Current Possibilities of Tinnitus Diagnostics and Treatment

Szumy uszne stanowią istotny problem w wymiarze indywidualnym i społecznym. Zaburzają codzienne funkcjonowanie, obniżają jakość życia, a ze względu na ich rozpowszechnienie, przewlekły charakter i wysokie koszty opieki medycznej stanowią obciążenie dla systemu opieki zdrowotnej. Szumy uszne mają charakter heterogeniczny, mogą być spowodowane różnymi przyczynami, a także występować w przebiegu różnych chorób. Z tego względu ich diagnostyka jest wnikliwa i szczegółowa, ma złożony, często interdyscyplinarny charakter. Obecnie nie ma jednego skutecznego sposobu leczenia osób z szumami usznymi. Stosowane są różne metody terapii, w tym protezowanie, terapia psychologiczna (w tym zwłaszcza terapia poznawczo-behawioralna), terapia dźwiękiem. Nową, obiecującą metodę terapii, której efektywność jest testowana w badaniach klinicznych, stanowi neurostymulacja.Tinnitus is a significant individual and social problem. It impacts daily functioning, decreases quality of life, and, due to its prevalence, persistent nature and high cost of medical care, burdens the health care system. Tinnitus is heterogeneous in nature, it can be caused by a variety of causes and can occur in the course of various diseases. For this reason, its diagnosis is thorough and detailed, has a complex, often interdisciplinary character. Currently, there is no single effective treatment for people with tinnitus. Various therapies are applied, including prosthetics, psychological therapy (cognitive-behavioral therapy in particular), and sound therapy. A promising new treatment, which effectiveness is being tested in clinical trials, is neurostimulation

Skarzynski Tinnitus Scale: validation of a brief and robust tool for assessing tinnitus in a clinical population

Abstract Background Many tinnitus scales are available, but all of them have certain limitations. The aim of the current study was to present a psychometric data of a new brief and reliable questionnaire that could be conveniently used for evaluating tinnitus complaint in adults (either with normal or impaired hearing)—Skarzynski Tinnitus Scale (STS). Methods The study included 125 participants with at least 1 month of tinnitus duration. All participants were asked to complete the STS, Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), and Beck Depression Inventory. Psychometric properties of the new tool were tested using exploratory factor analysis (EFA), Pearson bivariate correlation with other tinnitus questionnaires, Pearson bivariate correlation with pure-tone audiometry, Cronbach’s alpha coefficient, limits of agreement, smallest detectable change, and floor and ceiling effects. Norms for tinnitus severity as measured by the STS are proposed. Results As a whole, the STS has excellent reliability (ICC = 0.94) and good internal consistency (α = 0.91). The results of EFA and content analysis of wording of the items justified the three-factorial structure. The convergent validity was proven by a significant positive correlation with THI, TFI and THS Subscale A scores. Additionally, the authors proposed norms dividing the results into four tinnitus severity grades. Conclusions Statistical analysis shows that STS is a brief but robust tool well-suited to clinical practice. A feature of STS is that it takes into account the impact of tinnitus on the patient’s psychological (emotional, cognitive) and functional domains as well as their ability to cope with tinnitus-related distress

Distortion Product Otoacoustic Emissions in Normal-hearing Patients with Bilateral Tinnitus and in Non-tinnitus Controls

Abstract is available through the Journal of Hearing Science

Decreased Sound Tolerance in Tinnitus Patients

(1) Background: Decreased sound tolerance is a significant problem in tinnitus sufferers. The aim of the study was to evaluate the relationship between tinnitus and decreased sound tolerance (hyperacusis and misophonia). (2) Methods: The study sample consisted of 74 patients with tinnitus and decreased sound tolerance. The procedure comprised patient interviews, pure tone audiometry, impedance audiometry, measurement of uncomfortable loudness levels, and administration of the Hyperacusis Questionnaire, Tinnitus Handicap Inventory, and Visual Analogue Scales. (3) Results: The majority (69%) of the patients reported that noise aggravated their tinnitus. The correlation between tinnitus and hyperacusis was found to be statistically significant and positive: r = 0.44; p < 0.01. The higher the tinnitus severity, the greater the hyperacusis. There was no correlation between misophonia and hyperacusis (r = 0.18; p > 0.05), or between misophonia and tinnitus (r = 0.06; p > 0.05). (4) Conclusions: For tinnitus patients the more significant problem was hyperacusis rather than misophonia. The diagnosis and treatment of decreased sound tolerance should take into account not only audiological, but also psychological problems of the patients

Tinnitus and Normal Hearing: A Study of 175 Cases

Introduction: Due to our actual knowledge tinnitus in most cases results from abnormal neural activity elicited at any level of auditory pathways and is interpreted in auditory cortex as a perception of sound, which is not accompanied by any mechanic activity within the cochlea. Tinnitus patients usually present various degrees of cochlear dysfunction, which can be manifested as sensorineural hearing loss, loudness intolerance, a distinct decrease of the DPOAE amplitude, recruitment or abnormal efferent reduction of OAEs through contralateral acoustic stimulation. But 8-15% of tinnitus patients present normal audiometric profiles. In these patients the mechanism of tinnitus generation remains unclear. Aim of the study: The aim of the study was to assess DPOAE levels and EHF thresholds in tinnitus subjects with normal hearing and compare the data with those from a normally hearing control group without tinnitus, in order to evaluate if any detectable high frequency cochlear dysfunction might be responsible for the tinnitus generation. Material and methods: 175 tinnitus patients (group 1 – tinnitus in left ear - 47 patients, group 2 – tinnitus in right ear – 23 patients, group 3 – bilateral tinnitus – 105 patients) and 60 controls (group 4). Inclusion criteria: age up to 40, normal otoscopic examination, type A tympanometry, normal hearing (up to 20 dB) in PTA (250-8000 Hz), no loudness intolerance, constant tinnitus for at least 6 months of stable localization (site of tinnitus has not changed from the previous localization). In each patient high frequency audiometry (at 10, 12.5, 14 and 16 kHz) and DPOAE registration (L1=65 dB SPL, L2=55 dB SPL, f2/f1= 1.2, S/N≥3 dB) were performed. Then statistical analysis was applied for comparison between left and right ears in the same group and also across different group of patients. Results: statistically significant differences were observed mainly in unilateral tinnitus group. These differences were more evident in audiometric data than DPOAE data. Leftsided tinnitus was twice more frequent than right-sided tinnitus. Few statistically significant differences were found between bilateral tinnitus group and controls. Conclusions: Unilateral tinnitus in normally hearing individuals may be caused by the damage of the basal region of the cochlea. There is greater incidence of high frequency hearing loss (above 8 kHz) in the ear with tinnitus in comparison to control group. In unilateral tinnitus group, the organ of Corti at the site of tinnitus is more seriously damaged than in the opposite ear. The asymmetry of cochlear damage may be crucial for tinnitus lateralization. Bilateral tinnitus, more frequently than unilateral one, can result from other pathologies, not connected with the organ of Corti

The Influence of High Frequency Hearing Loss on the Distortion Product Otoacoustic Emissions in Tinnitus Subjects with Normal Hearing Thresold (0,25-8kHz)

Aim of the study: To evaluate the influence of high frequency hearing loss (\u3e8000 Hz) on distortion product otoacoustic emissions registered in the frequency range from 0,5 to 8 kHz. Material and methods: 280 ears with tinnitus and normal hearing (0.25–8 kHz) divided into 3 groups depending on the degree of high frequency hearing loss: group A – hearing threshold up to 20 dB for 10, 12.5, 14 and 16 kHz (68 ears); group B – hearing threshold 25–40 dB HLfor at least one of four EHfs (93 ears); group C – hearing threshold above 40 dB HL for at least one of four EHFs (119 ears). For each group mean audiogram and DP-gram were obtained and statistical analysis was used for comparison across these groups. Results: Mean DPOAE values in group C were significantly lower in comparison with group A for the frequency range 2–8 kHz, and in comparison with group B were significantly lower for the frequency range 4–8 kHz. Conclusions: High frequency hearing loss (above 8 kHz) has a relevant influence on distortion product otoacoustic emissions registered at frequencies below 8 kHz in tinnitus patients. The greater is hearing loss above 8 kHz, the lower is DPOAE value below 8 kHz

Chronic Tinnitus and the Positive Effects of Sound Treatment via a Smartphone App: Mixed-Design Study

BackgroundTinnitus is a phantom auditory sensation in the absence of an external stimulus. It is accompanied by a broad range of negative emotional symptoms and a significantly lower quality of life. So far, there is no cure for tinnitus, although various treatment options have been tried. One of them is mobile technology employing dedicated apps based on sound therapy. The apps can be managed by the patient and tailored according to their needs. ObjectiveThe study aims to assess the effect of a mobile app that generates background sounds on the severity of tinnitus. MethodsThe study involved 68 adults who had chronic tinnitus. Participants were divided into a study group (44 patients) and a control group (24 patients). For 6 months those in the study group used a free mobile app that enriched the sound environment with a background sound. Participants were instructed to use the app for at least 30 minutes a day using their preferred sound. The participants in the control group did not use the app. Subjective changes in the day-to-day functioning of both groups were evaluated using the Tinnitus Handicap Inventory (THI) questionnaire, a visual analog scale, and a user survey. ResultsAfter 3 months of using the app, the THI global score significantly decreased (P<.001) in the study group, decreasing again at 6 months (P<.001). The largest improvements were observed in the emotional and catastrophic reactions subscales. A clinically important change in the THI was reported by 39% of the study group (17/44). Almost 90% of the study participants (39/44) chose environmental sounds to listen to, the most popular being rain and ocean waves. In the control group, tinnitus severity did not change over 3 or 6 months. ConclusionsAlthough the participants still experienced limitations caused by tinnitus, the advantage of the app was that it led to lower negative emotions and thus reduced overall tinnitus severity. It is worth considering whether a mobile app might be incorporated into the management of tinnitus in a professional setting

Clinically important change in tinnitus sensation after stapedotomy

Abstract Background When measuring the treatment effect in tinnitus with multi-item outcome instruments, it is crucial for both clinical and research purposes to take into consideration clinical importance of the outcome scores. The aim of the present study is to determine minimal important change (MIC) in tinnitus which is clinically meaningful to patients with otosclerosis. Methods The study population was 95 patients with otosclerosis, suffering from tinnitus. They completed the Tinnitus Functional Index before stapedotomy and 3 months after the surgery. The minimal important change was estimated with the Clinical Global Impression Scale as the external criterion (anchor). The mean change method and the receiver operating characteristic (ROC) method were used to determine minimal important change in tinnitus sensation. Results The improvement in tinnitus after stapedotomy was reported by 69.4% of the patients with otosclerosis. Minimal important change in tinnitus was estimated as reduction of 8.8 points in the Tinnitus Functional Index. Conclusions The anchor-based approach using an external criterion (anchor) allows to determine change in tinnitus sensation which is meaningful to patients after stapedotomy. The value of 8.8 points in Tinnitus Functional Index could be used as benchmark of stapedotomy effectiveness in otosclerosis patients suffering from tinnitus. Hearing difficulties comorbid with tinnitus could affect the perception of tinnitus change

Effect of the COVID-19 Pandemic on Resting-State Brain Activity in Individuals with Tinnitus

This study looked at the possible effect of the COVID-19 pandemic on individuals who came to our clinic seeking relief from tinnitus. The performance of the subjects during the COVID-19 pandemic was compared with similar individuals who came to our clinic before the pandemic began. The study involved 50 adults with chronic tinnitus, made up of a study group (24 subjects tested during the COVID-19 pandemic of 2020–2021) and a control group before the pandemic began (26 subjects tested from 2013 to 2017). None of the 24 reported having contracted COVID-19. Data collection involved the Tinnitus Handicap Inventory (THI) questionnaire, audiological tests, and quantitative electroencephalography (qEEG). In terms of THI scores, there were no statistically significant differences between the two groups. However, with regard to qEEG, some changes were observed, with significant decreases in alpha and beta band activity in the study group compared to the control group, particularly over the auditory cortex. We conclude that COVID-19 did not have a discernible impact on the general well-being of individuals with tinnitus. However, it did appear to alter brain activity, specifically in the alpha and beta bands over the auditory cortex, and these reults warrant further investigation