Association between tinnitus retraining therapy and a tinnitus control instrument

Objective

Tinnitus retraining therapy (TRT), which is an adaptation therapy for tinnitus based on the neurophysiological model proposed by Jastreboff in 1990,consists of directive counseling and acoustic therapy with a tinnitus control instrument (TCI) or other devices. For the past 5 years, our hospital has administered TRT characterized by the use of a TCI.

Method

In this study, we reviewed the clinical course of patients with tinnitus who presented to our outpatient clinic for tinnitus and hearing loss during the 3-year period from April 2004 to March 2007 and underwent TRT with a TCI. Among 188 patients with tinnitus (105 males and 83 females), 88 patients (51 males and 37 females, excluding dropouts) who purchased a TCI and continued therapy were included in the study.

Results

Significant improvement in Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. Among the noises generated by the TCI, the sound pressure output from the TCI was set at just below tinnitus loudness level both of the first adjustment and the second adjustment. Speech noise and white noise were frequently selected, whereas high-frequency noise and pink noise were infrequently selected. Speech noise was most frequently selected at the first adjustment, and the number of patients selecting white noise increased at the second adjustment. The results that we compared the two also revealed that the mean hearing level and tinnitus loudness levels were higher in the white noise group than in the speech noise group, which suggested that the inner ear disorder was more harder in the white noise group. Both the THI score and VAS grade improved after 1 month of treatment in the speech noise group, whereas improvement in these parameters was observed in the white noise group after 6 months of treatment. These results suggest that it took much longer the patients in the white noise group to improve.

Conclusion

: Significant improvement in THI and VAS scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. It resulted that many patients chose the speech noise or the white noise. And also it was indicated that noise generators set at just below mixing point with tinnitus are more effective. In this study, however, speech noise was often selected probably because of the reduced output at high frequencies and the level of comfort. As white noise produces greater sound volume, patients tended to switch from other therapeutic sound to white noise at the second adjustment. These findings may help administer acoustic therapy in the future.     

Evaluation of tinnitus retraining therapy for patients with normal audiograms versus patients with hearing loss

Objective

A few chronic tinnitus patients show normal hearing thresholds in the pure tone audiometry from 125 Hz to 8000 Hz (≤20 dB). We report the characteristics of the course of those patients underwent tinnitus retraining therapy (TRT) compared with other patients suffering from chronic and severe tinnitus.

Small-Group Counseling in a Modified Tinnitus Retraining Therapy for Chronic Tinnitus

Objectives

The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling.

Methods

The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening.

Results

Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months.

Conclusion

The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.     

Pros and cons of tinnitus retraining therapy

CONCLUSIONS: A significant reduction in the Tinnitus Handicap Inventory (THI) was obtained as early as 1 month after implementation of tinnitus retraining therapy (TRT). Over half of our patients either could not tolerate the tinnitus control instrument (TCI) or obtained a poor result in the TRT trial. Candidates for TRT should thus be restricted to patients who can use the TCI. OBJECTIVES: TRT has been regarded as a promising therapy for tinnitus, although there have been very few studies to determine which patients are most likely to benefit from TRT. The aim of the present study was to demonstrate TRT's pros and cons based on our experience. SUBJECTS AND METHODS: The subjects were 217 patients with intractable tinnitus. Of those, 84 tolerated TRT and 79 were followed for 6 months. The remaining subjects did not undergo TRT. Japanese translations of the THI and visual analogue scale of annoyance caused by tinnitus (VAS) were administered to evaluate the effect of TRT. RESULTS: The average THI score at the beginning of the treatment was 48.8, but it was 36.3 (p<0.01) 1 month after starting the treatment and 28.3 (p<0.005) after 6 months.     

Short Term Effects of Repetitive Transcranial Magnetic Stimulation in Patients with Catastrophic Intractable Tinnitus: Preliminary Report

Objectives

The short-term effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) in the patients with catastrophic and intractable tinnitus were investigated.

Methods

Fifteen participants were recruited among patients with catastrophic intractable tinnitus to receive 1 Hz rTMS treatment. Tinnitus severity was assessed before rTMS and directly after sham or real rTMS using the tinnitus handicap inventory (THI) and visual analog scale (VAS).

Results

There was no statistical difference in the THI score before and after sham stimulation. However, after 5 replications of real rTMS there was statistically significant reduction in THI score. Eight patients showed a decrease of more than 10 in THI score. Patients who showed a vast change in THI score after rTMS also showed a large decrease in their VAS score (r=0.879, P<0.001). Duration of tinnitus and change of THI score showed statistically significant moderate negative correlation (r=-0.637, P=0.011). But in case of VAS, there was no significant difference between VAS and duration of tinnitus.

Conclusion

Among total 15 patients with catastrophic intractable chronic tinnitus, eight patients showed some improvement in symptoms after 1 Hz rTMS. rTMS can be considered management modality for intractable tinnitus even with distress as severe as catastrophic stage.     

Effect of stapedotomy on pre-operative tinnitus and its psychosomatic burden

Objective

According to the literature, between 40 and 90% of otosclerosis patients suffering from hearing loss also suffer from tinnitus on the affected side. For a lot of these patients tinnitus represents a handicap that is just as debilitating as the hearing loss itself. The main goal of the surgical treatment of otosclerosis is a significant improvement in hearing loss, but frequent reports of reduced tinnitus after surgery suggest that this can be a positive side effect.

Methods

All patients who underwent stapedotomy were initially included in the study. Retrospectively, the tinnitus questionnaire as compiled by Goebel and Hiller was sent to the patients, and 34 patients (37 ears) replied. The pre- and postoperative cases of tinnitus were divided into compensated and non-compensated tinnitus. In addition the following tinnitus-related factors were evaluated: emotional, cognitive and mental burden; intrusiveness of the tinnitus; hearing problems; somatic ailments; and sleep disturbances.

Results

Over 80% of the patients surveyed suffered from tinnitus pre-operation. The tinnitus disappeared or improved in over 60% of the cases after stapedotomy. In addition, the related factors surveyed also improved appreciably post surgery and reached a significant level in patients with compensated tinnitus.

Conclusion

Besides a significant improvement in hearing loss the intensity and the psychosomatic burden of a pre-operative tinnitus can be reduced by stapedotomy.     

耳鸣训练疗法治疗耳鸣

文中记载了1997年9月至11月间收治的9例耳鸣患者,采用耳鸣训练疗法(tinnitusretrainng therapy,TRT)进行治疗,包括(1)正确的咨询指导;(2)对合并有听力损失者选配助听器;(3)用一个低强度的噪声来掩蔽;(4)松驰练习.结果有7例患者取得了较好的效果,为耳鸣的治疗开拓了另一条途径.     

The Cochleural Alternating Acoustic Beam Therapy (CAABT): A pre-clinical trial

Purpose

We intend to assess the effectiveness of a novel tinnitus treatment therapy, the Cochleural Alternating Acoustic Beam Therapy (CAABT) using the psychoacoustic measures, the questionnaires and rs-fMRI.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group

Introduction

Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life.

Results of TRT after eighteen months: Our experience

The aim of this study was to evaluate the efficacy of TRT in patients suffering from tinnitus. The tinnitus disorder affects about 10–15% of the population and, in one person out of a hundred, it is a disabling disorder. TRT treatment is based on Jastreboff's neurophysiological model. TRT consists of two parts: counselling, and sound therapy by means of dedicated hearing aids and sound generators. It proved to be useful to reduce the symptoms related to tinnitus. Jastreboff's structured interviews were proposed to a sample of 51 patients with tinnitus belonging to the I-II-III-IV classes according to Jastreboff. These patients were treated for 18 months. Sixty-eight percent of patients reported a reduction in the symptoms related to tinnitus, such as sleep disturbance, problems in concentration, and inability to relax. A percentage (64.7%) of patients thought that their quality of life was improved. Patients who had suffered from tinnitus for less than one year achieved significantly better results than patients who had suffered for a longer period of time. TRT is an effective tool in the treatment of tinnitus.     

The application of direct current electrical stimulation of the ear and cervical spine kinesitherapy in tinnitus treatment

Objective

The aim of the study was to evaluate the effectiveness of electrical stimulations of the hearing organ in tinnitus treatment adapting the frequency of stimulation according to tinnitus frequency, to assess the influence of cervical spine kinesitherapy on tinnitus, as well as to evaluate hearing after electrical stimulations alone and together with cervical spine kinesitherapy.

Methods

The study comprised 80 tinnitus, sensorineural hearing loss patients (119 tinnitus ears) divided into two groups. In group I (n – 58 tinnitus ears) electrical stimulation of the hearing organ was performed, in group II (n – 61 tinnitus ears) electrical stimulation together with cervical spine kinesitherapy. Hydrotransmissive, selective electrical stimulations were conducted using direct, rectangular current. The passive electrode was placed on the forehead, the active – a silver probe – was immersed in the external ear canal in 0.9% saline solution. The treatment involved fifteen applications of electrical stimulations (each lasted for 4 min) administered three or four times a week (whole treatment lasted approximately 30 days). The evaluation of the results considered a case history (change from permanent to temporary tinnitus), questionnaires (the increase/decrease of the total points) and the audiometric evaluation of hearing level.

Results

Before the treatment, group I comprised 51 ears (87.93%) with permanent, and 7 ears (12.07%) with temporary tinnitus; group II – 55 ears (90.17%) with permanent and 6 ears (9.83%) with temporary tinnitus. After the treatment, in both groups the number of ears with permanent tinnitus decreased considerably obtaining the pauses or disappearing of tinnitus. Directly after the treatment, group I comprised 25 ears (43.11%) with permanent, and 10 ears (17.24%) with temporary tinnitus, in 23 ears (39.65%) tinnitus disappeared; group II – 33 ears (54.1%) with permanent and 11 ears (18.03%) with temporary tinnitus, in 17 ears (27.87%) tinnitus disappeared.Regarding questionnaires, improvement was observed in group I – in 43.11% of ears, in group II – 32.8%. In both groups audiometric improvement of hearing was recognized.

Conclusions

(1) Electrical stimulation of the hearing organ, with the application of current frequencies according to tinnitus frequencies (selective electrical stimulation), was an efficient method in severe tinnitus treatment. (2) Cervical spine kinesitherapy in the treatment of tinnitus, using electrical stimulation, did not have any supporting influence.     

慢性耳鸣急性加重时的听阈改变及其对耳鸣预后的影响

目的 探讨慢性耳鸣急性加重时患者的听阈改变及其对耳鸣预后的影响.方法 对32例在习服治疗过程中出现耳鸣急性加重的患者进行纯音听阈、声导抗、耳声发射、听性脑干反应、耳蜗电图及甘油试验等听力学检测,对新出现听阈提高者在习服治疗的同时,按照突发性聋方案治疗.对照组75例仅接受习服治疗.分析慢性耳鸣急性加重时的听阈改变,以及耳鸣加重组与对照组在习服治疗的第3、6、9、12个月时的耳鸣代偿情况.结果 慢性耳鸣急性加重时,出现3种类型的局部频率听阈提高:①既往为4～8 kHz高频下降型听力曲线,耳鸣加重时,相邻的中频区1～2个频率(含半倍频)听阈提高;②既往中频区单个频率听力损失,耳鸣加重时,紧邻的中频区新增单个频率听阈提高,听力曲线由锯齿型转变为凹槽型;③低频听力波动型,慢性耳鸣急性加重时,125～1000 Hz平均听阈较既往提高10～30 dB,而高频区听阈无改变.按照突发性聋方案治疗后,随着新出现听力损伤的恢复,25例随之实现耳鸣代偿.耳鸣加重组与对照组在习服治疗的第3、6、9个月,代偿率差异无统计学意义(X2值分别为0.005、0.005、2.587,P值均>0.05),12个月时,耳鸣加重组代偿率明显高于对照组,差异有统计学意义(X2=0.108,P<0.05).结论 慢性耳鸣急性加重时,出现了不同形式的局部频率听力损失,对新出现听力损失及时有效的治疗,在挽救听力的同时,加速了耳鸣的代偿.     

Validation of a Korean Version of the Tinnitus Handicap Questionnaire

Objectives

The goal of the present study was to evaluate the reliability and validity of the Korean version of the tinnitus handicap questionnaire (THQ-K).

Methods

A total of 60 patients were included in this study. Patients responded to the THQ-K, the tinnitus handicap inventory (THI), Beck''s depression index (BDI), and the visual analogue scale (VAS) for loudness and pitch, loudness match, and minimum masking level (MML) test were performed.

Results

Internal consistency of the THQ-K was examined using Cronbach coefficient alpha. Cronbach alpha was 0.96. The THQ-K showed a significant correlation with THI, BDI, VAS for distress, and VAS for loudness, but no significant correlation with psychoacoustic measurement of tinnitus, such as loudness match, pitch match, and MML.

Conclusion

The THQ-K is a reliable and valid test for evaluating the degree of handicap due to tinnitus for both research and clinical use.     

Untersuchungen von Rauschsignalen für die akustische Tinnitustherapie

Background

In terms of sound acceptance and tinnitus-masking efficacy, tinnitus sound therapy appears to be more effective using dynamic natural sounds than static noise signals. The aim of this study was to systematically determine the effects of physical dynamics parameters on tinnitus masking and sound acceptance.

Materials and Methods

Based on a dynamic model, noise signals with different dynamic properties were synthesized and used to investigate minimal masking levels (MMLs) and spontaneous sound acceptance in six tinnitus patients.

Results

High signal dynamics resulted in high MMLs and low sound acceptance. In some instances, low signal dynamics gave rise to slightly lower MMLs than white noise. Despite unfavourable MMLs, natural dynamic sounds were better accepted than synthesized sounds with comparable dynamics.

Conclusions

The higher spontaneous acceptance of natural sounds as compared to white noise appears not to be due solely to physical sound properties, but rather to result primarily from psychological factors. It may be possible to improve sound acceptance in tinnitus sound therapy by using signals with low amounts of dynamics and implementing the use of natural sounds.     

Characteristics of tinnitus with or without hearing loss: Clinical observations in Sicilian tinnitus patients

Objective

To analyze the clinical characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss.

Methods

The study considered 312 tinnitus sufferers, 176 males and 136 females, ranging from 21 to 83 years of age, who were referred to the Audiology Section of the Department of Bio-technology of Palermo University. The following parameters were considered: age, sex, hearing threshold, tinnitus laterality, tinnitus duration, tinnitus measurements and subjective disturbance caused by tinnitus. The sample was divided into two groups: Group 1 (G1) subjects with normal hearing; Group 2 (G2) subjects with hearing loss.

Results

Among the patients considered, 115 have normal hearing while 197 have a hearing deficit. There is a slight predominance of males respect to females that is more evidenced in G2 (61.42% of males vs. 38.58% of females). The highest percentage of tinnitus results in the decades 41–50 for G1 and >70 for G2 with a statistically significant difference between the two groups (P < 0.0001).The hearing impairment results in most cases of sensorineural type (74.62%) and limited to the high frequencies (58.50%), moreover the 72.10% of the patients with SNHL had a high-pitched tinnitus while the 88.37% of the patients high-frequency sensorineural hearing loss had a high-pitched tinnitus (P < 0.0001). As for the subjective discomfort, the catastrophic category resulted most representative among subjects with normal hearing with a statistically significant difference between the two groups but no significant correlation was found between the level of tinnitus intensity and the tinnitus annoyance confirming the possibility that tinnitus discomfort is elicited by a certain degree of psychological distress as anxiety, depression, irritability and phobias that do not allow the phenomenon of the ‘habituation’.

Conclusion

This work, according to literature data, suggests that the hearing status and the elderly represent the principal tinnitus related factors; moreover tinnitus characteristics differ in the two groups for tinnitus pitch. There is, in fact, a statistically significant association between high-pitched tinnitus and high-frequency SNHL suggesting that the auditory pathway reorganization induced by hearing loss could be one of the main source of the tinnitus sensation.     

Tinnitus and cochlear implants

Objective

Several published studies seem to confirm the clinical observation that cochlear implants (CI) have a suppressive effect on tinnitus in most CI users. The aim of this paper is to present our personal experiences on tinnitus improvement after cochlear implantation.

Methods

Before surgery, 51 post-lingually profoundly deaf adults, who underwent cochlear implantation between 2005 and 2007, filled out a questionnaire reporting tinnitus characteristics and the Italian version of the Tinnitus Handicap Inventory (THI-I). Moreover, they were asked to scale tinnitus loudness and annoyance. Six months after implant activation, patients repeated the same evaluations. Scores were statistically analysed by means of a Wilcoxon signed ranks test on the hypothesis that a CI could change the tinnitus magnitude and/or its annoyance.

Results

In our series of 36 patients, 36.10% reported total loudness suppression and another 41.6% reported a reduction. Annoyance scores reduced in 75% of patients. THI reduced in 72.2% of patients.

Conclusion

Tinnitus reduction after CI may manifest as several mechanisms, such as habituation, acoustic masking, direct electrical nerve stimulation and cortical reorganization. Nevertheless, it is our opinion that data on CI benefits on tinnitus should be interpreted with caution and it seems reasonable to admit that further data is still necessary before considering CI as a treatment of tinnitus especially in unilateral deafness.     

The effects of tinnitus and/or hearing loss on the Symptom Checklist-90-Revised test

Objective

This study aims to evaluate the psychological attitudes of patients with tinnitus by using The Symptom Checklist-90-Revised and to investigate the relationship between hearing loss and attributed psychological attitudes.

Materials and methods

142 subjects (73 female, 69 male) divided into 4 groups: Group 1 (32 patients with tinnitus and hearing loss-), Group 2 (38 patients with tinnitus), Group 3 (36 patients with hearing loss), Group 4 (36 healthy subjects without tinnitus and hearing loss-control group). The Symptom Checklist-90-Revised (SCL-90-R) test was used to detect the subjects’ tendency for psychological problems due to tinnitus and/or hearing loss.

Results

Mean values of Somatization (SOM), Obsessive-Compulsive (O-C) and Additional Scale (AS) were higher than cut-off points of 1.00 for Groups 1 and 2 (tinnitus and/or hearing loss). In patients with tinnitus and/or hearing loss, SOM, O-C, Depression (DEP), AS and Global Severity Index (GSI) were significantly higher than patients with hearing loss and control group. By multiple linear regression analysis, tinnitus was the significantly detected confounding factor for increase of SOM, O-C, Interpersonal Sensitivity (I-S), DEP, Hostility (HOS), Paranoid Ideation (PAR), AS and GSI parameters.

Conclusion

It was concluded that tinnitus could induce some psychological symptoms such as depression; and this is independent of hearing loss. Tinnitus with or without hearing loss is the essential factor for causing psychological problems in patients. Tinnitus duration is not important in the scene of psychological status of the patients. This result shows that, age, gender (male, female), chronic or acute tinnitus experience, and having hearing loss did not cause too much problems in patients. But tinnitus experience in every form (for the present study, intermediate level subjective tinnitus) is significantly important confounding factor for affecting psychological status of the patients.     

Application of distortion product otoacoustic emissions to inflation of the eustachian tube in low frequency tinnitus with normal hearing

Objective

This study was designed to investigate the applications of distortion product otoacoustic emissions to assess the efficacy of eustachian tube inflation on low frequency tinnitus with normal hearing.

Methods

Ninety-four patients (155 ears) suffering from subjective tinnitus with normal hearing sensitivity participated in this study. Control group consists of fifty volunteers (100 ears) without tinnitus. They were subjected to full history taking, otoscopy, basic audiologic evaluation and distortion product otoacoustic emissions (DPOAE). As for the patients with decreased DPOAE amplitude over a limited frequency range from 0.5 to 1 kHz, we offered nose dropping and tubal inflation for a week and DPOAE was preformed again. The patients were followed up for a month.

Results

34.8% DPOAE-gram showed decreased amplitude at the frequencies from 0.5 to 1 kHz in tinnitus group and “the ring” is mostly lower in pitch. Among the patients accepted the treatment of eustachian tube inflation, 16.7% the tinnitus disappeared, no recurrence within one month; 66.67% the tinnitus reduced within one month. 95.5% the amplitude of DPOAE showed improved over the limited frequency. 16.7% the tinnitus still existed.

Conclusion

The changes of the mechanical properties of ossicular chain or the tympanic membrane influenced by tympanum pressure may cause tinnitus, which is sub-clinical prior to the changes of audiometry and tympanometry. The low frequency tinnitus may gain transitory relief from ringing with the tubal inflation. DPOAE was proved to be a useful tool in the evaluation of the efficacy of tubal inflation on low frequency tinnitus with normal hearing.     

Hearing Abilities at Ultra-High Frequency in Patients with Tinnitus

Objectives

To compare tinnitus patients who have normal hearing between 250 Hz and 8 kHz with normal controls with regard to the ability of each group to hear extended high-frequency pure tone thresholds.

Methods

We enrolled 18 tinnitus patients, each of whom had a threshold of HL <25 dB and threshold differences of <10 dB between ears at frequencies of 250 and 500 Hz and 1, 2, 4, and 8 kHz. We also enrolled age- and gender-matched normal volunteers (10 ears), for each patient. Extended high frequency pure tone audiometry was performed, and the mean hearing thresholds at 10, 12, 14, and 16 kHz of each tinnitus ear were compared with those of the 10 age- and sex-matched normal ears.

Results

Of the 18 patients with tinnitus, 12 had significantly increased hearing thresholds at more than one of the four high frequencies, compared with the normal group. When we assessed results according to frequency, we found that 8 patients had decreased hearing ability at 10 kHz, 10 at 12 kHz, 8 at 14 kHz, and 4 at 16 kHz.

Conclusion

Some patients with tinnitus who have normal hearing below 8 kHz have decreased hearing ability at extended high-frequencies. Thus, the proportion of patients with tinnitus who have normal hearing over the entire audible range is smaller than in previous reports.