The prevalence of psychological disturbance in neurotology outpatients.

This study assesses the prevalence of psychological disturbance among a consecutive series of 120 neuro-otology outpatients, using a structured interview conducted by a clinical psychologist. 42% of all patients were found to be in need of, and were offered, psychological help (27% of those with hearing loss, 45% of those with tinnitus and 64% of those with dizziness). 86% of those offered psychological help accepted it. Current psychological distress was associated with the number of symptoms complained of and past psychiatric history. Patients completed the General Health Questionnaire which was found to have a sensitivity rate of 82% and a specificity rate of 87% in this setting. Physicians were also asked to rate patients' psychological state; close agreement was found between these ratings and those of a psychologist. The contribution of psychological assessment of neuro-otology patients is discussed.     

A retrospective case-controlled study of 1490 consecutive patients presenting to a neuro-otology clinic to examine the relationship between blood lipid levels and sensorineural hearing loss

This study set out to test the null hypothesis that the distribution of blood lipid levels is the same in a population with a sensorineural hearing loss (SNHL) as in a control population. Hyperlipidaemia has been implicated as an aetiological factor in SNHL; however, the majority of reports are retrospective, lack adequate controls, or are based on a series of cases which may represent incidental findings and not a true causal relationship. In all, 1490 consecutive patients who presented to a neuro-otology clinic were studied retrospectively. This group is exceptional in that all patients had had fasting lipid profiles done regardless of their presenting problem. Those with a mean SNHL > 25 dB (0.5, 1, 2 and 4 kHz) were compared with those with hearing thresholds < or = 25 dB. An analysis of variance was also done. The study group was also compared with the National Study of Hearing data set to add external validity. Simple correlations were found between hearing thresholds and many parameters such as blood pressure, fasting glucose, triglyceride or fasting cholesterol. Analysis of variance of the neuro-otology group, controlling for variables such as age and sex, showed no significant association between hearing and blood pressure, packed cell volume, mean corpuscular volume, fasting glucose, triglyceride or fasting cholesterol. However, when general linear interactive modelling was used to analyse hearing thresholds, raised total fasting cholesterol was associated with significantly better hearing threshold levels. This study leads to a rejection of the Null hypothesis that the distribution of lipid levels is the same in a population with a hearing loss as in a control population, as hearing thresholds were found to be significantly better in those with raised cholesterol levels.     

Long term outcome of psychogenic voice disorders

Objectives

To evaluate different therapy for psychogenic voice disorders.

Methods

Epidemiological data, organic and psychological symptoms, therapeutic options and outcome were prospectively analyzed in 40 consecutive patients with psychogenic voice disorders. Their voice was evaluated by subjective means and self assessment (voice handicap index) and an organic or functional disorder was excluded by videolaryngostroboscopy. Additionally, a detailed psychological examination and exploration were made. Every patient received intensive voice exercises with biofeedback by a phoniatrician and counseling by a clinical psychologist. Following this, therapy options of psychotherapy or a combination of psychotherapy and voice therapy were given. After an interval (average 16 months) from first contacting our section, every patient was asked to complete a questionnaire about their therapies and quality of voice.

Results

Patients had previously received insufficient voice therapy or antibiotics. The psychological examination detected psychological disorders as a basic problem. Overall, in 70% of patients there was either an improvement or resolution of voice problems. For all patients psychotherapy or a combination of voice therapy and psychotherapy was recommended, but only accepted in 37.5%. In all cases, when psychotherapy in combination with speech therapy took place, it was successful, whereas speech therapy alone provided improvement only in 12.5%.

Conclusion

Psychogenic voice disorders are often misdiagnosed, leading to inadequate therapy. Psychotherapy (often in combination with voice therapy) was most effective also in the long term, but is often not accepted by patients. Voice therapy alone had a poor success rate.     

Somatic and psychological factors contributing to handicap in people with vertigo.

Questionnaires assessing symptoms, disability and handicap, predisposition to anxiety, and current anxiety and depression were completed by 127 people attending neuro-otology clinics with a major complaint of vertigo or dysequilibrium. Definite signs of vestibular dysfunction (spontaneous or positional nystagmus, or canal paresis) were found in 56% of the sample, but the presence or absence of abnormal vestibular test results was unrelated to diagnosis, reported symptoms, handicap and psychological status. Two-thirds of employed respondents admitted to occupational difficulties, and more than one in seven had left work because of vertigo. Although the number of people in the sample with a predisposition to anxiety was not unusually high, over a third of the sample had abnormally elevated levels of current anxiety. Multiple regression analyses indicated that disability was determined mainly by physical factors (vertigo severity and duration, age and sex). Handicap was influenced by a mixture of somatic and psychological variables, including the severity of autonomic symptoms. Anxiety and depression were only indirectly related to the severity and duration of the vertigo, insofar as this contributed to handicap. The partial dissociation between these different aspects of patient well-being suggests a need for separate evaluation and differing management of problems at each level of functioning.     

Auditory and vestibular damage in head injuries at work

A series of 50 unselected patients who reported a head injury to the Workers' Compensation Board of British Columbia were referred to the AudioVestibular Unit of the Vancouver General Hospital for studies of auditory and vestibular function. All patients were interviewed and examined by a neuro-otology team during the course of their investigation. It was found that dizziness was the most common symptom of which they complained (60%), and bleeding from the ear was the least common (4%). Of the 50 patients studied, 32% showed evidence of either auditory and/or vestibular injury. Of the total number studied, 16% had auditory injuries and 26% had vestibular injuries. The most common auditory injury was unilateral partial loss of hearing. Central vestibular dysfunction was the most common vestibular injury. A study of the most effective means of selecting patients from the population with head injuries for referral for audiology and vestibular testing was undertaken. The most effective combination of symptoms for referral is the presence of one or more of the triad: hearing loss, unsteadiness, or loss of consciousness/amnesia.     

Joint medico-psychological consultation for patients suffering from tinnitus

Because no effective treatment against tinnitus is available, all sorts of approaches have been developed. We believe the care of tinnitus patients concerns mainly ENT medical doctors. In order to take care of such patients, we started in 1993 a joint medico-psychological consultation (JMPC) to dispense adequate care for patients and training to the ENT residents. Every patient visiting our clinic for a tinnitus consultation benefits first from a comprehensive audiological examination. Once all objective causes of tinnitus are excluded, those patients who were not able to accept their auditory disorder or who insist on focusing on the annoyance caused by the perception of their tinnitus are invited by the doctor to the JMPC. The intolerance caused by tinnitus is enhanced by psychological and social aspects. These aspects are considered and discussed during the JMPC. The patients talk about their tinnitus bringing additional information on professional, familial and relational issues. In the JMPC, the therapists try to help the patients to void the affective irritation and the internal tension they clearly demonstrate. When the patients notice that the therapists accept their distress, they usually talk more calmly about their hearing irritation and even consider it tolerable. The medical and psychological information given during the JMPC helps the patients to understand the links between tinnitus and the disturbing elements of their current life. During the JMPC, the medical residents have been able to observe how somatic complaints can lead to complaints of another nature, to distress, to aggressive or angered behaviors. They have acknowledged the way the psychologist deals with the attitudes of these patients. This learning process became mandatory to all our residents specializing in ENT. At the end of their training they should have learned how to help the patient accept the tinnitus and the irritation it causes. They should be able to help tinnitus patients to stop searching for a treatment that does not exist in the so-called specialized centers, which often do not fulfill their expectations.     

Psychological evaluation of the child with a suspected central auditory dysfunction

I have attempted to summarize the role of the psychologist and psychological evaluation in assessing a child with a suspected central auditory dysfunction. The reasons why a child may be referred for a psychological evaluation along with some of the exhibiting behaviors were discussed. The role of the psychological evaluation was examined. The indications for psychological evaluation in central auditory dysfunction were presented and alternative types of education were discussed.     

精神性眩晕临床诊疗初探

目的：研究轻中症精神性眩晕的临床评价与干预方法。方法选取精神性眩晕患者37例，平均年龄46.1（20～68）岁，采用症状自评量表（Self-reporting Inventory），即90项症状清单（Symptom Checklist-90，SCL-90）、抑郁自评量表（Self-rating Depression Scale，SDS）和焦虑自评量表（Self-rating Anxiety Scale，SAS）评定为轻中度异常。对患者进行乌灵菌粉药物干预和心理干预，持续28天；安排2次随访（基线和第28天），随访中评估眩晕的症状（包括严重程度、持续时间及发作频率、伴随症状等）并进行精神心理评价。结果①原发性精神性眩晕17例，继发性精神性眩晕20例。原发性精神性眩晕主要表现为不稳感和漂浮感，而旋转感、倾倒感和站立困难均为继发性精神性眩晕；②治疗后，患者不稳感和漂浮感改善，与治疗前比较差别显著（P〈0.05）；③治疗前，SCL-90躯体化障碍患者占91.9%（34/37），焦虑自评异常患者占91.9%（34/37），抑郁自评异常患者占56.8%（21/37）；心理评价为轻度异常的占86.5%（32/37），中度异常占13.5%（5/37）；治疗后躯体化障碍、焦虑和抑郁的异常率都有下降，且差别显著（P〈0.05）。结论乌灵菌粉制剂可改善轻中症的精神性眩晕症状,对出现的轻中度焦虑和抑郁状态、躯体症状（本文主要为眩晕）有一定疗效；必要的心理干预有助于建立医患互信，实现良好的医嘱依从性。     

Application of autogenic training in patients with Ménière disease

Data are limited on the role of psychotherapy in the treatment of Ménière disease. We sought to document the effect of a psychotherapeutic technique known as autogenic training on clinical outcome in Ménière disease. Six patients with Ménière disease were studied. Retrospective chart review was conducted. All patients were refractory to conventional therapy and completed a course of autogenic training, which was offered as a complementary treatment. Autogenic training with initial psychological counseling was conducted by a clinical psychologist during 45-min sessions. Outcome measures assessed were the frequency of vertigo and functional levels 2 years after initiation of autogenic training. Functional levels were evaluated according to the 1995 guidelines of the American Academy of Otolaryngology-Head Neck Surgery (AAO-HNS). As a personality measure, we used the Maudsley Personality Inventory (MPI), devised by Eysenck, which measures neuroticism (N), extraversion (E), and propensity to lie (L). Five of six patients showed improved functional level after three to eight sessions of psychotherapy; hearing level did not change. The score of the N scale of the MPI was closely related to the number of psychotherapy sessions. Prognosis was evaluated based on the AAO-HNS reporting guidelines, as follows: A = 3, B = 1, C = 1, F = 1. The value of N in MPI was closely related to the number of psychological counseling sessions (R = 0.97, P < 0.05). In conclusion, autogenic training may enhance the mental well-being of patients with Ménière disease and improve clinical outcome.     

Chronic subjective dizziness

Conclusion. Chronic subjective dizziness (CSD) is frequent and affects twice as many women as men. Anxiety is a strong predisposing factor. The pathophysiologic concept of this disorder assumes that balance function and emotion share common neurologic pathways, which might explain that the balance disorder can provoke fear and vice versa, giving rise to a problem in perception of space and motion. In anxious patients this can turn into a space and motion phobia, with avoidance behaviour. Objective. CSD is a diagnosis based on the hypothesis of an interaction between the vestibular system and the psychiatric sphere. Patients complain of chronic imbalance, worsened by visual motion stimulation, and frequently suffer from anxiety. Vestibular examination reveals no anomalies. We evaluated the incidence and characteristics of CSD in patients referred to our neuro-otology centre (tertiary hospital outpatient clinic). Subjects and methods. This was a retrospective study of 1552 consecutive patients presenting with vertigo. CSD was diagnosed in 164 patients (female:male=111:53). Results. CSD represents 10.6% of the dizzy patients in our clinic. Psychiatric disorder, mainly anxiety, was found in 79.3% of the cases. Other frequently associated factors were fear of heights and former vestibular lesion (healed). In all, 79.0% of the patients with CSD had poor balance performance on dynamic posturography testing.     

The psychosocial environment of patients with neoplasms of the head and neck. A clinical study

A survey was made of 96 patients of the University ENT Clinic G?ttingen suffering from malignomas in the head and neck region, to gain insight into the patients' personal assessment of discomfort during and after tumour therapy, and into their psychological and social environment. The questionnaires were developed in cooperation with a psychologist trained in oncology. The most important result of the survey was a tendency to idealisation and alexithymia in patients with head and neck tumours. The situation of the tumour patients is characterised by a feeling of lonesomeness and isolation within their social environment. It also became evident that some of the patients in the survey had a certain "health-promoting potential". Our results are compared with reports published on the subject so far and suggestions are made for the incorporation of psychological support during and after tumour therapy.     

Initial treatment of the early stages (I, II) of supraglottic squamous cell carcinoma: partial laryngectomy versus radiotherapy

The purpose of this study was to define the treatment of choice (partial laryngectomy vs radiotherapy) in the early stage of supraglottic squamous cell cancer (ESSC). One hundred and fifteen patients with ESSC were treated with either partial laryngectomy (25 patients) or with radiotherapy(90 patients) between January 1984 and December 1996. All patients had a follow-up of over ¶29 months. Radiotherapy (RT) had a local control rate of 79%, which increased to 90% with salvage surgery, and a high larynx preservation rate (83%). Partial laryngectomy (PL) offered a better initial local control rate of 84%, which increased to 88% with salvage surgery, and functional results were also good (80%). No statistically significant differences were found between RT and PL. RT was less costly, showed better suitability for treatment, produced moderate morbidity and sequelae, and local recurrence was easier to rescue. However, it is a once-only application technique. PL showed higher immediate postoperative morbidity, higher cost and lower suitability for treatment but had fewer sequelae, offered the best initial local control and is multi-applicable. No clear oncological arguments were found in our series to define whether PL or RT is the treatment of choice for ESSC. Both are effective therapies. Secondary factors such as suitability for treatment, morbidity, cost and applicability should be individually evaluated when choosing the type of treatment. As the laser endoscopic approach decreases morbidity and costs and makes the condition more suitable for treatment, it could be the treatment of choice for ESSC, in cases where local tumoral extent and larynx exposure allow radical excision.     

Matched and self-reported loudness of tinnitus: methods and sources of error

A consecutive series of 62 patients who reported tinnitus at the time of their first attendance at a neuro-otology clinic were studied. Loudness matches were obtained both at the frequency of the tinnitus and at 1 kHz. These matches were expressed in dB HL, dB SL and in units derived from individualised loudness functions (personal loudness units; PLUs). Self-reports of the loudness of tinnitus at the time of loudness matching were obtained on five different scales. Moderate correlations were found between self-reported loudness and some of the scales by which the loudness match was expressed. When subjects who had some difficulty with the test procedures were excluded, the correlations between PLU expressions of the matched loudness and certain of the self-report scales were found to be markedly improved. Correlations of traditional expressions of matched loudness with self-report improved to a limited extent. It was concluded that: measurement error can appreciably reduce the maximum correlation between the best self-report measure and loudness match measures; PLU conversions of matched loudness data produce the highest correlations with self-report measures of loudness, and explicitly labelled self-report scales (Guttman and adjectival) produce better correlations with loudness match values than other self-report scales.     

Proportion and characteristics of patients who were offered,enrolled in and completed audiologist-delivered cognitive behavioural therapy for tinnitus and hyperacusis rehabilitation in a specialist UK clinic

Objective: The aim was to determine the proportion and characteristics of patients who were offered, enrolled in and completed an audiologist-delivered cognitive behavioural therapy (CBT) programme for tinnitus and/or hyperacusis in a specialist Audiology Department in the National Health Service, UK. Design: This was a retrospective study. Study sample: Data were gathered for 266 consecutive patients with an average age of 56?y (standard deviation =15?y). Results: Following an initial assessment session, 68% of patients were judged to have problems sufficient for them to be offered audiologist-delivered CBT. The remaining 32% were discharged. Of those enrolled for CBT, 31% were discharged after the first CBT session, because they were judged to have insufficient tinnitus and/or hyperacusis distress. Of those offered continuing CBT, 45% declined to continue. Patients who continued were younger, had worse insomnia and had better hearing in their better ear than patients who declined. Of those who continued, 68% completed the six sessions of CBT. Conclusion: Although CBT is resource intensive, only 17% of the total patient sample received the full course of six sessions of CBT. Patients who accepted continuing CBT were younger, had worse insomnia and had better hearing than those who declined.     

Longitudinal follow-up of tinnitus complaints

OBJECTIVE: To investigate the long-term outcome of patients with tinnitus, the long-term effects of cognitive behavioral therapy, and what properties of tinnitus predict distress at follow-up. DESIGN: A longitudinal follow-up of a consecutive sample of patients with tinnitus initially seen by a clinical psychologist. SETTING: Department of Audiology, University Hospital, Uppsala, Sweden. PARTICIPANTS: A consecutive series of 189 patients with tinnitus treated between January 1988 and March 1995 were sent a postal questionnaire booklet. One hundred forty-six (77 women and 69 men) provided usable responses, in all yielding a 77% response rate. MAIN OUTCOME MEASURES: A questionnaire was derived from a structured interview "Questions About Your Tinnitus." Also included were the Tinnitus Reaction Questionnaire and tinnitus-matching data. RESULTS: Questionnaire data showed that many patients with tinnitus still experienced distress an average of 4.9 years after admission. Tolerance of tinnitus increased over time overall. For patients who had received cognitive behavioral therapy (59%), there was a reduction in tinnitus-related distress. Further, an open-ended question showed that the benefits from treatment outnumbered the deficits. Multiple regression analysis showed that tinnitus maskability at admission was a significant predictor of distress at follow-up. CONCLUSIONS: Severe tinnitus shows some signs of improvement over time, especially when psychological treatment has been given. Tinnitus maskability is an important prognostic factor of future tinnitus annoyance.     

口吃患者的心理调查与分析

目的 通过问卷调查形式了解口吃患者心理障碍的程度及其与年龄、性格、环境的关系。方法 对96例患者治疗前和治疗后分别以60道测试题从“对现实的感知性”、“情绪的稳定性”、“人际关系和谐性”、“心理适应性”等方面的心理变化和动态进行测试。结果 以上四个部分矫治前平均分分别为16.6、129.5、31.8和25.1；矫治后平均分分别为8.9、55.9、19.1和14.6。矫治后得分比矫治前均有不同程度下降。结论 口吃患者存在着严重的心理障碍，通过矫治，心理障碍问题得到了较大的改善，说明心理障碍是治疗口吃患者的关键环节。     

Ionomeric bone cement in neuro-otological surgery.

The use of a polymaleinate glass ionomer cement in 80 neuro-otology cases is described. It has proved of great value in translabyrinthine acoustic neuroma surgery, reducing the incidence of CSF fistula to nil. It is the method of choice for fixation of the Nucleus cochlear implant, and has many other applications in the field of otology and neuro-otology. It is easy to use and appears to have no side effects.     

甲状腺癌手术患者术前心理痛苦状况调查及影响因素分析

目的 调查甲状腺癌手术患者心理痛苦状况,分析其原因和影响因素,为临床护理提供依据.方法 使用一般资料问卷和心理痛苦温度计对300例甲状腺癌住院患者进行手术前心理状况调查.结果 本研究共发放问卷300份,收回300份,有效回收率100％.300例甲状腺癌手术患者术前心理痛苦得分为0～10分,平均(2.77±2.07)分,...     

Results of surgery for chronic otitis media in patients with a cleft palate

The long-term results of surgical treatment of 19 chronic ears in 16 patients with a cleft palate were analysed. The mean follow-up period was 6.5 years. The patients were found to be significantly younger than other patients with chronic otitis media. Granulating otitis media was the indication for surgery in 11 ears and cholesteatoma in 7 ears. A successful outcome after the primary operation was found in 68% of the patients. Four patients required a revision operation which was successful in all of them. Hearing results of patients with cleft palate did not differ significantly from those obtained in other patients. It is concluded that middle ear surgery should be offered to patients with a cleft palate with the same indications as in other patients with chronic otitis media.     

Adaptación transcultural en versión de lengua española del cuestionario Dizziness Handicap Inventory en la población pediátrica. Análisis de su aplicación en niños

BackgroundThe Dizziness Handicap Inventory (DHI) is a questionnaire to assess self-perception of disability produced by the effects of vestibular system disorders.It is a tool used by professionals who treat patients with balance disorders, although it is not widely used in children.The aim of this study is to carry out a cross-cultural and linguistic adaptation of the DHI children/adolescent in the Argentine population from a version already published in Portuguese and to evaluate it in a group of patients.Materials and methodsA cross-cultural adaptation was carried out, maintaining semantic, conceptual, content, technical and criteria equivalence; and it was verified that the new Argentinian version of the DHI for children and adolescents maintains the reliability of the original questionnaire. According to Beaton's et al. recommendations, the questionnaire was translated from Portuguese to Spanish (Argentine) by 2 different translators and a back-translation to the original language by 2 other translators. Since this questionnaire is directed at a paediatric population, some terms were adapted to be understood by children from 4 years old. A psychopedagogue and a psychologist joined the team to delve more deeply into the questions that focus on the emotional or psychological aspects of the symptom.ResultsNo difficulties were found in obtaining equivalent expressions from the original questionnaire to Spanish (Argentine). The internal consistency of this cross-culturally adapted questionnaire was like those already published in other languages. Most paediatric patients do not have disabilities in the areas studied. The patients with the highest total scores presented vestibular migraine as a diagnosis.ConclusionsThis questionnaire will be culturally and linguistically adapted for use in the Argentine population. The emphasis was placed on terms and expressions that could be understood by the paediatric population.