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How to cite this article Mendes RCCG, Ribas A, Macedo IP, Buschle M, Ataide AL, Pereira R, Kochen AP, et al.
Several studies have shown that cochlear implants may reduce or even eliminate tinnitus in patients with bilateral profound hearing loss.
Keywords: cochlear implants, deafness, language and hearing sciences, speech, speech perception, tinnitus. Tinnitus means perceiving a sound that is not being generated in the environment at that time. Considered one of the most common symptoms of profound sensorineural hearing loss, tinnitus can significantly affect the quality of life of individuals2.
The latest international publications7,8 suggest that patients with unilateral hearing loss, or even severe hearing loss, presenting ipsilateral tinnitus with hearing loss, unresponsive to several treatments, may also benefit from electrical stimulation of the auditory nerve through the CI.
The beneficial effect of a CI on tinnitus can be explained by acoustic masking, by electrical stimulation directly to the auditory nerve, and especially by the reorganization of the central auditory system and associative brain areas that occurs after activation of the implant. The aim of this study was to describe the audiological results of a patient with asymmetric hearing loss with ipsilateral disabling tinnitus, who was underwent the CI procedure. Throughout the ENT care, various treatments were performed without success, for the reduction or remission of tinnitus, which led the patient at the time to have suicidal thoughts. The patient underwent cochlear implant surgery to the right ear in an attempt to improve auditory acuity, but mainly as a last resort in tinnitus treatment. Before the CI, results were compatible with profound hearing loss to the right ear and severe loss to the left. After the CI, thresholds compatible with normal hearing on the right ear were observed, as shown in Figure 1. We used the Glendonald Auditory Screening Procedure (GASP test)12 which classifies the category of hearing on a scale of zero to six, where zero means no detection of speech sounds and six means open-set speech recognition. The protocol for assessing tinnitus was applied at the following times: before surgery, 45 days after surgery (activation of CI), two months later, six months later and one year after CI surgery.
The literature11 states that the CI is configured as an alternative treatment of deafness and constitutes a multifactorial process with proven effectiveness.
The Brazilian study17 indicates that the hearing assessment obtained six months after the first implant programming demonstrates that English-speaking patients get excellent results in tests of recognizing words and sentences in open presentation, regaining useful hearing. Despite these satisfactory and known findings by physicians and audiologists, the primary complaint by the subject, which is the focus of this study, was the tinnitus. Di Nardo et al.6 reported that the CI provides effective results in reducing the perception of tinnitus intensity.
Statistically significant reduction in THI overall indices and sub-indices, pre and post CI, were demonstrated in scientific studies8,11 showing lower levels of discomfort and a decrease in the intensity of tinnitus as a result of direct electrical stimulation of the auditory nerve and reorganization of the central auditory pathways and cortical association areas, leading to the use of tinnitus as a criterion for choosing the ear to be implanted. The results related to the concentration (66%), emotional (100%), sleep (26%) and hearing (96%) obtained by preoperative TAQ converged at a rate of 72% indicating strong interference of tinnitus, especially in the emotional and hearing states of the patient.
Factor 3, life prospects, went from a preoperative score of 100% to 50% after activation of the CI, 25% after two months of use, 75% after six months and reduction to 25% after 1 year of CI use. The consulted study11 shows that the CI generates maximum benefit in remission buzz around seven months after the performed procedure. The reduction in the intensity and degree of tinnitus annoyance confirms the improvement in the quality of life of individuals, a fact that must be considered in preoperative counseling of patients with tinnitus as candidates for cochlear implants.
CI as a treatment for post-lingual profound hearing loss is highly effective, there is improvement seen in hearing thresholds in performance and perception of speech sounds, as in the case presented. Although the literature describes the indication of CI for patients with tinnitus, the initiative is still not being widely accepted by physicians and speech-language pathologists, especially when hearing loss is unilateral or asymmetric. Paper submitted to the ITJ-SGP (Publishing Management System) on May 21, 2013; and accepted on June 21, 2013. Allow your Audiologist to professionally evaluate the type and severity of your hearing loss. We hypothesize that relief in the ear with the tinnitus complaint may result from oral intake of Clear Tinnitus for patients with severe disabling tinnitus in whom the factor of aeration of the middle ear and that of eustachian tube dysfunction is identified and treated.
Interference in aeration of the middle ears accompanying allergy and inflammation of the upper respiratory tract has been identified via a medical-audiological tinnitus patient protocol (MATPP) to be a factor that can influence the clinical course of subjective idiopathic tinnitus of the severe type [6-8].
Historically, the influence of aeration of the middle ear "effecting permeability of the eustachian tube" was reported by Politzer in 1863 [9].
Since 1979, the tinnitus clinic of the Health Science Center at Brooklyn, State University of New York, and the Martha Entenmann Tinnitus Research Center, Inc., have reported on more than 10,000 patients who had subjective idiopathic tinnitus (seen in neurotological consultation) and completed the MATPP.
The prospect of a trial of Clear Tinnitus to attempt tinnitus relief in a selected cohort of patients who have subjective idiopathic tinnitus and exhibit objective evidence of interference in eustachian tube function provided a clinical opportunity to use our established experience to test the efficacy claimed for this preparation. We selected 15 individuals with reported subjective, severe, disabling idiopathic tinnitus lasting at least 1 year.
The parameters of the patients' tinnitus included tinnitus intensity, location, masking characteristic, and duration.
All 15 subjects reported the tinnitus to be of the severe disabling type lasting for at least 1 year.
The homeopathic preparation for tinnitus relief- Clear Tinnitus-was taken on a daily basis. The patients in this study completed multiple measures for evaluating the subjective idiopathic tinnitus and the hypothesized tinnitus relief.
We identified for each patient multiple risk dimensions known to influence the clinical course of subjective, idiopathic, severe, disabling tinnitus, with a focus on fluctuation of aeration of the middle ear and eustachian tube dysfunction. We used multiple objective measures to evaluate the risk dimensions for each tinnitus patient. The measures included audiological testing via puretone audiometry and speech audiometry performed using a Beltone 2000 audiometer. Extensive scientific research has been carried out on the preparation's chemical composition, and pharmacological and clinical research has focused on its individual herbs.
We performed all statistical analyses using the Statistical Package for the Social Sciences (SPSS Release 14) [19]. Regression analysis failed to detect any trends in the change in response to audiometric tests across the hearing spectrum; thus, we could not derive coefficients of change for testing. Ultra-high-frequency audiometry (UHFA) did not show any clinically significant change in threshold at 10,000-20,000 Hz before and after testing with airconduction high-frequency or electrical high-frequency audiometry.
In the 11 patients completing the study, all masking curves were either type I or type IV according to Feldmann's classification system. Minimum masking level (MML) changes for the right ear before and after the study are reported for 10 individuals, as 1 had no tinnitus at the end of the study. We established LDLs at 250-8,000 Hz for the right and left ears before and after the study (Table 5).
For the tympanogram type, using -100 mm H2O as abnormal, three of the seven responders went from type C tympanogram to type A.
Both responders and nonresponders (N = 11) correlated to recorded MEPs before and after the study (see Table 1). We found improvement in aeration of the middle ear, as established by tympanometry and supported by physical examination of the tympanic membranes, in eight patients.
Five of the seven patients reporting subjective tinnitus abatement recorded MEP improvement at the start and conclusion of the study.
A nonsignificant difference occurred over time when testing for a quadratic change over the course of the study, with a lowering of the total significant abnormal recordings.
We analyzed the results of the outcome questionnaires as an average for all patients who completed the study (N = 11) and separately for the responders (n = 7) and nonresponders (n = 4; Table 7).
The measurement of depression test (Zung) indicated a mean change of -2.27 before and after the study, which also was not considered statistically significant. In summary, a statistically significant improvement in one or more of the outcomes (TII, TAI, TRQ) was identified in six of seven patients reporting tinnitus relief. This study differentiated between the efficacy of the Clear Tinnitus preparation for maintenance and improvement of MEP and the correlation of the MEP improvement with reported tinnitus relief. Seven of the 11 patients reported relief from severe, disabling-type tinnitus after oral intake of Clear Tinnitus. The clinical course of the tinnitus patients selected for this study was identified, by their clinical history and physical examination, to have been influenced by fluctuation of MEP. The patients' clinical history was positive for the association of tinnitus intensity fluctuation with the subjective report of ear blockage-specifically, increased tinnitus intensity with increased ear blockage and vice versa.
The regression analysis failed to detect any trends in a change in response with audiometric tests across the hearing spectrum; thus, we could not derive coefficients of change from testing. The range of normal and abnormal MEP varies in reports from different investigators (from -25 mm H2O to -100 mm H2O) [20-26]. The QEEG testing was recommended in this study to improve the accuracy of the tinnitus diagnosis. Clinically, when interpreted in terms of the tinnitus dyssynchrony-synchrony theory, the QEEG data in this study are considered to provide an understanding of the clinical course of the tinnitus in the patients in this study and of the efficacy of the Clear Tinnitus therapy attempting tinnitus relief [2]. The outcome results reflect the dilemma of all professionals involved in attempting to evaluate modalities of therapy attempting tinnitus relief: specifically, how a subjective response becomes one of affect and how a subjective response might be objectified [1,13]. The 11 tinnitus patients who completed the study demonstrated with tympanometry a statistical and clinical significance in MEP improvement (n = 8) or maintenance of MEP (n = 3) or both. The subjective report of tinnitus relief in those seven patients was supported by objective measures of analysis in five patients; the remaining two responders recorded normal MEP before and after the study.
We gratefully acknowledge the support of Clear Products and the Martha Entenmann Tinnitus Research Center, Inc., for this educational and research effort.
However, there are not consistent references regarding ipsilateral tinnitus compared to unilateral profound hearing loss. It is a very frequent symptom, which may affect around 17% of the population in some countries. Several studies claim that the cochlear implant (CI) can diminish or even eliminate the perception of tinnitus in patients with bilateral profound hearing loss and that, although a risk of tinnitus perception that increases after implantation exists, it is very small3-6.
With the support of these findings researchers suggest that tinnitus should be a selection criterion in choosing which ear to implant and that patients with severe unilateral hearing loss associated with severe tinnitus can be considered CI candidates9-11. The comparison between the responses obtained before and after the CI verify the benefits achieved with this therapy.
The tests were conducted in a soundproof booth, with the Madsen Itera - GN Otometrics audiometer.
The test was applied prior to the CI, five months later, eight months later, and finally, after a year.
This fact was borne out in this case report, where the pre and postsurgical audiometric tests showed improvement in tone thresholds with CI use. In this study, by applying the VAS, we observed a significant reduction in the intensity of tinnitus perception, and that after activation of the CI, the rating went from four to one after 60 days of using the device. In our study, after activation of the CI, there was a reduction in the THI total index (six) and sub-indices (functional 2, catastrophic 0, and emotional 4) to a score of one.
A total reduction of assessed scores on aspects of sleep and concentration with a reduction of greater than 20%, significant data regarding the emotional and hearing aspects, was observed after activation of the CI. In our study there was a significant reduction in the percentage of THQ (Table 3) after activation of the CI and the subsequent evaluations (two and six months of CI use) mainly in factors 1 and 2. In addition, it can be seen that the CI was critical to the reduction of tinnitus perception. Speech, Language and Hearing Sciences - Universidade Tuiuti do Parana - Curitiba - PR - Brasil. Department of Otolaryngology - Hospital Infantil Pequeno Principe - Curitiba - PR - Brasil. Speech, Language and Hearing Sciences - Hospital Infantil Pequeno Principe - Curitiba - PR - Brasil.
Our goal was to establish the efficacy, in a 12-week period, of Clear Tinnitus for tinnitus relief in patients with tinnitus of the severe, disabling type. We employed a descriptive data analysis method across dimensions of risk to evaluate a base of multidimensional evidence to support our hypothesis.
We clinically identified all patients in this study as having subjective idiopathic tinnitus of the severe type lasting at least 1 year. A focus on risk factors for each tinnitus patient provides an increased level of flexibility for interpretation of the clinical significance of the results of a treatment method and its future application for tinnitus relief.
Its application for hearing improvement and tinnitus relief has been reported in his classic textbook: "When there are accumulations of secretion in the middle ear, or anomalies of tension in the sound conducting apparatus which bring about an increased pressure in the labyrinth, it has been found inflations of air into the middle ear and rarefaction of air in the external meatus are often the most effectual means by which these subjective noises are overcome" [10]. Significant tinnitus relief was obtained in approximately 10-15% of tinnitus patients in whom identification of and satisfactory treatment for the factor of aeration of the middle ear and of eustachian tube dysfunction was completed [6-8,11,12].
Using multiple measures of analysis of risk factors, this study presents the results and conclusions of attempted tinnitus relief with Clear Tinnitus.
The 15 patients variously reported a bilateral tinnitus location (n = 12), a unilateral tinnitus in the right ear (n = 2), bilateral tinnitus in the head and ears (n = 1), a tonal quality to the tinnitus (n = 11), a noise band (n = 1), a combination tone and noise band (n = 3), and high frequency (n = 15; Table 1). All tinnitus patients completed an MATPP to identify the clinical type of tinnitus and factors influencing the clinical course of their tinnitus [6-8,11,12]. The specific regimen consisted of three capsules taken with food two times daily for 3 months. The answer to the final question was whether the reported tinnitus relief was considered significant to the patient. We originally planned to use the data obtained to provide a base for a multivariate risk-benefit stratified analysis of the significance of the reported tinnitus relief.
Conventional pure-tone audiometry conducted at 250-8,000 Hz (including 3,000 and 6,000 Hz) showed no significant difference in thresholds for either ear at any of the frequencies before and after testing all 11 subjects. Among our 15 patients, 12 originally reported tinnitus in the ears bilaterally, 2 originally reported unilateral tinnitus in the right ear, and 1 reported tinnitus in the head and ears bilaterally.
Five were type I before the study, four were type IV before the study, and two were mixed (type I for one ear and type IV for the other ear). No clear trend in the data for either ear was demonstrated by the mean change in LDL before and after the study. Two patients with a normal starting MEP that remained unchanged reported a positive tinnitus relief outcome, whereas one patient with a normal starting MEP that remained unchanged reported negative tinnitus relief. MEP improvement was recorded in three patients and remained unchanged in one, who had a normal MEP both before and after the study.
Results of quantitative electroencephalography (QEEG) recordings of the four EEG frequency bands for the 11 patients completing the study. Results of quantitative electroencephalography (QEEG) recordings of the four EEG frequency bands for the seven responders. Five responders reported positive significance of the tinnitus relief, and two reported it as negative (see Table 6).
An improvement in the TII and TAI scores of 2 units or more was reported by four of the seven.
All patients who completed the study demonstrated via tympanometry a statistical and clinical significance in MEP improvement (n = 8) or maintenance of MEP (n = 3) or both (see Table 1).
As identified with tympanometry, five demonstrated a significant improvement in MEP, and two showed maintenance of a normal MEP (see Table 1). This clinical medical-audiological approach provided a basis for objective interpretation of the reported subjective tinnitus relief with the Clear Tinnitus treatment. The MATPP electrodiagnostic cochleovestibular test battery identified the tinnitus to be predominantly a cochlear type, bilateral and unilateral, with a middle-ear and central component.
Physical examination of the tympanic membranes before and at the conclusion of the study identified mild to moderate scarring of the tympanic membranes consistent with eustachian tube dysfunction.
Clinically, this suggests to the limits of examination that the site of Clear Tinnitus action is not cochlear in location.
Pitch match did not correlate with outcome measurements, masking curve type, MMLs, or LDLs. Clinically for this study, tympanometry values for a normal range of MEP were established to be from 0 to -50 mm H2O. It could function as a monitor for establishing the efficacy of the therapeutic modality-Clear Tinnitus-attempting tinnitus relief and aid in understanding the clinical course of the tinnitus as reflected in brain function of memory, consciousness, attention, and affect [3,12].
The low power of the analysis for the nonresponders (n = 4) precluded any conclusion or clinical correlation. To determine patients' baseline responses, we administered questionnaires to record subjective tinnitus at the outset of the study and again at the conclusion.
If the reality of the absence of a tinnitus cure at this time is accepted and tinnitus relief is the goal, is relief expected for the tinnitus sensation or for the annoyance and intrusion into one's lifestyle, as manifested in the behavioral response of affected patients to the presence of the tinnitus? Of the 11 patients, 7 with severe, disabling tinnitus and fluctuation of aeration of the middle ears (diagnosed with the MATPP as a factor influencing the clinical course of their tinnitus) reported tinnitus relief with Clear Tinnitus.
These results indicate that a slightly larger sample size might have changed the outcome of this analysis. The aim of this paper is to describe audiological results of a patient with asymmetrical hearing loss with incapacitating ipsilateral tinnitus in the ear subjected to cochlear implant surgery. We do not know its prevalence in Brazil, but if we extrapolate the data from our international population, it is possible that some 28 million Brazilians have already had some form of tinnitus1. Chart 1 shows the comparison between the results where it can be verified that the patient progressed from category zero to six in the 12-month study. The patient went from category zero to six, where there is open-set recognition of words and phrases together. The degree of discomfort, intolerance or failure often are not related to the intensity of tinnitus, says a consulted study1, but mood disorders (depression, dysthymia) and anxiety often present, exerting strong influences on the worsening of the tinnitus. After 180 days of use, the patient did not perceive any ringing with the CI turned on and noticed only mild tinnitus with the CI off.


Influence of evoked compound action potential on speech perception in cochlear implant users. Incapacitating unilateral tinnitus in single-sided deafness treated by cochlear implantation. Stimulation by cochlear implant in unilaterally deaf rats reverses the decrease of inhibitory transmission in the inferior colliculus. Techniques for assessing auditory speech perception and lipreading enhancement in young deaf children. Resultados auditivos com o implante coclear multicanal em pacientes submetidos a cirurgia no Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. 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.
The benefits of a risk-stratified multivariate analysis across dimensions of risk, originally planned for this study, could not be achieved owing to an insufficient final sample size [4]. We hypothesize in this study that relief occurs by identifying and treating the factor of aeration of the middle ear. The clinical history of each tinnitus patient reflected periods of tinnitus relief associated with fluctuation of tinnitus intensity and the location and degree of ear blockage. Such an analysis provided information of both the sensory and affect components of the tinnitus complaint [15].
Tinnitus evaluation included pitch and loudness matching, masking curves, and loudness discomfort levels (LDLs). A copy of the manufacturer's cGMP certification and standard operating procedures used in the production of Clear Tinnitus is maintained by Clear Products, Inc.
We modeled recordings of audiometric tests across the hearing spectrum using nonlinear regression. The adverse reactions included gastrointestinal complaints (one with gastroesophageal reflux disease and one with bloating and constipation) and ear complaints (one with "ear spasms"). Likewise, speech audiometry did not show any significant difference for speech reception threshold or word discrimination scores before and after testing. The quality was reported as tonal in 11 patients, as noise band in 1, as combined tone and noise band in 3, and as high-frequency in all 15. After the study, five with type I remained unchanged, and three of the four with type IV remained unchanged. For the left ear, the eight patients who had tinnitus after the study exhibited a reduction in the masking level of - 11.25 dB at 8,000 Hz (Tables 3 and 4).
Of the four who did not report improvement, three went from type C to type A (one on both ears, the other two on one of the two ears; see Table 1).
Two patients whose MEP was abnormal to start but changed to normal reported positive tinnitus relief, whereas three patients whose MEP was abnormal to start but changed to normal reported negative tinnitus relief.
The number of significant abnormal power recordings was identified with a normative database and analyzed by the Lexicor Corporation.
When tested by a paired Student's t-test for change over the course of the study, only the TII, the TAI, and the TRQ demonstrated a significant decrease in the patients' responses. One patient reported tinnitus relief, improvement in MEP, and no improvement in outcome measures. A multidimensional method of analysis across dimensions of risk is recommended for all clinical studies attempting to evaluate the efficacy of therapeutic modalities attempting tinnitus relief. The clinical type of this tinnitus correlates with the patients' reports of tinnitus relief in five of seven.
The reported improvement in MEP with tympanometry was associated with reported subjective abatement in ear blockage in the tinnitus ear and with evidence of increased aeration of the middle ear on physical examination of the tympanic membrane.
Otoacoustic emission tests in the future may provide a basis for audiological coefficients of change.
In the 11 patients completing the study, all masking curves were either type I or type IV, according to Feldmann's classification system. The Clear Tinnitus preparation did not significantly influence the tinnitus evaluation measures consisting of pitch match, masking curves, MMLs, or LDLs.
The QEEG results are considered to be electrophysiological brain function responses hypothesized to reflect a synchrony of responses at the cortex in the central nervous system (see Fig. The delta band was significantly higher than the alpha and beta bands both for the overall cohort of 11 patients and for the 7 reporting tinnitus relief (see Table 5; see Figs. In only one patient in this study, demonstration of the theta and its increase may reflect the persistence of the tinnitus and the ongoing development of a paradoxical memory for the dyssynchronous auditory signal-tinnitus [2,3,27-29]. Of the six outcome measures, only the TII, TIA, and TRQ reported the data to be statistically significant (as noted by the asterisk in the top row of Table 7). This study supports the hypothesis that identifying and treating the MEP fluctuation factor may provide tinnitus relief from a predominantly cochlear-type tinnitus.
Quantitative electroencephalography - power analysis: An electrophysiologic correlate of brain function in subjective idiopathic tinnitus patients.
Tinnitus reaction questionnaire-psychometric properties of a measure of distress associated with tinnitus. Audiological exams and responses to perception protocols for tinnitus before and after surgery were analyzed. Without a personal sound amplification device (PSAP) during the application of the GASP, the patient reported that he felt only a slight vibration in the right ear to the presented sound stimuli. In our study, the patient reported he had considered suicide due to the discomfort caused by tinnitus. Experiencia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. We hypothesized that tinnitus relief with Clear Tinnitus reflects improvement in the sensory component of the tinnitus complaint by controlling the factor of aeration of the middle ears and improving eustachian tube function.
The designers of Clear Tinnitus have claimed that this blend of homeopathic remedies and herbal medicine, when taken on a daily basis for 3 months, has resulted in significant tinnitus relief [5].
We used quantitative electroencephalography (QEEG) as a monitor at the start and conclusion of the study to identify patterns of electrical activity of brain function hypothesized to reflect tinnitus relief [16]. We performed ultra-highfrequency audiometry using the Tonndorf audiometer for electrical high-frequency audiometry and the Beltone 2000 audiometer for air-conduction high-frequency audiometry. We correlated the physical examination of the tympanic membrane with the tympanometry result. We used within-group repeated-measures analysis of variance (RMANOVA) to assess the differences in the TAI, the TST, the TII, the THI, the stress test, and the depression scale. The remaining patient dropped out after 1 week in the study because of difficulty in adhering to the regimen, even though subjectively reporting tinnitus relief through the use of Clear Tinnitus. For 10 of the 11 patients who completed the study, tinnitus location was unchanged; the remaining patient had no tinnitus at the end of the study. Of the remaining three, one with type IV went to type I for both ears; the other two with type IV in both ears went from type IV to type I for one ear and remained at type IV for the other.
Two patients with a borderline MEP at the outset that changed to normal reported a positive tinnitus relief outcome, and a single patient with an originally abnormal MEP that changed to borderline also reported positive tinnitus relief. Comparison QEEGs of the seven responders and four nonresponders demonstrated similar patterns. The TST indicated a mean change before and after the study of -4.18, which was not statistically significant.
Owing to small sample size, statistical analysis was limited to univariate and repeated-measures statistical procedures.
The correlation of the nonresponders (n = 4) and the responders with the recorded fluctuation in MEP is considered significant.
The tympanogram findings of improvement in MEP function in responders is considered to support the hypothesis that improvement in MEP underlies Clear Tinnitus resultant efficacy for tinnitus relief by influencing the transduction mechanism of the middle and inner ear.
The similarity of the mean delta QEEG response in the 11 patients and the 7 individual responders and the relative lack of correlation of the delta response to the remaining theta, alpha, and beta find clinical support for consideration that the action of the Clear Tinnitus preparation is predominantly its peripheral MEP effect, with secondary tinnitus relief as reported by the responders, and not specifically its effect on the tinnitus.
No significance appeared in comparing the results of responders to those of nonresponders but, again, this could be owing to the small sample size when separating the patients into independent groups. The tests showed improvements in the hearing threshold on the side with the implant, improvements in speech perception and a significant reduction in tinnitus perception, which consequently led to an improvement in the patient's quality of life. Shortly after activation of the CI he began to recognize open-set word and auditory performance, improving at each evaluation. At the start and conclusion of the study, we performed QEEG testing using a Neurosearch 24 Instrument (Lexicor Medical Technology, Inc., Colorado) to measure objectively a spectral analysis of electrical activity of the brain.
Type I masking curves are considered consistent with peripheral tinnitus and type IV with central tinnitus (Table 2).
Of the seven responders, two reported no MEP change; one nonresponder also reported no MEP change.
At the conclusion of the study, 10 of the 11 patients had normal to borderline MEPs, and 1 had an abnormal MEP. No significant main effects arose for either changes in the number of abnormal QEEGs over time or the interaction of the EEG band by time. In a comparison of the change in response between responders (n = 7) and nonresponders (n = 4), we observed no significant differences. The THI indicated a mean pre- and post-study change of -11.73, which was not considered to be statistically significant. In both groups, MEP fluctuation or maintenance of normal pressure was and was not (respectively) correlated with positive tinnitus relief.
Significant for this study is the correlation of -100 mm H2O as abnormal with the tympanogram results: Of the seven patients who reported subjective improvement, three went from type C tympanograms to type A. In general, it was hypothesized for this study that an alteration in an original dyssynchronous auditory signal from the peripheral auditory system, resulting from improvement in MEP, and its subsequent effect on the transduction processes of the middle and inner ear, when received by the thalamus, would be synchronized at brain cortex in the form of different brain rhythms. A reduction in the number of significant delta band recordings occurred over the time course of the study; however, the reduction was not statistically significant. We recommend a larger patient sample over a longer interval of Clear Tinnitus treatment to determine whether the delta rhythm data, although not significant at this time, may reflect a trend of a positive response to therapy when correlated with the remaining theta, alpha and beta frequencies.
For the tinnitus outcome tests that were statistically significant, the key question to be asked is whether the reported tinnitus relief is clinically significant to the patients.
For still others, a combination of these factors or other issues are the goals of treatment. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. We placed an electrode array (consisting of 19 electrodes) on the scalp in a standard international 10-20 pattern [16]. The clinical significance to the patient of reported and recorded tinnitus relief was positive in five patients. Of the remaining three, one with type IV went to type I for both ears, and the other two who were type IV for both ears went from IV to I for one ear and remained type IV for the other. Alterations in the brain rhythms may reflect the efficacy of the Clear Tinnitus for tinnitus relief. The QEEG data suggest that a slightly larger sample size might have changed the outcome of this analysis. Of interest was the response of the seven patients who reported tinnitus relief: When asked whether their relief was "significant," the response was negative for two and positive for five.
In any case , the outcome results of this study emphasizes the need for a battery of outcome measures to be included in the evaluation of therapeutic modalities attempting tinnitus relief [13]. It is sold on the understanding that the publisher is not engaged in rendering professional services. We employed a descriptive data analysis method across dimensions of risk to evaluate a base of multidimensional evidence and establish support for our hypothesis.
At the conclusion of the 12-week period, we repeated all the audiological tests administered on the initial visit. The analysis compared changes over time in the number of abnormal recordings from the main locations of the scalp recordings (frontal, temporal, parietal, and occipital). This difference, when analyzed by a general linear RMANOVA, was not significant owing to the low power and small sample size. Type I masking curves are considered consistent with peripheral tinnitus and type IV with central tinnitus.
Of the four who did not report subjective improvement, three went from type C to type A (one in both ears, the other two in one ear). Efficacy of treatment was hypothesized to be reflected by a reduction in the delta or beta frequencies (or both), a minimal or unchanged theta frequency, and an increase in the alpha frequency.
The reduction in the delta response was accompanied by a small increase in the theta response in one patient (not statistically significant at this time). Such a battery of outcome measures should be completed at least at the start and end of the study. A medicalaudiological tinnitus patient protocol completed by each patient identified the clinical type of tinnitus as predominantly cochlear, with a central and middle-ear component bilaterally. We used the RMANOVA to test changes in the number of abnormal recordings for the 12-week period of the study for the EEG band frequencies delta, theta, alpha, and beta. This lack of significance, due to low power (.336), estimates that there was approximately a 66% chance of missing a significant result for the change in the number of significant recordings over time. We found no statistically or clinically significant correlation of masking curve type to outcomes. Nonresponders with normal MEP and responders with no MEP change provide an inconsistency surrounding the hypothesis.
Furthermore, the duration of clinical studies evaluating therapeutic modalities for tinnitus relief should be long-term (at least 6-12 months). We identified fluctuation in middle-ear pressure (MEP) via patients' clinical history, supported by physical examination and established with tympanometry, as a factor influencing the clinical course of the tinnitus in each patient. No significant relationship appeared with the number of reductions of significant QEEG recordings over time and MMLs or LDLs. In the patients reporting tinnitus relief when a tympanogram type A was identified at the start of the study and remained unchanged at the conclusion of the study, the tinnitus relief correlated more with the improvement in appearance of the tympanic membrane and the reported reduced negative MEP than with the tympanogram type (see Table 1).
Descriptive data analysis failed to detect any trends in a change in response with audiometric tests across the hearing spectrum; thus, we could derive no coefficients of hearing change. The Feldmann masking curve comparison at the start and end of the study showed no significant change in the 11 patients. There was no significant alteration in the minimum masking levels or loudness discomfort levels before and after the study. Quantitative electroencephalography analysis revealed a marked difference in the number of significant abnormal recordings between the different frequency bands, with the delta band significantly higher than the theta, alpha, and beta bands for both the overall cohort of patients (n = 11) and those reporting tinnitus relief (n = 7). The notorious abundance of tinnitus a€?curesa€™ suggests that there are (at least) as many tinnitus causes, triggers and mechanisms. The tinnitus outcome questionnaires-the tinnitus intensity index, the tinnitus annoyance index, and the tinnitus reaction questionnaire- revealed a significant difference for the patients (7 of 11) obtaining tinnitus relief. 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. Results of the tinnitus stress test , the tinnitus handicap index, and the measurement of depression scale before and after the study were not statistically significant. Most researchers and practising clinicians report that a combination of sound therapy and counselling facilitates the patienta€™s ability to manage the tinnitus experience. Conclusions: Patients who completed the study demonstrated with tympanometry a statistical and clinical significance in MEP improvement or maintenance of MEP (or both). 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. Patients with tinnitus of the severe disabling type selected for this study and responding to Clear Tinnitus reported tinnitus relief accompanied by improvement in or maintenance of MEP of the middle ears. 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.
The statistical and clinical significance of Clear Tinnitus for establishing tinnitus relief remains to be established with a larger cohort of tinnitus patients. 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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Random loss of hearing and ringing in one ear 2014




Comments to «Unilateral tinnitus and stress buster»

  1. AFTOSH_QAFAR_088 writes:
    They occur, but help(s) should be provided for individuals with a mild hearing experiences themselves.
  2. Sibel writes:
    Only ever hear movement-provoked dizziness might issues going on in my life which.
  3. Gunewlinec_CeKa writes:
    Investigations can be accomplished by the audiology team accompanied by yellow or white crusty scales hands.