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PubMed2006

Relationships among speech perception, self-rated tinnitus loudness and disability in tinnitus patients with normal pure-tone thresholds of hearing.

Exactly how speech perception and tinnitus perception are related remains unclear. This study investigated how tinnitus alone affects speech perception and the relationship between speech perception, tinnitus loudness, and tinnitus disability. The Mandarin Speech Perception in Noise Test (MSPIN), Tinnitus Loudness Scaling (TLS), and Tinnitus Handicap Inventory (THI) were utilized to assess 20 tinnitus patients with normal hearing. The tinnitus group had a significantly lower MSPIN score than the control group (p < 0.01). TLS and THI scores were strongly correlated (r(2): 0.534 approximately 0.627, p < 0.05). Correlations between MSPIN and TLS or THI scores were not significant. Tinnitus loudness correlated well with tinnitus-related disability. Neither tinnitus loudness nor disability was strongly correlated with speech perception. In noisy environments, tinnitus sufferers had significantly poorer ability to recognize speech than control subjects.

Adult↗
PubMed1993

A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms.

OBJECTIVE: To determine whether the antidepressant, nortriptyline, is effective for treatment of depression, tinnitus-related disability, and tinnitus symptoms in patients with severe chronic tinnitus. DESIGN: A 12-week, double-blind, randomized controlled trial. SETTING: A university otolaryngology clinic. PATIENTS: Ninety-two subjects with severe chronic tinnitus: 38 with current major depression and 54 with depressive symptoms and significant tinnitus-related disability. INTERVENTION: Nortriptyline (maintained at 50 to 150 mg/mL for 6 weeks) or placebo. MAIN OUTCOME MEASURES: Hamilton Depression Rating Scale, Tinnitus Disability Measures, and Audiometric Measures. RESULTS: Nortriptyline was superior to placebo by multivariate analysis of covariance for depression (10.6 vs 14.3 final Hamilton Depression score), for tinnitus-related disability (1.8 vs 2.4 final MPI Tinnitus Interference), and tinnitus loudness (13.6 vs 20.0 dB final loudness match [in worst ear at tinnitus frequency]). When major depression and depressive symptoms groups were considered separately, nortriptyline was superior to placebo on these same measures but differences did not achieve statistical significance. CONCLUSIONS: The antidepressant nortriptyline decreases depression, functional disability, and tinnitus loudness associated with severe chronic tinnitus. What appears to be irreversible disability of otologic origin may, in part, be reversible disability of psychiatric origin.

Aged↗
PubMed2006

Characteristics of tinnitus in a population of 555 patients: specificities of tinnitus induced by noise trauma.

Tinnitus is often associated with hearing loss of a known etiology. In this study, we compared tinnitus that appeared to be induced by noise trauma with that perceived to start in other circumstances in a population of 555 patients attending the specialist tinnitus clinic at the University Hospital in Montpellier, France. Patients had consulted for persistent tinnitus for 7 years from the onset of their symptoms. Among these tinnitus patients, 17% described their tinnitus as starting after excessive noise exposure. The patients who had a history of noise trauma had a symmetrical hearing loss, and no difference was seen in lateralization of tinnitus perception. This subset of patients was mainly male and on average was 10 years younger than other tinnitus patients. In this population, the hearing loss is significantly less than that measured in the other patients, even allowing for their younger age. Statistical analysis showed a significant correlation between a history of exposure to noise trauma and the presence of a high-pitched "whistling" tinnitus. The presence of whistling tinnitus was significantly correlated with high-frequency hearing loss. The intensity of tinnitus, measured using a visual analog scale, appeared to be stronger than the measured hearing loss would suggest.

Adolescent↗
PubMed2006

Tinnitus and Ménière's disease: characteristics and prognosis in a tinnitus clinic sample.

The aim of this study is to describe tinnitus epidemiological characteristics in Ménière's disease (MD), the prognosis and its interaction with other MD symptoms. It is a descriptive transversal study. One hundred two MD patients were referred to a tinnitus clinic. Tinnitus was evaluated according to psychoacoustical tinnitogram, visual analogue scale, and tinnitus handicap inventory (THI). All patients were diagnosed with definitive MD (following AAO-HNS' 95 criteria). Pitch was more commonly identified in low and medium frequencies. Psychoacoustical intensity was matched in 12.7 dB. The visual analogue scale showed a value of 7.1, while THI score reached an average of 49%. Compared with other aetiologies (acoustic trauma, otosclerosis), MD showed a statistical difference in tinnitus severity parameters (P<0.05). Tinnitus increased VAS and THI score as a function of duration and bilateral disease (P<0.01). We found a statistical association (P<0.05) between tinnitus intensity and worse hearing loss or hyperacusis, but it was not influenced by number of vertigo spells. Higher MD stage increased tinnitus intensity and handicap. Tinnitus in MD patients referred to our tinnitus clinic presents a high intensity and handicap levels and represents the most troublesome symptom. Severity is influenced by the longer duration of the disease, the bilateral affection, hearing impairment or hyperacusis and a higher MD stage.

Adolescent↗
PubMed2006

Clinical trial to compare tinnitus masking and tinnitus retraining therapy.

CONCLUSION: Both tinnitus masking (TM) and tinnitus retraining therapy (TRT) can be effective therapies for amelioration of tinnitus. TM may be more effective for patients in the short term, but with continued treatment TRT may produce the greatest effects. OBJECTIVES: Although TM and TRT have been used for many years, research has not documented definitively the efficacy of these methods. The present study was a controlled clinical trial to prospectively evaluate the clinical efficacy of these two methods for US military veterans with severe tinnitus. SUBJECTS AND METHODS: Over 800 veterans were screened to ensure that enrolled patients had tinnitus of sufficient severity to justify 18 months of individualized treatment. Qualifying patients (n=123) were placed quasi-randomly (alternating placement) into treatment with either TM or TRT. Treatment was administered at 0, 3, 6, 12, and 18 months. Outcomes of treatment were evaluated primarily using three self-administered tinnitus questionnaires (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index). RESULTS: Findings are presented from the three written questionnaires with respect to three categories of patients: describing tinnitus as a 'moderate,' 'big,' and 'very big' problem at baseline. Based on effect sizes, both groups showed considerable improvement overall. In general, TM effects remained fairly constant over time while TRT effects improved incrementally. For the patients with a 'moderate' and 'big' problem, TM provided the greatest benefit at 3 and 6 months; benefit to these TRT patients was slightly greater at 12 months, and much greater at 18 months. For patients with a 'very big' problem, TM provided the greatest benefit at 3 months. For these latter patients, results were about the same between groups at 6 months, and improvement for TRT was much greater at 12 months, with further gains at 18 months.

Acoustic Stimulation↗
PubMedDate not supplied

Psychoacoustic characterization of the tinnitus spectrum: implications for the underlying mechanisms of tinnitus.

In this study, an original psychometric procedure was used in order to characterize in more detail than in previous studies the different perceptual components of tinnitus, i.e. auditory sensations which are perceived in the absence of a corresponding external acoustic stimulus. Ten subjects with chronic tinnitus were asked to rate on a numeric scale the contribution of elementary pitch sensations evoked by isolated frequency components to their overall tinnitus sensation. The resulting 'internal tinnitus spectra', which represented the estimated perceptual contribution to the tinnitus sensation as a function of frequency over a large range of frequencies, were found to occupy a wide frequency range corresponding largely to that at which hearing thresholds were abnormally elevated. In most cases, they exhibited a broad peak falling within the hearing loss range. This pattern of result suggests that in subjects with high-frequency hearing loss, tinnitus sensations, when present, resemble those evoked by high-frequency noise bands with, in some cases, a superimposed tonal-like pitch. These results confirm and extend earlier results in the literature and agree with the patients' reports; their practical implications for the design of future studies on tinnitus and theoretical implications for the understanding of the neurophysiological mechanisms underlying tinnitus are discussed. The results of an additional experiment showed that the internal tinnitus spectrum could be altered by perceptual training in a fine frequency discrimination task with tones in the frequency range of the main peak of the tinnitus spectrum.

Adult↗
PubMed2006

Consequences of suppressing thoughts about tinnitus and the effects of cognitive distraction on brain activity in tinnitus patients.

Tinnitus is the perception of sound in the absence of any appropriate external stimulus. Based on the clinical observation that tinnitus patients may distract themselves from their sounds, we performed an experimental test on the effects of suppressing thoughts about tinnitus with 45 tinnitus patients, to systematically evaluate the immediate consequences of suppressing thought vs. attending to tinnitus. Suppression instructions tended to lead to a subsequent decrease in tinnitus-related thoughts, whereas attention to tinnitus resulted in an increase in such thoughts. No effects were seen in a control group who neither suppressed nor attended to their tinnitus. In an independent positron emission tomography study of cerebral blood flow with 8 patients we found that silent backward counting ('serial sevens test') led to a decrease in neural activity in auditory cortex, as well as perceived decrease of tinnitus loudness and annoyance. Thus, distraction that altered the tinnitus experience seemed to attenuate auditory cortex activity.

Adult↗
PubMed2000

Convergent validity of the tinnitus handicap inventory and the tinnitus questionnaire.

For research into tinnitus to be robust and credible, the use of well-validated instruments of self-perceived tinnitus handicap as outcome measures is essential. The tinnitus handicap inventory (THI) and the tinnitus questionnaire (TQ) are two such instruments which are in widespread use. Both questionnaires were administered by mail to 100 consecutive new patients of the Cambridge Tinnitus Clinic, and completed in randomized order. These patients had been referred by the otolaryngology team and had not undergone any tinnitus therapy. The response rate was 78 per cent, neither questionnaire being more acceptable to patients than the other. The convergent validity of the instruments was high, with total and subscale scores all being significantly correlated at the five per cent level (Spearman correlation coefficients). A number of subscale scores were not significantly correlated at the one per cent level however. In particular, the sleep disturbance element of the TQ was demonstrated to have some discriminant validity from the THI and from other elements of the TQ at the one per cent significance level. The THI and TQ have been demonstrated to have high convergent validity and are both suitable for tinnitus outcome studies involving the quantification of self-perceived tinnitus handicap. For research that aims to determine the specific effect of an intervention on tinnitus-related sleep disturbance, the TQ sleep subscale has potential utility. The hypothetical constructs of tinnitus handicap underlying the psychologist-developed TQ and the audiologist-developed THI have been shown to be convergent.

Adolescent↗
PubMed2006

Outcomes of clinical trial: tinnitus masking versus tinnitus retraining therapy.

A controlled clinical study was conducted to evaluate prospectively the clinical efficacy of tinnitus masking (TM) and tinnitus retraining therapy (TRT) in military veterans having clinically significant tinnitus. Qualifying patients were placed into the two groups in an alternating manner (to avoid selection bias), and treatment was administered at 0, 3, 6, 12, and 18 months. Outcomes of treatment were evaluated using three self-administered tinnitus questionnaires (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index) and the verbally administered TRT interview forms. Findings are presented from the three written questionnaires, and from two of the interview questions (percentage time aware of, and annoyed by, tinnitus). Outcomes were analyzed on an intent-to-treat basis, using a multilevel modeling approach. Of the 123 patients enrolled, 118 were included in the analysis. Both groups showed significant declines (improvements) on these measures, with the TRT decline being significantly greater than for TM. The greater declines in TRT compared to TM occurred most strongly in patients who began treatment with a "very big" tinnitus problem. When patients began treatment with a "moderate" tinnitus problem, the benefits of TRT compared to TM were more modest.

Acoustic Stimulation↗
PubMed1995

Tinnitus Synthesis: Fluctuant and Stable Matches to the Pitch of Tinnitus.

Five subjects mimicked the sensation caused by their tinnitus with a complex sound pattern consisting of the sum of sine waves. The imitation tinnitus was generally broadband, spanning an average of 2.94 kHz. Measures of the pitch of the tinnitus were made using both a forced-choice double-staircase (FCDS) task and a method of adjustment (MOA) task. Even tinnitus portrayed as broadband was matched reliably using a FCDS task, presumably because all but one component of the tinnitus was ignored. With the MOA task, successive matches to the predominant tinnitus pitch were fluctuant, presumably because disparate components of the tinnitus were subsequently matched. Because tinnitus is a broad-band signal, clinical trials evaluating the effect of a treatment on tinnitus should involve assessing changes occurring at any location in tinnitus spectrum.

Journal Article↗
PubMed1996

[Direct loudness scaling in diagnosis of tinnitus. A contribution to loudness perception in tinnitus].

We used free-field audiometry to investigate the loudness perception of unilateral high-frequency tinnitus in 16 "normal-hearing" ears by comparing the results with loudness scaling in 20 normally hearing ears without any tinnitus. Narrow-band noise signals at four different frequencies from 500 to 4000 Hz were employed. The parameters used included the slope m of the loudness function and the level Lm (corresponding to the loudness perception of "medium loud") as well as the suitability of fit (delta FIT). The results showed that in subjects with tinnitus the slope of the mean loudness level tended to decrease at 4000 Hz. The dynamic range of ears affected by tinnitus was restricted for stimulation with noise signals at 1000, 2000 and 4000 Hz. The parameters of delta FIT fitted to the loudness functions were increased in the whole frequency range of 500-4000 Hz, indicating that loudness scaling was not as reliable for normal hearing ears when influenced by tinnitus. Tinnitus masking was based on the finding that external sound could change tinnitus loudness. Our results showed that the loudness perception of external sound was influenced by tinnitus. This change in loudness perception seemed to be not restricted to the frequency range of the tinnitus.

Adult↗
PubMedDate not supplied

A questionnaire study of the quality of life and quality of family life of individuals complaining of tinnitus pre- and post-attendance at a tinnitus clinic.

Tinnitus is a condition that is difficult to treat, and treatment outcomes are difficult to measure The majority of people who experience tinnitus are not troubled by it; however, the troubled minority are referred by an otorhinolaryngologist for specialist clinic help. The aim of this study was to investigate how the impact of tinnitus changes following attendance at a tinnitus clinic and to find out how acceptable the questionnaires used were for measuring recovery. Fifty-seven tinnitus sufferers completed three questionnaires covering the characteristics of tinnitus, and its effect on daily life, quality of life, and quality of family life, before and after treatment at the Nottingham Tinnitus Clinic. Questionnaires were answered at patients' homes while they were on the waiting list to attend the clinic, and again I year after their first attendance. Measures of functional and social handicap were significantly reduced following attendance at the clinic (mean change in functional handicap = 13%, p<0.01, and mean change in social handicap = 8%, p<0.01). Quality of life was significantly better after treatment at the clinic (mean visual analog scale difference = 6.5%, p = 0.01). We conclude that attendance at the Nottingham Tinnitus Clinic had a positive effect on the impact of tinnitus on patients and their families, and that the questionnaires gave an accurate measure of patient distress.

Family↗
PubMed2006

Tinnitus as an alarm bell: stress reaction tinnitus model.

Stress is a significant factor influencing the clinical course of tinnitus. Auditory system is particularly sensitive to the effects of different stress factors (chemical, oxidative, emotional, etc.). Different stages of reaction (alarm, resistance, exhaustion) lead to different characteristics of tinnitus and different therapeutic approaches. Individual characteristics of stress reaction may explain different aspects of tinnitus in various patients with different responses to treatment, despite similar audiological and etiological factors. A model based on individual reactions to stress factors (stress reaction tinnitus model) could explain tinnitus as an alarm signal, just like an 'alarm bell', informing the patient that something potentially dangerous for subject homeostasis is happening. Tinnitus could become a disabling symptom when the subject is chronically exposed to a stress factor and is unable to switch off the alarm. Stress signals, specific for each patient, have to be identified during the 'alarm' phase in order to prevent an evolution toward the 'resistance' and 'exhaustion' phases. In these phases, identification of stressor is no more sufficient, due to the organization of a 'paradoxical auditory memory' and a 'pathologically shifted attention to tinnitus'. Identification of stress reaction phase requires accurate otolaryngology and anamnesis combined with audiological matching tests (Feldman Masking Test, for example) and psychometric questionnaires (Tinnitus Reaction and Tinnitus Cognitive Questionnaires).

Adult↗
PubMed2002

Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy.

OBJECTIVE: To determine whether the Tinnitus Handicap Inventory (THI), a validated patient-based outcomes measure, may improve our ability to quantify impact and assess therapy for patients with tinnitus. DESIGN: Nonrandomized, prospective analysis of 32 patients undergoing tinnitus retraining therapy (TRT). Assessment tools included comprehensive audiology, a subjective self-assessment survey of tinnitus characteristics, and the THI. Tinnitus Handicap Inventory scores were assessed at baseline and 6 months following TRT. RESULTS: Baseline analysis revealed significant correlation between the subjective presence of hyperacusis and higher total, emotional, and catastrophic THI scores. Tinnitus Handicap Inventory scores correlated with subjective perception of overall tinnitus effect (P<.001). Mean pure-tone threshold average was 17.4 dB, and mean speech discrimination was 97.0%. There were no consistent correlations between baseline audiologic parameters and THI scores. Following 6 months of TRT, the total, emotional, functional, and catastrophic THI scores significantly improved (P<.001). Loudness discomfort levels also significantly improved (P< or =.02). CONCLUSIONS: There is significant improvement in self-perceived disability following TRT as measured by the THI. The results confirm the utility of the THI as a patient-based outcomes measure for quantifying treatment status in patients with primary tinnitus.

Adolescent↗
PubMed2006

Analysis of responses to individual items on the tinnitus handicap inventory according to severity of tinnitus handicap.

PURPOSE: To investigate whether certain aspects of tinnitus tend to trouble people even when they are not severely affected by tinnitus in many ways. METHOD: A total of 274 patients who had requested a tinnitus clinic appointment were divided into 4 categories depending on their Tinnitus Handicap Inventory scores: no handicap (0-16), mild handicap (18-36), moderate handicap (38-56), or severe handicap (58-100). Mean scores for each of the 25 items on the questionnaire were calculated and compared within each group and between the 4 groups. RESULTS: Two items concerning lack of control over tinnitus and inability to escape it had the highest mean score overall and in each category, and elicited positive responses from the majority of patients in all but the "no handicap" group. One item concerning the belief that tinnitus indicates a terrible disease was found to have the lowest mean score overall and in each category and elicited negative responses from the majority of patients in all but the "severe handicap" group. CONCLUSIONS: These findings indicate that only those who are severely handicapped by tinnitus tend to regard it as a terrible disease, and that lack of control and inability to escape are common feelings among many people with tinnitus, from the most to the least severely handicapped.

Disability Evaluation↗
PubMed2005

Pulsatile tinnitus: a review of the literature and an unusual case of iatrogenic pneumocephalus causing pulsatile tinnitus.

BACKGROUND: Pulsatile tinnitus is frequently attributed to identifiable and treatable causes, in contrast to the more common subjective non-pulsatile tinnitus. It usually originates from vascular structures as a result of either increased blood flow or lumen stenosis; atherosclerotic carotid or subclavian artery disease; arterial, venous, or arteriovenous malformations, fistulas, or dissection; and paragangliomas. Other causes have also been reported, with often unclear pathophysiology. OBJECTIVE: The aim of this paper is to present a case of pulsatile tinnitus secondary to iatrogenic pneumocephalus and to review the literature on pulsatile tinnitus. SUBJECT: A 48-year-old white woman had a roaring, very disturbing, pulsatile tinnitus after the removal of a cerebellar lobe meningioma. When the patient experienced the symptom of tinnitus, a pulsatile movement of the tympanic membrane could be clearly seen, and this was synchronous with the patient's heartbeat. Computed tomography revealed an epidural pneumocephalus in the left posterior fossa communicating freely with the air cell system of the left mastoid cavity without any sign of residual tumor. A simple mastoidectomy was performed. The whole air cell system was removed and the mastoid cavity was filled with abdominal fat. After the operation, the pulsatile tinnitus ceased completely and the pneumocephalus disappeared gradually. The patient is free of symptoms 11 months after surgery. CONCLUSION: Otologists, neurosurgeons, and skull base surgeons should be aware of this surgical complication and be careful to identify any accidental opening to the air cell system of the temporal bone and meticulously close it when it happens. The review of the literature leads to the conclusion that pulsatile tinnitus should be thoroughly investigated, as it may be related to diseases that may have serious complications.

Cerebellar Neoplasms↗
PubMed1984

The perceived severity of tinnitus. Some observations concerning a large population of tinnitus clinic patients.

Detailed information about tinnitus was obtained from over 1800 patients attending a tinnitus clinic. Patients rated their tinnitus severity on a scale from 1 to 10 and also provided information concerning the quality, duration, localization, and other attributes of their tinnitus. In addition to standard audiometric tests, patients received tests for tinnitus pitch, loudness, maskability, and residual inhibition, and provided a brief medical history. The severity ratings of over 90% were at or above the scale value of 5. There was no correlation between rated severity and the loudness of tinnitus (obtained by a loudness balance procedure using external sounds matching the tinnitus pitch), thus confirming earlier observations. The severity also was not related to the type, quality, or pitch of tinnitus sound heard. However, severity ratings were highly correlated with incidence of sleep disturbance. Additional observations concerning relationships between perceived severity and other patient characteristics are discussed.

Acoustic Impedance Tests↗