Classification Of Tinnitus Research Articles

Auditory Neural Plasticity in Tinnitus Mechanisms and Management.

Tinnitus, which is the perception of sound in the absence of a corresponding external acoustic stimulus, including change of hearing and neural plasticity, has become an increasingly important ailment affecting the daily life of a considerable proportion of the population and causing significant burdens for both the affected individuals and society as a whole. Here, we briefly review the epidemiology and classification of tinnitus, and the currently available treatments are discussed in terms of the available evidence for their mechanisms and efficacy. The conclusion drawn from the available evidence is that there is no specific medication for tinnitus treatment at present, and tinnitus management might provide better solutions. Therapeutic interventions for tinnitus should be based on a comprehensive understanding of the etiology and features of individual cases of tinnitus, and more high quality and large-scale research studies are urgently needed to develop more efficacious medications.

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.

Incidence and Clinical Characteristics of Patients with Tinnitus According to Diagnostic Classification

Received January 28, 2011 Revised April 11, 2011 Accepted May 6, 2011 Address for correspondence Shi-Nae Park, MD, PhD Department of Otolaryngology-HNS, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea Tel +82-2-2258-6215 Fax +82-2-595-1354 E-mail snparkmd@catholic.ac.kr Background and ObjectivesZZKnowledge about the incidence and clinical characteristics of tinnitus can be useful for diagnostic approach and treatment plan. We analyzed the incidence and clinical characteristics of each case of tinnitus according to the classification of tinnitus. Subjects and MethodZZThe study recruited 211 tinnitus patients who visited tinnitus clinic from March 2009 to August 2009. First, patients were diagnosed and classified as sensorineural tinnitus and somatosounds. Somatosounds were subdivided to vascular tinnitus, muscle origin tinnitus and patulous Eustachian tube. Patients were evaluated by history taking by means of having them fill out tinnitus questionnaires and psychoacoustic questionnaires. Audiologic findings of each type of tinnitus have also been analyzed. ResultsZZIncidences of sensorineural tinnitus and somatosounds were 82.9% and 17.1% respectively. Among somatosounds, vascular tinnitus occupied 7.6%, muscle origin tinnitus, 4.3% and patulous Eustachian tube, 5.2%. The mean age of the patients with sensorineural tinnitus was older than somatosounds. Patients with muscle origin tinnitus had higher scores of tinnitus loudness, effect on life, tinnitus handicap inventory, stress and depression than those with other types of tinnitus. Overall compliance of the treatment was 66.7% and their tinnitus had been significantly improved after treatment. ConclusionZZWith the knowledge of incidence, clinical characteristics and treatment approach for each tinnitus, clinicians can be more confident in providing proper diagnosis and management of patients with tinnitus. Somatosounds, which showed relatively high incidence in this study, should not be neglected but properly treated with early diagnosis. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:392-8

Traitement des acouphènes : aspects neurochirurgicaux

Tinnitus is a very frequent symptom affecting 10% of the general population. It corresponds to the perception of an internal noise that can severely impair the quality of life. Tinnitus management requires a multidisciplinary approach in which neuromodulation and neurosurgery tend to play major roles. Classification of tinnitus separates objective tinnitus (i.e., tinnitus that can be heard or recorded) from the more frequent subjective tinnitus (i.e., tinnitus only perceived by the patient). Objective tinnitus is either pulsatile synchronous with heartbeat or asynchronous. In the former, appropriate radiological testing should search for a vascular abnormality as well as other neurological diseases (intracranial hypertension, Arnold-Chiari malformation, vascular loops, etc.). Asynchronous objective tinnitus generally corresponds to muscular contractions that require specific management. The pathophysiology of subjective tinnitus is more complex, showing strong analogies with postamputation pain syndromes. After peripheral middle ear or inner ear damage, auditory deafferentation could result in hyperactivity and/or functional reorganization within central auditory and nonauditory structures. This could explain the persistence of tinnitus after total hearing amputation (e.g., translabyrinthine approach for vestibular schwannoma) and associated symptoms such as hyperacusis or anxiety and depression. This central model finds strong support in animal experiments and in functional neuroimagery (PET, fMRI, MEG). Since no etiologically based therapies are currently available, severe subjective tinnitus management only targets tinnitus tolerance with sound enrichment or cognitive behavior therapy. However, in the near future better knowledge of tinnitus pathophysiology and innovative therapeutic tools could emerge from neuromodulation techniques such as repeated transcranial magnetic or epidural electric stimulation.

Mechanisms and classification of tinnitus: a discussion paper

Tinnitus is often described as subjective or objective tinnitus. This categorisation is sometimes inconsistent with classification such as ‘pathological’, ‘temporary’, ‘extra‐auditory ’or ‘associated tinnitus’. The great majority of the tinnitus sufferers have subjective tinnitus and generally when the word ‘tinnitus’ is used, it implies subjective tinnitus, which only is audible by the tinnitus patient. Instead of classifying tinnitus in ‘subjective’ or ‘objective tinnitus’, ‘genuine tinnitus’, could be used and replace the term ‘subjective tinnitus’. Objective tinnitus which is a sound sensations created by an acoustical source within the body, should rather be described by the condition causing this sensation and not be described as tinnitus. Tinnitus can consequently be defined as “a sound sensation in the absence of an internal or external acoustical source or electrical stimulation”.

Towards an objectification by classification of tinnitus

Objectives: The objectives of this study are to identify the presence of tinnitus and classify its different forms, in terms of changes in noise.Methods: Late auditory evoked responses (LAERs) were recorded from Fz in response to 1000 Hz tone bursts of various intensities, in 13 tinnitus-free subjects and in 25 tinnitus sufferers (16 bilateral and 9 unilateral tinnitus sufferers). A classification of different forms of tinnitus, in terms of changes in noise, was also undertaken. N1-P2 component amplitudes and N1 and P2 latencies were measured.Results: Objective identification of the affected ear in unilateral tinnitus sufferers was found feasible on the basis of N1-P2 intensity-dependence and N1-P2 amplitude. The bilateral tinnitus group was found to differ from controls by greater intensity-dependence of the N1-P2 component and shorter N1 latency. These characteristics varied with tinnitus type: a classification on the basis of intensity-dependence and latencies proved feasible. The group of patients showing improved tinnitus in noise had greater intensity-dependence and longer N1 latency than did the group showing aggravated tinnitus in noise.Conclusions: Data are discussed in light of the inhibitory role of frontal cortex on the sensory inputs and the modulatory function of central serotonergic system on the processing of auditory information.

Neurotologic Classification and Tinnitus

The primary goals of the physician to be achieved for the tinnitus patient are: (a) Exclusion of disease entity(ies) benign and/ or malignant which may be the cause of tinnitus by performing a complete neuroto-logic examination, (b) Control/treatment of tinnitus based upon a classification of the tinnitus. In both cases, an attempt is made to objectivize the subjective symptom of tinnitus. Both classification and evaluation of tinnitus are fundamental for treatment.

Tinnitus masking curves (updates and review)

A classification of tinnitus may use the following scheme (Fig. 1): There are spon-taneous attributes of tinnitus, which can easily be explored or evaluated more or less accurately by comparison with calibrated external sounds.

Tinnitus: Diagnosis and Treatment

Few conditions are seen as commonly by the otologist and are more poorly understood than subjective tinnitus. Tinnitus has been reported in as high as 80% of patients seen in an otolaryngology practice. This symptom is especially marked in patients with a hearing problem and can be so severe that it becomes incapacitating. Careful diagnosis and classification of tinnitus is important for understanding of the problem. Identification of the frequency and intensity of masking, using a tinnitus analyzer, is useful in selecting the form of treatment. Analysis of the history, physical findings and the use of special electrocochleography and brain stem evoked response audiometry help to identify the site of lesion, which may be within the cochlea, cochlear nerve, cochlear nucleus, brain stem, midbrain or auditory cortex. Specific disease entities should be identified and treated. Lesions of the end-organ or cochlear nerve can be treated when necessary by translabyrinthine or middle cranial fossa section of the cochlear nerve. Tinnitus from cervical nerve lesions can be treated by rhizotomy. The use of a hearing aid or introduction of a sound with a tinnitus masker has been found to be 82% effective in suppressing tinnitus. Maskers can be combined with a hearing aid in some cases. The pathogenesis of tinnitus is discussed, but the method of action of tinnitus relief by auditory stimulation is still unclear. A thoughtful and complete examination with our new diagnostic tools and the judicious selection of therapy now makes it possible to give relief to the majority of patients suffering with disturbing tinnitus.