Effects of Selective Serotonin Reuptake Inhibitor on Treating Tinnitus in Patients Stratified for Presence of Depression or Anxiety

We evaluated the effects of a selective serotonin reuptake inhibitor, paroxetine, on treating tinnitus.Tinnitus patients stratified for the presence of depression and anxiety were studied retrospectively. Fifty-six patients were observed for more than 6 months. They were initially treated with paroxetine only at a dose of 10 mg/day for 2-4 weeks; thereafter, the dose was increased to 20 mg/day. Tinnitus distress was evaluated with the Tinnitus Handicap Inventory (THI) and with visual analog scales (VASs) for tinnitus loudness and annoyance. Depression and anxiety were measured with the Self-Rating Depression Scale (SDS) and the trait section of the State-Trait Anxiety Inventory (STAI). The patients were grouped according to their SDS and STAI scores, and each variable was compared at baseline and the 6-month follow-up. Changes among these variables were also examined to determine whether reduced tinnitus distress was related to the improvement of depression or anxiety. Patients with both depression and anxiety showed better results (decrease in THI, VASs, SDS and STAI scores) than patients with anxiety alone, or patients without depression and anxiety. In patients with depression and anxiety, changes in tinnitus variables and changes in depression and anxiety scores were strongly correlated. In other patients, however, changes in tinnitus variables and changes in depression and anxiety scores were not correlated. These results suggest that paroxetine is effective in treating distressed tinnitus patients with depression and anxiety by reducing their tinnitus severity as well as their depression and anxiety.

from Audiology & Neuro-Otology

Brazilian young adults and noise: Attitudes, habits, and audiological characteristics

The objective of this study was to examine behaviors and attitudes of Brazilian teenagers towards noise, and determine their audiological characteristics. Participants were 245 young persons (14 to 18 years old) who attended private school. Behaviors and attitudes were measured using the validated Portuguese version of the Youth Attitude to Noise Scale (YANS). Pure-tone audiometry was used to evaluate the hearing of a sub-sample of 24 participants. Music played through personal media players was the most common exposure reported. A substantial percentage of participants reported temporary tinnitus (69%) after attending discos, music concerts, and listening to music through headphones. Tinnitus complaints were more frequent among females (41%) than males (27%). Four participants (1.6%) reported use of a hearing protector. Among a subsample of 24 participants, two (8%) young women had bilateral audiometric notches. YANS scores in the present study were slightly lower than those obtained in Sweden and the US, indicating a more negative attitude towards noise. Gender, age, country, and/or region are variables that will influence exposure to noise or music and possibly hearing outcomes.

from the International Journal of Audiology

Molecular aspects of tinnitus

Abstract
Molecular changes caused by sensory trauma and subsequent structural alterations of the central nervous system are only beginning to be identified. In most cases, the generation of tinnitus can be linked to damage of the peripheral auditory system, probably even in cases where hearing impairment cannot be assessed by audiometry. Within a common view, acoustic trauma and salicylate induce abnormal excitability at the level of the brainstem, subcortical and cortical level that may be related to tinnitus.The present review summarizes studies emphasizing a crucial role of molecular events that occur in the cochlea exhibiting the potential to alter the network activity in distinct areas of the brain, including the limbic system. We proceed from the inner ear to the auditory cortex and discuss the recent molecular findings in the central auditory system as a secondary step of previous neuronal changes in the periphery.

from Hearing Research

The relationship between tinnitus pitch and the audiogram

Abstract
We studied the relationship between tinnitus pitch and the audiogram in 195 patients. Patients with tone-like tinnitus reported a higher pitch (mean = 5385 Hz) compared to those with a noise-like quality (mean = 3266 Hz). Those with a flat audiogram were more likely to report: a noise-like tinnitus, a unilateral tinnitus, and have a pitch < 2000 Hz. The average duration of bilateral tinnitus (12 years) was longer than that of unilateral tinnitus (5 years). Older subjects reported a less severe tinnitus handicap questionnaire score. Patients with a notched audiogram often reported a pitch ≤8000 Hz. Subjects with normal hearing up to 8000 Hz tended to have a pitch ≥8000 Hz. We failed to find a relationship between the pitch and the edge of a high frequency hearing loss. Some individuals did exhibit a pitch at the low frequency edge of a hearing loss, but we could find no similar characteristics among these subjects. It is possible that a relationship between pitch and audiogram is present only in certain subgroups.

from the International Journal of Audiology

Evaluation of tinnitus patients with normal hearing sensitivity using TEOAEs and TEN test

This work has shown a higher prevalence of OAE abnormalities in tinnitus patients with normal hearing in contrast to TEN test denoting the more vulnerability of OHCs to damage.

from Auris Nasus Larynx

The relationship between tinnitus pitch and the audiogram

We studied the relationship between tinnitus pitch and the audiogram in 195 patients. Patients with tone-like tinnitus reported a higher pitch (mean = 5385 Hz) compared to those with a noise-like quality (mean = 3266 Hz). Those with a flat audiogram were more likely to report: a noise-like tinnitus, a unilateral tinnitus, and have a pitch < 2000 Hz. The average duration of bilateral tinnitus (12 years) was longer than that of unilateral tinnitus (5 years). Older subjects reported a less severe tinnitus handicap questionnaire score. Patients with a notched audiogram often reported a pitch ≤8000 Hz. Subjects with normal hearing up to 8000 Hz tended to have a pitch ≥8000 Hz. We failed to find a relationship between the pitch and the edge of a high frequency hearing loss. Some individuals did exhibit a pitch at the low frequency edge of a hearing loss, but we could find no similar characteristics among these subjects. It is possible that a relationship between pitch and audiogram is present only in certain subgroups.

from the International Journal of Audiology

The relationship between tinnitus pitch and the audiogram

We studied the relationship between tinnitus pitch and the audiogram in 195 patients. Patients with tone-like tinnitus reported a higher pitch (mean = 5385 Hz) compared to those with a noise-like quality (mean = 3266 Hz). Those with a flat audiogram were more likely to report: a noise-like tinnitus, a unilateral tinnitus, and have a pitch < 2000 Hz. The average duration of bilateral tinnitus (12 years) was longer than that of unilateral tinnitus (5 years). Older subjects reported a less severe tinnitus handicap questionnaire score. Patients with a notched audiogram often reported a pitch ≤8000 Hz. Subjects with normal hearing up to 8000 Hz tended to have a pitch ≥8000 Hz. We failed to find a relationship between the pitch and the edge of a high frequency hearing loss. Some individuals did exhibit a pitch at the low frequency edge of a hearing loss, but we could find no similar characteristics among these subjects. It is possible that a relationship between pitch and audiogram is present only in certain subgroups.

from the International Journal of Audiology

The role of anxiety sensitivity and behavioral avoidance in tinnitus disability

The purpose of this study was to investigate the role of anxiety sensitivity and behavioral avoidance in tinnitus distress and functioning. A cross-sectional sample of 283 individuals experiencing tinnitus was obtained from an epidemiological national survey study on hearing loss, dizziness, and tinnitus. The subjects completed a series of questionnaires measuring anxiety sensitivity, anxiety, and depression. They also answered questions regarding tinnitus distress, functioning, and avoidance. Results revealed a positive significant correlation between anxiety sensitivity and tinnitus distress. This relationship was not better explained by anxiety and depression symptoms. In addition, the findings provided support for a model where behavioral avoidance fully mediated the relationship between anxiety sensitivity and tinnitus functioning, and partially mediated the relationship between anxiety sensitivity and tinnitus distress. Implications for the role of anxiety sensitivity and behavioral avoidance in tinnitus research are discussed.

from the International Journal of Audiology

The role of anxiety sensitivity and behavioral avoidance in tinnitus disability

The purpose of this study was to investigate the role of anxiety sensitivity and behavioral avoidance in tinnitus distress and functioning. A cross-sectional sample of 283 individuals experiencing tinnitus was obtained from an epidemiological national survey study on hearing loss, dizziness, and tinnitus. The subjects completed a series of questionnaires measuring anxiety sensitivity, anxiety, and depression. They also answered questions regarding tinnitus distress, functioning, and avoidance. Results revealed a positive significant correlation between anxiety sensitivity and tinnitus distress. This relationship was not better explained by anxiety and depression symptoms. In addition, the findings provided support for a model where behavioral avoidance fully mediated the relationship between anxiety sensitivity and tinnitus functioning, and partially mediated the relationship between anxiety sensitivity and tinnitus distress. Implications for the role of anxiety sensitivity and behavioral avoidance in tinnitus research are discussed.

from the International Journal of Audiology

Evaluation of tinnitus patients with normal hearing sensitivity using TEOAEs and TEN test

Conclusion
This work has shown a higher prevalence of OAE abnormalities in tinnitus patients with normal hearing in contrast to TEN test denoting the more vulnerability of OHCs to damage.

from Auris Nasus Larynx

Effects of hearing aid fitting on the perceptual characteristics of tinnitus

Restoration of auditory input through the use of hearing aids has been proposed as a potentially important means of altering tinnitus among those tinnitus sufferers who experience significant sensorineural hearing loss. In animal models of neural plasticity induced by noise trauma, high-frequency stimulation in deafferented regions of the auditory spectrum has been shown to modulate cortical reorganization after hearing loss, a result which suggests that the neural basis of tinnitus is subject to interference by acoustic stimulation. This study drew on deafferentation models to investigate the effect of hearing aids on the psychoacoustic properties of the tinnitus sensation, using both conventional amplification and high-bandwidth amplification regimes. The tinnitus percept was affected only weakly in the conventional amplification group, and was not at all affected in the high-bandwidth group. The changes observed under conventional, low-to-medium frequency amplification may indicate that the perceptual characteristics of tinnitus depend on the pattern of sensory inputs – notably a contrast in activity between adjacent central auditory regions of more and less afferent activity – while the absence of modifications in the high-bandwidth amplification group suggests limit on the tractability of the tinnitus percept. This limit to the malleability of the tinnitus percept may arise from either the extent of hearing deficits or the duration and robustness of the neuroplastic changes that originally give rise to tinnitus.

from Hearing Research

Hearing Impairment and Traumatic Brain Injury among Soldiers: Special Considerations for the Audiologist

The increased use of explosive devices and mines in warfare and excessive noise of weapons has created an unprecedented amount of auditory dysfunction among soldiers. Blast-related injuries may damage the auditory processing and/or balance centers resulting in hearing loss, dizziness, tinnitus, and/or central auditory processing disorders. Some also lead to traumatic brain injury (TBI), postconcussive syndrome (PCS), and/or posttraumatic stress disorder. Some PCS symptoms such as dizziness, loss of balance, hearing difficulty, and noise sensitivity also can signify auditory or vestibular dysfunction and should not be obscured with the PCS package. This article provides information about the mechanisms of blast injury with emphasis on auditory dysfunction and TBI. Audiologists must be prepared to identify those at risk for TBI or mental health problems and adapt audiologic clinical practices to this population. An interdisciplinary comprehensive evaluation of peripheral, central, and vestibular components of the auditory system should be employed in patients with TBI to ensure that auditory dysfunction is accurately diagnosed and that appropriate rehabilitation can be performed.

from Seminars in Hearing

Understanding tinnitus distress: Introducing the concepts of moderators and mediators

We focus this theoretical paper on a neglected distinction in tinnitus research between moderators and mediators of tinnitus distress. A moderator variable is one that influences the strength of a relationship between two other variables. In the paper we propose that several variables might act as moderators of tinnitus distress. Degree of hearing loss, arousal, insomnia, characteristics of tinnitus, noise sensitivity, and a range of psychological factors such as personality and perceived control are discussed as potential moderators. We then move on to mediator variables. A mediator variable is one that explains the relationship between the two other variables, and must by definition be caused by a predictor, and then mediate between the predictor and the dependent variable. We propose that stress levels (caused by tinnitus), classical conditioning, selective attention towards tinnitus, and psychological acceptance of tinnitus (versus experiential avoidance) might be mediators of distress. We encourage more research on moderators and mediators of tinnitus distress, as these will help illuminate treatment protocols and how they might work.

from the International Journal of Audiology

Comparable efficacy and tolerability between twice daily and three times daily betahistine for Ménière’s disease

Conclusion. Betahistine at oral doses of 16 mg tid and 24 mg bid provides similar efficacy and tolerability in the treatment of vertigo in patients with Ménière’s disease. Objective. To compare the efficacy and tolerability of betahistine 16 mg tid and 24 mg bid in the treatment of vertigo in patients with Ménière’s disease. Patients and methods. This was a randomized, open-label study of 120 consecutive patients with well-established Mnire’s disease treated with betahistine 16 mg tid or 24 mg bid for 24 weeks. Treatment efficacy, assessed by clinical outcome level in terms of severity, frequency and duration of vertigo spells, was evaluated at baseline and at weeks 4, 12 and 24. Between-group comparisons of outcome data (Wilcoxon, Mann-Whitney U test) and adverse events (chi-squared test) were made. Results. Betahistine 16 mg tid or 24 mg bid showed a significant improvement in clinical outcome level from baseline to week 24 (p<0.01). There was no significant difference between dosage groups regarding improvement in vertigo at any time point during the study. There was no significant difference between groups in the incidence of adverse events, which was low (maximum: headache, 16 mg tid, 16.7% of patients at week 4; 6.7% at week 24). The number of patients reporting adverse events diminished with time.

from Acta Oto-Laryngologica

Idiopathic intracranial hypertension in otolaryngology

Abstract Idiopathic intracranial hypertension (IIH) is defined as increased intracranial pressure in the absence of intracranial mass or obstructive hydrocephalus. Over 80% of patients are overweight women. IIH is usually encountered in the neurology and ophthalmology practise as headaches, visual disturbance and papilloedema are the characteristic features of this syndrome. Patients with IIH also experience tinnitus, hearing loss, balance disturbance, cerebrospinal fluid (CSF) otorrhoea or rhinorrhoea and in some cases these otorhinological symptoms can be presenting features of this syndrome. IIH is also associated with obstructive sleep apnoea. Otolaryngologists should be familiar with this important condition as it can manifest a variety of symptoms that are more frequently seen in their clinics. Sometimes otolaryngologists may be involved in the surgical management of this condition, such as repair of CSF rhinorrhoea or otorrhoea or endoscopic optic nerve decompression. The aim of this review article is to familiarise the otolaryngologists with the important features of this unusual syndrome which may remain unrecognised in the otolaryngology practice.

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