COMD News

from the International Tinnitus Journal

The translation of a neurovascular hypothesis for Alzheimer’s disease to subjective idiopathic tinnitus (SIT) is presented as a challenge to the predominantly sensorineural view of SIT and its clinical application for tinnitus treatment. The concept of neurovascular dysfunction and neurodegeneration (ND) in SIT patients has been proposed and reported as an etiology in a particular subset of tinnitus patients with a diagnosis of medical-audiological tinnitus, through a medical-audiological tinnitus patient protocol, to be a predominantly central-type, severe, disabling SIT (n = 54 of 96). A medical-audiological ND tinnitus profile was the basis for selection of 18 SIT patients (n = 18 of 54) for nuclear medicine brain imaging (i.e., single-photon emission computed tomography or positron emission tomography, or both). Objective findings were reported in 16 of this cohort of 18 SIT patients selected for nuclear medicine imaging (88.9%). Classification of central nervous system (CNS) ND and tinnitus differentiated between (1) ND, nonspecific and of unknown etiology; (2) ND manifested by perfusion asymmetries in brain associated with ischemia (n = 11 of 18); and (3) ND CNS disease consistent with nuclear medicine criteria for senile dementia Alzheimer’s-type disease (n = 5 of 18). The diagnosis was associated with cerebrovascular disease (n = 16 of 18). The identification of pathological processes of inflammation and ischemia, linked to ND, in a particular cohort of SIT patients may provide a basis for establishing the medical significance and treatment of SIT and influence the clinical course of the tinnitus.

from the International Tinnitus Journal

Patients with superior semicircular canal dehiscence (SSCD) may have conductive hearing loss (CHL) with normal middle ear (ME). A patient with CHL and normal tympanic membrane at otoscopy underwent tympanotomy for presumed otosclerosis but had negative intraoperative findings. A high-resolution computed tomography (CT) scan of the temporal bone performed a few years later showed the absence of middle-ear disorder (especially the absence of imaging signs of otosclerosis) and revealed a bony dehiscence of the superior semicircular canal. High-resolution CT scan is the test of choice for diagnosing SSCD; it mimics otosclerosis by manifesting itself as CHL with a normal ME. The aim of this study is to remind radiologists and otolaryngologists that SSCD should be systematically considered among the etiologies of CHL with normal ME.

from the International Tinnitus Journal

We examined 179 inpatients with severe chronic tinnitus for tinnitus-related distress and psychological dysfunction after treatment. We conducted a prospective, nonrandomized, noncontrolled study. We calculated treatment outcome in tinnitus-related distress, depression, and somatic complaints by analysis of variance with repeated measurement at admission, at discharge, and at 3, 6, and 12 months after treatment. Additionally, on the basis of reduction in tinnitus-related distress, responders and nonresponders were determined. We compared the effects of treatment for both groups on tinnitus-related distress, depression, and somatic complaints. In our entire sample, tinnitus-related distress, depression, and somatic complaints decreased significantly at discharge. After discharge, all patients showed improvement for up to 12 months as compared to their condition at admission. Of the 179 severely distressed patients, 67% were found to have improved clinically at discharge, and 47% still benefited after 12 months. In comparison to the nonresponders, the responders displayed less depression, fewer physical complaints, and fewer body-related anxieties at each measuring point. The only distinguishing factors between responders and nonresponders were their age and the extent of their psychosocial stress. Limitations of the study and consequences for treatment of chronic tinnitus patients are discussed.

from the International Tinnitus Journal

From 2001 to 2006, we performed a retrospective study of patients suffering from chronic unilateral or bilateral tinnitus that was previously ineffectively treated by oral drugs [betahistine (Betaserc), extract of Ginkgo biloba (EGb 761), tanakan (Tebokan), and cinnarizine-dimenhydrinate (Arlevert), singly or in combination]. We divided 150 tinnitus patients (80 men, 70 women) into seven treatment groups. Treatments consisted of application of intravenous pentoxifylline, lidocaine, or vinpocetine (Cavinton) and combination of these agents with physiotherapy and soft laser. Mean duration (+/- standard deviation) of tinnitus in these patients was 7.4 +/- 6.0 years; their mean age was 55.6 +/- 12.5 years. The aim of our study was to compare treatment modalities and define their effectiveness for tinnitus relief. The most effective treatment was defined as a combination of Cavinton and physiotherapy. We evaluated pure lidocaine infusion therapy as ineffective. None of the treatment modalities had an objective correlate of improvement, though improvement was reported by a visual analog scale.

from the International Tinnitus Journal

The insula cortex (Brodmann’s 13-16) has distinct auditory and multisensory areas that have been identified through imaging to be active or hypoactive in cases of severe tinnitus. As such, the insula is a candidate for inclusion in the final common pathway (FCP) for tinnitus. The insula has connection with the prefrontal and auditory cortices, amygdala, thalamus, parabrachial nucleus, orbitofrontal cortex, striate, cuneus, and cerebellum. The insula, as part of the medial temporal lobe system-which also includes the amygdala and the hippocampus-modulates its metabolic activity after high-frequency stimulation. The FCP is characterized by numerous areas in the lemniscal and extralemniscal pathways, including the auditory regions in the thalamus, the cortex, and the cerebellum. It is suggested that elements of the FCP, formulated into a general model of tinnitus, should be considered as beads on a string in designing treatment strategies. This view is the direct result of our past and recent new experiences using ultra-high-frequency sound therapy in cases of severe disabling tinnitus, presented at this time. Behaviorally, tinnitus symptoms decrease by self-report and changes in minimal masking levels with high-frequency sound therapy. The use of multisensory vibration stimulation (somatosensory and high-frequency jointly) should also be explored to maintain or reprogram the auditory cor tical map and induce activity in the FCP circuit, including the parabrachial nucleus and the in sula, which may be the physiological substrate of tinnitus behavioral tests.

from the International Tinnitus Journal

The main objective of this study was to determine reliability, validity, and reproducibility of the Italian version of the Tinnitus Handicap Inventory (THI) self-administered questionnaire aimed at evaluating the impact of tinnitus on the quality of life of subjects affected by this symptom. The questionnaire was presented to a sample of 443 subjects (285 men and 158 women; ages 19-86; mean age, 53) who were referred to our Tinnitus Centre in Rome and came from the entire national territory. All subjects reported as their main problem a tinnitus that had persisted for at least 6 months. Statistical analysis carried out on THI questionnaire results showed high internal consistency and reliability for the total scale (Cronbach’s alpha = .94). Despite the poor number of items, the THI proved useful for the functional scale (0.86), the emotional scale (0.89), and the catastrophic scale (0.75).

from the International Tinnitus Journal

Recent studies have indicated that the pathophysiological basis for tinnitus may be abnormal activity in the auditory areas of the brain rather than aberrant activity in the periphery. Tinnitus-related activity leads to changes in tonotopic representation in auditory cortex. However, such reorganization can be reversed through training-induced changes in the response pattern of cortical neurons. We address this problem by using customized sounds that reproduce the subjective experience to reduce overactive auditory circuits. The results of two preliminary studies indicate that customized sound therapy (CST*) aimed at this central dysfunction reduces tinnitus quickly and safely. Participants described immediate relief, showed changes on the Tinnitus Handicap Questionnaire, and reported changes in hearing threshold within 3 weeks. We also saw changes in the intensity dependence of the auditory N100 in tinnitus patients, supporting the idea that tinnitus reflects a reorganization of tonotopic maps in the auditory cortex. The main correlate of this reorganization was the enhanced contrast between responses to the perceived tinnitus pitch and tones approximately one octave lower. After 3 weeks of CST, the intensity dependence to the tinnitus pitch decreased, making these responses more similar to those from normal subjects responding to tones in the same frequency.

from the International Tinnitus Journal

Anatomical, physiological and metabolic properties of tinnitus have been identified and a comprehensive theory is immerging. The key elements and their interaction are presented in a general fashion highlighting areas of concern such as needed details of individual biosusceptibility and the need for continued tinnitus modeling for predictions as an aid in the development of effective treatment modalities. Nonetheless, there remains something of the uniqueness of tinnitus as a personal experience. The use of the final common pathway (FCP) as a unifying principle in diagnosis and treatment is presented.

from Medical News Today.com

A study conducted at the University of Arkansas for Medical Sciences (UAMS) has shown potential to markedly improve tinnitus, commonly known as “ringing in the ears.”

from Applied Psychophysiology and Biofeedback

Abstract The etiological tinnitus models propose that suffering can be caused and aggravated by heightened physiological arousal. Therefore psychophysiological treatments are applied. Stability of the measured parameters is essential for the use of biofeedback as well as to permit the attribution of changes to the administered treatment. The aim of our study was to investigate the 3-month reproducibility of psychophysiological parameters in 60 tinnitus patients. Using a repeated-measures design, the activity of these parameters was assessed twice during various stress and relaxation trials. The results showed that the measurements of frontalis, masseter and trapezius muscles were stable, while for the sternocleidomastoid, the skin conductance level (SCL) and the skin temperature retest-stability could not be evidenced. For all parameters, test–retest stability was weak for the relative scores. In conclusion, our study has important implications for applied psychophysiology research: (1) the measurement of EMG assessed in a clinical sample is stable over a 3-month interval; (2) in contrast, the measurements of SCL and skin temperature as well as all relative scores are less stable; and (3) the stability of EMG-parameters in our sample gives first hints that physiological changes can be attributed to an administered biofeedback treatment but further research is required.

from Trends in Amplification

Over the past two decades, recognition has grown that measures for evaluating treatment outcomes must be designed specifically to have high responsiveness. With that in mind, four major types of tinnitus measures are reviewed, including psychoacoustic measures, self-report questionnaires concerning functional effects of tinnitus, various rating scales, and global outcome measures. Nine commonly used tinnitus questionnaires, developed in the period 1980-2000, are reviewed. Because of many similarities between tinnitus and pain, comparisons between pain and tinnitus measures are discussed, and recommendations that have been made for developing a core set of measures to evaluate treatment-related changes in pain are presented as providing a fruitful path for developing a core set of measures for tinnitus. Finally, the importance of having both immediately obtainable outcome measures (psychoacoustic, rating scales, or single global measures) and longer term measures (questionnaires covering the negative effects of tinnitus) is emphasized for further work in tinnitus outcomes assessment.

fromMediscape.com

Most results from auditory brainstem response testing in patients with tinnitus and normal hearing fall within normal limits, but certain details differ in tinnitus patients compared with those without the condition, Brazilian researchers report in the June issue of the Archives of Otolaryngology, Head and Neck Surgery.

from Laryngoscope

Abstract:
Objectives/Hypothesis: A single patient was tested to examine the safety and feasibility of using maintenance sessions of low-frequency repetitive transcranial magnetic stimulation (1 Hz rTMS) to reduce tinnitus loudness and prevent its return over time.

Study Design: Interrupted time series with multiple replications.

Methods: Tinnitus loudness was assessed using a visual analogue rating (VAR) with 0 = no tinnitus, and 100 = loudest tinnitus experienced; 1,800 TMS pulses delivered at 1 Hz and 110% of motor threshold were administered over the posterior, superior lateral temporal gyrus of the subject’s right hemisphere until subjective tinnitus fell to a VAR of 25. TMS was reapplied as tinnitus returned to a VAR of 25 or higher. Cerebral metabolism was measured using positron emission tomography before and after treatment.

Results: In this patient, tinnitus could be reduced to a VAR of 6 or lower each time it reoccurred using one to three maintenance sessions of rTMS. Tinnitus loudness remained at or below a VAR of 25 and was reported to be unobtrusive in daily life when last assessed 4 months after the third and final round of maintenance treatment. Asymmetric increased cerebral metabolism in the right hemisphere reduced following treatment and as tinnitus improved. Maintenance treatment was well tolerated with no side effects.

Conclusions: Although a case study cannot establish treatment efficacy, this study demonstrates for the first time that it is feasible to use maintenance rTMS to manage chronic tinnitus. Maintenance rTMS might impede cortical expansion of the tinnitus frequency into adjacent cortical areas, but group studies are necessary to confirm this speculation.

from the European Archives of Oto-Rhino-Laryngology

Abstract Scientific evidence has proved reorganisation processes in the auditory cortex after sensorineural hearing loss and overstimulation of certain tonotopic cortical areas, as we see in auditory conditioning techniques. Acoustic rehabilitation reduces the impact of these reorganisation changes. Recent theories explain tinnitus mechanisms as a negative consequence of neural plasticity in the central nervous system after a peripheral aggression. Auditory discrimination training (ADT) could partially reverse the wrong changes in tonotopic representation and improve tinnitus. We discuss different studies and their efficacy on tinnitus perception and annoyance. Indications, method, dose and sound strategy need to be implemented.

from the ASHA Leader

“Audiologists are arguably the most qualified of all health care professionals to offer clinical services for tinnitus. Yet many audiologists lack a high level of training in appropriate interventions, leaving them wondering how to most effectively treat ‘tinnitus patients’.”

from Transcultural Psychology

Somatic symptoms are a common clinical presentation of distress among ethnic populations in the USA, particularly traumatized refugees. In this article, we apply a `multiplex model’ of bodily experience to explain how a somatic symptom is evoked, amplified, and generates distress, particularly distress related to post-traumatic stress disorder. We illustrate the multiplex model’s applicability to acute episodes of tinnitus (i.e., a buzzing-like sound in the ear) among Cambodian refugees, a common symptom in that group. The article demonstrates the importance of carefully examining somatic symptoms and associated meanings in distressed ethnic populations, especially traumatized refugees, and aims to contribute to a medical anthropology of somatic symptoms.

from Ear, Nose & Throat Journal

In patients with tinnitus, achieving consistently positive treatment results is a challenge. We conducted a controlled clinical study of a new treatment approach (Neuromonics Tinnitus Treatment) that involves the use of a customized neural stimulus. This stimulus is delivered to the patient in the form of a pleasant acoustic sensation that is spectrally modified according to each patient’s individual audiometric profile. This treatment approach is provided as part of a structured rehabilitation program. In our study, patients who received the customized stimulus (Neuromonics group) reported significantly greater and more consistent alleviation of tinnitus symptoms than did patients who participated in a counseling and support program with and without delivery of a broadband noise stimulus (Noise+Counseling group and Counseling-Only group, respectively). After 6 months of treatment, 86% of the Neuromonics patients met the minimum criterion for clinical success, defined as an alleviation of tinnitus disturbance of at least 40% (as determined by the Tinnitus Reaction Questionnaire score). By contrast, only 47 and 23% of the Noise+Counseling and Counseling-Only groups, respectively, reported a successful result according to this criterion. Mean improvements in tinnitus disturbance scores in the Neuromonics, Noise+Counseling, and Counseling-Only groups were 66, 22, and 15%, respectively. The differences between the Neuromonics group and the control groups were statistically significant. Significant differences were observed in other clinical outcomes. Patient reports of user acceptability were more consistently positive in the Neuromonics group.

from Drugs.com

Neuromonics Inc. today announced publication of the first clinical study evaluating the Neuromonics Tinnitus Treatment’s effectiveness compared to relevant control groups.

from Archives of Otolaryngology–Head and Neck Surgery

Objective To evaluate electrophysiologically the auditory nerve and the auditory brainstem function of patients with tinnitus and normal-hearing thresholds using the auditory brainstem response (ABR).

Design Case-control study.

Setting Ambulatory section of the Department of Otolaryngology, Hospital de Base de Brasília.

Patients Thirty-seven individuals with tinnitus and 38 without tinnitus, with ages ranging from 20 to 45 years and pure-tone thresholds of 25 dB or better at frequencies between 500 and 8000 Hz.

Main Outcome Measures We compared the latencies of waves I, III, and V; the interpeak intervals I-III, III-V, and I-V; the interaural latency difference (wave V); and the V/I amplitude ratio between the 2 groups.

Results Among the 37 patients in the study group, abnormal results were found in 16 (43%) in at least 1 of the 8 parameters evaluated. When we analyzed the latencies, although the values were on average in the normal range used in the present study, the tinnitus group presented a significant prolongation of the latencies of waves I, III, and V when compared with the control group. Furthermore, we found the interpeak I-III, III-V, and I-V values to be within the normal limits, but the interpeak III-V value was significantly (P = .003) enlarged in the study group compared with the control group. The V/I amplitude ratio found in the tinnitus group was within normal limits; however, a significant (P = .004) difference was found when the 2 groups were compared. The averages of the interaural latency difference (wave V) did not show significant differences in relation to the control group.

Conclusions We conclude that, although the averages obtained in several analyzed parameters were within normal limits, the ABR results from the patients with and without tinnitus and normal hearing are different, suggesting that ABR might contribute to the workup of these patients. Our data show that there are changes in the central pathways in the study group. The meaning of these changes must be further investigated.

from the American Journal of Audiology

Purpose: While tinnitus is very common among the hearing impaired population, specific treatment for tinnitus is not provided in most clinics. This article provides a plan for establishing a tinnitus treatment program that can be implemented in stages at most audiology clinics.

Method: Preparation for establishing a tinnitus clinic includes having an overall plan regarding the type and degree of tinnitus management. Assessment involves a measurement of tinnitus and of the reaction a patient has to the tinnitus, including the use of handicap questionnaires. Management typically involves some form of counseling and sound therapy. Four problematic areas in tinnitus management are thoughts and emotions, hearing and communication, sleep, and concentration.

Conclusions: Licensed audiologists generally have the essential training necessary to provide counseling and sound therapy to treat tinnitus patients. We introduce 3 levels of treatment implementation, depending on whether the patient is curious, concerned, or distressed. Follow-up and referrals might be necessary in more severe cases. Finally, the development of a tinnitus clinic centers around establishing a need for individual treatment, creating a treatment plan, estimating the need for additional staff and resources, reimbursement options, and assessing the effectiveness of the program.

from the Indian Journal of Otolaryngology and Head and Neck Surgery

No abstract available.

from Medical News Today.com

The research itself is challenging because Moore can’t ask mice and rats if their ears are ringing. Now, he’s working with zebrafish (yes, they do have ears, which are remarkably similar to humans’ ears.) He’s been able to cause ringing in their ears — he thinks — by exposing them to certain drugs and tracking their erratic swimming on video. Moore then looks at the cells in their ears to see if the electrical firing has increased, an early sign of damage and tinnitus. His early findings show an increased firing.

Then Moore attempts to block this effect with drugs to return the cells to their normal activity. In preliminary research, it appears the drugs he has tested do slow down the increased electrical firing or tinnitus-like behavior of the hair cells in the ear.

Moore is beginning to meet with doctors to discuss launching a clinical trial to test these drugs for patients with tinnitus.

from Acta Oto-Laryngologica

Conclusion. There is evidence of an inverse association between cerebral infarction and tinnitus in this study. The effects of cerebral infarction on tinnitus could be explained by a neurophysiological model of tinnitus. Objectives. We examined the relationship between tinnitus and brain MRI findings including cerebral infarction, brain atrophy, ventricular dilatation, and white matter lesions. Subjects and methods. This was a cross-sectional population-based study of 2193 subjects aged 41-82 years living in Aichi prefecture, Japan. Detailed questionnaires, pure tone audiometry, and brain MRI were performed. Results. After adjusting for potential confounders in a multiple logistic analysis, cerebral infarction was inversely associated with tinnitus (odds ratio (OR)=0.649, 95% confidence interval (CI)=0.477-0.884). Cerebral infarctions of the basal ganglia (OR=0.542), thalamus (OR=0.441), and pons (OR=0.319) were especially associated with tinnitus. Brain atrophy, ventricular dilatation, and white matter lesions had no significant effects on the prevalence of tinnitus.

from the Journal of Laryngology and Otology

Objective: To evaluate effectiveness of 5 mW laser irradiation in the treatment of chronic tinnitus.

Study design: Prospective, randomised, double-blind study.

Methods: This investigation included 66 ears in 45 patients with chronic unilateral or bilateral tinnitus. A 5 mW laser with a wavelength of 650 nm, or placebo laser, was applied transmeatally for 15 minutes, once daily for a week. A questionnaire was administered which asked patients to score their symptoms on a five-point scale, before and two weeks after laser irradiation. A decrease of one scale point, regarding the loudness, duration and degree of annoyance of tinnitus, was accepted to represent an improvement.

Results: The loudness, duration and degree of annoyance of tinnitus were improved, respectively, in up to 48.8, 57.7 and 55.5 per cent of the patients in the active laser group. No significant improvement was observed in the placebo laser group.

Conclusion: Transmeatal, low power (5 mW) laser irradiation was found to be useful for the treatment of chronic tinnitus.

from ORL -Journal for Oto-Rhino-Laryngology and Its Related Specialties

Aim: The effect of the transcutaneous application of the electrical stimulus on tinnitus perception has been reviewed in a placebo-controlled, randomized and comparative analysis to eventually determine the outcome of the therapeutic role of the therapy. Method: There are 42 patients who were randomized into 2 groups according to their order of admission. Group A consists of 31 patients who were subjected to transcutaneous electrical stimulation 3 times a week for 1 month. Group B includes 11 patients who had electrical stimulus attachment but where no stimulus was given (placebo group). The stimulator is a custom-made device which generates direct and alternative current in 10-200 Hz frequency. An alternative low-frequency (not >100 Hz) pulsed current was used for tinnitus therapy through a preauricular skin electrode. The amplitude of stimulus ranged between 50 and 2,000 mA. The pulse frequency was 30 Hz. Each session lasted for 25 min for both groups. Statistical analysis was performed. Result: The rate of improvement following the therapy was 42.8% (18/42) in the electrical therapy group and 28.5% (4/14) in the placebo group. Conclusion: Electrical suppression of the tinnitus does not offer a promising outcome for patients with tinnitus in the presented study.

from ABC News.com

Tinnitus Has No Cure; Some Sufferers Found Relief in New Treatments

from the International Tinnitus Journal

No abstract available.

from the New York Times

Modern life is loud. The jolting buzz of an alarm clock awakens the ears to a daily din of trucks idling, sirens blaring, televisions droning, computers pinging and phones ringing — not to mention refrigerators humming and air-conditioners thrumming. But for the 12 million Americans who suffer from severe tinnitus, the phantom tones inside their head are louder than anything else.

from Acta Oto-Laryngologica

Conclusions. Pulsatile tinnitus requires a careful physical examination and evaluation with selected imaging techniques to identify the origin of the symptoms. Objective. To evaluate the incidence of identifiable anomalies in patients with pulsatile tinnitus. Subjects and methods. This was a retrospective chart review undertaken in a tertiary care center. Patients seen in the outpatient otolaryngology clinic with the chief complaint of pulsatile tinnitus were evaluated by physical examination and imaging including CT angiography. The outcome measure was the incidence of identifiable abnormalities on imaging studies. Results. Fifty-four patients were seen between January 2002 and June 2007 with the chief complaint of constant pulsatile tinnitus, excluding those with chemodectomas. On the basis of physical examination and imaging, 14 were considered arterial, 23 venous, and 15 were indeterminate in origin. Among patients with venous tinnitus, sigmoid sinus diverticulum was the most common finding. Among patients with arterial tinnitus, carotid atherosclerotic disease was the most common. One patient had erosion of the cochlea by the carotid artery. Non-vascular entities identified include superior semicircular canal dehiscence and benign intracranial hypertension.

from Acta Oto-Laryngologica

Conclusions. This article shows that the inferior colliculus plays a key role in unilateral subjective tinnitus. Objectives. The major aim of this study was to determine tinnitus-related neural activity in the central auditory system of unilateral tinnitus subjects and compare this to control subjects without tinnitus. Subjects and methods. Functional MRI (fMRI) was performed in 10 patients (5 males) with unilateral tinnitus (5 left-sided, 5 right-sided) and 12 healthy subjects (6 males); both groups had normal hearing or mild hearing loss. fMRI experiments were performed using a 3T Philips Intera Scanner. Auditory stimuli were presented left or right and consisted of dynamically rippled broadband noise with a sound pressure level of 40 or 70 dB SPL. The responses of the inferior colliculus and the auditory cortex to the stimuli were measured. Results. The response to sound in the inferior colliculus was elevated in tinnitus patients compared with controls without tinnitus.