单侧特发性耳鸣临床特点和情绪、认知特征的对比分析及相关性研究

目的　分析左、右侧特发性耳鸣临床特点和情绪、认知状态差异及相关性。方法　入选左、右侧耳鸣各44、36例,采集临床资料及耳鸣障碍评估量表（tinnitus handicap inventory,THI）、贝克抑郁量表（Beck depression inventory,BDI）、状态特质焦虑量表（state trait anxiety inventory,STAI）、蒙特利尔认知评估量表（Montreal cognitive assessment,MoCA）评估。结果　男性左侧耳鸣发生率明显高于女性患者（68.2% vs 31.8%）。左侧耳鸣伴听力下降发生率明显高于右侧（90.9% vs 69.4%）。两组间 年龄、体质量指数（BMI）、受教育年限、耳鸣持续时间、听力阈值和THI、BDI、状态焦虑量表（S-AI）、特质焦虑量表（T-AI）、MoCA评分无显著性差异。影响日常生活和睡眠、抑郁、状态焦虑、特质焦虑和认知损害的发生率是23.8%、33.8%、17.5%、6.3%和33.8%。耳鸣严重程度与抑郁、状态焦虑、特质焦虑和认知功能损害呈正相关,耳聋严重程度与认知功能损害呈正相关。结论　单侧特发性耳鸣较严重,抑郁、焦虑和认知损害发生率高且与耳鸣和耳聋严重程度密切相关。     

思诺思治疗合并睡眠障碍的主观性耳鸣疗效分析

目的：分析思诺思对合并睡眠障碍的主观性耳鸣患者的疗效。方法采用随机、双盲的对照方法,将68例合并睡眠障碍的主观性耳鸣患者随机分为治疗组和对照组各34例,对照组给予银杏叶提取物（金纳多片）及甲钴胺片（弥可保）口服治疗,治疗组在此基础上加思诺思临睡前口服,并对全部研究对象治疗前及治疗两周后分别进行耳鸣残疾评估量表（tinnitus handicap inventory,THI）及匹兹堡睡眠质量指数（pittsburgh sleep quaIity in-dex,PSQI）评估。结果治疗组治疗后的 THI 评分（31．94±17．501分）和 PSQI 评分（4．68±4．132分）均较治疗前（分别为51．88±18．725、13．47±3．38分）明显改善,差异有统计学意义（均为 P ＜0．05）;对照组治疗后的 THI评分（42．06±18．55分）和 PSQI 评分（12．24±3．742分）较治疗前（分别为50．29±16．88和13．59±3．43分）显著改善,差异有统计学意义（均为 P ＜0．05）。治疗后治疗组 THI 和 PSQI 评分较对照组改善更明显,差异有统计学意义（均为 P ＜0．05）。结论思诺思能改善合并睡眠障碍的主观性耳鸣患者的耳鸣严重程度和睡眠障碍。     

性别、年龄、听力损失程度与耳鸣严重程度的关系探讨

目的用耳鸣残疾量化表得分评估耳鸣患者耳鸣的严重程度,分析患者的性别、年龄、听力损失程度是否影响耳鸣严重度。方法对97例以耳鸣为第一主诉的主观性耳鸣患者进行系统的耳鼻咽喉科检查、听力学检查和耳鸣残疾评估量表(tinnitus handicap inventory,THI)评分,分析患者的性别、年龄及听力损失程度与THI得分的关系。结果 97例中,男36例,年龄18～78岁(平均47±12.5岁);女61例,年龄15～71岁(平均55±17.6岁),经Wilcoxon秩和检验分析,不同性别间患者的THI得分差异无统计学意义(P>0.05),Spearman相关性分析显示,耳鸣患者的年龄、听力损失程度与THI得分之间无明显的相关性(均为P>0.05)。结论耳鸣残疾评估量表得分分析可知耳鸣患者的性别、年龄、听力损失程度对耳鸣严重程度无明显的影响。     

耳鸣咨询联合多元复合声治疗在慢性原发性耳鸣患者中的疗效评价

目的评价耳鸣咨询联合多元复合声治疗在慢性原发性耳鸣患者中的临床效果。方法40例慢性原发性耳鸣患者采用耳鸣咨询+多元复合声治疗的联合疗法,在治疗前、治疗1个月后分别进行耳鸣咨询,在治疗前、治疗1个月及治疗半年后,采用耳鸣致残量表法（THI）及主观视觉耳鸣严重程度标尺评分法（VAS）进行治疗效果的评价。结果经THI和VAS评分统计显示,治疗1个月与治疗前、治疗6个月与治疗前以及治疗1个月与治疗6个月比较,差异均具有统计学意义（P均<0.05）。以THI评分降低20分以上为有效,耳鸣咨询联合多元复合声治疗1个月后,总有效率为27.5%,耳鸣咨询联合多元复合声治疗6个月后有效率为67.5%。费德曼曲线分型中,以重叠型和汇聚型居多,重叠型的治疗效果最佳。统计分析显示在治疗前与治疗6个月后,VAS评分和THI评分具有相关性（P<0.05）。结论耳鸣咨询联合多元复合声治疗在慢性耳鸣中具有广泛应用价值,未来能够作为治疗慢性主观性耳鸣的首选方法;治疗效果可以采用THI和VAS评分系统进行评价分析。     

中文版耳鸣致残量表和耳鸣功能指数的检验以及临床应用

目的验证耳鸣致残量表(THI)和耳鸣功能指数(TFI)中文版本的信度和效度,为其在中国的临床推广应用提供依据。方法对100例耳鸣患者进行THI及TFI的调查分析并分别进行信度及效度检验。同时让患者填写流行病研究中心抑郁量表(CES-D)、贝克焦虑量表(BAI)和生活满意度量表(SWLS),将THI和TFI得分分别与这些量表的关系进行相关性分析。结果 100份中文版THI量表的Cronbach’sα=0.939,TFI量表的Cronbach’sα=0.966。THI的探索性因素分析显示了3个因子,其累计方差贡献率为54.637%。TFI的因子分析显示各子量表的信度在0.351到0.859之间。其中84份量表与各心理量表进行相关性分析,结果表明除SWLS量表外,其余量表之间均呈正相关关系。结论中文版本THI和TFI的信度检验显示了很高的内部一致性,具有较高的信度和效度,可用于中国的临床评估耳鸣对患者生活造成的影响,是可靠的耳鸣严重程度的评估工具。     

伴围绝经期综合征的主观性耳鸣患者临床特征分析

目的　观察与分析围绝经期女性的耳鸣特征。方法　对就诊我科248例患主观性急性耳鸣伴围绝经期综合征女性进行纯音听阈测试、耳鸣频率和响度匹配测试、耳鸣问卷调查、睡眠质量评价和血清促卵泡刺激素（follicle-stimulating hormone, FSH）测定。结果　单耳鸣多于双耳鸣，差异有统计学意义（χ2=97.58，P＜0.05），左、右耳耳鸣发生率基本相当，差异无统计学意义；高频耳鸣占总数的62.73%、中频占2.80%、低频占34.47%；耳鸣频率与听力下降频率无明显相关性，与严重程度亦无明显相关性；耳鸣残疾评估量表（tinnitus handicap inventory,THI）响度评级主要为2、3级，占72.18%，其次为1、4级，占24.60%，5级极少，仅占3.22%；FSH水平与耳鸣严重程度有相关性，与耳鸣响度无明显相关性；睡眠障碍发生率58.06%，随耳鸣程度增加，睡眠障碍发生率增加，耳鸣程度与睡眠质量呈正相关。结论　围绝经期女性耳鸣特征、病因与发病机制与听觉系统病变的耳鸣有所不同，主要与FSH水平有关。耳科医师应注意鉴别诊断，综合分析和治疗。     

耳鸣和情绪认知的相关性研究

目的针对耳鸣患者的情绪问题进行研究,探索耳鸣与情绪之间的相关性以及认知条件和影响因素。方法对以耳鸣为主诉的179例患者进行一般情况调查、纯音测听、声导抗检测,并使用耳鸣致残量表、汉密尔顿焦虑量表、汉密尔顿抑郁量表进行量化评估。结果 179例耳鸣患者中,男性90例(50.3%),女性89例(49.7%);年龄13-82岁,平均44.82±15.84岁。耳鸣严重程度及三个维度与焦虑、抑郁均呈正相关,耳鸣严重程度与焦虑、抑郁各因子除体重外均呈正相关。年龄是抑郁的影响因素,睡眠是焦虑和抑郁的影响因素。结论焦虑、抑郁情绪是影响耳鸣严重程度的重要因素,同时需考虑到年龄和睡眠对情绪和耳鸣的影响。     

人工耳蜗植入对成人语后聋患者耳鸣的影响

目的 探讨人工耳蜗植入（CI）对成人语后聋患者耳鸣的影响。方法 回顾性分析88例于我院行人工耳蜗植入的语后聋患者资料,筛选术前有耳鸣的患者分别于术前、术后0.5、1及6个月行耳鸣残疾量表（tinnitus handicap inventory,THI）和视觉模拟评分法（visval analogue scale,VAS）评价患者耳鸣及转归情况。结果 80.7%(71/88)的成人语后聋患者术前伴有耳鸣症状,不同性别患者耳鸣严重程度无差异;THI评分在术后6个月时降低最明显,耳鸣严重程度从术前的重度（38.48±23.95）降至中度（20.59±18.38）,响度也较术前明显减小。青年组患者术后耳鸣改善情况较中年组及老年组更好。使用声音处理器时耳鸣响度明显减小。结论 人工耳蜗植入术可有效改善语后聋成人患者的耳鸣症状,术后耳鸣症状可随时间推移逐渐缓解。青年患者耳鸣症状在术后得到改善的效果更好,所需时间更短。人工耳蜗开机后,声音处理器的使用对耳鸣的抑制有显著而长期的作用。     

TSG助听器用于耳鸣患者的临床结果

目的 评估TSG助听器(GN Resound Live 9 TS)改善患者耳鸣的效果,从而检验该技术用于治疗单纯性耳鸣和耳鸣伴有听力障碍患者的可行性和疗效.方法 采用耳鸣残疾评估量表(TinnitusHandicap Inventory,THI)作为评估素材,分别对9名受试者在TSG助听器配戴前后的耳鸣残疾程度进行评估.结果 ①全部受试者配戴GN Resound Live 9 TS助听器前后THI总分和各条目得分均有显著性差异(P<0.0001) ; ②GN Resound Live 9 TS助听器配戴前后受试者THI的功能性、情感性及严重性得分均得到显著性改善(P<0.0001).结论 GN Resound Live 9 TS助听器对单纯耳鸣受试者或耳鸣伴有轻中度感音神经性听力损失者均显示出明显的改善作用.     

耳鸣严重程度与焦虑的相关性研究

目的:研究耳鸣严重程度与焦虑的相关性,探讨其在耳鸣康复中的作用。方法:对以耳鸣为第一主诉就诊的119例患者,用耳鸣一般情况问卷表、耳鸣残疾量表(THI)和焦虑自评量表(SAS)进行横断面调查,分析其相关性。结果:THI得分和SAS得分正相关(r=0.573,P<0.01),THI得分分级和SAS得分正相关(r=0.551,P<0.01)。耳鸣严重程度越高,焦虑得分越高。结论:耳鸣严重程度与焦虑呈中度正相关性,对以耳鸣为第一主诉且其THI得分分级≥中度(即≥38分)的耳鸣患者,应注意了解其焦虑程度,进行必要的心理干预,有助于耳鸣患者的康复。     

Tinnitus Retraining Therapy (TRT): outcomes after one-year treatment

The aim of the study is to present our results regarding the efficacy of TRT for tinnitus relief in patients with clinically significant tinnitus compared to a group treated with vasoactive agents. In a nonrandomized prospective study, 63 patients with disabling tinnitus were recruited. Greek translation of the Tinnitus Handicap Inventory (THI) and visual analogue scale (VAS) for annoyance caused by tinnitus when conducting four major activities of everyday life (work, sleep, relaxation and concentration) were examined in a 12-month period. The THI score was significantly improved in the TRT group, as well as mean VAS scores, in all measures. Comparison of the mean improvement of THI and VAS scores after treatment showed significant differences between the two groups, favoring TRT treatment. Our data suggest that TRT is an effective treatment. It reduces the level of annoyance induced by tinnitus and improves the ability of patients to work, sleep, relax or be concentrated.     

突发性聋伴耳鸣患者耳鸣特征

目的 分析研究突发性聋伴耳鸣患者的耳鸣特点、耳鸣与听力损失的关系、耳鸣对患者的影响程度, 探讨突聋患者耳鸣的产生机制。 方法 突发性聋伴有耳鸣患者231例常规采集病史, 填写耳鸣致残量表(THI)及视觉模拟得分表(VAS), 同时进行纯音听阈测试、耳声发射、耳鸣检测及掩蔽试验等检查。分析患者的耳鸣特点、耳鸣与听力的关系、耳鸣的THI及VAS得分以及它们特点。 结果 ①听力损失特点：低中频下降型20例(占8.7%), 中高频下降型60例(占26.0%), 平坦型44例(占19.0%), 全聋型79例(占34.2%), 不规则型28例(占12.1%);②耳鸣频率:低频耳鸣(≤500 Hz)49例(占21.2%), 中频耳鸣(51～2 000 Hz)54例(23.4%), 高频耳鸣(>2 000 Hz)122例(52.8%), 未匹配6例(占2.6%)。其中听力损失类型为低中频下降型的患者中, 低频、中频、高频耳鸣的比例分别为75%、15%、10%;中高频下降型患者中, 低频、中频、高频耳鸣的比例分别为13.3%、26.7%、60.0%;全聋型患者中, 低频、中频、高频耳鸣的比例分别为17.1%、19.0%、63.3%。听力下降最明显的频率对数与耳鸣频率对数呈线性关系, r=0.592, P<0.01;③耳鸣响度:0～30 dB HL 45例(占19.5%), 31～60 dB HL 60例(占26.0%), 60～90 dB HL 102例(占44.2%), 大于90 dB HL 18例(占27.8%), 未匹配6例(占2.6%)。耳鸣响度与听力损失程度(250～4 000 Hz平均听阈)有相关性, 相关系数r=0.216, P=0.001<0.05。④耳鸣致残级别:按照Newman等依据THI得分将耳鸣残疾分级, 其中1级27例(占11.7%), 2级耳鸣44例(占19.0%), 3级66例(占28.6%), 4级94例(占40.7%)。⑤THI及VAS得分特点:THI得分与听力损失程度无相关性r=0.087, P=0.287>0.05。VAS得分与听力损失程度无相关性r=0.002, P=0.982>0.05。THI得分与耳鸣频率对数无相关性, 相关系数r=-0.056, P=0.402>0.05。VAS得分与耳鸣频率对数无相关性, 相关系数r=-0.003, P=0.970>0.05。THI得分与耳鸣响度无相关性, 相关系数r=0.039, P=0.563>0.05。VAS得分与耳鸣响度无相关性, 相关系数r=0.136, P=0.110>0.05。结论 ①突发性聋伴耳鸣患者中高频耳鸣最常见;②耳鸣频率与听力损失类型显著相关, 低中频下降型以低频耳鸣多见, 而中高频下降型及全聋型以高频耳鸣多见;③听力损失最大的频率与耳鸣的频率有较高的一致性;④突发性聋伴耳鸣患者急性期的耳鸣致残程度以3～4级为多;⑤THI及VAS得分与听力损失的程度、耳鸣的频率、耳鸣的响度均无相关性。     

Relationships among speech perception, self-rated tinnitus loudness and disability in tinnitus patients with normal pure-tone thresholds of hearing

Exactly how speech perception and tinnitus perception are related remains unclear. This study investigated how tinnitus alone affects speech perception and the relationship between speech perception, tinnitus loudness, and tinnitus disability. The Mandarin Speech Perception in Noise Test (MSPIN), Tinnitus Loudness Scaling (TLS), and Tinnitus Handicap Inventory (THI) were utilized to assess 20 tinnitus patients with normal hearing. The tinnitus group had a significantly lower MSPIN score than the control group (p < 0.01). TLS and THI scores were strongly correlated (r(2): 0.534 approximately 0.627, p < 0.05). Correlations between MSPIN and TLS or THI scores were not significant. Tinnitus loudness correlated well with tinnitus-related disability. Neither tinnitus loudness nor disability was strongly correlated with speech perception. In noisy environments, tinnitus sufferers had significantly poorer ability to recognize speech than control subjects.     

Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy

OBJECTIVE: To determine whether the Tinnitus Handicap Inventory (THI), a validated patient-based outcomes measure, may improve our ability to quantify impact and assess therapy for patients with tinnitus. DESIGN: Nonrandomized, prospective analysis of 32 patients undergoing tinnitus retraining therapy (TRT). Assessment tools included comprehensive audiology, a subjective self-assessment survey of tinnitus characteristics, and the THI. Tinnitus Handicap Inventory scores were assessed at baseline and 6 months following TRT. RESULTS: Baseline analysis revealed significant correlation between the subjective presence of hyperacusis and higher total, emotional, and catastrophic THI scores. Tinnitus Handicap Inventory scores correlated with subjective perception of overall tinnitus effect (P<.001). Mean pure-tone threshold average was 17.4 dB, and mean speech discrimination was 97.0%. There were no consistent correlations between baseline audiologic parameters and THI scores. Following 6 months of TRT, the total, emotional, functional, and catastrophic THI scores significantly improved (P<.001). Loudness discomfort levels also significantly improved (P< or =.02). CONCLUSIONS: There is significant improvement in self-perceived disability following TRT as measured by the THI. The results confirm the utility of the THI as a patient-based outcomes measure for quantifying treatment status in patients with primary tinnitus.     

Tinnitus in patients with profound hearing loss and the effect of cochlear implantation

The objectives of this study were to characterize the features of tinnitus in patients with profound sensorineural hearing loss and to evaluate the effect of cochlear implantation (CI) on their tinnitus. Medical records were reviewed for 35 patients who underwent CI, and completed tinnitus questionnaire between March 2003 and August 2011. Of them, 22 had tinnitus prior to CI (62.9 %) and the tinnitus group was older than the non-tinnitus group (47.5 ± 15.1 vs. 28.9 ± 15.2). The mean tinnitus handicap inventory (THI) score of the tinnitus group was 50.5 ± 28.7 before surgery, and the mean THI score and visual analogue scale (VAS) scores for loudness, annoyance, effect on life, and awareness decreased significantly after CI, with a mean follow-up period of 10.7 months. Tinnitus was completely eliminated in ten patients (45.5 %) and THI scores decreased in all patients. In a correlation analysis of the decrease in THI scores, preoperative VAS scores for loudness, awareness, effect on life, and annoyance, as well as preoperative THI scores, were highly correlated with the degree of decrease in THI scores postoperatively. The auditory performance of patients older than 40 years did not differ from that of younger patients, but their tinnitus was more improved after CI. In conclusion, tinnitus is a common complaint in patients with cochlear implants, and is more prevalent in elderly implantees. In the present study, CI improved tinnitus in all patients, although the most severe cases had the greatest benefit.     

Convergent validity of the tinnitus handicap inventory and the tinnitus questionnaire

For research into tinnitus to be robust and credible, the use of well-validated instruments of self-perceived tinnitus handicap as outcome measures is essential. The tinnitus handicap inventory (THI) and the tinnitus questionnaire (TQ) are two such instruments which are in widespread use. Both questionnaires were administered by mail to 100 consecutive new patients of the Cambridge Tinnitus Clinic, and completed in randomized order. These patients had been referred by the otolaryngology team and had not undergone any tinnitus therapy. The response rate was 78 per cent, neither questionnaire being more acceptable to patients than the other. The convergent validity of the instruments was high, with total and subscale scores all being significantly correlated at the five per cent level (Spearman correlation coefficients). A number of subscale scores were not significantly correlated at the one per cent level however. In particular, the sleep disturbance element of the TQ was demonstrated to have some discriminant validity from the THI and from other elements of the TQ at the one per cent significance level. The THI and TQ have been demonstrated to have high convergent validity and are both suitable for tinnitus outcome studies involving the quantification of self-perceived tinnitus handicap. For research that aims to determine the specific effect of an intervention on tinnitus-related sleep disturbance, the TQ sleep subscale has potential utility. The hypothetical constructs of tinnitus handicap underlying the psychologist-developed TQ and the audiologist-developed THI have been shown to be convergent.     

耳鸣对患者心理影响分析

目的调查耳鸣对患者造成的心理负担以及影响因素,为临床耳鸣患者咨询提供依据。方法选取四川大学华西医院听力中心收治的针对耳鸣为第一主诉的初诊患者,使用耳鸣评价量表(tinnitus evaluation questionnaire,TEQ)中的两个开放性问题调查耳鸣对患者最大的影响及患者对耳鸣最担心的情况。采用耳鸣残疾量表(tinnitus handicap inventory,THI)和TEQ评估耳鸣严重程度。结果共调查214例耳鸣患者,其中男性90例(42.06%),女性124例(57.94%)。患者中55.14%(118例)认为耳鸣主要影响情绪,26.17%(56例)认为耳鸣主要影响睡眠。对耳鸣,患者最担心的前3项依次是听力下降或耳聋(33.64%)、耳鸣治不好(32.24%)以及因耳鸣而担心其它健康问题(16.36%)。两组患者对耳鸣有或没有担心在基础疾病以及耳鸣严重程度得分方面具有显著差异(P<0.05)。结论耳鸣容易影响患者情绪,尤其是有基础疾病且耳鸣较严重的患者更易对耳鸣产生担心。患者最担心听力下降、耳鸣预后以及可能的潜在健康问题。针对患者的担忧予以疏解指导有利于促进耳鸣者康复。     

69例梅尼埃病伴耳鸣的发病特点及影响因素

目的 分析梅尼埃病患者的耳鸣特点和相关影响因素。 方法 2012年8月~2016年8月诊治的69例梅尼埃病患者,收集每位患者的纯音听阈、耳鸣患侧、持续时间、睡眠质量,采用耳鸣残障量表(THI)、眩晕残障程度评定量表(DHI)(中文版)评分。 结果 (1) 耳鸣主调频率为低频者31例,中频15例,高频23例。耳鸣响度<10 dB(SL)、10~14 dB(SL)、≥15 dB(SL)分别为41例、18例、10例;持续性耳鸣患者60例,间歇性耳鸣9例;一侧耳鸣患者58例,双侧耳鸣患者11例;(2) 伴有持续性耳鸣(t=3.099,P=0.008),睡眠质量较差(t=2.987, P=0.012),耳鸣响度较大(F=3.356,P=0.013)的患者其THI评分高于间断性耳鸣、睡眠质量较好、耳鸣响度较小的患者;(3) 多元线性回归分析结果显示,耳鸣发作频率、病程、平均听阈与DHI评分呈正相关。 结论 梅尼埃病患者伴随的耳鸣特点主要为持续低频性耳鸣。耳鸣的严重程度与耳鸣的响度、持续时间、睡眠质量有关。梅尼埃病患者性别、年龄、耳侧、双温试验对DHI评分无影响,但发作频率、持续时间、平均听阈均为影响评分的主要因素,发作频率越高的患者,其眩晕感觉越重。     

Tinnitus characteristics and associated variables on Tinnitus Handicap Inventory among a Hungarian population

BackgroundTinnitus is a sound precepted without an external sound stimulus. Its background can be categorised into primary and secondary cases. The secondary cases include pathologies of the external, middle and inner ear. Tinnitus can be objective or subjective; the latter can only identified by the sufferer. Previous research results have shown that tinnitus significantly affects the quality of life and daily functioning.ObjectivesTo analyse the impact of tinnitus on the daily functioning and the possible influence of demographical data and tinnitus duration on it.Methods630 patients (265 males and 365 females, 25–85 years of age) suffering from primary tinnitus were enrolled. In the Hungarian language, these patients completed the Tinnitus Handicap Inventory (THI) questionnaire and underwent a complete otorhinolaryngological examination. IBM SPSS V24 software was used for data processing; correlation tests, the Mann-Whitney U and Kruskal-Wallis non-parametric tests were used.ResultsAccording to the THI questionnaires outcomes, most patients (62.5%) were presented with a mild handicap. Based on statistical analysis, no significant correlation was observed between the total THI points and the age of the patients, along with the duration and localisation of the symptoms. However, the total THI scores of male and female patients significantly differed, indicating higher THI values in the female group (p = 0.000521).ConclusionsThe tinnitus severity was not affected by the duration, localisation of the symptoms and age but by gender, indicating higher values in the case of females.     

Effect of Melatonin on Tinnitus

Objective: Evaluate melatonin as a treatment for subjective tinnitus. Study Design: Randomized, prospective, double-blind, placebo-controlled crossover trial. Patients were given 3.0 mg melatonin, which was taken nightly for 30 days followed or preceded by a placebo nightly for 30 days, with a 7-day washout period between medications. Setting: Outpatient, private, neurotology practice. Patients: Thirty patients with subjective tinnitus. Main Outcome Measures: Tinnitus matching, Tinnitus Handicap Inventory (THI), patient questionnaire and interview. Results: The average pretreatment THI score was 33.91 as compared with 26.43 after the placebo and 26.09 after melatonin. The difference in the THI scores between melatonin and placebo treatment were not statistically significant. The average pretreatment THI score for patients who reported overall improvement with melatonin was statistically higher (P = 0.02) than the average pretreatment THI score for patients who reported no improvement with melatonin. Among subjects reporting difficulty sleeping attributable to their tinnitus, 46.7% reported an overall improvement after melatonin compared with 20.0% for placebo (P = 0.04). There was also a statistically significant difference in improvement with melatonin for those patients with bilateral tinnitus compared with those with unilateral tinnitus (P = 0.02). Conclusion: Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are most likely to benefit from treatment with melatonin. In light of its minimal side effects, melatonin should be a part of the physician's armamentarium in the treatment of tinnitus.