The effect of a gluten-free diet on a patient complaining of severe tinnitus

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Customized Versus Noncustomized Sound Therapy for Treatment of Tinnitus: A Randomized Crossover Clinical Trial.

ObjectivesTo determine the effectiveness of a customized sound therapy and compare its effectiveness to that of masking with broadband noise.MethodsSubjects were randomized to receive either customized sound therapy or broadband noise for 2 hours per day for 3 months and then switched to the other treatment after a washout period. The outcome variables were tinnitus loudness (scored 0-10), Tinnitus Handicap Inventory (THI), Beck Anxiety Inventory (BAI), minimum masking levels (MML), and residual inhibition (RI).ResultsEighteen subjects completed the study. Mean age was 53 ± 11 years, and mean tinnitus duration was 118 ± 99 months. With customized sound therapy, mean loudness decreased from 6.4 ± 2.0 to 4.9 ± 1.9 ( P = .001), mean THI decreased from 42.8 ± 21.6 to 31.5 ± 20.3 ( P < .001), mean BAI decreased from 10.6 ± 10.9 to 8.3 ± 9.9 ( P = .01), and MML decreased from 22.3 ± 11.6 dB SL to 17.2 ± 10.6 dB SL ( P = .005). After 3 months of broadband noise therapy, only BAI and, to a lesser degree, MML decreased ( P = .003 and .04, respectively).ConclusionsCustomized sound therapy can decrease the loudness and THI scores of tinnitus patients, and the results may be superior to broadband noise

Temporal resolution and selective attention of individuals with tinnitus

BACKGROUND: speech comprehension difficulty is a very common complaint of individuals with tinnitus with and without hearing loss. This study was conducted in order to analyze if tinnitus interferes in auditory processing and speech comprehension in individuals with normal hearing levels. AIM: to asses and compare the auditory behavior of temporal resolution and selective attention of adults with normal hearing levels with and without tinnitus. METHOD: 45 individuals, 15 with continuous tinnitus and 30 without tinnitus were selected and assessed by three auditory processing tests: Speech in Noise Test, Dichotic Digits Test and Gaps in Noise. After that, the results of each group were compared by appropriated statistic's tests; one of them was ANOVA. RESULTS: there were no significant statistical differences between the groups and both ears. CONCLUSION: tinnitus did not interfere in the auditory abilities of selective attention and temporal resolution.TEMA: é comum a queixa de dificuldade de compreensão da fala em indivíduos que apresentam zumbido com ou sem perda auditiva. Para conhecer se o zumbido interfere no processamento auditivo e compreensão da fala em sujeitos com audiometria normal, foi realizado este trabalho. OBJETIVO: foi avaliar e comparar o comportamento auditivo de resolução temporal e de atenção seletiva de indivíduos adultos com audiometria normal, com e sem zumbido. MÉTODO: 45 indivíduos, 15 com zumbido constante e 30 sem zumbido, foram selecionados e avaliados por meio de três testes de processamento auditivo: Teste de Fala com Ruído Branco, Teste Dicótico de Dígitos e Gaps In Noise. Em seguida os resultados de cada grupo foram comparados entre si, utilizando testes estatísticos apropriados, dentre eles o ANOVA. RESULTADOS: não foi observada diferença estatisticamente significante entre os grupos em ambas as orelhas. CONCLUSÃO: o zumbido não interferiu nas habilidades auditivas de atenção seletiva e resolução temporal.Universidade Federal de São Paulo (UNIFESP) Departamento de FonoaudiologiaUNIFESP Departamento de FonoaudiologiaUNIFESP, Depto. de FonoaudiologiaUNIFESP, Depto. de FonoaudiologiaSciEL

Hyperacusis in tinnitus patients relates to enlarged subcortical and cortical responses to sound except at the tinnitus frequency

Hyperacusis, a hypersensitivity to sounds of mild to moderate intensity, has been related to increased neural gain along the auditory pathway. To date, there is still uncertainty on the neural correlates of hyperacusis. Since hyperacusis often co-occurs with hearing loss and tinnitus, the effects of the three conditions on cortical and subcortical structures are often hard to separate. In this fMRI study, two groups of hearing loss and tinnitus participants, with and without hyperacusis, were compared to specifically investigate the effect of the latter in a group that often reports hyperacusis. In 35 participants with hearing loss and tinnitus, with and without hyperacusis as indicated by a cut-off score of 22 on the Hyperacusis Questionnaire (HQ), subcortical and cortical responses to sound stimulation were investigated. In addition, the frequency tuning of cortical voxels was investigated in the primary auditory cortex. In cortical and subcortical auditory structures, sound-evoked activity was higher in the group with hyperacusis. This effect was not restricted to frequencies affected by hearing loss but extended to intact frequencies. The higher subcortical and cortical activity in response to sound thus appears to be a marker of hyperacusis. In contrast, the response to the tinnitus frequency was reduced in the group with hyperacusis. This increase in subcortical and cortical activity in hyperacusis can be related to an increase in neural gain along the auditory pathway, and the reduced response to the tinnitus frequency to differences in attentional resources allocated to the tinnitus sound. (c) 2020 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/

A prospective pharmacovigilance study to evaluate adverse effect profile of first line anti-tubercular drugs in newly diagnosed sputum positive patients

Background: Tuberculosis (TB) continues to remain one of the most pressing health problems in India with highest TB burden country in the world. Anti-tubercular therapy (ATT) induced organ toxicities are potentially serious ADRs of first line ATT regimen. The underlying mechanism of ATT-induced ADRs especially hepatotoxicity and the factors predisposing to its incidence which is significantly high in Indians are not clearly understood. It's vital to emphasize on ATT induced ADRs as it has direct influence on therapeutic outcome; result in high dropout rate and potential to develop MDR/XDR cases. ADR monitoring help us to revise the treatment protocol thereby improve treatment adherence and therapeutic outcome. Objective of this study is therefore designed to explore and monitor ADRs of first line anti-TB drugs.Methods: In this prospective observational study 60 TB patients (18-70 yrs) of either sex, newly sputum positive with normal parameters were included. Patients were followed up for six months aiming primarily to assess rate of ADRs and to identify preventable and potentially serious ADRs of anti-TB drugs. The ADRs of ATT on various organ systems (heart, kidney and liver), biochemical and haematological parameters were assessed and compared after 2 and 6 months; gender and age specific adverse events were also studied. Data obtained was analysed using student’s t-test of OpenEpi statistical software.Results: Study clearly revealed that ATT exhibit significant increase in toxicity markers viz. liver enzymes (p<0.01), urea and creatinine (p<0.01), ESR (p<0.05) and PTINR (p<0.01), wherein decrease in Hb% (p<0.01) when compared to baseline.Conclusions: ATT related ADRs is the major cause of dropouts and development of MDR/XDR cases. It's crucial to develop strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely. The data obtained from present study may be helpful in developing these effective strategies

Catastrophizing and fear of tinnitus predict quality of life in patients with chronic tinnitus

Objectives: It is well established that catastrophic misinterpretations and fear are involved in the suffering and disability of patients with chronic pain. This study investigated whether similar processes explain suffering and disability in patients with chronic tinnitus. We hypothesized that patients who catastrophically (mis)interpret their tinnitus would be more fearful of tinnitus, more vigilant toward their tinnitus, and report less quality of life. Moreover, tinnitus-related fear was expected to act as a mediator in reduced quality of life. Design: Sixty-one tinnitus patients from an outpatient ENT department of the University Hospital of Antwerp (Belgium) completed a number of questionnaires about their tinnitus. Hierarchical regression analyses were performed to test hypothesized associations and to assess mediation by tinnitus-related fear. Results: Analyses revealed significant associations between catastrophizing and fear and between catastrophizing and increased attention toward the tinnitus. Furthermore, both tinnitus-related catastrophizing and fear were negatively associated with quality of life; moreover, tinnitus-related fear fully mediated the association between catastrophizing about the tinnitus and quality of life. Conclusions: The findings confirm earlier suggestions that tinnitus-related concerns and fears are associated with impaired quality of life, which is in line with a cognitive behavioral account of chronic tinnitus. Future research avenues and clinical applications are discussed

Balanço da utilização da versão portuguesa do Tinnitus Handicap Inventory (THI)

Sendo as queixas da existência de acufenos um motivo frequente de procura da consulta de ORL (Otorrinolaringologia), e sendo frequente encontrar na literatura referências à depressão, à ansiedade, entre outras dimensões psicopatológicas, associadas a essas queixas, pretendemos com o nosso trabalho verificar a existência de eventuais correlações entre essas dimensões e a existência de acufenos. Para tal, utilizamos a escala de avaliação psicológica BSI (Brief Syntoms Inventory), que avalia nove dimensões psicológicas, tendo igualmente efectuado uma avaliação audiométrica nos indivíduos com queixas de acufenos. Estes indivíduos frequentavam a consulta de ORL de três hospitais, e apresentavam como queixa principal os acufenos. Os resultados obtidos nesses indivíduos, foram comparados com os resultados de um grupo de controlo. Dos resultados obtidos, é de destacar o facto de os elementos do sexo feminino com queixas de acufenos, apresentarem valores significativamente mais elevados para as dimensões de somatização e ansiedade fóbica. Relativamente ao nível de audição não foram encontradas diferenças significativas entre os diferentes níveis considerados e as mesmas dimensões. Quando comparamos os resultadosobtidos nas referidas dimensões entre o grupo de pacientes com acufenos e o grupo de controle, é de destacar o facto de existirem diferenças significativas para seis das nove dimensões avaliadas pela escala usada, o que vem confirmar os resultados encontrados na literatura, evidenciando o interesse do recurso a escalas de avaliação psicológica para referenciar o paciente, e abrir portas a estudos mais aprofundados nesta área

Memory Networks in Tinnitus: A Functional Brain Image Study

Tinnitus is characterized by the perception of sound in the absence of an external auditory stimulus. the network connectivity of auditory and non-auditory brain structures associated with emotion, memory and attention are functionally altered in debilitating tinnitus. Current studies suggest that tinnitus results from neuroplastic changes in the frontal and limbic temporal regions. the objective of this study was to use Single-Photon Emission Computed Tomography (SPECT) to evaluate changes in the cerebral blood flow in tinnitus patients with normal hearing compared with healthy controls. Methods: Twenty tinnitus patients with normal hearing and 17 healthy controls, matched for sex, age and years of education, were subjected to Single Photon Emission Computed Tomography using the radiotracer ethylenedicysteine diethyl ester, labeled with Technetium 99 m (99 mTc-ECD SPECT). the severity of tinnitus was assessed using the Tinnitus Handicap Inventory (THI). the images were processed and analyzed using Statistical Parametric Mapping (SPM8). Results: A significant increase in cerebral perfusion in the left parahippocampal gyrus (pFWE<0.05) was observed in patients with tinnitus compared with healthy controls. the average total THI score was 50.8+18.24, classified as moderate tinnitus. Conclusion: It was possible to identify significant changes in the limbic system of the brain perfusion in tinnitus patients with normal hearing, suggesting that central mechanisms, not specific to the auditory pathway, are involved in the pathophysiology of symptoms, even in the absence of clinically diagnosed peripheral changes.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psiquiatria, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Radiol, Secao Med Nucl, São Paulo, BrazilHosp Israelita Albert Einstein, Inst Cerebro, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Fonoaudiol, São Paulo, BrazilUniv Western Australia, Med Res Ctr, Western Australian Ctr Hlth & Ageing, Perth, WA 6009, AustraliaUniversidade Federal de São Paulo, Dept Psiquiatria, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otorrinolaringol & Cirurgia Cabeca & Pescoco, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Radiol, Secao Med Nucl, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Fonoaudiol, São Paulo, BrazilFAPESP: FAPESP-2010/14804-6Web of Scienc

Changes in Tinnitus After Middle Ear Implant Surgery: Comparisons With the Cochlear Implant

OBJECTIVES: Tinnitus is a very common symptom in patients with hearing loss. Several studies have confirmed that hearing restoration using hearing aids or cochlear implants (CIs) has a suppressive effect on tinnitus in users. The aim of this study was to analyze the effect of other hearing restoration devices, specifically the middle ear implant (MEI), on changes in tinnitus severity. DESIGN: From 2012 to October 2014, 11 adults with tinnitus and hearing loss underwent MEI surgery. Pure-tone audiometry, tinnitus handicap inventory (THI), and visual analog scale scores for loudness, awareness, and annoyance and psychosocial instruments were measured before, immediately after, and 6 months after surgery. Changes in hearing thresholds and THI scores were analyzed and compared with those of 16 CI recipients. RESULTS: In both MEI and CI groups, significant improvements in tinnitus were found after the surgery. The THI scores improved in 91% of patients in the MEI group and in 56% of those in the CI group. Visual analog scale scores and psychosocial scale scores also decreased after surgery, but there were no statistical differences between the groups. CONCLUSIONS: The results indicate that the MEI may be as beneficial as the CI in relieving tinnitus in subjects with unilateral tinnitus accompanying hearing loss. Furthermore, this improvement may manifest as hearing restoration or habituation rather than a direct electrical nerve stimulation, which was previously considered as the main mechanism underlying tinnitus suppression by auditory implants.ope

Eyes and Ears: Cross-Modal Interference of Tinnitus on Visual Processing

The visual processing capacity of tinnitus patients is worse than normal controls, indicating cross-modal interference. However, the mechanism underlying the tinnitus-modulated visual processing is largely unclear. In order to explore the influence of tinnitus on visual processing, this study used a signal recognition paradigm to observe whether the tinnitus group would display a significantly longer reaction time in processing the letter symbols (Experiment 1) and emotional faces (Experiment 2) than the control group. Signal detection and signal recognition, which reflect the perceptual and conceptual aspects of visual processing respectively, were manipulated individually in different conditions to identify the pattern of the cross-modal interference of tinnitus. The results showed that the tinnitus group required a significantly prolonged reaction time in detecting and recognizing the letter symbols and emotional faces than the control group; meanwhile, no between-group difference was detected in signal encoding. In addition, any gender- and distress-modulated effects of processing were not found, suggesting the universality of the present findings. Finally, follow-up studies would be needed to explore the neural mechanism behind the decline in speed of visual processing. The positive emotional bias in tinnitus patients also needs to be further verified and discussed.Highlights:- The bottom-up visual processing speed is decreased in tinnitus patients.- Tinnitus primarily interferes with the detection of the visual signals in individuals