Tinnitus handicap inventory 12,can gabapentin cause ringing in ears remedies,tinnitus behandlung salzburg - Plans Download

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How to cite this article Passi S, Ralli G, Capparelli E, Mammone A, Scacciatelli D, Cianfrone G. The main objective of this study was to determine reliability, validity, and reproducibility of the Italian version of the Tinnitus Handicap Inventory (THI) self-administered questionnaire aimed at evaluating the impact of tinnitus on the quality of life of subjects affected by this symptom.
Over time, different authors have made various attempts at defining and classifying tinnitus; however, that none of their proposals has proved to be exhaustively descriptive suggests the great level of complexity of the pathogenesis and phenomenology associated with tinnitus.
One of the first definitions was coined by Itard (1774-1838), who described tinnitus as "an extremely irksome discomfort, which leads to a profound sadness in affected individuals." He advised several therapeutic approaches to gain relief, among which was the use of environmental noise [1,2].
Our opinion is that no single theory, model, or hypothesis will be exhaustive in all the affected patients [21].
Tinnitus may be continuous or intermittent and it can be localized at the ear level, bilaterally or unilaterally, or at various points in the head [24]. Therefore, because the tinnitus symptom is not always associated with a specific and easily detectable pathogenic factor and varies greatly in both qualitative and quantitative terms, it escapes instrumental evaluation. Further studies showed that the level of distress is not related to type, assumed cause, or features (such as pitch and loudness) of tinnitus [30-32]. In the course of the last two decades, several selfadministration questionnaires for the investigation of the disabling aspects of tinnitus have been reported in the literature [37,38], using various evaluation systems and presenting different features. On the occasion of the Fourth International Tinnitus Seminar in Bordeaux in 1991, Halford and Anderson [42] introduced the Subjective Tinnitus Severity Scale (STSS), composed of 16 items and a single factor evaluating severity of tinnitus in terms of intrusiveness and interference with sleep, relaxing capacity, and distress level.
The two instruments discussed in the following paragraphs focus mainly on psychological reactions to tinnitus, a further confirmation of a trend in the most recent literature that takes into account tinnitus-coping strategies more than symptom severity. Normally, the tinnitus sufferer turns, in the first place, to specialists, such as an otolaryngologist or an audiologist. One of the criticisms leveled at the THI in the past was that, compared with other self-assessment scales (Tinnitus Questionnaire [TQ], THQ, TRQ), its factorial structure had not been validated [52-54]. The THI has been adopted as either a primary outcome measure or in association with other evaluation scales and has been used in double-blind trials with a control group to assess the effect of pharmacological treatments administered to tinnitus sufferers. In light of our Italian clinical experience, we chose to evaluate reliability, validity, and psychometric properties of the THI, for we believe that among all tests described in this study, its questions are the most easily understood and provide an exhaustive framework for tinnitus impact on the sufferers' everyday life and function.
It is interesting to note that item 24, relating to the effect of stress on tinnitus, turns out to be the least correlated to the total score of the scale. High total scores are always suggestive of high scores in the catastrophic scale, in support of the findings of McCombe et al.
These definitions based on grading are very useful in clinical practice and help doctors to quickly identify the most appropriate therapeutic choices. INTRODUCTION: Tinnitus Handicap Inventory (THI) was developed in English to quantify the handicap caused due to tinnitus. OBJECTIVES: India being a multilingual country needs to develop and standardize THI in Indian languages. MATERIALS AND METHODS: Questions from English version of THI were translated and modified by two professionals who have a degree of MA Kannada. RESULTS: Analysis revealed 14% of the patients fall under the category of Slight, 38% under Mild, 26% under Moderate, 16% under Severe and 6% under Catastrophic group. CONCLUSION: Scores of Cronbach-alpha test shows that Kannada version of THI is a standard and reliable tool for measuring the handicap caused by tinnitus and can successfully classify individuals on a severity basis. Recent interest has surfaced in symptom - specific handicap outcome measures for many audiological and otological diseases4. A symptom specific assessment of many otological disorders will aid in understanding the severity of the symptom and effects of this on routine life.
The English version of THI which is shown in Appendix 1 was the only tool available for quantifying the handicap caused by tinnitus.
The beta version of THI developed by Newman and Jacobson in 1996 consists of 25 questions under the 3 sub scales of emotional, functional and catastrophic.
Individuals who were suffering from tinnitus with or without any otological diseases were selected for the study.
Tinnitus questionnaire was administered on the participants using a structured interview by the clinician to have a record of the demographic details and to cognize the type, nature, and the lateralization of the tinnitus, factors that affect tinnitus, presence of hearing loss, and the concern about the tinnitus.
Following the administration of the tinnitus questionnaire, the participants were instructed regarding the self - assessing Kannada version of THI, its importance and the system to grade it. Among all the participants, 94% of the participants had a minimum qualification of SSLC and a maximum qualification of a degree and could fill up the Kannada version of THI without the help of the clinician. The results of the THI and the self assessing questionnaire were tabulated and are graphically represented below in Graph 1. After the complete analysis of the obtained data, the percentages of the patients coming under various severities were found out. The purpose of this study was to develop a handicap inventory in native language (Kannada), to obtain a standard measurement instrument for evaluating tinnitus in patients to apprehend the effects caused due to tinnitus. From the study, we could observe that the perception of tinnitus handicap differs drastically between subjects as demonstrated by high values of standard deviations, which may be due to effective coping starategies5. Related to the emotional aspects, the Kannada THI allows assessing the relation between tinnitus and manifestation of stress, depression, anxiety & frustration. The result of the current study shows good reliability and internal consistency as indicated by the Cronbach alpha test.
Hence this inventory can serve as an effective tool to successfully classify the individuals into different grades according to the symptoms. Since the main focus of this study was to develop and standardize the THI into Kannada language, and to be administered on all Kannada patients who complain of tinnitus.
The main aim of this study was to develop and standardize the Tinnitus Handicap Inventory in Kannada; hence it can be administered on Kannada patients without difficulty. Paper submitted to the ITJ-SGP (Publishing Management System) on December 17, 2012; and accepted on January 17, 2013. 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.
Recent interest has surfaced in symptom-specific handicap outcome measures for many audiological and otological diseases.
There is no valid and reliable tinnitus handicap inventory for Turkish people in their native language. We assessed test-retest reliability with a second investigation in 21 randomly chosen patients. The three groups of patients were divided according to their ages: 19-39 years, 40-59 years, and 60 years and older. We tested internal validity by multi-item analysis, to assess item convergent and discriminant validity.
This study was designed to obtain the THI as a standard measuring instrument for patients and clinicians all over Turkey.
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. 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.
Introduction: The clinical experiment shows that dizziness may cause psychosocial consequences. INTRODUCTION Dizziness, which is generally considered one of the most frequent complaints on medical clinics, may cause difficulties on the subject daily life and even reduce their life quality.(1)The study of the group of physical and emotional disturbances that concern the several kinds of dizzinesses may produce intense functional disturbances, which harms the professional, social and domestic activities of the patient, which makes the recover of their physical and psychological balance a great challenge (2). Introducao: A experiencia clinica mostra que a tontura pode acarretar consequencias psicossociais. INTRODUCAOA tontura, considerada uma das mais frequentes queixas na clinica medica em geral, pode gerar dificuldades na vida diaria do individuo e ainda reduzir a sua qualidade de vida (1).O estudo do conjunto de perturbacoes fisicas e emocionais que envolvem os varios tipos de tontura pode provocar prejuizo funcional intenso, comprometendo as atividades profissionais, sociais e domesticas do paciente, tornando a recuperacao de seu equilibrio fisico e psicologico um grande desafio (2). The THI Questionnaire: Psychometric Data for Reliability and Validity of the Italian Version.
Shulman [1] defined tinnitus as "the aberrant perception of sound reported by a patient that is unrelated to an external source of stimulation," whereas Jastreboff [2] mainly referred to the most recent neurophysiological acquisitions regarding the auditory function and described tinnitus as "the perception of sound that results exclusively from activity within the nervous system without any corresponding mechanical, vibratory activity within the cochlea and not related to external stimulation of any kind" [3].
Among the various pathologies that may cause or accompany tinnitus are otitis media, otosclerosis, Meniere's disease, presbycusis, exposure to noise and ototoxic drugs, sudden deafness, head trauma, acoustic neuroma, meningitis, and temporomandibular joint disorders [6-10]. Tinnitus is a very frequent symptom among the population and, indeed, some epidemiological studies report that temporary tinnitus can be commonly perceived by individuals of any age [22,23].
It can manifest suddenly or gradually, and sufferers describe it in a broad variety of qualitative features, from hissing to tinkling, from buzzing to steaming, or as a pool of undefined sound components, all descriptions that, unfortunately, do not provide the clinician with helpful indications for therapy or pathogenesis. As a matter of fact, no currently available methods are able to ascertain the presence of tinnitus or its severity in audiological terms: hence the necessity of alternative assessment instruments ranging beyond the audiology area and focusing instead on the impact of tinnitus on affected subjects' activities of daily living [25]. To account for the differences between tinnitus sufferers and nonsufferers, many authors considered the cognitive factor, thus identifying cognitive reactions to tinnitus as crucial to the development of habituation [33-35].
Some of these were formulated by audiologists, some others by psychologists and multidisciplinary teams. Such a change of focus is researchers' answer to the growing evidence that tinnitus responds more readily to a global and multidisciplinary approach than to medical treatments. Such specialists make a clinical evaluation of the auditory apparatus to exclude or detect the presence of pathological situations causing tinnitus. It should provide indications for a multidisciplinary therapeutic approach and also serve for the assessment of therapeutic outcomes. Such validation was later provided by a Danish working group [47] and by Baguley and Andersson [52], who defined it as a distress-specific monofactorial scale.
The THI was employed to evaluate the efficacy of baclofen, melatonin, and glycopyrrolate in the treatment of Meniere's disease and of Ginkgo biloba, botulinum toxin type A, gabapentin, and melatonin on tinnitus and, in the case of melatonin, on sleep [57-63]. The Centre is located at the University of Rome Sapienza, Department of Otorhinolaryngology, Audiology, and Phoniatrics, G. This indicates the extent to which stress is a fundamental element in determining the degree of distress, independent of severity of tinnitus. National Research Council Working Group 89 Committee on Hearing, Bioacoustics, and Biomechanics. Translated inventory was given to 50 native Kannada speakers for the familiarity check & the most familiar sentences were included in the study. According to the data obtained from the National Center for Health Statistics, tinnitus is more commonly seen in males than females and increases in prevalence with advancing age. There are two important aspects of symptom - specific evaluation that is generally done by a valid and reliable inventory5.
A Tinnitus Handicap Inventory (THI) was developed in order to measure the handicap caused by tinnitus. India being a multilingual country with a multicultural background, there is no such inventory available in any of the Indian languages other than in Tamil.
For the present study, the English version of THI was translated to Kannada using the standard Translation-back-translation method (Bardley, 1994) by two professors who have a degree of MA in Kannada. Participants were interviewed briefly regarding tinnitus and those who complained tinnitus for more than 3 months were included for the further procedures, so that, they can quantify accurately the physical, emotional and catastrophic impacts of tinnitus on their daily acvtivities.
Thereafter based on the subject's grading for all the questions, the total scores were calculated.
Rest percentages of participants were from a lower socio-economic status and could fill up the questionnaire only with the help of the clinician due to their inability to read and understand Kannada.
Cronbach alpha test was administered to check for the internal consistency and reliability of the Kannada version of the THI and also an Item-Total Correlation was also carried out. Thus, according to the Cronbach alpha score, the Kannada version of THI has got a good internal consistency and reliability to administer on the tinnitus patients in the Kannada population. With the administration of Kannada THI it was found that, all the subjects could quantify the severity of tinnitus from slight degree to catastrophic degree, and thus fulfilled the aim of the study. Tinnitus assessment not only involves to match the tinnitus, ascertain the intensity of the tinnitus and to find out the intensity of wide band noise that can mask the tinnitus, but also involve administration of various inventories like THI to rate and assess the severity of tinnitus in order to help the clinician to counsel the patient as well as to know the level at which the management options should begin8. With respect to the functional aspect, the Kannada THI allows to identify the relationship between tinnitus and activities involving concentration, hearing acuity, attention & reading. This inventory could easily be understood to all the laymen and 94% of patients could fill the inventory without any help from the clinician.
Following all the analysis and standardization, the Kannada version of THI came out successfully for the evaluation of tinnitus and found to be reliable. The Kannada version will help the patients with tinnitus to comprehend the severity and intensity of their problem and also considered as a reliable instrument for the verification of the impairment in the quality of life due to tinnitus.
Department of Speech Language Pathology - All India Institute of Speech & Hearing - Mysore - India. 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.
Each of two individuals independently translated and retranslated the English version of the THI, and it was adapted by an expert team. That is, clinicians plan to quantify their patients' symptoms, administer their treatment, and get objective results about the patient's satisfaction. Therefore, most clinicians use their own questionnaires, which lack reliability or validity (or both). This study sought to analyze the validity and reliability of the Turkish version of the THI.
Internal consistency reliability of the Turkish version of the THI was assessed using Cronbach's alpha. This was assessed by categorizing the patients into three groups according to their age and according to tinnitus duration. We investigated the differences in the mean values for scale and subscales, though the F test results did not provide significant results. The 25-item inventory can be used in neurootology clinics to evaluate the tinnitus symptom and its impact on knowledge and attitudes toward tinnitus.
After minor alterations in translation and retranslation, scaling assumptions were met satisfactorily for the three multi-item subscales, and the first Turkish-language scale for evaluating tinnitus was developed.
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.
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). Study of the Handicap Caused by Dizziness in Patients Associated or Not with Tinnitus Complaint. Therefore, over time questionnaires were developed on handicap caused by dizziness, to evaluate daily life difficulties and consequences in the quality of life in this population.
Speech doctors that work with evaluation and rehabilitation of body balance disturbances, should bare in mind that recognizing such disturbances may be an important step in the rehabilitation of their patients.Anyway, it is correct that vestibular disorders of any kind produce several significant harms on the patients' abilities, in terms of managing their independence.
Assim, ao longo dos anos, foram desenvolvidos questionarios sobre o handicap em pacientes com tontura, contendo informacoes sobre os prejuizos que esse sintoma causa na qualidade de vida do individuo. Conclusao: A vestibulometria pode detectar disfuncoes vestibulares, porem nao analisa a influencia da doenca na qualidade de vida dos pacientes. O fonoaudiologo que atua na area da avaliacao e reabilitacao dos transtornos do equilibrio corporal, deve ter em mente que reconhecer estas perturbacoes pode ser um passo importante na reabilitacao dos seus pacientes.De qualquer forma, e certo que desordens vestibulares de qualquer natureza causam diversos prejuizos significantes nas habilidades dos pacientes, quanto a administracao da sua independencia. All subjects reported as their main problem a tinnitus that had persisted for at least 6 months. In our view, the most exhaustive definition, including the numerous aspects of this symptom, is McFadden's: "Tinnitus is the conscious experience of a sound that originates in the head or neck, and without voluntary origin obvious to that person" [3].
Recent hypotheses refer to sensorineural hearing loss of autoimmune and neuroendocrine origin and metabolic disease.
The reported prevalence of continuous tinnitus is 6-30%, of which only a portion (0.5-2%) of the population turns out to be significantly affected.
Even from a quantitative viewpoint, descriptions given by tinnitus sufferers do not provide useful clinical correlates, as numerous factors can affect the patients, such as environmental noise and the level of attention that the subject pays to the symptom. In this regard, the observations of Tyler and Baker [25] of 72 patients-members of a tinnitus self-help group-are a starting point for the formulation of some specific tests. In addition, a psychological predisposition that was hypothesized can affect tinnitus-coping abilities.
In 1990, Sweetow and Levy [40] introduced the Tinnitus Severity Scale (TSS), with 15 items and five relevant factors: symptom intrusiveness, distress, hearing loss, sleep disorders, and drug use. The widely known Tinnitus Reaction Questionnaire (TRQ), proposed by Wilson et al [45], is made up of 26 items investigating four factors: general distress, level of interference in work performance, severe distress, and avoidance strategies. As previously stated, specialists who normally see tinnitus sufferers know well that the symptom's severity is not directly related to the triggering pathology or to psychoacoustic characteristics of the symptom. Specifically, 11 items are included in the functional scale, 9 in the emotional scale, and 5 in the catastrophic scale. These authors found the reliability of the test-retest to be high and reported a high validity correlating with other distressmeasuring scales, specifically the TQ, as shown by Baguley et al. The use of the THI in association with other instruments, such as the Tinnitus Coping Style Questionnaire, has been reported in assessing the efficacy of low-power laser on tinnitus [64]. Its validity was confirmed as an outcome-measuring instrument determining the efficacy of tinnitus retraining therapy as compared to acoustical masking [68]. The first version of the questionnaire (the alpha version) constituted 45 items, some based on interviews with patients and others adapted from both the Hearing Handicap Inventory for the Elderly and the Dizziness Handicap Inventory and others based on the symptomatic categories defined by Tyler and Baker [25]. Specifically, the THI devotes 11 items to the functional scale, 9 to the emotional scale, and 5 to the catastrophic scale. These properties provide clinicians or health operators with an instrument that completes the audiology diagnosis, thus indicating the necessity for involving other professionals who are not directly related to audiology, such as psychologists and neuropsychiatrists.
In that interesting and very useful study, the authors provide a characterization of the type of impact that tinnitus causes in connection with the subject's ratings.
Development of tinnitus-related neuronal hyperactivity through homeostatitic plasticity after hearing loss: A computational model.
Etanercept therapy for immune-mediated cochleovestibular disorders: A multicenter, open-label, pilot study. Sudden hearing loss as a first complication of long-standing Type 1 diabetes mellitus: A case report. The inner hair cell synaptic complex: Physiology, pharmacology and new therapeutic strategies.
Increases in spontaneous neural activity in the hamster dorsal cochlear nucleus following cisplatin treatment: A possible basis for cisplatin-induced tinnitus. Cisplatininduced hyperactivity in the dorsal nucleus and its relations to outer hair cell loss: relevance to tinnitus.
Elevated fusiform cell activity in the dorsal nucleus of chinchillas with psychophysical evidence of tinnitus. In vivo optical imaging of toneevoked activity in the dorsal cochlear nucleus with a voltage sensitive dye.
Evidence of decreased GABAergic influence on temporal integration in the inferior colliculus following acute noise exposure: A study of evoked potentials in the rats. Lateralized tinnitus studied with functional magnetic resonance imaging: Abnormal inferior colliculus activation. The perceived severity of tinnitus: Some observations concerning a large population of tinnitus patients. Psychological characteristics of individuals high and low in their ability to cope with tinnitus. Psychological dimensions in patients with disabling tinnitus and craniomandibular disorders.
Tinnitus Reaction Questionnaire: Psychometric properties of a measure of distress associated with tinnitus.
Brazilian Portuguese language version of the Tinnitus Handicap Inventory: Validity and reproducibility.
Validation of the German-version Tinnitus Handicap Inventory (THI) Psychiatr Prax 34(1):140-142, 2007. Ginkgo biloba does not benefit patients with tinnitus: A randomized placebocontrolled double-blind trial and meta-analysis of randomized trials. An investigation of the audiological handicap associated with unilateral sudden sensorineural hearing loss. Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy. Tinnitus questionnaire was then administered, followed by the Kannada version of THI on 140 patients and total scores were obtained.
The diagnosis and rational management of tinnitus is one of the legacies of the past millennium, which the medical profession has carried unsolved to this century2. Initially, the self-assessment tool assesses the severity of symptoms and provides objective data about the severity of the symptomand later, the evaluation allows investigators to accurately assess and compare the pre-treatment and post-treatment periods. THI is a method of quantifying the impact that tinnitus has on an individual's daily living conditions. The translated form of the inventory was given to 50 native Kannada speakers who were exposed to Kannada language or had first language as Kannada, who were able to read and write Kannada, for the content validation.
Individuals with any significant neurological history, history of psychiatric or psychological counseling with regard to their tinnitus were excluded from the study. Under the functional subscale, 30% of responses were for YES and 50% of responses were for NO and 20% of responses were for SOMETIMES. 38% of patients fall under the category of mild, 26% of patients fall under the category of Moderate, and 16% fall under the category of severe and 6% fall under the category of catastrophic group which is represented in Graph 2.
Also a comparative study was carried out between the English version of THI and the Kannada version of THI. The quality and intensity of tinnitus can affect daily routine of an individual which have an effect on the individual's psychological functioning7. The catastrophic aspect of Kannada THI allows identification of negative sensations produced by the tinnitus in the patient's lives such as intolerance, loss of control of the sensation. The English version of THI is currently used by most of the audiologists and otorhinolaryngologist to find out the severity of the problem in different patient population and found to be difficult to administer on native speakers of Karnataka. The recruited subjects for this research presented changes in their Quality of Life (QL) as regards to the functional, emotional and catastrophic aspects due to tinnitus. The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity.
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.
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 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. The Tinnitus Handicap-Support Questionnaire [1,7], the Tinnitus Effect Questionnaire [8], and the Tinnitus Severity Questionnaire [9] are measurement tools in the English literature, but they have no (or low) internal consistency reliability and low test-retest reliability.
One translator was aware of the purpose of the study and the concepts involved in the instrument: to obtain a better idiomatic and conceptual-rather than literal-equivalence between the two versions of the inventory and to render the intended measurement more reliable. We made an inspection of the percentage of subjects responding "yes," "sometimes," or "no" to individual questions.
Total scale scores, Pearson's correlation coefficients (r), and ICCs for three subscales are shown in Table 7.
Patients with tinnitus generally live with their problem for long periods of time; thus, they want to know their symptom's quality or intensity.
On the basis of our study results, we found the first Turkish version of the THI to be a measure that is acceptable, reliable, and valid for evaluating tinnitus in patients.
The Hearing Handicap Inventory for Adults: Psychometric adequacy and audiometric correlates.
Functional status and well-being of patients with chronic conditions: Results from the Medical Outcomes Study.
Brazilian- Portuguese validation of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer.
In JM Aran, R Dauman (eds), Tinnitus 91: Proceedings of the Fourth International Tinnitus Seminar. 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. 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. 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. Objective: To determine the handicap caused by dizziness in patients associated or not with tinnitus complaint. They may require assistance for simple tasks that were previously performed normally in their lives (3). Objetivo: Determinar o handicap em individuos com tontura associada ou nao a queixa de zumbido.
Assim, o uso do DHI brasileiro, mostrou ser um instrumento util e valioso na rotina clinica.
Eles podem requerer assistencia para simples tarefa que antes executavam normalmente em suas vidas (3). Of the 72 patients, 93% (67) reported consequent changes in their lifestyle, 56% (40) reported effects on their general health, and 70% (50) reported emotional difficulties [26-29]. House [36] stated, in this regard, that the perception of tinnitus could be determined by specific personality characteristics, a viewpoint shared by other authors as well. The TRQ is based primarily on data provided by Tyler and Baker [25] and on that from the aforementioned TEQ, THQ, and TSS. Each item is made up of a statement that the subject can rate on a Likert scale with three alternative assessments: 0 (no), 2 (sometimes), and 4 (yes).
The THI was also the main instrument employed in the study of the effects of an acoustic prosthesis on tinnitus, which evaluated 34 patients affected by tinnitus and hyperacusis and using a hearing aid for the first time [65].
The THI beta version is the one currently being used and is the object of our work (Table 1). Each item is made up of a statement that affected subjects can rate on a Likert scale with three gradations: 0 (no), 2 (sometimes), and 4 (yes). We also computed Pearson's product-moment correlations between the THI and the three subscales (Table 3). Each question is easily and precisely formulated and allows time for the responders to reflect on the actual impact of the symptom on their everyday life situations, unlike a standard interview.
The scale that appears to be most independent of the others is the catastrophic scale; however, the low number of items in this scale should be taken into account. In Aran JM, Dauman R (eds), Tinnitus 91-Proceedings of the Fourth International Tinnitus Seminar. In Aran JM, Dauman R (eds), Tinnitus91- Proceedings of the Fourth International Tinnitus Seminar.

The THI was developed by the British Association of Otolaryngologist, Head and Neck surgeons, which consists of 50 questions6. The speakers were given a five-point rating scale to grade the items from very familiar to non-familiar. A score of 4 was given for YES and a score of 0 was given for NO and a score of 2 was given for SOMETIMES. The overall Cronbach alpha score of both the THI versions and the individual scores for all the three subscales in both the versions were compared. From the current study, it is clear that the Kannada version of THI is readily available, easy to understand and is a reliable tool for measuring the handicap occurring due to tinnitus. 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. We assessed the internal consistency and reliability of the Turkish version by Cronbach's alpha. Additionally, these evaluations quantify the effects of tinnitus on functional, emotional, and social life. The original Tinnitus Handicap Inventory (THI), developed by a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, consists of 50 questions [10]. The other translator was unaware of the translation objective, and this was useful in eliciting unexpected meanings from the original tool. We assessed internal consistency coefficients (ICCs) for all three subscales: emotional, catastrophic, and functional.
Item 21 had the greatest contribution-the emotional subscale-because of its highest item-total correlation score.
This preliminary version of the THI is able to detect the quality of the tinnitus symptom and its impact on patients' daily lives and psychosocial functioning, in addition to registering satisfaction with treatment. 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. 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.
Material and Method: A Dizziness Handicap Inventory (DHI) questionnaire was applied fro 27 subjects, aging from 17 to 78 years, suffering from dizziness for at least 6 months. Casuistica e Metodo: Foi aplicado o questionario Dizziness Handicap Inventory (DHI) em 27 individuos, entre 17 e 78 anos, com queixa de tontura ha pelo menos 6 meses.
Esses achados podem hoje ser avaliados a partir do emprego de inventarios de handicap.O handicap pode ser entendido como as consequencias sociais da incapacidade, tal como a dificuldade de trabalhar devido a dependencia de dirigir causada pela vertigem (4).
In any case, it is necessary to have an initial basic measurement backing up the clinical audiological evaluation and indicating the degree of tinnitus impact on the sufferers' quality of life.
Each of the instruments described are meant to evaluate the direct effects of tinnitus on hearing and on function in terms of disability level.
The Tinnitus Handicap Inventory (THI) [46] is a questionnaire made up of 25 items divided into three subscales: functional, emotional, and catastrophic. The score of each scale is the sum of the answers to the items that constitute the scale itself. The author stated that both questionnaires are easily used and can be completed quickly -in about 5-15 minutes for the TQ and 10 minutes for the THI-and that directions for operator's use are rather simple, though the THI shows some advantages in terms of reproducibility because it is not subject to copyright. It consists of 25 items, as a result of a selection made from the previous 45, item selection being unaffected by age, gender, and hearing level. For our purposes, we considered audiological data gathered by means of half-octave tonal liminal audiometry and impedanciometry. Subjects were told to read each question carefully and to answer by choosing one of the three possible answers-yes, no, and sometimes- without skipping any question. A Student's t-test for independent samples was used to detect differences between women and men regarding the perception of tinnitus distress (Table 4). Our choice is supported by the results of the test-retest performed on the questionnaire, which corroborated its validity and solidity as a measuring instrument. Later, a modified beta version with 25 questions was developed by Newman et al.5 which is in the form of a self-assessment report that a person suffering from the condition can fill in. In such circumstance administering these inventories becomes difficult and sometimes impossible too.
Later, all the 50 filled inventories were assessed to find out if all the words and the meaning of the questions were understood by the Kannada speakers.
Once the subject finished rating the questions, they were grouped under 5 categories based on the severity that is Slight, Mild, Moderate, Severe and Catastrophic. A validated THI in Filipino can also be used by these Filipinos abroad who prefer to answer questionnaires in their native language. Because the items having high item-total correlation were considered more representative of the scale's content, all itemtotal statistics were reported and are shown in Table 4. 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. 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.
Results: 41% and 33% of the subjects presented a mild to moderate degree of handicap, with physical and functional aspects proportionally equal. The handicap may be seen as the social consequences of incapacity, such as the difficulty to work due to the dependence to drive caused by dizziness (4).
Resultados: 41% e 33% dos individuos avaliados encontraram-se na faixa leve e moderada do handicap, respectivamente, estando os aspectos fisico e funcional em proporcoes iguais.
Assim, a literatura tem mostrado que o handicap pode ser maior ou menor a partir das caracteristicas da lesao vestibular (5,6,7), pela duracao e intensidade dos sintomas fisicos (3,8), assim como o estilo de vida, expectativas, motivacoes e estado psicologico de cada um.E bastante forte a relacao entre a vertigem e as desordens psicologicas em adultos e idosos (9, 10, 11, 12, 13, 14). The THI has been widely employed at an international level in clinical contexts, both to evaluate the subjective perception of handicap level and to measure the outcomes of treatments [47-51]. Perhaps this is the reason for the frequent choice of the THI by several work teams in recent years. We had the questionnaire translated a first time by a bilingual translator; since then, the translated test has been back-translated into the original language to guarantee that the author's scope was respected for each question.
The self report has been developed subsequent to previous studies that have thrown up reliable data that can be used to classify tinnitus into different grades according to the degree to which the tinnitus has affected a subject.
As this inventory quantified the alterations of the daily life of an individual due to tinnitus and due to the non capability of multilingual Speech & Hearing professionals to translate accurately the English version of THI to the regional languages and to avoid communication interpretation, there is a need to develop and standardize the Tinnitus Handicap Inventory in Indian languages. The questions which were rated as 1 or 2 were selected for the inventory and any questions with ratings over 3 were re-framed according to the familiarity of the speakers.
All the participants underwent assessment by an otorhinolaryngologist and complete audiological evaluation prior to the administration of the inventory.
Two (3 per cent) showed a unilateral mixed hearing loss and seven patients had bilateral conductive hearing losses. We assessed construct validity by analyzing the patients according to their age and to tinnitus duration.
These findings indicate that the Turkish version of the THI has good stability in the test-retest trial to assess the clinical change. 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.
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. 16 out of the 27 (59.2%) subjects referred associated tinnitus complaint, and the presence of this symptom influenced the DHI score. Therefore, medical literature has shown that the handicap may be higher or lower according to the features of the vestibular lesion (5,6,7), to the duration and intensity of physical symptoms (3,8), as well as to the life style, expectations, motivations and psychological state of each subject.The relation between dizziness and psychological disorders in adult and elderly subjects is very strong (9,10,11,12,13,14). Dos 27 individuos portadores de tontura, 16 (59,2%) referiram zumbido e a presenca desse sintoma influenciou na pontuacao do DHI.
Ha uma alta proporcao de pacientes otoneurologicos que apresentam disturbios psicologicos (15). The main factor is relevant to the social and emotional spheres and to problems of sleep and rest.
This scale refers to the reactions of people interacting daily with tinnitus sufferers; therefore, rather than assessing the sufferers themselves, it is an additional instrument for the evaluation of how relatives, friends, and colleagues support or interact with sufferers. The test has, indeed, been translated and validated into Danish, Spanish, Korean, Brazilian Portuguese, and German. According to Dobie [54] as well, both the TQ and the THI are likely to become common instruments for any work team involved in the diagnosis and treatment of tinnitus [55,56].
THI consists of 25 questions under the 3 sub-scales of emotional, functional and catastrophic.
Internal validity was tested by multi-item analysis, to assess item convergence and discriminant validity. The THI, beta version, is the most standardized tinnitus handicap- measuring tool in the literature (Table 1). One of them was a medical doctor, and the other was a chiropractor; however, both were unaware of the content and original wording of the THI. Three days after the first investigation, the inventory was answered again by randomly selected patients. 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.
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.
Variables such as intensity and type of dizziness, presence of neurovegetatives symptoms, gender and age were not significant for DHI score, just as the findings of vestibular evaluation. There is a high proportion of otoneurological patients that demonstrate psychological disorders (15). The second factor refers to hearing capacity, and the third covers patients' opinions on tinnitus. Considering the growing interest in tinnitus in Italy, our study objective was to work at the cultural adaptation of the questionnaire to the Italian language and to its validation.
Unfortunately, neither of the two questionnaires takes into consideration the presence of hyperacusis as an accessory phenomenon, though the relevant literature states that some 40% of tinnitus sufferers report this symptom as well.
The final score obtained is directly proportional to the impact of tinnitus on the sufferer's life.
Tinnitus is perceived even in the presence of environmental sound; however, daily activities are not impaired. The THI beta version is one of the best and most standardized tinnitus measuring tools and has got a good reliability, validity and a good internal consistency to administer on tinnitus patients. An expert team composed of one of the investigators and a bilingually experienced translator reviewed the preliminary version of the THI. We calculated Pearson correlation coefficients for total item score and score for three subscales and ICCs.
To evaluate the regularity of the saccadic movements, we used the normal ranges of the following parameters: latency, accuracy, and velocity of movement.
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.
Conclusion: Balance evaluation may detect vestibular disorders but it cannot study its influence in the quality of life. It demonstrates adequate reliability-validity and has good internal consistency, reliability, and convergent and construct validity.
Construct validity was assessed by separating the patients into three groups according to their age and to tinnitus duration.
It is also useful to calculate the efficient of multiple determination (R2) by using multiple linear regression to understand the importance of an item. 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.
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. So, the use of DHI may be an useful and valuable complementary tool at daily dizziness clinic. The Turkish version of the THI is a highly consistent and reliable measure that can be used in evaluating symptoms in tinnitus patients. Internal validity was tested by multi-item analysis to assess item convergence and discriminant validity. In this approach, one of the items is taken to be a dependent variable whereas others are taken to be independent variables. 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. 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. We asked them whether they had any difficulties in understanding the questions or had any comments regarding the content or layout of the inventory.
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). According to the answers obtained from the interview and face validity test, we performed minor alterations, and our Turkish version of the THI was finalized.
When an item was deleted, Cronbach's alpha for that item did not change, except for items 2, 15, and 19. Criteria for decision making in improper quality of each translation items was the average score less than 90 (determined by translators 3 and 4).
Therefore, it can be concluded that all items indicated high internal consistency (Cronbach's alpha scale, 0.886). Accordingly, in this step, Persian version of the THI was obtained, which regarding to all translators 1 to 4, had satisfactory quality. The vectoeletronistagmography VN 116 BERGER has been used, with three register channels and the otocalorimeter OC 114 BERGER for the performance of the caloric tests.After that, the Dizziness Handicap Inventory (DHI) has been applied, which has been developed by Jacobson and Newman (1990) (16) and translated to Portuguese by Castro (2003) (7). Such material is made of an auto perception questionnaire which evaluates the dizziness associated to the incapacities and handicap in the three areas of a patient's life: Physical, functional and emotional. The spontaneous nystagmus has been absent with open eyes, and with closed eyes it has been presented in 10 subjects, but its direction and velocity have been within the normal standards.The results found on the NSE, RP and NO research have been within the adopted normal standards, as well as the symmetry of the directional preponderance of the nystagmus in the PRPD. One subject presented labyrintic preponderance > 33% and another presented hyperrflexy in total value on his left ear.
It has not been possible to obtain the Jongkees Rate in two subjects due to the intensity of the neurovegetative symptoms presented in the warm tests, but its responses were found normal. Seus valores foram relacionados com o DHI brasileiro conforme visto a seguir (Tabela 5).DISCUSSAOPodemos observar pela amostra que a idade parece ter sido um fator que contribuiu para o aumento da frequencia dos sintomas vestibulares. E visto que a literatura mostra ser mais frequente no sexo feminino e acomete mais as pessoas adultas e idosas (21,22,23).Apesar da prevalencia de mulheres e maior numero de pessoas entre 42 e mais de 61 anos de idade na casuistica avaliada, essas variaveis por si so nao estao relacionadas com o aumento do handicap. Their values have been related with the Brazilian DHI according to the following table (Table 5).DISCUSSION According to the sample, it can be observed that age must have been a factor that contributed for the increase of frequency of vestibular symptoms. Os dados analisados estao de acordo com a literatura, que tambem nao encontraram nenhuma relacao entre sexo e idade com a severidade das incapacidades (3,11,24,25,26).Dessa forma, podemos pensar que a idade, analisada como um fator isolado nao contribui para o aumento do handicap, porque, muitas vezes, a concomitancia da tontura com outros sintomas ou enfermidades para uma pessoa idosa nao trara grandes repercussoes no seu dia-a-dia, por ter uma vida menos ativa ou por nao estar mais atuando profissionalmente. The medical literature demonstrates that it is more frequent in female subjects and affects more adult and elderly people (21,22,23).Despite of the higher number of women and of people between 42 and over 61 years old in the investigation, those variables are not related to the increase of handicap. O fato da amostra apresentar maior pontuacao nos aspectos fisicos e funcionais da tontura, seguido do aspecto emocional, corrobora com a literatura, em que foi observado comprometimento maior nos aspectos fisicos nos grupos de vertigem posicional paroxistica benigna (VPPB) e nos aspectos fisicos e funcionais nos grupos com Doenca de Meniere (26).Ao analisar a presenca do zumbido, podemos observar que este foi um fator que chamou a atencao para a contribuicao do handicap para tontura nestes sujeitos, apesar de nao ser significante.
The analyzed data are in accordance with the medical literature, which have not found any relation between sex and age with the incapacities severity (3,11,24,25,26).
Em uma amostra com maior numero de individuos, talvez esse resultado possa se mostrar diferente.E importante ressaltar que os sujeitos que foram classificados como portadores de handicap de grau leve, faixa compreendida entre 26 e 50 pontos, estavam distribuidos de forma nao uniforme entre os que tem zumbido (n=6) e os que nao tem (n=2). Por outro lado, os 3 sujeitos com DHI brasileiro de grau severo, apresentaram zumbido e tontura associados, enquanto que nao foi encontrado nenhum sujeito nessa faixa de handicap que tivesse zumbido.Talvez estes dados nos facam pensar na contribuicao da uniao de dois ou mais sintomas para o aumento das incapacidades, refletindo na qualidade de vida dos individuos. The fact that the sample presents a higher punctuation in the physical and functional aspects of dizziness, followed by emotional aspect, corroborates with the medical literature, in which a higher modification in the physical aspects in the groups of benign paroxistic positional dizziness and in the physical and functional aspects in the groups with Meniere Disease (26) have been observed.As the presence of tinnitus is analyzed, it can be observed that this has been a factor that called the attention for the contribution of the handicap for dizziness in those subjects, although it has not been significant. In a sample with a higher number of subjects, such result may be different.It is important to pint out that the subjects that have been classified as holders of mild handicap, between 26 and 50 points, were distributed in a not even way among the ones who have tinnitus (n=6) and the ones who do not have it (n=2). On the other hand, the 3 subjects with Brazilian DHI with severe degree presented associated tinnitus and dizziness, while no subject under this handicap range holding tinnitus has been found.Those data may make us think about the contribution of the union of two or more symptoms for the increase of incapacities, reflecting on the life quality of the subjects. A higher emotional suffering is common in patients with complaints of three or more symptoms.The medical literature has demonstrated that the tinnitus itself brings handicap to the lives of the subjects (27,28). Depending on what the subject does during their day-by-day, the functioning of the vestibular system needs to be harmonic between the years.
In one study, it has been observed that patients with DPVS presented higher harm on life quality in the functional aspects to the Brazilian DHI application, in relation to IPVS patients.
No harm has been found on the life quality significantly associated with the vestibulometry findings. O grau de prejuizo nestas areas, muitas vezes, contribui no comparecimento do paciente ao consultorio e nos faz entender porque existem pessoas com labirintopatia que procuram tratamento e outras nao. This way, all the symptoms that follow dizziness, as well as the handicap profile and its incapacity analysis, will suffer some kind of interference according to their life style, to their expectations, motivations and psychological situation.
Talvez a aglutinacao de tais procedimentos na rotina clinica forneca dados mais apurados que nos permitam a definicao da melhor conduta e aconselhamento com o paciente vertiginoso.A insercao dos questionarios na rotina clinica auxilia, entre outras coisas, na diminuicao da discrepancia que ocorre no parecer do profissional e do paciente. That is why the description of a dizzy patient is very particular, once it gathers all those variables and even the role that the subject has at work, at home and in society.Because of that, we realize the importance of handicap questionnaire in clinics practice, once the clinical exam and vestibulometry are not enough to investigate the functional and emotional parts of dizziness. Many times the harm degree on those areas influences in the patient's attendance to the doctor's office and makes us understand why there are some labyrintopathy patients that look for treatment and some that do not. Apesar da experiencia clinica mostrar que a vertigem pode acarretar consequencias psicossociais, nao ha na literatura nacional muitos trabalhos que tratem desta questao com mais detalhes, como ocorre com a perda auditiva, em que existem varias pesquisas referentes a este assunto.
Maybe the agglutination of such procedures in the clinic routine provides more specific data which allow the definition of the best behavior and counseling with the dizzy patient.The introduction of questionnaires in the clinical routine aids, among other things, the reduction of discrepancy found in the doctor's and patient's opinion. Evaluation of health-related quality of life in individuals with vestibular disease using disease-specific and general outcome measures. Evaluation of health-related quality of life in individuals with vestibular disease using diseasespecific and general outcome measures. The effect of severity of unilateral vestibular dysfunction on symptoms, disabilities and handicap in vertiginous patiens. Prevalence and presentation of dizziness in a general practice community sample of working age people. Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study.
A longitudinal study of symptoms, anxiety and subjective well-being in patients with vertigo. McKenna L, Hallam RS, Hinchcliffe R.The prevalence of psychological disturbance in neuro-otology outpatients.
Tipos de zumbido e sua influencia na vida do paciente: estudo em uma populacao ambulatorial. Interferencia da tontura na qualidade de vida de pacientes com sindrome vestibular periferica. Specialist degree (Speech Doctor graduated at PUC-SP, specialist on Audiology graduated at IEAA responsible for the Otoneurology and Audiology department of the PROMUR Institute)2. PhD (Assistant Professor at Faculdade de Fonoaudiologia da PUC-SP (Speech Therapy College) and professor at IEAA.3. PhD (Doctor on Human Communication Disorders and titular professor at the Speech Therapy College of PUC-SP)4.

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