Tinnitus Annoyance Research Articles

Tinnitus in patients with hearing loss due to mitochondrial DNA pathogenic variants

PurposeTinnitus described as individual perception of phantom sound constitutes a significant medical problem and has become an essential subject of many studies conducted worldwide. In the study, we aimed to examine the prevalence of tinnitus among Polish hearing loss (HL) patients with identified mitochondrial DNA (mtDNA) variants.MethodsAmong the selected group of unrelated HL patients with known mtDNA pathogenic variants, two questionnaires were conducted, i.e. Tinnitus Handicap Inventory translated into Polish (THI-POL) and Visual Analogue Scale (VAS) for measuring subjectively perceived tinnitus loudness, distress, annoyance and possibility of coping with this condition (VASs). Pathogenic mtDNA variants were detected with real-time PCR and sequencing of the whole mtDNA.ResultsThis is the first extensive tinnitus characterization using THI-POL and VASs questionnaires in HL patients due to mtDNA variants. We have established the prevalence of tinnitus among the studied group at 23.5%. We found that there are no statistically significant differences in the prevalence of tinnitus and its characteristic features between HL patients with known HL mtDNA variants and the general Polish population. In Polish HL patients with tinnitus, m.7511T>C was significantly more frequent than in patients without tinnitus. We observed that the prevalence of tinnitus is lower in Polish patients with m.1555A>G as compared to other available data.ConclusionsOur data suggest that the mtDNA variants causative of HL may affect tinnitus development but this effect seems to be ethnic-specific.

Ginkgo biloba extract EGb 761\xae versus pentoxifylline in chronic tinnitus: a randomized, double-blind clinical trial

Background Ginkgo biloba extract EGb 761® and pentoxifylline are frequently prescribed for the treatment of tinnitus. Objective To compare the treatment effects of Ginkgo biloba extract EGb 761R and pentoxifylline. Setting The study was performed at Department of Otorhinolaryngology of University Hospital Královské Vinohrady and 3rd Medical Faculty, Charles University in Prague. Method Patients with sub-chronic or chronic tinnitus were enrolled in double-blind trial and randomized to receive 120 mg EGb 761® or 600 mg pentoxifylline, each twice a day and in double-dummy fashion over a 12-week period. Main outcome measure changes in 11-Point Box Scales for tinnitus loudness and annoyance, the abridged Tinnitus Questionnaire (Mini-TQ), the Hospital Anxiety and Depression Scale (HADS), and the Sheehan Disability Scale (SDS). Results Full analysis set for efficacy analysis comprised 197 patients (EGb 761®, 99; pentoxifylline 98). For both treatment groups, significant improvements were observed in the Mini-TQ, the 11-Point Box Scales for tinnitus loudness and annoyance, the HADS anxiety score and the SDS. There was no relevant difference with regard to tinnitus-related outcomes between the two treatment groups. 20 adverse events were documented in EGb 761® group and 36 adverse events were reported for pentoxifylline group. No serious adverse event was reported during the study. Conclusion EGb 761® and pentoxifylline were similarly effective in reducing the loudness and annoyance of tinnitus as well as overall suffering of the patients. The incidence of adverse events was lower in the EGb 761® group.

Urine Cotinine Should Be Involved in Initial Evaluation of Tinnitus in Adolescents.

ObjectivesSmoking is associated with hearing loss, while the correlation between tinnitus and smoking is not fully elucidated. This study aimed to evaluate risk factors of tinnitus in adolescents in terms of smoking, and we identified a rectifiable parameter that can be serially monitored.MethodsA cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey, with 2,782 participants aged 12 to 18 years, from 2008 through 2011. Participants with history of ear disease, hearing loss, and inadequate responses to questionnaires were excluded. We investigated the prevalence of tinnitus and tinnitus-related annoyance by questionnaire and sought potential risk factors in blood and urine tests and smoking history.ResultsThe prevalence of tinnitus in the 12- to 18-year-old population was 17.5%, with 3.3% reporting tinnitus-related annoyance. On univariate analysis, the prevalence of tinnitus increased with age (P<0.001) and was higher among girls (P=0.012). Blood tests and urinalysis showed significant correlation between tinnitus and red blood cell count, alkaline phosphatase levels, and urine cotinine (P=0.002, P<0.001, P=0.018, respectively). In multivariate analysis, the urine cotinine level was the only parameter associated with tinnitus (odds ratio, 1.000; 95% confidence interval, 0.999 to 1.000; P=0.038). Smoking was also significantly correlated with tinnitus (P=0.043), and amount of smoking with tinnitus-related annoyance (P=0.045). However, current smoking and past smoking were not correlated with tinnitus.ConclusionUrine cotinine may be a rectifiable marker for management of tinnitus in adolescents. This suggests that smoking cessation should be incorporated in the management of tinnitus in adolescents.

The Cochleural Alternating Acoustic Beam Therapy (CAABT): A pre-clinical trial

PurposeWe intend to assess the effectiveness of a novel tinnitus treatment therapy, the Cochleural Alternating Acoustic Beam Therapy (CAABT) using the psychoacoustic measures, the questionnaires and rs-fMRI. Materials and methodsIn this study, we enrolled 11 older than 18 years old Chinese patients with normal hearing who had unilateral, chronic (longer than 6 months), sensorineural tinnitus, of frequencies between 125–8000 Hz, and an average loudness of 31 dB. The patients underwent the treatment with the CAABT method for 12 weeks and the outcomes were evaluated with tinnitus questionnaire scores, a set of psychoacoustic measures, and rs-fMRI testing before treatment and at 3 months. This was an earlier study of the controlled randomized clinical trial which was registered with ClinicalTrials.gov, number NCT02774122. ResultsAlmost all the patients reported reduced tinnitus annoyance after the three-month treatment. The THI and VAS scores showed decreased tinnitus severity. The rs-fMRI results indicated that the right middle frontal gyrus and the right superior temporal gyrus displayed noticeable decreases of the ReHo values for the subjects between the before and after treatment, supporting the clinical evidence of significant tinnitus reduction. ConclusionThe therapy seemed effective in patients of varying severities, and no side effects were observed in this trial. The CAABT can be an alternative for those who are suitable for sound therapy once a large scale of and better controlled clinical studies have validated the findings of this experiment.

Thoughts about Suicide and Self-Harm in Patients with Tinnitus and Hyperacusis.

There are conflicting reports with regard to the relationship between suicidal ideations and tinnitus and hyperacusis. Audiology departments play a major role in offering therapy and support for patients experiencing tinnitus and hyperacusis. If suicidal and self-harm ideations among patients seen in audiology clinics are high, then it would be important to screen for them to make onward referrals to mental health services. The aim of this study was to assess the prevalence of and factors related to suicidal and self-harm ideations in patients with tinnitus and hyperacusis seen at an audiology outpatient service. This study was a part of a service evaluation survey using a correlational design. All patients who sought help concerning their tinnitus or hyperacusis from an audiology clinic of the National Health Service in the United Kingdom in a 1-yr period were asked to complete the survey questionnaires (n = 402). The focus of this article is on analysis of the patients' responses about suicidal and self-harm ideations as measured via the Patient Health Questionnaire, item 9, and their associated factors. A total of 150/402 of patients answered the question about suicidal and self-harm ideations. Of these, 13% indicated that they had suicidal or self-harm ideations in the past 2 weeks. Suicidal and self-harm ideations were moderately correlated with scores on the anxiety and depression subscales of the hospital anxiety and depression scale. Suicidal and self-harm ideations decreased with increasing age. There were small statistically significant correlations between suicidal and self-harm ideations and tinnitus handicap, hyperacusis handicap, insomnia, and scores on the visual analog scale (VAS) of effect of tinnitus on life. The correlations between suicidal and self-harm ideations and gender, pure-tone average of the worse and better ears, uncomfortable loudness levels of the worse ears, and VAS of tinnitus loudness and annoyance were not statistically significant. A regression model showed that abnormal depression scores increased the chance of suicidal and self-harm ideations by a factor of 6.2 (95% confidence interval = 1.13-34.1, p = 0.036). Audiologists offering tinnitus and hyperacusis rehabilitation should screen for suicidal and self-harm ideations among patients, especially for those with comorbid depression, and make onward referral to appropriate services when needed.

Relationship Between Diet and Tinnitus: Korea National Health and Nutrition Examination Survey.

Objectives This study aimed to analyze the association between nutritional intake and tinnitus prevalence by evaluating a large cross-sectional cohort.Methods Data from the Korea National Health and Nutrition Examination Survey collected between 2013 and 2015 were analyzed. The study population consisted of 7,621 individuals aged 40 to 80 years with complete tinnitus-related data. Individuals with inadequate responses to tinnitus history, noise exposure in the work place, or subjective hearing loss were excluded. Prevalence of tinnitus and tinnitus-related annoyance, and nutrition intake were measured using this questionnaire, and associations between tinnitus and nutritional data were evaluated by binary logistic regression analysis.Results Subjective tinnitus was reported by 1,435 individuals with subjective normal hearing (18.8%). Prevalence of tinnitus increased with age. However, among individuals with tinnitus, the proportion of individuals with tinnitus-related annoyance was similar across age groups. Older age, female sex, lower body mass index (BMI), and less vitamin B2 intake were significantly associated with tinnitus (P<0.001, P=0.002, P=0.041, P=0.013, respectively). Vitamin B2 intake was significantly less in individuals with tinnitus who were middle-aged (ages 51–55 and 56–60 years, P=0.012 and P=0.020, respectively). Less intake of water, protein, and vitamin B3 were associated with tinnitus-related annoyance (P=0.038, P=0.009, and P=0.005, respectively). Prevalence of annoyance was significantly associated with less water intake in younger ages (age 45–55 years) but with less protein and vitamin B3 intake in older ages (age 66–80 years).Conclusion Reduced intake of vitamin B2 and B3, water, and protein may be associated with tinnitus and tinnitus-related annoyance, and further studies regarding the importance of adequate nutritional intake in the tinnitus management need to be performed.

Tinnitus Relief Using High-Frequency Sound via the HyperSound Audio System

Purpose: Many tinnitus patients report a reduction in their tinnitus with use of sound therapy. We were interested in determining the magnitude of tinnitus relief that results from exposure to a novel, high-frequency directional audio system. Method: Twenty-three individuals with sensorineural tinnitus were exposed to a 30 minute sound of their choice using the HyperSound audio system. Ratings of tinnitus loudness and annoyance were measured prior, during, and after the sound exposure. Magnitude estimates of loudness and annoyance were obtained over this period. The Tinnitus Primary Functions Questionnaire was administered pre- and post-exposure to determine the degree of change in the functional impact of tinnitus. Following the exposure, the change in tinnitus loudness was quantified numerically in 1-minute intervals, and acceptability of the masker was rated. Results: Results revealed a reduction in tinnitus loudness for 16 of 23 participants and in annoyance for 14 of 23 participants. There were three individuals who reported an increase in their tinnitus after exposure to the sound stimulus and, therefore, did not benefit from the sound therapy. A significant improvement was found in concentration abilities and in the functional impact of tinnitus with use of this sound therapy device, which was represented by an improvement in mean scores for the concentration subscale and total score on the Tinnitus Primary Functions Questionnaire. Further, for 30% of the group, a post-masking effect was observed after exposure or a reduction in tinnitus loudness after the cessation of the stimuli. Finally, 72% of the participants reported that the sound therapy was acceptable in masking their tinnitus. Conclusion: These results indicate that the HyperSound audio system using high-frequency stimuli may be helpful in alleviating tinnitus for tinnitus sufferers. More research is needed to determine the effectiveness of the HyperSound audio system compared to clinical treatments for tinnitus.

A Review of a Steady State Coherent Bio-modulator for Tinnitus Relief &amp; Summary of Efficiency and Safety Data from the Clinical Study Program and Post Market Clinical Follow-up.

To evaluate a non-energy consuming light bio-modulator patch creating coherency for tinnitus relief. Three independent clinical studies and continuous post market clinical follow up have been performed during the year 2012 to 2018. The first study was a limited interventional investigation with 10 patients, the second was a larger interventional study with finally 48 patients further investigated, and the third a randomized, placebo-controlled, double-blind study with 82 patients. In the clinical studies patch performance evaluated with questionnaires related to tinnitus, quality-of-life, and safety were assessed prior, during and after the end of treatment. In all studies the treatment time was 3 weeks and the patches were placed behind one year. The first study indicated a relief with half of the patients at the end of the treatment. Still two years after the study one third reported tinnitus relief. However, the numbers of patients were low. The second study showed a responder relief in 58% directly after end of treatment and 60% one month after. The third study showed that the biomodulator patch had statistical significant three times more responders than placebo one month after end of treatment, measured as a decrease from baseline in at least 2 points in tinnitus annoyance visual analogue scale as a minimal clinical significant difference. Tinnitus handicap inventory was improved by mean-16 points significantly for the active responder group, but with no statistically significant changes for the placebo group or between the groups. The biomodulator patch was safe and well-tolerated in all three studies. The post market clinical follow up has shown a 30% reported relief and with no new risks or unexpected issues affecting the effectiveness or safety. Taken under consideration the lack of easy-to-use alternative and the low risk profile, this patch device could highly be recommended to try for tinnitus relief as a conclusion based on the clinical studies and post market surveys. Further studies of how this bio-modulator more specific act on the auditory system, how long this may sustain and if there can be subgroups of patients or variations in the treatment time, delayed onset, number of patches, and frequency for more efficiency needs to be considered.

Characteristics of somatic tinnitus patients with and without hyperacusis.

ObjectiveDetermine if somatic tinnitus patients with hyperacusis have different characteristics from those without hyperacusis.Patients and methods172 somatic tinnitus patients with (n = 82) and without (n = 90) hyperacusis referred to the Tinnitus Unit of Sapienza University of Rome between June 2012 and June 2016 were compared for demographic characteristics, tinnitus features, self-administered questionnaire scores, nature of somatic modulation and history.ResultsCompared to those without hyperacusis, patients with somatic tinnitus and hyperacusis: (a) were older (43.38 vs 39.12 years, p = 0.05), (b) were more likely to have bilateral tinnitus (67.08% vs 55.56%, p = 0.04), (c) had a higher prevalence of somatic modulation of tinnitus (53.65% vs 36.66%, p = 0.02) and (d) scored significantly worse on tinnitus annoyance (39.34 vs 22.81, p<0.001) and subjective hearing level (8.04 vs 1.83, p<0.001).ConclusionOur study shows significantly higher tinnitus modulation and worse self-rating of tinnitus and hearing ability in somatic tinnitus patients with hyperacusis versus somatic tinnitus patients without hyperacusis. These differences could prove useful in developing a better understanding of the pathophysiology and establishing a course of treatment for these two groups of patients.

High-definition transcranial direct current stimulation of the dorsolateral prefrontal cortex for tinnitus modulation: a preliminary trial.

Tinnitus is the perception of sound in the absence of its external source. Non-invasive neuromodulation techniques have been used in the past decade to investigate the impact of stimulation on tinnitus perception. The objective is to invest the impact of high-definition transcranial direct current stimulation (HD-tDCS) of dorsolateral prefrontal cortex (DLPFC) stimulation on tinnitus loudness and annoyance. Thirteen participants underwent two sessions of HD-tDCS (real and sham) in a double blind, sham controlled, randomized trial. The washout period between the real and sham stimulation session was 1week. Tinnitus loudness and annoyance was measured using a ten-point tinnitus loudness/annoyance numeric rating scale at the baseline, after 5, 10, 15 and 20min of stimulation. There was a significant reduction in the tinnitus loudness after the HD-tDCS of DLPFC. A comparison of the different time points (5, 10, 15 and 20min) with the baseline measurement for tinnitus loudness showed a statistically significant reduction after 15min (t=1.82, p=0.047) and 20min (t=1.82, p=0.047) of stimulation using the real HD-tDCS; this effect was not observed for tinnitus annoyance. HD-tDCS of DLPFC is a safe technique for tinnitus modulation. The most common transient sensations experienced during HD-tDCS were tingling, sleepiness and scalp pain. HD-tDCS of DLPFC resulted in transient tinnitus loudness suppression after 15min of stimulation. We propose the optimum stimulation duration for HD-tDCS of DLPFC for tinnitus suppression to be 15min instead of 20min.

Hearing disorder from music; a neglected dysfunction

Conclusion: Music-induced acute acoustic trauma is not inevitably linked to hearing dysfunction as validated by conventional pure tone audiometry. Tinnitus is often in combination with hyperacusis. Our results point at ‘silent hearing loss’ as the underlying pathology, having afferent nerve terminal damage rather than hair cell loss as the structural correlate.Objectives: Exposure to loud music is one of the most common causes of acute acoustic trauma, which adolescents and teenagers experience by voluntary exposure to loud music of sound levels up to 110 dB(A).Methods: The clinical and psychophysical data of 104 consecutive patients with music-induced hearing disorder (MIHD) were analyzed to construct individual hearing and tinnitus profiles. In all cases, tinnitus was the presenting symptom.Results: Hearing abilities were normal in about two-thirds of the tinnitus patients. Tinnitus was experienced most often as a high-frequency tone (83%). The Tinnitus Handicap Inventory (THI) scores ranged from 0 to 94 with an average score of 43.1. Visual analog scales (VAS) were used to assess tinnitus loudness (average 42.4) and annoyance (average 54.2), and tinnitus awareness was estimated (average 60.3). All VAS values correlated strongly with the THI. Hyperacusis was present in 65% and 71% of the patients reported sleeping disorders.

Low Level Laser Therapy In Treatment Of Tinnitus

Many studies have been conducted regarding using low power laser in treating patients suffering from tinnitus. The aim of this study is to evaluate the effectiveness of 2Watt laser irradiation in the treatment of tinnitus(subjective tinnitus of sensor- neural in origin). A new procedure is used in this study by selecting 19 patients suffering from tinnitus who have not responded to medical therapy for a long period of time. Those treated by low level laser therapy have the irradiation toward cochlea,27 ears in 19 patients with unilateral or bilateral tinnitus , 2 Watt laser with wavelength of 790- 805 nm is applied toward cochlea for 7.5 minuets three times per week . A questionnaire is administered by asking patients to score their symptoms on a percentage scale before and after laser irradiation. A decrease of one scale regarding the loudness, duration of tinnitus and degree of annoyance of tinnitus is accepted to represent any improvement.The results are estimated by the change of loudness, duration and degree of annoyance due to tinnitus.57.8%of patients have demonstrated improvement in their tinnitus. It is concluded that laser therapy seemed to be worth trying on patients with intractable tinnitus.

Exploring Tinnitus-Induced Disablement by Persistent Frustration in Aging Individuals: A Grounded Theory Study.

Background: Qualitative research can help to improve the management of patients, meet their expectations and assist physicians in alleviating their suffering. The perception of moment-to-moment variability in tinnitus annoyance is an emerging field of exploration. This study sought to enlighten variability in tinnitus-induced disablement using a qualitative approach.Methods: Twelve participants (six females, six males, aged 51–79) were recruited via the French Tinnitus Association Journal for participation in recorded semi-structured interviews. Each participant had three interviews lasting 1 h, the sessions being separated one from the other by 2 weeks. Following recommendations of Charmaz (2014), the second and third interviews were aimed at gathering rich data, by enhancing the participants' reflexivity in the circumstances of distress caused by tinnitus. After transcription, the data (n = 36 interviews) were analyzed using the approach to Grounded Theory proposed by Strauss and Corbin (1998).Results: Tinnitus as persistent frustration emerged as being the core category uniting all the other categories of the study. Hence, the core category accounted for the broader scope in participants' experience of chronic tinnitus. It is suggested that tinnitus-induced disablement varied according to the degree of frustration felt by the participants in not being able to achieve their goals. The implications of this were analyzed using the following categories: “Losing body ownership,” “Lacking perspectives,” and “Persevering through difficulties.” Based on these findings, we draw a substantive theory of tinnitus tolerance that promotes an active, disciplined and individualized approach to tinnitus-induced disablement. The model distinguishes pathways from sustained suffering to reduced annoyance (i.e., emerging tolerance). It accounts for difficulties that the participants experienced with a perceived unchanged annoyance over time. Furthermore, this model identifies a set of new attitudes toward oneself and others that tinnitus tolerance would entail.Conclusion: The subjective experience of frustration enlightens tinnitus-induced disablement, offering new perspectives for long-term self-management. Modulation of frustration, rather than moderation of tinnitus interference, is suggested as a new approach to the clinical management of tinnitus-related distress.

Factors related to tinnitus and hyperacusis handicap in older people

Objective: The aim was to assess factors related to tinnitus and hyperacusis handicap in older people. Design: Retrospective cross-sectional. Study sample: Data were gathered for 184 patients with an average age of 69 years. Results: Tinnitus handicap as measured via the Tinnitus Handicap Inventory (THI) was significantly predicted by tinnitus annoyance as measured via the visual analogue scale (VAS) (regression coefficient, b = 2.9, p < 0.001) and the effect of tinnitus on the patient’s life as measured via the VAS (b = 3.9, p < 0.001). Hyperacusis handicap as measured via the Hyperacusis Questionnaire (HQ) was significantly predicted by the score on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) (b = 0.8, p < 0.001) and to a small extent by the THI score (b = 0.07, p = 0.048). Insomnia scores as measured via the Insomnia Severity Index (ISI) were significantly predicted by scores on the depression subscale of the HADS (b = 0.46, p = 0.007). Conclusions: Since tinnitus annoyance significantly predicts tinnitus handicap, it is important to explore factors associated with annoyance that may be useful in designing appropriate rehabilitative interventions aimed at reducing tinnitus handicap in older people. Future studies should explore whether hyperacusis and insomnia in older people with tinnitus need to be managed in conjunction with treatment for depression.

Results of an Interdisciplinary Day Care Approach for Chronic Tinnitus Treatment: A Prospective Study Introducing the Jena Interdisciplinary Treatment for Tinnitus.

Objective: Considering the heterogeneity of the symptoms shown by patients suffering from chronic tinnitus, there are surprisingly few interdisciplinary treatments available, and mostly available only for inpatients. In order to provide an interdisciplinary treatment, we developed a day care concept in which each patient was treated by an ENT doctor, a cognitive behavioral therapist, a specialist for medical rehabilitation and an audiologist (Jena Interdisciplinary Treatment for Tinnitus, JITT). The aim of this study was to observe the changes of tinnitus related distress due to interdisciplinary day care treatment and to determine which factors mediate this change.Subjects and Methods: Tinnitus annoyance was measured using the Tinnitus Questionnaire on 308 patients with chronic tinnitus. They were treated in the day care unit over five consecutive days between July 2013 and December 2014. Data were collected before treatment when screened (T0), at the beginning (T1) and at the end of the 5 day treatment (T2), as well as 20 days (T3) and 6 months after treatment (T4).Results: Overall, tinnitus annoyance improved significantly from the screening day to the beginning of treatment, and to a much larger degree from the beginning to the end of treatment. The treatment outcome remained stable 6 months after treatment. Patients with the following symptoms displayed higher tinnitus annoyance at T0: dizziness at tinnitus onset, tinnitus sound could not be masked with background noise, tinnitus worsening during physical stress, comorbid psychiatric diagnosis, higher age and higher hearing loss. Loudness of tinnitus perceived in the right ear correlated with tinnitus annoyance significantly. Demographic, tinnitus and strain variables could only explain 12.8% of the variance of the change in tinnitus annoyance from T0 to T4. Out of 39 predictors, the only significant ones were “sick leave 6 months before treatment” and “tinnitus annoyance at T0.”Conclusion: The newly developed JITT represents a valuable treatment for chronic tinnitus patients with improvement remaining stable for at least 6 months after treatment. Using a large number of variables did not allow predicting treatment outcome which underlines the heterogeneity of tinnitus.

Neural activity during attentional conflict predicts reduction in tinnitus perception following rTMS

BackgroundSubjective idiopathic tinnitus is an intrusive, distracting, and potentially disabling disorder characterized by phantom perception of sounds. Although tinnitus has no approved pharmacologic treatment, recent evidence supports the use of repetitive transcranial magnetic stimulation (rTMS) to alleviate tinnitus symptoms. Objective/HypothesisRepetitive TMS delivered over the middle superior temporal gyrus (STG) may alter ratings of tinnitus awareness and annoyance more than loudness due to change in attentional processing. STG has reciprocal connections to regions of the prefrontal cortex that mediate attention. To probe the hypothesized influence of STG stimulation on attention, a subset of patients with tinnitus enrolled in an rTMS clinical trial [n = 12, 9 male, mean (sd) age = 49 (15) years] underwent an attentional conflict task before and after rTMS treatment in a repeated-measures functional magnetic resonance imaging (fMRI) study. MethodsThe Multi-Source Interference Task (MSIT), a Stroop-based visual attentional conflict fMRI task, was used to map participants' neural processing of attentional conflict prior to rTMS intervention (Baseline) and after three rTMS intervention arms: Sham, 1 Hz, and 10 Hz (four sessions per arm, 1800 pulses per session, delivered @110% of the motor threshold over the posterior superior temporal gyrus). ResultsAll measures of tinnitus severity (awareness, loudness, and annoyance) improved with 1 Hz rTMS intervention; however, the greatest and most robust changes were observed for ratings of tinnitus awareness (mean 16% reduction in severity from Baseline, p < 0.01). The MSIT elicited a similar pattern of neural activation among tinnitus participants at Baseline compared to an independent sample of 43 healthy comparison adults (r = 0.801, p = 0.001). Linear regression with bootstrap resampling showed that greater recruitment of bilateral prefrontal and bilateral parietal regions by MSIT at Baseline corresponded with poorer treatment response. Individual regions' activities explained 37–67% variance in participant treatment response, with left dorsolateral prefrontal cortex's MSIT activity at Baseline explaining the greatest reduction in tinnitus awareness following 1 Hz stimulation. Although left dorsolateral prefrontal cortex activity at Baseline also predicted reduction in tinnitus loudness and annoyance (∼50% variance explained), these symptoms were more strongly predicted by right middle occipital cortex (∼70% variance explained) – suggesting that the neural predictors of symptom-specific treatment outcomes may be dissociable. ConclusionThese candidate neural reactivity markers of treatment response have potential clinical value in identifying tinnitus sufferers who would or would not therapeutically benefit from rTMS intervention.

Electric field-navigated transcranial magnetic stimulation for chronic tinnitus: a randomized, placebo-controlled study

Objective: Repetitive transcranial magnetic stimulation (rTMS) may alleviate tinnitus. We evaluated effects of electric field (E-field) navigated rTMS targeted according to tinnitus pitch. No controlled studies have investigated anatomically accurate E-field-rTMS for tinnitus. Design: Effects of E-field-rTMS were evaluated in a prospective randomised placebo-controlled 6-month follow-up study on parallel groups. Patients received 10 sessions of 1 Hz rTMS or placebo targeted to the left auditory cortex corresponding to tonotopic representation of tinnitus pitch. Effects were evaluated immediately after treatment and at 1, 3 and 6 months. Primary outcome measures were visual analogue scores (VAS 0–100) for tinnitus intensity, annoyance and distress, and the Tinnitus Handicap Inventory (THI). Study sample: Thirty-nine patients (mean age 50.3 years). Results: The mean tinnitus intensity (F3 = 15.7, p < 0.0001), annoyance (F3 = 8.8, p = 0.0002), distress (F3 = 9.1, p = 0.0002) and THI scores (F4 = 13.8, p < 0.0001) decreased in both groups over time with non-significant differences between the groups. After active rTMS, 42% and 37% of the patients showed excellent response at 1 and 3 months against 15% and 10% in the placebo group (p = 0.082 and p = 0.065). Conclusions: Despite the significant effects of rTMS on tinnitus, differences between active and placebo groups remained non-significant, due to large placebo-effect and wide inter-individual variation.

Prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with cervicogenic somatic tinnitus

BackgroundTinnitus can be related to many different aetiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus(CST). Recently, a positive effect of multi-modal cervical physical therapy on tinnitus severity in patients with CST was demonstrated. To date however, the outcome of the intervention cannot be predicted. ObjectiveTo identify prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with CST. PatientsPatients with moderate to severe subjective tinnitus (Tinnitus Functional Index(TFI):25–90points) and neck complaints (Neck Bournemouth Questionnaire(NBQ) > 14points). InterventionAll patients received multimodal cervical physical therapy for 6 weeks (12 sessions). This physical therapy contained a combination of manual mobilizations and exercises of the cervical spine. MeasurementsTFI and NBQ-scores were documented at baseline, after treatment and after a 6-weeks follow-up period. Impairments in cervical spine mobility and muscle function were identified at baseline and after 6-weeks follow-up. ResultsPatients with co-varying (increasing or decreasing simultaneously) tinnitus and neck complaints had significantly lower TFI-scores after treatment (p = 0.001) and follow-up (p = 0.03). The presence of this co-variation and a combination of low pitched tinnitus and increasing tinnitus during inadequate cervical spine postures are prognostic indicators for a decrease in TFI-scores after cervical physical therapy (adjusted R2 = 0.357). ConclusionPatients who experience a decrease in tinnitus annoyance from cervical physical therapy are those with co-varying tinnitus and neck complaints and those with a combination of low-pitched tinnitus and increasing tinnitus during inadequate cervical spine postures.

Pilot Investigation of a Topographical Filter Dermal Patch in Patients with Tinnitus.

A new topographical filter in a dermal administration patch that organizes water molecules has been suggested as an alternative treatment for manifested tinnitus. The aim of this study was to evaluate this patch in a pilot study. 12 patients were included (10 completed) in an open study all receiving treatment with daily changed patches. The objectives were to evaluate safety and performance of the patch during and after treatment. The primary objective was to evaluate the tinnitus severity (by Tinnitus Severity Questionnaire, TSQ) and tinnitus annoyance (by Visual Analogue Scale, VAS). The secondary objective was to evaluate if the patch could improve the patient's quality of life (by SF-36 Quality of life questionnaire) and sleep initiation time (self-rated). At visit 4, after 21 days of treatment, an improvement (decrease in TSQ score) was seen in 5 responder patients, which was sustained at the post-treatment visit. A marginal increase in TSQ score was seen also initially in 5 non-responder patients, 4 of which were responders post-treatment. The rated tinnitus annoyance, quality of life and sleep initiation time did not show significant changes. The safety evaluation did not present any safety concerns. This small pilot study indicates that it can be reasonable to recommend on a risk-benefit and safety perspective treatment with the dermal patch to patients with tinnitus as a consumer product based on the lack of other effective alternative treatment. Further and larger studies, and also proven experience, are recommended for stronger evidence.

Effect of Age, Gender and Hearing Loss on the Degree of Discomfort Due to Tinnitus

Introduction:Tinnitus is one of the complex symptoms of hearing described as a phantom auditory sensation without any external stimulation. Due to the subjective nature of tinnitus, perception and discomfort of tinnitus vary among the patients. The main aim of this study is to investigate the effects of gender, age and the degree of hearing loss on discomfort due to tinnitus.Methods:Eighteen patients with tinnitus, aged 21–72 years, (9 males and 9 females) were recruited. Tinnitus discomfort was investigated by Tinnitus Handicap Inventory (THI) questionnaire. Psychoacoustic assessments of tinnitus and auditory threshold assessments were evaluated using a 2-channel clinical audiometer.Results:The results showed no significant correlation between THI scores with loudness matching (P=0.187), mean of auditory threshold (P=0.304), gender (P=0.93) and age (P=0.200). Also, no significant correlation was found between maximal level of hearing loss and pitch matching (P=0.208).Conclusion:The study findings suggests that tinnitus is not correlated with age, gender and hearing loss. Overall, tinnitus is a complicated clinical condition which its real impact and degree of discomfort are unclear. More investigation is needed to clarify the factors involving in tinnitus annoyance.