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OBJECTIVE: To determine the validity and reliability of a Filipino translation of the Tinnitus Handicap Inventory (THI), a self-report measure of tinnitus handicap.
CONCLUSION: The results of the present study suggest that the THI-PH is a valid and reliable tool that can be used to quantify the effects of tinnitus on the quality of life of Filipino tinnitus patients. A review of the audiology request forms at the Ear Unit of the Philippine General Hospital from January to July 2009 revealed that out of 1079 patients that underwent audiometry testing, 348 complained of tinnitus - 207 of which as a symptom secondary to another problem, and 141 as a chief complaint.
Depending on its severity, tinnitus can have serious effects on a patient's quality of life.
There are a number of questionnaires available to measure the effects of tinnitus on quality of life. Since there are currently no available tinnitus-specific questionnaires in Filipino and there are currently no available data on the effects of tinnitus on the quality of life of Filipino tinnitus patients, there is a need for a valid tinnitus questionnaire in the language. A Filipino tinnitus questionnaire will help quantify the effects of tinnitus on the quality of life of Filipino tinnitus patients, assist clinicians in justifying their decision for tinnitus therapy or in making the appropriate referrals, and can be used to objectively classify tinnitus patients into the three categories described by Tyler et al. The THI by Newman is psychometrically robust, easy to administer and interpret, and broad in scope. Each question can be answered by a "yes" which is given four points, a "sometimes" which is given two points, or a "no" which is given zero points. The final version of the Filipino THI was administered to 75 patients, 38 females and 37 males, ages 18 - 82 (mean age = 47.6) recruited consecutively at the Ear Unit of the Philippine General Hospital from February to mid-March 2010 after being assessed at the ENT-OPD.
Tinnitus pitch and loudness matches were determined using the two-alternative forced-choice method described by Vernon24. The original version of the THI (THI-US) was first translated into Filipino by three native speakers of Filipino bilingual in English.
The final THI-PH was then given to 75 tinnitus patients referred at the Ear Unit of PGH for audiologic testing after assessment at the ENT-OPD of PGH. Cronbach's alpha for the THI-PH total and its subscales compared to the THI-US and its subscales are given in Table 3. A majority of the subjects (46 per cent) were 46-65 years old followed by those in the 26-45 year-old age range (33 per cent), those in the 65 years and older followed (11 per cent), while the lowest concentration of subjects was found in the 18-25 year-old age range (9 per cent). A majority of the subjects (68 per cent) suffered from chronic tinnitus (tinnitus for more than six months).
In terms of tinnitus sounds reported, a majority of the patients claimed that their tinnitus was either insect-like or wind-like. Tinnitus pitch was most frequently matched at 2,000 Hertz while loudness was most frequently matched at 0-10 decibels sensation level.
A non-significant correlation was found between the duration of the tinnitus and tinnitus handicap scores (p-value = 0.34). In terms of age, across all tinnitus handicap grades, most of the cases affected were in the 46-65 year-old age range except for the severe grade where a majority of the cases were in the 26-45 year-old age range (Table 2).
For the tinnitus sounds reported in relation to tinnitus handicap, in the moderate level, a majority of the patients reported their tinnitus to be insect-like while in the severe level they reported it to be wind-like. For the pitch and loudness matches, in the mild and catastrophic grades, pitch was mostly matched at 2,000 Hertz while in the severe grade, pitch was most frequently matched at 1,000 Hertz (Figure 1). Table 4 shows that the results obtained are similar to the original version and also to other language validations.
The slightly poorer internal consistency reliability for the Catastrophic subscale is attributed to the shorter number of items in that scale.
Findings in terms of the prevalence of tinnitus as a function of age are similar to the findings of Hinchcliffe (1961)26,who concluded that tinnitus was most prevalent in the 55-64 year old age range and was least prevalent in the 18-24 year old age range.
Tinnitus being more frequently experienced in the left ear compared to the right was previously reported by Axelsson and Ringdahl (1989)27, Hazell (1981)28 and Coles (1984)29.
Since the design of this study did not allow for the testing of the questionnaire's repeatability, it is recommended that the THI-PH be tested on another set of patients.
It would also be interesting to investigate the relationship between the THI-PH and psychopathological problems for the subset of patients with catastrophic tinnitus. In conclusion, the results of the study suggest that the THI-PH is a valid and reliable tool that can be used on Filipino patients to quantify the effects of tinnitus on daily living and to test the efficacy of tinnitus treatments. Paper submitted to the RBCMS-SGP (Publishing Management System) on July 2, 2012; and accepted on August 16, 2012. How to cite this article Mahmoudian S, Shahmiri E, Rouzbahani M, Jafari Z, Keyhani MR, Rahimi F, Mahmoudian G, et al.
Tinnitus is a debilitating condition that is widespread yet difficult to successfully diagnose and treat.
Regarding to McFadden (1982), Tinnitus is the "conscious experience of a sound that originates in an involuntary manner in the head of its owner or may appear to him to be so"1. Some underlying causes were defined for tinnitus, including otological diseases, tumors, ototoxicity, acoustic trauma, noise-induced and psychological disturbances. Since almost the majority of tinnitus questionnaires for assessing individual's reaction to tinnitus are in English language and there is still no standardized and valid questionnaire in Persian, the provision of a Persian version of these questionnaires according to the culture of Iranian society is inevitable.
The first aim of the current study was to investigate the linguistic validity of the Persian Version of the THI as a measure of tinnitus-related reactions in three dimensions 95 International Tinnitus Journal, Vol. The present study consists of translation and standardization of the original version of THI [25] into Persian version (Linguistic validation) then the reliability of the Persian version of THI has been identified. In the first step according to the IQOLA protocol26, THI questionnaire was translated by two native speakers of Persian, bilingual in English and Persian, separately translated the original instrument into Farsi (Persian) language (translator 1 and 2). At the second step of linguistic validation, we used two other translators (5 and 6) with high level of proficiency in Persian and English languages. Before the THI-P can be administered to assess the effects of tinnitus, its test-retest stability must be determined. The degree of hearing loss is defined as the severity of the hearing loss measured by audiometry. Patients were asked to complete the THI-P questionnaire as part of the initial assessment at the tinnitus center. All analyses were performed using statistical package for social science (SPSS) version 16. Student t-test was used to test for differences between THI scores and its subscales and gender, hearing impairments and tinnitus laterality. From the 25 items of THI-US version translated to Persian version of THI, thirteen items (52%) including 2, 3, 7, 8, 9, 10, 11, 15, 16, 20, 21 and 22 as an easy translation, six items (24%) including 6, 12, 14, 17, 18 and 19 as a relatively easy translation and finally other six items including 4, 5, 13, 23, 24 and 25 as a difficult translation were evaluated by translators. The tinnitus characteristics of the 112 subjects attending the tinnitus center to consult about tinnitus management have been summarized in Table 1. The frequency distribution of tinnitus subjects who answered the various items in the THI-P questionnaire has been outlined in Table 3. The correlation of age and total THI-P score was calculated by Pearson's product and for calculating the effect of sex and total THI-P score we applied independent student t-test. Pearson product-moment correlations were calculated between the first and second administrations of the THI-P among the tinnitus subjects to assess the strength of the relationship between tests and retest (Figure 2).
We assessed the percentages of "Yes", "Sometimes" and "No" answers and then we calculated the reproducibility (internal consistency reliability) of items in THI-P using the Cronbach's-alpha coefficient. In recent years, the need to assess and consider the consequences of diseases as well as distressing symptoms has been specifically considered in all special facilities of medical and rehabilitation. Hence, as a first step, standardization and validation of appropriate tools such as psychometric questionnaires are very important in order to evaluate disease or monitor treatment outcomes. One of our ultimate goals for validating the Persian version of THI and for conducting current study was to develop a standard self-report tinnitus instrument, appropriate to the Persian's culture so that it could be administered as a criterion measure in clinical and research approaches available to clinicians and other researchers who are involved in different aspects of tinnitus subjects. It is widely agreed that in addition to desirable translation to validate an assessment tool, we should also use the terms adapted for socio-cultural setting of the population which will serve.
The translation quality was assessed by translator 3 and 4 using a VAS criterion (from desirable up to absolute undesirable score). In order to determine the divergent or discriminate validity of THI-P, we used the effects of three factors including hearing impairment, gender and age of the tinnitus subjects on the questionnaire scores. Regarding to other studies, in order to identify validity of THI questionnaires (German, Brazilian, Danish versions), authors administered the correlation between items in translated THI with the other standardized questionnaires (convergent validity structure)33. The most important specifications of one assessing instrument are always including repeatability, consistency and validity of obtained scores.
The other part of consistency was related to the correlation between test-retest which was evaluated by Pearson correlation coefficient.
In this study, with omitting any of the THI-P items, the acquired score of Cronbach's alpha coefficient as calculated by the total score of Cronbach's alpha coefficient was very close (r = 0.943). In conclusion, this study demonstrated that the Persian version of THI (THI-P) is a valid and reproducible tool to assess the psychological complaints of tinnitus sufferers. We find that THI-P in structural and practical point of view is compatible with the original English version of THI.
In this era, the determination of both objective and subjective effects of clinical intervention is critical, because clinicians using outcome measures could make decision about patient's status and the effective treatment. Vertigo, imbalance and nystagmus frequently occur in Multiple Sclerosis (MS) cases due to an involvement of regions of the brainstem, spinal cord and optic nerves.
Vestibular Rehabilitation (VR) exercises have been proposed as treatment for balance disorders.
Participants with complaints of vertigo were selected, regardless the type of vertigo, period of treatment or diagnosis date. Patients were interviewed for their medical history and examined by an ENT specialist to rule out other vestibular conditions that might be interfering with the exam.
Patients undertook a special diet, starting 72 hours before the otoneurological exams (abstaining from the intake of coffee, any kind of soda or caffeinated tea, chocolate, smoke, or alcohol). We performed ENG with a three-channel equipment (Berger Eletromedicina, model VN316, made in Sao Paulo, Sao Paulo, Brazil).
We performed tests with a rotating chair (Ferrante, model COD 14200, made in Sao Paulo, Sao Paulo, Brazil), a visual stimulator (Neurograff Eletromedicina, model EV VEC, Sao Paulo, Sao Paulo, Brazil), and an air caloric stimulator (Neurograff Eletromedicina, model NGR 05, Sao Paulo, Sao Paulo, Brazil). Calibration of the ocular and saccadic movements is based on the capture of electric potential variations between the cornea and the retina.
The normal velocity range for spontaneous nystagmus is less than 7 degrees per second with closed eyes. For the oscillatory tracking test, we requested patients to visually track oscillatory targets in the visual stimulator, and we registered the ocular movements. In the optokinetic nystagmus search, we requested that patients track multiple targets (three horizontal streams of lighted dots) moving forward and backward.
In the rotation test, the patient's head was tilted 30 degrees laterally to stimulate lateral semicircular ducts (right anterior and left posterior), where the variations of angular acceleration are sensed. The caloric test requires a tilting of the head and body to 60 degrees backward position (Brunning's position I) for proper stimulation of the lateral semicircular canals5. We compared the results with normal standards which were obtained from Brazilian population epidemiological studies6-8. This questionnaire was designed by Jacobson et al.9 and aims to assess the perception of the disabling effects caused by dizziness. The questionnaire was applied by a licensed audiologist before and after completion of the VR exercises. The objective of VR exercises was the improvement of static and dynamic balance function and spatial coordination. Patients were informed that they would be working within a level of minimal discomfort, and that the exercises could trigger the symptoms which would activate the natural mechanisms of compensation. CASE 1 - Female, 35, six years of disease, started experiencing symptoms of frequent dizziness three years ago, of moderate intensity, associated with headaches, falls, deviation of gait to the right, and sensations of fainting. CASE 3 - Female, 43, five years of disease, started experiencing symptoms of dizziness three years ago, deviation of gait to the left, tinnitus, paraesthesia in the extremities, sensation of objects moving around and lack of movement coordination. CASE 4 - Female, 38, two years of disease, started experiencing symptoms of dizziness one year ago, sensations of instability, loss of muscular strength in superior and inferior members, imbalance on walking, falls and lack of movement coordination. The VR exercises accelerate the physiological process of compensation by means of habituation, generating a conditioned compensatory response of the reticular neurons. Comparison between pre- and post VR therapy DHI scores showed improvement in the physical, functional and emotional scales. The improvement of the clinical condition after VR is determined by neural adaptations, sensory substitutions, functional recovery of the vestibulo-ocular (RVO) and vestibulo-spinal (RVE) reflexes, improvements in general physical conditioning, changes in lifestyle and by the positive psychological effect that they exert on the patient with the restoration of physical and psychological security16.
For Craig et al.17 the treatment's decision should be based on some points such as lifestyle, physical, functional and emotional aspects, always with the goal of reducing disability and limitations. The present study demonstrated the effectiveness of VR in the treatment of labyrinth dysfunction, decreasing the intensity, frequency and duration of symptoms, improving physical and emotional health of patients and improving the quality of life. In the United States alone, the American Tinnitus Association estimates that around 40 million Americans experience tinnitus regularly, 10 million seek medical attention for it, and close to two million find their tinnitus to be debilitating1. There have been a few studies on the efficacy of medications in the treatment of tinnitus, but none on the local prevalence and incidence of tinnitus. One is the Tinnitus Reaction Questionnaire which aims to describe the psychological distress associated with tinnitus7. It is widely used in clinical practice abroad and would serve as an effective tool to use in the local setting16.
The total score could range from zero, indicating no tinnitus handicap, to 100 indicating the worst annoyance from tinnitus possible.
If the tinnitus was equally loud in both sides, the ear with the better hearing was the test ear. The three translations were then combined and the final version was back-translated into English by an English speaker who was unfamiliar with the THI-US. The THI-PH's Cronbach's alpha for the total scale is only slightly lower than the original version. In the majority of cases (77 per cent) the audiograms revealed bilateral sloping high-frequency hearing losses. In 52 per cent of the cases (39 patients), tinnitus was reported as a secondary symptom, while the remaining 48 per cent (36 patients) cited tinnitus as a chief complaint. A majority of the cases were moderate (31 per cent), followed by mild (24 per cent), slight and severe (16 per cent each), and catastrophic (13 per cent). In the catastrophic level, a majority of the patients reported their tinnitus to be similar to a whistling sound. Almost all loudness matches across all handicap grades were at 0-10 decibels sensation level (SL) except for the severe grade where the loudness was most commonly matched at 11-20 dB SL (Figure 2).


They postulated that this could be due to a number of factors including handedness and asymmetrical noise exposure.
Philippine National Ear Institute, National Institutes of Health - University of the Philippines - Manila - AC - Philippines.
Department of Otorhinolaryngology, College of Medicine and Philippine General Hospital - University of the Philippines - Manila - Philippines. Persian language version of the "Tinnitus Handicap Inventory": translation, standardization, validity and reliability. This symptom is a debilitating condition that is widespread yet difficult to successfully diagnose and treat. For some patients with tinnitus this sensation does not interfere with their daily activities and for others it is disabling and restricts their work, sleep, and social activities10,11. Numerous studies using various open-ended or self-report structured questionnaires have been conducted.
For this reason we perform according to the International Quality of Life Assessment protocol (IQOLA) approved by WHO in 1991. Craig Newman, author of the original questionnaire of THI, has permitted us to develop and use the Tinnitus Handicap Inventory in Persian Language Version. They were asked, if needed, to mention a list of possible translations for some words, sentences and phrases. On the other hand, the words and items on the level of reading ability of 14 years old or less were noticed for linguistic validation of THI-P. All subjects gave written informed consent in accord with the declaration of Helsinki before examinations. So, in retest after one week from filling the first THI-P, the questionnaire was filled again by the same patients. Descriptive statistics, including frequency distributions, means and standard deviation were computed for each item of THI-P. Multiple linear regression analysis was used to study the effect of gender, hearing loss and the tinnitus laterality on the overall THI score as well as the functional, emotional and catastrophic subscales.
In this study, the research method and the role of subjects were explained clearly and completely.
The translation clarity exception in one item (item 17) which was evaluated as relatively desirable, in the other 24 items (96%) of THI-P was evaluated as desirable.
Most of tinnitus subjects (72.7%) perceived one type of tinnitus sound, while others complained of sensation of more than one type of sound on different occasions. Scatter plots illustration the relationship between the THI-P score and the age in all subscales. As shown in Figure 2, the scatter plot indicates the correlation between the first (test) and second (retest) administration of the THI-P and their subscales on tinnitus subjects. Scatter plots illustration the correlation between the first (test) and second (retest) administration of the THI-P and their subscales. Researches in many different countries around the world in this area indicate the global emphasis on the importance of these assessments. This symptom is as a common problem which can affect several aspects of patients' life including: going to sleep, understanding speech, depression, irritation, concentration and worse on awakening.
To acquire this expressed goal, it was necessary to translate and standardize the original version of THI and then to evaluate the test-retest reliability of the THI-P.
The measure of difficulty of Persian translation of THI was evaluated by translator 1 and 2 using a visual analogue scale from easy up to difficult (VAS; 100 mm total length). The measure of this criterion administers three measures including clarity scores, common language and identifies conceptual equivalence.
Both convergent and discriminate validity methods were used for identifying validity of original English version of THI19. In current research the reliability of THI-P was evaluated from two 102 International Tinnitus Journal, Vol. We obtained 0.96 in Persian THI version, consistent with significant correlation in retest. The findings showed that none of the items of the Persian version of the questionnaire need to be removed. Also, THI-P could be administered as a standard measuring instrument for patients and clinicians all over Iran. Henceforth, THI-P could be used for both clinical and research purposes by different professionals like audiologists, otolaryngologists, psychiatrists and could be also used for monitoring, treatment and rehabilitative effects on the life's quality of tinnitus sufferers.
ENT and Head & Neck Research Center, Hazrat Rasoul Akram Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran. Department of Audiology, School of Rehabilitation Sciences, Tehran University of Medical Sciences (TUMS). Department of Biometry, School of Rehabilitation Sciences, Tehran University of Medical Sciences (TUMS).
Objective: To evaluate the effectiveness of the Cawthorne and Cooksey protocol of vestibular rehabilitation (VR) exercises in reducing the physical, functional and emotional impact of multiple sclerosis among individuals who complained of vertigo.
Hearing and balance disorders can be early signs of MS due to a close relationship between preferred MS sites and structures that contribute to the maintenance of corporal balance1.
They are based on the mechanisms of neuroplasticity known as adaptation, habituation and substitution and they are used to obtain vestibular compensation2. After a neurological exam, the exclusion criterions were patients with psychological or oculomotor paresis (or both), internuclear ophthalmoparesis or other severe visual disturbances. They underwent a vestibular examination (labyrinthine function, ocular tests and electronystagmography) performed by a licensed audiologist. Analgesics, tranquilizers, and antihistaminic and antivertigo medications were suppressed during this period to minimize possible interferences with the test results. The first part of our patient's evaluation was simply clinical and was based on a systematic search for spontaneous, gaze, and positional nystagmus. First of all the periorbital region is cleaned with alcohol and after that the electrodes are placed, using electrolytic paste, at the lateral angle of each eye and also in the midpoint of the frontal line. We requested patients to keep the head still while visually tracking a light target moving firstly in horizontal direction and then in vertical direction.
After that, the patient's head was positioned 60 degrees backward and 45 degrees to the right and left sides stimulating the vertical semicircular canals. Table 1 shows the criteria used to analyze each test as well as to distinguish central from peripheral vestibulopathy. We used the Brazilian version which was translated, validated and culturally adapted to the Brazilian population by Castro10. The Protocol of Cawthorne and Cooksey12,13 was selected for its easy administration and because it allowed group sessions.
The diagnosis of peripheral vestibulopathy is achieved not only by the comparison with normal standards but also by the absence of pathognomonic signs of central vestibular alterations.
Such manifestations are determined by the demyelination plates in the area of the vestibular nuclei in the floor of the IV ventricle14. These maintain the activation of the cerebral cortex at a homeostatic level by a process similar to the conditioning. Frohman et al.18 demonstrated that benign paroxysmal positional vertigo was the most common cause of vertigo in patients with MS in four years of study. An increase in motivation, integration and socialization of the patients was observed as a result of the practice of the exercises in group, revealing that this therapeutic approach can also have implications outside of the hospital. The Catastrophic subscale showed poorer internal consistency reliability (Cronbach's alpha = 0.63) due to the shorter number of items in that scale.
Out of the 1,756 reviewed patient records, they discovered that tinnitus was the third most common pretest diagnosis, comprising 9.3 per cent2.
Another is the Tinnitus Problem Questionnaire for determining the different health, hearing, sleep, psychological, and situational difficulties associated with tinnitus13. A valid and reliable Filipino translation of the THI will help assess the effects of tinnitus on non-English speaking Filipinos and those with poor English skills. A pair of tones was presented and the subject was asked to identify which tone best matches the pitch of their tinnitus.
After comparing the THI-US and the back translation for coherence and making the appropriate revisions, the THI-PH and a tinnitus information sheet (Appendix B) were given to patients.
The reliability coefficients of the THI-PH subscales are also comparable to the original THI-US. In males, a majority of the cases were concentrated in the Moderate and Severe grades while in females most of the cases were either Moderate or Mild (Table 1). This problem could be resolved by adding items to the catastrophic subscale to increase the alpha.
Tyler (2000) stated that the relationship between these factors and the left-sidedness of the tinnitus was eventually proven to be insignificant.
As stated by Monzani, et al., this adds to the general, cross-cultural validity of the tool as a measure of perceived tinnitus handicap17. Tinnitus Reaction Questionnaire: Psychometric properties of a measure of distress associated with tinnitus. Tinnitus Annoyance and Difficulty in Activities of Daily Life Evaluated by the Tinnitus Handicap Inventory.
Brazilian Portuguese Language Version of the Tinnitus Handicap Inventory: Validity and Reproducibility.
Validity of the Italian Adaptation of the Tinnitus Handicap Inventory; focus on quality of life and psychological distress in tinnitus patients. Prevalence of the commoner ear, nose, and throat conditions in the adult rural population of Great Britain. Objectives: The aim of current study was to compose and validate a Persian version of the Tinnitus Handicap Inventory (THI-P). The prevalence of chronic tinnitus in the general population is estimated between 5-15% and causes to develop serious psychosocial complications in 1% to 3%1. It is reported that tinnitus can be severe enough to cause significant discomfort in one's daily life12. Finding the effects of tinnitus on the quality of life and assessing the individual's reaction to tinnitus are very important.
The aim of IQOLA is to translate and provide health questionnaires with high validity and reliability for using in different countries by their formal language26.
This version is both simple to administer and interpret and also a powerful psychometric tool. After that, each of the expert translators were asked about the difficulties of the translations and they were attributed a score according to the 100 point visual analogue scale (VAS). Afterward, the pooled back translation was compared and formed by translators and then an agreement was obtained for one English version of THI questionnaire for finding the coherency with original version. Therefore the formulated initial Persian version of the instrument was attended by 24 (10 female and 14 male) high school students in Tehran. The Cronbach's Coefficient Alpha test (where values>0.70 indicate a satisfactory internal consistency) was used to test for the evaluating internal stability of the THI-P29, and Pearson correlation coefficient was calculated between the total score of the THI-P and the scores of its subscales, age and pure tone average (PTA). The common language score of THI-P was assessed as desirable in all 25 items (100%) and also the conceptual equivalence for three items (4, 10, 16) undesirable response (12%), for two items (23 and 14) in a relatively desirable level (8%), and the other items were desirable response (80%).
The type of sound reported by most tinnitus subjects was subjectively described as high-pitch tone, matched by external stimuli (described by 52.3% of subjects). Table 2 summarized the mean air conduction thresholds across frequencies of 500-4000 Hz for left and right ears. As shown in Figure 1, the total score of THI-P and its subscales were not correlated with the age of tinnitus subjects. Total score of the THI-P and its associated subscales are very close to corresponding values in the original THI-US (Table 6). In Iran, in order to converge and coordinate with the ongoing research at the international level concerning the evaluation of consequences of diseases, impairments, handicaps, treatments and rehabilitation, we should create a new movement.
Sense of the various problems among the subject sufferer from tinnitus and understanding the impact of tinnitus on their quality of life are of the uttermost importance. Translation of the original questionnaire of THI in Persian language in overall was easy due to its simple sentences, whereas, the translators in six items acknowledged difficult translation (items of 4, 5, 13, 23, 24 and 25).
The translation clarity in 24 items of THI-P was evaluated desirable and only one item (item 17) evaluated as relatively desirable. Majority of epidemiological tinnitus studies have reported a positive relationship between tinnitus and hearing loss4,34-35. This valid tool allows us to quantify how much tinnitus impacts the life's quality of these individuals. Functional brain abnormalities localized in 55 chronic tinnitus patients: fusion of SPECT coincidence imaging and MRI. Prevalence of tinnitus and hearing thresholds of a non-noise-exposed population with and without tinnitus. Assessment of psychopathological aspects and psychiatric comorbidities in patients affected by tinnitus. Psychologic profile of tinnitus patients using the SCL-90-R and tinnitus handicap inventory. Psychological profile and somatic complaints between help-seeking and non-help-seeking tinnitus subjects. Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus. Developmental and Psychometric Adequacy of the Screening Version of the Tinnitus Handicap Inventory. Psychometric Adequacy of the Tinnitus Handicap Inventory (THI) for Evaluating Treatment Outcome.
Tinnitus with normal hearing sensitivity: extended high-frequency audiometry and auditory nerve brain-stem-evoked responses. Validity of the Italian adaptation of the Tinnitus Handicap Inventory; focus on quality of life and psychological distress in tinnitus-sufferers. Brazilian Portuguese Language version of the "Tinnitus Handicap Inventory": Validity and Reproducibility. Impact of tinnitus as measured by the Tinnitus Handicap Inventory among tinnitus sufferers in Singapore.


Methods: Four patients with remittent-recurrent multiple sclerosis underwent an interview, otorhinolaryngological and vestibular evaluation, VR exercises and the Dizziness Handicap Inventory pre- and post-intervention. We identified 12 patients with the diagnosis of remittent-recurrent multiple sclerosis (RRMS) according to McDonald's3 criteria, who were interested in participating in the study. The second part was based on interpretation of the ENG test (register the corneoretinal potentials variations using sensitive electrodes) results. The electrodes are placed on these locations in order to design a triangle that enables the registration of not only horizontal but also vertical and oblique ocular movements. The equipment is adjusted so that the eye's movement performs an angle of 10 degrees (standard calibration). Occurrence, direction, inhibiting effect of ocular fixation (IEOF), and maximum slow-component velocity of nystagmus were registered. The test is used to evaluate the integrity of the oculomotor system in controlling the slow movements of the eyes.
Occurrence, directional preponderance, and measurements of the maximum slow component angular velocity (MSCAV) of nystagmus were evaluated.
Records were registered with open and closed eyes to detect IEOF, direction, MSC absolute values, and correlation between directional preponderance and postcaloric nystagmus direction. For the translation and cultural adaptation of DHI the internationally accepted steps proposed by Guillemin et al.11 and used in Europe and America were followed. The instrument has 25 questions divided in 3 scales: emotional (9 questions), functional (9 questions) and physical (7 questions). Exercises were administered during a 3-month interval, in 2 30-minute supervised sessions per week.
Due to the diffuse nature of the disease, there is an extensive variety of clinical manifestations which are established during recurring sharp or semi-sharp episodes with varying remission14.
Cawthorne and Cooksey 12,13 exercises were used by Pavan et al.15 in cases of vestibular disorders and it was documented that the compensation process can be accelerated. The authors reported that the use of steroids and labyrinthine suppressants should be administered after careful labyrinth examination. Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the Diagnosis of Multiple Sclerosis Ann Neurol.
Normal limits of parameters for evaluation with digital vectoelectronystagmography neurograff [in Portuguese]. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. A randomized controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment.
Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques. Tyler and Baker (1983) found that tinnitus is associated with numerous complaints including irritability, depression, inability to relax and sleep, and concentration problems4.
As of 2010, the Philippine Overseas Employment Administration estimated the number of Filipinos working abroad to be around 9.5-12 million as of 201022. It is composed of three subscales, namely, the functional subscale with 12 items to address role and physical functioning, the emotional subscale with eight items to address psychological distress, and the catastrophic response subscale with five items to address desperation and loss of control9. The patients were asked for feedback on the questionnaire and the appropriate revisions were then made. Those who refused to participate or opted to discontinue their participation were excluded from the study. He suggested that more detailed research studies be done to investigate the concept of left versus right ear differences30. Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999, Clin Otolaryngol.
Materials and Methods: The linguistic validation of the original version of THI into Persian version (THI-P) included translation, back translation and data gathering. Epidemiological studies indicated that in developed countries such as Germany about 1.5 million people, in the United States about 10 million out of 40 million tinnitus sufferers and a similar ratio in the United Kingdom have been reported that were seriously affected by tinnitus2-4.
Tinnitus symptoms have been linked to various psychological and psychosomatic disorders13-15. One of the most important methods in the assessment of the severity of tinnitus and its effects on the lifestyle of a patient is the use of psychometrical evaluations. Finally, we formulated the initial Persian version of the instrument with proper and satisfactory translation.
The final version of THI-P was administered in all tinnitus subjects who were managed in our center between September 2009 and May 2010. The score of "Yes", "No" and "Occasionally" were 4, 0 and 2, respectively in three subscales: emotional, functional and catastrophic. All personal information in the questionnaire were confidential and only used in this research.
The other descriptions of tinnitus included cricket, sizzling, hissing, humming and other sounds. Tinnitus is a subjective idiopathic symptom in which it is not detected by blood examination and CT scan or like this.
In this regard, translator 1 and 2 were asked to provide a list of possible alternative translations for the replacement in relatively difficult and difficult items of THI-P.
The prevalence of tinnitus among normal hearing subjects has been reported between 7%-10%36-37. Results: There was significant improvement in the physical, functional and emotional aspects of the DHI after the completion of the VR. However, there is a lack of studies analyzing the VR exercises results on patients with remittent-recurrent MS (RRMS). The ENG test consists of: calibration of the ocular movements, detection of spontaneous and gaze nystagmus, the oscillatory tracking test, optokinetic nystagmus search, rotatory and caloric tests.
As these movements are registered, we adjust the gain of the graphic needle to 10-mm of amplitude (first channel) and to 5-mm of amplitude (second and third channels). To calculate the directional preponderance we used the Jongkees formula4 that is detailed below. We observed the presence, directional preponderance, and frequency of the ocular movements, using the same formula for optokinetic nystagmus search. Normal absolute values are within 2 degrees and 19 degrees per second, whereas normal relative values are lower than 33% for labyrinth preponderance and less than 22% for nystagmus directional preponderance.
Participants received printed instructions describing exercises on each phase of the therapy. The case reports are detailed below and are followed by Table 2, which summarizes their pre-and post-intervention DHI scores. Observations on the directional preponderance of caloric nystagmus resulting from cerebral lesions.
A validated THI in Filipino can also be used by these Filipinos abroad who prefer to answer questionnaires in their native language. It is shown that 48% to 60% of patients with chronic or disabling tinnitus have major depressive disorder (MDD)16. Such self-report questionnaires include the Tinnitus Questionnaire (TQ)18, Tinnitus Handicap Inventory (THI)19, Tinnitus Severity Scale (TSS)20, Tinnitus Handicap Questionnaire (THQ)21, Subjective Tinnitus Severity Scale22 and Tinnitus Reaction Questionnaire (TRQ)23. The THI is a 25-item self-report instrument which is divided into three subscales including functional, emotional and catastrophic reactions to tinnitus.
On the basis of these two translations and their VAS scores to each THI items, we formed the pooled version that was then reviewed by presence of translators for considering suggested replacing words and difficulty in translation.
This questionnaire was used as an initial instrument for gathering data from tinnitus subjects at next steps.
Each single item was read loudly and the participants were asked to follow the items on the given sheet. Age, gender, medical history and tinnitus characteristics were recorded as baseline information. In total, more than 92% of tinnitus subjects who attended the current study revealed high pitch tinnitus, matched by external stimuli (>3000 Hz). Independent Student t-tests did not demonstrate statistically difference between total THI-P score and those with or without hearing impairment, neither did those with unilateral or bilateral tinnitus (Table 4). The main problem with tinnitus is its subjective nature so that evaluation of this complaint always depends upon patient's words. These alternative items were reviewed again by translator 3 and 4 in order to optimize quality of translation and finally revised for appropriate items. In conceptual equivalence of the translation, three items had undesirable response (4, 10 and 16) and two items had relatively desirable response. Conclusion: The VR exercises appeared useful in reducing subjective complaints of the study participants.
The objective of our study was to evaluate the effectiveness of VR exercises in reducing the physical, functional and emotional impact of multiple sclerosis.
They were asked to do repetitions at home and record the number of times a day they performed each exercise and whether they experienced any symptoms or difficulties.
Two (3 per cent) showed a unilateral mixed hearing loss and seven patients had bilateral conductive hearing losses. In addition, tinnitus is a common symptom of the auditory system disorders that is usually associated with sensoryneural hearing loss6,7.
Asplund reported that among subjects with tinnitus poor sleep and frequent waking were more common in men and women17. In this regard the client was questioned in order to find out which activity or performance of the patient is affected by tinnitus.
Analysis of the THI items suggested that this self-report instrument had excellent internal consistency reliability and adequate convergent and constructive validity28. It is worth to mention that in this step, for differentiation of the level of difficulty in translation, average scores less than 25 were considered as easy, more than 30 as difficult and between 25 and 30 as relatively easy. Thus, items with undesirable translation were revised by translator 5 and 6 and revised by suggested replacing proper words, sentences and phrases. As reported in several studies for the original version (US), Italian, Turkish, Danish, Portuguese and Singapore translations of THI19,28,38-41, the Persian version of THI was not significantly different in the handicap scores between those with normal hearing and those with hearing impairment with regard to the degree of handicap severity.
Eventually it became clear that internal consistency was high and the response of every item to the response of total items was matched. Study participants were evaluated at the Otoneurology Laboratory of the Universidade Tuiuti do Parana. The functional scale assesses the independence and ability to perform professional activities and everyday life.
All participants complained of chronic unilateral or bilateral subjective idiopathic tinnitus lasting for at least 6 months before consulting about their tinnitus. An epidemiological study in Italy based on a tinnitus questionnaire demonstrated that the prevalence of tinnitus was 8% in normal hearing subjects while this amount rose up to 30.5% in the presence of auditory dysfunctions8. This agreed version of Persian THI translation was given to the two other translators who were expert to Persian philology (translator 3 and 4). Finally, the results of the present investigation suggest that the THI-P was simple and clear, without losing its equivalence towards cultural issues. All values of item-total correlation coefficient are greater than 0.3 which also indicated high internal consistency in THI-P except item 19.
The x is the distance between the targets, y is the distance between the patient and the target and tg is a tangent. A "Yes" answer corresponded to a score of 4; "Sometimes" received a score of 2 and "No" received a score of 0. Results: There was no significant difference between gender, age, hearing impairment and total score and subscales of THI-P.
Therefore, the valid psychometrical evaluations such as THI can be administered as a robust instrument to objectify tinnitus distress, but additional measures might be needed in order to catch the dimensions of tinnitus-related problems.
Inoverall the translation quality of THI-P was evaluated as desirable from both aspects of a careful translation and adapted to the socio-cultural setting.
To evaluate the regularity of the saccadic movements, we used the normal ranges of the following parameters: latency, accuracy, and velocity of movement.
Pearson product-moment correlations revealed adequate test-retest reliability for the THI-P (r = 0.96). Also the valid questionnaires are valuable in the evaluation of results from before to after special treatment and its effect on the individual's quality of life. The extension of disability caused by dizziness in the patient?s daily life will be considered greater if the final score value was near 100. Therefore, the symptom of tinnitus has forced clinicians to attempt to establish protocols for accuracy of tinnitus diagnosis and treatment9. The Tinnitus Handicap Inventory (THI)25 has gained widespread acceptance as a self-report measure of tinnitus around the world. Therefore, these translators (3 and 4) for each question determined 3 scores on the basis of 100 point criteria. Therefore, the Persian translation of THI was not affected by hearing impairment, gender and age factors. A score of 100 points indicates the maximum damage caused by dizziness; on the other hand, a score of 0 points indicates no injury caused by dizziness in the patient's life. In this VAS, zero point means absolutely improper quality and 100 means absolutely proper and satisfactory quality.
After that, the subsequent processing was attended by audiologists from department and research center of otolaryngology of Tehran University of Medical Sciences (TUMS).
Criteria for decision making in improper quality of each translation items was the average score less than 90 (determined by translators 3 and 4). Accordingly, in this step, Persian version of the THI was obtained, which regarding to all translators 1 to 4, had satisfactory quality.



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09.04.2014 admin



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