below tinnitus loudness. We found some tinnitus suppression in terms of reduced loudness by at least one of the 17 stimuli in 90% of the subjects, with the greatest suppression by amplitude-modulated tones with carrier frequencies near the tinnitus pitch for tinnitus sufferers with relatively normal loudness growth. Our results suggest that, in addition to a traditional masking approach using unmodulated pure tones and white noise, modulated sounds should be used for tinnitus suppression because they may be more effective in reducing hyperactive neural activities associated with tinnitus. The long-term effects of the modulated sounds on tinnitus and the underlying mechanisms remain to be investigated.