Course of hearing loss and occurrence of tinnitus

Chronic tinnitus is often accompanied by a hearing impairment, but it is still unknown whether hearing loss can actually cause tinnitus. The association between the pitch of the tinnitus sensation and the audiogram edge in patients with high-frequency hearing loss suggests a functional relation, but a large fraction of patients with hearing loss does not present symptoms of tinnitus. We therefore, investigated how the occurrence of tinnitus is related to the shape of the audiogram. We analyzed a sample where all patients had noise-induced hearing loss, containing 30 patients without tinnitus, 24 patients with tone-like tinnitus, and 17 patients with noise-like tinnitus. All patients had moderate to severe high-frequency hearing loss, and only minor to moderate hearing loss at low frequencies. We found that tinnitus patients had less overall hearing loss than patients without tinnitus. Moreover, the maximum steepness of the audiogram was higher in patients with tinnitus (-52.9+/-1.9 dB/octave) compared to patients without tinnitus (-43.1+/-2.4 dB/octave). Differences in overall hearing loss and maximum steepness between tone-like and noise-like tinnitus were not significant. For tone-like tinnitus, there was a clear association between the tinnitus pitch and the edge of the audiogram, with tinnitus pitch being on average 1.48+/-0.12 octaves above the audiogram edge frequency, and 0.81+/-0.1 octaves above the frequency with the steepest slope. Our results suggest that the occurrence of tinnitus is promoted by a steep audiogram slope. A steep slope leads to abrupt discontinuities in the activity along the tonotopic axis of the auditory system, which could be misinterpreted as sound.     

Hearing impairment and tinnitus pitch in patients with unilateral tinnitus: comparison of sudden hearing loss and chronic tinnitus

OBJECTIVES: The objectives were to analyze the results of pitch-matching and loudness-balance testing in patients with unilateral tinnitus and to evaluate the relationship between audiological findings based on the tinnitus-affected and tinnitus-unaffected threshold differences and tinnitus pitch by using linear interpolation methods. In addition, the effects of the duration of the tinnitus on this relationship were investigated. Sudden sensorineural hearing loss with tinnitus was selected for the "acute tinnitus" group, and unilateral tinnitus with unknown disease and a duration of more than 3 months was selected for the "chronic tinnitus" group. STUDY DESIGN: Retrospective study of the clinical records of patients. METHODS: One hundred thirty-two patients with unilateral tinnitus (comprising 68 female [51.5%] and 64 male [48.5%] patients) were investigated as subjects. Their mean age was 50.4 years (SD = 15.8 y). All patients underwent otoneurological testing, including the pure-tone audiogram and pitch-matching and loudness-balance tests. RESULTS: The mean difference in the hearing threshold between the tinnitus-affected ear and the tinnitus-unaffected ear was largest near the tinnitus pitch in both the acute and the chronic tinnitus groups. However, the relationship between hearing impairments and tinnitus pitch was somewhat different in the two groups: It exhibited a single smooth peak in the acute tinnitus group but a bimodal peak in the chronic tinnitus group. CONCLUSION: The results suggest that tinnitus is related to hearing impairment in the same frequency region in patients with sudden sensorineural hearing loss with tinnitus or in patients with chronic tinnitus, whereas some instances of chronic tinnitus are caused by reorganization in cortical cells.     

正常听力耳鸣患者的耳鸣音调

目的通过观察正常听力耳鸣患者的耳鸣音调分布状况,探讨耳鸣的听力下降相关机理。方法总结美国Iowa大学医院2000—2007年耳鸣患者数据库,根据听力图筛选196例耳鸣患者中的听力正常者,对他们的耳鸣音调进行观察。结果耳鸣患者中有34.69%为正常听力者,听力正常耳鸣患者的耳鸣音调分布从500Hz至8kHz频率范围,8kHz耳鸣音调患者占55.88%。最大听阈提高频率与耳鸣音调之间不存在相关性。结论耳鸣可以存在于正常听力人群中,耳鸣音调分布范围较广,耳鸣起源于听力损失的理论不适用于解释正常听力耳鸣人群,耳鸣产生的机理不能用单一的理论来解释。     

Masking of tinnitus compared to masking of pure tones

In 10 subjects with sensorineural tinnitus (associated with a sensorineural hearing loss and no apparent source for a tinnitus originating elsewhere), the minimum level required to mask the tinnitus was determined for tonal maskers at several masker frequencies. This tinnitus masking pattern was compared to a psychoacoustical tuning curve (PTC) in which the signal frequency and level were determined from tinnitus pitch and loudness matching. Different patterns emerged. One subject showed a near-normal PTC but required high-level maskers across the frequency range to mask the tinnitus. Another subject showed some frequency resolution in the PTC but required low-level maskers across the frequency range to mask the tinnitus. For the remaining eight subjects, the masker levels required to mask the tone were generally higher than those levels required to mask the tinnitus. In addition, it was noted that the tinnitus pitch-match frequency was sometimes associated with an increase or a decrease in threshold sensitivity, or it was found at the low-frequency edge of a steep high-frequency threshold loss. In other subjects there was no apparent relationship between the tinnitus pitch and the audiogram shape.     

Relationship between tinnitus pitch and edge of hearing loss in individuals with a narrow tinnitus bandwidth

Objective: Psychoacoustic measures of tinnitus, in particular dominant tinnitus pitch and its relationship to the shape of the audiogram, are important in determining and verifying pathophysiological mechanisms of the condition. Our previous study postulated that this relationship might vary between different groups of people with tinnitus. For a small subset of participants with narrow tinnitus bandwidth, pitch was associated with the audiometric edge, consistent with the tonotopic reorganization theory. The current study objective was to establish this relationship in an independent sample. Design: This was a retrospective design using data from five studies conducted between 2008 and 2013. Study sample: From a cohort of 380 participants, a subgroup group of 129 with narrow tinnitus bandwidth were selected. Results: Tinnitus pitch generally fell within the area of hearing loss. There was a statistically significant correlation between dominant tinnitus pitch and edge frequency; higher edge frequency being associated with higher dominant tinnitus pitch. However, similar to our previous study, for the majority of participants pitch was more than an octave above the edge frequency. Conclusions: The findings did not support our prediction and are therefore not consistent with the reorganization theory postulating tinnitus pitch to correspond to the audiometric edge.     

耳鸣声学特征与扩展高频听阈的关系

目的 探讨纯音听阈正常的耳鸣患者耳鸣音调与扩展高频听阈的关系。 方法 对156例纯音听阈正常的耳鸣患者进行耳鸣生理声学检测,以纯音听阈正常的无耳鸣患者为对照组,对两组均进行扩展高频听阈检测。按年龄(25~35岁、36~45岁、46~55岁、≥55岁)分组,比较各组扩展高频听阈的平均值。将耳鸣组患者按耳鸣音调进行分类:低频组(125 Hz、250 Hz、500 Hz)、中频组(1.5 kHz、3 kHz)、高频组(4 kHz、6 kHz、8 kHz、≥9 kHz),一共9组,将各扩展高频平均听阈值(9 kHz、10 kHz、11.2 kHz、12.5 kHz、14 kHz、16 kHz)与对照组患者分别比对分析。 结果 耳鸣组和无耳鸣组之间比较,扩展高频各频率平均阈值差异无统计学意义(P>0.05),但各年龄组之间对比,年龄、是否耳鸣对扩展高频平均听阈都有显著影响。耳鸣音调1.5 kHz耳鸣组中9 kHz、耳鸣音调3 kHz耳鸣组中11.2 kHz、耳鸣音调4 kHz耳鸣组中10 kHz、耳鸣音调6 kHz耳鸣组中10 kHz和11.2 kHz、耳鸣音调8 kHz耳鸣组中10 kHz和11.2 kHz、耳鸣音调≥9 kHz耳鸣组中10 kHz、11.2 kHz和12.5 kHz平均阈值与对照组比较差异有统计学意义。 结论 扩展高频听阈下降与是否耳鸣、年龄有关。10 kHz、11.2 kHz平均听阈值下降与中、高频耳鸣有关联,特别是对高频耳鸣的患者很敏感,可以作为早期评估高频耳鸣患者早期耳蜗功能的敏感指标。     

无自觉听力障碍的耳鸣患者462例听力分析

目的:探讨耳鸣的危险因素,为耳鸣的预防提供科学依据。方法:通过分析462例以耳鸣为惟一主诉的患者听力情况及其耳鸣调查表中所提供的病史,了解各型听力曲线的患者年龄分布、性别特点及所占比例,分析其与噪声接触史、耳毒药物、基础疾病之间的关系。结果:①高频下降型、低频下降型、正常型、中频切迹型、覆盆型及其他型听力曲线所占比例依次为:46.10%、15.80%、14.07%、11.04%、7.58%、5.41%;②年龄分布:高频下降型主要分布在30～40岁患者,低频下降型、正常型、中频切迹型主要分布在20～30岁患者,覆盆型主要分布在50岁以上患者;③男女比例:高频下降型、低频下降型、正常型、中频切迹型、覆盆型及其他型依次为158/55、14/59、29/36、12/39、20/15、9/16;④危险因素:高频下降型、低频下降型、中频切迹型、覆盆型主要危险因素分别为:噪声接触、疲劳或/和精神压力、长期接触乐器、高龄;正常型及其他型未发现明确的危险因素。结论:无自觉听力障碍的耳鸣患者中,听力异常率高达86.00%,其中高频下降型高达46.10%,噪声为主要危险因素,男性为主要受害者;低频下降型占15.80%,疲劳或精神压力为主要危险因素,女性为主要受害者;中频切迹型占11.04%,长期接触乐器为主要危险因素;覆盆型占7.58%,高龄为主要危险因素。     

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.     

Re-examining the relationship between audiometric profile and tinnitus pitch

Abstract

Objective: We explored the relationship between audiogram shape and tinnitus pitch to answer questions arising from neurophysiological models of tinnitus: ‘Is the dominant tinnitus pitch associated with the edge of hearing loss?’ and ‘Is such a relationship more robust in people with narrow tinnitus bandwidth or steep sloping hearing loss?’ Design: A broken-stick fitting objectively quantified slope, degree and edge of hearing loss up to 16 kHz. Tinnitus pitch was characterized up to 12 kHz. We used correlation and multiple regression analyses for examining relationships with many potentially predictive audiometric variables. Study Sample: 67 people with chronic bilateral tinnitus (43 men and 24 women, aged from 22 to 81 years). Results: In this ample of 67 subjects correlation failed to reveal any relationship between the tinnitus pitch and the edge frequency. The tinnitus pitch generally fell within the area of hearing loss. The pitch of the tinnitus in a subset of subjects with a narrow tinnitus bandwidth (n = 23) was associated with the audiometric edge. Conclusions: Our findings concerning subjects with narrow tinnitus bandwidth suggest that this can be used as an a priori inclusion criterion. A large group of such subjects should be tested to confirm these results.

Sumario

Objetivo: Exploramos la relación entre la forma del audiograma y el tono del acufeno para responder a preguntas provenientes de modelos neurofisiológicos del acúfeno: ‘Es el tono dominante del acúfeno asociado con el borde de la hipoacusia?’y ‘Será tal relación más robusta en personas con un acúfeno de banda angosta o con una hipoacusia de caída abrupta?’ Diseño: Una pendiente tipo “palo roto” objetivamente cuantificada, con severidad y borde de la hipoacusia hasta 16 kHz. El tono del acúfeno fue caracterizado hasta 12 kHz. Utilizamos un análisis de correlación y regresión múltiple para examinar la relación con muchas de las variables potencialmente predictivas. Muestra del estudio: 67 personas con acúfeno bilateral crónico (43 hombres y 24 mujeres con edades entre 22 y 81 años). Resultados: En esta amplia muestra de 67 sujetos, la correlación no demostró ninguna relación entre el acúfeno y el borde de la frecuencia. El tono del acúfeno generalmente cayó dentro del área de la hipoacusia. En un subgrupo de sujetos, que tenían un acúfeno de banda angosta (n=23), si hubo asociación con el borde audiométrico. Conclusiones: Nuestros hallazgos que corresponden a los sujetos con un acúfeno de banda angosta, sugieren que esto puede ser utilizado a priori como un criterio de inclusión. Un grupo grande de sujetos debe ser examinado para confirmar estos resultados.     

耳鸣患者1/24倍频程精细化纯音测试结果分析

目的了解精细化匹配耳鸣位点与听损最大点之间的关系,分析耳鸣患者听力及临床特征与耳鸣的关系。方法对常频听力正常及异常组均进行1/24倍频程精细化纯音测听,寻找听损最大点及耳鸣位点;两组患者均进行病史分析,分析耳鸣患者听力及临床特征与耳鸣的关系。结果常频听力正常的患者38例行1/24倍频程精细化听力测试,检出听力损失者12例;两组患者127例均进行1/24倍频程听力精细化测试及耳鸣位点精细化评估,其中36例患者听力损失最大点和耳鸣位点一致。将常频听力正常组和异常组临床特征对比分析,常频听力异常组高血压、脑供血不足、睡眠障碍的发病率高于常频听力正常组。结论常频听力正常的患者行1/24倍频程精细化纯音测听可提高耳鸣声治疗的“靶向性”。     

Spontaneous Otoacoustic Emissions in Tinnitus Patients

IntroductionOtoacoustic emissions (OAEs) are believed to bethe products of active cochlear mechanics. The activityprocess in the cochlea is important for hearing sensitivi-ty, fine-tuning and maybe self-protection. Compromiseof this process is usually accompanied by hearing loss,auditory distortion and often tinnitus. It is now generallyagreed that OAEs are associated with relatively intactouter hair cell function. The relations between the cen-tral and peripheral auditory systems can be co…     

The relationship between stream segregation and frequency discrimination in normally hearing and hearing-impaired subjects

We examined the relationship between the fission boundary (FB) at which a sequence of pure tones alternating between two frequencies cannot be heard as two separate streams and the frequency difference limen (FDL), using normally hearing subjects and subjects with cochlear hearing loss. The stimuli used in the two tasks were as similar as possible in duration and inter-tone interval. The frequency range examined was 250-8000 Hz for the normally hearing subjects and 250-2000 Hz for the hearing-impaired subjects. For normally hearing subjects, the FBs were almost invariant with frequency when expressed as ERB(N) values; the mean FB was about 0.4 ERB(N). The FDLs, also expressed as ERB(N) values, increased for frequencies above 2000 Hz. The ratio FB/FDL was roughly constant at 7-9 in the frequency region 250-2000 Hz, but decreased for higher frequencies, reaching about 1 at 8000 Hz. For the hearing-impaired subjects, FB/FDL ratios varied over a large range (1-40), and were not systematically related to the amount of hearing loss. These results suggest that the FB is not determined solely by the discriminability of successive tones.     

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.     

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.

Endolymphatic hydrops in patients with tinnitus as the major symptom

Tinnitus is one of the symptoms of Meniere’s disease. The relationship between a clinical presentation of subjective tinnitus or ear fullness and endolymphatic hydrops (EH) has not yet been explored. We studied 15 patients with symptoms of tinnitus as their major complaint, with or without hearing loss, who were evaluated using magnetic resonance imaging (MRI). The mean age of the subjects was 59 years (range 35–79 years). Nine were women and six were men. Patients were divided into two groups based on whether they had fluctuating or stable tinnitus. These groups were subdivided in the presence or absence of accompanying sensation of ear fullness. MRI was performed 4 h after intravenous gadolinium administration. Overall, 30 ears were evaluated. EH in the cochlea was present in 14 of 25 symptomatic ears (56 %) in patients with tinnitus as the major complaint. Significant hydrops was present in 7 of 14 ears and mild hydrops in the other ears. Patients with fluctuating tinnitus had EH more frequently than patients with stable tinnitus. Furthermore, the presence of ear fullness also correlated with the presence of EH in the cochlea. However, there was no significant relationship between EH in the cochlea and age, sex, duration of tinnitus, hearing level or the configuration of the audiogram. Our study revealed that patients who had tinnitus as their major symptom often had EH. Using MRI to identify this covert early EH in patients who have tinnitus as their major symptom may broaden the treatment options for tinnitus.     

The relationship between tinnitus pitch and hearing sensitivity

Tinnitus is the phantom perception of sounds. No single theory explaining the cause of tinnitus enjoys universal acceptance, however, it is usually associated with hearing loss. The aim of this study was to investigate the relationship between tinnitus pitch and audiometry, minimum masking levels (MML), tinnitus loudness, and distortion product otoacoustic emissions (DPOAE). This was a retrospective analysis of participant’s records from the University of Auckland Hearing and Tinnitus Clinic database. The sample consisted of 192 participants with chronic tinnitus (more than 18 months) who had comprehensive tinnitus assessment from March 2008 to January 2011. There were 116 males (mean = 56.5 years, SD = 12.96) and 76 females (mean = 58.7 years, SD = 13.88). Seventy-six percent of participants had a tinnitus pitch ≥8 kHz. Tinnitus pitch was most often matched to frequencies at which hearing threshold was 40–60 (T50) dBHL. There was a weak but statistically significant positive correlation between tinnitus pitch and T50 (r = 0.15 at p < 0.05). No correlation was found between tinnitus pitch and DPOAEs, MML, audiometric edge and worst threshold. The strongest audiometric predictor for tinnitus pitch was the frequency at which threshold was approximately 50 dBHL. We postulate that this may be due to a change from primarily outer hair cell damage to lesions including inner hair cells at these levels of hearing loss.     

正常听力耳鸣患者听尼特TM检测及高刺激率听觉脑干反应结果及分析

目的 观察正常听力耳鸣患者的耳鸣音调、响度、掩蔽曲线及高刺激率听觉脑干反应(ABR)检测结果，探讨耳鸣的临床特征及发病机制。方法 选取162例正常听力耳鸣患者，对其进行耳鸣音调、响度匹配，同时选取其中140例单侧耳鸣患者，对140患耳与对侧140健耳，分别进行高、低刺激率ABR检测，比较不同刺激率下PL差值(△PL)、IPL差值(△IPL)。结果 听力正常耳鸣的耳鸣音调分布从125～8000Hz，以4000～8000Hz高频为主；耳鸣响度从0～20dB，5～10dB最多；佛德曼曲线以汇聚型为主；患耳与健侧耳高、低刺激率ABR Ⅰ～Ⅴ △IPL差值＞0.28ms的耳数分别为16耳及12耳，差值无显著意义(P＞0.05)。结论 总结162例听力正常耳鸣患者的临床特征，为进一步的临床诊疗提供依据；耳鸣起源于内耳微循环障碍的理论不适用于解释正常听力耳鸣患者，耳鸣产生的机制可能不能用单一的理论解释。     

不同类型听力下降伴耳鸣治疗的疗效分析

目的通过分析耳鸣与听力下降的关系,总结耳鸣与不同类型听力下降的关联性,以及不同类型听力下降所伴有耳鸣的治疗效果。方法分析2016年1月~2017年6月因“耳鸣”或者因“听力下降伴有耳鸣”就诊的急性耳鸣患者188例,其中男102例,女86例;年龄23~62岁,平均年龄44岁。双侧耳鸣者65例,单侧耳鸣者123例。所有患者入院时均进行电测听及耳鸣检查,根据听力曲线类型对耳鸣患者进行分组,其中听力正常者12例,低频听力下降者36例,高频听力下降者84例,平坦听力下降者42例,全聋型14例。入院后所有患者予以行营养神经、改善循环、激素冲击等治疗,并于入院当日、第3天、第5天及第10天行听力检查及耳鸣检查,比较各组患者耳鸣治疗的疗效。结果不同听力下降类型的耳鸣患者构成比比较,差异具有统计学意义（P＜0.05）。听力正常者耳鸣治疗有效率为91.67%（11/12）,低频听力下降组耳鸣治疗有效率为83.33%（30/36）,高频听力下降组耳鸣治疗有效率为54.76%（46/84）,平坦型听力下降组耳鸣治疗有效率为69.05%（29/42）,全聋型听力下降组耳鸣治疗有效率为28.57%（4/14）,对各组的耳鸣治疗有效率进行比较,差异具有统计学意义（P＜0.05）。结论高频听力下降者耳鸣发生率最高,听力正常者耳鸣发生率最低。听力正常及低频听力下降者耳鸣治疗有效率最高,高频听力及全聋者耳鸣治疗效果较差。     

Tinnitus Pitch and Acoustic Trauma

56 Subjects complaining of tinnitus underwent an audiometric test and a test for identifying the analogous pitch of their tinnitus. All of the subjects reported that they had been exposed to noise in the past. The subjects were divided into two groups on the basis of their audiometric test results. Group P was composed of subjects who showed a sensorineural hearing loss typical of acoustic trauma. Group N was composed of subjects whose hearing was within normal limits. The pitch of the tinnitus in group P was concentrated in the high-frequency range, whereas in group N tinnitus pitch values were distributed over the low and mid-audiometric frequency spectrum. It was deduced that different processes are involved in the generation of tinnitus in the two groups.     

Tinnitus pitch and acoustic trauma

56 Subjects complaining of tinnitus underwent an audiometric test and a test for identifying the analogous pitch of their tinnitus. All of the subjects reported that they had been exposed to noise in the past. The subjects were divided into two groups on the basis of their audiometric test results. Group P was composed of subjects who showed a sensorineural hearing loss typical of acoustic trauma. Group N was composed of subjects whose hearing was within normal limits. The pitch of the tinnitus in group P was concentrated in the high-frequency range, whereas in group N tinnitus pitch values were distributed over the low and mid-audiometric frequency spectrum. It was deduced that different processes are involved in the generation of tinnitus in the two groups.