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How to cite this article Matsushima J, Sakai N, Uemi&# N, Miyoshi&# S, Sakajiri&# M, Ifukube&# T. An electrical tinnitus suppressor developed at the Hokkaido University was implanted in two women and five men, aged 44-77 years old.
The AI registered at a severe level in five patients and a moderate level in two patients before implantation of the suppressor.
The TII registered as extreme in all patients before implantation of the suppressor, although the intensity of tinnitus varied from patient to patient according to the loudness balance test.
After the operation, at TST, AI, and TII results were positively correlated (p =.01), though there was no correlation among these parameters before the operation.
There is a clear agreement among implant groups that the majority of patients can experience tinnitus suppression while using an implanted electrical tinnitus suppressor [1]. An electrical tinnitus suppressor incorporating the use of an extracochlear stimulator has been developed at Hokkaido University [2]. Although we often speak of tinnitus as if it were a single entity, tinnitus actually consists of sensory and affective components [5]. The differences in the degree of affective disorders that patients perceive are explained by a stress model for tinnitus [7]. Such affects as insomnia, annoyance, anxiety, and interference in communication capability that are induced by tinnitus would constitute stress that is highly associated with patients' quality of life. Therefore, a good assessment of the impact of tinnitus on patients' lives should be based on the amount of stress induced by tinnitus. Few questionnaires are available to ascertain the degree of tinnitus that would affect patients' lives [9,10]. Patient 1, 57-year-old woman, complained chiefly of bilateral hearing loss and tinnitus in the left ear.
Patient 2, a 61-year-old woman, complained chiefly of bilateral hearing loss and right-ear tinnitus at the first consultation.
Patient 5, a 67-year-old man, was chiefly concerned with bilateral hearing loss as a result of ear infections in childhood and tinnitus in both ears. In Patient 7, a 44-year-old man, audiography showed moderate hearing loss in the right ear due to Meniere's disease. The electrical tinnitus suppressor consists of an external coil inside a behind-the-ear type of hearing-aid case and an implanted coil in the mastoid [3]. Seven patients in whom a tinnitus suppressor was implanted received three self-evaluative tests in April 1996: the TST, the tinnitus intensity index (TII), and the annoyance index (AI). Annoyance refers to interference in lifestyle-that is, vocational, recreational, and social activities as well as sleep.
Tinnitus in six patients disappeared for several hours to a half-day after electrical promontory stimulation at the outpatient clinic Table 2. Before device implantation, five patients registered an extreme level on the TST, one patient was at a moderate level, and one was at a severe level. All patients reported an extreme score on the TII before device implantation, although the intensity of tinnitus varied from patient to patient based on the loudness balance test.
The TII finding revealed the loudness of tinnitus as perceived by the patients before and after the operation; the implanted tinnitus suppressor was effective for improving the sensory component in all patients. The AI scores revealed a severe level in five patients and a moderate level in two patients before device implantation.
Patient 1 experienced a small amount of persistent tinnitus in the left ear all day after device implantation in the right ear, although tinnitus reappeared during a common cold and when the patient was very tired.
Patient 2 abandoned use of the stimulator because of the electrode trouble she experienced in 1996. Patient 3 experienced tinnitus disappearance for several hours in the implanted ear after 30 minutes of stimulation.
Patient 4 has experienced no tinnitus in the unimplanted ear after usage of the suppressor.
In Patient 5, tinnitus in the unimplanted ear has completely disappeared, and tinnitus in the implanted ear usually disappears after several electrical stimulations per day. Patient 6 had never experienced relief from tinnitus since the first consultation at our outpatient clinic. After use of the suppressor, hearing in Patient 7 improved to normal (Figure 4) and tinnitus completely disappeared except when he was suffering from a common cold or from extreme tiredness. We recommended two female and five male tinnitus patients for implantable tinnitus suppressors.
Patients selected for the implantable suppressor should have experienced tinnitus disappearance for more than a few hours after electrical promontorium tympani stimulation at an outpatient clinic. In addition, the intensity of alternating current stimulation for tinnitus relief was emphasized because the stimulator is designed to be portable.
Previously, we reported the outcome of treatment of tinnitus with an implanted tinnitus suppressor in 3 of 7 patients considered in this study [11]. For Patient 2 in the earlier report, we noted that the effect on tinnitus suppression was unstable. The third report in our earlier publication (concerning Patient 6 from the present study) noted that the patient experienced tinnitus all day despite using the stimulator twice daily. A discrepancy was demonstrated among these patients regarding the degree of annoyance and tinnitus intensity before the operation. Subjective improvement in hearing was reported in the ear with tinnitus relief after combination therapy of tinnitus masking and external electrical stimulation, although no change in the hearing threshold was demonstrated by audiometric testing [13].
The patients have been investigated with electronystagmography, dynamic posturography, pure-tone audiometry, and speech audiometry before and after the gentamicin treatment.
Six patients were given three instillations, whereas 25 patients were given four instillations (either according to the quadruple method or via a repeated dual method). With use of the initial method of daily drug instillation until the effect was obvious, three ears became deaf.
For patients treated by the original unlimited method, the mean hearing loss after treatment was 12 dB. We wished to determine whether the pure-tone threshold level was predictive of the hearing result after treatment. After gentamicin treatment, the endolymph-producing dark cells in the stria vascularis are damaged and, possibly, their function is diminished [12,13]. Dynamic posturography reveals that in the weeks immediately subsequent to gentamicin treatment, an ataxia is present that gradually disappears and, after 3 months, is no longer detectable [16]. Without vestibular rehabilitation and physiotherapy, there is a risk for some permanent ataxia and slight vertigo.
In addition to the shunt operation, other surgical procedures such as labyrinthectomy or vestibular nerve sectioning might be performed. Forty hospitalized patients with sudden hearing loss and tinnitus were compared to a control group (N = 28) of inpatients of an ear-nose-throat ward.
Certain single-case studies have reported the association between stress and SHL [9], as have some group studies that used qualitative interviews as assessment instruments [10,11]. From a physiological point of view, the assumption of the contribution of stress to the onset of SHL and TIN has some plausibility.
The main objective of the current study is to examine the association between stress SHL and TIN in a control group design, using a comprehensive and methodologically refined assessment strategy. Our study, therefore, tested the following assumptions: Onset of SHL and TIN is associated with a high level of stress defined by life events and daily hassles, habitual dysfunctional coping strategies, a high level of worrying, and a low level of social support.
Because a prospective design relating to the stress hypothesis with hundreds of non symptomatic subjects was beyond our research capacities, a control group design was used.
Daily hassles (DH) were assessed by the German questionnaire Alltagssorgen-Skala [33] (Cronbach's alpha = 0.96), which is based on the Daily Hassles Scale by Kanner et al. To determine the level of worrying (W), the German version of the Penn State Worry Questionnaire [36] (16 items; a 5-point rating scale) was presented to the subjects.
The experimental subjects were contacted by telephone 3 months after they had been assessed for the first time. Patients with SHL and TIN show significantly higher scores on both measures of stress, on the life event scale, and on the daily hassles scale than those in the clinical control group. As expected, significantly more negative coping strategies (COPneg) were found in the experimental group. The prospective part of our study examined the connection of psychological test variables (LOCint, LOCpow, LOCfat and LE, DH, W, and social support), sociodemographic variables (age, gender, family status, number of children), and characteristics associated with the disorder (TIN in the past, acute TIN, disability due to TIN and SHL, and WB at the onset of the disorder), all measured at onset of the hearing disorder, to the chronicity of TIN and hearing loss 3 months later. The chronicity of TIN is correlated most closely to WB at disorder onset, COPneg, and LOCfat (Table 5). In a discriminant analysis, the six variables of all three categories (WB, COPneg, LOCfat, acute TIN, age, disability due to TIN) associated most highly with chronicity of TIN were used to separate the group of patients with TIN from recovered patients. Chronicity of SHL (n = 18 of 35 subjects) is associated most closely with WB at the onset of the disorder, with disability due to TIN and SHL, and with the degree of anxiousness concerning SHL and LOCfat. The six variables-WB, disability due to acute TIN, SHL, LOCfat, anxiety concerning SHL, and number of SHL-correlated most highly to the chronicity of hearing loss were entered into a discriminant analysis at the same time. The hypothesis regarding the stress differences expected between SHL and TIN patients and the control group before the onset of the disorder was confirmed fully. The affective state of certain persons often has been shown to influence memory; in a negative state, more negative memory contents are activated and retrieved. At first glance, the data about worrying confirm our hypothesis that it is more intense in SHLITIN patients.
The discrimination analysis fully supported the foregoing conclusions, selecting daily hassles as the strongest variable in the prediction of group membership and coping as a further relevant aspect.
The second part of our study was concerned with the prediction of chronicity of SHL or TIN 3 months after onset. Though the validity of these predictions cannot be guaranteed and has to be cross-checked, an interesting note is that the supposedly predisposing stress factors that seem important for the onset of the studied hearing disorders do not contribute to its chronicity. All in all, our study suggests that psychological variables related to stress and its processing are predisposing for TIN and SHL and that the actual subjective state of well-being shortly after onset of the di sorder is a relevant predictor of chronicity of both disorders. Though our data support the hypothesis of psychological influences on disease etiology and prognosis in SHL and TIN, some methodological limitations of the study have to be taken into account. The intent of our study was to sample similar groups maximally except for the disorder itself. Furthermore, the conclusions drawn from the prospecti ve part of the study, especially regarding the importance of psychological variables, are somewhat uncertain.
However, the AI improved after the operation, being moderate in three patients and mild in two, and achieving no level in two patients. After device implantation, the TII did not register any level in two patients, was mild in another two patients, was moderate in yet two more patients, and was severe in a patient whose device had electrode trouble. However, implantation for tinnitus suppression previously was not performed in patients with nearly normal hearing because of the cost and potential damage to the cochlea. This device is likely to result in minimal damage to the cochlea because the stimulating electrode is near the round window. The sensory component is a sound sensation, whereas the affective components are many, including insomnia, annoyance, anxiety, and interference in communication capability [6]. It is hypothesized that both the hippocampus and the amygdala of the medial temporal lobe system are significant for transition from the sensory to the affective component. The tinnitus stress test (TST) is a tool for monitoring the efficacy of treatment, control, and relief procedures for tinnitus. She has suffered from chronic otitis media that has resulted in bilateral eardrum perforations.
In procedure A, each of 16 questions was equally weighted and scored on a 5-point rating scale. The index was rated by each individual as 0 for no tinnitus and 7 for the loudest imaginable. The AI was rated by each individual as mild (1 or 2), moderate (3, 4, or 5), or severe (6 or 7). The duration of residual tinnitus inhibition with the implanted suppressor was similar to that at the outpatient clinic except in one patient in whom the electrode broke free from the promontory.
Post-operatively, the results of TST improved except in one patient who experienced electrode trouble (Figure 2). After the operation, results of the TII reveal no level in two patients, a mild level in two other patients, a moderate level in two patients, and a severe level in a single patient (Figure 3). Only Patient 6 did not experience tinnitus disappearance, although the intensity was diminished relative to that before the operation. Tinnitus did not disappear in the implanted ear if the patient was suffering from a common cold or was very tired. The tinnitus weakened so dramatically after the operation that he was satisfied with the suppressor.
No vertigo, ear blockage, headache, or worsening of residual hearing level was reported either. For patient selection, we emphasized the evaluation of residual tinnitus suppression after transtympanic electrical stimulation. Patient 6 never experienced the disappearance of tinnitus at an outpatient clinic, and so in this patient we could not guarantee tinnitus disappearance even if he continued to use the implantable device.
In our earlier report, Patient 1 still experienced slight tinnitus all day after using the device, and tinnitus reappeared during a common cold or when the patient was tired. When the patient began using the device, she experienced little tinnitus all day after 1 hour or more of stimulation two or three times daily.
All patients before the operation thought that the intensity of tinnitus was the loudest imaginable.
Patient 5 also reported improvement in his hearing" but the hearing threshold did not improve after use of the implantable suppressor. It should be noted, however, that among the 69 patients involved in this study, only 3 failures of the vertigo treatment were seen.


The quadruple method caused a mean hearing loss of 8 dB, whereas in the patients treated by the dual strategy, no mean hearing loss was noted.
In Figure 3, a comparison is made between the pure-tone threshold before treatment and the change in pure-tone average after treatment.
Also, the vestibular epithelium is damaged or destroyed, causing a unilateral vestibular loss that results in a destruction type of nystagmus and caloric loss [14].
Also, if a full effect of gentamicin is not experienced with a few instillations of the drug, a risk for vertigo attacks remains. The labyrinthectomy offers relief from the attacks of vertigo but also abolishes hearing totally and so should not be used. If correctly applied, gentamicin treatment is the method of choice and should be attempted before destructive surgery is even considered. Lange G: Die Indikation zur intratympanalen Gentamycin- Behandlung der Meniereschen Krankheit. Beck C, Schmidt C: Ten years of experience with intratympanally applied streptomycin (gentamycin) in the therapy of morbus Meniere. Magnusson M, Padoan S: Delayed onset of ototoxic effects of gentamicin in treatment of Meniere's disease. Tran Ba Huy P, Deffrennes D: Aminoglycoside binding sites in the inner ears of guinea pigs.
Most studies dealing with chronic TIN focus on its symptomatology, consequences, and treatment [13-21]. One presently prominent theory postulates that both disorders result from a diminished supply of blood to the inner ear, which impairs the inner and outer hair cells by lack of oxygen [1,5,10,22]. Stress is assessed by psychometrically validated inventories of life events and daily hassles. The study examines whether psychological predictors exist for maintenance of hearing loss and TIN 3 months after onset. The main guideline for the selection of the control group was to assess patients with maximal similarity to those in the experimental group of patients with SHL and TIN so as to rule out threats to internal validity, as addressed by Kazdin [29].
At the time of the assessment, all patients selected for the study were hospitalized in the ear-nose-throat ward.
Patients were on the average approximately 40 years old, and nearly one-half (48.5%) were female. The first questionnaire asked for sociodemographic data (age, gender, family status, number of children, profession), information regarding the circumstances of the disorder (both groups), and a detailed description of SHL and TIN (experimental group only). Stober [37] found a Cronbach's alpha of 0.86 for the German version of the Penn State Worry Questionnaire, which is similar to the Cronbach's alpha found by Molina and Borkovec [38]. This outcome is true for both aspects, the number and stressfulness of events (Table 3), though subjective strain differentiates more clearly between the groups. However, in contrast to expectation, they also showed significantly more positive strategies (COPpos, see Table 3). This finding indicates that the lower the state of wellbeing, the higher is the probability of TIN maintenance. The number of predictors is limited to six, as the number of subjects should not be less than the number of predictors multiplied by five. Chronicity of hearing loss is not correlated to the other sociodemographic variables or characteristics attributed to the disorder (Table 6).
Life events and daily hassles before the onset of the disorder were significantly more frequent, and their stressfulness was more distinct in the experimental group.
As a marked difference in well-being was found between the two groups (worse mood in the experimental subjects), the variance between groups attributed to differences in well-being was eliminated by partial correlation. The hypothesis of more COPneg strategies in the experimental group was supported, but the level of positive coping endeavors also is much higher in the SHLITIN group, a finding contrary to expectation. However, after controlling for well-being, this effect vanished, which demonstrates that the process of worrying is intensified markedly by an individual's negative state. The general assumption is that the probability of remission of these special hearing disorders at that time is rather low, so that a chronic state can be assumed. The only psychological trait variable with some predictive power for TIN is negative coping. Only habitual processing variables (coping, fatalistic LOC) show some influence on chronicity, but the best predictor is well-being, probably an indicator of the subjective evaluation of the biopsychosocial state of an individual.
Habitual psychological trait characteristics (coping, LOC) exhibit some, but not a strong, influence. The experimental group exists of patients suffering predominantly from both types of hearing disorders; very few persons were afflicted with TIN or SHL only. This was successful in nearly all assessed variables, with the exception of well-being, which turned out to be an important variable. Residual inhibition results found at outpatient clinics and at the homes of patients with implanted suppressors were closely correlated except in one patient in whom the device's electrode was free from the promontorium tympani. After the operation, the TST improved except in one patient whose device had electrode trouble. In addition, the small size of the implanted chip coil (6 mm wide, 5 mm thick, and 10 mm long) in the mastoid contributes to the avoidance of injury risk [3,4]. The severity of the affective component is not always commen-surate with the severity of the sensory component. The transition is purported to be modulated by the influence of stress, according to the level of cortisone [7].
The tinnitus described by this patient was white noise at an intensity of 95 dB in the right ear and 75 dB in the left ear.
Endolymphatic shunt surgery was performed 2 years before implantation of the tinnitus suppressor but failed to improve this patient's hearing loss or to decrease the number of vertigo attacks. The electrical stimulator weighs approximately 300 g, and the electrical pulse is provided by 100-V alternating current. Briefly, the silicon-covered coil is implanted in the mastoid after mastoidectomy using a postauricular incision. The TIl was rated by each individual as mild (1 or 2), moderate (3, 4, or 5), or severe (6 or 7). Six patients' responses registered as no or mild level on the TST, and only one patient still reported an extreme level on this test. Filled bars show the level on the tinnitus stress test before the operation, whereas open bars indicate postoperative levels. Tinnitus in two patients who registered as no level disappeared for the entire day, although tinnitus reappeared if the patient suffered from a common cold or was severely tired.
Filled bars show the scores on the tinnitus intensity index and annoyance index before the operation, whereas open bars indicate postoperative scores.
Patient 2, in whom the electrode was problematic, still perceived her tinnitus as the loudest imaginable because the suppressor did not work well. Three patients were at a moderate level, two were at a mild level, and two registered no level after the operation.
A positive correlation after the operation (at the .01 level of significance using the t-test) was observed although no correlation was observed among those tests before the operation. The TII was lower than that before the implantation because tinnitus that reappeared was weaker than the preoperative condition.
Tinnitus did not disappear in the implanted ear when the patient suffered from a common cold or was very tired. Therefore, the TST, AI, and TII dramatically improved in this man after device implantation. No patient experienced extrusion of the wire under the external skin, although the stimulating electrode has broken free from the promontorium tympani in one patient.
The degree of tinnitus suppression using the implanted device was consistent with that reported from outpatient clinics, as shown in Table 2; that is, the duration of residual inhibition using the suppressor was not longer in home users of the device than at outpatient clinics, but tinnitus intensity improved.
As expected, Patient 6 did not experience tinnitus disappearance after use of the implanted suppressor. The patient was becoming so dependent on the device that the stimulation time extended to four or more times per day. However, not all patients were severely affected by tinnitus even while reporting that it was the loudest imaginable.
One patient had a labyrinthectomy, and 2 others had vestibular nerve sectioning after the gentamicin treatment failed.
With use of the dual method, no ear has lost hearing, but one ear that was re-treated and ultimately received a total of four doses of gentamicin experienced a pure-tone threshold increase of 65 dB. In the latter group, there was a mean 0.3 dB gain and a median hearing improvement of 5 dB.
No correlation exists between the pretreatment level and the change in threshold after gentamicin treatment.
Vestibular nerve sectioning is associated with a 20% risk for added hearing loss, which exceeds the risk for hearing loss that is associated with gentamicin treatment. The risk for cochlear damage is minimized if the dual method of gentamicin administration is used.
Presented at the Third International Symposium on Meniere's Disease, Rome; Italy, October 20-23, 1993.
The main objective of our study was to test the hypothesis of stress as a predisposing risk factor in the development of sudden hearing loss and tinnitus.
Their pathophysiological features, the assumptions concerning their pathogenesis, and their medical treatment are rather similar [5-8].
Patients suffering from SHL (N = 98) reported more stress than did 13 patients with morbus Meniere who were used as control subjects.
Vascular processes, mainly responsible for blood flow, are regulated by the sympathetic nervous system and the hypothalamic pituitary adrenal axis, the main systems activating cardiovascular stress responses.
Because external stressors have no direct influence on health but are mediated by subjective evaluation and processing of the stressful situation [23], habitual coping strategies also are studied.
The variables examined as possible predictors are the same as those mentioned earlier as assessed at the time of the onset of the disorder.
Additionally to the disorder itself being different in the control group, the disease should not be associated conceptually with stress in its etiology. Furthermore, patients rated their actual well-being (WB) on a 5-point scale from very good (5) to very bad (0). The 56 items reflect a variety of everyday hassles concerning work, household, marriage, money, friends, and family. The Streβverarbeitungsbogen assesses the likelihood of various habitual coping behaviors in situations leading to discomfort, arousal, or tension. The contacted subjects were interviewed about the status of their hearing disorder, especially whether their TIN or hearing deficit still were present.
Also, the more negative coping strategies individuals exhibit and the stronger a fatalistic locus of control in individual patients, the more probable is the maintenance of TIN. Interestingly, the reported strain due to the stressful events differentiates more clearly between groups than does their number.
Otherwise, the reported higher amount of stress could be ascribed to the negative state of those in the hearing loss and TIN group at time of assessment. One can assume that the classification of coping behaviors into "bad" or "good" regarding their problemsolving or palliative capacity may be invalid, as some often have argued that the effectiveness of coping also depends on the kind of stressor and other characteristics of the situation. The discrimination between groups was well above chance but, with an error rate of 25%, was not really very satisfactory.
Interestingly, this global self-evaluation is more important than is the rating of disability due to TIN and SHL and variables related to the history of the disorder. The definitely worse state of well-being in the experimental group points to the fact that the comorbidity of SHL and TIN probably is very stressing and annoying. Nevertheless, our data support the hypothetical role played by stress and related psychological factors in the etiology of SHL and TIN. Verhaltensmedizinische Untersuchungen zum HOrsturz [The behavioral medicine of sudden hearing loss]. Plotzliche doppelseitige Ertaubung durch psychische Konfliktsituation [SHL in both ears as a consequence of psychological conflict]. General and specific coping strategies used by middle aged males with noise induced hearing loss, with or without tinnitus. Structure of perceived handicap in middleaged males with noise-induced hearing loss, with and without tinnitus. The management of chronic tinnitus-comparison of a cognitive-behavioral group training with yoga. Psychologische Behandlung des chronischen Tinnitus [Psychological treatment of chronic tinnitus]. Multidimensional health locus of control as partial predictor of serum phosphorus in chronic hemodialysis.
Zur interund intraindividuellen Reliabilitat einer modifizierten deutschen Fassung der Social Readjustment Rating Scale [Inter- and intraindividual reliability of the modified Social Readjustment Rating Scale].
Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events.
The Penn State Worry Questionnaire: Psychometric properties and associated characteristics.
Fragebogen zur Erhebung von Kontrolluberzeugungen zur Krankheit und Gesundheit (KKG) [Questionnaire to assess locus of control regarding illness and health (KKG)].
Some patients can accept tinnitus with little affective disorder, although they still perceive a tinnitus sensation. The location of cortisol control under stress is considered to be in the hippocampus, not in the hypothalamus [8]. The objective of this article is to evaluate benefits of the implanted tinnitus suppressor on the basis of the TST.


Audiography revealed profound mixed deafness in the right ear and slight sensorineural deafness in the left ear. The frequency of the tinnitus was 125 Hz at an intensity of 50 dB in the right ear and 125 Hz at an intensity of 65 dB in the left ear. The Pt-Ir ball electrode, covered with polyalcoholic gel, is placed on the promontorium tympani, and the return electrode is fixed to the subcutaneous tissue at the tip of the mastoid.
Ten items-questions 1, 2, 4, 5, 7-9, 12, 14, and 15-were given zero points for a response of "not at all," 1 point for "a little bit," 2 points for "moderate," 3 points for "quite a bit," and 4 points for "extremely." The remaining seven items-questions 3, 4, 6, 10, 11, 13, and 16-received double the points for each category. The two patients with a mild TII level sometimes perceive tinnitus, indicating that the effects of one-time stimulation sometimes were not long-lasting enough to relieve tinnitus altogether. In Patient 2, the AI results worsened after the operation (from moderate to severe), owing to the electrode problem.
For others, the maximum current was set at less than 600 μA owing to the requirement for a more intense current to make tinnitus disappear. It should be noted that even during the era of unlimited numbers of gentamicin instillations, some patients had a nystagmus response after two, three, or four installments (Figure 2) [10,11]. The head-shaking test may unveil a unilateral vestibular loss, but other clinical tests will be negative. Furthermore, if vestibular nerve severing is not performed by an extremely experienced surgeon, the complications can be severe. Thus, differences in life events and daily "hassles" were expected between groups, as were differences in coping styles, habitual worrying, and social support. Quite a number of experts and laymen believe that the onset of SHL and TIN is mediated by stress. However, no standardized measures were applied, and no quantitative statistical analysis of the data was conducted. What must be borne in mind, however, is the existence of various theories of pathogenesis and etiology of these hearing disorders; in general, all lack sound empirical support and somehow differ in their views of the functional role attributed to stress. Furthermore, worrying [24] is an important factor related to the processing of stressful information, a trait variable that has not yet been considered in regard to the onset of hearing disorders. Additionally, locus of control assessed at the same time is included as a psychological trait variable, which has been studied often in the context of chronic disease [25-28]. For the control group, inpatients suffering from different conservatively treated illnesses of throat, ear, and nose were selected.
Life events (LE) were assessed by the German version of the Social Readjustment Rating Scale (retest-reliability after 10 weeks, Pearson's coefficient, r = 0.71) [31,32]. Number and stressfulness of hassles during the last 4 weeks before the onset of the illness were assessed. Wellbeing showing a significant difference between groups can be considered as a potentially confounding variable.
Worrying had a significantly higher level in the experimental group, but this difference was lost after statistical control for well-being. Thus, the subjective evaluation of stressful events is more important than is the sum of events.
However, the difference in stressfulness of life events and daily hassles were shown to be maintained at a significant level. Regardless, the fact remains that different coping behaviors, whether positive or negative, are used much more frequently by the experimental group. All subjects reported an extraordinary high degree of social support (high above the average of the norm group).
The most powerful predictor both for chronic TIN and for SHL is the state of subjective wellbeing at time of first assessment immediately after the onset of the disorders.
Furthermore, what should be mentioned is that the explained variance is higher in the prediction of chronicity than in the discrimination of the different clinical groups.
The search for prognostic factors of chronicity must be continued, after this first attempt offering some challenging data. In Bradley WG, Deroff RB, Fenichel GM, Marsden CD (eds), Neurology in Clinical Practice, Vol. However, some patients are disturbed by affects (especially the severe disabling type of tinnitus).
She visited our outpatient clinic with concerns about the discharge from both ears and increased hearing loss in the left ear. On August 11, 1992, the patient had visited our outpatient clinic with complaints of ear discharges and bilateral hearing loss. These categories addressed standard of living, socialization, coping with anger, depression, and fear. The duration of the residual inhibition was so much longer than that of other patients that the number of uses per day (once or twice) is smaller than that of other patients. Because of the limitations of the stimulator, the maximum current delivered to the promontorium tympani, however, appeared to be less than 300 μA.
Initially, this apparent dependency was attributed to the patient's personality, not to problems with the electrode, which were the actual cause. Nonetheless, a positive correlation at the .01 level of significance was observed among the postoperative TII, AI, and TST scores [12]. Broadfrequency rotatory testing using pseudorandomized stimulation unveils the asymmetry that is not obvious in sinusoidal tests [15]. Gentamicin should be used particularly in patients who suffer a significant and severe hearing loss, and these patients should be warned about the possibility of additional hearing deficit.
The hypothesis of more frequent and more stressful life events and daily hassles was supported empirically.
Because of the abundant clinical evidence for the importance of stress, the simplified model illustrated in Figure 1 and derived from Hoffmeister [1] is used for the conceptualization of the presumed interplay of stressrelated somatic and psychological factors.
Patients were asked whether any of the 42 given life events took place within the last year. It consists of three scales: internality (LOCint), powerful others-externality (LOCpow), and fatalistic externality (LOCfat). The group differences in both aspects of LE and DH, however, remain significant after statistically controlling for well-being (see Table 3). No difference was registered in the level of social support; both groups showed very high scores (Table 3).
Our data show, as is found often in other studies, that life events and daily hassles are not independent of each other but correlate to a large degree.
Thus, well-being had some effect on remembering and reporting negative events, especially on the number, but the difference between experimental and control group cannot be explained totally by their different state of well-being. What might be posited is that the experimental group uses more coping strategies because they meet more life problems, as shown. Generally, social support may be very high in the special situation to which all subjects were exposed: being in the hospital for their first few days.
Also very influential is the degree of disability due to TIN experienced at first assessment. One undesirable aspect of our study is the difference in the number of subjects in the experimental control group, due to the difficulty in recruiting control patients. Tinnitus in the ears opposite the device implantation site in patients 4 and 5 completely disappeared. Patient 5 felt that the intensity of his tinnitus was the loudest imaginable preoperatively, although it annoyed him only slightly. Patients reported that tinnitus did not disappear if they were suffering from a common cold or were very tired. The patient reported that she was apt to pay too much attention to the existence of the implanted coil in the mastoid. This finding indicates that patients can so much more easily manage tinnitus after use of the stimulator than before such use that tinnitus no longer scares patients. In patients 1 and 2, the effects of middle-ear infection on the hearing threshold were taken into account.
Although relief from tinnitus cannot be promised, the world literature indicates that most patients suffer less severe tinnitus after gentamicin treatment [17]. The dominant role of daily hassles, especially their stressfulness as a risk factor, was shown clearly.
In a well-designed but unpublished study by Mtinzel and Sander (oral presentation), however, no differences in stress were found between a group of patients with SHL and those in a clinical control group. Additionally, they had to rate the subjective stressfulness (or strain) of each event on a rating scale from 0 to 100. To assess the relative importance of LE and DH, controls were applied for their common variance.
A further assumption might be that they are trying hard to cope with stress most of the time but are not successful, as the reported strain by the events is higher in the experimental group. In the prediction of chronic SHL, both disability due to SHL and TIN at onset are important.
The task of identification of patients for the study was allotted to the hospital staff, who then informed the psychologists of their potential subjects. The frequency of the left-ear tinnitus was 250 Hz at an intensity of 95 dB 1 month after the first visit (September 18, 1992). Bone conduction hearing thresholds before and after the operation also are shown show the bone conduction hearing thresholds on June 1994; [and] on August 11, 1992. After use of the suppressor, the tinnitus annoyed him far less, indicating that the suppressor might be beneficial even to those patients in whom tinnitus is only slightly annoying. Takirig into account such situations as a common cold or tiredness, we should select for suppressor implantation those patients in whom less than 200 μA of maximum current is necessary to make tinnitus disappear. She reported trying to push down the switched button of the stimulator repeatedly, but her tinnitus was not reduced. However, in Patient 7, we should not dismiss improvement in the hearing threshold (see Figure 4), although we also could not ascertain the reason for hearing threshold improvement in the ear with the implanted device. This selection criterion was used to reduce bias effects of memory on self-report measures [30]. The groups did not differ significantly in any of the sociodemographic variables (Table 2). After controlling for the effect of DH, the difference in LE between groups no longer was significant; on the other hand, after controlling for the effect of LE, the difference in stressfulness of DH was maintained (see Table 4). After this procedure, the discriminating function of life events, be it number or strain, was lost. Thus, their potentially exhausting coping endeavors could also contribute to onset of the hearing disorders.
Because the identification of potential control group patients was much more difficult than was the identification of SHLITIN patients and because of the fact that pending surgery excluded many patients from the control group, the recruitment of the control subjects was very time-consuming and less successful.
Because we were afraid that the operation would worsen a preexisting hearing loss in the left ear, the suppressor device was implanted in the patient's right ear. Finally, the patient abandoned use of the stimulator and felt despair because she thought that she could not escape from tinnitus.
Approximately 9 months after the im was a response in the form of ataxia or destruction-type nystagmus. Wellbeing is the only variable differing significantly, with control patients feeling better than did the experimental subjects. On the other hand, daily hassles (especially their stressfulness) retain their differentiating function. However, the number of subjects lies within the range of statistical demands (number of subjects = 5 × number of variables) [41]. The patient's desperation caused her to feel impatient, and she registered an extreme score on the TST.
In the period 1989-1992, the number of instillations was limited to four (the so-called quadruple method) [6,7]. The prospective part of the study aimed at the prediction of chronicity of sudden hearing loss and tinnitus (3 months after onset) by sociodemographic, psychological, and disease-associated variables.
Patients who fulfilled the established criteria were informed about the study and then were given the questionnaires, which they were supposed to complete within 2 days.
Thus, what can be concluded is that life events probably give rise to various stressful daily hassles that undermine health status. We now are able to see the electrode tip through the eardrum and are aware that the decreasing efficacy of the suppressor was caused by problems with the electrode trouble, not by the patient's personality. Alternatively, the dual strategy was used as suggested by Magnusson and Padoan [8] in 1991, in which gentamicin is instilled on 2 consecutive days and thereafter the patient's condition is observed and drug is administered as needed; if there is a substantial caloric loss or the vertigo attacks cease, no more gentamicin is instilled.
The strongest predictor of chronicity was the degree of well-being at the time of first assessment (soon after disease onset). Consequently, our study applying psychological instruments of satisfying reliability and validity in a control group design confirms findings by Hoffmeister [1], Kropp and Rad [10], Stange [11], and Neuser and Knoop [12]. After the patient was supplied with an upgraded stimulator and the free electrode again touched on the eardrum, the patient's TST score leveled off to her preoperative level.
With both the dual method [8] and the quadruple method [7], one must be prepared to administer additional drug after 1 or several months.
Only one person contacted in the experimental group and three in the control group refused to participate (see Table 2). Even if the initial therapeutic regimen almost always causes a unilateral caloric loss, and some relapses occur that necessitate additional instillations of gentamicin.



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Comments to “Extreme stress tinnitus remedies”

  1. Significantly less written in a easy style and is based on literature assessment such.
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