Characteristics Of Tinnitus Research Articles

Clinical Implications of Chloroquine and Hydroxychloroquine Ototoxicity for COVID-19 Treatment: A Mini-Review

At this time of the COVID-19 pandemic, potentially effective treatments are currently under urgent investigation. Benefits of chloroquine and hydroxychloroquine for the treatment of COVID-19 infection have been proposed and clinical trials are underway. Chloroquine and hydroxychloroquine, typically used for the treatment of malaria and autoimmune diseases, have been considered for off-label use in several countries. In the literature, there are reports of ototoxic effects of the drugs causing damage to the inner ear structures, which then result in hearing loss, tinnitus, and/or imbalance. This mini-review represents a summary of the findings from a systematic search regarding ototoxicity of chloroquine and hydroxychloroquine in the published literature. The characteristics of sensorineural hearing loss and/or tinnitus after chloroquine or hydroxychloroquine treatment can be temporary but reports of persistent auditory and vestibular dysfunction exist. These are not frequent, but the impact can be substantial. Additionally, abnormal cochleovestibular development in the newborn was also reported after chloroquine treatment in pregnant women. The suggested dose of chloroquine for COVID-19 infection is considerably higher than the usual dosage for malaria treatment; therefore, it is plausible that the ototoxic effects will be greater. There are potential implications from this review for survivors of COVID-19 treated with chloroquine or hydroxychloroquine. Patient reports of hearing loss, tinnitus, or imbalance should be noted. Those with troublesome hearing loss, tinnitus and/or imbalance are encouraged to be referred for hearing evaluation and interventions once they are stable. Clinical trials of chloroquine or hydroxychloroquine should also consider including audiological monitoring in the protocol.

Perceptual Modeling of Tinnitus Pitch and Loudness

Tinnitus is the phantom perception of sound, experienced by 10%–15% of the global population. Computational models have been used to investigate the mechanisms underlying the generation of tinnitus-related activity. However, existing computational models have rarely benchmarked the modeled perception of a phantom sound against recorded data relating to a person’s perception of tinnitus characteristics, such as pitch or loudness. This article details the development of two perceptual models of tinnitus. The models are validated using empirical data from people with tinnitus and the models’ performance is compared with the existing perceptual models of tinnitus pitch. The first model extends existing perceptual models of tinnitus, while the second model utilizes an entirely novel approach to modeling tinnitus perception using a linear mixed effects (LMEs) model. The LME model is also used to model the perceived loudness of the phantom sound which has not been considered in previous models. The LME model creates an accurate model of tinnitus pitch and loudness and shows that both tinnitus-related activity and individual perception of sound are factors in the perception of the phantom sound that characterizes tinnitus.

Особенности комплексной диагностики субъективного ушного шума

Tinnitus is one of the most common ENT complaints. The peculiarity of this disease is lack of objective measurements. It is hard to monitor evaluation of treatment results. The main reference points, such as the presence or absence of ear noise – are not sufficient to determine this pathology. Also, most of these patients have negative emotions connected with their ear noise. That is why the characteristics of tinnitus and its influence on the quality of life are very individual. Thus, it is advisable to distinguish two components of ear noise: noise itself, as a physical quantity that has amplitude and frequency parameters, and noise, as the main source of subjective suffering of the patient. To determine the characteristics of these two noise components, we used two diagnostic methods: standard noise measurement and a visually analog scale to assess the degree of discomfort caused by ear noise. In current study, we investigated interconnection between tinnitus intensity measured by tinnitus matching and data of visual-analog scale of subjective perception of tinnitus. We evaluated that severity of tinnitus intensity did not correlate with thresholds in tinnitus pitch matching. In addition, with the help of international questionnaire survey SCL-90-R we revealed correlation between subjective noise level and patient’s psycho-emotional condition.

Amplitude Modulated Noise for Tinnitus Suppression in Tonal and Noise-Like Tinnitus

Background: The phenomenon of short-term tinnitus suppression by different forms of acoustic stimulation is referred to as residual inhibition (RI). RI can be triggered in the majority of tinnitus cases and was found to be depending on the used intensity, length or types of sounds. Past research already stressed the impact of noise stimulation as well as the superiority of amplitude modulated (AM) pure tones at the individual tinnitus frequency for RI in tonal tinnitus. Recently a novel approach for the determination of noise-like tinnitus characteristics was proposed. Objectives: The aim of the present study was to investigate whether in participants with noise-like tinnitus RI can be increased by AM noise stimuli according to the individual tinnitus frequency range. Methods: For this purpose the individual tinnitus characteristics (noise-like and tonal tinnitus) of 29 people affected by tinnitus (mean age = 55.59, 7 females, mean tinnitus duration = 159.97 months) were assessed via customizable noise-band matching. The objective was to generate bandpass filtered stimuli according to the individual tinnitus sound (individualized bandpass filtered [IBP] sounds). Subsequently, various stimuli differing in bandpass filtering and AM were tested with respect to their potential to induce RI. Participants were acoustically stimulated with 7 different types of stimuli for 3 min each and had to rate the loudness of their tinnitus after each stimuli. Results: Results indicate a general efficacy of noise stimuli for the temporary suppression of tinnitus, but no significant differences between AM and unmodulated IBP. Significantly better effects were observed for the subgroup with noise-like tinnitus (n = 14), especially directly after stimulation offset. Conclusions: The study at hand provides further insights in potential mechanisms behind RI for different types of tinnitus. Beyond that, derived principles may qualify for new or extend current tinnitus sound therapies.

Analysis of the audiological characteristics and comorbidity in patients with chronic tinnitus.

Tinnitus is defined as perception of a sound without sound stimulation. This study aims to investigate the correlation between chronic tinnitus and the most significant clinical comorbidities and pharmacological treatments. We recruited 130 consecutive outpatients with a tinnitus for least from three months and 100 subjects without tinnitus. All patients had a full medical and audiological evaluation and all filled in Tinnitus Handicap Inventory questionnaire and Khalfa’s Hyperacusis questionnaire. We also analyzed the qualitative variables: audiometry exam, tinnitus characteristics and psychometric questionnaires. Univariate logistic regression was performed to evaluate the associations between the presence of tinnitus and the presence of comorbidities and drug intake. The statistical analysis provided the following results in the group of patients with tinnitus. We obtained an Odds Ratio statistically significant for the following categories taken into consideration: the presence of anxiety and depression, neurological diseases, headache, temporomandibular joint (TMJ) disorders, intake of levothyroxine and proton-pump inhibitor. In this study, we tried to evaluate the audiological characteristics in the subjects affected by chronic tinnitus in order to find a possible correlation with the comorbidities and any drugs intake. We found a statistically significant correlation between tinnitus and comorbidities like anxiety, depression, TMJ disorders, dysthyroidism, headache and levothyroxine and PPI intake.

Evaluation of Differential Sensitivity for Frequency, Intensity, and Duration around the Tinnitus Frequency in Adults with Tonal Tinnitus

The perceptual characteristics of tinnitus are usually assessed by a matching procedure, where loudness and pitch of an external sound are matched to those of the tinnitus percept. The duration discrimination test (DDT), differential limen for intensity (DLI) and differential limen for frequency (DLF) are relatively simple psychoacoustic methods of measuring differential sensitivity. 15 participants with normal or minimal hearing loss with tinnitus in the age range of 18 to 40 years were enrolled in the present study. Pure tone audiometry (PTA), immittance audiometry and otoacoustic emissions were done to diagnose the degree of hearing loss. Duration discrimination test (DDT), differential limen for intensity (DLI) and differential limen for frequency (DLF) was administered on all the participants using MATLAB software (MLP toolbox) at the matched tinnitus frequency, half an octave below - above the frequency. The results show that there was a significant increase in DDT, DLI and DLF thresholds at the tinnitus frequency compared to half an octave above and below the matched frequency. The result suggests that differential sensitivity abilities regarding frequency, intensity, and duration are affected at the tinnitus frequency in individuals with tinnitus. The results of the study suggest that the differential sensitivity ability is affected in individuals with tinnitus especially at the frequency of tinnitus.

Toward Personalized Tinnitus Treatment: An Exploratory Study Based on Internet Crowdsensing.

Introduction: Chronic tinnitus is a condition estimated to affect 10–15% of the population. No treatment has shown efficacy in randomized clinical trials to reliably and effectively suppress the phantom perceptions, and little is known why patients react differently to the same treatments. Tinnitus heterogeneity may play a central role in treatment response, but no study has tried to capture tinnitus heterogeneity in terms of treatment response.Research Goals: To test if the individualized treatment response can be predicted using personal, tinnitus, and treatment characteristics.Methods: A survey conducted by the web platform Tinnitus Hub collected data of 5017 tinnitus bearers. The participants reported which treatments they tried and the outcome of the given treatment. Demographic and tinnitus characteristics, alongside with treatment duration were used as predictors of treatment outcomes in both an univariate as well as a multivariate regression setup. First, simple linear regressions were used with each of the 13 predictors on all of 25 treatment outcomes to predict how much variance could be explained by each predictor individually. Then, all 13 predictors were added together in the elastic net regression to predict treatment outcomes.Results: Individual predictors from the linear regression models explained on average 2% of the variance of treatment outcome. “Duration of treatment” was the predictor that explained, on average, most of the variance, 6.8%. When combining all the predictors in the elastic net, the model could explain on average 16% of the deviance of treatment outcomes.Discussion: By demonstrating that different aspects predict response to various treatments, our results support the notion that tinnitus heterogeneity influences the observed variability in treatment response. Moreover, the data suggest the potential of personalized tinnitus treatment based on demographic and clinical characteristics.

An auditory brainstem implant for treatment of unilateral tinnitus: protocol for an interventional pilot study

IntroductionTinnitus may have a very severe impact on the quality of life. Unfortunately, for many patients, a satisfactory treatment modality is lacking. The auditory brainstem implant (ABI) was originally indicated...

Analysis of Factors Influencing the Efficiency of Acupuncture in Tinnitus Patients.

An effective acupuncture treatment must comprehend the influence of various factors, but studies in this aspect remain limited. This study aimed to identify relevant factors and search for the best practical method of acupuncture for patients with tinnitus. The study was a retrospective review of patients' data with a prospective design who had subjective idiopathic tinnitus and received acupuncture between May 2012 and August 2017. Patients' demographics, tinnitus characteristics, previous diseases, underlying diseases, oral habits, audiograms, acupuncture sessions, and acupoints were recorded and analyzed. A visual analog scale (VASloudness) was used for measuring the loudness of tinnitus, and the Clinical Global Impression-Improvement scale (CGI-I) was used for assessing the suffering of patients. Good treatment responses in patients were defined as the magnitude of change from the baseline VASloudness for ≥ 30% plus CGI-I ≤ 3 points. In total, 107 patients were enrolled. Most factors were not significantly associated with the treatment effectiveness of acupuncture in tinnitus patients. Only the combination of acupoints and the number of acupuncture sessions reached statistically significant differences. Further analyzing these two factors, we confirmed that the combination of periauricular and distal acupuncture and 17 to 24 acupuncture sessions contributed to a considerably better outcome. This result would serve as a reference for clinical acupuncturists to select an appropriate acupuncture strategy in the treatment of tinnitus.

A double-blind randomized controlled trial on the efficacy of mixed pure tone sound therapy in chronic tinnitus patients with different hearing loss

Objective: The effectiveness of two different sound therapies in chronic subjective tinnitus was compared. The effectiveness of different degrees of hearing loss patients on two different sound therapies were analyzed preliminarily and the possible mechanisms were discussed. Methods: This clinical trial was conducted in the Peking Union Medical College Hospital, China from January 2018 to April 2018. Patients were received sound therapy when they were diagnosed as subjective tinnitus. This was a double-blinded randomized controlled trial. In our clinical trial, we included 56 participants who were randomly divided into Groups A and B with different sound therapies by using a computer allocation sequence. Pure tone audiometry, tympanometry and tinnitus matching were performed. The patients were followed up for 2 weeks, 1 month, 2 months and 3 months. Tinnitus handicap inventory (THI) and visual analog scales (VAS) measuring were used to evaluate the handicap, loudness and anxiety of tinnitus. An analysis of variance (ANOVA) of 2×5 repeated-measures was conducted. Results: With the prolongation of the treatment time, both groups showed significantly lower scores after 3 months training compared with baseline which were measured by THI scores. While there was no effect between the two groups. According to the degree of hearing loss, Group A and B were divided into normal to mild hearing loss group (26-40 dB HL, Group A1, Group B1), moderate to profound hearing loss group (41 dB HL group and above, Group A2, Group B2). In the patients with normal hearing and mild hearing loss, the THI (P=0.013), VAS loudness and annoyance scores (P<0.01) after 3 months in Group B1 was significantly lower than those at baseline and the sound therapy in Group B1 was effective. In patients with moderate to profound hearing loss, the THI, VAS loudness and annoyance scores (P<0.01) after 3 months in Group A2 was significantly lower than those at baseline and the sound therapy in Group A2 was effective. Conclusions: Sound therapy may be effective for some patients. Sound therapy for patients with different degrees of hearing loss are different. The tinnitus of most patients could not disappear completely, but reduce or eliminate. Doctors should use appropriate and individualized acoustic parameters for different characteristics of tinnitus. Doing so would provide effective and specific sound therapy for patients and reduce or eliminate tinnitus.

Altered Resting-State EEG Microstate in Idiopathic Sudden Sensorineural Hearing Loss Patients With Tinnitus.

In order to clarify the central reorganization in acute period of hearing loss, this study explored the aberrant dynamics of electroencephalogram (EEG) microstates and the correlations with the features of idiopathic sudden sensorineural hearing loss (ISSNHL) and tinnitus. We used high-density EEG with 128 channels to investigate alterations in microstate parameters between 25 ISSNHL patients with tinnitus and 27 healthy subjects. This study also explored the associations between microstate characteristics and tinnitus features. Microstates were clustered into four categories. There was a reduced presence of microstate A in amplitude, coverage, lifespan, frequency and an increased presence of microstate B in frequency in ISSNHL patients with tinnitus. According to the syntax analysis, a reduced transition from microstate C to microstate A and an increased transition from microstate C to microstate B were found in ISSNHL subjects. In addition, the significant negative correlations were found between Tinnitus Handicap Inventory (THI) scores and frequency of microstate A as well as between THI scores and the probability of transition from microstate D to microstate A. While THI was positively correlated with the transition probability from microstate D to microstate B. To sum up, the significant differences in the characteristics of resting-state EEG microstates were found between ISSNHL subjects with tinnitus and healthy controls. This study suggests that the alterations of central neural networks occur in acute stage of hearing loss and tinnitus. And EEG microstate may be considered as a useful tool to study the whole brain network in ISSNHL patients.

Dynamic Changes of Functional Neuronal Activities Between the Auditory Pathway and Limbic Systems Contribute to Noise-Induced Tinnitus with a Normal Audiogram

Tinnitus is thought to be triggered by aberrant neural activity in the central auditory pathway and is often accompanied by comorbidities of emotional distress and anxiety, which imply maladaptive functional connectivity to limbic structures, such as the amygdala and hippocampus. Tinnitus patients with normal audiograms can also have accompanying anxiety and depression, clinically. To test the role of functional connectivity between the central auditory pathway and limbic structures in patients with tinnitus with normal audiograms, we developed a murine noise-induced tinnitus model with a temporary threshold shift (TTS). Tinnitus mice exhibited reduced auditory brainstem response wave I amplitude, and an enhanced wave IV amplitude and wave IV/I amplitude ratio, as compared with control and non-tinnitus mice. Resting-state functional magnetic resonance imaging (fMRI) was used to identify abnormal connectivity of the amygdala and hippocampus and to determine the relationship with tinnitus characteristics. We found increased fMRI responses with amplitude of low-frequency fluctuation (ALFF) in the auditory cortex and decreased ALFF in the amygdala and hippocampus at day 1, but decreased ALFF in the auditory cortex and increased ALFF in the amygdala at day 28 post-noise exposure in tinnitus mice. Decreased functional connectivity between auditory brain regions and limbic structures was demonstrated at day 28 in tinnitus mice. Therefore, aberrant neural activities in tinnitus mice with TTS involved not only the central auditory pathway, but also limbic structures, and there was maladaptive functional connectivity between the central auditory pathway and limbic structures, such as the amygdala and hippocampus.

Intermittent tinnitus-an empirical description.

Tinnitus is often classified into acute or chronic persistent forms. However, epidemiologic studies have shown that intermittent tinnitus (IT), which does not clearly belong to either category, is the most common form. The aim of this study was to further characterize IT empirically. We conducted an exploratory cross-sectional interview study among 320 subjects with tinnitus. Sociodemographic and tinnitus characteristics, concomitant complaints, perceived triggers, and help-seeking behavior were assessed. Subjects were classified into continuous (CT), IT, or single-episode tinnitus (SET) if they had experienced tinnitus "continuously," "temporarily time and again," or "only once but for several days," respectively, during the past 12months. Of the sample, 62% reported IT, 23% SET, and 16% CT. Mean time since onset was 36(CT), 28(IT), and 19months (SET), respectively. Most subjects with IT experienced episodes lasting afew days, whereas in 25%, episodes lasted 1-4weeks. Mean duration was 1.6weeks. The frequency of IT episodes ranged from every few days to half-yearly; mean frequency was every 7weeks. Leading triggers were occupational and private stress. Asthenia, depression, social isolation, psychiatric disorders, and inner ear disorders were more prevalent among CT than IT subjects. Help-seeking behavior was comparable between CT and IT. IT is associated with emotional reactions and situational impairment severe enough to trigger multiple treatment attempts, but usually does not result in severe impairment. Inner ear disorders and psychological changes are less frequent than in CT; therefore, treatment response and prognosis might be better. We suggest classification of tinnitus into acute single-episode (<3months), intermittent, or chronic persistent (>3months) forms.

Standardised profiling for tinnitus research: The European School for Interdisciplinary Tinnitus Research Screening Questionnaire (ESIT-SQ)

BackgroundThe heterogeneity of tinnitus is substantial. Its numerous pathophysiological mechanisms and clinical manifestations have hampered fundamental and treatment research significantly. A decade ago, the Tinnitus Research Initiative introduced the Tinnitus Sample Case History Questionnaire, a case history instrument for standardised collection of information about the characteristics of the tinnitus patient. Since then, a number of studies have been published which characterise individuals and groups using data collected with this questionnaire. However, its use has been restricted to a clinical setting and to the evaluation of people with tinnitus only. In addition, it is limited in the ability to capture relevant comorbidities and evaluate their temporal relationship with tinnitus. MethodHere we present a new case history instrument which is comprehensive in scope and can be answered by people with and without tinnitus alike. This ‘European School for Interdisciplinary Tinnitus Research Screening Questionnaire’ (ESIT-SQ) was developed with specific attention to questions about potential risk factors for tinnitus (including demographics, lifestyle, general medical and otological histories), and tinnitus characteristics (including perceptual characteristics, modulating factors, and associations with co-existing conditions). It was first developed in English, then translated into Dutch, German, Italian, Polish, Spanish, and Swedish, thus having broad applicability and supporting international collaboration. ConclusionsWith respect to better understanding tinnitus profiles, we anticipate the ESIT-SQ to be a starting point for comprehensive multi-variate analyses of tinnitus. Data collected with the ESIT-SQ can allow establishment of patterns that distinguish tinnitus from non-tinnitus, and definition of common sets of tinnitus characteristics which might be indicated by the presence of otological or comorbid systemic diseases for which tinnitus is a known symptom.

Gender Differences Affecting Psychiatric Distress and Tinnitus Severity.

ObjectiveThis study evaluated gender differences in the relationship between psychiatric distress and subjective tinnitus severity.MethodsThis cross-sectional study included 134 female and 114 male patients who visited the otology outpatient clinic at Seoul St. Mary’s Hospital for tinnitus from February to July 2015. Patients completed a series of instruments, including the Tinnitus Handicap Inventory, Beck Depression Inventory, Korean version of Brief Encounter Psychosocial Instrument (BEPSI-K), and visual analogue scales assessing various tinnitus characteristics (loudness, awareness, annoyance, and effect on life).ResultsTinnitus severity did not significantly differ between the gender groups (p=0.632), and it correlated significantly with tinnitus characteristics and psychiatric distress. Partial correlations between tinnitus severity and depressive symptoms were stronger in males (r=0.411, p<0.01) than in females (r=0.304, p<0.01) while controlling for duration of tinnitus and tinnitus characteristics. However, stress (BEPSI-K) was positively correlated with tinnitus severity in only males (r=0.463, p<0.01). A multiple regression analysis revealed that effect of tinnitus on life, depressive symptoms, and stress were significantly associated with tinnitus severity in males, whereas only tinnitus annoyance and depressive symptoms were associated with tinnitus severity in females.ConclusionTinnitus severity was significantly correlated with depressive symptoms and stress, and there were gender differences in the relationship between tinnitus severity and psychiatric components. It is necessary to be vigilant of psychiatric symptoms among patients with tinnitus who visit the otology outpatient clinic, especially for male patients.

Intermittent tinnitus-an empirical description. German version

Tinnitus is often classified into acute or chronic persistent forms. However, epidemiologic studies have shown that intermittent tinnitus (IT), which does not clearly belong to either category, is the most common form. The aim of this study was to further characterize IT empirically. We conducted an exploratory cross-sectional interview study among 320 subjects with tinnitus. Sociodemographic and tinnitus characteristics, concomitant complaints, perceived triggers, and help-seeking behavior were assessed. Subjects were classified into continuous (CT), IT, or single-episode tinnitus (SET) if they had experienced tinnitus "continuously," "temporarily time and again," or "only once but for several days," respectively, during the past 12months. Of the sample, 62% reported IT, 23% SET, and 16% CT. Mean time since onset was 36(CT), 28(IT), and 19months (SET), respectively. Most subjects with IT experienced episodes lasting afew days, whereas in 25%, episodes lasted 1-4weeks. Mean duration was 1.6weeks. The frequency of IT episodes ranged from every few days to half-yearly; mean frequency was every 7weeks. Leading triggers were occupational and private stress. Asthenia, depression, social isolation, psychiatric disorders, and inner ear disorders were more prevalent among CT than IT subjects. Help-seeking behavior was comparable between CT and IT. IT is associated with emotional reactions and situational impairment severe enough to trigger multiple treatment attempts, but usually does not result in severe impairment. Inner ear disorders and psychological changes are less frequent than in CT; therefore, treatment response and prognosis might be better. We suggest classification of tinnitus into acute single-episode (<3months), intermittent, or chronic persistent (>3months) forms.

Tinnitus Perspectives among Israeli Ear, Nose and Throat Physicians: A Nationwide Survey.

To study the compliance of ear, nose, and throat (ENT) physicians to the American Association Otolaryngology-Head - Neck Surgery (AAO-HNS) clinical practice guidelines (CPG) for tinnitus and to identify the disparity of both diagnosis and management options in the absence of a local protocol for the management of adult tinnitus. A voluntary and anonymous questionnaire was emailed in a Google spread-out sheet format to all practicing ENT physicians across the country (n=370). Overall, 126 ENT physicians responded to the questionnaire (34% of the physicians to whom the questionnaire was sent). Medical history focuses on tinnitus characteristics and otological signs, and symptoms are often queried (80%-98%). Physicians routinely perform an otoscopic examination, whereas other relevant possible physical findings, such as temporomandibular joint disorders or neck trauma, are less frequently examined. Treating physicians have the most frequent recourse to sound therapy and cognitive behavioral therapy in accordance with AAO-HNS CPG. The publication of the AAO-HNS CPG for tinnitus is important, permitting a common approach for the diagnosis and management of primary tinnitus (PT). A diagnosis and management scheme that takes into consideration both the AAO-HNS CPG for tinnitus as well as physician diagnosis and management paradigms is suggested.

Relating tinnitus features and audiometric characteristics in a cohort of 34 tinnitus subjects

Although tinnitus, the conscious perception of a sound without a sound source external or internal to the body, is highly correlated with hearing loss, the precise nature of such correlation remains still unknown. People with high pitch tinnitus are used to suffer from high frequency hearing losses, and vice versa, low pitch tinnitus is mostly associated with low frequency hearing losses. However, many subjects with low or high frequency losses do no develop tinnitus. Thus, studies trying to relate audiometric characteristics and tinnitus features are still relevant. This article presents a correlational study of audiometric and tinnitus variables in a sample of 34 subjects, paying special attention to the heterogeneous subtypes of both audiometry shape and tinnitus etiology. Our results, which concur with others previously published, demonstrate that the tinnitus pitch, the main frequency of the tinnitus spectrum, in subjects with high-steep high-frequency and continuously steep hearing losses, are highly correlated with the frequency at which hearing loss reaches 50 dB HL.

Clocking tinnitus: An audiology symptom of migraine

ObjectivesIn contrast to previous concept that tinnitus is confined to an otologic disorder, current evidence supports it as a phantom sensory phenomenon of vestibulocochlear damage with cortical reorganization. It is a common problem worldwide, but the treatment response is always unsatisfactory. Patients and MethodsIn this study, we report 10 patients who described their staccato tinnitus as simulating the ticking sound of a pendulum or quartz clock (or termed clocking tinnitus). The tinnitus characteristics, laboratory tests, and treatment response were recorded. ResultsClocking tinnitus was unilateral in three patients, bilateral in one patient, and at midline in another six patients. It usually subsided within 15 min. Neither patient experienced vertigo, hemifacial spasm, focal neurological deficit or otic disorder in association with tinnitus. Pre-existing migraine was present in seven patients. During tinnitus attack, a few migraine symptoms concurrently occurred in six patients. Pure-tone audiometry showed symmetric sloping pattern of hearing impairment in half patients whereas brainstem auditory evoked potentials revealed a prolonged wave I-III latency in 30% of patients. The p300 and electroencephalogram were normal in all of them. Neuroimaging study did not disclose structural change. All patients responded poorly to conventional treatments but favorably to flunarizine or topiramate. ConclusionClocking tinnitus may be an audiology manifestation of migraine in some individuals. Antimigraine treatment can be considered in this specific group of staccato tinnitus. Audiogenic classification of tinnitus may provide diagnostic and treatment clues in tinnitus patients.

Clinical profile and implications of tinnitus in individuals with and without hearing loss.

To compare clinical characteristics of tinnitus and interference in quality of life in individuals with and without associated hearing loss, as well as to discuss the association of quantitative measurements and qualitative instruments. A quantitative, cross-sectional and comparative study approved by the Research Ethics Committee (No. 973.314/CAEE: 41634815.3.0000.0106) was carried out. The responses of the psychoacoustic assessment of tinnitus (intensity, frequency, minimum masking level and loudness discomfort level for pure tone and speech), as well as the Tinnitus Handicap Inventory (THI) questionnaire, and the visual analogue scale (VAS) were compared between 15 patients with tinnitus and peripheral hearing loss (group I) and 16 adults with normal hearing (group II). The mean VAS and THI scores obtained in GI were 5.1 (+1.5) and 42.3 (+18), and in GII, 5.7 (+2.6) and 32.7 (+25), respectively. This result suggests moderate GI annoyance and moderate/mild GII annoyance (p>0.005). There was a positive and moderate correlation between THI and VAS only in GII. In the psychoacoustic evaluation, significant differences were observed between the groups regarding the measurement of loudness (*p=0.013) and the minimum masking level (*p=0.001). There was no direct influence of the presence of hearing loss in relation to the impact of tinnitus. The differences found between the groups regarding the psychoacoustics measures can be justified by the presence of cochlear damage. The objective measurement of tinnitus, regardless of the presence or absence of peripheral hearing loss, is an important instrument to be used along with self-evaluation measures.