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.     

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.     

Efficacy of transmeatal low power laser irradiation on tinnitus: a preliminary report

Thirty-eight patients suffering from tinnitus resistant to several medical therapies for more than 6 months were treated by low power laser irradiation. A 40 mW laser with a wavelength of 830 nm was irradiated via their external auditory meatus toward the cochlea for 9 min once a week, 10 times or more. Patients were asked to score their symptoms on a 5 point scale before and after the treatment for a subjective evaluation of the effect. The results were estimated by the change of the loudness and duration of tinnitus, and the degree of annoyance due to tinnitus. Although only 26% of the patients had improved duration, loudness and degree of annoyance were relieved in up to 58 and 55%, respectively, without major complication. Laser therapy seemed to be worth trying on patients with intractable tinnitus.     

The efficacy and safety of multiple sessions of multisite transcranial random noise stimulation in treating chronic tinnitus

IntroductionRandom noise stimulation was reported as the more effective and safer type of electrical stimulation techniques in relieving tinnitus symptoms. The multisite protocol of transcranial random noise stimulation has shown additional favorable effects.ObjectiveHere we will discuss the role of applying eight sessions of multisite transcranial random noise stimulation in decreasing tinnitus loudness and annoyance without exerting additional adverse effects.MethodsTwenty-nine subjects (8 female), the mean age of (45.34 ± 9.57) with chronic tinnitus received transcranial random noise stimulation in the multisite protocol, 10 min of auditory-transcranial random noise stimulation applied over the T3, T4 preceded by 10 min of prefrontal-transcranial random noise stimulation applied over F4, FP1. In the first group, only one session was applied and the multiple-sessions group contained eight repeated sessions. Visual analog scale scores for loudness and distress were recorded before and immediately after the treatment. Multivariate repeated measure ANOVA test was used and minimal detectable change calculated.ResultsThere was a statistically and clinically significant reduction in tinnitus loudness and annoyance in both groups (p < 0.05, effect size (η²) > 0.8), while the amount of annoyance suppression in the multiple-sessions group was significantly greater than the single-session group. The patients of the multiple-sessions transcranial random noise stimulation group reported an improvement in their sleep and lower tinnitus handicap inventory scores without experiencing any additional adverse effects of the intervention.ConclusionsThe results of this study showed a substantial improvement in tinnitus symptoms by using the multiple sessions of transcranial random noise stimulation in the multisite protocol without producing any additional side effects. We suggest further clinical trials with long-term follow-up be investigated.     

耳鸣掩蔽结合心理咨询治疗耳鸣的长期康复效果研究

目的:探讨耳鸣掩蔽结合心理咨询治疗耳鸣的长期康复效果。方法:对耳鸣掩蔽结合心理咨询的患者在治疗前、治疗后半年、1年、2年、3年进行随访,填写耳鸣残疾评估量表。结果:共纳入86例患者。半年后应随访82例,失访9例。1年后应随访79例,失访16例。2年后应随访60例,失访26例。3年后应随访44例,失访16例。治疗后半年、1年、2年、3年耳鸣残疾评估量表得分大于等于20分的例数占应随访人数的66%、56%、40%、48%。结论:耳鸣掩蔽结合心理咨询治疗耳鸣随访1年的有效率为66%,但1年以上长期疗效由于失访率高,需进一步研究。     

Transcranial magnetic stimulation for tinnitus: influence of tinnitus duration on stimulation parameter choice and maximal tinnitus suppression.

OBJECTIVE: Tinnitus is a distressing symptom for which few treatments exist. It leads to an important decrease in quality of life in 2 to 3% of the population. Tinnitus is considered a phantom sound, the result of cortical reorganization. Transcranial magnetic stimulation (TMS) is a noninvasive method to modulate cortical reorganization and has been shown to be able to influence tinnitus perception. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary referral center. PATIENTS: The effect of TMS of the contralateral auditory cortex in 114 patients with unilateral tinnitus is investigated as one of the selection criteria used for surgical implantation of electrodes on the auditory cortex. INTERVENTION: TMS is performed at 90% of motor threshold at 1, 3, 5, 10, and 20 Hz, with each stimulation session consisting of 200 pulses. Results were classified as no effect (0-19% improvement), partial effect (20-79% improvement), and good effect (80-100 suppression). MAIN OUTCOME MEASURES: TMS had a good effect in 25% of the patients studied, partial effect in 28% patients, and no effect in 47%. RESULTS: TMS at 200 pulses is capable of tinnitus suppression for seconds only. The results were influenced by tinnitus duration: the longer the tinnitus exists, the lower the stimulation frequency that yields maximal tinnitus suppression (p < 0.001). The maximal amount of tinnitus suppression decreases in time (p < 0.01), resulting in a 2% decrease of potential tinnitus suppression per year. CONCLUSION: TMS of the auditory cortex is capable of modifying tinnitus perception for a very short time. The maximal amount of suppression and best stimulation frequency depends on the tinnitus duration.     

Transdermal electrical stimulation in sensorineural tinnitus

In 73 patients composing 84 ears, with persistent decompensated tinnitus and sensorineural deafness, tinnitus suppression was attempted with low frequency, low ampere transdermal electrical stimulation (TDES). The causes of tinnitus were presbyacusis, unknown aetiology, Noise exposure, otosclerosis, ototoxic drugs, Endolymphatic hydrops, labyrinthitis and post head injury. Reduction of tinnitus was achieved in 38 of 84 ears. Results were achieved in patients with the following order. 1) Unknown aetiology 53.3% 2) Ototoxic drugs 50% 3) Presbyacusis 45% 4) Labyrinthitis 40% 5) Post head injury, Endolymphatic hydrops & otosclerosis 33.3% each. The lasting effect of the tinnitus suppression varied from few hours to few weeks. Effective reduction could be re-achieved by re-stimulation.     

经耳道鼓室探查术手术入路的应用

经耳道鼓室探查术传统应用于传导性耳聋外科治疗，本文根据８例不同中、内耳疾患经此入路确诊及手术治疗的典型资料，对此入路应用范围进行了讨论。包括：病因不能肯定的传导性聋－不典型耳硬化症、先天中耳畸形；外伤后鼓膜完整的传导性聋；可疑中耳占位病变－先天胆脂瘤、胆固醇肉芽肿；外淋巴瘘和脑脊液耳漏等。此入践不但对中耳及相关内耳结构可充分暴露，术野清晰，且组织损伤小，操作易，是一种安全可靠的手术入路，但由于确切     

Identifying and treating persistent tinnitus in CI users

The study was undertaken within an established cochlear implant (CI) centre, in conjunction with a tertiary Tinnitus Clinic. The primary aim was to identify more readily which CI recipients experience significant tinnitus, by introducing the Tinnitus Handicap Inventory (THI). A secondary aim was to pilot a specialist joint clinic for CI users with tinnitus, involving clinicians from both the implant and the tinnitus teams. This paper reports principally on the level of agreement between the centre's established tinnitus self-report measure and the THI.     

Treatment of tinnitus by external electrical stimulation

Transcutaneous electrical stimulation was used in 5 consecutive patients suffering from troublesome tinnitus. The study included three parts. Part one constituted an open trial using the stimulation equipment. During this part, 2 patients reported a reduced subjective tinnitus loudness. These 2 patients proceeded to part two where the effect from the stimulation equipment was compared with the effect from a placebo apparatus in an experimental double-blind trial. One of these 2 patients reported similar effects from active stimulation and placebo, while the other patient reported a constant positive effect from the active stimulation and no effect at all from placebo. The latter patient continued to part three where the effect of the equipment was studied over a 3-month period. Throughout the study, continuous self-recordings of the complaints was used. The results show that the electrical stimulation had a genuine tinnitus-reducing effect in one patient, remaining over a 3-month period, a positive placebo effect in one patient, but no effect in 3 patients. To determine the applicability of this method in the clinical population, carefully designed outcome studies, with appropriate control conditions, are required.     

Transcutaneous nerve stimulation (TNS) in tinnitus

Low-frequency (2 Hz) TNS applied distally to peripheral nerves of the upper extremity is known to induce a wide-spread, non-segmental and prolonged relief of pain and an increased microcirculation due to sympatho-inhibition in a number of vascular beds. Such stimulation was administered in 29 tinnitus patients of various etiology. Reduction of tinnitus was encountered in 9 subjects in response to a 45-min TNS-session. The improvement was mainly seen in tinnitus characterized by lower frequencies (125-500 Hz). In 7 of the 9 patients, the tinnitus reduction was associated with improvement of hearing, predominantly in the low-frequency band. The effects were still present after one week following daily stimulation at home. On continued treatment, the effects were found to be transitory in 4 of the patients, whereas the remaining 5 patients are still using the stimulator after 2 to 5 years. It is suggested that the mechanism behind the beneficial effects is increased microcirculation in part of the auditory pathways.