The serum zinc level in patients with tinnitus and the effect of zinc treatment

We measured the serum zinc level in patients with tinnitus and evaluated the effectiveness of zinc in the treatment of tinnitus. Blood zinc levels were measured in 121 patients with tinnitus. All patients were examined between 1995 and 1997 at the outpatient clinic of otorhinolaryngology St. Marianna University Toyoko Hospital. Forty-seven patients who had received any drug such as a calcium channel blocker and others or had been affected by any diseases were excluded and therefore 74 patients consisting of 46 females (62%) and 28 males (38%) were investigated. Twenty two healthy volunteers served as a control group. The mean age and standard deviations for the tinnitus group and the control group were 47.8 +/- 17.1 and 31.4 +/- 8.2 years, respectively. There was a significant decrease (p < 0.0001) in serum zinc levels in patients with tinnitus compared with the control group. Because there was a significant difference (p < 0.0001) in age distribution between tinnitus and control groups, patients were selected by their age in order to neglect the effect of aging. In this situation, a significant difference (p < 0.01) was noted between the tinnitus group and control group. Low blood zinc level was defined by using the mean and standard deviation for the control group (mean-1 S.D.). We treated patients with low blood zinc levels. A total dose of 34-68 mg of Zn++ was administered daily for over 2 weeks. The degree of tinnitus was expressed on a numeric scale from 0 to 10 before and after treatment. Blood zinc levels were significantly elevated (p < 0.05) after treatment. We found a significant decrease (p < 0.01) in the numeric scale. These findings suggest that zinc is useful in at least some patients suffering from tinnitus. It is possible to classify patients with tinnitus by measuring serum zinc level and this leads to improvement of the overall treatment effect.     

Acupuncture worth trying in severe tinnitus

The article consists in a report of a study of 22 patients with disabling tinnitus, performed to elucidate the effects of a 3-month course of acupuncture (15 treatments) on the severity of tinnitus and on quality of life (QOL), as compared with those of individualised physiotherapy. The study was designed as a prospective, randomised, cross-over study with a follow-up period of one year after the final treatment. Treatment effects were evaluated in terms of the patients' VAS (visual analogue scale) ratings and answers to questionnaires, including the NHP (Nottingham Health Profile), regarding the impact of tinnitus on different aspects of QOL. Baseline NHP scores showed tinnitus patients to manifest pronounced depressive characteristics. Acupuncture was found to yield immediate relief, both in terms of loudness and disturbance of the tinnitus, and significant improvement in QOL (NHP) for three months after the conclusion of treatment. Although many patients in the subgroup with concurrent muscle tension reported beneficial effects of individualised physiotherapy, such treatment yielded no significant reduction of tinnitus loudness or disturbance due to tinnitus, and no improvement in NHP scores. In both treatment groups, however, both annoyance due to tinnitus and QOL scores had returned to pretreatment levels at one-year follow-up. Thus, the results suggest tinnitus patients to manifest depressive characteristics, and that acupuncture may yield temporary improvement in terms of tinnitus relief and QOL.     

Effects of relaxation therapy as group and individual treatment of chronic tinnitus

42 patients, suffering from chronic tinnitus, participated in our psychological orientated treatment consisting of relaxation therapy with autogenic training according to J. H. Schultz. The results of individual therapy are compared with group therapy. Using visual analogy scales the therapeutical efficiency can be tested. The individual estimated loudness and annoyance of tinnitus are registered as well as a general emotional status. The results show a positive short-time effect in most cases. A reduction of tinnitus loudness and annoyance after individual and group therapy is seen directly. A positive effect throughout the whole treatment is only found in individual therapy. Concerning the group therapy, many of our patients reported an increase of the pretherapeutical estimation of tinnitus loudness and -annoyance. We believe that the permanent confrontation with the tinnitus problem may advance the psychological conflict in many cases. Therefore psychological management of tinnitus should be concentrated on a temporary limited support aiming to the neglect of tinnitus sensation.     

Biofeedback-based behavioral treatment for chronic tinnitus: Results of a randomized controlled trial.

Many tinnitus sufferers believe that their tinnitus has an organic basis and thus seek medical rather than psychological treatments. Tinnitus has been found to be associated with negative appraisal, dysfunctional attention shift, and heightened psychophysiological arousal, so cognitive-behavioral interventions and biofeedback are commonly suggested as treatments. This study developed and investigated the efficacy of a biofeedback-based cognitive-behavioral treatment for tinnitus. In total, 130 tinnitus patients were randomly assigned to an intervention or a wait-list control group. Treatment consisted of 12 sessions of a biofeedback-based behavioral intervention over a 3-month period. Patients in the wait-list group participated in the treatment after the intervention group had completed the treatment. Results showed clear improvements regarding tinnitus annoyance, diary ratings of loudness, and feelings of controllability. Furthermore, changes in coping cognitions as well as changes in depressive symptoms were found. Improvements were maintained over a 6-month follow-up period in which medium-to-large effect sizes were observed. The treatment developed and investigated in this study is well accepted and leads to clear and stable improvements. Through demonstration of psychophysiological interrelationships, the treatment enables patients to change their somatic illness perceptions to a more psychosomatic point of view. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cathepsin G and alpha 1-antichymotrypsin in the local host reaction to loosening of total hip prostheses

Although it is well known that asthma is influenced by psycho-social factors, the present medical system does not take any measures to deal with these underlying factors. Many physicians are unable to assist patients with psycho-social problems due to the lack of time they are allowed for each patient. We have employed a variety of psychological test scales to assist in screening patients. As a result, we found that many severe asthmatics lack enthusiasm for therapy, possess pessimistic feelings toward their prognosis. They also have personality traits of extroversion in combination with psychological instability, which may given them problems of compliance, while some manifest a tendency to flight to illness. These factors may lead to further difficulty in treatment, including steroid dependency and death from asthma. Early intervention must be contemplated to prevent such outcomes.     

Systemic levels of 6-keto-prostaglandin F1 alpha following administration of inhaled aerosolized prostacyclin

Tinnitus is sometimes suppressed by cochlear implantation. Tinnitus conditions were examined in 60 adult patients who underwent cochlear implantation in 1990 or later. Before surgery, 90% of these patients reported some type of tinnitus. The patients completed a questionnaire evaluating the loudness and duration of the tinnitus, immediately after the first electrical stimulation and 2 months later. The loudness of tinnitus was suppressed in 65% of the patients at first evaluation. Two months later, the tinnitus was suppressed in 93% of the patients. As for the duration of tinnitus, at first evaluation the tinnitus duration was suppressed in 41% of the patients. Two months later, the duration of tinnitus was suppressed in 61% of the patients.     

Psycho-social aspects of serious renal disease and dialysis: a review of the literature

The most severe form of kidney disease is renal failure, a life-threatening condition known as end-stage renal disease (ESRD). Though social work intervention is an integral part of the response to serious kidney disease, the topic has been noticeably absent in the discipline's literature. This article synthesizes the research on the psycho-social aspects of end-stage renal disease, with a particular focus on dialysis patients at different stages of the life cycle. Social work services are particularly important to dialysis patients because (1) ESRD influences patients' psycho-social environments and (2) the psycho-social environments in which ESRD sufferers live impact the course of the disease and physical well-being. Intervention issues are discussed. The review found that most research on this topic lacks adequate sampling to generalize to the ESRD population. Future research needs to address this shortcoming and increase sample sizes to allow for statistical controls.     

Characteristics of tinnitus induced by head injury

OBJECTIVE: To determine if the characteristics of tinnitus produced by head trauma are specific and exclusive when compared with other origins of tinnitus. DESIGN: Retrospective study using clinic test results and data from the Tinnitus Data Registry compiled from questionnaires, interviews, and testing. Tinnitus produced by head injury was compared with tinnitus of mixed origins, including no known origin. SETTING: A tinnitus referral clinic where all patients must see an otologist or an ear, nose, and throat physician prior to attending the clinic. PATIENTS: All patients had severe to moderately severe constant tinnitus and presented with tinnitus as the primary symptom. RESULTS: No exclusive characteristics were found to describe head injury-induced tinnitus. The tinnitus for the group with head injury was statistically significantly (P = .004) louder and occurred with greater incidence of continuing pain in the ears. The group with head injury also had more episodes of dizziness and a more severe form of tinnitus. However, no marked difference was noted in pitch of tinnitus, complexity (number of sounds) of tinnitus, or the minimum masking level. CONCLUSIONS: This retrospective study found that tinnitus induced by head injury was significantly (P = .004) louder than tinnitus induced from other causes but, interestingly, did not require higher levels of masking. The patients with head injury-induced tinnitus more frequently (P = .0003) displayed residual inhibition although the duration of residual inhibition was not different from that of the comparison group. Other symptoms associated with the tinnitus onset were more frequently mentioned by the group with head trauma-induced tinnitus, except for the condition of pressure sensation in the ears. Using a severity questionnaire, the group with head trauma-induced tinnitus rated their tinnitus as being more severe than did the comparison group. However, such things as pitch of the tinnitus, masking level, acceptance of wearable maskers, general hearing level, and complexity of the tinnitus did not distinguish the two groups.     

The effect of traditional Chinese acupuncture on severe tinnitus. A double-blind, placebo-controlled clinical study with an open therapeutic surveillance]

The aim of the present study was to determine the effect of intensive acupuncture on severe tinnitus. The structure of the study was a randomized, double-blind, clinical investigation with open therapeutic surveillance and included 54 patients. All were subjected to 25 treatment sessions over a period of two months, each treatment lasting 30 minutes. Fifty-two patients completed the study. The variables used for self-registration were based on the Visual Analogue Scale, where annoyance, loudness and awareness of the tinnitus were assessed. These were recorded twice daily over a four month period starting one month before the first treatment and ending one month after the last treatment. Questionnaires, interviews and audiometry were carried out repeatedly. No statistically significant differences were found between the acupuncture group and the placebo group.     

A critical analysis of directive counselling as a component of tinnitus retraining therapy

Tinnitus retraining therapy (TRT) has been presented as a new approach to tinnitus management. In this paper a number of theoretical and practical problems with TRT are identified. These problems relate to the distinction between directive counselling and cognitive therapy, the adequacy of the cognitive therapy components, the nature of the outcome data which have been presented to date, the theoretical basis for the treatment, and the conceptual clarity of terms such as perception, attention and coping. The stated goal of removal of the perception of tinnitus may lead to confusion about the likely outcome of TRT for most patients. Methodological limitations in the research which has been published to date preclude any claims about the efficacy of TRT at the present time. It is suggested that randomized, controlled studies which include no-treatment and placebo conditions need to be undertaken. Studies are required in which the efficacy of the counselling and white noise components can be clearly isolated. Suggestions are made about the role of psychologists and non-psychologists in the provision of counselling and cognitive therapy services to tinnitus patients.     

Effect of intrathecal morphine on blood glucose, glucagon and tissue glycogen in rat: comparison with the effect of xanthan gum on blood glucose

Eleven patients suffering from chronic disabling tinnitus underwent an FDG-PET study (positron emission tomography with [18F]deoxyglucose). Nine tinnitus patients revealed a significantly increased metabolic activity in the left, 1 in the right primary auditory cortex (PAC, Brodmann area 41). These results were statistically significant when compared to 14 healthy control individuals without tinnitus. A negative result was obtained from a chronic tinnitus patient but who had no subjective complaints during the period of PET investigation. One patient was first investigated during a disabling tinnitus period, later during a period with tinnitus relief and again when suffering from severe tinnitus. The metabolic activity of his left PAC was in good accordance with the subjective degree of tinnitus complaints present during each PET investigation. Although for the first time these results give objective evidence of tinnitus sensation and localization, they are difficult to interpret because of the limited research data available that combine functional brain imaging and acoustic stimuli.     

Wegener''s granulomatosis presenting as a recurrence of chronic otitis media

INTRODUCTION: Tinnitus is still one of the most frequent symptoms encountered by the otorhinolaryngologist. Diagnosis and therapy present high demands due to the complex etiology and secondary symptoms. PATHOPHYSIOLOGY: In contrast to objective ear ringing with a physical sound source near the ear, tinnitus is faulty coding within the auditory system. Damage due to all kinds of causes can lead to a change of spontaneous activity in the auditory system. The result is a subjective auditory impression which is increased by further learning processes. DIAGNOSTICS: The aim of otorhinolaryngologic and especially audiologic diagnostic studies is to find the cause of the tinnitus. Modern methods for the objectivation of tinnitus are still experimental. The psychosomatic diagnostic studies evaluate secondary symptoms. THERAPY: Acute tinnitus is treated like sudden deafness. For chronic forms, the analysis of the causes is particularly important for developing an individual consultation and therapy plan. Providing information of the patient is the first step for a sensible treatment of the symptoms. The retraining therapy represents a learning process to reduce subjective symptoms, inconvenience, and loudness. Supportive therapy includes the use of instrumentation and medication. CONCLUSION: Acute tinnitus is often curable. However, only palliative treatment is available for chronic tinnitus. The otorhinolaryngologist plays a crucial role in the management of the disorder.     

Distortion products in normal hearing patients with tinnitus

Otoacoustic emissions are the result of cochlear active non-linear micromechanical mechanisms which probably originate within the OHC. OAE findings in patients with tinnitus are not univoque and there is no clear correlation between OAE modifications and tinnitus. We investigated distortion products in 20 normal hearing patients with tinnitus; all patients were selected with restrictive criteria (audiogram within 20 dB for all the frequencies, ABR and other tests normal, no history of ototoxic, nootropic drug intake, normal psychological evaluation, etc.). 12 patients out of 20 (60%) showed DP alterations. This finding is interpreted as an abnormality or a dysregulation of the efferent system (olivo-cochlear pathways) or of the other structures of the control loop which could modify outer hair cell activity in an otherwise normal cochlea with the development of tinnitus.     

The tinnitus intensive therapy habituation program: A 2-year follow-up pilot study on subjective tinnitus.

Objectives: To explore the effects of a new tinnitus treatment program (tinnitus intensive therapy [TIT]) based on auditory perception principles and neural habituation. Methods: A follow-up study with measurement of treatment effects every third month over a 2-year period in which the cases were their own controls. Participants: There were 25 participants with a mean age 50.1 years (SD = 16.1); 10 women (52.7 years; SD = 16.8) and 15 men (48.3 years; SD = 15.9). The participants were recruited from clinical population admitted to a polyclinic tinnitus treatment program in western Germany. Results: There was a significant reduction of tinnitus in the follow-up period. Mean baseline tinnitus scores (Tinnitus Fragebogen; Goebel & Hiller, 1998) at the start of the treatment were 50.9 (SD = 14.5) and the final scores were 14.2 (SD = 5.9). In total, the clinical improvement over the follow-up period was 72.1%. Conclusion: The TIT program showed a significant clinical treatment effect and should be tested further in a multicenter treatment project. The findings support the Jastreboff habituation model of tinnitus, but social cognitive factors should also be taken into account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tinnitus and ECT

We report the case of a 69-year-old man with major depressive disorder and occupational tinnitus; both problems were refractory to several different treatment modalities, but were successfully treated with electroconvulsive therapy (ECT). The tinnitus was present for 15-20 years, but had worsened during the 3 years before treatment, causing him significant distress. Extensive organic workup did not identify a treatable etiology for his symptoms. To date, he has been hospitalized four times due to depressive symptoms associated with tinnitus. He has received ECT each time, and has responded well on each occasion.     

Association between tinnitus and somatoform disorders

Pathophysiological mechanisms are often unknown in patients suffering from "idiopathic" tinnitus, and the presence of other unexplained physical symptoms such as those seen in somatoform disorders can be assumed. This study investigates how often tinnitus exists in general medical out-patients with and without somatoform disorders. In an international study initiated by the World Health Organization (WHO), 1275 patients from 12 participating centers located in 11 different countries were examined by means of the WHO Somatoform Disorders Schedule. The overall prevalence of unexplained tinnitus was 11%; however, tinnitus was clearly more frequent among patients with somatization disorder (42%) or hypochondriacal disorder (27%). It was also more frequent than a great number of other symptoms considered to be typical of somatoform disorders. Tinnitus was also related to depression, anxiety, and to symptoms indicating autonomic arousal. Three possible conclusions are discussed: (i) tinnitus may be a somatoform symptom; (ii) the findings may indicate a substantial comorbidity of two different conditions; (iii) tinnitus and somatization may be linked through common mechanisms of arousal and somatic anxiety.     

The usefulness of screening for chlamydial trachomatis infection with cervical mucus leukocyte esterase

OBJECTIVE: This study was conducted to evaluate the psychological distress in patients with tinnitus that is often correlated with sleeping disorders, difficulties in concentration, and compromized social relations. METHODS: Eighty-four patients were studied using preliminary clinical and audiologic evaluations, and successive psychological tests. RESULTS: The cluster analysis indicated two essential groups composed of 45 patients (CLST-1) and 38 patients (CLST-2), respectively. The CLST-1 group had higher scores for depression, anxiety, and neuroticism. The IBQ CLST-1 revealed a greater degree hypochondria, conviction of disease dysphoria, and irritability. CONCLUSIONS: Our results indicate that the relationship between the intensity of the tinnitus and the extent of the distress is supported by the larger number of patients with more intense tinnitus in the first cluster. The CLST-2 with its normal psychological test results, apart from marked denial, would support the hypothesis of a somatic expression of the distress.     

Stimulation of heparan sulfate proteoglycan synthesis and secretion during G1 phase induced by growth factors and PMA

Pulsatile tinnitus is a disorder that can be extremely disabling. Nonetheless, it has not been well-researched in the fields of psychology or behavioral therapy. This article describes the evaluation and behavioral treatment of a gentleman with pulsatile tinnitus. The evaluation included polygraphic assessment of vasomotor and electromyographic function both before and after treatment. The results show that the combination of lifestyle modifications and specific behavioral interventions were successful in modifying not only self-report indices of functioning, but also the underlying physiology related to the disorder. The potential role of the various treatment components and the value of including polygraphic assessment for informing treatment and evaluating outcome are discussed.     

Brainstem auditory evoked responses in patients with tinnitus

Brainstem auditory evoked responses of 355 patients with uni- or bilateral tinnitus were recorded in order to evaluate the effect of tinnitus on the central auditory system. The amplitudes of waves I, III and V and the latencies of each wave and interpeak latencies were compared to those of a group of 129 controls with normal hearing. The study of the control group initially identified a certain number of concurrent parameters. The brainstem evoked responses of men and women evolved differently from the age of 30 years, latencies of I-III and I-V in men lengthening with age and those of women tending to shorten. The patient groups were therefore compared to a control group of the same sex ratio or of the same sex, half being between 30 and 56 years of age. The tinnitus patients were divided into three groups according to the side affected by tinnitus. Latencies and amplitudes in these groups differed significantly from those of the control group. In order to eliminate hearing loss, the most difficult concurrent factor and almost always associated with tinnitus, the results of individuals with symmetrical hearing loss were compared to those of the control group. Tinnitus was always associated with significant lengthening of 0-I and I-V latencies on the tinnitus-affected side, with a significant reduction in amplitudes of waves I and III, and sometimes of wave V, particularly in the group with left-sided tinnitus. Comparison of tinnitus patients with symmetrical and asymmetrical hearing by sex showed that tinnitus patients of all groups had lengthening of right and left 0-I latencies, apart from the women in the group with right-sided tinnitus, and significant reduction in amplitudes of waves I and III in women and of left III only in men. When hearing loss was asymmetrical and on the tinnitus-affected side, there was also lengthening of 0-I latencies on the tinnitus-affected side in both sexes and of ipsi- and contralateral I-V latencies in women. Right- and left-sided tinnitus was associated with additional differences between the three groups. Correlation coefficient study confirmed that 0-I, I- III and I-V latencies were independent of the mean degree of deafness, deafness at high frequencies and at frequencies around the tinnitus, up to a threshold of hearing loss of 40 dB, above which 0-I and 0-V lengthened in addition to tinnitus. On the other hand, whatever the frequency, tinnitus involved significant lengthening of wave I latencies and modification of the previously recorded amplitudes. Two groups of tinnitus patients could be distinguished: the first, with symmetrical hearing loss, with symmetrical normal latencies, apart from 0-I latencies and the amplitude of the wave on the tinnitus side, and the second with hearing loss predominant on the tinnitus-affected side, with different latencies on each side, 0-I being shorter on the unaffected side, I-III and I-V being lengthened on the unaffected side and 0-I being lengthened on the tinnitus-affected side. Moreover, as disturbances of brainstem evoked responses caused by tinnitus particularly affected waves I and III, the hypothesis of possible involvement of the efferent systems could be proposed.     

Treatment of Menière's disease with betahistine (author's transl)

Betahistine was gien to 86 patients with Meniere's disease in a thric daily dose of 8 mg. All patients except for three had earlier been treated medically without success. Symptomatic improvement occurred overall in 82,5%, including in 66% ear pressure symptoms, in 59.5% headache in 57% tinnitus, and in 35% hearing, although this latter statistically was not confirmed. The duration of administration of betahistine is therapeutically important and benefit from 4 months' continued use was demonstrated. After stopping treatment, the therapeutic effects were maintained and more than 6 months later improvement in hearing and ear pressure symptoms was still recorded. There was though a deterioration in symptoms of vertigo, tinnitus and headache in 18% over the same period. The shorter the duration of the symptoms the better the therapeutic effect gained. Improvement estimations of 81% in patients affected for up to 1 month, of 65% in patients affected from 1 to 12 months, and of 50% in patients affected more than one year were obtained. These results compare averagedly with the widely varible results of others. The management of Meniere's disease with betahistine can be regarded as an improvement in the conservative therapy of this disorder.