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.     

Psychopathological profile of tinnitus sufferers: evidence concerning the relationship between tinnitus features and impact on life

This study involving 281 French tinnitus sufferers sought to investigate possible correlations between psychopathological profile and scores obtained from three tinnitus questionnaires. The patients all completed a French version of the Mini-Mult--a shortened Minnesota Multiphasic Personality Inventory--and French translations of three questionnaires designed especially for the clinical assessment of tinnitus: Tinnitus Reaction Questionnaire (TRQ), Subjective Tinnitus Severity Scale (STSS) and Tinnitus Handicap Questionnaire (THQ). Significant correlations were found (p < 0.0001) between scores on various Mini-Mult scales and total or factor 1 THQ and total TRQ scores. No significant correlation was found between the STSS and any Mini-Mult score.     

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.     

Tinnitus. Current evaluation and management

Evaluation and management of tinnitus presents a significant challenge to the internist and the otolaryngologist. Tinnitus may be divided into two basic categories: subjective and objective. The importance of a thorough history and physical examination is emphasized in this article. The steps in a complete evaluation and the rationale for referral to an otolaryngologist are outlined. Multidisciplinary care of the tinnitus patient is best coordinated by the otolaryngologist.     

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.     

Attenuation of salicylate-induced tinnitus by Ginkgo biloba extract in rats

The effects of an extract from Ginkgo biloba, EGb 761, on tinnitus were tested using an animal model of tinnitus. Daily oral administration of EGb 761 in doses from 10 to 100 mg/ kg/day began 2 weeks before behavioral procedures and continued until the end of the experiment. Tinnitus was induced by daily administration of 321 mg/kg sodium salicylate s.c. (corresponding to 275 mg/kg/day of salicylate acid) in fourteen groups of pigmented rats, 6 animals/group. The results from salicylate- and EGb-761-treated animals were compared to control groups receiving either salicylate, saline, or EGb 761 only in doses of 100 mg/kg. Administration of EGb 761 resulted in a statistically significant decrease of the behavioral manifestation of tinnitus for doses of 25, 50 and 100 mg/kg/ day.     

Tinnitus and Hearing Loss in Hamsters (Mesocricetus auratus) Exposed to Loud Sound.

Hamsters were trained to go left and right to sounds on their left and right sides, respectively. Silent trials were occasionally given in which no sound was presented. Hamsters exposed to a loud 2- or 10-kHz tone in 1 ear often shifted their responding on the silent trials to the side of the exposed ear, suggesting that they perceived a sound in that ear (i.e., tinnitus). The degree of tinnitus was related to the degree of the accompanying hearing loss (estimated by the auditory brainstem response). However, a conductive hearing loss (plugging 1 ear) did not cause a hamster to test positive for tinnitus. Tinnitus could be demonstrated within minutes following tone exposure, indicating an immediate onset, as occurs in humans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

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.     

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)     

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.     

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.     

Neurology and psychiatry

This study examined 4,547 workers' compensation claims accepted for hearing-related conditions in Washington state between 1984 and 1991; 80% resulted in disability compensation (n = 3,660). Acute hearing-related conditions comprised 11% of accepted conditions (95% confidence interval [CI], 2-15%); most claims were for chronic noise-related hearing loss. Tinnitus was reported in 64% of accepted claims (95% CI, 54-75%). The median binaural-equivalent hearing loss in compensated claims was 12.5% (inter-quartile interval, 5-22%; 90th percentile, 34%), although it declined by 30% during the study period. The number of claims and associated impairment increased with claimant age, but the number of claims dropped dramatically after age 65. Annual total disability settlements almost tripled in 8 years, totaling $22.8 million. This study indicates that occupational hearing-related conditions: 1) are manifested by mild to moderate hearing loss, accompanied by tinnitus in a majority of cases; 2) may be under-recognized in older, formerly noise-exposed individuals; and 3) were associated with substantial increases in compensation and medical costs over time, through 1991.     

A matching-to-sample feedback technique for training self-control of tinnitus.

Treated 30 individuals (aged 24–82 yrs) with subjective tinnitus aurium with a matching-to-sample feedback procedure. Ss' tinnitus sounds were reproduced audiometrically on all characteristics and were presented to them in the noninvolved ear or in both ears when the tinnitus was binaural. This experimental sound was then reduced in 5-db steps within sessions, and Ss had the task of concentrating on reducing the loudness of their tinnitus until a match was achieved between it and the experimental sound at each new db level. Results show a significant difference in db levels from baseline to final training session. Nearly all Ss demonstrated a marked reduction in tinnitus loudness, with several eliminating it completely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain location and associated symptoms in post-lumbar puncture headache

In this prospective study of 239 patients, 88 (37%) suffered from post-lumbar puncture headache (PPH). The pain was located within the region innervated by the trigeminal nerve in 49% of the drawings, within the occipital and/or suboccipital region in 11%, and within the combined trigeminal/occipital region in 39%. The headache was unilateral at least once in 34% of the patients. Changes in pain location from one region to the other and/or between bilateral and unilateral headache were observed in 54% of the patients throughout the PPH period. Associated symptoms were experienced by 85%, nausea (73%) and dizziness (60%) being the most frequently reported. In the upright position, nausea, dizziness, and tinnitus tended to be present during a fairly large part of the PPH period (57-63% of the days), vomiting occurring only occasionally (28%). The intensity of associated symptoms was positively correlated to PPH severity. Pain in the combined trigeminal/occipital region was most severe and related to more associated symptoms than pain in other regions, and unilateral pain was milder than bilateral pain. Pain in the occipital and/or suboccipital region was mildest. The severity of nausea decreased significantly on the last 2 days of the PPH period, and the intensity of dizziness decreased when PPH was about to subside. Tinnitus is probably due to a cochlear dysfunction, and presents special characteristics. Its incidence was not clearly related to PPH severity and it increased with increasing duration of PPH; its intensity did not decline when PPH was about to wane.     

Psychosocial treatment of tinnitus

After all medical and audiological treatments have failed, tinnitus patients often get the advise to "learn to live with it". The aim of psycho-social treatment is assisting patients in the identification of tinnitus aggravating factors and teaching them various coping skills. Treating these problems is primarily recommended for patients suffering from other disorders, even related to tinnitus. Motivation for psycho-social treatment depends on the ability of patients to accept tinnitus as a fundamental fact in their existence.     

Macrophage-derived cytokines in the follicular fluids of women with infertility due to immunological causes. Elevated levels of interleukin 6 and low levels of granulocyte-macrophage colony-stimulating factor

Myoclonus of the middle ear is a rare condition characterized by abnormal repetitive muscle contractions of the tympanic cavity. In this paper we describe what we believe is the first reported case of continuous high-frequency objective tinnitus caused by middle ear myoclonus. During exploratory tympanomastoidectomy it was hypothesized that a small dural arteriovenous malformation not identified on previous tests was the cause of the tinnitus. However, complete disappearance of the tinnitus during administration of curare for anesthesia led us to believe that the tinnitus might have been caused by myoclonus of the middle ear. Sectioning of the stapedius and tensor tympani tendons rendered the patient asymptomatic and confirmed the diagnosis of middle ear myoclonus. At follow-up of one year, the patient's quality of life had improved substantially; the tinnitus did not recur and she no longer had vertigo.     

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.     

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.     

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.