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

Transcanal approach for implantation of a cochlear nerve electrode array.

Objectives/hypothesisTo evaluate a transcanal approach for placement of a stimulating electrode array in the cochlear nerve.Study designProspective cadaveric temporal bone study.MethodsTen human cadaveric temporal bones were dissected. Both a facial recess approach with mastoidectomy and a transcanal approach using the novel technique were performed in each bone. A middle fossa dissection of the internal auditory canal was performed to confirm the position of the electrode in the cochlear nerve.ResultsThe transcanal approach offered a direct approach to the cochlear nerve in all 10 bones. The procedure was quicker than the facial recess approach and did not endanger the facial or chorda tympani nerves. Inspection of the medial end of the internal auditory canal confirmed correct placement of the electrode in the cochlear nerve. In contrast, anatomical constraints, specifically the position of the facial nerve, blocked access to the cochlear nerve by the facial recess approach in three of the specimens to achieve the exposure to place the electrode at a perpendicular angle to the cochlear nerve. Sacrifice of the chorda tympani was necessary in five of the seven bones in which the cochlear nerve could be accessed.ConclusionsThe transcanal approach offers a simpler, safer approach for cochlear nerve implantation compared to the facial recess approach. This approach can be accomplished in less time and avoids the hazards of dissection around the facial nerve. Use of the proposed approach will facilitate development of intraneural stimulation for an improved auditory prosthesis

Transcanal approach for implantation of a cochlear nerve electrode array.

Objectives/hypothesisTo evaluate a transcanal approach for placement of a stimulating electrode array in the cochlear nerve.Study designProspective cadaveric temporal bone study.MethodsTen human cadaveric temporal bones were dissected. Both a facial recess approach with mastoidectomy and a transcanal approach using the novel technique were performed in each bone. A middle fossa dissection of the internal auditory canal was performed to confirm the position of the electrode in the cochlear nerve.ResultsThe transcanal approach offered a direct approach to the cochlear nerve in all 10 bones. The procedure was quicker than the facial recess approach and did not endanger the facial or chorda tympani nerves. Inspection of the medial end of the internal auditory canal confirmed correct placement of the electrode in the cochlear nerve. In contrast, anatomical constraints, specifically the position of the facial nerve, blocked access to the cochlear nerve by the facial recess approach in three of the specimens to achieve the exposure to place the electrode at a perpendicular angle to the cochlear nerve. Sacrifice of the chorda tympani was necessary in five of the seven bones in which the cochlear nerve could be accessed.ConclusionsThe transcanal approach offers a simpler, safer approach for cochlear nerve implantation compared to the facial recess approach. This approach can be accomplished in less time and avoids the hazards of dissection around the facial nerve. Use of the proposed approach will facilitate development of intraneural stimulation for an improved auditory prosthesis

The prevalence and characteristics of tinnitus in the youth population of the United States.

Objectives/hypothesisTo evaluate the prevalence, characteristics, and associated risk factors of tinnitus in U.S. adolescents.Study designCross-sectional analyses of U.S. representative demographic and audiometric data, the National Health and Nutrition Examination Survey (NHANES) 2005 to 2008.MethodsThe study population consisted of 3,520 individuals aged 12 to 19 years with complete tinnitus-related data. Tinnitus was defined as the presence of ringing or buzzing in the ears lasting for at least 5 minutes during the preceding 12 months. In addition, we defined a chronic tinnitus subgroup as being bothered by tinnitus for more than 3 months. Demographic and other data regarding tinnitus, smoking, body mass index (BMI), anemia, hypertension, history of ear infections, tympanostomy tube placement, otoscopy, tympanometry and hearing thresholds, history of firearm use, and recreational and occupational exposure to noise were extracted and analyzed.ResultsOverall, tinnitus lasting 5 minutes or more in the preceding 12 months was reported by 7.5% of the 12- to 19-year-old population. This represents about 2.5 million adolescents in the United States. The prevalence of chronic tinnitus was 4.7%, corresponding to about 1.6 million adolescents in the United States. Multivariable-adjusted analysis revealed that both overall and chronic tinnitus were associated with female gender, low income, exposure to passive smoking, type A tympanogram, and occupational and recreational noise exposure. History of ≥ 3 ear infections and history of tympanostomy tube placement were associated only with overall tinnitus.ConclusionsTinnitus afflicts a substantial portion of the youth population. Further investigation of the association between tinnitus and the identified risk factors is warranted

Efficacy of commercial earplugs in preventing water intrusion during swimming.

ObjectiveTo evaluate and compare the efficacy of commercially available earplugs in preventing water intrusion in healthy individuals.Study designExperimental study.SettingTertiary care medical center.Subjects and methodsTen subjects (20 ears) were assessed. After insertion of the earplugs, subjects underwent 3 standardized head-wetting protocols, including (1) surface swimming for 10 minutes, which entailed no head submersion and moderate splashing; (2) head submersion at a 90-cm depth for 20 seconds with their head upright; and (3) head submersion at a 90-cm depth with head tilted 90 degrees left and then tilted 90 degrees right for 10 seconds on each side to apply vertical pressure. Color change of a wetness indicator was used to determine water intrusion after each protocol. The same protocol was repeated for all 9 earplugs.ResultsWater intrusion was observed in 44%, 67%, and 88% of ears after surface swimming, horizontal submersion, and vertical submersion, respectively. The results revealed a significant difference in the waterproofing qualities of the various types of earplugs. The soft silicone type (Pillow Soft) earplug had the lowest rate of water penetration during all 3 protocols (P < .001). The difference between the most effective earplugs, Pillow Soft and Aquaseal, were only significant during the horizontal submersion protocol (P = .008).ConclusionWater intrusion occurred even with the use of earplugs. The intrusion was more significant with horizontal or vertical head submersion. The soft silicone Pillow Soft earplug was the most effective earplug for preventing water intrusion in surface swimming