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Primar behandelt der HNO-Arzt den Tinnitus, der Psychotherapeut die psychische Problematik. Zwischen Februar und April 2005 nahmen 89 Tinnitus-Patienten, die stationar in der Tinnitus-Klinik Bad Arolsen therapiert wurden, und 105 Psoriasis-Patienten, die von Oktober 1999 bis Oktober 2004 stationar in der TOMESA-Fachklinik, Bad Salzschlirf, behandelt wurden, an einer umfangreichen psychologischen Testdiagnostik teil, die den Tinnitus-Fragebogen (TF) nach Goebel u.
Im Gegensatz zu Psoriasis-Patienten, die mehr unter ihrer nach au?en sichtbaren Stigmatisierung leiden, zeigen sich bei Tinnitus-Patienten vermehrt Suizidalitat, Depression und Angstlichkeit. Bei Tinnitus-Patienten ist der Einsatz einer spezifischen psychologischen Testdiagnostik sinnvoll, wobei der Tinnitus-Fragebogen nach Goebel u. Treatment of tinnitus is primarily the task of ENT specialists, while treatment of the psychiatric diseases lies in the hand of psychotherapists. Between February and April 2005, 89 tinnitus patients, who underwent in-patient therapy in a neurootological and psychosomatic hospital, and 105 psoriasis patients, who had in-patient treatment from October 1999 until October 2004 in a specialized clinic, were examined with psychological tests, which included the Tinnitus questionnaire proposed by Goebel und Hiller, the Symptoms Check List of Derogatis SCL-90-R, the HADS and the suicide rating according to Poldinger. Tinnitus in-patients suffered significantly more from suicidal tendencies, depression and anxiety in contrast to patients with psoriasis, who suffered more from problems associated with their outward appearance. The use of a specific psychological test diagnostic is very helpful in the hand of the ENT specialist, but the Tinnitus questionnaire of Goebel and Hiller enables an initial screening. Literatur1.D’Amelio R, Archonti C, Scholz S (2004) Psychological distress associated with acute tinnitus. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser.
Tinnitus is a noise, a ringing, or a roaring sound in the affected ear and is becoming an increasingly serious problem for health care systems. The term tinnitus is derived from the Latin tinnire ("ringing") and is defined as the perception of sound in the absence of any appropriate external stimulation. The incidence of patients experiencing tinnitus in Germany and the Western world is approximately 10%. Today, such integrative therapy concepts as cognitive-behavioral treatment compiled from counseling, relaxation therapy, music therapy, and pharmacological preparations (lidocaine, neurotransmitters) are regarded as promising therapeutic approaches for managing tinnitus [7]. AST is a complex program of MT originally employed in the treatment of chronic pain and developed specifically for tinnitus treatment. Finally, the objective of AST is to bring about a change in sound perception that induces relaxation, reduces anxiety, and stimulates changes in unfavorable behavior patterns, thus improving the emotional state.
The outpatient therapy (duration, 2 weeks) with AST consisted of a total of 38 hours of therapy (20-hr psychological training, 10-hr MT [AST], 8-hr kinesi-therapy) and also included counseling by ear, nose, and throat experts, orthopedists, and dentists. At the Tinnitus Therapie Zentrum Krefeld (Germany), we performed an observational study on a multimodal treatment concept (Krefelder-Modell) being applied on an outpatient basis for subacute and chronic tinnitus over a projected period of 2 years. For an evaluation of the efficiency and sustained success of the therapy, we applied the t-test to show significant differences of tinnitus questionnaire scales after therapy. As the treatment concept presented in this study (Krefelder-Modell) is a multimodal concept, the different elements of treatment can be compared to achieve more detailed results on the efficiency of the MT training program (AST). To evaluate effectiveness of the therapy and to render the results comparable with each other and also with other treatment facilities in the health care sector, we calculated effect sizes according to Cohen [18] and corrected according to McGaw and Glass [19]. Patients were also asked how often they resorted to seeking assistance through the health care system over 6 months before treatment, and they had the option of several possible answers. The total score of the tinnitus questionnaire (Tinnitus Fragebogen [TF]) at the different measurement points is shown in Figure 2. In a comparison of the individual therapies, AST was responsible for a surprisingly high percentage of the positive total result and clearly was preferred by patients, despite the fact that psychological training was twice as long (20 therapy session hours as compared to 10 for MT).
In answer to the question of whether the therapy helped them to cope better with ringing in the ear, 40% of patients described the success as excellent, 29% as good, and 16.8% as satisfactory. An analysis of the tinnitus problem, particularly from a traditional perspective, suggests a general confusion among most experts, although many scientists have explored the problem.
In this study, we were able to demonstrate that the multimodal concept achieves highly significant changes.
If we assume that tinnitus is not a disease but a symptom of an underlying process, singular symptom-oriented approaches will fail [2]. Our follow-up interview of patients after 6 months showed a high degree of sustained therapeutic success.
The subjective symptom of tinnitus is a phenomenon that the unaffected cannot easily understand, as defining a cause is difficult in most cases. This study demonstrates that MT is an effective treatment approach and offers a way to make progress in tinnitus treatment.
Anders als bei von au?en gut erkennbaren Erkrankungen erschlie?t sich bei Tinnitus-Patienten die Schwere der Erkrankung oft nur uber psychologische Tests sowie das psychosomatisch-psychotherapeutische Gesprach. Hiller, die Symptomcheckliste nach Derogatis (SCL-90-R), den HADS und den Suizid-Fragebogen nach Poldinger beinhaltete. Different from mostly very apparent dermatological diseases, the severity level of tinnitus can often only be determined by psychological test batteries as well as a specific psychosomatic exploration. Auditive Stimulation Therapy as an Intervention in Subacute and Chronic Tinnitus: A Prospective Observational Study . Integrative treatment concepts are currently regarded as promising therapeutic approaches for managing tinnitus. Some 1-2% of the population is severely disturbed by tinnitus, which may disrupt everyday activities and sleep [3]. In particular, music therapy offers the chance of a global treatment approach for tinnitus patients [14].
It consists of a total of 10 therapy sessions and employs specifically developed receptive music programs in combination with an education program. Complete 2-week program of auditive stimulation therapy (AST) as a function of hours of therapy per day . Data on treatment were collected and evaluated in a prospective observational study using several standardized questionnaires immediately before and after therapy and at follow-up after 6 months. We carried out subgroup analysis of outcome measures according to the degree of tinnitus severity. Kinesitherapy having received a distinctly lower rating by patients, only the two treatment elements rated as most successful were compared with respect to their effectiveness: psychological training (PT) and music therapy (MT). The follow-up sample with regard to the TF total score did not differ significantly from that of the general population, which has been demonstrated [16]. Total score on the tinnitus questionnaire (TF) at the different measurement points, according to degree of disease severity. The details of this transition process will, however, be the subject of a following evaluation using Marcov-chains methods. For further analysis of these findings, we calculated effect sizes at measurement times and related to the patients' subjective evaluation.
A great variety of models and treatment approaches are available, the effectiveness of which is still inconclusive. The calculation of effect size, according to the tinnitus questionnaire results, illustrates that the most significant effect sizes occurred in the area of psychological stress and total score changes. Sixty-one percent of patients state that professional medical help was not of much use - a shockingly high figure in view of the numerous medical interventions. Furthermore, these interviews provide important feedback for therapists and show longer-term positive treatment results, specifically in the areas of well-being and reintegration of patients in their family environment, as amply demonstrated in our study.
Hearing of sounds that are normally located externally is suddenly directed internally and, therefore, is difficult for others to imagine. Department of Medical Theory and Complementary Medicine, University of Witten Herdecke, Germany. In dieser Studie werden Psoriasis-Patienten mit Tinnitus-Patienten hinsichtlich Lebensqualitat, Angstlichkeit, Depressivitat, und Suizidalitat verglichen, um den psychischen Einfluss zu erkennen und geeignete Instrumente zu dessen Therapie zu finden. In this study patients with psoriasis were compared with tinnitus patients regarding quality of life, anxiety, depression and imminent suicidal tendencies, in order to realize the psychological impact and find appropriate instruments for treatment. The aim of this study was to present the results of auditive stimulation therapy, a program of music therapy developed specifically for tinnitus treatment.
The term objective tinnitus is used for ear sounds based on genuine physical vibrations-oscillations that may be perceived by others or even measured [1].
If the symptoms continue for 6 months, we consider the condition to be chronic, the degree of which differs considerably from person to person and affects patients in different ways [4].

Harmony, for instance, as a connecting link between rhythm and melody also has a social function.
Musical self-control (MSC) training is a music program designed on the basis of music psychology and MT, the effectiveness of which was demonstrated in a clinical study [16].
Apart from anamnestic data, the questionnaires asked for a subjective evaluation of treatment results. Therefore, Figure 3 shows the mean scale values of the tinnitus questionnaire before and after outpatient tinnitus therapy (n = 146) and also at follow-up after 6 months (n = 106).
The combination of MT-PT comprises the partial therapies MT and PT, and this suggests that the share of MT in this result is higher than that of PT.
The standard therapies in Germany include medication to improve blood circulation or, with increasing frequency, infusions as part of a hospitalization period, with disproportionate side effects as compared to the severity of the complaints [20].
In comparison with effect sizes of other studies with hospitalized patients and outpatients summarized in a meta-analysis by Schilter [21], the advantages of this treatment concept become evident. Much suggests a holistic treatment approach, in which ringing in the ear is viewed as a sign of particularly high stress. The affected individual suffers from a personal noise problem that is inaudible to others; consequently, others lack understanding.
How we integrate sounds into our daily life and how they become perceived as noise or music is a complex activity involving the physiological, the psychological, and the social. Metaanalyse zur Effektivitat medikamentoser und psychologischer Therapien bei chronischem subjektivem Tinnitus.
A preliminary study of creative music therapy in the treatment of children with developmental delay. We collected data on outpatient treatment results from 155 tinnitus patients and evaluated them in a prospective observational study with three defined times of measurement (start, end, and 6 months after the end of treatment).
The objective of MSC training is to improve patients' control of ear sounds and to relieve their feelings of helplessness. The tinnitus questionnaire designed by Goebel and Hiller [17], now the recommended standard tool throughout Germany, was used at all times for measurement.
In addition, MT shows excellent effect sizes over longer periods, a clear indication of the quality of the concept of AST as to contents and didactic implementation. With an overall effect size of 0.63 from pretherapy to follow-up, other multimodal therapeutic strategies range far behind the results of the therapeutic approach described in this study.
The question of whether the symptom is of a somatic or a psychosomatic nature seems to be of no importance in the treatment of subacute and chronic tinnitus.
If a reorientation in terms of perception takes place, the consequences of this reorientation, as therapeutic effects, are best seen in follow-up assessments.
A therapeutic intervention that incorporates these understandings appears to offer considerable benefits, not as a cure but as a healthy adaptation.
Die verlorene Stille: Auswirkungen und psychotherapeutische Moglichkeiten beim komplexen chronischen Tinnitus. In G Goebel (ed), Ohrgerausche-psychosomatische Aspekte des komplexen chronischen Tinnitus. Administration, scoring & procedures manual-II for the R(evised) version and other instruments of the Psychopathology Rating Scale Series.
Apart from anamnestic data and subjective evaluation of treatment, the major outcome parameter was the score of the tinnitus questionnaire. These components form the theoretical background for auditive stimulation therapy (AST), the music therapy (MT) program evaluated in this study. Included in the evaluation were only those questionnaires in which more than 90% of the questions were answered properly. The results appear to confirm in particular the intention of enabling patients to continue independently with MT and to make autonomous use of receptive music programs. An analysis not only of the biological but of the psychological and social needs of patients [22] provides a more comprehensive insight into and understanding of their situation. If we encourage the ability of selective hearing, we can promote some sounds in the hierarchy of perception and ignore other sounds or regulate them until they become hardly perceptible.
The most expressive results in this context certainly are those of the follow-up, as the data from these particular patients are available for all measurement times. Therefore, our nonpharmacological intervention achieves the high effect sizes of the drug-based therapies without their concomitant side effects. MT AST is seen as salient to their problems among patients and as highly effective, perhaps because we are not making a direct, singular psychological intervention but an intervention in the same modality as that in which the symptom is experienced. This phenomenon is most obvious in Ludwig van Beethoven who composed without being able to hear. High-frequency sounds are perceived far more often than are low-frequency sounds [2], and a hearing impairment is detectable in more than 50% of all cases. Although several case studies reported efficacy of these treatments, the empirical support in well-controlled studies is still weak [12,13]. The Krefelder-Modell treatment concept alone uses an MT training program embedded within a complex treatment approach, indicating that the advantage - compared to other treatment forms - is principally the influence of the specific MT intervention. By accommodating sound control within an ecology of other sounds, itself within a stress-reduction context, we are offering a form of self-control that is adapted to a personal environment [23-25]. Of the 155 patients, 137 (88%) were capable of gainful employment, which means that they fell in the age range between 18 and 65 years. On this extended basis of our knowledge about hearing, we should be able to develop for affected patients coping strategies that address the causes of the problem directly and thus render the symptom superfluous. Neugebauer reminded us that a sensory stimulation must not necessarily result in a conscious perception, nor must a sensory experience necessarily be caused by a physical stimulus. Tinnitus als Indikator eines dekompensierten Gruppenprozesses innerhalb einer Organisation. The duration of tinnitus was more than 6 months for 80% of patients, and 43% had been suffering from tinnitus for more than 3 years. The specific way in which music therapists or musicians hear may indeed be helpful or suitable in understanding tinnitus patients and also in explaining - taking a composer as an example - how such experiences of internal hearing may also be observed in different settings in which they are absolutely normal and by no means pathological.
Aldridge [25] suggested that the purpose of MT is that patients are enabled to generate expressive potentials that reveal new possibilities for becoming healthy. Closer investigations indicated that a combination of music therapy and psychological training rendered the best effect sizes. In the context of ear ringing, MT might help to create a context of meanings that integrates the sounds or noises into the music and thus removes them from conscious perception, which would clearly promote recovery.
This study demonstrated that music therapy is an effective integrated treatment approach and offers a way to make progress in tinnitus treatment. Sounds no longer perceived as disturbing, once brought under control, are perceived as musical. Hofgrefe, Gottingen9.Goebel G, Kahl M, Arnold W (2006) 15-year prospective follow-up study of behavioral therapy in a large sample of inpatients with chronic tinnitus. Hogrefe, Gottingen, S 11711.Hallam RS, Rachman S, Hinchcliffle R (1984) Psychological aspects of tinnitus. Huber, Bern13.Hesse G, Rienhoff NK, Nelting M, Laubert A (2001) Ergebnisse stationarer Therapie bei Patienten mit chronisch komplexem Tinnitus.
Huber, Bern, S 6924.Preyer S, Bootz F (1995) Tinnitusmodelle zur Verwendung bei der Tinnituscounsellingtherapie des chronischen Tinnitus.
Schattauer, Stuttgart, S 14228.Schaaf H, Holtmann H (2002) Psychosomatische Aspekte bei Tinnitus-Patienten mit Schwerhorigkeit. Dissertation, Naturwissenschaftliche Fakultat, Universitat Salzburg, Salzburg31.Tilmann M (2007) Ein Versuch zum individuellen und kulturellen Verstandnis der psychodynamischen Bedeutungen des Tinnitus aurium. Thieme, Stuttgart, S 462–47133.Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale.

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