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23.01.2015
Forty hospitalized patients with sudden hearing loss and tinnitus were compared to a control group (N = 28) of inpatients of an ear-nose-throat ward. Certain single-case studies have reported the association between stress and SHL [9], as have some group studies that used qualitative interviews as assessment instruments [10,11]. From a physiological point of view, the assumption of the contribution of stress to the onset of SHL and TIN has some plausibility.
The main objective of the current study is to examine the association between stress SHL and TIN in a control group design, using a comprehensive and methodologically refined assessment strategy. Our study, therefore, tested the following assumptions: Onset of SHL and TIN is associated with a high level of stress defined by life events and daily hassles, habitual dysfunctional coping strategies, a high level of worrying, and a low level of social support. Because a prospective design relating to the stress hypothesis with hundreds of non symptomatic subjects was beyond our research capacities, a control group design was used. Daily hassles (DH) were assessed by the German questionnaire Alltagssorgen-Skala [33] (Cronbach's alpha = 0.96), which is based on the Daily Hassles Scale by Kanner et al.
To determine the level of worrying (W), the German version of the Penn State Worry Questionnaire [36] (16 items; a 5-point rating scale) was presented to the subjects.
The experimental subjects were contacted by telephone 3 months after they had been assessed for the first time. Patients with SHL and TIN show significantly higher scores on both measures of stress, on the life event scale, and on the daily hassles scale than those in the clinical control group. As expected, significantly more negative coping strategies (COPneg) were found in the experimental group. The prospective part of our study examined the connection of psychological test variables (LOCint, LOCpow, LOCfat and LE, DH, W, and social support), sociodemographic variables (age, gender, family status, number of children), and characteristics associated with the disorder (TIN in the past, acute TIN, disability due to TIN and SHL, and WB at the onset of the disorder), all measured at onset of the hearing disorder, to the chronicity of TIN and hearing loss 3 months later. The chronicity of TIN is correlated most closely to WB at disorder onset, COPneg, and LOCfat (Table 5). In a discriminant analysis, the six variables of all three categories (WB, COPneg, LOCfat, acute TIN, age, disability due to TIN) associated most highly with chronicity of TIN were used to separate the group of patients with TIN from recovered patients.
Chronicity of SHL (n = 18 of 35 subjects) is associated most closely with WB at the onset of the disorder, with disability due to TIN and SHL, and with the degree of anxiousness concerning SHL and LOCfat. The six variables-WB, disability due to acute TIN, SHL, LOCfat, anxiety concerning SHL, and number of SHL-correlated most highly to the chronicity of hearing loss were entered into a discriminant analysis at the same time.
The hypothesis regarding the stress differences expected between SHL and TIN patients and the control group before the onset of the disorder was confirmed fully.
The affective state of certain persons often has been shown to influence memory; in a negative state, more negative memory contents are activated and retrieved. At first glance, the data about worrying confirm our hypothesis that it is more intense in SHLITIN patients. The discrimination analysis fully supported the foregoing conclusions, selecting daily hassles as the strongest variable in the prediction of group membership and coping as a further relevant aspect. The second part of our study was concerned with the prediction of chronicity of SHL or TIN 3 months after onset. Though the validity of these predictions cannot be guaranteed and has to be cross-checked, an interesting note is that the supposedly predisposing stress factors that seem important for the onset of the studied hearing disorders do not contribute to its chronicity. All in all, our study suggests that psychological variables related to stress and its processing are predisposing for TIN and SHL and that the actual subjective state of well-being shortly after onset of the di sorder is a relevant predictor of chronicity of both disorders. Though our data support the hypothesis of psychological influences on disease etiology and prognosis in SHL and TIN, some methodological limitations of the study have to be taken into account. The intent of our study was to sample similar groups maximally except for the disorder itself. Furthermore, the conclusions drawn from the prospecti ve part of the study, especially regarding the importance of psychological variables, are somewhat uncertain. Idiopathic sudden deafness is defined as sudden sensorineural hearing loss of undetermined etiology. Hearing is one of our most important senses, and its sudden loss is likely to frighten affected individuals owing to the speed of its evolution, bringing feelings of frustration to such patient and to their physicians. According to Caldas and Caldas Neto [1] and Snow and Telian [2], the definition of sudden deafness (SD) is "a sensorineural hearing loss whose quick installation can last minutes, hours or a few days.
Shaia and Sheehy [3] found a 2% incidence of SD in all otological cases, with no significant difference related to gender. In 2000, Loughran [6] undertook an SD survey of 100 otolaryngologists, checking the specialists' answers regarding the examinations they requested and the treatments they adopted for this condition. The confirmation of deafness with sensorineural characteristics and knowledge of the depth of the lesion are obtained through pure-tone audiometry, speech audiometry (speech reception threshold and speech discrimination score [SDS]), and tympanometry curve and acoustic reflex. Our sample was composed of patients who reported to the otolaryngology emergency room of the Federal University of Sao Paulo-Paulista Medical School (UNIFESP-EPM), all of whom had received care during the entire year of 2001. The pure-tone audiometry (air tone at frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz and bone tone at frequencies of 500, 1,000, 2,000,3,000, and 4,000 Hz), speech reception threshold, and SDS examinations were carried out at the audiometer (MAICO MA 41, Maico Hearing Instruments, Inc., Minneapolis, MN).
Our sample included 20 patients with unilateral SD (20 ears), of whom 12 were men and 8 were women (right side, 11; left side, 9).
In our analysis, we used as factors for hearing improvement the definition of improvement of hearing loss in terms of change of thresholds, as provided by the American Academy of Otolaryngology-Head and Neck Surgery: improvement of 10 dB or more at frequencies of 500, 1,000, 2,000, and 3,000 Hz and improvement of 15% or more in SDSs.
At its beginning, SD is usually associated with other symptoms that may appear before, at the same time as, or a little after the loss of hearing.
Owing to the prospective aspect of our study,it is possible to fail to monitor some patients' progress. All 12 patients (60%) who recovered total hearing showed improvement on the SDS, some associated to tonal thresholds. The five patients (25%) whose hearing did not normalize did not show a good SDS at the outset. Of the three (15%) patients who abandoned treatment, two did not show any improvement until the third and fourth weeks of treatment. Of the patients with totally recovered hearing,11 (55%) started treatment before 10 days had elapsed from the onset of SD, and 1 (5%) started treatment after 31 days had passed.
Those researchers observed the correlation between hearing and final hearing result through threedimensional audiograms aiming to evaluate prognostic factors. In their 1998 retrospective study of 132 SD cases that were monitored for 10 years, Molini et al. In our work, we observed that of the six patients (30%) with a light or moderate level of hearing loss at the beginning of the SD, five (25%) had normalized hearing in the second week of treatment, and one did not have total recovery in 2 months but started to improve in the second week.
Our preliminary results suggest that the degree of hearing loss may not be very important in determining the prognosis for patients who experience SD. How to cite this article Nicolas-puel C, Faulconbridge RL, Guitton M, Puel J, Mondain M, Uziel A. The aim of this study was to highlight the clinical characteristics of tinnitus and to attempt a quantitative assessment in relation to any underlying etiologies.
Tinnitus constitutes an important public health problem; it is estimated that in France alone, there are 5 million tinnitus sufferers. One hundred twenty-three patients were treated in a specialist tinnitus clinic at Gui de Chauliac1 Hospital, Montpellier, France, between 1998 and 2000 [1]. The assessment was based on a questionnaire that was used to evaluate the clinical aspects of tinnitus (see the appendix at end of article). When asked, patients usually liken the sound of their tinnitus to environmental noise, such as the sound of the wind or the sound of an insect. To investigate the temporal variation of tinnitus, patients were asked whether the intensity of their tinnitus was stable or whether it fluctuated during the course of the day. The aim of the clinical examination was to determine any underlying etiology that would explain the presence of tinnitus.
The great majority of patients (almost 90%) presented with tinnitus associated with deafness of known etiology (Table 1). Hearing losses were divided into four groups: highfrequency (60%), low-frequency (25%), flat losses (11%), and dead ear (2%).
Of the patients from the endocochlear group, 65% had stable tinnitus, and 32% had fluctuating tinnitus. Of patients with Meniere's disease or Meniere's-like syndrome, 84% described fluctuating tinnitus. Of patients with endocochlear deafness, 77% described their tinnitus as a high-pitched whistling, and 21 % described it as a low-pitched buzzing (Fig. In our study, 58 of the 77 patients with a stable high-pitched tinnitus (77%) had a high-tone hearing loss. This study attests to the rare incidence of objective tinnitus: There was no case of objective tinnitus in this series. The study of the etiology of the underlying deafness offers interesting results for understanding tinnitus, especially in patients with high-frequency hearing loss. We have confirmed in this study that the general frequency of tinnitus pitch perceived by the patient is correlated in broad terms with the frequency of the hearing loss, in agreement with some other studies [7]. This study has raised interesting findings about the fluctuation of tinnitus after periods of sleep, especially in patients with low-frequency tinnitus. We have shown in this study that audiometry can be used as a simple indirect test to evaluate tinnitus, as it correlates well with a visual analog scale of tinnitus intensity in the majority of our patients.
We thank Professors Bernard Guerrier and Remy Pujol, who supported and encouraged this work. Most cases of tinnitus should checked by an ENT physician to make sure that the sound in your ear is not caused by another problem that is treatable. Pulsatile tinnitus sounds like a rhythmic pulsing in the ear, typically in time with your heartbeat.
Check your Blood Pressure - If you suffer from high blood pressure, it could be the reason for your pulsating ear, or at least it's making it much louder.
Regular aerobic exercise - The most effective and quick way to reduce blood pressure is a daily walk. Ginko Biloba - Many pulsatile tinnitus sufferers have reported a significant improvement in their condition after a short period of taking a daily dosage of Ginko Biloba. The weird thing about tinnitus is that there are many natural and not so natural ways to lower the volume in your ears.
To find out about the top 5 natural methods to eliminate all kinds if tinnitus - Click Here - Right now! Tinnitus is the perception of internal noises, mainly originating involuntarily within the head, in the absence of any external acoustic stimuli.
If you notice a sudden onset of Tinnitus, manifesting itself as hearing loss in one ear, with or without dizziness, it could be indicative of a potentially serious medical condition. Although there is no cure for Tinnitus, there are techniques such as the use of amplification that can help minimize its effects and alleviate its symptoms. OBJECTIVE: Patients suffering with tinnitus are often advised to accept the noise, but few studies have examined what tinnitus acceptance entails. CONCLUSION: The TRS factors provide an alternative conceptualisation of tinnitus responding.
Keywords: adaptation, psychological, reproducibility of results, scales, tinnitus, validity of tests. Tinnitus is the perception of noise in the ears or head in the absence of an external acoustic source1-3 that is often associated with hearing loss4. The historical focus of the tinnitus distress literature has been on people's negative cognitive appraisals of tinnitus and their individual coping resources, which have been used to help explain tinnitus annoyance and the associated distress8. Thus, an alternative approach is required to identify tinnitus response pattern(s) that do lead to better tinnitus outcomes. In the literature, acceptance is described as a process of allowing or letting be, rather than avoiding, fixing, changing, or eliminating unwanted experiences that cannot be changed22.
To help guide the development of the TRS, we used the Chronic Pain Acceptance Questionnaire CPAQ25, similar to the approach used by Westin, Hayes, Andersson5 in developing the TAQ. The University of New England Human Research Ethics committee assessed and evaluated all components of the present project. Four groups of volunteers were recruited to assist with initial scale development, using the content validation guidelines of Haynes, Richard, Kubany28 and Clark, Watson29. The first contained relevant experts: a mindfulness researcher, clinical psychologist, and two health psychologists, one specialising in hearing and tinnitus.
The second group had twelve university staff with chronic tinnitus (duration: 6-months to 30-years), 6 males and 6 females, aged 45 to 63 years, were recruited via an online advertisement and asked to describe their tinnitus experiences in a short interview.
The third group employed 12 volunteers (from the second group) and seven more (n = 19), 9 females and 10 males, aged 45 to 70 years, were asked to complete a draft version of the TRS, and then categorize items into the subscales and provide feedback on the intelligibility of items; the items were revised in line with this feedback. The study URL got 701 visits in the six-month data gathering period and 273 participated (39% response rate). The 87-item prototype of theTinnitus Response Scales (TRS) was administered to both the Internet and the hard-copy samples.
The Depression Anxiety and Stress Scales-2133 was used to assessed self-rated stress, anxiety and depression. TRS items were examined empirically using exploratory (EFA) and confirmatory factor analyses (CFA). Reliability and validity of the TRS responses were assessed using responses received from 103 of the 150 people in the Internet sample who agreed to be contacted about future testing, and 41 of 50 people in the hardcopy sample who had similarly agreed, giving a total of 144 responses. TRS-defeat and tinnitus distress were log and inverse transformed due to positive skewing, but this did not change the relevant results, relative to untransformed scores. Half the Internet (n = 273) sample described tinnitus that started gradually (n = 132) and half described a sudden onset (n = 141). EFA was conducted on the TRS responses using the maximum likelihood function in SPSS, which provides the best match for the mathematical algorithm used in CFA.
Several solutions resulted in clearly defined factors with simple structures, but some factors had insufficient items for subscale development. Using the above statistical criteria, 47 items were deleted and EFA was rerun using the remaining items. CFA was conducted on the 24-item TRS using AMOS, and tested the goodness-of-fit of the 1, 2, and 3 factor models, see Table 2.
Chi-square difference tests were used to determine if the 3-factor model fitted the data better than the other models.
Test-retest reliability was computed for the TRS subscales, using the Internet and hard-copy samples, see Table 3.
Associations between the TRS subscales and maladjusted and effective coping (TCSQ) were examined, see Table 4.
Next the validity of the TRS sub-scores was examined in relation to illness representations, using the IPQ-R subscales, see Table 7.
Finally, the validity of the TRS was examined in relation to tinnitus parameters and clinical details, using the TRS sub-scores, BATS, and TRQ as the study outcomes, in an exploratory manner, see Table 8. Using the Internet sample, an EFAshowed that the 12-item BATS had a single factor which included 5-items, explaining 57% of the item variance, see Table 9. The Tinnitus Response Scales (TRS) describe three distinct cognitive, behavioral, and emotional response patterns termed control, defeat and acceptance. In the TRS, the acceptance and defeat sub-scores were highly inversely correlated, and in validity testing, they tended to be correlated with opposite characteristics in terms of age, tinnitus duration, cognitions, tinnitus distress and general distress; whereas the control and acceptance sub-scores were only moderately and inversely correlated with each other. In relation to tinnitus coping, high defeat and low acceptance scores explained much of the variance in maladjusted coping2,9, although only high control was related to effective coping, explaining 17% of its variance. These findings have potentially important treatment implications: first, defeat was common in people who had a recent tinnitus onset or had little knowledge about their condition, suggesting that adequate information provision is especially important in newly-diagnosed tinnitus patients.
Taken together, these results suggest that the way in which people will respond to tinnitus is likely to be governed by the severity, chronicity and novelty of the condition.
Finally, we examined correlates of tinnitus severity and distress, including the three TRS subscales.
Regarding the relevant literature, few prior studies have examined the above associations or they used different but analogous constructs. Further psychometric analysis of the TRS and BATS is warranted including examinations of their test sensitivity, specificity, predictive validity, and additional convergent and divergent validity. The Tinnitus Response Scales assessed three distinct response patterns that differed in terms of their cognitive, behavioural, and emotional responses to chronic tinnitus. Paper submitted to the ITJ-SGP (Publishing Management System) on February 20, 2014; and accepted on March 18, 2014. Dorntherapy was developed in the 1980s by Dieter Dorn, a nonmedical person, to cure his and his family members' vertebral problems. The craniocervical junction, the upper part of the vertebrae, includes the atlanto-occipital region, the atlanto-axial region, and the C2 and C3 segments [l].
Dysfunctions of the craniocervical junction affect the central nuclei via the afferent system, in particular the vestibular nuclei, thus leading to disturbances of the efferent profile [l]. Traditionally, dysfunctions of the vertebrae are treated, for example, by chiropractic therapy, meaning high velocity and minimal impact. However, in the last few years, a new method known as Dorntherapy has been fairly successfully employed for treating problems of the vertebrae. This study employed the technology of quantitative electroencephalography (EEG) to prove that correction of the craniocervical dysfunction by Dorntherapy induces changes in electroencephalographic activity.
All EEG data were visually inspected for artifacts due to movements and to muscular activity before the records were subjected to quantitative analysis and interpretation. All EEG data were collected under controlled conditions with the subject reclining comfortably in an armchair with eyes closed in a sound-attenuated, electrically shielded room. Our study included 10 tinnitus patients with craniocervical dysfunctions and additional dysfunctions of other vertebral parts.
Subdividing the alpha band into alpha), alpha2, and alpha3, the statistical analysis revealed a significant increase (p 2 band (9-11 Hz) (Fig. Owing to increased noise exposure, a dramatic rise in subjects suffering from tinnitus is expected. Biofeedback allows the control of physiological processes, such as body temperature or heart frequency. This article was presented at the Twenty-Ninth Neurootological and Equilibriometric Society Meeting in Bad Kissingen, Germany, March 15-17, 2002. The differentiation of peripheral and central causes of vertigo is based on history and examination findings including onset, duration, aggravating and relieving factors, nystagmus, gait and the wonderful Dix-Hallpike manoeuvre. Obviously, this study was set in a group of high-risk patients with a high incidence of central causes. In the data supplement of the HINTS study, you'll find videos of each examination technique used, or you can see all of them in one video by one of the authors, David Newman-Toker. The nice people at EMJ club have collated videos on youtube demonstrating the normal and abnormal findings in central and peripheral vertigo. An upcoming systematic review in the Annals of Emergency Medicine looking at the accuracy of HINTS identified only 3 studies on HINTS and 1 more that included all of the examination tests. The authors of the HINTS trial have also published a systematic review of bedside diagnostic tests.
Despite the lack of evidence for its use in the undifferentiated ED population, there is probably still a role in helping us better examine vertiginous patients and diagnose central causes in combination with our usual stellar history-taking and neurological examining. Most studies dealing with chronic TIN focus on its symptomatology, consequences, and treatment [13-21]. One presently prominent theory postulates that both disorders result from a diminished supply of blood to the inner ear, which impairs the inner and outer hair cells by lack of oxygen [1,5,10,22]. Stress is assessed by psychometrically validated inventories of life events and daily hassles. The study examines whether psychological predictors exist for maintenance of hearing loss and TIN 3 months after onset. The main guideline for the selection of the control group was to assess patients with maximal similarity to those in the experimental group of patients with SHL and TIN so as to rule out threats to internal validity, as addressed by Kazdin [29].
At the time of the assessment, all patients selected for the study were hospitalized in the ear-nose-throat ward. Patients were on the average approximately 40 years old, and nearly one-half (48.5%) were female. The first questionnaire asked for sociodemographic data (age, gender, family status, number of children, profession), information regarding the circumstances of the disorder (both groups), and a detailed description of SHL and TIN (experimental group only). Stober [37] found a Cronbach's alpha of 0.86 for the German version of the Penn State Worry Questionnaire, which is similar to the Cronbach's alpha found by Molina and Borkovec [38]. This outcome is true for both aspects, the number and stressfulness of events (Table 3), though subjective strain differentiates more clearly between the groups.
However, in contrast to expectation, they also showed significantly more positive strategies (COPpos, see Table 3).
This finding indicates that the lower the state of wellbeing, the higher is the probability of TIN maintenance. The number of predictors is limited to six, as the number of subjects should not be less than the number of predictors multiplied by five. Chronicity of hearing loss is not correlated to the other sociodemographic variables or characteristics attributed to the disorder (Table 6). Life events and daily hassles before the onset of the disorder were significantly more frequent, and their stressfulness was more distinct in the experimental group. As a marked difference in well-being was found between the two groups (worse mood in the experimental subjects), the variance between groups attributed to differences in well-being was eliminated by partial correlation. The hypothesis of more COPneg strategies in the experimental group was supported, but the level of positive coping endeavors also is much higher in the SHLITIN group, a finding contrary to expectation.
However, after controlling for well-being, this effect vanished, which demonstrates that the process of worrying is intensified markedly by an individual's negative state.
The general assumption is that the probability of remission of these special hearing disorders at that time is rather low, so that a chronic state can be assumed. The only psychological trait variable with some predictive power for TIN is negative coping. Only habitual processing variables (coping, fatalistic LOC) show some influence on chronicity, but the best predictor is well-being, probably an indicator of the subjective evaluation of the biopsychosocial state of an individual. Habitual psychological trait characteristics (coping, LOC) exhibit some, but not a strong, influence. The experimental group exists of patients suffering predominantly from both types of hearing disorders; very few persons were afflicted with TIN or SHL only.
This was successful in nearly all assessed variables, with the exception of well-being, which turned out to be an important variable. Audiological Evaluation of Twenty Patients Receiving Pentoxifylline and Prednisone After Sudden Deafness: Prospective Study. Loss of hearing impairs understanding of words and interactions between individuals and their environment, creating several emotional problems that may lead to a series of difficulties and changes in their lives.
The severity of the hearing loss may vary from mild to total loss of perception of the most intense sound. Several etiological theories have been proposed to explain SD, such as infection, vascular involvement, and perilymphatic fistulas. He did not find a consensus, but most of the doctors surveyed (98.5%) used steroids in the treatment, alone or combined with other drugs. Our objective was to analyze the evolution of a hearing loss in patients with SD through puretone audiometry and speech audiometry (SDS). All patients were subjected to a complete otolaryngological evaluation with magnetic resonance imaging, pure-tone audiometry, speech audiometry (speech reception threshold and SDS), and tympanometry curve and acoustic reflex. For impedance audiometry, the tympanometry curve and acoustic reflexes were obtained using the Interacoustics AZ 7 (Interacoustics, Assens, Denmark) at frequencies of 500, 1,000, 2,000, and 4,000 Hz.
Usually, owing to sudden loss of hearing, affected individuals look for professional aid as soon as possible, as shown in our protocol wherein 16 of the 20 patients (80%) began the medical treatment and were subjected to the first audiometry examination before the tenth day of SD.
Duration of sudden deafness and level of hearing loss at the beginning of treatment (20 patients). Of four patients (20%) whose hearing normalized in the fourth week, two (l 0%) started with severe loss, and two (10%) started with profound loss. Of these, two (10%) improved on the SDS only in the fourth week, and one of them already showed a good SDS from the outset. Two (10%) began to improve only in the pure-tone thresholds, one in the third week after the beginning of treatment and the other in the fifth week.


In one case (5%), the complete improvement began to occur, but the patient abandoned treatment after the second week. Of those whose hearing improved but did not normalize after 2 months, three (15%) started treatment before 10 days had elapsed, one (5%) started between 11 and 20 days,and one (5%) started between 21 and 30 days. All patients were analyzed before the ninth day from onset of SD, and all received the same treatment. As a criterion for improvement, those authors used 15 dB or more in average frequencies and classified the groups according to loss configuration, besides classifying them into categories of total deafness (absence of answers in all frequencies) or deafness. Nevertheless, we also observed a significant index of improvement in six patients (30%) with deep and severe levels of hearing loss. Characteristics of Tinnitus and Etiology of Associated Hearing Loss: A Study of 123 Patients. We undertook to study a population of 123 patients attending a tinnitus clinic between 1998 and 2000. Although previous studies have been descriptive, few have attempted a quantitative assessment of tinnitus qualities, such as its intensity, and have correlated it with the etiology of any associated hearing loss.
To allow its easy use during normal otological clinic visits, the questionnaire was based on a vertigo and hearing loss questionnaire already in use, and it was limited to certain aspects. The frequency composition of tinnitus is extremely difficult both to describe and to understand, especially for those patients with low-pitched or complex tinnitus, even when using an audiometer or a synthesizer to define tinnitus pitch [2]. If the latter was the case, we asked them to evaluate this fluctuation on a visual analog scale, with the maximum value corresponding to the loudest intensity during the course of the day and the minimum value corresponding to the weakest intensity. All patients underwent a full otological, audiological, and vestibular examination, which included audiometry, evoked otoacoustic emissions (OAEs), evoked auditory brainstem potentials, and videonystagmoscopy (two CCD cameras mounted on lightproof goggles). All but one of the patients with tinnitus seen in this specialist clinic had an associated hearing loss. Evoked OAEs were performed in the first 50 patients only, because the high incidence of hearing thresholds greater than 30 dB in our patients meant that OAE assessment contributed little to the evaluation of the etiology. Patients with active endolymphatic hydrops described fluctuation of their tinnitus during vertiginous attacks but, interestingly, also every day between crises, even when they thought that their hearing was stable.
Obviously, our hospital population was selfselected and does not necessarily reflect the true epidemiology of tinnitus. This type of subjective tinnitus reflected a cochlear problem in the majority of cases: More than 80% were associated with an endocochlear hearing loss.
A strong correlation was seen between clinical characteristics of tinnitus and the nature of the cochlear pathology. By simply having three categories of tinnitus pitch in the questionnaire (high pitch, low pitch, or other), we have avoided some of the problems associated with pitch matching using an audiometer. Many studies report tinnitus associated with sleep disturbance, but a literature review does not reveal any other studies reporting such marked increase in tinnitus on waking. We believe that it is important to develop this clinically based approach, and we will continue to investigate further correlations in our clinic. Gui de Chauliac (1300- 1368) was a physician associated with the Montpellier School of Medicine; he wrote what became the standard book on surgery for the next two centuries. Realizing for the first time that your ears are pulsating can be very frightening, and as the days go by all you think about is whether this awful noise ever leave you alone. Second, if the ear pulsating began suddenly you should seek rapid medical care because in rare cases it is a symptom of an aneurysm or a sudden onset of high blood pressure.
Ear pulsating is most commonly caused by abnormal blood flow in the blood vessels near the ears. Start changing your nutrition to low fat, low sugar diet and monitor your blood pressure every day to see how it goes down.
Tinnitus sufferers often describe the noises that they hear as being similar to a high pitch whistle, or steam escaping. Although generally Tinnitus is not considered to be a serious condition, it may be an early warning sign that some level of damage is being done to the auditory system. It is important to have your hearing assessed and the results forwarded to your family physician as soon as possible. At Sense of Hearing we have professionals available to assess your situation and apply the appropriate techniques to help you better cope with the condition. Development of the Tinnitus Response Scales: Factor analyses, subscale reliability and validity analyses.
The present project developed and tested a new instrument to assess the mindfulnessbased constructs of acceptance, control, and defeat, in relation to the experience of chronic tinnitus.
Participants were recruited from the general population and tinnitus support organizations and complete the first version of the Tinnitus Response Scales (TRS) and measures of tinnitus coping, severity and distress, general distress, illness cognitions, and tinnitus and health characteristics. Factors were shown to have high internal consistency and testretest reliabilities and differed in terms of their related cognitions, behaviour, and emotional responses to tinnitus, and their tinnitus characteristics.
TRS is a brief psychometrically valid measure of tinnitus responding that appears to distinguish between adaptive and non-adaptive responses to tinnitus noise, and should prove useful as a clinical measure. In the present project, we report on the development of the Tinnitus Response Scales (TRS) which was designed to delineate tinnitus response patterns associated with better tinnitus outcomes, using an acceptance and mindfulness psychotherapy approach5. Several tinnitus coping models and their psychometrically sound scales are described in the literature. Therefore, in this project, we used acceptance and mindfulness psychotherapy models5 to help characterize chronic tinnitus responses. In addition, tinnitus acceptance responses have been shown to be related to less tinnitus distress20, although the authors used an earlier untested version of the TRS-acceptance subscale, which included slightly different items to those in the 24-item TRS proposed by the present project. Thus, it is a neutral response that enables the non-judgemental perception of life situations in the present moment.
Thus, an acceptance-based approach may permit chronic tinnitus sufferers to develop skills that enable them to simply observe the tinnitus noise rather than reacting negatively to the experience. That is, control will reflect a negative primary appraisal of tinnitus noise, and a positive secondary appraisal of the availability of coping resources. They were asked to review the subscale definitions, which were refined in line with their feedback. Fifty-nine items were generated from the interviews, with approximately equal numbers of items evaluating cognitive, behavioral, and emotional responses in each of the three subscales. Several experts suggested that the tinnitus-related behavior should be more systematically examined (e.g.
They were directed to the study URL for the online surveyor they could request a paper (hard-copy) version of the survey. They completed the 87-item TRS and answered several questions about their tinnitus history. They were mailed an information package and survey, and returned it anonymously or they confirmed their contact details if they wished to participate in future testing. Respondents rated the extent to which each statement applied to them or their tinnitus, using 0 to 10 rating scales, where 0 means not at all true and 10 means perfectly true. Respondents were asked to rate how often they used each strategy, using 7-point Likert scales.
This 5-item measure of tinnitus severity was developed from an original pool of 12-items that asked participants about how much they were bothered by the tinnitus, frequency of the bother, how loud the noise was at worst and best, how much the noise impacted on their life and threatened their health and wellbeing, how distressing the tinnitus was currently and when it was first heard, and how much they were bothered by everyday sounds, using 0 to 10 point rating scales, with high scores indicating worse tinnitus severity. Only core features of the syndromes are included in the measure, permitting a maximal discrimination between the different symptom clusters. Test-retest reliability and convergent and divergent validity of the subscales were also assessed, using a sub-sample of respondents. Most (n = 232) described tinnitus loudness that was variable over time, and tinnitus awareness that was constant (n = 177).
Correlational matrices showed many correlations above .3, thus, indicating suitability for factoring. Eigen values indicated there were 3 factors for retention, and scree plots suggested a one or three factor s olution.
Following the recommendations of Kline38, multiple indices were used to assess goodness-of-fit with chi-square values and chi-square divided by degrees of freedom reported for each model.
Following the recommendation of Kline38, chi-square values of the 2 and 3-factor models were subtracted from values of the 1-factor model. Test-retest reliabilities of the defeat and acceptance sub-scores were very good to excellent, and those of the control subscale were adequate to good see38, categorization of coefficients. As expected, defeat was associated with all the states, explaining 30% of the variance in stress, 19% of the variance in anxiety, and 40% of variance in depression; suggesting that defeat was characterized by a pattern of high stress, depression, and also possible anxiety. In the present project, empirical support was provided for the scale using two community samples of people with chronic tinnitus who had similar clinical and demographic profiles to those reported elsewhere15,40,41, although their tinnitus distress was lower than that reported in prior studies14,32. In contrast, control responses reflect a degree of agency and attempts to manage the tinnitus or its impact, whereas acceptance is defined as a neutral response to tinnitus that is reflected in lack of need for agency, and unconcern or non-reactivity to tinnitus. Thus, the model was robust across two samples that were recruited by different mechanisms, and differed in terms of their age, tinnitus duration, and other tinnitus parameters. In addition, the three TRS subscales showed good to excellent test-retest reliabilityover 5 to 12 weeks.
These results indicate that defeat responses overlapped considerably with maladjusted coping, whereas acceptance was related to a lack of maladapted coping, and control shared some features in common with effective coping. Cognitively, defeat was related to less understanding of the tinnitus and an exaggerated perception of tinnitus threat. Cognitive features of control included a good understanding of tinnitus, high personal- and treatment-related control, but a magnified perception of tinnitus threat.
Cognitive features of acceptance included moderate levels of personal control, few tinnitus threat perceptions and little seeking meaning in the tinnitus, consistent with the results of Davis & Morgan21. People may respond to tinnitus noise by trying to control it, or they may feel defeated by it, but over time, they may come to accept it, with or without assistance; although this conclusion requires substantiation using a longitudinal study. In the latter case, the acceptance subscale of the TAQ5, Acceptance and Action Questionnaires27, and Multidimensional Health Locus of Control Scale43 may be used.
Psychology - School of Behavioural, Cognitive and Social Sciences - University of New England - Armidale - Australia. Dorntherapy: Its Effect on Electroencephalographic Activity in Tinnitus Patients with Craniocervical Dysfunction.
This technique achieves correction of dysfunctions of the vertebrae and joints simply by using natural movements of arms and legs Or by applying gentle pressure (thumb) to the spinous process. This area, rich in neuronal sensors, is neurophysiologically and mechanically fairly different from the rest of the cervical spine. Other therapies employed for the correction of dysfunction of the vertebrae are Brugger therapy, craniosacral therapy, straincounterstrain, and the specific adjustment technique. Possible dislocations of the vertebrae are localized by moving thumbs gently up and down the spinous process.
Quantitative EEG was undertaken using the Electro-cap (Electro-cap International, Inc., Eaton, OH). Unless stated otherwise, the data used for topographical color maps have been manually screened for eye blink movements, and only eye blinkfree epochs were used in the preparation of quantitative results, including spectral averages and topographical maps. After completion of the tests, the EEG data were analyzed to reject artifacts due to eye movements, blinks, and muscle activity.
All 10 patients complained of tinnitus, headache, nausea, and concentration problems and exhibited restricted head and neck movement and segmental vertebral dysfunctions. In 1986, he fell 36 feet from a ladder, fracturing several ribs and his right wrist and receiving a mild traumatic brain injury. Percentage of change in power of (A) delta, theta, alpha, and beta frequency bands and (B) alpha1, alpha2, and alpha3 frequency bands after Dorntherapy. Neurofeedback is a form of biofeedback linked to aspects of the electrical activity of the brain, such as frequency, location, or amplitude of specific EEG activity.
In fact, this combination of examination findings was more sensitive than MRI at presentation, which was falsely negative in 8 patients with an ischaemic stroke (and detected on MRI up to 3 days later).
No surprises that they support the use of HINTS: Tarnutzer et al, Does my dizzy patient have a stroke? The examination itself should only take minutes, and provides valuable information (assuming we know how to do and interpret it) that we won't pick up in a standard ED screening neuro exam.
Alternatively, you can respond on Twitter or via the Share button above, with a link to this post. The main objective of our study was to test the hypothesis of stress as a predisposing risk factor in the development of sudden hearing loss and tinnitus. Their pathophysiological features, the assumptions concerning their pathogenesis, and their medical treatment are rather similar [5-8]. Patients suffering from SHL (N = 98) reported more stress than did 13 patients with morbus Meniere who were used as control subjects. Vascular processes, mainly responsible for blood flow, are regulated by the sympathetic nervous system and the hypothalamic pituitary adrenal axis, the main systems activating cardiovascular stress responses.
Because external stressors have no direct influence on health but are mediated by subjective evaluation and processing of the stressful situation [23], habitual coping strategies also are studied.
The variables examined as possible predictors are the same as those mentioned earlier as assessed at the time of the onset of the disorder. Additionally to the disorder itself being different in the control group, the disease should not be associated conceptually with stress in its etiology. Furthermore, patients rated their actual well-being (WB) on a 5-point scale from very good (5) to very bad (0). The 56 items reflect a variety of everyday hassles concerning work, household, marriage, money, friends, and family.
The Streβverarbeitungsbogen assesses the likelihood of various habitual coping behaviors in situations leading to discomfort, arousal, or tension. The contacted subjects were interviewed about the status of their hearing disorder, especially whether their TIN or hearing deficit still were present. Also, the more negative coping strategies individuals exhibit and the stronger a fatalistic locus of control in individual patients, the more probable is the maintenance of TIN. Interestingly, the reported strain due to the stressful events differentiates more clearly between groups than does their number.
Otherwise, the reported higher amount of stress could be ascribed to the negative state of those in the hearing loss and TIN group at time of assessment.
One can assume that the classification of coping behaviors into "bad" or "good" regarding their problemsolving or palliative capacity may be invalid, as some often have argued that the effectiveness of coping also depends on the kind of stressor and other characteristics of the situation. The discrimination between groups was well above chance but, with an error rate of 25%, was not really very satisfactory. Interestingly, this global self-evaluation is more important than is the rating of disability due to TIN and SHL and variables related to the history of the disorder.
The definitely worse state of well-being in the experimental group points to the fact that the comorbidity of SHL and TIN probably is very stressing and annoying. Nevertheless, our data support the hypothetical role played by stress and related psychological factors in the etiology of SHL and TIN. Verhaltensmedizinische Untersuchungen zum HOrsturz [The behavioral medicine of sudden hearing loss].
Plotzliche doppelseitige Ertaubung durch psychische Konfliktsituation [SHL in both ears as a consequence of psychological conflict]. General and specific coping strategies used by middle aged males with noise induced hearing loss, with or without tinnitus.
Structure of perceived handicap in middleaged males with noise-induced hearing loss, with and without tinnitus. The management of chronic tinnitus-comparison of a cognitive-behavioral group training with yoga. Psychologische Behandlung des chronischen Tinnitus [Psychological treatment of chronic tinnitus].
Multidimensional health locus of control as partial predictor of serum phosphorus in chronic hemodialysis.
Zur interund intraindividuellen Reliabilitat einer modifizierten deutschen Fassung der Social Readjustment Rating Scale [Inter- and intraindividual reliability of the modified Social Readjustment Rating Scale]. Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. The Penn State Worry Questionnaire: Psychometric properties and associated characteristics.
Fragebogen zur Erhebung von Kontrolluberzeugungen zur Krankheit und Gesundheit (KKG) [Questionnaire to assess locus of control regarding illness and health (KKG)]. The loss of hearing may be permanent, or the hearing may spontaneously return to normal or near normal. Besides these, metabolic disorders, drug toxicity, and several other diseases may contribute to the appearance of SD. Owing to the difficulty in establishing an etiology for SD, several treatments have been suggested. The heari ng loss of these patients was monitored through successive audiometric examinations for a minimum period of 2 months, excluding cases of abandonment of treatment.
Of the sample, two patients (10%) showed a mild level of initial loss, four (20%) showed a moderate level, four (20%) showed a severe level, and six (30%) showed a profound level of hearing loss. Given these results, the most common symptom associated with the hearing loss was tinnitus, which appeared in 16 patients (80%). Of the other two (10%) whose hearing normalized in the seventh week, one (5%) had a moderate level of hearing loss, and the other (5%) had a severe level of hearing loss at the beginning of the treatment (Table 2). Of these, one (5%) who began with a moderate level of hearing loss showed initial improvement in the second week of treatment. Of the patients who experienced complete improvement, six (30%) improved in the second week, and four already had a good SDS: two (10%) in the fourth week and two (10%) in the seventh week (Table 5).
Of those who began to improve on the SDS as well as in pure-tone thresholds, one began in the second week, another in the third week, and the last in the seventh week (Table 6). Of those who abandoned treatment, two (10%) began treatment before 10 days from the onset of SD, and one (5%) began after 31 days. The analysis was conducted within 2 weeks from the onset of SD, and the conclusion was that gender and age had no influence on the index of hearing improvement. For this reason, in our work we did not analyze those factors as variables that could have some influence on the prognosis of SD. Of these, one (5%) had hearing that normalized in the second week, four (20%) in the fourth week, and one (5%) in the seventh week. The level of hearing loss was investigated through audiometry at the beginning and at the recovery of hearing. Vasoactive therapy versus placebo in the treatment of sudden hearing loss: A double-blind clinical study. Their answers on a questionnaire allowed detailed evaluation of the characteristics of tinnitus, including such variables as the circumstances in which the tinnitus was first noticed and evaluation of its intensity and frequency. If the assessment did not uncover any obvious precipitating events, the tinnitus was considered to have arisen spontaneously.
Tinnitus that was present on some days but entirely absent on others was designated as intermittent (Fig. Three categories of tinnitus emerged from our survey: tinnitus with a stable intensity over time, tinnitus perceived to fluctuate in relation to periods of sleep, and tinnitus perceived as intermittent (present on certain days but not on others).
If it was necessary for diagnosing the hearing loss, we also performed supplementary investigations: videonystagmography when hearing loss was associated with vertigo, magnetic resonance imaging when retrocochlear hearing loss was suspected, or magnetic resonance angiography, Doppler imaging of the local vasculature, and tomodensitometry of the temporal bone to evidence vascular problems. Even though deafness had not been described by any of the patients, audiometry unmasked in each patient a high-frequency loss that was more marked (10 dB) in the ear affected with tinnitus.
At age 23, he described his tinnitus as "creaking"; it was precipitated by movement of his head.
Because such a significant number of patients with tinnitus had an endocochlear hearing loss (8l.3%), we looked in more detail at this subgroup. Each portion of the chart represents tinnitus associated with endocochlear deafness according to its variability of intensity over time. It is interesting to note that the remaining 16% of patients with Meniere's disease or syndrome had had it for more than 5 years; they had a stable hearing loss and no vertiginous attacks for 2 years, and they described their tinnitus as stable (see Fig. Only 2% of patients were unable to categorize their tinnitus into either of these categories.
Each portion of the chart represents tinnitus associated with endocochlear deafness according to its frequency characteristics. This correlation was calculated for those patients with stable, high-pitched tinnitus and a high-pitched hearing loss. Studies that use an audiometer or synthesizer for pitch matching have found the process to be very difficult, both because of the difficulty that patients have in matching complex tinnitus and because of the possible modulation of the tinnitus by the external sound [8].
He recommended fumigation of the ear with ox urine , vinegar, and myrrh for certain cases of tinnitus. In this guide you will find the causes for pulsatile tinnitus and 3 simple steps to reduce and eliminate the ear pulsating - without medication or surgery.
This means that when your blood pressure rises, it can cause the pulsating that you hear in your ears. Sometimes anti-anxiety medication and muscle relaxants are helpful for tinnitus, but they are not worth the side effects and are not recommended for long term use. Other descriptors can include the sound of high voltage wires, a humming sound, music, even a song with words.
We posited that people who accept their tinnitus will fully adapt to the noise; whereas people who attempt to control the noise or are defeated by it, may be unable to adapt, and may continue to experience tinnitus distress. Further, acceptance was shown to be associated with a lack of seeking meaning in the tinnitus experience21. The construct was initially developed for use in cognitive-behavioural-therapies such as Mindfulness-Based Cognitive Therapy22, Dialectical Behaviour Therapy23, and Acceptance and Commitment Therapy16.
Further, additional items were generated in line with participant responses in a series of qualitative interviews; which resulted in the development of equal numbers of items assessing the cognitive, behavioral, and emotional aspects of tinnitus acceptance responses, as well as control and defeat subscales.
Finally, tinnitus characteristics will be examined in relation to the TRS subscales making no a priori assumptions.
Internet sample responses were used to explore the factor structure of the TRS, and hard-copy survey responses were used to confirm the factor structure of the TRS. The sample included 156 males and 122 females, with ages ranging from 19 to 88 years (M = 51, SD = 14.3 years). They also described their tinnitus symptoms, diagnosis, and history, related diagnoses, medication use, current tinnitus treatments, and they used a 0 to 10 scale to rate the tinnitus loudness at its worst, the frequency and degree of bother caused by the tinnitus, tinnitus distress, and impact of the noise on daily life. Respondents were asked to rate the extent to which they experienced each state over the past week using 4-point severity and frequency subscales, with high scores indicating greater stress and distress. Test-retest reliability was assessed by examining the TRS responses at baseline and 5 to 12-weeks later. Values less than 3 on the latter statistic are better indicators of acceptable fit than chi-square39. Respondents who completed the hard-copy version of the TRS were older than the Internet respondents, and they had had their tinnitus for substantially longer than those who completed the project online. Interestingly, two of the original TRS-acceptance items, if my tinnitus disappeared tomorrow I might not notice it had gone for some time, and sometimes I need to focus on the tinnitus noise before I can hear it, failed to load onto this model, suggesting that these responses were not typical of the acceptance construct. However, the samples did not differ in terms of their TRS response patterns, although acceptance levels were higher, and control and defeat levels were lower in the hard-copy sample. For example, the TAQ subscale, Activity Engagement, overlaps considerably with TRS-defeat, and the TAQ subscale, Tinnitus Suppression overlapped somewhat with TRS-control. Behaviorally, defeat was associated with maladjusted coping and seeking out tinnitus treatments; whereas emotionally, it was associated with high stress, anxiety, and depression levels. Behaviorally, acceptance was only slightly or not related to maladjusted coping and tinnitus treatment-seeking, and emotionally, it was consistently unrelated to any emotional response pattern, even the absence of an emotional response.
These results are somewhat consistent with our finding that young age was related to worse tinnitus severity and tinnitus distress perceptions.
However, preliminary reliability and validity analyses in this paper provide encouraging results for both measures.
The relationship between coping style, tinnitus severity and emotional distress in a group of tinnitus sufferers. Tinnitus Cognitions Questionnaire: Development and Psychometric Properties of a Measure of Dysfunctional Cognitions Associated with Tinnitus.


Psychological characteristics of individuals high and low in their ability to cope with tinnitus. Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress.
Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial.
A randomized controlled trial of Internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus. Mindfulness-based cognitive behaviour therapy for depression: A new approach to preventing relapse. Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Content validity in psychological assessment: a functional approach to concepts and methods. The Behavioural Responses to Illness Questionnaire (BRIQ): a new predictive measure of medically unexplained symptoms following acute infection. T Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus. The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychological profile and somatic complaints between help-seeking and non-help-seeking tinnitus subjects.
Various observations suggest that craniocervical dysfunction can lead to tinnitus, thus causing changes in the electroencephalographic patterns.
Being the end point of the statomotoric system, the craniocervical junction can also be affected by dysfunctions of other parts of the vertebrae [1-3].
A diagnosed dislocation of the vertebrae is corrected via a gentle pressure against the spinous process while the patient is moving an arm or leg back and forth. The quantitative EEG frequency bands chosen were delta (2-4 Hz), theta (4-7 Hz), alpha (8-13 Hz), and beta (14-21 Hz), with sub-alpha bands of alpha1 (7-9 Hz), alpha2 (9-11 Hz), and alpha3 (11-13 Hz).
In addition, he experienced a bilateral tinnitus (left-sided tinnitus duration, 6 years; right-sided tinnitus duration, 2 weeks). Neurofeedback has been employed for treatment of patients experiencing attention deficit-hyperacti vity disorder, generalized anxiety disorder, depression, conduct disorder, epilepsy, and posttraumatic stress disorder and for patients with closed-head injury and drug addiction [6-12]. This report hints at the involvement of the craniocervical system and muscular dysfunction in the pathogenesis of tinnitus (C.F.
The most prominent changes are associated with the 8-to 13-Hz band and the 9-to 11-Hz band. Effects of central cortical EEG feedback training on seizure incidence in poorly controlled epileptics.
Neurotherapy and drug therapy in combination for adult ADHD, personality disorder and seizure disorder:A case report. Cortical representation of the vestibular system as evidenced by brain electrical activity mapping of vestibular late evoked potentials. Effects of EEG guided alpha train ing in patients suffering from chronic tinnitus [in German]. Thus, differences in life events and daily "hassles" were expected between groups, as were differences in coping styles, habitual worrying, and social support. Quite a number of experts and laymen believe that the onset of SHL and TIN is mediated by stress. However, no standardized measures were applied, and no quantitative statistical analysis of the data was conducted.
What must be borne in mind, however, is the existence of various theories of pathogenesis and etiology of these hearing disorders; in general, all lack sound empirical support and somehow differ in their views of the functional role attributed to stress. Furthermore, worrying [24] is an important factor related to the processing of stressful information, a trait variable that has not yet been considered in regard to the onset of hearing disorders. Additionally, locus of control assessed at the same time is included as a psychological trait variable, which has been studied often in the context of chronic disease [25-28]. For the control group, inpatients suffering from different conservatively treated illnesses of throat, ear, and nose were selected. Life events (LE) were assessed by the German version of the Social Readjustment Rating Scale (retest-reliability after 10 weeks, Pearson's coefficient, r = 0.71) [31,32]. Number and stressfulness of hassles during the last 4 weeks before the onset of the illness were assessed. Wellbeing showing a significant difference between groups can be considered as a potentially confounding variable. Worrying had a significantly higher level in the experimental group, but this difference was lost after statistical control for well-being.
Thus, the subjective evaluation of stressful events is more important than is the sum of events.
However, the difference in stressfulness of life events and daily hassles were shown to be maintained at a significant level. Regardless, the fact remains that different coping behaviors, whether positive or negative, are used much more frequently by the experimental group.
All subjects reported an extraordinary high degree of social support (high above the average of the norm group). The most powerful predictor both for chronic TIN and for SHL is the state of subjective wellbeing at time of first assessment immediately after the onset of the disorders. Furthermore, what should be mentioned is that the explained variance is higher in the prediction of chronicity than in the discrimination of the different clinical groups. The search for prognostic factors of chronicity must be continued, after this first attempt offering some challenging data.
In Bradley WG, Deroff RB, Fenichel GM, Marsden CD (eds), Neurology in Clinical Practice, Vol. We analyzed this treatment's results in our patients through conventional audiograms, and speech audiometry was performed in the acute stage and during the treatment. Although sudden deafness is usually unilateral, it may be bilateral." Many times, it is accompanied by other symptoms, such as tinnitus and vertigo. In 1991, Shikowitz [5] pointed out that although several studies on SD have been carried out, researchers do not have a definition that is universally accepted. For years,many treatment protocols have appeared in the medical literature, each associated with varying success rates.
In our study, we used pentoxifylline and prednisone, after we eliminated through magnetic resonance imaging the possibility of neoplastic processes or demyelinating diseases. For these authors, when the loss was of 60 dB NA or more, the prognosis was less favorable than when the loss was lower, showing that the intensity of the initial hearing damage is an important prognostic factor. In their study, these authors noted that recovery was less probable after 9 days had elapsed since onset of SD. The patients each underwent a full neurootological examination with the aim of diagnosing an etiology. The assessment of patients with tinnitus was similar to that for patients with vertigo and hearing loss, within the setting of a neurootology clinic.
In each case, the patients were able to state the exact time and date of onset of their tinnitus.
In none of these four patients did clinical or vascular examination identify an underlying cause. It is impossible to say whether the deafness was linked to the head trauma (although this is likely) or whether it preceded it.
Tinnitus was stable in 65 cases, fluctuant in intensity in 32 cases, and intermittent in 3 cases. Tinnitus was perceived as a high-pitched whistling in 77 cases and as a low-pitched buzzing in 21 cases.
The intensity of the tinnitus (x axis) was measured on a visual analog scale graduated from 0 to 100. In cases of active Meniere's disease or Meniere' s-like syndrome with low-frequency hearing loss, the tinnitus was almost always described as a fluctuating low-pitched noise, even between vertiginous crises. In J-M Aran, R Dauman (eds), Tinnitus 91: Proceedings of the Fourth International Tinnitus Seminar. You have to find the right solution for YOU, so you have to try every method out there and to be aware of all kinds of treatments. However, some people do not adapt, become sensitized, and may go on to suffer from tinnitus-related distress3,7. Taken together, these results suggest that tinnitus acceptance may occur in people with less severe or distressing tinnitus or those not searching for meaning in their condition. Thus, defeat responses will reflect a negative primary and secondary appraisal of tinnitus26.
The experts reached consensus as to which items belonged to which subscale in most cases, thus, all items were retained for later analysis. To be eligible, participants had to be 18 years or older and have had their tinnitus for one month or more. The sample was comprised of 150 males and 123 females, ranging in age from 18 to 99 years (M = 51, SD = 14.3). These statistics indicated that a 1 and 2 factor model did not achieve an adequate fit, but the 3-factor model achieved an adequate fit on all indices.
The non-fit of these particular items suggests that affected individuals were typically aware of the tinnitus, despite having developed tolerance or acceptance to it. Conceptually, these results are consonant with the small emerging literature related to tinnitus acceptance and the mindfulness-based treatment of tinnitus5,17,18. The TRS-acceptance had no analogous construct in the TAQ and it is therefore possible that the TRS has additional utility in measuring a broader range of tinnitus responses, especially since the TRS-acceptance subscale included items that tap into behavioral adaptation or habitation to tinnitus noise. However, CFA did not support this two-factor solution, nor was the solution stable in the EFA. Convergent and divergent validity of the TRS sub-scores was also assessed, using additional measures of tinnitus coping, severity, and distress, general distress, tinnitus cognitions, and tinnitus and general health parameters. These results are consistent with the aforementioned definition of 'tinnitus acceptance', as a predominantly neutral cognitive response to tinnitus noise that involves neither concern nor bother about the noise.
Finally, the study was cross-sectional in nature therefore precluding any causal inferences being made. This study demonstrates that the successful application of Dorntherapy induced prominent changes of the electroencephalographic activity.
The differences in lengths of legs are very often a sign of torsion of the vertebrae; however, these differences can also cause torsion of the vertebrae by themselves, thus inducing rotatory dysfunction of the vertebrae and dysfunction of the craniocervical junction. It is best described as follows: A therapist uses the natural movements of a patient with a gentle pressure to the spinous process to correct the dysfunction. Dysfunctions of the cervical vertebrae are corrected while the patient is slowly shaking the head.
In the last few years, two new therapeutic concepts have been advanced:neurofeedback and tinnitus retraining therapy (TRT). Comparison of EEG data before and after neurofeedback revealed significant changes of EEG parameters and items of the Göbel Tinnitus Questionnaire. These findings clearly indicate the necessity for correcting vertebral dysfunctions prior to starting any other therapies. In GK Siebert (ed), Facial Pain and Headache: An Interdisciplinary Overview for Medical Doctors, Dentists and Psychologists [in German].
The hypothesis of more frequent and more stressful life events and daily hassles was supported empirically. Because of the abundant clinical evidence for the importance of stress, the simplified model illustrated in Figure 1 and derived from Hoffmeister [1] is used for the conceptualization of the presumed interplay of stressrelated somatic and psychological factors.
Patients were asked whether any of the 42 given life events took place within the last year.
It consists of three scales: internality (LOCint), powerful others-externality (LOCpow), and fatalistic externality (LOCfat). The group differences in both aspects of LE and DH, however, remain significant after statistically controlling for well-being (see Table 3).
No difference was registered in the level of social support; both groups showed very high scores (Table 3). Our data show, as is found often in other studies, that life events and daily hassles are not independent of each other but correlate to a large degree. Thus, well-being had some effect on remembering and reporting negative events, especially on the number, but the difference between experimental and control group cannot be explained totally by their different state of well-being. What might be posited is that the experimental group uses more coping strategies because they meet more life problems, as shown.
Generally, social support may be very high in the special situation to which all subjects were exposed: being in the hospital for their first few days. Also very influential is the degree of disability due to TIN experienced at first assessment. One undesirable aspect of our study is the difference in the number of subjects in the experimental control group, due to the difficulty in recruiting control patients.
However, they are usually based on emotional and nonscientific considerations, because the exact etiology is unknown. These drugs were chosen for their action in the inner ear cells, independent of the etiology. Of the three patients (15%) who showed profound loss at the outset of SD, two (10%) showed some improvement at the third week, and one (5%) showed some improvement at the fifth week (Table 3). In our work, of the 12 patients (60%) whose hearing normalized, 11 (55%) presented with SD before 10 days had passed and obtained total recovery at different times: 5 (25%) in the second week after beginning treatment, 4 (20%) in the fourth week after beginning treatment, and 2 (10%) in the seventh week after beginning treatment. The great majority of tinnitus patients had an endocochlear deafness and, among these patients, acoustic trauma, endolymphatic hydrops, and presbyacusis were the commonest diagnoses (32%,32%, and 23%, respectively). Zero corresponds to an absence of tinnitus; 100 corresponds to the loudest tinnitus you can imagine. One patient attending the tinnitus clinic was given a diagnosis of an acoustic neuroma, two patients of vascular loops in the internal auditory meatus, and two of cholesteatoma. Even though it was thought that his tinnitus had an origin in some head or neck joint and thus was a somatic noise, it was not possible to define it further. All patients who described their tinnitus as fluctuating in intensity described a very clear increase in intensity of their tinnitus after periods of sleep (whether nighttime or siesta). The highfrequency hearing loss (y axis) was calculated as a mean of the thresholds over three frequencies (4 , 6, and 8 kHz).
Thus, in the present project, we expected that TRS-acceptance will be related to less severe and distressing tinnitus, and lower Illness Perception Questionnaire-consequences of illness scores, which assesses the meaning of tinnitus. In contrast, acceptance responses are characterized by neutral thoughts, emotion, and behavior or non-reactivity to tinnitus noise, such that the noise neither concerns nor bothers the person. In addition, mindfulness theory suggests that acceptance is antithetical to a range of different responses that may include defeat, helplessness, and resignation, but also control, and unwillingness16,22,23,27. These correlations helped to better delineate the tinnitus response patterns as detailed below.
In fact, defeat explained more than 75% of the variance in tinnitus distress, suggesting that perceptions of tinnitus distress were mostly influenced by feelings of defeat.
Data analysis revealed a significant increase in the power of the alpha (8-13 Hz) and the alpha2 (9-11 Hz).
Dysfunctions of the lower part of the vertebrae will significantly affect the mobility of the craniocervical junction, thereby affecting central regulation mechanisms via the afferent systems [3,4]. Dislocation of the vertebrae is corrected via gentle pressure against the spinous process while the patient moves an arm or a leg back and forth. Again, a gentle pressure is projected to the spinous process to place the vertebra in its appropriate position. TRT is based on the assumption that nonauditory systems, particularly the limbic system and the autonomic nervous system, playa crucial part in each case of troublesome tinnitus. The dominant role of daily hassles, especially their stressfulness as a risk factor, was shown clearly.
In a well-designed but unpublished study by Mtinzel and Sander (oral presentation), however, no differences in stress were found between a group of patients with SHL and those in a clinical control group.
Additionally, they had to rate the subjective stressfulness (or strain) of each event on a rating scale from 0 to 100. To assess the relative importance of LE and DH, controls were applied for their common variance. A further assumption might be that they are trying hard to cope with stress most of the time but are not successful, as the reported strain by the events is higher in the experimental group. In the prediction of chronic SHL, both disability due to SHL and TIN at onset are important. The task of identification of patients for the study was allotted to the hospital staff, who then informed the psychologists of their potential subjects. The global incidence of this disease seems to be low but, in reality, it may be higher because patients who spontaneously recover hearing may never look for medical aid. Hearing in one patient (5%) showing SD for more than 1 month improved in the second week after the beginning of treatment.
The aim of the clinical examination was to diagnose the etiology of any underlying hearing loss. Furthermore, the more frequent use of coping strategies is related to greater tinnitus annoyance14 and control strategy use is related to greater sensitivity to ambient sound15.
However, it is regarded as an active state inasmuch as it requires people to actively observe their thoughts, feelings and bodily sensations as they occur27 although definitionally, there is a lack of need for agency in these situations. The scale is reported to have good test-retest reliability and high internal consistency (Cronbach's alpha = .96). Besides electrophysiological effects, changes in the quality of tinnitus and in the intensity of the tinnitus were noted.
This can lead to vertigo, dizziness, nausea, tinnitus, diplopia, concentration problems, and headache, to name but a few effects [4-6]. These movements induce changes of the muscle tension, thus enabling a soft correction of the dislocated vertebra. For both approaches, the natural movements of muscles and vertebrae are used; thus, the corrections are not performed against increased tensions.
The power spectrum data analysis revealed a significant decrease of the power of the delta band. According to this model, the annoyance of tinnitus is determined exclusively by the limbic and autonomic nervous system.
A highly significant change was noted for emotional distress and annoyance from the tinnitus. This selection criterion was used to reduce bias effects of memory on self-report measures [30]. The groups did not differ significantly in any of the sociodemographic variables (Table 2).
After controlling for the effect of DH, the difference in LE between groups no longer was significant; on the other hand, after controlling for the effect of LE, the difference in stressfulness of DH was maintained (see Table 4).
After this procedure, the discriminating function of life events, be it number or strain, was lost.
Thus, their potentially exhausting coping endeavors could also contribute to onset of the hearing disorders. Because the identification of potential control group patients was much more difficult than was the identification of SHLITIN patients and because of the fact that pending surgery excluded many patients from the control group, the recruitment of the control subjects was very time-consuming and less successful. Of those who began treatment before 10 days, two (10%) did not show improvement until the fourth week and abandoned treatment. Those patients with active Meniere's disease or Meniere's-like syndrome described a low-pitched buzzing tinnitus. However, four patients did have a presbyacusis, and one had a mild hearing loss in the higher frequencies.
Taken together, these results suggest that tinnitus noise may be the 'wrong target' for tinnitus therapy. The basic idea of this concept is the treatment of the complete vertebrae, not the treatment only of the problem zones. TRT has two key elements:directive counseling and sound therapy to achieve habituation of the tinnitus. These reports prompted us to evaluate, with the assistance of quantitative EEG analysis, the role of vertebral dysfunctions in patients suffering from tinnitus. Wellbeing is the only variable differing significantly, with control patients feeling better than did the experimental subjects.
On the other hand, daily hassles (especially their stressfulness) retain their differentiating function. However, the number of subjects lies within the range of statistical demands (number of subjects = 5 × number of variables) [41]. We compared the hearing threshold results in the different periods in this prospective study. Thus, the relation between time of SD onset and beginning of recovery showed great diversification and was not significant. Five patients (25%), among them some with moderate hearing loss, began a slow improvement in only the pure-tone thresholds or in the complete aspect and showed a low SDS at the beginning.
Analysis of those patients with a stable high-pitched tinnitus associated with a high-frequency hearing loss shows a statistically significant correlation between the elevation of the audiometric thresholds and the loudness of the tinnitus. The quality of the bestfitting linear regression curve is indicated by r, and the number of patients by n. That is, attempting to control one's tinnitus requires giving attention to the noise, likely reducing the potential for habituation and tinnitus adaptation; possibly intensifying the experience and leading to greater tinnitus annoyance and distress16.
Of great additional importance is the correction of possible different lengths of legs [5].
Habituation is the point at which affected patients no longer are aware of the tinnitus except when they focus on it. The correction of vertebral dysfunctions in tinnitus patients was achieved by Domtherapy [5].
The prospective part of the study aimed at the prediction of chronicity of sudden hearing loss and tinnitus (3 months after onset) by sociodemographic, psychological, and disease-associated variables. Patients who fulfilled the established criteria were informed about the study and then were given the questionnaires, which they were supposed to complete within 2 days. Thus, what can be concluded is that life events probably give rise to various stressful daily hassles that undermine health status. These patients have been monitored by us for more than 2 months but have not obtained normalization of hearing.
For a large majority of patients with tinnitus, therefore, audiometry provides an indirect test for evaluating the tinnitus. Since the factor solutions were unaffected by the outliers, they were retained in all analyses.
Dorntherapy permits the correction of dysfunctions without any risk of injuring muscles or tendons (or both). The patient reported a remission of the right-sided tinnitus and a decrease in the tinnitus intensity in the left ear. Evaluation of the recorded EEG data revealed significant changes within the alpha range and prominently in the alphaz band.
The strongest predictor of chronicity was the degree of well-being at the time of first assessment (soon after disease onset). Consequently, our study applying psychological instruments of satisfying reliability and validity in a control group design confirms findings by Hoffmeister [1], Kropp and Rad [10], Stange [11], and Neuser and Knoop [12].
Only one person contacted in the experimental group and three in the control group refused to participate (see Table 2).



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