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Author: admin, 10.06.2014. Category: Severe Tinnitus Symptoms

INTRODUCTION: Comorbidity of chronic tinnitus and mental disorders may result in more disability.
OBJECTIVES: This research provides an evaluation about the effects of medically treated comorbid mental disorder on chronic tinnitus. MATERIALS AND METHODS: Fifty-five patients diagnosed with chronic tinnitus and mental disorders were randomly requited by producing a before-after design. RESULTS: Three months medical treatment puts forward the argument that among mental disorders, anxiety and major depressive disorder demonstrate a significant reduction. CONCLUSION: Findings lay emphasis on tinnitus severity reduction and connection might be established between alleviated mental disorders comorbidity and the improvement of quality of life. The word tinnitus originates from the Latin word "tinnier" which means tinkling or ringing1. The aim of this study is to determine the impact of treatment of Comorbid mental disorders accompanied chronic tinnitus on the outcomes of the tinnitus symptom. This study was conducted by creating a before-after design in two discrete phases during August 2009 and 2010. The Structured Clinical Interview for DSM-III-R, axis I psychiatric disorders (SCID).The Structured Interview for DSM-III-R (SCID-I) was applied as a diagnostic instrument for DSM-III-R axis I psychiatric disorders to identify mental disorders.
The P-THI measures the impact of measures and tinnitus on daily life, which had been developed by Newman et al. The SCL-90-R is a 90-item self-report system inventory developed by Derogatis in the 1980s26.
Pitch and Loudness Match tinnitus (PMT and LMT) was evaluated in tinnitus subjects using an external tone presented to the contra lateral ear. This study has been approved by the Ethical Committee of ENT and Head & Neck Research Center, Iran University of Medical Sciences (IUMS) code number of MT-4250.
The prevalence of mental disorders yielded from SCID among the study subjects is shown in Table 3.
The consequences of comparing the mean scores of severity of tinnitus (LMT) and the disability (THI),which were brought about before and after pharmacotherapyof mental disorders, revealed significant reduction (Table 5). By employing Pearson correlation coefficient analysis provided information made it manifest that disability resulted from tinnitus (THI) has the positive and significant correlation solely and merely with depression diagnosis variable. This study shows that three months of medical treatment for comorbid mental disorders with chronic tinnitus reduces the intensity and disabilities of tinnitus. While yet, theory that maintains the concept in which chronic tinnitus is considered to be a type of chronic stress having the potential to develop essential changes via neuronal network, was underpinned by other evidences. Regardless of the mechanism of psychotropic agents on buzz sound of tinnitus, the study results confirmed that these agents could be effective on the intensity of tinnitus, reducing the resulted disabilities and improving the quality of life. This study was registered and supported by the ENT and Head & Neck Research Center, Iran University of Medical Sciences (IUMS) with collaboration of Tehran Psychiatric Institute, Mental Health Research Centre. Paper submitted to the ITJ-SGP (Publishing Management System) on July 31, 2013; and accepted on August 31, 2013. This study evaluated the interference of tinnitus on the quality of life for noiseexposed workers enrolled in a hearing conservation program.
Most tinnitus research has focused on effective treatments and the mechanisms of the cause, detection, and perception of tinnitus. In addition to its medical and audiological aspects, the psychosocial consequences of tinnitus can be of significance and have also been investigated. Tinnitus is a common complaint among noise-exposed workers, and in some countries it is even recognized as a work-related condition for compensation purposes. The objective of our study is to evaluate the impact of tinnitus on the quality of life of workers who are exposed to noise and enrolled in a corporate hearing conservation program. We enrolled participants from a meat-packing facility in the state of Rio Grande do Sul, Brazil. We administered a questionnaire to all the employees of the company (N = 372) at the beginning of the training sessions of their hearing conservation program. To assess the workers' hearing status, we performed otoscopy and pure-tone audiometry, according to the requirements of the Brazilian legislation [10].
We administered to the 52 participants the Brazilian version of the Tinnitus Handicap Inventory (THI) questionnaire, elaborated by Newman et al. We calculated Pearson coefficients of linear correlation and tested their significances via the Student's t -test and Fisher's exact test, using a significance level of 5%.
Eighty-two workers (22%) of the total population of 372 workers in the studied company reported tinnitus in the first interview of this study. Company records also indicated that 15% of the participants who were exposed to noise were also exposed to other hazards. The results of the relationship between tinnitus and the three THI scales are presented in Figure 2. Table 2 displays the correlations between the functional, emotional, and catastrophic scales and medical history. Table 3 presents the correlations of the THI results with the health problems described by the participants (n = 52).
We separated the participants into two groups: The first was composed of 37 participants with normal hearing (71%), and the second included 6 participants (12%) with a bilateral high-frequency notch. Twenty-two percent of the noise-exposed participants complained of tinnitus, a finding comparable to rates of 25% reported by Sahley and Nodar [14] and 15.5% reported by Zimmermann [15]. Seventy-one percent of the participants with tinnitus complaints presented normal audiometric results, which suggests that tinnitus can be an early indicator of auditory risk from exposure to noise.
The application of the Brazilian version of the THI was both easy and expedient, as indicated by Newman et al. In Table 2, we found significant results involving the functional scale results with the use of prescription drugs and the catastrophic scale results with consumption of coffee. Concerning the degree of severity of tinnitus, 44% presented degree 1 or "slight" tinnitus according to the classification by McCombe et al. We observed a significant correlation between tinnitus severity and exposure to noise and chemical pollutants, predominantly CO. We observed a significant correlation between the duration of noise exposure and the emotional scale for the participants with high-frequency notches, suggesting an extra-auditory effect of noise.
The results of this study demonstrated that the prevalence of tinnitus was high (22%) in this population, despite the fact that study participants were young individuals who had a short duration of noise exposure. The Brazilian version of the THI proved to be an easy instrument to use for evaluating the impact of tinnitus on the quality of life of noise-exposed workers. A retrospective study at the ear, nose, and throat department of the EuromedClinic showed considerable improvements immediately after the end of the treatments for acute and for chronic tinnitus.
The subject of this retrospective study is the results of the treatment of acute and chronic tinnitus with conventional infusion therapy or hyperbaric oxygen (HBO) therapy (or both). One hundred patients with tinnitus (71 male, 29 female) were evaluated in this study, 65 suffering from acute tinnitus and 35 suffering from chronic tinnitus. After analysis of the data, the grade of success was divided into four categories: no tinnitus, reduced, unchanged, and increased.
The age distribution in this random sample of patients suffering from tinnitus shows a peak in the group from 41 to 50 years.
Only 55 patients could be checked for long-termresults: 42 of the acute tinnitus group and 13 of the chronic tinnitus group (Table 3).
An important consideration is that the therapeutic effect of the HBO therapy is proved through clinical and experimental studies [5-7]. The treatment of chronic tinnitus is, in general, less sufficient than treatment of acute tinnitus.
Shulman [4] also described the use of neuroprotective substances for the improvement of inner ear function, even in patients suffering from tinnitus. In our ear, nose, and throat department (one of three study centers in Germany) a caroverin double-blind test has just started. How to cite this article Valente JPP, Pinheiro LAM, Carvalho GM, Guimaraes AC, Mezzalira R, Stoler G, Paschoal JR, et al. OBJECTIVES: To evaluate the correlation between the degree of discomfort caused by tinnitus and the hearing loss level.
RESULTS: 107 patients were studied and there was no correlation between the degree of annoyance of tinnitus with hearing loss, age, gender, presence of dizziness, of neck pain, headache, changes of the temporomandibular joint, the use of caffeine or excessive intake of carbohydrates. CONCLUSION: Dizziness, neck pain, headache and caffeine abuse are prevalent complaints in patients with tinnitus. In the literature, some factors possibly related to the nuisance caused by tinnitus have been tested, such as age, gender, presence of vestibular symptoms and hearing loss15,16,17,18. Therefore, the main objective of our study was to evaluate the correlation of the degree of discomfort caused by tinnitus with hearing loss. We conducted a clinical epidemiological study with a retrospective analysis of medical records of patients seen at the Otolaryngology Service of the State University from Campinas, in the period from February 2009 to April 2010. The study included patients over 18 years who had unilateral or bilateral tinnitus with normal hearing or sensorineural hearing loss. Patients with pulsatile tinnitus or infectious disease of the external and middle ear were excluded.
To measure the degree of discomfort caused by tinnitus, the patients were evaluated by visual-analogue scale (VAS), graduated from zero to ten. For associated clinical symptoms, there was a high prevalence of patients with dizziness, neck pain and headache.
The correlation between the degrees of discomfort related to the tinnitus and the three groups separately showed that 48% of the patients in group I (normal hearing) rated their tinnitus as severe. Most studies in the literature show that the prevalence of patients with tinnitus and normal hearing is around 8% to 10%28. We know there is a close relationship between tinnitus and audiometric conditions and also in situations of normal hearing22. In the literature, most studies suggest that hearing loss, regardless of its degree, is related to greater inconvenience caused by tinnitus8,29,36,37. Specifically evaluating patients in group I, a high prevalence of psychoaffective disturbs such as depression and anxiety disorder was found.
In this study we found no difference within the group of patients with hearing loss (groups II and III), consistent with several other studies which have been published39,40,41. Concerning the related clinical symptoms, a high prevalence of patients with dizziness, neck pain, headache and abuse of caffeine was found, which could be acting as triggering factors or worsening of tinnitus. In this study it was concluded that the degree of annoyance of tinnitus, using the visual analogue scale, was higher in patients without hearing loss and in females, but there was no statistical significance. Disciplina de Otorrinolaringologia, Cabeca e Pescoco - Universidade Estadual de Campinas (UNICAMP) - Campinas - SP - Brasil. Disciplina de Otorrinolaringologia, Cabeca e Pescoco - UNICAMP Faculdade de Ciencias Medicas, PO Box: 6111.
Paper submitted to the RBCMS-SGP (Publishing Management System) on October 12, 2011; and accepted on August 16, 2012. Introduction: The correlation between hearing loss with tinnitus can be justified if we consider that this is a tinnitus-causing factor, since the impairments or degenerations on the inner ear and the vestibulocochlear nerve can cause the tinnitus. INTRODUCTIONHearing loss is a factor apart from the attack degree affecting the people's quality of life, and when it is acquired in adults, it gradually appears and it makes oral language difficult (1). They underwent three months of drug therapy for comorbid mental disorders by psychiatrists.
Pearson Correlation coefficient ostensibly reveals that there is no significant relationship between mental disorders and tinnitus severity. This study was performed in the ENT and Head & Neck Research Center, Hazrate Rasoul Medical Complex, Iran University of Medical Sciences, Tehran, Iran. In the first phase in order to investigate the prevalence of mental disorder in tinnitus, amongst 2350 patients suffering from tinnitus registered at the ENT and Head & Neck Research Center of Hazrate Rasule General Hospital, 400 patients over 18 years old, were clinically interviewed by well-trained psychiatrists22. The global severity index (GSI), is one of the three global indexes which measures the extent or depth of the individual's psychiatric disturbances. This task was accomplished using a Tinnitus Evaluation Device (TinnED®) which includes 6 channels to reconstruct the Most Troublesome Tinnitus (MTT) with a similar frequency and intensity. The results of comparing the mean scores of the psychological indexes yielded before and after treatment; show that the pharmacotherapy has been significantly successful in reducing the severity of the psychological symptoms. The results revealed that medical treatment of comorbid mental disorders was successful in improving the subscales of sleep, emotional distress, cognitive distress, intrusiveness and auditory perceptual difficulties (Table 4). Is this due to the direct effect of psychotropic drugs on tinnitus or the result of reduction in the disabilities and the subjective perception of tinnitus? Shulman's study has shown that treatment with GABAergic and benzodiazepine medication results in local blood flow increase in SPECT series which is accompanied by a decrease in the intensity of tinnitus19. Prescribing antiepileptic drugs might reduce the intensity of tinnitus32.Tinnitus can be directly affected by antidepressants and mood stabilizers33. Therefore, diagnosing comorbid mental disorders and managing them correctly can alleviate the subjective perception of annoying and continuous sound in the ear and have positive effects on the outcome of chronic tinnitus and improve the quality of life. In a study performed by Zoger, the results demonstrated that depression and anxiety were not directly correlated with the intensity of tinnitus, but it was efficacious in diminishing the features of tinnitus disabilities43.
Department of Psychiatry and Tehran Psychiatric Institute, Mental Health Research Centre - Iran University of Medical Sciences (IUMS), Tehran, Iran. Laboratory for Auditory Neuroscience, ENT and Head & Neck Research Center and Otorhinolaryngology Department - Iran University of Medical Sciences (IUMS), Tehran, Iran; and Hanover Medical University (MHH), Hanover, Germany. ENT and Head & Neck Research Center - Iran University of Medical Sciences (IUMS), Tehran, Iran. Department of Community Medicine, School of Medicine - Iran University of Medical Sciences (IUMS), Tehran, Iran - Tehran - Germany. Noise measurements, a questionnaire, a Brazilian version of the Tinnitus Handicap Inventory (THI), and pure-tone audiometry were conducted with 52 participants (mean age, 29 years) who suffered from tinnitus.


Among the risk factors for tinnitus, the most prominent are age, gender, various diseases (otological, metabolic, neurological, and vascular alterations and dental factors), hearing loss, and exposure to noise, ototoxic drugs, caffeine, nicotine, and alcohol [1-4]. Tinnitus can alter an individual's ability to function in professional, social, and leisure activities and in family relationships, hence affecting the quality of life [5,6]. In addition to being beneficial for clinical applications, the tinnitus questionnaires are valuable for understanding the relationship between personality and the psychopathology of tinnitus, its impact on the daily life of persons who suffer from tinnitus, the difficulties and the perception of social support in relation to the problem, and the incapacities and the difficulties produced by tinnitus that can seriously affect quality of life [7-9].
Occupational hearing loss prevention initiatives rarely focus on the prevention and management of tinnitus.
The company employs 372 workers (120 female, 252 male) working in two fixed 8-hour and 48-minute shifts.
The questionnaire gathered information on demographics and occupational and medical histories for each worker. We also used Spearman's rank correlations to examine the results of exposure information versus the outcome. Because of attrition, we were able to study only 52 workers (14% of total population of the plant).
Of those, 62% were exposed to carbon monoxide (CO), 13% to CO and vibration, 12% to hydrochloric acid, and 13% to sodium hydroxide. We observed that of the 52 participants, 71% had normal audiometric results, whereas 12% presented a bilateral high-frequency notch and 17% presented audiometric configurations of hearing loss due to causes other than noise, such as unilateral losses and flat audiometric configuration. Median of hearing thresholds for the groups with normal hearing (all thresholds 25 dB hearing level [HL]), hearing loss configurations suggestive of noise-induced hearing loss (NIHL), and hearing loss from various causes. The distribution of poorest scores across scales of the Tinnitus Handicap Inventory, in percent (n = 52). We observed a significant correlation between headaches (p = .0458) and the duration of tinnitus.
We did not include the remaining 9 individuals (17%), who displayed other audiometric configurations of hearing loss in the statistical analysis. The prevalence of tinnitus complaints in male subjects was 16% and in female subjects was 9%, similar to what has been reported [16-18]. Schleuning [2] explained that caffeine and nicotine could aggravate tinnitus because they are stimulants and can induce the constriction of blood vessels.
The participants of the study who had such combined exposure had a higher degree of tinnitus severity.
Moreover, a negative impact of tinnitus on the subjects' quality of life could de detected. The 22% tinnitus rate among workers, most of whom nonetheless had normal hearing, suggests a need to address tinnitus in occupational hearing loss prevention initiatives.
Rick Davis and Robert Randolph (National Institute for Occupational Safety and Health, USA) and Alberto Behar (University of Toronto, Canada) provided helpful critiques of the manuscript.
Eighty percent of our patients suffering from acute tinnitus showed an improvement with intravenous medication without hyperbaric oxygen treatment, and 65.7% showed improvement with infusion therapy and hyperbaric oxygen. It includes in the head and the ear all types of noise sensations that are not generated by sound waves coming from outside [1]. Simultaneously, HBO treatment was offered daily (5- 15 times) to 55 patients without inflammatory or cardiac contraindications to this therapy (up to 2.5 AT A up to 3 periods of 30 min breathing of pure oxygen with 2 pauses of 10 min air-breathing). The annoyance of the tinnitus is rated on a subjective scale from 0 (no tinnitus) to 10 (unbearable) by the patients. The data before starting therapy were compared with the data recorded immediately after treatment and again at least 3 months later (long-term-results). The positive treatment effect (improved or stable condition) decreased from 80% (24 cases) to 67% in patients with acute tinnitus (12 patients) and therapy with infusions only and from 65.7% (23 patients) to 46% (11 cases) in patients with combined therapy (infusion and HBO).
The effect of the HBO therapy on tinnitus was investigated in studies with a total of 1,223 patients.
This test is being undertaken to prove the possible positive effect of the glutamate antagonist caroverin (cochlea-synaptic effect) [9]. The limitations caused by tinnitus are related to psychological factors, mood changes and psychiatric conditions, while other factors related to discomfort caused by tinnitus are being studied. Materials and Methods: A retrospective study of the patients treated at the Otolaryngology Service of the State University from Campinas for 15 months, using the Visual-Analogue Scale to classify the degree of discomfort by tinnitus. Some patients describe tinnitus as loud and intense, which may trigger psychosocial disorders and compromise their quality of life4,5. The THI is the most accepted method to evaluate tinnitus, because of its easy application, interpretation and the fact that it addresses several aspects of the patient?s quality of life13,14.
In the genesis of tinnitus, the consensus is that hearing loss acts as one of the main triggers at the onset of tinnitus19, beyond a discussion of a common pathway that integrates all the central relationships of tinnitus20,21. In addition, the presence of associated clinical symptoms and general data were also evaluated.
For the analysis epidemiological data such as gender and age; and clinical features like the presence of unilateral or bilateral tinnitus, dizziness, headache, neck pain, temporomandibular joint disorder (TMJD) and abuse of caffeine or carbohydrates were used. Distribution of population (n = 107) in the groups classified according to hearing loss group I (n = 23), Group II (n = 38) and Group III (n = 46).
Distribution of age groups classified according to the hearing loss, Group I (n = 23), Group II (n = 38) and Group III (n = 46). Distribution of patients according to gender in the groups classified according to the hearing loss, Group I (n = 23), Group II (n = 38) and Group III (n = 46). Some authors also demonstrated the great value of associated symptoms like those described above26.
Epidemiological studies show that one third of the population has experienced the sensation of tinnitus at least once in life. Concerning the three groups separately, it was observed that in group I (normal hearing) there was a higher prevalence of patients below 45 years old.
Heller and Bergman in 1953 showed that 94% of normal hearing patients reported sensation of tinnitus in completely quiet environments34. Considering the patients with hearing loss (groups II and III), this percentage was 28%, suggesting that patients with tinnitus and normal hearing are more related to tinnitus annoyance.
Several studies indicate that these disturbances are mainly involved in the genesis and perpetuation of tinnitus39.
According to different reports, 85%-96% of patients with tinnitus show some degree of hearing loss. According to Brazilian Otology Society - SBO (2005) (2), the hearing loss attacks around 70% of the individuals, hence it is a matter of public health with specific requirements regarding health promotion and hearing rehabilitation.The positive correlation between hearing loss and tinnitus can be justified if we consider that this is the tinnitus-causing factor, since damages or degenerations on the inner ear and the vestibulocochlear nerve can cause tinnitus (3-6). Study instruments are Tinnitus Handicap Inventory, Tinnitus Questionnaire, Loudness Match Tinnitus, Hamilton Depression Rating Scale, Beck Anxiety Inventory, The Structured Clinical Interview and Symptom Check List -90. The statistics lend support to profound effect of major depressive disorder as a key factor on tinnitus disability exacerbation.
Tinnitus is a common complaint, usually subjective, perceived only by the patient; thus, diagnosis and monitoring rely basically on self-report3. In the second phase from among aforementioned 400 patients, the ones suffering from comorbid mental disorder on tinnitus were selected. The subjects with chronic severe tinnitus having scores more than 44% in TQ-P were enrolled in the study. The accuracy of the calibrating equipment should be sufficient to determine whether the TinnED® is within the tolerances permitted by American Standard Specification for Audiometers, S3.6-2004.
Items with quantifiable severity were ranked on a scale of 0-4 and those measuring symptoms that weredifficult to assess reliably were ranked on a scale of 0-229.
In the case of absence or any other reasons, the next registry would be contacted by telephone and invited to participate in the study. Each of the study subjects was visited at the time of zero, two and four weeks later, then eight and twelve weeks later from the time of zero. We applied Kolmogorov Smirnov as a method for testing the normality of distribution ofcontinuous variables, which demonstrated that all the numeric variables had normal distributions (P > 0.05).
Comparing the outcomes of treatment on mental disorder diagnosis in each study subjects, revealed that pharmacotherapy was effective on anxiety disorders and depressive disorder but there have not been significant changes in somatoform, eating and bipolar disorders (Table 3).
But the comorbid mental disorder on tinnitus doesn't have a significant and meaningful effect on tinnitus severity (LMT) (Table 6). Furthermore in stress process, dopaminergic system placed in prefrontal region, medial temporal lobe and the hippocampus is strongly influenced34,35. It can be hypothesized that exhaustion may reduce the threshold of subjective pain perception and tinnitus intensity. GABAA-benzodiazepine-chloride receptor-targeted therapy for tinnitus control: preliminary report. Subjective tinnitus, temporomandibular joint dysfunction, and serotonin modulation of neural plasticity: causal or casual triad? Randomized placebo-controlled trial of a selective serotonin reuptake inhibitor in the treatment of nondepressed tinnitus subjects.
Persian language version of the "Tinnitus Handicap Inventory": translation, standardization, validity and reliability.
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. Psychopathological dimensions of tinnitus and psychopharmacologic approaches in its treatment.
Psychological comorbidity in patients with chronic tinnitus: analysis and comparison with chronic pain, asthma or atopic dermatitis patients.
Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. Cortisol and inflammatory processes in ovarian cancer patients following primary treatment: relationships with depression, fatigue, and disability. Tinnitus interferes with daily life activities: a psychometric examination of the Tinnitus Disability Index.
Impact of tinnitus as measured by the Tinnitus Handicap Inventory among tinnitus sufferers in Singapore.
Impact of tinnitus on quality of life, loudness and pitch match, and high-frequency audiometry.
THI results indicated that tinnitus had the greatest influence in the functional scale (54%).
We used the overall result to identify the degree of severity of tinnitus for each individual and for completing an analysis of the total scores by scales.
Of all noise-exposed female workers in the plant, 11 (9%) reported having experienced tinnitus, and 41 (16%) of the noise-exposed male workers reported the condition.
Spearman's rank correlation coefficient results indicated a significant correlation between noise levels and how often workers experience tinnitus (p = .01). We also observed a significant correlation between the duration of noise and the functional scale (p = .039).
It is important to notice that the average age of the population of our study (29.2 years) is younger than in other studies, which reported results from groups whose mean ages varied from 40 to 50 years and who had a short duration of noise exposure (average, 7 years)[18-21] . According to that author, doctors believe that 50% of patients with complaints of tinnitus improve significantly when they stop smoking or reduce caffeine intake. In recent decades, studies have demonstrated that simultaneous chronic exposure to CO and noise represents a potential risk to hearing, but reports of tinnitus exist only for cases of intense poisoning from CO [24]. This supports the inclusion of tinnitus prevention initiatives alongside workplace hearing loss prevention initiatives because of shared causal factors.
Information on tinnitus prevention and treatment could have a measurable, positive impact on a person's quality of life.
The authors thank all those who participated in the study for their time, interest, and cooperation.
Guidelines for the grading of tinnitus severity: The results of a working group commissioned by the British Association of Otolaryngologists.
However, at 3 months and then later (long-term results), the figures decreased to 67% and 46%, respectively. Loudness and character of the tinnitus in comparison to sinusoidal tones, narrow-band noise, and broad-band noise also were monitored every second day. In this case, according to a study of Almeling, [8] positive results were achieved also with patients who had experienced their tinnitus for even longer than 6 months. For tinnitus that exists for more than half a year, Biesinger [2] recommended a drug therapy that can interfere with the transmission of the auditory signal in the inner ear and brain.
Der Einfluss der hyperbaren Sauerstofftherapie auf den Tinnitus und den Horverlust bei akuten und chronischen Innenohrschaden.
In its most common form, tinnitus is presented as a phantom sensation which is not associated with an external sound stimulus1. Some studies show that the limitations caused by tinnitus are related to psychological factors, such as mood swings, irritability and psychiatric diseases6,7,8,9. However, previous studies have shown that EVA, in which the patient classifies his discomfort related to tinnitus from 1 to 10, has a good correlation with the THI10-14.
However, hearing loss and its relationship with the distress associated with tinnitus is still controversial. All patients underwent complete ENT examination and pure tone audiometry, testing the following frequencies: 250, 500, 1,000, 2,000, 3,000, 4,000, 6,000 and 8,000 Hz. They were classified in three degrees of discomfort: mild (0-3), moderate (4-7) and severe (8-10). When compared to the level of discomfort related to tinnitus (VAS), none of the factors evaluated showed statistically significant results. However, there was no statistically significant difference between the three groups (Table 3). A possible explanation for this finding might be the fact that the work has been performed in Otoneurology, in which the main complaint is tinnitus and not hearing loss.


Sanchez in 2005 also observed that the average age of patients with tinnitus and normal audiometry was lower compared to patients with hearing loss23.
Riga in 2007, by testing for suppression of otoacoustic emission distortion products, suggested that patients with normal hearing may have a dysfunction of the cochlear efferent system, specifically the medial olivocochlear bundle35. Savastano in 2008, using the THI, found a higher number of patients who rated the annoyance by tinnitus in the group with moderate normal audiometry38.
Another hypothesis that could explain a greater discomfort in patients with normal hearing would be the impossibility of adaptation of a hearing aid in these patients. It is noteworthy that the diagnostic accuracy is essential to any attempt to relieve tinnitus42. Benzodiazepines and GABAergics in Treating Severe Disabling Tinnitus of Predominantly Cochlear Origin. Adaptacao para a lingua portuguesa do questionario Tinnitus Handicap Inventory: validade e reprodutibilidade.
Final Common Pathway for Tinnitus: Theoretical and Clinical Implications of Neuroanatomical Substrates.
Abnormal auditory mismatch response in tinnitus sufferers with high-frequency hearing loss is associated with subjective distress level.
Avaliacao da relacao entre severidade do zumbido e perda auditiva, sexo e idade do paciente.
Impact of Tinnitus on Quality of Life, Loudness and Pitch Match, and High-Frequency Audiometry.
Tinnitus with normal hearing sensitivity: extended high-frequency audiometry and auditory nerve brain-stem-evoked responses. Hearing disorders in the population: first phase findings of the MRC national study of hearing. A Clinical Study of the Efferent Auditory System in Patients With Normal Hearing Who Have Acute Tinnitus.
The aetiology of tinnitus: risk factors for tinnitus in the UK population-a possible role for conductive pathologies. Objective: To correlate the sex, age, degree and type of hearing loss with the tinnitus disorder in patients at the Electronic Devices-related Clinic of Deafness).
Medical treatment also touches on issue such as tinnitus severity, its disabling effects and TQ subscales that statistics shows significant trends in their reduction.
Tinnitus of the same level may be regarded as a problem by a subject while it may be even unrecognizable for another subject4. Improvement or worsening of condition was determined by patients' declaring a change in tinnitus of at least 40%. After obtaining a fully informed consent from each study subject, and having evaluated and completed the study instruments, they were entered into study. Paired sample t-test, and McNemar test were conducted to compare variables before and after intervention. Chronic stress via a complex neurotransmitter network can result in endocrine and autonomic hyperactivity.
Comparing to a potent person whit high quality of life a frail person is more capable to percept pain and buzz sounds.
Eighty-two individuals (22% of the total population) had experienced tinnitus and were invited to participate in the study.
The equipment used was an Interacoustics audiometer, model AD 229, with TDH-39 earphones, calibrated according to ISO 8253. The average age of the sample was 29.2 years, and the average duration of noise exposure was 7 years. Moreover, significant results were found for the degree of tinnitus and exposure to chemical pollutants (p = .02). The THI indicated that even the degree 1 "slight" tinnitus experienced by most of the participants who reported tinnitus nevertheless had an impact on their quality of life. For instance, lesions in the neck and the middle ear and sinusitis and headaches increase the risk of tinnitus from 28% to 35%. The findings underscore the need for noise control and other effective strategies to mitigate causal factors. The use of an instrument designed to evaluate the impact of tinnitus on a person's life, such as the THI, can contribute to a greater understanding of the needs of a specific person or group (or both). Experiencia do hospital das clinicas da faculdade de medicina da Universidade de Sao Paulo.
In the chronic tinnitus group, the therapeutic effect dropped from 66.7% to 34% (with only intravenous medication) and from 60% to 28% (with combined therapy). Side preference of tinnitus was not observed (28 right ear, 30 left ear, and 42 both ears). He preferred lidocaine (as a drug for stability of the nerve cell membrane and for blocking the transmission of stimuli), a calcium antagonist, glutamate, or glutamate antagonists [2].
In 2004, Weisz showed that patients with hearing loss at high frequencies are more subjectto tinnitus nuisance22. As for their gender, 72% of patients were women, with similar distribution among the three groups (Figures 2 and 3).
Comparing the buzzing nuisance related to the presence or absence of hearing loss (Group I x II + III) no statistically significant difference was observed.
In: Proceedings of the Sixth International Tinnitus Seminar - The Tinnitus and Hyperacusis Center. In: Proceedings of the Fifth International Tinnitus Seminars The Tinnitus and Hyperacusis Center. The prevalence of tinnitus varies from 3% to 30% depending on the definition of tinnitus and the study group3. The main goal of this study is the medical therapy of psychiatric disorders but not tinnitus. All of the subjects remained in the study and followed their medical prescriptions for three months.
There is a direct pathway between the limbic system and the prefrontal area via dopamine neurotransmitter. Psychological aspect of subjective tinnitus has been emphasized to assess tinnitus and its disabilities. Twenty (24%) of the 82 were not able to participate because they lost their jobs before collection of data, 5 (6%) declined to participate saying that they no longer had symptoms of tinnitus, and 5 (6%) were on vacation at the time of data collection.
We performed puretone audiometry for all subjects at frequencies of 0.5, 1, 2, 3, 4, 6, and 8 kHz. The functional subscale, composed of 11 questions, evaluates the limitations that tinnitus induces in the mental, social, occupational, and physical areas.
Table 1 displays the findings pertaining to the health problems and auditory and medical histories described by the participants.
In the THI, tinnitus was shown to have the greatest relationship to the functional scale (54%), indicating that its impact is more noticeable in social, daily, and reading activities involving concentration, auditory acuity, attention, and rest. The analysis of the THI results along with the audiometric results indicated that a considerably greater number of significant correlations were verified in the group with altered hearing, which was expected because the two conditions-compromised hearing and tinnitus-are often associated. Information dissemination on the risks and prevention alternatives is of great importance, as is the management of tinnitus.
Finally, it could be used in the design of appropriate strategies to manage tinnitus in the workplace. Therefore, what appears to be essential is not only to examine people who suffer from tinnitus but to offer them treatment. In 23 patients, tinnitus was accompanied by a sudden hearing loss, in 12 by sensorineural hearing loss, in 9 by ventilation disturbance of the eustachian tube because of a chronic sinusitis, and in 1 by a vestibular neuritis.
The results of our indoor patients with acute tinnitus were at first excellent (80% success rate). In that model, damage to peripheral organs act as triggers of tinnitus, and is supported by events that occur in the central auditory pathway, such as maladaptive neuroplastic processes and phenomena such as hyperactivity of the auditory cortex. As for a correlation between age and gender with a degree of discomfort caused by tinnitus through the EVA, there was no significant difference (Table 1). Finally, comparing groups II and III (respectively loss in patients with high frequency and loss in patients in general), no difference was found. Results and Conclusion: Sex, age and degree of hearing loss do not have an influence over the tinnitus disorder, but the hearing loss in tinnitus listeners is progressively bigger according to age and in individual with neurosensorial hearing loss. It consists of a sensation deemed to be illusory that can be characterized as a noise similar to that of rain, sea, running water, bells, insects, whistles, squeaking, doorbell, pulsation, among others. Patients who experience tinnitus often report significant accompanied morbidities such as sleep deprivation, lifestyle detriment, emotional disturbances, work difficulties, social interaction problems, and decreased overall health5-7. Subsequently, with the auditory threshold level at that frequency, the sound was increased in 1-dB steps until a patient reported that the external tone equaled the loudness of the tinnitus. This pathway shows that chronic stress such as chronic tinnitus can have a crucial effect on affective disorders; however, this can also be seen in other chronic physical disorders such as asthma, pain and atypical dermatitis36 and may not be specific to chronic tinnitus. Therefore, the final sample of the study consisted of 52 participants: 11 females (9% of the total of 120 noiseexposed female workers in the studied plant) and 41 males (16% of the total of 252 noise-exposed male workers in the studied plant). The emotional subscale, composed of 9 questions, includes affective answers for tinnitus (anger, frustration, irritability, and depression). All participants exposed to noise levels greater than 85 dB are required to use ear muffs, and information on their use and maintenance are given when workers are hired. The emotional scale was the second most affected and is related to manifestations of nervousness, frustration, irritation, depression, anxiety, insecurity, and difficulty in relationships with family and friends. Estabelece diretrizes e parametros minimos para avaliacao e acompanhamento da audicao dos trabalhadores expostos a niveis de pressao sonora elevados. In eight patients, the tinnitus was caused by an acute otitis media, in three by an acoustic trauma, in two by a chronic otitis media, and in one by a labyrinthine contusion (Table 1). The positive effect was shown for 77% of patients immediately after the application and for 68% of patients even 6 months after the application [10].
This can be explained by the increased demand of women to medical services, or the greater prevalence of psychological disorders in this group, such as anxiety and depression31,32. This sensation can be continual or intermittent and it can show different tone characteristics, be intense or soft, as well as be noticed in the ears or head (10-13).
Although causative relations are yet unrevealed, patients with tinnitus are at increasing risk for depression, anxiety and insomnia5,8,9. None of the study subjects had taken any medication for their tinnitus including psychotropic or antiepileptic agents since a long period before being included in the study.
The subjects had to have LMT over 6 decibel sensation level (dB SL) to be included in this study. We also performed daily biological calibration checks on the audiometer immediately before testing subjects. Last, the catastrophic subscale is composed of 5 questions and examines the most severe reactions from tinnitus (desperation, loss of control, inability to face problems, inability to escape tinnitus, and fear of having a serious ailment)[12].
Walkthrough observations suggest that use of the hearing protection is high, but no information exists on the consistency of hearing protection use. The catastrophic scale demonstrated alterations related to desperation, intolerance to tinnitus, and loss of control in situations when experiencing tinnitus (see Fig. In one patient with a unilateral tinnitus, a diagnosis of acoustic neuroma could be made, and this patient was excluded from this study. The positive atmosphere from a private clinic might be the reason for the good early results in comparison with the later results (obtained from patient questionnaire).
In 2010, the same author, using the THI, found no significant correlation between degree of hearing loss and discomfort related to tinnitus24. On the other hand, when the risk factor under study is the exposure to noise, there is a higher prevalence of the male sex33.
It is indicated that 48% to 60% of patients suffering chronic and disabling tinnitus have major depressive disorder (MDD)10-12.
The least objective score was ± 2 dB sensation level (SL) which is considered important clinically28.
In our study, factors such as gender, age, tobacco, and exposure to firearms were not significantly associated with tinnitus. No significant difference was observed between the positive effect of intravenous medication only and combined treatment (intravenous medication and HBO).
Despite of this prevalence among women, our work suggests that tinnitus-related annoyance is similar in both groups. Asplund reported poor sleep and frequent waking to be more common among chronic tinnitus patients than the general population in both sexes13. Coles [26], among several authors, reported that the worse the hearing is, the more probable is the occurrence of tinnitus. Many clinical trials have been performed in order to evaluate the efficacy of psychotropic agents on tinnitus so far. Clonazepam and antidepressants such as nortriptyline and amitriptyline have been proved to be effective in reducing the severity of the problem and improving the quality of life of tinnitus patients14-18. Approximately 20% of the patients with hearing loss present complaints of tinnitus, whereas 90% of those with severe tinnitus had hearing loss. The studies have illustrated that Benzodiazepines and GABA-egric agents may decrease the severity of tinnitus and the SPECT evaluation has proved that the brain blood flow increases objectively in tinnitus19. Using SSRIs has been successful in reducing the severity of tinnitus by lowering the conduction of impulse of tinnitus20,21.



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