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Copyright © 2014 Special Gift, All trademarks are the property of the respective trademark owners. How to cite this article Olsen US, Lello E, Nagaraj VS, Reimer A, Ibertsson T, Brannstrom J. OBJECTIVE: The aim of the present study was to examine whether perceived tinnitus severity changes over time, and if so what factors contribute to this change. DESIGN: A modified Swedish version of tinnitus severity questionnaire (MS-TSQ) was used to examine changes in tinnitus severity over a period of time.
STUDY SAMPLE: The MS-TSQ questionnaire was completed by 455 subjects visiting an Ear, Nose and Throat (ENT) clinic in Sweden as part of baseline assessment (Sb). CONCLUSIONS: Results provide valuable framework for understanding the factors that affect tinnitus severity over a period of time. Keywords: duration, hearing loss, modified swedish tinnitus severity questionnaire, psychological treatment, tinnitus severity. Subjective tinnitus is defined as the perceived sensation of sounds by individuals in the absence of any external physical stimulus1.
Various factors can trigger the severity of tinnitus such as emotional stress, psychological factors and other physical or mental illnesses. Many theories and models have been proposed to explain the etiology of tinnitus in individuals with hearing loss and in normal hearing6-8. Previous research has shown that psychoacoustic measurements of tinnitus do not always correlate with how tinnitus affects a person17. There are few studies on how tinnitus severity changes over time and it has been observed that many subjects report to health clinics with questions about the course of tinnitus severity. The subjects sample consisted of a consecutive series of 455 adult subjects who were self-referred to an ENT clinic in Lund, Sweden. The Modified Swedish version of Tinnitus Severity Questionnaire (MS-TSQ) developed by Axelsson and Schenkmanis24 (see Appendix 1 for English version of the questionnaire) was used in the present study.
Pearson's correlation coefficient (rho) was used to examine associations between age, improvement, and PTA's. A one-way ANOVA test was administered to assess significant differences, if any, in age, PTAs (low and high) and improvement in the MS-TSQ scores between the three subject groups. Results indicated that subjects with NH scored the least and subjects with USNHL scored the highest on the baseline MS-TSQ assessment.
Independent-Sample t-test was used to test if there were significant gender and psychological treatment differences in age, PTAs, MS-TSQ baseline, follow-up and difference score. The purpose of this study was to explore the association between self-reported tinnitus severity and duration between baseline and follow-up assessment, degree of hearing loss, subject groups, age, gender and psychological treatment. The present study assessed tinnitus severity performance obtained through questionnaires and calculated baseline scores (Sb), follow-up scores (Sf) and difference scores (Sd). The results of the preset study are in agreement with some of the earlier studies, which conclude that the severity of the tinnitus decreases over time. Results related to hearing thresholds and tinnitus scores indicated a significant difference in PTAlow between USNHL and NIHL in the right ear. Various studies have been carried out to investigate the effect of psychological treatment on the severity of tinnitus20,21. The present study investigated whether perceived tinnitus severity changes over time, and if so what factors contribute to this change. Paper submitted to the ITJ-SGP (Publishing Management System) on June 10, 2014; and accepted on September 22, 2014. Internationally recognized innovator, scientist and clinical specialist in the fields of Laryngology and Voice Sciences.
If this doesn't help they may refer you to an ear, nose and throat specialist to check for problems such as nasal polyps or enlarged tonsils.
Factors affecting severity of tinnitus - a follow-up study of tinnitus subjects at an Ear Nose Throat clinic in Sweden. The same questionnaire was completed during follow-up assessment (Sf) by 174 of these subjects to examine changes in tinnitus severity, if any. The sounds associated with tinnitus have been described as ringing, hissing, humming, whistling, etc2. It has been shown that many factors might affect the severity of tinnitus such as hearing loss, depression, anxiety and insomnia4.
A variety of assessment techniques have been designed that reports subjects' tinnitus severity through questionnaires and interviews18,19. These techniques range from providing psychological treatments20,21 to wearing tinnitus maskers6,22 for subjects with tinnitus. For the baseline assessment, subjects were selected from a consecutive sample of 455 adult subjects that visited the clinic between the years 2000 and 2008.
The questionnaire covers topics such as quality of life, concentration and effect on sleep quality. Descriptive data including mean, standard deviation (SD) and significance levels (p) are presented in Table 3.
There was a significant difference in PTAhigh for right and left ears between genders, indicating lower hearing thresholds for females than males. Previous studies have indicated that tinnitus patients experience increased tolerance over time20,28,29. Previous studies have reported no significant differences between subjects with high degree tinnitus and those with mild or moderate annoyance in terms of age, gender or follow-up duration30.
Furthermore, it has been shown that tinnitus annoyance may increase with increasing hearing loss. In the present study, we asked our subjects if they had received treatment from a psychologist. A modified Swedish version of the tinnitus severity questionnaire was administered to assess changes of tinnitus severity. Garret Herzon is an internationally recognized innovator, scientist and clinical specialist in the fields of Laryngology and Voice Sciences.  Dr. Herzon’s approach to his patient’s health care is to use the best science available to make the  most accurate diagnosis and then to attempt to treat the identified illness beginning with the simplest, most natural form of therapy and to slowly progress to the more complex and advanced treatment as guided by the patient’s response. It is designed to provide reliable medical information in a format that is easy to understand. The patient's tonsils were dissected using the electrocautery device in a capsular fashion. The difference in scores obtained from the two assessments was calculated and was termed as difference scores (Sd). A previous study by Stouffer et al.5 analyzed the factors responsible for the reduction or enhancement of tinnitus severity on 528 subjects with tinnitus. Most neurophysiologic evidence for tinnitus points to changes in the auditory system in individuals having hearing loss following noise exposure9,10 and over-representation in the cortical tonotopic organization at frequencies having normal hearing thresholds11. These assessment techniques quantify the impact of tinnitus on subjects' everyday life based on baseline and follow-up assessment scores. Forti et al.23 investigated the effect of tinnitus retraining therapy on 45 subjects having idiopathic tinnitus for at least 6 months. A modified Swedish version of the Tinnitus Severity Questionnaire (MS-TSQ) developed by Axelsson and Schenkmanis24 was used to measure the baseline and follow-up scores for assessment of tinnitus severity in the present study.
During this initial visit a medical and audiological examination was performed on all subjects to identify any underlying ear diseases. The MS-TSQ which was used in this study for both baseline and follow up assessment also contains 10 items.
A one-way analysis of variance (ANOVA) was used to examine any significant differences between the groups with different diagnoses regarding age, PTAs, Sb, Sf, and Sd scores. No significant differences were observed among the three groups in the follow-up MS-TSQ score. The effect of psychological intervention on the reduction of tinnitus severity has been shown to be positive.
It has been shown that females seem to be at a greater risk for reporting significant tinnitus than males28. In terms of gender differences, it was found that females were less annoyed by tinnitus than males30. Changes in spontaneous neural activity in the dorsal cochlear nucleus following exposure to intense sound: relation to threshold shift.


Elevated fusiform cell activity in the dorsal cochlear nucleus of chinchillas with psychophysical evidence of tinnitus.
Changes in spontaneous neural activity immediately after an acoustic trauma: implications for neural correlates of tinnitus. The relationship between tinnitus pitch and the edge frequency of the audiogram in individuals with hearing impairment and tonal tinnitus. Prevalence and 5-year incidence of tinnitus among older adults: the epidemiology of hearing loss study. When tinnitus loudness and annoyance are discrepant: audiological characteristics and psychological profile. Herzon began his academic career teaching Ear, Nose and Throat Surgery at Northwestern University Medical School in Chicago as full-time faculty and Assistant Professor of Otolaryngology-Head and Neck Surgery for over ten years.   While at Northwestern Dr.
Herzon, MD, FACS is a board-certified otolaryngologist and head and neck surgeon at the Cedars-Sinai Sinus Center of Excellence.  Dr. He then completed his residency in a combined General Surgery-Otolaryngology-Head and Neck Surgery at the Northwestern University Medical School.  Dr.
As Chief of Medical Resources, I hold an undergraduate degree in Neuroscience from the University of California, Los Angeles and a graduate degree in Medical Science from the University of Southern California. Previous literature has shown that tinnitus can have a significant impact on the quality of life in terms of altered psychosocial functions. Studies on the effect of noise exposure and tinnitus12 have shown that exposure to occupational noise gave increased odds for tinnitus in subjects with hearing loss.
Axelsson and Ringdahl10 administered a tinnitus questionnaire on a large population of randomly selected adults. Results indicated that the percentage of individuals with tinnitus who reported the disappearance of difficulties in different activities such as concentration, sleep, relaxation, work and social relations improved after the end of therapy. All subjects underwent audiological and medical examinations to identify any abnormality in the ear condition. In terms of baseline audiometric assessment, two pure tone averages (PTAs) were calculated - one for the low frequencies (PTAlow consisting of 0.5, 1 and 2 kHz) and the other for high (PTAhigh consisting of 3, 4 and 6 kHz) frequencies. The MS-TSQ items are identical to those of the original TSQ, but the number of response alternatives differs.
A post-hoc analysis was conducted using Bonferroni correction to know if significant differences existed between groups. In terms of the improvement in the MS-TSQ scores, the USNHL group obtained significantly lower scores than the NIHL group.
The method of obtaining the responses through questionnaires sent out by mail has generally been shown to obtain a low response rate.
A study by Nondahl et al.28 assessed tinnitus severity of subjects with five years in between. The results of the present study observed that females had a higher Sb and Sd scores than males.
It is possible that the subjects may only have had a conversation or may have had further follow-up sessions with a psychologist, but those subjects who answered 'yes' in the questionnaire did receive psychological intervention. Also, psychological intervention had an influence on the improvement in tinnitus annoyance in subjects with tinnitus.
Herzon specializes in medical treatments for patients who are not yet ready for sinus surgery or for those who wish to try non-surgical medical treatments as an alternative to surgery.
He co-authored the first two editions of the American Academy of Otolaryngology Head and Neck Surgery publication, Practice Parameters and Indications for Surgery, Guidelines for Surgery of Ear, Nose and Throat. Herzon completed a Fellowship in Head and Neck Cancer Surgery and Medicine recognized by the Combined American Society for Head and Neck Surgery and the Society of Head & Neck Surgeons and funded by the American Cancer Society at Northwestern Memorial Hospital and the Rehabilitation Institute of Chicago under his preceptor, George A. In such cases, the subjects' response to tinnitus can produce annoyance, mood changes, fear, anxiety and depression - all of which are associated with tinnitus severity3.
They also concluded that tinnitus severity increased as a function of number of years since onset.
These subjects were mainly exposed to leisure-time noise and had frequent tinnitus but their thresholds were within normal limits. Studies have shown that tinnitus affects a person's well being and can lead to a range of associated problems.
Audiological examination consisted of pure tone audiometry supplemented with Auditory Brainstem Response (ABR) and Magnetic Resonance Imaging (MRI) if required.
An addition of a response alternative of 'not sure' was added to the already existing four response alternatives in the original TSQ version. Independent samples t-test was used to analyze gender differences and the effect of psychological treatment.
No significant differences were observed in the MS-TSQ difference scores between NH and NIHL; and between NH and USNHL groups.
Two-hundred and thirty-three patients reported significant tinnitus at the first examination, and 105 patients (45%) reported decreased annoyance during the follow-up assessment.
Also, no significant hearing threshold differences were observed between the groups who received psychological intervention versus those who did not. The NIHL group showed the lowest Sd score and these scores were significantly lesser compared to USNHL group.
Herzon and his colleagues in the fields of biomedical research and neuroscience have successfully developed and tested the first totally implantable electronic artificial pacemaker to re-animate the paralyzed larynx.   Dr.
He has written and presented over 100 papers, chapters in books and oral presentations in the field of ENT (ear,nose and throat) including papers original manuscripts on the origin of sinus allergies, endoscopic sinus surgery safety inventions, facial nerve monitoring and testing and the development of the a new, wireless, disposable, thermocautery device called the THERMOCPES™ to control bleeding during operations.  Dr. Studies have suggested that being exposed to excessive noise for longer periods of time, could lead to hearing loss and tinnitus, whereas a noise exposure over a short time period, could cause tinnitus as the only symptom. No significant correlation was observed between improvement in tinnitus scores and other variables of age, pure tone audiometry types or duration of follow-up.
A study by Snow27 concluded that a questionnaire can be a good method to assess tinnitus severity.
Of these 105 patients, 45 reported no tinnitus, and 60 reported that their tinnitus had shifted from significant to mild.
In our study, the NH group had the lowest Sb score among the three groups, but had a higher Sd score than subjects with NIHL.
In the present study baseline audiometric measurements indicate females had significantly lower hearing thresholds in the high frequencies. This finding indicates that hearing thresholds may not be the most important influencing factor on how the subjects experienced annoyance by their tinnitus, especially since the group receiving treatment had a significantly higher Sb score. Further studies investigating the effects of the type and duration of psychological treatment on the tinnitus severity can be explored. Herzon holds six United States Patents on new medical inventions and devices which aid in the safety and effectiveness of surgery and medical care.   He was an important co-investigator on a special investigation which demonstrated for the first time that patients can develop allergies to bacteria in the nose and is a common source of sinus disease. Since only frequencies from 125 Hz to 8 kHz are measured in conventional pure-tone audiometry, it is possible that a person with normal hearing can have a hearing loss at frequencies higher than 8 kHz accompanied by tinnitus13,14. In relation to hearing thresholds, it was observed that, in subjects who had tinnitus always, 19% considered themselves as having normal hearing, 55% had some hearing loss, 19% had marked hearing loss and 3% were deaf.
The study had the approval of the Ethical committee in the section of Logopedics, Phoniatrics and Audiology, Lund University. The subjects' responses were rated based on the global score obtained from the MS-TSQ questionnaire. We believe that the 'true' response rate in our study is much higher (around 59%) since 267 of the total 455 subjects initially responded to the questionnaires that were sent to them. For 341 patients who reported mild tinnitus at baseline, 40% reported that their tinnitus had not changed, compared to 55% of the 233 who had moderate tinnitus.
The range of the duration between the baseline and follow-up visit varied from 1 year and 11 months to 9 years and 4 months and this factor might have had an effect on the audiometric thresholds during the follow-up phase.
It is shown that subjects with tinnitus have steeper maximum high-frequency slopes compared to the subjects without tinnitus. It has also been shown that cognitive behavioral therapies can improve a person's ability to cope with their tinnitus21. Of the total 455 subjects, 267 subjects (response rate of around 59%) returned back the questionnaire. After exclusions based on subject category and responses to all items in the questionnaire, our study yielded a final response rate of around 38% (n = 174). Studies have shown that prevalence of tinnitus increases due to exposure to industrial and recreational noise1,6. THESE VERY SAME ENFORCEMENT AGENCIES, WHO HAVE SWORN TO PROTECT AND SERVE, OUR COUNTRY, AND CITIZENS ,ARE BUT SOME, OF THE CORRUPT,GREEDY TRAITORS .ENGAGED IN THE TYRANNY AND TORTURE.


Studies have argued that the presence of tinnitus is related to the boundary in the audiogram between the frequency regions of normal or near-normal hearing and a region with a higher degree of hearing loss15,16. A similar study by Andersson et al.20 observed that the severity of tinnitus reduced over time in all of their subjects, when psychological intervention was provided. In the MS-TSQ item 1 is provided with scores ranging from 2-8, item 2 from 1-4 and items 3-10 has scores ranging from 0-4. In the present study, no significant associations were found between Sd scores in the MS-TSQ and age, PTA, or duration. It has been shown that NIHL results in an imbalance of spontaneous and sound-driven cochlear output across different frequencies.
Herzon has been the recipient of more than a dozen medical awards including the prestigious Francis L. These results indicate that both the degree of hearing loss and the shape of an audiogram were factors that could predict the occurrence of tinnitus.
It was observed that females had a higher MS-TSQ Sb score and a lower MS-TSQ Sf score than males. Herzon is also a recipient of the National Honor Award for his services to the American Academy of Head and Neck Surgery, Inc. Subjects with a global score below 20 were classified to have mild tinnitus, while a global score above 30 was classified as severe. Hence, these pathophysiological changes might be responsible for observing lesser improvement in the tinnitus severity scores in subjects with NIHL.
Subjects with global scores between 20 and 30 were classified as having moderate tinnitus24.
Herzon served as Chairman of Quality Management for the American Academy of Otolaryngology, Inc. The MS-TSQ was administered on all subjects in two stages - a baseline score (Sb) during the initial visit and a follow-up score (Sf) with varying duration of time after the baseline assessment. Herzon works closely with singing teachers, speech therapists and gastroenterologists in his attempt to help his patient’s regain their important vocal skills.  He specializes in the medical care of the professional voice users such as cantors, actors and singers both classically trained opera singers and popular music performers.
The change in the tinnitus severity was calculated as (Sb - Sf), termed as the difference scores (Sd).
The duration between the baseline and follow-up assessment varied from 1 year 11 months to 9 years and 4 months. Herzon is also a current member of the Cedars-Sinai Voice and Swallowing Rehabilitation Clinic. The school district has moved to a biometric identification program, saying students will no longer have to use an ID card to buy lunch.A  BIOMETRICS TO TRACK YOUR KIDS!!!!!i»?i»?A TARGETED INDIVIDUALS, THE GREEDY CRIMINALS ARE NOW CONDONING THEIR TECH!
Paul Weindling, history of medicine professor at Oxford Brookes University, describes his search for the lost victims of Nazi experiments. The chairman of the board at ESL a€” then proprietor of the desert wasteland in Nevada known as a€?Area 51a€? a€” was William Perry, who would be appointed secretary of defense several years later. EUCACH.ORG PanelIn a 2-hour wide-ranging Panel with Alfred Lambremont Webre on the Transhumanist Agenda, Magnus Olsson, Dr. Henning Witte, and Melanie Vritschan, three experts from the European Coalition Against Covert Harassment, revealed recent technological advances in human robotization and nano implant technologies, and an acceleration of what Melanie Vritschan characterized as a a€?global enslavement programa€?.Shift from electromagnetic to scalar wavesThese technologies have now shifted from electromagnetic wave to scalar waves and use super quantum computers in the quantum cloud to control a€?pipesa€? a reference to the brains of humans that have been taken over via DNA, via implants that can be breathed can breach the blood-brain barrier and then controlled via scalar waved on a super-grid. Eventually, such 'subvocal speech' systems could be used in spacesuits, in noisy places like airport towers to capture air-traffic controller commands, or even in traditional voice-recognition programs to increase accuracy, according to NASA scientists."What is analyzed is silent, or sub auditory, speech, such as when a person silently reads or talks to himself," said Chuck Jorgensen, a scientist whose team is developing silent, subvocal speech recognition at NASA Ames Research Center in California's Silicon Valley. We numbered the columns and rows, and we could identify each letter with a pair of single-digit numbers," Jorgensen said. People in noisy conditions could use the system when privacy is needed, such as during telephone conversations on buses or trains, according to scientists."An expanded muscle-control system could help injured astronauts control machines. If an astronaut is suffering from muscle weakness due to a long stint in microgravity, the astronaut could send signals to software that would assist with landings on Mars or the Earth, for example," Jorgensen explained. These are processed to remove noise, and then we process them to see useful parts of the signals to show one word from another," Jorgensen said.After the signals are amplified, computer software 'reads' the signals to recognize each word and sound.
Our Research and Development Division has been in contact with the Federal Bureau of Prisons, the California Department of Corrections, the Texas Department of Public Safety, and the Massachusetts Department of Correction to run limited trials of the 2020 neural chip implant. We have established representatives of our interests in both management and institutional level positions within these departments.
Federal regulations do not yet permit testing of implants on prisoners, but we have entered nto contractual agreements with privatized health care professionals and specified correctional personnel to do limited testing of our products.
We need, however, to expand our testing to research how effective the 2020 neural chip implant performs in those identified as the most aggressive in our society. In California, several prisoners were identified as members of the security threat group, EME, or Mexican Mafia. They were brought to the health services unit at Pelican Bay and tranquilized with advanced sedatives developed by our Cambridge,Massachussetts laboratories. The results of implants on 8 prisoners yielded the following results: a€?Implants served as surveillance monitoring device for threat group activity. However, during that period substantial data was gathered by our research and development team which suggests that the implants exceed expected results.
One of the major concerns of Security and the R & D team was that the test subject would discover the chemial imbalance during the initial adjustment period and the test would have to be scurbbed. However, due to advanced technological developments in the sedatives administered, the 48 hour adjustment period can be attributed t prescription medication given to the test subjects after the implant procedure. One of the concerns raised by R & D was the cause of the bleeding and how to eliminate that problem. Unexplained bleeding might cause the subject to inquire further about his "routine" visit to the infirmary or health care facility. Security officials now know several strategies employed by the EME that facilitate the transmission of illegal drugs and weapons into their correctional facilities. One intelligence officier remarked that while they cannot use the informaiton that have in a court of law that they now know who to watch and what outside "connections" they have.
The prison at Soledad is now considering transferring three subjects to Vacaville wher we have ongoing implant reserach. Our technicians have promised that they can do three 2020 neural chip implants in less than an hour.
Soledad officials hope to collect information from the trio to bring a 14 month investigation into drug trafficking by correctional officers to a close.
Essentially, the implants make the unsuspecting prisoner a walking-talking recorder of every event he comes into contact with. There are only five intelligence officers and the Commisoner of Corrections who actually know the full scope of the implant testing.
In Massachusetts, the Department of Corrections has already entered into high level discussion about releasing certain offenders to the community with the 2020 neural chip implants.
Our people are not altogether against the idea, however, attorneys for Intelli-Connection have advised against implant technology outside strick control settings.
While we have a strong lobby in the Congress and various state legislatures favoring our product, we must proceed with the utmost caution on uncontrolled use of the 2020 neural chip. If the chip were discovered in use not authorized by law and the procedure traced to us we could not endure for long the resulting publicity and liability payments.
Massachusetts officials have developed an intelligence branch from their Fugitive Task Force Squad that would do limited test runs under tight controls with the pre-release subjects. Correctons officials have dubbed these poetnetial test subjects "the insurance group." (the name derives from the concept that the 2020 implant insures compliance with the law and allows officials to detect misconduct or violations without question) A retired police detective from Charlestown, Massachusetts, now with the intelligence unit has asked us to consider using the 2020 neural chip on hard core felons suspected of bank and armored car robbery. He stated, "Charlestown would never be the same, we'd finally know what was happening before they knew what was happening." We will continue to explore community uses of the 2020 chip, but our company rep will be attached to all law enforcement operations with an extraction crrew that can be on-site in 2 hours from anywhere at anytime. We have an Intelli-Connection discussion group who is meeting with the Director of Security at Florence, Colorado's federal super maximum security unit. The initial discussions with the Director have been promising and we hope to have an R & D unit at this important facilitly within the next six months.
Napolitano insisted that the department was not planning on engaging in any form of ideological profiling. I will tell him face-to-face that we honor veterans at DHS and employ thousands across the department, up to and including the Deputy Secretary," Ms. Steve Buyer of Indiana, the ranking Republican on the House Committee on Veterans' Affairs, called it "inconceivable" that the Obama administration would categorize veterans as a potential threat.



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