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Tinnitus reaction questionnaire results uk,sinus infection 8dpo good,zedd loses hearing in left ear vibrating - Step 1

Author: admin | 20.10.2013 | Category: Treatment For Ear Ringing

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Resumo: Um dos topicos mais questionado nos estudos clinicos sobre zumbido e o metodo de mensuracao do mesmo. Abstract: One of the most challenging topics in tinnitus clinical studies is the measuring method used.
INTRODUCAOZumbido e definido como a percepcao auditiva na ausencia de uma fonte sonora externa.
How to cite this article Robinson SK, Viirre ES, Bailey KA, Kindermann S, Minassian AL, Goldin PR, Pedrelli P, et al.
This study is a randomized, waitlist-controlled trial testing the effect of a brief, "manualized," cognitive-behavioral group therapy on distress associated with tinnitus, quality of well-being, psychological distress including depression, and internal focus. Cognitive-behavioral therapy (CBT) is efficacious as an intervention for psychological disorders: depression [1], anxiety disorders [2], physical disorders (nonspecific pain [3-5], spinal and low back pain [6-9], temporomandibular disorders [10,11], and other medical conditions). Interestingly, despite the strong association between tinnitus and depression and the well-documented treatment effects of CBT for depression, research has been inconclusive about whether CBT decreases depression for tinnitus sufferers. In summary, CBT has been shown to decrease the levels of tinnitus annoyance and increase tinnitus-related quality of life. Participants enrolled in the study either through referral by their medical provider or by self-referral.
The primary inclusion criterion was self-reported distress due to tinnitus; no level of severity or frequency of tinnitus was required.
Once contacted, a member of the study staff described the study to the potential participant.
Participants began treatment either immediately after their intake or after their 8-week assessment and completed additional follow-up assessments at 16 weeks and 52 weeks (Fig.
The first [SRK] and last author [JRM] trained all clinicians in the manualized CBT intervention. The (Iowa) Tinnitus Handicap Questionnaire (THQ) is a 27-item self-report questionnaire that assesses specific areas of tinnitus handicap and patients' perceived severity of the handicaps associated with tinnitus, including (1) the physical, emotional, and social consequences of tinnitus, (2) hearing ability of the patient, and (3) "the patients' view of tinnitus" [23]. The Tinnitus Reaction Questionnaire (TRQ) is a 26- item self-report questionnaire that measures psychological distress related to tinnitus, including general distress, interference with activities, severity of distress, and avoidance of activities [26].
The Tinnitus Handicap Inventory (THI) is a 25-item self-report questionnaire that quantifies the effect of tinnitus on daily living by assessing functional, emotional, and catastrophic response reactions to tinnitus [27]. The Tinnitus (Effects) Questionnaire (TQ) is a 52- item self-report questionnaire, of which only 41 items are scored [28]. The Modified Somatic Perception Questionnaire (MSPQ) is designed to measure somatic sensations and awareness of bodily sensations [31].
The Private Self-Consciousness Scale (PSC) is a subscale of the Self-Consciousness Scale, a self-report questionnaire designed to assess stable dispositions of selffocused attention-that is, internal thoughts, sensations, and feelings [32]. The Hamilton Rating Scale for Depression 17-Item Version (HRSD) is an interview assessment of depressive symptoms and severity [33]. The Beck Depression Inventory (BDI) is a standard self-report measure of depressive symptoms [36].
The Symptom Checklist 90, revised (SCL-90-R), is designed to assess presence and severity of distress by participants experiencing symptoms of psychiatric disorders [38].
The Quality of Well-Being Scale, (self-administered version (QWB-SA), is designed to assess patient's quality of well-being and functional impairment among patients with medical disorders [40]. The primary hypotheses were tested using orthogonal planned contrasts in a repeated-measures analysis of covariance (ANCOVA) with one between-participants factor (group: treatment versus waitlist) and one repeated factor with four levels (baseline, 8 weeks, 16 weeks, and 52 weeks). Consistent with current statistical practices, we carried the last observation forward for any person having at least two data points among the outcome measures. After completion of the baseline assessments, 38 participants were randomly assigned to the immediate treatment condition, and 27 participants were randomly assigned to the waitlist control condition. Twenty-six of 38 participants in the treatment condition and 15 of 27 participants in the waitlist condition completed at least six sessions (of a total of eight possible sessions), for a total of 41 "completers." Twentyfour participants (37%) were unable to complete the study.
The primary test of each hypothesis (improvement in tinnitus-related quality of life, global quality of life, psychological distress, and internal focus) was a treatment group-by-time period ANCOVA, with a test of the quadratic function, on all of the outcome measures: tinnitus, psychiatric symptoms, internal focus, and quality of wellbeing.
Similar to the results of other studies investigating CBT for tinnitus, this study found significant improvements in tinnitus distress as compared to a waitlist control.
Our study found improvements in depression on the basis of BDI but not on the HRSD; this is similar to the results from meta-analyses [12,19].
This study suggests that the current intervention provided some initial relief from tinnitus distress, but the benefits were not maintained. Strengths of this study include a manualized intervention that can be used by others to replicate results and a waitlist control condition.
Limitations of this study include the use of blind raters only at the end of the study instead of throughout the entire study and the absence of external validation of adherence to our treatment manual. Interesting questions about CBT and its use in the treatment of distress related to tinnitus, which ought to be studied in the future, include the optimal length of each session, optimal number of sessions and use of booster sessions, an assessment of which skills learned were helpful and which were not helpful, and whether a specific subgroup of tinnitus patients exists for whom CBT would be beneficial. In conclusion, evidence from this and other studies suggests that CBT is helpful at decreasing distress related to tinnitus; however, more research is needed in determining whether there is a specific group of participants who benefit, what the crucial elements of treatment are, and how long treatment should last. As Escalas Visual-Analogas (EVAs) e o Tinnitus Handicap Inventory (THI) sao frequentemente utilizados para este fim. Visual Analogue Scales (VAS) and Tinnitus Handicap Inventory (THI) are frequently used in tinnitus. Estudos epidemiologicos relatam a incidencia de zumbido em 1 a 32% da populacao, estimando-se cerca de 35 a 50 milhoes de pessoas nos EUA. Cognitivebehavioral therapy (CBT) included training in activity planning, relaxation training and, primarily, cognitive restructuring. Research on the effects of CBT on tinnitus-related outcomes has begun to accumulate, and results are promising. Research has shown that tinnitus sufferers with higher levels of attention to their thoughts, feelings, and bodily sensations have greater perceived tinnitus handicap [15], and CBT may modify this attention. Small decreases in depression have been found in some [19] but not all studies of CBT for tinnitus [12]. However, currently unknown is whether global quality of life that is nonspecific to tinnitus can be improved with CBT. Staff at the University of California-San Diego (UCSD) or the VA San Diego Healthcare System (VASDHC) otolaryngology or audiology clinics asked patients for permission to have a researcher contact them. If a participant was interested, a research assistant scheduled an appointment during which the participant provided consent and completed the initial assessments. The intervention emphasized cognitive restructuring, an increase in pleasant activities, and relaxation training.
Clinicians were a psychiatrist [SRK] and master's-level clinicians (psychology doctoral students). Items are scored on a Likert scale from 0 to 100 ("strongly disagree" to "strongly agree"), with two items reverse-scored; total scores are presented in this study. Items are scored 0 to 4 ("not at all" to "almost all the time"); total scores are presented in this study. Items are scored 0-2 ("not true," "partly true," "true"), and total scores are presented here. Ten items are scored 0 to 4 ("extremely uncharacteristic" to "extremely characteristic") with total scores presented. Items are scored 0-2 or 0-4 ("symptom not present" to "present in an extreme form"), and total scores are presented here. The BDI has 21 items and is scored 0 to 4 ("not at all" to "extreme"); the total scores are presented here. It includes 90 items scored 0 to 4 ("not at all" to "extremely"), and mean scores are presented here.
If 90% of the items on a questionnaire were answered, we substituted the mean of the other items from the questionnaire for the missing data and calculated a total score.
Completers were more likely to have finished college than were non-completers ( X2 [1, n = 65] .


To reduce unaccounted variance, we included gender, age, education, and duration of tinnitus as covariates. Tinnitus Reaction Questionnaire (TRQ) scores from baseline to 1-year follow-up for waitlist and immediate treatment.
Beck Depression Inventory (BDI) scores from baseline to 1-year follow-up for waitlist and immediate treatment. Symptom Checklist 90, revised (SCL-90-R), scores baseline to 1-year follow-up for waitlist and immediate treatment. Despite failure to maintain improvements in diminishing tinnitus distress, improvements in lessening depressive symptoms were sustained on the basis of the BDI. However, waitlist controls may not be optimal because the condition does not discern whether improvement was due to CBT techniques or to nonspecific factors, such as the opportunity to receive feedback and support from other group members.
In our study, participants who were more distressed were more likely to complete treatment. Thought should be given to establishment of a network of tinnitus researchers across the country and around the world to implement studies with a sufficiently large and diversified population to answer these questions. We could not have performed this study without referral of participants from the UCSD Departments of Otolaryngology and Audiology and the VASDHC Departments of Otolaryngology and Audiology and the American Tinnitus Association, which distributed flyers to their southern California members. Ne wman CW, harton J, Jacobson GS.elf focused and somatic attention in patients with tinnitus. Objetivo: Verificar a correlacao entre os escores da EVA e do THI em pacientes com zumbido neurossensorial atraves de um estudo prospectivo. Aim: To verify the relationship between VAS and THI scores in tinnitus patients in a prospective study. A incidencia aumenta na populacao idosa, chegando a ate 15% na faixa etaria cima dos 65 anos1,2.Pode-se classificar o zumbido em para-auditivos (gerados por estruturas musculares e vasculares proximas as vias auditivas) e auditivos (gerados por alteracoes na orelha e vias auditivas). A recent meta-analysis of randomized, controlled trials of CBT for tinnitus concluded that though tinnitus loudness does not seem to be affected by CBT, the quality of life for patients with tinnitus increases after CBT [12].
Maladaptive coping has been associated with higher levels of perceived tinnitus severity [16], and CBT provides training in coping skills. Additionally, CBT interventions have not been able to show conclusively that CBT decreases depressive symptoms. Patients who agreed were then contacted by one of the research staff involved with this study. Neither the staff nor the participant knew to which arm the participant was randomly assigned until after completion of initial assessments.
Research assistants who administered assessments were psychology doctoral students, psychiatry residents, or bachelor's degree nursing staff specializing in psychiatry. This questionnaire assesses emotional-cognitive distress, intrusiveness, auditory perceptual difficulties, sleep disturbance, and somatic complaints [29].
Previous studies have inter-rater reliability coefficients above .85 in seven of eight studies [34].
We tested the linear, quadratic, and cubic contrasts over time to determine whether change over time differed for the two treatment groups.
If fewer than 90% of the items had been answered, we did not calculate a total score for that measure. The immediate treatment condition and the waitlist condition did not differ significantly in regard to age, gender, ethnicity, education, number of months with tinnitus, HRSD, BDI, SCL-90-R, TQ, THI, MSPQ, or PSC.
Post hoc analysis indicated that significant change occurred from baseline to time 2 (8 weeks) for the TRQ (in the hypothesized direction). Post hoc analysis indicated that significant change occurred from baseline to time 3 and was maintained to time 4 (in the hypothesized direction; Fig. Possibly this intervention was too brief, and perhaps additional components could lead to better outcomes.
Improvements were seen on only one of two depressive measures, possibly because depression was not specifically addressed in the group sessions.
This study indicates that this treatment needs refining to address long-term maintenance of treatment gains and to target tinnitus symptoms more directly. Ideally, a control condition in which participants meet in a group setting with a health care professional without receiving treatment would shed light on whether improvement was associated with therapy or nonspecific factors. Possibly, CBT is very effective for those who are distressed but not for those who are not distressed. The effects of cognitive-behavioral pain management program on quality of work and employment status of chronic pain patients. Multimodal cognitive-behavior treatment for workers with chronic spinal pain: A matched cohort study with an 18 month follow up. Incorporation of cognitive-behavioral treatment into the medical care of chronic low back pain patients: A controlled randomized study in German pain treatment centers. Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain. Dysfunctional patients with temporomandibular disorders: Evaluating the efficacy of tailored treatment protocol. Coping with tinnitus: Two studies of psychological and audiological characteristics of patients with high and low tinnitus-related distress.
Randomized controlled trial of internetbased cognitive behavior therapy for distress associated with tinnitus. Cognitive-behavioral therapy for depression in low income and minority medical outpatients: Description of a program and exploratory analysis. Tinnitus Reaction Questionnaire: Psychometric properties of a measure of distress associated with tinnitus.
Reliability of self-rated tinnitus distress and association with psychological symptom patterns.
Quantitative rating of depressive states: Correlations between clinical assessment, Beck's self-rating scale and Hamilton's objective rating scale. The Quality of Well-Being Scale: Comparison of the interview administered version with the self-administered questionnaire.
Material e Metodo: 43 pacientes com zumbido neurossensorial quantificaram o zumbido pelos dois metodos, sendo os escores comparados atraves do Coeficiente de Relacao de Spearman. Materials and methods: 43 patients classified their tinnitus according to VAS and THI, and both scores were compared through the Spearman's correlation coefficient test. Dentre estes ultimos, a grande maioria dos casos corresponde ao chamado "zumbido neurossensorial"3.
Participants were randomly assigned to receive 8 weeks of manualized group CBT either immediately or after an 8-week waiting period. Incidentally, the conclusion regarding tinnitus loudness is not surprising because loudness has not been associated with distress due to tinnitus [13,14] and has not been the focus of CBT for tinnitus. Individuals with tinnitus who report higher levels of distress also report higher levels of dysfunctional thinking about tinnitus [14]. It is also possible that the CBT interventions investigated in past studies have included components that are relatively less effective in alleviating depressive symptoms. For tinnitus-related depression, the most benefit might be gained from a CBT intervention that highlights cognitive restructuring versus relaxation techniques.
Some individuals responded to a flyer from the American Tinnitus Association or from their local audiologist. Random assignment was made using a random number generator, and each participant had an equal chance of being assigned to begin treatment either immediately or after an 8-week waiting period.
The original manualized treatment has been shown to be an effective intervention for depression [22]. We included the quadratic and cubic contrasts because we predicted that the curve over time would differ for our two groups. Two participants decided they did not feel distressed enough to make participation worth the effort. It is also reasonable to consider that our high dropout rate may have contributed to our difficulty in detecting improvements on all measures.


Also, possibly a floor effect impaired our ability to detect a change in depression because only 25% of our patients were moderately or severely depressed. Future studies could also benefit from assessing patient satisfaction and assessing which components are most effective. Though this may be seen as a limitation by some, little evidence demonstrates that CBT would produce a change in tinnitus matching based on pitch and frequency of tinnitus. Additionally, the etiology of tinnitus may be correlated to those responding to a certain type of treatment.
As teorias mais recentes situam a geracao do zumbido em nivel coclear, com posterior percepcao nas vias auditivas centrais4,5.O tratamento do zumbido e, ainda nos dias de hoje, um dos maiores desafios para o otorrinolaringologista. Participants completed outcome measures at the time of their random assignment and at 8, 16, and 52 weeks later. In this meta-analysis, quality of life was operationalized as a "decrease of global tinnitus severity" and was measured with quality-of-life questionnaires specific to tinnitus: the Tinnitus Handicap Questionnaire, the Tinnitus Questionnaire, and the Tinnitus Reaction Questionnaire. CBT teaches individuals to be mindful of their thoughts and to look for evidence that challenges negative or dysfunctional thoughts. Components of CBT vary; for example, relaxation techniques, cognitive restructuring, increasing pleasant activities, and goal setting may be more helpful for tinnitus, whereas others may be more helpful for depression [20]. Theoretically, attentional control training should also be included in a CBT package and, to date, measures of internal focus (attention to bodily sensations and thoughts) have not been included as outcome measures in the evaluation of CBT on tinnitus.
Initially, participants received no compensation; however, funding became available during the course of the study, and participants received $10 for assessments. The interventions in this study were modified to make them relevant to coping with tinnitus and stress in general. Test-retest reliability of the QWB-SA has been shown, and QWB scores have been shown to be responsive to clinical change [42].
Specifically, we anticipated that those receiving immediate treatment would report lower tinnitus distress, psychological symptoms, internal focus, and improved well-being at 8 weeks but that, after 16 weeks (when the waitlist control condition had completed treatment), the two conditions would be equivalent-that is, that the waitlist condition would now have a significant decrease in symptoms leading to a nonlinear curve. Two participants decided they did not wish to make the commute from Los Angeles to San Diego. One important consideration should be that there was no severity requirement to enter this study. Though the CBT intervention had a component designed to educate participants about attention control techniques, such as increasing pleasant activities and relaxation techniques, a reduction in internal focus after treatment was not found.
Looking for mediators of response to treatment may also be important; for example, tinnitus patients who use more effective coping skills may benefit more than tinnitus patients who do not use effective coping skills. Conclusao: Em pacientes com zumbido neurossensorial existe correlacao entre os escores da EVA e do THI.
Conclusion: There is correlation between VAS and THI scores in patients with sensorineural tinnitus. Dentre os varios fatores responsaveis por esta dificuldade, um deles e, sem sombra de duvida, a precariedade dos metodos de avaliacao e mensuracao do zumbido, nao havendo consenso pleno na literatura quanto ao metodo ideal de avaliacao.Um dos metodos mais utilizados e a escala visual-analoga (EVA), bastante utilizada na avaliacao da dor cronica. Repeatedmeasure analysis of covariance revealed significant group-by-time interactions on measures of tinnitus distress and depression, indicating that CBT led to greater improvement in those symptoms.
Overall, CBT was found to have a moderate to strong effect on tinnitus-related quality of life. Finally, CBT is an effective treatment for depression and anxiety [17,18], which are problems known to be associated with tinnitus [14]. This study investigated the effects of a "manualized" CBT for tinnitus-that is, therapy that was modeled after a CBT manual for depression and was administered in a group format. In other words, every participant had an equal chance of being assigned to either the treatment group or to the waitlist control group; the number of participants allocated to each group was not limited to a targeted group size designed to yield equal membership between groups. In addition, we modified the manual by adding relaxation techniques that have previously been shown to be efficacious for treating tinnitus. Finally, we predicted that the main effect for time would be significant for all outcome measures.
Participants reported having experienced tinnitus for an average of 11.0 years (range, 1 month to 42 years). General studies that have required high severity of tinnitus to enter have found more positive results. Despite the instruction on increasing pleasant activities and use of relaxation techniques, the possibility of using these or other techniques as distraction from tinnitus was not explicitly stated to the participants. Future studies should address each of these questions, and consideration should be given to combining treatment approaches, such as medications and therapy to provide optimal outcomes-as is often seen in depression and anxiety studies. Nos pacientes com zumbido, pede-se para o paciente atribuir uma nota de 0 a 10 para o seu zumbido, com o auxilio de uma regua apropriada (Figura 1). The current results suggest that CBT, applied in a group format using a manual, can reduce the negative emotional distress, including depression, associated with tinnitus.
In fact, it was concluded that CBT increases quality of life for tinnitus sufferers significantly more than absence of intervention (waitlist control) and more than other psychological interventions [12].
Assessments were made after treatment and 1 year later and included measures of tinnitus-related quality of life, global quality of life, depression, psychological distress, and internal focus.
Three participants completed the intervention but did not provide the 8-week follow-up data. Post hoc analysis indicated that significant change occurred from baseline to time 2, baseline to time 3, and baseline to time 4 (Fig.
Only 12% of our patients reported unbearably severe tinnitus, and only 29% reported that they were extremely annoyed by their tinnitus. It is also possible that distraction is not the ideal approach with tinnitus, and a more mindful approach may be more fruitful.
However, currently unclear is whether CBT for tinnitus improves global health-related quality of life or improves only tinnitus-specific quality of life. Finally, despite improvement in tinnitusrelated quality of life (as measured by the TRQ) and depression (as measured by the BDI), global quality of life (QWB-SA) did not improve, suggesting that the benefits from this treatment do not generalize.
Twelve percent of the sample reported their tinnitus to be "unbearably" severe, and 29% reported that they were "extremely" annoyed by their tinnitus.
Entretanto, trata-se de avaliacao superficial, influenciada por aspectos culturais, intelectuais e psicologicos6.Figura 1. Os criterios para inclusao foram zumbidos de etiologia neurossensorial, sendo excluidos casos com doenca da orelha externa e media e disturbios da articulacao temporo-mandibular concomitantes. Audiometria tonal, vocal e imitanciometria foram realizadas em todos os pacientes, sendo excluidos todos aqueles com disacusia condutiva, mista e com presenca de timpanogramas do tipo A-r, A-d, C e B.
O audiometro utilizado foi o AMPLAID A 177 PLUS, e o Imitanciometro AMPLAID 750.Os pacientes foram solicitados a preencher um questionario validado, no caso o THI (Tinnitus Handicap Inventory) em sua versao para o portugues. Adicionalmente, os pacientes classificaram o zumbido de acordo com escala analogo-visual, de 1 a 10 (para volume e incomodo), sendo feita a correlacao entre os escores do THI e EVA, atraves do coeficiente de correlacao de Spearman. O coeficiente de correlacao de Spearman (rs) mede o grau de associacao entre duas variaveis numericas. Este coeficiente varia de -1 a 1, quanto mais proximo estiver de 1 ou -1, mais forte e a associacao, quanto mais proximo estiver de zero, mais fraca e a relacao entre as duas variaveis.
Isto significa, que quanto maior o EVA, maior o valor esperado do THI (relacao direta), conforme ilustra o grafico (Figura 2).Figura 2. Relacao entre os escores da EVA e THI.DISCUSSAOGrande parte das inumeras criticas aos ensaios clinicos em zumbido incide sobre os metodos de avaliacao.
Na procura pelo metodo ideal de mensuracao do zumbido, varios questionarios tem sido propostos, sendo o THI um dos mais empregados na literatura internacional.
No Brasil, a maioria dos estudos clinicos ja realizados empregou a EVA, mas os trabalhos mais recentes vem sendo feitos com o THI.A correlacao entre os dois metodos, verificada em nossos dados, aumenta a credibilidade dos estudos ja realizados com a EVA, um metodo mais simples e, em nossa opiniao, de assimilacao mais facil pela maioria da populacao brasileira.



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