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Author: admin | 13.12.2013 | Category: Tinnitus Hearing Loss

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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. Bericht uber elf Patienten mit Horsturz, die nach Beginn des Ereignisses einen fortschreitenden Horverlust zeigten.
JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. In Belgium the product is sold under the name "Rilatine" and in Brazil and Portugal as "Ritalina".
Zones of the Neck This actually applies to penetrating trauma but is useful to review when discussing neck anatomy.
Morbidity: Esophageal Injury Odynophagia, dysphagia, hematemesis Airway injury ? 25% have esophageal injury Transcervical trajectory Saliva in wound, subcutaneous emphysema Prevertebral air on lateral neck X ray Kietdumrongwong P & Hemachudha T 2005 Kietdumrongwong P & Hemachudha T. Morbidity: Airway Injury More common in blunt trauma 5-15% PNI will have laryngotracheal trauma Hoarseness, stridor, hemoptysis, difficulty breathing, pain Air leak in wound, difficult airway ? surgery!!! Auricular Hematoma accumulation of blood in the subperichondrial space, secondary to blunt trauma.
Nasal trauma Timing of repair : Within 1 - 3 hours of the time of injury before significant edema has developed. 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. Therefore, to clarify its pathophysiology, it is important to know whether the progression of hearing loss occurs in the early stage of sudden deafness. Als Ursachen hierfur werden eine Verstarkung einer viralen Labyrinthitis, eine Zunahme der Gefa?storung im Innenohr und eine Ruptur der Membran des runden Fensters diskutiert. Laryngoscope 81: 1462–1474Goodhill V, Harris I, Brockman SJ, Hantz O (1973) Sudden deafness and labyrinthine window ruptures. Retropharyngeal carotid artery important for presurgical planning Esophageal injury can track air into RP, prevertebral space Missed esophageal injuries can present as retropharyngeal abscess, mediastinitis, sepsis Bleeding that displaces prevertebral muscles anteriorly is associated with vertebral body fractures. Majority airways managed by rapid sequence intubation (RSI) at scene or ED Mandavia DP 2000RetrospectiveN = 74811% emergent intubation -67% RSI with ? 100% success -33% fiberoptic ? 91% success -3 fiberoptic failures ? RSI Eggen JT 1993 N = 11460% intubated, 22% ED No intubation complications Shearer VE 1993 N = 10783% RSI with DL ? 100% success 6% surgical airway ? 100% 7% awake fiberoptic ? 98% 4% blind nasotracheal ? 75% Eggen JT et al.
This creates a barrier for diffusion between the cartilage and the perichondrial vascularity, leading to necrosis of the cartilage.
However, patients rarely present this early and often require reevaluation within 3 -7 days to allow for extensive facial edema to subside.
The main objective of our study was to test the hypothesis of stress as a predisposing risk factor in the development of sudden hearing loss and tinnitus. Their pathophysiological features, the assumptions concerning their pathogenesis, and their medical treatment are rather similar [5-8].
Patients suffering from SHL (N = 98) reported more stress than did 13 patients with morbus Meniere who were used as control subjects. Vascular processes, mainly responsible for blood flow, are regulated by the sympathetic nervous system and the hypothalamic pituitary adrenal axis, the main systems activating cardiovascular stress responses. Because external stressors have no direct influence on health but are mediated by subjective evaluation and processing of the stressful situation [23], habitual coping strategies also are studied.
The variables examined as possible predictors are the same as those mentioned earlier as assessed at the time of the onset of the disorder. Additionally to the disorder itself being different in the control group, the disease should not be associated conceptually with stress in its etiology. Furthermore, patients rated their actual well-being (WB) on a 5-point scale from very good (5) to very bad (0). The 56 items reflect a variety of everyday hassles concerning work, household, marriage, money, friends, and family. The Streβverarbeitungsbogen assesses the likelihood of various habitual coping behaviors in situations leading to discomfort, arousal, or tension.
The contacted subjects were interviewed about the status of their hearing disorder, especially whether their TIN or hearing deficit still were present. Also, the more negative coping strategies individuals exhibit and the stronger a fatalistic locus of control in individual patients, the more probable is the maintenance of TIN.
Interestingly, the reported strain due to the stressful events differentiates more clearly between groups than does their number. Otherwise, the reported higher amount of stress could be ascribed to the negative state of those in the hearing loss and TIN group at time of assessment. One can assume that the classification of coping behaviors into "bad" or "good" regarding their problemsolving or palliative capacity may be invalid, as some often have argued that the effectiveness of coping also depends on the kind of stressor and other characteristics of the situation. The discrimination between groups was well above chance but, with an error rate of 25%, was not really very satisfactory. Interestingly, this global self-evaluation is more important than is the rating of disability due to TIN and SHL and variables related to the history of the disorder. The definitely worse state of well-being in the experimental group points to the fact that the comorbidity of SHL and TIN probably is very stressing and annoying. Nevertheless, our data support the hypothetical role played by stress and related psychological factors in the etiology of SHL and TIN. Verhaltensmedizinische Untersuchungen zum HOrsturz [The behavioral medicine of sudden hearing loss]. Plotzliche doppelseitige Ertaubung durch psychische Konfliktsituation [SHL in both ears as a consequence of psychological conflict].
General and specific coping strategies used by middle aged males with noise induced hearing loss, with or without tinnitus. Structure of perceived handicap in middleaged males with noise-induced hearing loss, with and without tinnitus. The management of chronic tinnitus-comparison of a cognitive-behavioral group training with yoga.
Psychologische Behandlung des chronischen Tinnitus [Psychological treatment of chronic tinnitus].
Multidimensional health locus of control as partial predictor of serum phosphorus in chronic hemodialysis. Zur interund intraindividuellen Reliabilitat einer modifizierten deutschen Fassung der Social Readjustment Rating Scale [Inter- and intraindividual reliability of the modified Social Readjustment Rating Scale].
Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. The Penn State Worry Questionnaire: Psychometric properties and associated characteristics. Fragebogen zur Erhebung von Kontrolluberzeugungen zur Krankheit und Gesundheit (KKG) [Questionnaire to assess locus of control regarding illness and health (KKG)]. The subjects were 11 patients with sudden deafness showing the progression of hearing loss by pure tone audiometry after the onset of the initial attack of hearing loss. Ann Otol Rhinol Laryngol 82: 2–12Kanzaki J, Takahasi M (1977) The nystagmus and the therapeutic effects on early-diagnosed cases of sudden deafness.
The anterior part ( little area ) of the nasal septum is the most frequent site for bleeding, because of rich blood supply. 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. The progression of hearing loss was mostly observed within 4–7 days after the onset of the initial attack.
2009 Volume 9 Number 1 CT shows right thyroid cartilage fracture & air escape suggesting tracheal tear.
Open :usually reserved for cases in which either a prior closed reduction has failed or malunion has occurred.
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.
Average hearing loss in initial audiometry was severe and the recovery was poor in the majority of cases. 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. An exploratory tympanotomy was performed in five cases and revealed one case of perilymphatic leak from the round window and another case of suspected round-window membrane rupture. 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. As far as the causes of the progression of hearing loss in the early stage of sudden deafness are concerned, the following could be considered (1) aggravation of viral labyrinthitis, (2) aggravation of the vascular lesion of the inner ear, and (3) rupture of the membranous labyrinth of window(s).
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 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.
The strongest predictor of chronicity was the degree of well-being at the time of first assessment (soon after disease onset). Consequently, our study applying psychological instruments of satisfying reliability and validity in a control group design confirms findings by Hoffmeister [1], Kropp and Rad [10], Stange [11], and Neuser and Knoop [12].
Only one person contacted in the experimental group and three in the control group refused to participate (see Table 2).

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