Effective Treatment For Tinnitus Research Articles

Applications of auditory evoked potentials in tinnitus: a review

Background and Aim: Subjective tinnitus is a phantom auditory perception caused by different factors and affects the patient’s quality of life. The tinnitus pathophysiology is not fully unders­tood; therefore, there is no effective treatment for tinnitus. Along with other methods, auditory evo­ked potentials (AEPs) may be helpful in unders­tanding this condition and the involved struc­tures. This study aimed to review the applications of AEPs in tinnitus studies. Recent Findings: The studies investigating tinnitus were categorized into three groups of tinnitus pathophysiology, pre- or post-treatment/intervention evaluation of tinnitus, and objective diagnosis of tinnitus. Contradictory and unrep­eatable findings were observed in each group. Conclusion: Discrepancies in the results of AEPs studies can be due to between-group and within-group differences, lack of proper match­ing in terms of tinnitus etiology and hearing loss, and difference in neurophysiologic models of tinnitus.

Sound therapy can modulate the functional connectivity of the auditory network

The functional connectivity of the auditory network is considered to be important in the development of tinnitus. We hypothesized that sound therapy, as a commonly used effective treatment for tinnitus, can modulate the functional connectivity of the auditory network. In this prospective observational study, we recruited 27 tinnitus patients who had undergone 12 weeks of sound therapy and 27 matched healthy controls. For the two groups of subjects, resting-state functional magnetic resonance imaging was acquired both at baseline and at the 12th week. We utilized independent component analysis and seed-based functional connectivity analysis to characterize the connectivity features of the auditory network. Interaction effects between the two groups and the two scans within the auditory network were observed, which were driven by increased functional connectivity in the left primary auditory cortex (PAC) and decreased values in the secondary auditory cortex (SAC) in tinnitus patients after treatment. Increased connections between the auditory network and limbic network, as well as decreased values with the bilateral thalami, were identified. The effects were mainly driven by the functional connectivity alterations of the SAC rather than that of the PAC. Significant positive correlations between the percent improvement in the Tinnitus Handicap Inventory (THI) score and the percentage change rates of functional connectivity between the SAC and bilateral thalami were observed. Our study contributes to the understanding of the mechanism of tinnitus and effective sound therapy, providing evidence to support the theory of a gain adaptation mechanism that quantifies the recovered gating function of the thalamus in tinnitus patients.

Different Stimuli Were Given to Patients With Chronic Pure Tone Tinnitus to Verify the Effective Treatment of Tinnitus.

Different Stimuli Were Given to Patients With Chronic Pure Tone Tinnitus to Verify the Effective Treatment of Tinnitus.

Manganese and Lipoflavonoid Plus(®) to Treat Tinnitus: A Randomized Controlled Trial.

Several tinnitus sufferers suggest that manganese has been helpful with their tinnitus. We tested this in a controlled experiment where participants were committed to taking manganese and Lipoflavonoid Plus(®) to treat their tinnitus. Randomized controlled trial. 40 participants were randomized to receive both manganese and Lipoflavonoid Plus(®) for 6 months, or Lipoflavonoid Plus(®) only (as the control). Pre- and postmeasures were obtained with the Tinnitus Handicap Questionnaire, Tinnitus Primary Functions Questionnaire, and tinnitus loudness and annoyance ratings. An audiologist performed the audiogram, the tinnitus loudness match, and minimal masking level. Twelve participants were dropped out of the study because of the side effects or were lost to follow-up. In the manganese group, 1 participant (out of 12) showed a decrease in the questionnaires, and another showed a decrease in the loudness and annoyance ratings. No participants from the control group (total 16) showed a decrease in the questionnaires ratings. Two participants in the control group reported a loudness decrement and one reported an annoyance decrement. We were not able to conclude that either manganese or Lipoflavonoid Plus(®) is an effective treatment for tinnitus.

Experimental, Controversial, and Futuristic Treatments for Chronic Tinnitus

Because chronic tinnitus is a condition that negatively impacts the quality of life of millions of people worldwide, a safe and effective treatment for tinnitus has been sought for millennia. However, effective treatments for tinnitus are greatly outnumbered by ineffective strategies, medications, devices, and surgeries that continue to be developed and promoted for the condition. This article describes and critiques experimental, controversial, and potential treatments for chronic tinnitus. The purpose of this review is to provide information that should help patients and clinicians to select tinnitus treatment and management strategies most likely to be effective for each set of symptoms and circumstances. PubMed and MEDLINE databases (National Center for Biotechnology Information, U.S. National Library of Medicine) were searched for the term tinnitus in articles published from 1940 to 2012. Other historical documents and publications were also reviewed as needed for particular topics. Studies included in this review were selected to represent a sampling of treatment methodologies that have been used for tinnitus. Due to the heterogeneity of the studies reviewed, it was not appropriate to perform a meta-analysis. A selective review of the literature was conducted to summarize and critique published research results. Most invasive treatments for tinnitus should be avoided because (1) at best, there is scant evidence that any of these treatments is effective, and (2) the risk to patients for most invasive procedures is much greater than the risk posed by the tinnitus perception. Effective and noninvasive treatments for tinnitus include acoustic therapy (which includes hearing aids and other types of environmental sound enrichment); cognitive-behavioral therapy; psychological counseling; hypnosis; biofeedback; and relaxation training. Over-the-counter or prescription medications may be used as needed to facilitate sleep and to reduce anxiety, depression, or obsessive-compulsiveness. Patients and clinicians should be especially cautious when considering invasive (and potentially harmful) treatments for tinnitus, which is a non-life-threatening symptom. Unless well-designed clinical trials verify that a tinnitus therapy demonstrates effectiveness above and beyond the placebo effect, consumers should be wary of medications, devices, or procedures promoted as a "cure." Although a true cure for tinnitus has not yet been found, effective and noninvasive tinnitus management strategies are available now. If progress is made to medically (or genetically) treat sensorineural hearing loss in humans, this breakthrough should also help to simultaneously reduce the perception of tinnitus for many patients.

Zinc to Treat Tinnitus in the Elderly

Several reports suggest that zinc, which is involved in several neural transmissions systems throughout the auditory pathway, might help some tinnitus patients. However, previous studies used inadequate experimental designs. Therefore, we tested the effectiveness of zinc to reduce tinnitus. Randomized, prospective double-blind placebo-controlled design. Tertiary referral center. Tinnitus subjects older than 60 years, who are more likely to have a zinc deficiency. In Phase 1, 58 subjects were randomized to receive 50 mg of zinc per day for 4 months, and 58 subjects received a placebo. After a 1-month washout period, the 2 groups were crossed over to receive the alternative regime (Phase 2). Difference scores between before and after measures of the Tinnitus Handicap Questionnaire. Changes on the difference scores 20 or greater were considered as a statistically significant and, therefore, clinically meaningful improvement for THQ. Five percent (5 of 93 patients) had an improvement of 20 points or greater in THQ scores after zinc treatment, whereas 2% (2 of 94 patients) had an improvement of 20 or greater in THQ scores after placebo. The difference between 2 proportions is 5/93 - 2/94 = 0.03, the estimate of relative improvement is (5/93) / (2/94) = 2.53, with 95% confidence interval from 0.5 to 12.7. From chi-square independent test, there was no significant evidence that patients treated by zinc improved better than those treated by placebo (X2 (1) = 1.4, p > 0.05). The observed power in THQ for zinc is 0.16, and that for placebo is 0.06. Zinc is not an effective treatment for tinnitus in this subgroup of patients.

Stress and tinnitus—from bedside to bench and back

The aim of this review is to focus the attention of clinicians and basic researchers on the association between psycho-social stress and tinnitus. Although tinnitus is an auditory symptom, its onset and progression often associates with emotional strain. Recent epidemiological studies have provided evidence for a direct relationship between the emotional status of subjects and tinnitus. In addition, studies of function, morphology, and gene and protein expression in the auditory system of animals exposed to stress support the notion that the emotional status can influence the auditory system. The data provided by clinical and basic research with use of animal stress models offers valuable clues for an improvement in diagnosis and more effective treatment of tinnitus.

Short-Term Effect of Single Session Repetitive Transcranial Magnetic Stimulation in Chronic Unilateral Tinnitus

Received December 9, 2011 Revised March 20, 2012 Accepted March 27, 2012 Address for correspondence Moon Suh Park, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea Tel +82-2-440-6237 Fax +82-2-440-6296 E-mail pmsuh@yahoo.co.kr Background and ObjectivesZZThe repetitive Transcranial Magnetic Stimulation (rTMS) is generally performed over the course of several weeks, as its theoretical and experimental validity has been identified in repetitive procedures. If short term application of rTMS is proven to be significantly effective, more effective treatment of tinnitus can be expected. This study was conducted to measure the effect of one session of sham rTMS & one real trial of rTMS in chronic unilateral tinnitus patients. Subjects and MethodZZrTMS stimulation of 1 Hz and 100% magnitude was given 1200 times per day to 33 patients with chronic unilateral tinnitus on their left side, between T3 and C3/T5, following the convention of the 10-20 International EEG system. Visual Analogue Scale (VAS) and Tinnitus Handicap Inventory (THI) scores were measured four times-immediately before rTMS, immediately after sham rTMS, immediately after real rTMS and two weeks after real rTMS. ResultsZZVAS and THI scores were found to show a tendency of declining. Immediately after real rTMS application, a significant decrease in VAS and THI scores was observed compared to those measured immediately before rTMS (p 0.05) attributable to the direction of tinnitus were observed. ConclusionZZA single session rTMS is thought to be a possible adjunctive treatment for temporary relief of tinnitus. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:216-21

Association between tinnitus retraining therapy and a tinnitus control instrument

Objective Tinnitus retraining therapy (TRT), which is an adaptation therapy for tinnitus based on the neurophysiological model proposed by Jastreboff in 1990,consists of directive counseling and acoustic therapy with a tinnitus control instrument (TCI) or other devices. For the past 5 years, our hospital has administered TRT characterized by the use of a TCI. Method In this study, we reviewed the clinical course of patients with tinnitus who presented to our outpatient clinic for tinnitus and hearing loss during the 3-year period from April 2004 to March 2007 and underwent TRT with a TCI. Among 188 patients with tinnitus (105 males and 83 females), 88 patients (51 males and 37 females, excluding dropouts) who purchased a TCI and continued therapy were included in the study. Results Significant improvement in Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. Among the noises generated by the TCI, the sound pressure output from the TCI was set at just below tinnitus loudness level both of the first adjustment and the second adjustment. Speech noise and white noise were frequently selected, whereas high-frequency noise and pink noise were infrequently selected. Speech noise was most frequently selected at the first adjustment, and the number of patients selecting white noise increased at the second adjustment. The results that we compared the two also revealed that the mean hearing level and tinnitus loudness levels were higher in the white noise group than in the speech noise group, which suggested that the inner ear disorder was more harder in the white noise group. Both the THI score and VAS grade improved after 1 month of treatment in the speech noise group, whereas improvement in these parameters was observed in the white noise group after 6 months of treatment. These results suggest that it took much longer the patients in the white noise group to improve. Conclusion : Significant improvement in THI and VAS scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. It resulted that many patients chose the speech noise or the white noise. And also it was indicated that noise generators set at just below mixing point with tinnitus are more effective. In this study, however, speech noise was often selected probably because of the reduced output at high frequencies and the level of comfort. As white noise produces greater sound volume, patients tended to switch from other therapeutic sound to white noise at the second adjustment. These findings may help administer acoustic therapy in the future.

Tinnitus retraining therapy: prognosis factors

Introduction Tinnitus retraining therapy (TRT) is, nowadays, one of the most extended treatments for tinnitus control. The goal is the habituation to a nonsignificative signal, that is, tinnitus, first, eliminating its reaction and, second, minimizing its perception. Purpose The objective of this study is to identify the factors that could improve or reduce the efficacy of TRT. Materials and methods A prospective nonrandomized clinical assay (n = 137) was conducted. Three parameters were considered for tinnitus evaluation at 1-year follow-up: patient self-evaluation, visual analogue scale for intensity, and Tinnitus Handicap Inventory. Results Tinnitus retraining therapy group improved at 1-year follow-up, considering the 3 parameters. The most important factor of failure to TRT efficacy has been the refuse to instrumentation when it was required, according to TRT recommendations. Tinnitus Handicap Inventory score in this group did not show any improvement ( P = .009). Highest scores of tinnitus intensity (visual analogue scale) and handicap (Tinnitus Handicap Inventory) before treatment as well as the most disabled diagnosis (sudden deafness and Meniere's disease) had better response to TRT. Jastreboff's treatment categories, longer presence of tinnitus, existence of hyperacusis or hearing loss, type of prosthesis used, duration of the treatment, and index of assistance to our follow-up program were not related to the effectiveness of TRT. Conclusions Tinnitus retraining therapy has demonstrated to be an effective treatment of tinnitus. More severe tinnitus are susceptible to get better response with this approach. Instrumentation, when recommended, is mandatory to obtain a higher relief of this symptom (EMB rating: B-2).

Effects of Yoku-kan-san on undifferentiated somatoform disorder with tinnitus

Abstract Up to the present, there have been few strategies that are completely effective in treating undifferentiated somatoform disorder with tinnitus. We herein report that Yoku-kan-san (TJ-54), one of Japan's traditional herbal medicines, is an effective treatment for tinnitus in undifferentiated somatoform disorder complicated with headache and insomnia. TJ-54 has been also used as an effective treatment for insomnia and irritability in recent centuries and is considered to have some effects on the excitability of nerves. Further studies are needed to confirm the efficacies of Japanese herbal medicines.

EMG biofeedback in the treatment of tinnitus: An experimental evaluation

Twenty-six tinnitus patients received either EMG biofeedback with counterdemand instructions, EMG biofeedback with neutral demand instructions or no treatment. Assessment was conducted on self-report measures of the distress associated with tinnitus, the loudness, annoyance and awareness of tinnitus, sleep-onset difficulties, depression and anxiety. Audiological assessment of tinnitus was also conducted and EMG levels were measured (the latter only in the two treatment groups). No significant treatment effects were found on any of the measures. There was a significant decrease in the ratings of tinnitus awareness over the assessment occasions, but the degree of change was equivalent for treated and untreated groups. The results do not support the assertion that EMG biofeedback is an effective treatment for tinnitus. It is recommended that future research be directed towards the evaluation of broader treatment approaches.

An evaluation of relaxation training in the treatment of tinnitus

Thirty tinnitus patients received either relaxation training with counterdemand instructions, relaxation training with neutral demand instructions or no treatment. Assessment of subjective tinnitus severity, sleep difficulties, depression and anxiety was conducted at pretreatment, posttreatment and a 6-week follow-up. Assessment of subjective tinnitus severity and sleep difficulties was also conducted in the middle of treatment. Audiological assessment of tinnitus was conducted at pretreatment and posttreatment. No significant effects for relaxation training were found on any measure. Only the Beck Depression Inventory improved significantly from pretreatment to posttreatment, but the degree of change was equivalent for both treated and untreated groups. While this study suggests that relaxation training is not an effective treatment for tinnitus, a number of explanations for the findings are offered.

Effective treatment of tinnitus through hypnotherapy.

Abstract Tinnitus aurium, or ringing in the ears, is a vexing problem to both the patient and physician. The pathophysiology of the entity is poorly understood and drug therapy is often ineffectual. At times the symptom may be severe enough to interfere with normal daily activities or to cause insomnia, and on occasion has been productive of psychosis with suicidal tendency. Several cases of disturbing tinnitus successfully treated with hypnotherapy are presented and the technique is offered as another modality to be considered in the treatment of this entity.