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Capsule review: 2015 chrysler 200s awd - truth cars, I just spent a week with the all-new, all-wheel-drive 2015 chrysler 200 s.
Tire noise: tips to keep them rolling quietly - where the, Ma ny of us have purchased tires that were great when we first had them installed, only to find they get much louder as they wear down. Copyright © 2012 Autos Post, All trademarks are the property of the respective trademark owners. Clearly, putting together a car is a complex endeavor and the manufacturers need to strike an optimal balance between road handling, safety and comfort.
People often seem to assume that it is the hybrid technology that makes Lexus cars quieter than other makes.
The story about the LS 600h and its holistic noise reduction measures is very impressive and I would like to share with you the details of what has been done to offer the world’s quietest passenger car. Sound absorbing and isolating structures are added to the under floor parts to enhance quietness.
To prevent cavity noise, consideration has been given to prevent the airflow from hitting the inner side of the lower grille bars. Foam insulation has been optimally placed within the closed cross section of the side member pillars and front header. A lip is added to the base of the glass run, and low settling material is adopted to the main weather strip. Aero-stabilizing fins on the front door frame mouldings are also effective in reducing wind noise.
A power retractable unit is adopted to reduce motor noise when mirrors are being retracted. A roof moulding with rectifying shape, aero-stabilizing fin at the base of the front pillar, and newly shaped outer door mirror are adopted to rectify the airflow over the windshield glass towards the rear, helping to reduce wind noise. Noise insulating type laminated glass with an infrared cut feature is available for the front door glass, rear door glass, and rear door quarter glass. Front pillar base width has been increased to rectify the air flowing sideways over the pillar, helping to reduce rustling noise.
The following changes have been implemented to the door inner weather strip, helping to reduce wind noise.
Sound absorbing material has been added to the rear door service hole cover, helping to reduce road noise. A rear wheelhouse liner with a resin coating is adopted on the inside of the rear wheelhouse.
The rear wheelhouse liner contributes to quietness by insulating road noise, gravel noise, and splashing noise. Adopted a melamine material in the hood silencer to contribute to a more lightweight design and enhance sound absorption performance.
Thickness of front fender liner sound absorbing material has been increased, helping to suppress engine noise.
Rear liner sound absorbing shape and material have been changed, helping to suppress rear transmitted noise. An NV (Noise and Vibration) cover is installed on the outer area of the transmission to reduce noise generated from the powertrain. A dynamic damper is installed in the transfer to suppress the vibration transmission of the powertrain. Balance weights designed for weight reduction with hollow holes have been optimally arranged and the permissible unbalance has been reduced to lower vibration and noise. A dual mass type crank pulley equipped with a torsional damper and a bending damper is adopted to reduce vibration and noise. A Teflon shaft seal has been adopted for the cylinder internal pressure seal, and an insulator has been adopted for the areas that the injectors contact the head to reduce vibration and noise.
A more lightweight design has been achieved and vibration and noise are reduced by adopting a no.
PUR (polyurethane) covers with high-level sound absorption are installed in each area to reduce engine vibration and noise. A 4-point support structure is used for the fitting of the differential mount to the suspension member to reduce noise and vibration. A low coercive force, cross-grooved constant velocity joint with excellent noise and vibration performance is adopted. A 3-joint propeller shaft is adopted, which uses flexible coupling with excellent noise and vibration performance. In addition to enhancing parts precision and balance performance, the mounting precision of the propeller shaft has also been enhanced to reduce noise and vibration. The balance of the propeller shaft lengths has been optimized to reduce noise and vibration.
A low coercive force, tripod constant velocity joint with excellent noise performance is adopted on the differential side. I agree that there seems to be tremendous potential for anyone to obtain a substantially quieter ride by applying sound dampening materials throughout the car.
I just published findings from a case study of reducing road noise in a Ford F-150 Pickup Truck using Dynamat. Most Popular Posts Error: cannot ajaxify WordPress Popular Posts on this theme. Recommended GearGo to the Elevating Sound Store to check out exciting gear with leading sound benefits. Excessive noise is a common cause of both tinnitus and hearing loss, affecting up to 15% of teens and adults.
The use of hearing protection during exposure to loud sounds is critical to prevent short-term and permanent damage.
If you are frequently exposed to loud sounds, you are at risk for hearing loss and tinnitus. Examples: Attending live concerts, listening to a personal music player at high volume through headphones, playing amplified music in a band, playing in a large orchestra, working as a sound board operator. Examples: Working in a factory, or in mining, construction, forestry, farming, or manufacturing. Examples: Using power tools such as a table saw or chainsaw, drill, lawnmower, leaf blower, or snow blower. There are microscopic cells known as hair cells along the basilar membrane that vibrate to different frequencies depending on their specific location. Healthy hair cells transmit the electrical signal to the brain where it is interpreted as speech, music, sound, or noise.
Sound therapy includes different types of treatment sounds, and therapies differ by the volume of the treatment sound relative to the tinnitus. If you are experiencing a medical emergency, please call 9-1-1 or go to an emergency room to seek immediate care. I think it is the accumulated perpetual machine hum frequency over time that wears out the hyperstimulated recruited hair cells on cochlea, creating ringing. The oil pan, cylinder block, and converter housing are fastened in one unit to significantly reduce noise and vibration and achieve a more lightweight design. So now you know that it took a lot of engineering excellence in order to make the world’s quietest passenger car a reality. Whether you already have tinnitus or are trying to prevent it, protect your ears from loud sounds. It passes through the middle ear and eventually reaches the inner ear, which includes the cochlea and auditory nerve.  The cochlea, or organ of hearing, is a complex, snail-shaped structure in the inner ear. It is a conspiracy to unsettle the masses (432hz sacred healing vibration vs 440hz the Devil’s interval). No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.Designations used by companies to distinguish their products are often claimed as trademarks. Move away from the noise source if possible, or wear ear plugs, ear muffs, or other appropriate hearing protection. The cochlea's job is to translate the physical vibrations set forth by sound waves into electrical signals the brain can recognize as specific sounds. It is widest and least stiff at the apex of the cochlea, and narrowest and most stiff at the base.
Because of their location, the hair cells responsible for detecting high-frequency sounds make first contact with loud sounds entering the ear, and are, therefore, most susceptible to damage from loud noise.
As a result, each area of the basilar membrane vibrates preferentially to a particular sound frequency. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. What would you say are some of the differences between various sound dampening material brands such as Noisekiller, Dynamat, HushMat etc? If using earplugs, learn how to insert them properly, and if using earmuffs, ensure they fit properly over both ears. Children's toys that emit sound (especially since some toys lack a volume control, and children sometimes hold toys close to their head or ears).
As a result, each area of the basilar membrane vibrates specifically to a particular sound frequency, or pitch. There are examples of hybrid cars that are fairly noisy at highway speeds due to lacking soundproofing, letting in both unwanted road noise and wind noise. I see you have kits for a number of VW models; do you also have experience of treating the VW Phaeton even though it’s already a pretty well-isolated vehicle (yet more could probably be done to reduce road noise)? When listening to music, keep the volume at a moderate level.  If you work in a loud environment, please ensure that your employer is providing the proper protection for you and your co-workers.
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered.

It is sold on the understanding that the publisher is not engaged in rendering professional services.
Society thinks it is easier for them, but what about me and my access to complete a language (ASL)? The notorious abundance of tinnitus a€?curesa€™ suggests that there are (at least) as many tinnitus causes, triggers and mechanisms. It will probably always be the case that no one-size-fits-all approach to tinnitus management will succeed, but it is equally likely that a variety of interventions may, in many cases, produce some amelioration of the patienta€™s distress.
Most researchers and practising clinicians report that a combination of sound therapy and counselling facilitates the patienta€™s ability to manage the tinnitus experience. Psychotropic agents produce mixed success from which we infer that, at a minimum, such drugs work well for some patients regardless of whether the influence is upon the tinnitus sound, the patienta€™s psychological health or both. Herbal supplements, vitamins and alternative therapies such as acupuncture, biofeedback and hyperbaric oxygen therapy have produced mixed results that must be weighed against the potential, and substantial, risks associated with their use. What is the practitioner who answers the call, and decides to work with tinnitus patients, to make of this situation?The second edition of Tinnitus: A multidisciplinary approach promotes tinnitus management strategies built upon the collaborative care for suffering patients and the preparation of clinicians for such practice. We have a set of authors uniquely qualified to tackle thorny tinnitus problems, and it is clear that their work as clinicians and researchers has crystallised in the group the certainty that our patients more often than not require care that knows no borders. The centrepiece of this text is its dispensing of practical, evidence-based information from the fields of audiology, otology, psychology, psychiatry and auditory neuroscience. Tinnitus distress may derive from several different factors simultaneously, and the authors remind us to weigh the potential risks and benefits of action and inaction. Throughout, they provide thorough and current reviews of material germane not just to clinical practice but to the educating of individuals who will conduct the practice.The reader will find resources that facilitate the essential task of interacting with patients and determining a tinnitus management plan.
To address the likelihood that all tinnitus patients present unique challenges to the clinician, the authors provide A­guideposts, A­evidence and thoughtful rationales for selecting a course of action tailored to each patienta€™s needs.
For example, some tinnitus programmes focus on modifying a patienta€™s concept of tinnitus and its effects, thereby facilitating a change in the patienta€™s behaviour and approach to the problem (i.e. Others utilise particular protocol-driven therapy, specifying more consistent application of sound levels and A­specific counselling components (i.e.
Neuromonics) couple sound or music filtered specifically to account for each patienta€™s hearing sensitivity and loudness tolerance to counselling that varies little across patients. The reviews of these and other management protocols are of great value not only to present practitioners but also to the student or professional who considers working with tinnitus patients.It is admittedly difficult to report clinical success when the approach to patient A­management is idiosyncratic and driven more by the patienta€™s needs than by a cookbook plan of action.
Particularly at this time, when clinical success is defined in the context of evidence-based practice, an eclectic approach to management of a potentially disabling condition may provide benefit to patients but may be difficult to sell to peer reviewers and other clinicians.
Yet, when we observe improvements in our patients, it is undeniable, and when we measure a patienta€™s self-assessment of handicap, we may measure statistically significant changes in the patienta€™s tinnitus experience.
While it is difficult to define A­precise tinnitus distress or tinnitus relief, clinicians working with tinnitus patients see their share of both.A cliniciana€™s experience with suffering patients provides the impetus to adapt and adjust strategies in order to facilitate the patient managing the condition effectively.
As the authors point out, some of these a€?real timea€™ adjustments may lead to novel methods for use with other patients. However, the cliniciana€™s experience with tinnitus patients likely influences their willingness and ability to adapt clinical approaches with which they are comfortable. It is therefore important to gain, or help others achieve, the experience and confidence required to implement starkly different strategies for different patients.
The authors have provided a rich inventory of management strategies that should foster a cliniciana€™s flexibility in order to meet the diverse needs and challenges associated with the tinnitus patient population.Unfortunately, as the professional training of individuals to join the ranks of tinnitus clinicians lags far behind the need for such providers, it is also the case that the need for multidisciplinary patient care goes unrecognised too often. In this second edition, the authors stress the need for professionals across the disciplines of neuroscience, psychology, medicine and audiology to collaborate in the clinic and the lab in order to meet patient needs. Audiologists and otologists have for years recognised that tinnitus is frequently complicated by psychological co-morbidities. It is imperative for hearing health care professionals to seek out practitioners from related clinical areas to whom patients whose tinnitus is complicated by other factors may be referred. Recognising the signs that would trigger such referrals is the first step to providing comprehensive patient care.
The authors provide the means by which tinnitus clinicians can place the patienta€™s needs in a broader context than would be available through the inherently limited view of tinnitus as exclusively an auditory problem. Because the needs of tinnitus patients are difficult to meet in many cases, clinicians must be versed in the literature and practice of related disciplines. Tinnitus distress is multidimensional and this book does not purport to solve the myriad problems that derive from that fact. This is not restricted to the traditional themes of cochlear hair cells, and of sound-based and counselling-based therapies, but also involves robust pharmaceutical research, and also the design, implementation and evaluation of novel approaches to treatment.Additionally there are indications that a multidisciplinary ethos is permeating the tinnitus world, with voices from neuroscience, pharmacology, psychology and audiology interweaving as we investigate this fascinating and sometimes debilitating symptom.
New findings abound, and there are new treatments to describe and novel perspectives through which to consider tinnitus. While the magic pill continues to elude us, there are indications that progress is being made in effective intervention and that many more patients are accessing clinical services.The distinctive perspective of this book is that each of the four authors is a practising clinician while also involved in research. The emphasis for each of us is different, but being able to inhabit both worlds gives, we hope, insight into the translational nature of tinnitus work: that is, that the clinic must influence the research agenda and that research should underpin and inform clinical practice.
Seeing tinnitus patients in the clinic on a regular basis also gives an authenticity to what one believes about tinnitus and how it can best be treated.
Some of the insights in this book have been hard won.Our Editors at Wiley-Blackwell are to be thanked, not least for the patience they have shown to four authors who have been weighed down at times with administrative and clinical responsibilities.
Our colleagues too have been patient and supportive, but most of all our families and friends have been mainstays of support. That so many people can have some experience of these symptoms and not be distressed, while others are troubled to the point that they are no longer able to perform their normal daily activities remains paradoxical. Furthermore, researchers have reported that when tinnitus is matched in intensity in this troubled group of people, it has been indicated to match to sound of low intensity (though the complexities of such experiments will be discussed below).
Despite this apparent low intensity the intrusiveness of the symptom in patients with severe tinnitus is remarkable. Given these paradoxes, it is unsurprising that no single approach to tinnitus and hyperacusis has been shown to be overwhelmingly stronger than any other in terms of understanding and managing these symptoms.The aim of this book is to present a multidisciplinary approach to tinnitus and hyperacusis, incorporating insights from Audiology, Otology, Psychology, Psychiatry and Auditory Neuroscience. It is hoped that this will inspire a collaborative approach to tinnitus and hyperacusis management that will benefit patients and clinicians alike.
There is already good evidence that such collaborative and multidisciplinary initiatives in other fields, such as chronic pain, have increased the efficacy of treatments.DefinitionsThe word tinnitus derives from the Latin verb a€?tinnirea€™ meaning a€?to ringa€™, and in common English usage is defined as a€?a ringing in the earsa€™ (Concise Oxford English Dictionary, Allen, 1990). The first recorded use of the word occurred in 1693 in Blancharda€™s Physiciana€™s Dictionary, second edition as follows (Stephens, 2000):Tinnitus Aurium, a certain buzzing or tingling in the Ears proceeding from obstruction, or something that irritates the Ear, whereby the Air that is shut up is continually moved by the beating of the Arteries, and the Drume of the Ear is lightly verberated, whences arises a Buzzing and a Noife (p.
201).At the time that this Dictionary was compiled there were many conditions that were thought to be due to trapped air, and procedures were developed to address that. It is interesting that the Blanchard definition fits well with the experience of pulsatile tinnitus, where an individual becomes aware of the sound of arterial or venous blood flow (see Chapter 5).Some other languages have a variety of words to describe the phenomenon of tinnitus (Stephens, 2000), notably French, where five words are in regular use, each describing a particular timbre or quality of sound.
In Swedish the word for tinnitus used to be A–ronsus, which in direct translation stands for ear breeze. Few patients would agree that their tinnitus sounds like a breeze and this word does not catch the emotional impact experienced by some. MA?ller (2011b) distinguishes between objective tinnitus (which can be heard, measured or recorded by an external observer) and subjective tinnitus, which can be heard by the person alone. MA?ller defines subjective tinnitus as follows:Subjective tinnitus is a broad group of sensations that are caused by abnormal neural activity in the nervous system that is not elicited by sound activation of sensory cells in the cochlea (MA?ller, 2011b, p. 9).This definition has some insights, as it implies that tinnitus can be varied, both within and between individuals.
One might question whether anomalous might be a better word than abnormal, and this will be unpacked when we consider the neuroscience of tinnitus.Definitions of hyperacusis have tended to illustrate the perspective of the author. For instance, Vernon (1987a) proposed an open definition asa€¦ unusual tolerance to ordinary environmental sounds.For Vernon the emphasis may have been upon the unusual, as he could only recall four such cases, having seen over 4000 persons with tinnitus. In an initial differentiation between these two the second experience was entitled phonophobia, a term that is commonly used in neurology (Woodhouse and Drummond, 1993), in particular in association with migraine attacks. However, the inference that this phenomenon was essentially phobic in nature can be unhelpful to some patients.
Definitions of hyperacusis are further explored in Chapter 10.Historical aspectsThe experience of the perception of sound generated internally has been mentioned in many historical medical texts. These original sources have been reviewed by Stephens (1987, 2000) and Feldmann (1997), and while these authors have many detailed issues upon which they are at variance, they are in broad agreement on the interest expressed in tinnitus by medical authors from historical times. A series of ancient Babylonian medical texts, inscribed upon clay tablets, were housed in the library of King Assurbanipal (668a€“626 BC) in Ninevah. These were translated by Thompson (1931) and were found to include 22 references to tinnitus, described variously as the ears a€?singinga€™, a€?speakinga€™ or a€?whisperinga€™. Treatments are described, including whispered incantations, the instillation of various substances into the external auditory meatus and the application of charms (such as the tooth of a female ibex): specific treatments were advised for each experience of tinnitus as described above (Feldmann, 1997). Other authors writing in Graeco-Roman times mentioning tinnitus include Celsus (25 BCa€“50 AD) who described treatments with diet and abstinence from wine and Pliny the Elder (23a€“79 AD) who advocated the use of wild cumin and almond oil in cases of tinnitus (Stephens, 2000). The use of sedative medication to treat persons suffering with tinnitus, still in common use in the United States of America and Western Europe, was first described by Galen (129a€“199 AD), who considered the benefits of opium and mandrake.Dan (2005) considers a report that the Roman Emperor Titus (39a€“81 AD) experienced tinnitus. This is found in the Babylonian Talmud, and the tinnitus was considered to be punishment for the destruction of the Second Temple in Jerusalem (70 AD), though the report that at post mortem Titus was found to have a large intracranial tumour offers another perspective on this. Titus is said to have enjoyed some short-lived relief from sound therapy:A gnat entered his nostril and pecked at his brain for seven years.
For thirty days this worked fine but then the gnat became accustomed and resumed pecking (quoted in Dan, 2005).There are mentions of tinnitus in texts within the Islamic medical tradition from the period following the decline of medicine in Rome (Stephens, 1987, 2000, and Feldmann, 1997).
These include the first mention of the coincident complaint of tinnitus and hyperacusis (described as an a€?increased sensibilitya€™) by Paul of Aegina (625a€“690 AD) (Stephens, 2000, after Adams, 1844).Advances in the understanding and treatment of tinnitus were not to be seen until the seventeenth century, with the publication of the first text entirely dedicated to the ear and hearing.
The insights into tinnitus represented a move away from the concept that tinnitus may arise from trapped air in the ear, this having persisted since Roman times, towards a model of tinnitus arising from diseases of the ear and disorders of the brain. The implication of the influence of the brain over the ear is prophetic of later concepts of the function of the efferent auditory system in humans. This comprehensive text was based upon 20 years of experience in working with the deaf, and contained numerous case studies, including that of Jean-Jacques Rousseau (1712a€“1778), the eminent philsosopher who became afflicted by tinnitus in later life (Feldmann, 1997). Itard made the distinction between tinnitus experiences arising from sound, thus a€?objective tinnitusa€™ such as that caused by somatosounds, and that arising without any acoustic basis, a€?false tinnitusa€™ (now described as a€?subjectivea€™ tinnitus).

In addition to such medical insights Itard described the effect of tinnitus upon an individual: a€?an extremely irksome discomfort which leads to a profound sadness in affected individualsa€™ (translation by Stephens, 2000, p. The treatment of tinnitus was, as with previous authors, based upon treatment of the underlying otological condition, though when such treatment failed, however, Itard advocated attention to the behavioural manifestation of tinnitus and in particular to sleep disturbance, when the use of external environmental sounds (such as a watermill for low-pitched tinnitus or an open fire burning damp wood for high-pitched tinnitus) to mask the tinnitus was suggested.In the late nineteenth century the medical specialty of Otology underwent a renewal of interest and effort, and several individuals have been identified as leaders in this field. Joseph Toynbee (1815a€“1866) and William Wilde (1815a€“1876) (the father of Oscar Wilde) were pre-eminent in this regard and wrote extensively on ear disease, including consideration of tinnitus arising from such conditions.
Toynbee experienced distressing tinnitus himself and died during an experiment in which he attempted to determine a€?the effect of inhalation of chloroform upon tinnitus, when pressed into the tympanuma€™ (Feldmann, 1997, p. MacNaughton Jones (1981) has been credited (Stephens, 2000) with A­producingthe first book in English on tinnitus alone, which contained a classification of tinnitus based upon the site of origin and a review of contemporary treatments.The ability to use electronic instruments to measure hearing thresholds accurately by audiometry, and the consequent ability to determine hearing status in patients with a complaint of tinnitus, was developed in the early twentieth century, and became widespread in Western Europe and the United States of America from the 1940s (Weir, 1990). At this time Fowler (1941) considered the characteristics of tinnitus and is credited with the first comprehensive attempts to determine the matching and masking characteristics of tinnitus (Stephens, 2000). Among the insights gleaned by Fowler were that subjectively loud tinnitus is often matched to a low-level stimulus, that tinnitus may be masked by a broad-band noise and that it is not possible to generate beats between tinnitus and externally generated tones (Fowler, 1941). In subsequent writings Fowler collaborated with his son, also an Otologist, and formulated a protocol for the examination of tinnitus patients considering the qualities of the sound, the distress associated, as well as the otological health of the patient (Fowler and Fowler, 1955).In the late twentieth century there was little scientific or clinical interest in tinnitus and the field was kept alive by a small number of dedicated individuals.
The work of Jack Vernon has already been cited: Vernon was a Professor of Audiology working for most of his career in Oregon, USA, and developed the first practical wearable masking devices for tinnitus.
In the United Kingdom, Ross Coles was a prolific tinnitus researcher, clinician and teacher, and his influence and mentorship is still felt to this day. Coles worked as a Consultant Physician and academic at both Southampton and Nottingham Universities, and was the founder of the long-running European Tinnitus Course.
Also from a medical background, though working as a surgeon rather than a physician, Jonathan Hazell specialised in tinnitus, and in his collaborations with Pawel Jastreboff (a neuroscientist) developed an influential model of tinnitus and a concomitant treatment protocol (Tinnitus Retraining Therapy). From an Audiology perspective, Richard Tyler, working at the University of Iowa, has written, researched and taught extensively on how tinnitus can be managed and has been extremely influential.
In the early 1980s Richard Hallam, a psychologist working in London, proposed that the natural history of tinnitus is characterised by the process of habituation and pointed out the influence of psychological factors on this process. His work has had a major influence on the clinical management of tinnitus, particularly by psychologists.Thus there has been evidence of input to tinnitus research from otology, audiology, and to some extent neuroscience. What has been missing until recently, however, has been substantial input from pharmacology, from psychiatry and from auditory neuroscience.
There are indications that this is now underway and that the field is becoming characterised by collaboration and teamwork rather than a small number of experts.Given the existence of tinnitus throughout history and the wide prevalence of tinnitus experience (see Chapter 11 for details), one should expect mentions in art and literaA­ture. A comprehensive survey of such mentions will have to await another day, but some can be considered here as examples. The Czech composer Smetana (1824a€“1884) suffered progressive, and eventually profound, hearing loss and associated tinnitus.
He wrote his tinnitus into his string quartet a€?From my lifea€™ (1876) as a prolonged sustained high violin note towards the end. Thomas Hardy (1840a€“1928) has a character named William Worm, in his novel the A Pair of Blue Eyes (1873), speak of tinnitus:Ia€™ve got such a noise in my head that therea€™s no living night nor day.
God Aa€™mighty will find it out sooner or later, I hope, and relieve me (Chapter 4).More recently, Woody Allen has the male lead, played by himself, in the film Hannah and Her Sisters (1986) experience unilateral tinnitus and hearing loss, and is investigated for an acoustic neuroma. The first is that any consideration of tinnitus and formulation of possible treatment should consider the otological status of the patient and thus involve the treatment of ear disease where indicated.
The second is that this otological focus does not obviate the clinician of the responsibility to consider the distress caused by the tinnitus experience and, where significant behavioral manifestation of this is present, to treat that distress. The third is that the understanding and treatment of tinnitus is a changing and developing science.SummaryFrom the above it is evident that concern with tinnitus is not new, and in fact is demonstrated throughout written human history. Many scientists, clinicians and artists have considered tinnitus and the involvement of systems of reaction, arousal and emotion.
The indications are that a holistic view of tinnitus must consider the involvement of such systems.Chapter 2Prevalence and natural historyKnowledge of the epidemiology of tinnitus is fundamental to tinnitus cliniciansa€™ and researchersa€™ understanding of the subject. Studies tell us that tinnitus is one of the most common physical symptoms experienced by humans, which inevitably leads to the question of why it is so common.
One of the greatest challenges facing the tinnitus community is to understand why, if it is so common, do only some people suffer as a consequence of tinnitus? This question will be dealt with in other chapters, but knowledge of the epidemiology of tinnitus provides a backdrop against which to understand this fundamental issue.
In the famous experiment by Heller and Bergman (1953), subjects were asked to enter a soundproof booth and to report all the sounds they could hear; 94% reported some form of tinnitus-like perception, using terms like buzz, hum and ring.
Unfortunately, the conditions in which the Heller and Bergman (1953) study was conducted were not well controlled. It has been even suggested (Graham and Newby, 1962) that they did not assess subjectsa€™ hearing audiometrically; the idea that the subjects had normal hearing is therefore only an assumption. Attempts to replicate the study have not revealed the same proportion of subjects reporting tinnitus-like experiences. A replication by Graham and Newby (1962) found that only 40% of their normal hearing subjects reported tinnitus. Levine (2001) found that 55% of his normal hearing subjects had ongoing tinnitus when they were placed in a low-noise room. On the face of it, working out how many people have tinnitus experiences at any given moment in time might seem straightforward, but it is, in fact, a difficult thing to do.
There are considerable variations in the way that people experience tinnitus and in the way that they talk about it.
Formal definitions of tinnitus can be complex and not easily understood by the general population. Prevalence studies have tended to rely on simplified definitions that can be open to interpretation and different studies have used slightly different definitions. Participants were interviewed in their homes and asked a€?Have you at one time or another noticed noises in your ears or head?a€™ The prevalence of tinnitus showed a tendency to increase with age as follows 21% (18a€“24 years), 27% (25a€“34 years), 24% (35a€“44 years), 27% (45a€“54 years), 39% (55a€“64 years) and 37% (65a€“74 years).
This was carried out by the Medical Research Councila€™s Institute of Hearing Research and reported by Davis and El Rafaie (2000). In this study questions about tinnitus were incorporated into the National Study of Hearing, a longitudinal study that sampled a very large number of the population (n = 48 313) in four major cities (Cardiff, Glasgow, Nottingham and Southampton). The first part of the study involved a postal survey of 48 313 randomly selected people, with a response rate of over 80%. The questions used were a€?Nowadays do you get noises in your head or your ears?a€™ and a€?Do these noises last longer than five minutes?a€™ In this way these researchers used the concept of prolonged spontaneous tinnitus (PST).
Tinnitus was defined by the question, a€?During the past 12 months have you had noises in your head or ears (such as ringing, buzzing or whistling) that lasted longer than five minutes?a€™ One additional common restriction was that only tinnitus reported to occur most or all of the time was defined as persistent tinnitus (cf.
For men, the age-standardised prevalence of persistent tinnitus was 16.1% in those who reported severe hearing difficulties, whereas for those men with slight or no hearing problems the prevalence was only 5%.
They received a response rate of 64.2%, with 20% answering a€?yesa€™ to a question about experiencing noises in their heads or ears lasting more than 5 minutes.
They asked 3600 people a€?Do you suffer from tinnitus?a€™ They also asked people how often they experienced ear noises and asked questions about localization and severity. Scott and Lindberg (2000) approached a random sample of 2500 Swedish citizens from a population register (in which all citizens are registered). Responses were obtained from 1538 subjects (62%) and among these 15.8% responded a€?yesa€™ to the question, a€?Have you heard buzzing, roaring or tones, or other sounds which seem to come from inside the ears or the head and that have persisted for five minutes or longer (so-called tinnitus)?a€™ In addition, tinnitus was graded by use of the Klockhoff and Lindblom (1967) severity definition of mild, moderate or severe tinnitus, where it is masked by environmental sound, not masked but not affecting sleep or not masked and affecting sleep, respectively . As results were analysed separately for help-seeking and non-help-seeking people with tinnitus (with additional participants recruited from a clinic), no exact estimate of severe tinnitus in the general population can be derived. As only a minor proportion of subjects in the population survey had sought help (n = 7), however, the figures for the population-derived non-help-seeking group provide an estimate of the proportion of severe (grades IIa€“III) tinnitus.
Slightly below 50% had tinnitus of grades IIa€“III, with only a few (12.2% of the tinnitus sample) having tinnitus of grade III. Hence, a conservative estimate is that about one person in ten has severe tinnitus in the general population.In another study, Johansson and Arlinger (2003) studied 590 randomly selected subjects from the province of A–stergA¶tland. As many as 31%, however, had noticed tinnitus at some point in time and 19.5% had temporary tinnitus lasting not longer than five minutes. It is uncertain if this was a random sample (average cross-section) and severity of tinnitus was not clearly outlined. This study was published as a conference proceedings report and therefore the results were not described in much detail.
The authors derived that 13% of the German population has, or once had, noise in the ears lasting longer than five minutes. They also provided an estimate of those having tinnitus at the time of the investigation, which was 3.9% of the population.
They also estimated that approximately 50% of those with ongoing tinnitus considered the effect of their tinnitus as moderately serious or unbearable. The authors reported that the prevalence increased with age up to 79 years and that manual work, dyslipidosis, hypertension, liver diseases, cervical arthrosis and alcohol consumption were statistically significant risk factors.
She reported data from a national health examination survey dating back to 1960a€“1962 with a total of 6672 subjects.
Respondents were asked, a€?At any time over the past few years, have you ever noticed ringing (tinnitus) in your ears or have you been bothered by other funny noises?a€™ Given this very broad definition, it is not surprising that as many as 32.4% of adults aged 18a€“79 years said that they did. Interestingly, a linear association was found between age and presence of both mild and severe tinnitus. In common with many other studies, a strong association was found between severity of tinnitus and hearing impairment.Almost a decade later Brown (1990) explored the prevalence of tinnitus in older adults using data from the 1982a€“1987 USA Health Interview Survey together with the supplement on ageing to the 1984 Health Interview Surveys and the first Health and Nutrition Examination Survey 1971a€“1975. Participants were asked: a€?At any time over the past few years have you ever noticed ringing a€¦a€™, so providing information about prevalence over a period of time.

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