Somatosensorischer Tinnitus

Hintergrund Somatosensorischer Tinnitus stellt eine Untergruppe des chronischen Tinnitus dar. Einige wissenschaftliche Erkenntnisse zeigen Verschaltungen zwischen dem somatosensorischen und dem auditorischen System, welche für die Entstehung und Aufrechterhaltung des Tinnitus verantwortlich zu sein scheinen. Ziel der Arbeit Das Ziel dieser Arbeit ist es, einen Überblick über den somatosensorischen Tinnitus zu geben und ein Untersuchungsprotokoll vorzuschlagen. Dieses soll in Diagnostik und Therapie dieser Patientengruppe unterstützend sein. Material und Methoden Neben der Anamnese werden diverse klinische Untersuchungsmanöver vorgestellt, um die Diagnose eines somatosensorischen Tinnitus zu stellen. Ergebnisse Die Manöver werden eingeteilt in Untersuchungen der Halswirbelsäule, des Kiefergelenks sowie kiefergelenksnahe Weichteilpalpation. Sie sollten in ruhiger Umgebung und meist im Seitenvergleich durchgeführt werden. Diskussion Die korrekte Diagnosestellung eines somatosensorischen Tinnitus ist essentiell, um eine entsprechende Behandlung dieser Patientengruppe einzuleiten, wobei die hier vorgestellten klinischen Manöver hierfür gut geeignet sind

Tinnitus Is Marginally Associated with Body Mass Index, Heart Rate and Arterial Blood Pressure: Results from a Large Clinical Sample

Introduction: This study aimed to explore whether body mass index (BMI), systolic blood pressure (RR syst), diastolic blood pressure (RR diast) or heart rate (HR) are associated with tinnitus status and/or severity. Methods: To that end, we evaluated the influence of tinnitus status and Tinnitus Handicap Inventory (THI) score on BMI, RR syst, RR diast and HR by comparing data from a large sample of patients presenting to a specialized tertiary referral clinic (N = 1066) with data from a population-based control group (N = 9885) by means of linear models. Results: Tinnitus patients had a significantly lower BMI and higher RR syst, RR diast and HR than non-tinnitus patients; however, the contribution of the case–control status to R2 was very small (0.1%, 0.7%, 1.4% and 0.4%, respectively). BMI had little predictive power for the THI score (higher BMI scores were related to higher THI scores; R2 = 0.5%) and neither RR syst, RR diast, nor HR showed a statistically significant association with THI. Discussion: Our findings suggest that HR, RR and BMI are at most marginally associated with tinnitus status and severity

The Influence of Diet on Tinnitus Severity: Results of a Large-Scale, Online Survey

Optimization of dietary intake is an essential component in the multidimensional effort to prevent and manage chronic disease. Recently, demand has increased for nutrition-focused management strategies for chronic tinnitus. The primary aim of this study was to evaluate 10 dietary items for their association with changes in subjective tinnitus severity. A secondary aim was to develop an algorithm to better identify those individuals who might benefit from dietary modification strategies. A total of 5017 anonymous users of the TinnitusTalk forum completed an online survey regarding how various dietary items affected the severity of their tinnitus. Results suggest that, while intake of caffeine [positive effect (PE): 0.4%; negative effect (NE): 16.2%], alcohol (PE: 2.7%; NE: 13.3%, and salt (PE: 0.1%; NE: 9.9%) was most likely to influence tinnitus severity, it did so only for a small proportion of participants and reported effects were most commonly mild. Further, though a classification algorithm was able to leverage participant demographic, comorbidity, and tinnitus characteristics to identify those individuals most likely to benefit from dietary modification above chance levels, further efforts are required to achieve significant clinical utility. Taken together, these results do not support dietary modification as a primary treatment strategy for chronic tinnitus in the general population, though clinically meaningful effects might be observable in certain individuals

HHT-Related Epistaxis and Pregnancy—A Retrospective Survey and Recommendations for Management from an Otorhinolaryngology Perspective

Appropriate management of hereditary hemorrhagic telangiectasia (HHT) is of particular importance in females, as HHT-mediated modifications of the vascular bed and circulation are known to increase the risk of complications during pregnancy and delivery. This study was undertaken to evaluate female HHT patients’ awareness of and experience with HHT during pregnancy and delivery, with a focus on epistaxis. In this retrospective study, 46 females (median age: 60 years) with confirmed HHT completed a 17-item questionnaire assessing knowledge of HHT and its pregnancy-associated complications, the severity of epistaxis during past pregnancies and deliveries, and the desire for better education and counselling regarding HHT and pregnancy. Results revealed that 85% of participants were unaware of their disease status prior to the completion of all pregnancies. Further, 91% reported no knowledge of increased pregnancy-related risk due to HHT. In regard to epistaxis, 61% of respondents reported experiencing nosebleeds during pregnancy. Finally, approximately a third of respondents suggested that receiving counseling on the risks of HHT in pregnancy could have been helpful. Findings suggest that awareness of HHT and its potential for increasing pregnancy-related risk is poor. Best practices in HHT management should be followed to minimize negative effects of the disorder

The statistical analysis plan for the unification of treatments and interventions for tinnitus patients randomized clinical trial (UNITI-RCT)

Background Tinnitus is a leading cause of disease burden globally. Several therapeutic strategies are recommended in guidelines for the reduction of tinnitus distress; however, little is known about the potentially increased effectiveness of a combination of treatments and personalized treatments for each tinnitus patient. Methods Within the Unification of Treatments and Interventions for Tinnitus Patients project, a multicenter, randomized clinical trial is conducted with the aim to compare the effectiveness of single treatments and combined treatments on tinnitus distress (UNITI-RCT). Five different tinnitus centers across Europe aim to treat chronic tinnitus patients with either cognitive behavioral therapy, sound therapy, structured counseling, or hearing aids alone, or with a combination of two of these treatments, resulting in four treatment arms with single treatment and six treatment arms with combinational treatment. This statistical analysis plan describes the statistical methods to be deployed in the UNITI-RCT. Discussion The UNITI-RCT trial will provide important evidence about whether a combination of treatments is superior to a single treatment alone in the management of chronic tinnitus patients. This pre-specified statistical analysis plan details the methodology for the analysis of the UNITI trial results. Trial registration ClinicalTrials.gov NCT04663828. The trial is ongoing. Date of registration: December 11, 2020. All patients that finished their treatment before 19 December 2022 are included in the main RCT analysis

Potential Benefit of Selective CMV Testing after Failed Newborn Hearing Screening

Evidence-based guidelines for the prevention, diagnosis and treatment of congenital cytomegalovirus (cCMV) were recently released by two independent expert groups. Of particular emphasis was the relationship between cCMV and sensorineural hearing loss (SNHL), a major component of the virus’ overall disease burden. In this study, a literature review was performed to estimate the proportion of cCMV-related SNHL cases, which might be identified through selective cCMV testing following failed newborn hearing screening. Furthermore, it was of interest to estimate the potential benefit of emerging antiviral therapies. Currently, at most 10% of cCMV-related SNHL is likely to be identified clinically. Through use of a selective cCMV testing protocol, however, a significant improvement in the identification rate can be achieved. Recent expert group statements strongly recommend antiviral therapy in cases of moderate-to-severe disease, especially in the presence of central nervous system involvement. Though differences exist between recommendations in instances of isolated SNHL or SNHL in combination with only mild symptoms, the majority of experts in both groups offered at least a weak recommendation for antiviral treatment. Available results suggest antiviral treatment could therefore benefit a meaningful proportion of newborns referred for cCMV testing following failed newborn hearing screening

Chance-level hit rates in closed-set, forced-choice audiometry and a novel utility for the significance test-based detection of malingering.

The primary aim of this study was to extend existing theory on the relationship between chance-level performance and the number of alternatives and trials in closed-set, forced-choice speech audiometry and sound localization methods. When calculating chance performance for closed-set, forced-choice experiments with multiple trials, the binomial distribution should be preferred over the simple 1/a probability, as the latter is appropriate only for single trial experiments. The historical use of constant hit rates for determining chance performance has been based upon the assumption that random hits are distributed evenly across multiple trials. For any closed-set, forced-choice task with 2 to 10 alternatives and 2 to 100 trials, we calculated the probability of obtaining any given hit rate due to random guessing alone according to the binomial distribution. Hit rates with probabilities p > 0.05 were interpreted as being likely to occur due to random chance alone, whereas hit rates with probabilities of p ≤ 0.05 were interpreted as being unlikely to occur due to chance alone. For sound localization experiments with speakers at fixed positions, the expected probability of a random hit was also calculated using the binomial distribution. The expected angular root mean square (rms) error in sound localization resulting from the random selection of sound sources was investigated using Monte Carlo simulations. A new aspect in the interpretation of test results was identified for situations in which the observed number of hits is much lower than would be expected due to chance alone. For test methods incorporating a relatively low number of alternatives and a sufficiently high, yet clinically feasible, number of trials, both upper and lower thresholds for chance-level performance could be identified. This lower threshold represents the lowest hit rate which can be expected through random chance alone. Extending interpretation of results to include this lower threshold affords the ability to not only identify performance significantly superior to that of chance, but also that significantly poorer than chance and thereby represents a simple method for the objective detection of malingering

Avoiding disconnection: An evaluation of telephone options for cochlear implant users

Objective: The primary aim of this study was to evaluate the effect of coupling method on telephone-based speech recognition and perceived listening difficulty in noise for cochlear implant (CI) users. A secondary aim was to evaluate potential impacts of additional processing modifications within coupling conditions, such as activating noise reducing algorithms or muting environmental microphones.Design: Hochmair-Schulz-Moser sentences were bandpass-filtered (300-3400Hz) and presented unilaterally either via telephone handset or advanced wireless streaming device in a background of cafeteria babble (signal-to-noise ratio =15dB). Sentence recognition was scored at the word level and perceived listening difficulty was assessed via visual-analogue scale for each of five test conditions. Study sample: Twenty native German-speaking CI users participated. Results: Repeated measures analysis of variance revealed coupling via advanced streaming significantly improved sentence recognition and reduced listening difficulty, when compared to either telecoil or acoustic coupling configurations. In addition, program modifications further increased benefit within a coupling condition. CI users who exhibited the most difficulty during basic acoustic coupling were most likely to benefit from advanced wireless streaming. Conclusion: CI users have several options for improving speech recognition and decreasing listening difficulty over the telephone when listening in noisy environments

Somatosensorischer Tinnitus

Hintergrund: Somatosensorischer Tinnitus stellt eine klinisch bedeutsameUntergruppe des chronischen Tinnitus dar. Obwohl das Verständnis der Pathogenese des somatosensorischen Tinnitus noch unvollständig ist, zeigen einige wissenschaftliche Erkenntnisse Verschaltungen zwischen dem somatosensorischen und dem auditorischen System, welche für die Entstehung und Aufrechterhaltung des Tinnitus verantwortlich zu sein scheinen. Ziel der Arbeit: Das Ziel dieser Arbeit ist es, einen Überblick über den somatosensorischen Tinnitus zu geben und ein Untersuchungsprotokoll vorzuschlagen, welches in Diagnostik und Therapie dieser Patientengruppe unterstützend sein soll. Material und Methoden: Neben der Anamnese werden diverse klinische Untersuchungsmanöver vorgestellt, um die Diagnose eines somatosensorischen Tinnitus zu stellen. Ergebnisse: Die Manöver werden eingeteilt in Untersuchungen der Halswirbelsäule, des Kiefergelenks sowie kiefergelenknahe Weichteilpalpation. Diese sollten in ruhiger Umgebung und meist im Seitenvergleich durchgeführt werden. Schlussfolgerung: Die korrekte Diagnosestellung eines somatosensorischen Tinnitus ist essenziell, um eine entsprechende Behandlung dieser Patientengruppe einzuleiten, wobei die hier vorgestellten klinischen Manöver dafür gut geeignet sind

Wideband Absorbance and 226-Hz Tympanometry in the Prediction of Optimal Distortion Product Otoacoustic Emission Primary Tone Levels

Purpose: Distortion product otoacoustic emission (DPOAE) amplitude is sensitive to the primary tone level separation effective within the cochlea. Despite potential for middle ear sound transmission characteristics to affect this separation, no primary tone level optimization formula accounts for its influence. This study was conducted to determine if inclusion of ear- and frequency-specific immittance features improves primary tone level optimization formula performance beyond that achieved using a univariate, L-2-based formula. Method: For 30 adults with normal hearing, DPOAE, wideband absorbance, and 226-Hz tympanometry measures were completed. A mixed linear modeling technique, incorporating both primary tone and acoustic immittance features, was used to generate a multivariable formula for the middle ear-specific recommendation of primary tone level separations for f(2) = 1-6 kHz. The accuracy with which L-1OPT, or the L-1 observed to maximize DPOAE level for each given L-2, could be predicted using the multivariable formula was then compared with that of a traditional, L-2-based univariate formula for each individual ear. Results: Use of the multivariable formula L-1 = 0.47L(2) + 2.40A + f(2param) + 38 [dB SPL] resulted in significantly more accurate L-1OPT predictions than did the univariate formula L-1 = 0.49L(2) + 41 [dB SPL]. Although average improvement was small, meaningful improvements were identified within individual ears, especially for f(2) = 1 and 6 kHz. Conclusion: Incorporation of a wideband absorbance measure into a primary tone level optimization formula resulted in a minor average improvement in L-1OPT prediction accuracy when compared with a traditional univariate optimization formula. Further research is needed to identify characteristics of ears that might disproportionately benefit from the additional measure