Tinnitus Handicap Research Articles

The Placebo Effect on Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To quantify the placebo effect in randomized clinical trials treating tinnitus with oral or intratympanic placebo treatment. CINAHL, PubMed, and Scopus were searched for articles from conception to October 2022. MESH and key terms such as "tinnitus," "placebo," and "medication" were used to find randomized, placebo-controlled trials. The search was limited to articles in English. Randomized controlled trials with adult subjects evaluating tinnitus pretreatment and posttreatment with an oral or intratympanic medication versus a placebo arm were included. Crossover studies, studies involving middle/inner ear operations or devices, and studies that exclusively included nonidiopathic etiologies of tinnitus were excluded. Mean tinnitus symptom survey scores for the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index, Tinnitus Functional Index, Tinnitus Handicap Questionnaire, and Visual Analog Scales for tinnitus Intensity/Loudness (VAS-L), Annoyance (VAS-An), and Awareness (VAS-Aw) were extracted for both placebo and experimental groups. 953 studies were screened with 23 studies being included in the final analysis. Meta-analysis of mean difference (MD) was calculated using RevMan 5.4. MD between pretreatment and posttreatment THI scores of the placebo arms was 5.6 (95% confidence interval, 3.3-8.0; p < 0.001). MD between pretreatment and posttreatment VAS scores of the placebo groups for Loudness, Annoyance, and Awareness were 0.8 (0.0 to 1.6, p = 0.05), 0.2 (-0.2 to 0.5, p = 0.34), and 0.3 (-0.0 to 0.7, p = 0.08), respectively. Placebo treatment has shown effectiveness in improving patient-reported evaluations of tinnitus when using some standardized metrics such as THI and VAS-L; however, the improvement is not as substantial as nonplacebo treatment.

Neuromodulation for Treatment of Tinnitus: A Systematic Review and Meta-Analysis.

To evaluate the treatment efficacy of neuromodulation versus sham for the treatment of tinnitus. Cochrane Library, CINAHL, PubMed, Scopus. The Cochrane Library, CINAHL, PubMed, and Scopus were searched from inception through May 2023 for English language articles documenting "neuromodulation" and "tinnitus" stratified by sham-controlled randomized control trials with 40 or more patients. Data collected included Beck Anxiety Inventory, Beck Depression Inventory (BDI), Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire, and Visual Analog Scale. A Meta-analysis of continuous measures (mean) and proportions (%) were conducted. A total of 19 randomized control trials (N = 1186) were included. The mean age was 48.4 ± 5.3 (range: 19-74), mean duration of tinnitus was 3.8 ± 3.4 years, 61% [56.2-65.7] male, and 55.7% [46-65] with unilateral tinnitus. The short-term effect of transcutaneous electrical nerve stimulation and transcranial direct current stimulation on THI score is -16.2 [-23.1 to -9.3] and -19 [-30.1 to -7.8], respectively. The long-term effect of repetitive transcranial magnetic stimulation on THI score is -8.6 [-11.5 to -5.7]. Transcranial direct current stimulation decreases BDI score by -11.8 [-13.3 to -10.3]. As measured by the Tinnitus Handicap Index, our findings suggest the effects of transcutaneous electrical nerve stimulation and transcranial direct current stimulation reach significant benefit in the short term, whereas repetitive transcranial magnetic stimulation reaches significant benefit in the long term. Based on the BDI, transcranial direct current stimulation significantly reduces comorbid depression in patients with tinnitus.

Effect of the COVID-19 Pandemic on Resting-State Brain Activity in Individuals with Tinnitus.

This study looked at the possible effect of the COVID-19 pandemic on individuals who came to our clinic seeking relief from tinnitus. The performance of the subjects during the COVID-19 pandemic was compared with similar individuals who came to our clinic before the pandemic began. The study involved 50 adults with chronic tinnitus, made up of a study group (24 subjects tested during the COVID-19 pandemic of 2020-2021) and a control group before the pandemic began (26 subjects tested from 2013 to 2017). None of the 24 reported having contracted COVID-19. Data collection involved the Tinnitus Handicap Inventory (THI) questionnaire, audiological tests, and quantitative electroencephalography (qEEG). In terms of THI scores, there were no statistically significant differences between the two groups. However, with regard to qEEG, some changes were observed, with significant decreases in alpha and beta band activity in the study group compared to the control group, particularly over the auditory cortex. We conclude that COVID-19 did not have a discernible impact on the general well-being of individuals with tinnitus. However, it did appear to alter brain activity, specifically in the alpha and beta bands over the auditory cortex, and these reults warrant further investigation.

Noninvasive Treatment of Venous Pulsatile Tinnitus with an Internal Jugular Vein Compression Collar.

The study was conducted to evaluate the safety and efficacy of mild internal jugular (IJV) compression via an FDA approved compression collar for symptomatic treatment of venous pulsatile tinnitus. This is a prospective study that recruited 20 adult patients with venous pulsatile tinnitus. Participants completed the Tinnitus Handicap Inventory (THI), were fitted with the collar, and rated symptom intensity on a 10-point tinnitus intensity scale before and during collar use. Once weekly for 4 weeks, they answered a survey quantifying days used, average tinnitus intensity before and after wearing the collar each day of use, and any safety concerns. Lastly, they completed an exit interview. The primary outcome was symptomatic relief, with secondary outcomes of safety, effect of treatment setting, effect of time, and quality of life assessed via nonparametric testing. 18 participants completed the study, and 276 paired daily before use/during use intensity scores were submitted. The median symptom intensity without the collar was 6 (IQR 4, 7), whereas with the collar it was 3 (IQR 2, 5), for a median symptomatic relief of 50%. The collar had a significant effect in reducing symptom intensity (p < 0.0001) and burden of illness via the THI (p < 0.0001). There was no effect of setting, frequency, or time on symptomatic relief with the collar. There were no adverse safety events reported aside from minor discomfort upon initial application. Venous compression collars offer acute symptom relief for patients with venous pulsatile tinnitus. Further study is needed to assess safety and efficacy of longitudinal use. 4 Laryngoscope, 134:3342-3348, 2024.

Abnormal quantitative sudomotor axon reflex test results in patients with tinnitus as a possible indicator of small fiber neuropathy.

A few cases of small fiber neuropathy (SFN) and tinnitus (TN) associated with coronavirus disease 2019 have been reported. However, the relationship between SFN and TN has not been studied. This study investigated a possible relationship between SFN and patients with TN (PwTNs) using autonomic function tests (AFTs) including quantitative sudomotor axon reflex tests (QSART). We performed QSARTs and other AFTs such as the Sympathetic skin response (SSR), Valsalva ratio (VR), and heart rate variability (HRV). The QSART results, obtained at seven hospitals using same protocols, were compared between PwTNs and healthy controls. We confirmed the abnormalities in SSR, VR, and HRV in PwTNs, although those parasympathetic AFTs were not performed in healthy controls. Additionally, we checked Tinnitus handicap inventory (THI) scores for PwTNs and ~50% of PwTNs had low-grade disability, whereas 9.3% had high-grade disability. Data from 57 PwTNs and 122 healthy controls were analyzed. The sweat volumes of QSART in the older age group tended to be higher in the PwTNs than in age-matched healthy controls, and significant differences between the PwTN and control groups were observed in the feet in both sexes (p < 0.001) and in the arms in women (p = 0.013). In the younger age group, the sweat volumes in the feet of men were higher in PwTNs than in healthy controls (p = 0.017). No association was observed between THI and QSART scores. In this study, the sweat volumes in QSARTs were higher in PwTNs than in healthy controls. However, abnormal SSR, HRV, and VR results were not commonly observed in PwTNs. Although the results should be interpreted with caution because of limitations in study, PwTNs might also have SFN apart from dysautonomia. This is the first study to perform QSART with other parasympathetic AFTs in PwTNs. However, larger and more rigorously controlled studies will be needed to reveal the relationship between SFN and TN in the future.

Transmastoid Surgery for Superior Canal Dehiscence: Prospective Longitudinal Objective and Patient-Reported Audiovestibular Outcomes.

We assess symptom control, reversal and stability of objective third-window indicators, and hearing and balance function after transmastoid superior canal dehiscence plugging. To do this, we combine patient self-assessment questionnaires with auditory and vestibular test data collected at a preoperative and multiple postoperative visits. Prospective cohort study. Tertiary referral center. Patients who underwent transmastoid plugging for superior canal dehiscence from 2012 to 2020. Plugging of the superior semicircular canal using the transmastoid approach. Patients were evaluated preoperatively, 3-month postoperative, and at yearly follow-ups (up to 8 yr postoperative). Self-assessment questionnaires included Autophony Index, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, and Hearing Handicap Inventory. Objective tests included audiometry, cervical vestibular evoked myogenic potential, ocular vestibular evoked myogenic potential, and video head impulse test. There was a statistically significant improvement in Autophony Index and Hearing Handicap Inventory total scores from the preoperative evaluation to 1 year postoperative. Dizziness Handicap Inventory and Tinnitus Handicap Inventory total scores also improved but statistically insignificant. Cervical and ocular vestibular evoked myogenic potential amplitudes and low-frequency air-bone gap showed statically significant reversal of the third-window effect preoperative versus 1 year postoperative. Video head impulse test of the superior semicircular canal revealed cases of pathological function preoperative with postoperative recovery. Results were stable over time. Superior canal dehiscence repair resolves symptoms of autophony and improves hearing disability. Objective third-window indicators reverse and show long-term stability. Auditory and vestibular function is preserved postoperative, even superior semicircular canal function may be normal. Data suggest that surgical outcomes should not be evaluated until 1 year postoperative.

Alterations of resting-state functional network connectivity in patients with noise-induced hearing loss: A study based on independent component analysis.

Functional reorganization is a response to auditory deficits or deprivation, and less is known about the overall brain network alterations involving resting-state networks (RSNs) and multiple functional networks in patients with occupational noise-induced hearing loss (NIHL). So this study evaluated resting-state functional network connectivity (FNC) alterations in occupational NIHL using an independent component analysis (ICA). In total, 79 mild NIHL patients (MP), 32 relatively severe NIHL patients (RSP), and 84 age- and education- matched healthy controls (HC) were recruited. All subjects were tested using the Mini-mental State Examination scale, the tinnitus Handicap Inventory scale, the Hamilton Anxiety scale (HAMA) and scanned by T1-3DFSPGR, resting-state functional magnetic resonance imaging sequence in 3.0 T and analysed by the ICA. Seven RSNs were identified, compared with the HC, the MP showed increased FNC within the executive control network (ECN) and enhanced FNC within the default mode network (DMN) and the visual network (VN); compared with the HC, the RSP showed decreased FNC within the ECN and auditory network (AUN), DMN and VN; no significant changes in FNC were found in the MP compared with the RSP. Furthermore, the correlation analysis between the noise exposure time and hearing loss level, HAMA were both negative, and there were no significant correlations between the abnormal RSNs and the hearing level, noise exposure time and HAMA. These findings indicate that different degrees of NIHL involve different alterations in RSNs connectivity and may reveal the neural mechanisms related to emotion-related features and functional abnormalities following long-term NIHL.

The effect of MemoVigor 2 on recent-onset idiopathic tinnitus: a randomized double-blind placebo-controlled clinical trial.

Background: Tinnitus is a common symptom associated with the conscious perception of sound in the absence of a corresponding external or internal sound source, which can severely impact quality of life. Because of the current limited understanding of the precise pathophysiological mechanism of idiopathic tinnitus, no curable treatment has been attained yet. A food supplement trading as MemoVigor 2, which contains a combination of therapeutic ingredients with mainly antioxidant activity, has been used in the treatment of tinnitus. The objective of our study was to evaluate the effectiveness of MemoVigor 2 in the treatment of recent-onset idiopathic tinnitus. Methods: In a prospective single-centre randomized, double-blind, placebo-controlled clinical trial we studied 204 patients with idiopathic tinnitus divided into two groups: 104 patients who received MemoVigor 2 and 100 patients treated with placebo. To evaluate changes in tinnitus we used (1) audiometry/tympanometry; (2) specific measures of tinnitus perception, including tinnitus pitch, loudness at tinnitus pitch, loudness at 1kHz, minimum masking level, and residual inhibition; (3) questionnaires of tinnitus handicap inventory, mini tinnitus questionnaire and patients' global impression of change. All patients underwent this test battery at the beginning of the study and in a repeat post-3-month session. Results: All tinnitus measures, including pitch, loudness, minimum masking level and residual inhibition improved significantly in the intervention group. Most of these measures improved in the placebo group too, but in a lesser degree. All questionnaire scores diminished significantly in both groups, but the degree of decrease was greater in the intervention group. The participants' tinnitus outcome reported after treatment using the patients' global impression of change score differed significantly between the two groups, with greater improvement observed in the intervention group. Conclusion: We found that the use of MemoVigor 2 improved recent-onset tinnitus, as proved by a set of tests performed for its evaluation, including audiometric measures, specific measures of tinnitus perception and tinnitus questionnaires. Tinnitus in the placebo group improved too, but to a lesser degree. Clinical Trial Registration: isrctn.com, Identifier ISRCTN16025480.

A critical review of established tinnitus patient-reported outcomes as measures of Tinnitus Severity and Tinnitus Distress and exemplar analysis of the Tinnitus Handicap Inventory as a formative or reflective measure

Tinnitus Severity and Tinnitus Distress are frequently referenced and conflated constructs in research, measured using established tinnitus patient-reported outcome measures (PROs). Confusion regarding these constructs and their relation to fundamental scientific conceptions of tinnitus represents a threat to the validity of PROs as applied in tinnitus research, the conclusions that are reached when applying them, and subsequent progress of theory and clinical interventions for those experiencing tinnitus. Therefore, we critically review relevant literature, providing the Severity of Symptoms (SoS) and Correlates of Complaint (CoC) framework to link tinnitus theory to these constructs. We provide researchers with an overview of latent variable fundamentals (including distinctions between formative and reflective measures, and psychometric and clinimetric measurement traditions). We then provide a synthesis of the relationship between Tinnitus Severity and Tinnitus Distress, the SoS/CoC framework, and latent variable measurement to elucidate their distinctions. Finally, we take the Tinnitus Handicap Inventory (THI) as an exemplar of established tinnitus PROs and use study data (N = 200) to empirically evaluate the appropriateness of the THI as a reflective measure of Tinnitus Distress. Subsequently, conceptual and criterion mediation tests provide evidence that the THI is not a reflective measure of Tinnitus Distress according to the CoC conception and should be considered as a formative measure. Researchers should therefore consider whether established tinnitus PROs, such as the THI, are congruent with the scientific conceptions and subsequent theories that they aim to evaluate.

Sensory Gating Networks in Normal-Hearing Adults With Minimal Tinnitus.

The goal of this study was to observe sensory gating-related networks underlying cortical auditory evoked potential (CAEP) peak components in individuals with and without minimal tinnitus, as measured using the Tinnitus Handicap Inventory (THI). This analysis was performed on previously published sensory gating responses in normal-hearing adults with and without minimal tinnitus. Independent component analysis was performed for each individual CAEP gating component (Pa, P50, N1, and P2). Significant components were retained for source localization analyses within the following groups: no tinnitus, tinnitus with a THI score ≤ 6, and tinnitus with a THI score > 6. Brain source localization was performed on the gating difference wave for each component using standardized low-resolution brain electromagnetic tomography. Gating-related networks were identified within each group. Different regional sources were observed between groups, with parietal sources underlying the Pa and P50 components as tinnitus severity increased. A larger prefrontal regional activation was also shown for the N1 gating component as tinnitus severity increased. These results expand upon the functional gating responses via CAEP waveforms in a previously published study. The auditory gating response, as measured via CAEPs, has previously been shown to significantly correlate with an increase in tinnitus severity in adults with normal hearing. The corresponding changes in the gating response appear to be supported by different cortical regions in those without tinnitus, those with a THI score ≤ 6, and those with a THI score > 6. Next, functional differences between localized cortical regions should be tested.

Exploring the regulatory effect of acupuncture for Ningshen Tongqiao on the functional connectivity between the anterior cingulate cortex and the whole brain in the patients with subjective tinnitus based on fMRI.

To explore the effect of acupuncture for Ningshen Tongqiao (tranquilizing the spirit and unblocking the orifices) on the functional connectivity (FC) between the anterior cingulate cortex (ACC) and the whole brain in the patients with subjective tinnitus using the resting-state functional magnetic resonance imaging (fMRI). Forty patients with subjective tinnitus and 40 healthy subjects were recruited. The patients with subjective tinnitus were treated with acupuncture for Ningshen Tongqiao at Yamen (GV 15) and Baihui (GV 20), as well as Tinggong (SI 19), Touqiaoyin (GB 11) and Shuaigu (GB 8) on the affected side; and Tinggong (SI 19) and Touqiaoyin (GB 11) were attached to the electric acupuncture apparatus and stimulated with disperse-dense wave and 2 Hz/50 Hz in frequency. Acupuncture was operated once daily, 3 times a week and 10 treatments were required. Before and after treatment, the scores of tinnitus evaluation questionnaire (TEQ), tinnitus handicap inventory (THI) and tinnitus visual analogue scale (VAS) were evaluated; and the clinical therapeutic effect was assessed. Separately, the patients with subjective tinnitus received one time of fMRI within 2 days before and after treatment, and the healthy subjects underwent one time of fMRI after enrollment. The bilateral ACC was taken as the region of interest (ROI). Using matlab R2017b software, FC between ACC and the whole brain was calculated. After treatment, the scores of THI, TEQ and VAS were reduced in the subjective tinnitus patients compared with those before treatment (P<0.01); and the total effective rate was 92.5% (37/40). Before treatment, compared with the healthy subjects, FC between the right ACC and the left middle temporal gyrus, the left superior temporal gyrus and the left superior frontal gyrus decreased in the subjective tinnitus patients. FC between the right ACC and the left middle frontal gyrus and the bilateral angular gyrus was dropped, while that between the left ACC and the left middle frontal gyrus, the left thalamus, the left angular gyrus and the left middle temporal gyrus was decreased in the subjective tinnitus patients when compared with the healthy subjects after treatment. Compared with those before treatment, FC between the right ACC and the left lingual gyrus and the left thalamus were declined, and that between the left ACC and the right middle frontal gyrus and the right superior frontal gyrus was decreased in the subjective tinnitus patients after treatment. Acupuncture can effectively relieve the clinical symptoms of subjective tinnitus patients, and promote the functional re-construction of the auditory regions (temporal lobe, frontal lobe and thalamus) and the emotion-related brain regions.

Low-sodium diet with adequate water intake improved the clinical efficacy in Ménière’s disease

Background Ménière’s disease (MD) is a common idiopathic inner ear disorder in otorhinolaryngology characterized by recurrent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus and ear fullness. Objective To study the effects of low-sodium diet with adequate water intake on the clinical efficacy in MD. Methods Fifty patients diagnosed with stage-3 unilateral MD were randomly divided into control group(n = 25) and experimental group(n = 25). The control group was given routine medication therapy, and the experimental group was restricted to an sodium intake of 1500 mg/d and a water intake of 35 ml/kg/d based in addition to the routine medication therapy. The two groups were assessed using pure tone audiometry, electrocochleography, Tinnitus Handicap Inventory (THI), and Dizziness Handicap Inventory (DHI). Results The pure tone audiometry and electrocochleography showed better improvements after treatment in the experimental group than the control group (p < 0.05). The THI improved values in the experimental group were significantly higher than the control group (p < 0.001). The DHI improved values in the experimental group were significantly higher than the control group (p = 0.004). Conclusions and Significance Low-sodium diet with adequate water intake improved the hearing and alleviated vertigo and tinnitus in MD patients.

Pesquisas científicas sobre zumbido no Brasil: Um compilado observacional

ABSTRACT Purpose: to identify the profile of tinnitus research in Brazil and the main procedures adopted by professionals in the field in the national territory. Methods: an observational, descriptive, and cross-sectional study, in which an active search was made on digital platforms to identify researchers in Brazil who have tinnitus as a study focus. After identifying the tinnitus study groups, an online Form was sent to the researchers comprising 21 questions, so as to know the works in development. The collected responses were extracted and tabulated intoMicrosoft Excel Professional Plus2019 through the absolute and relative frequency measurements of the final sample. Results: 117 researchers were identified, of these, 21 participated in the study, being (90.5%) females, specifically from public universities (81%) in the Southeast region of Brazil (47.7%). These professionals develop clinical research (76.1%), focusing on therapies and/or treatments (38.1%), and use sound therapy (52.38%) as the main technological resource of their studies. Conclusion: the research profile is clinical, with a main focus on therapies and/or treatments for tinnitus. As for the procedures, there is a predominant application of the Visual Analogue Scale- VAS and the Tinnitus Handicap Inventory- THI as evaluation protocols and sound therapy as the main technological resource of their studies.

Enriched Acoustic Environment as a customized treatment for tinnitus: A non-controlled longitudinal study

Tinnitus is a heterogeneous hearing disorder with no cure at present, but some treatments, such as a combination of counselling and sound therapy, can alleviate the discomfort it causes. The sound therapy efficiency depends on both the type of sound stimulus and the time of exposure. This study describes the fundamentals of a personalized sound therapy that stimulates the auditory system with either continuous or sequential sounds whose spectra are adjusted to the hearing levels of the participants. This sound therapy is called Enriched Acoustic Environment and is assessed in a sample of 137 participants with tinnitus. Tinnitus-related distress relief was clinically relevant and statistically significant for 90% of these patients. This was quantified as a mean decrease of 24.3 points on the Tinnitus Handicap Inventory. 31% of participants were treated with sequential stimuli and achieved greater relief of distress (29.4 points on their Tinnitus Handicap Inventory score) compared to those treated with continuous sound (69%). According to these results, sequential sound seems to be optimal compared to continuous sound.

Triple semicircular canal occlusion with endolymphatic sac decompression for intractable Meniere's disease.

Meniere's disease (MD) is characterized by idiopathic endolymphatic hydrops (ELH). Frequent vertigo attacks is the most disabling symptom of MD. This study evaluated the efficacy of triple semicircular canal occlusion combined with endolymphatic sac decompression in the treatment of frequent vertigo in patients with MD. Eleven patients with complete medical records were included in this study conducted from May 2021 to April 2022. All patients were enrolled to undergo triple semicircular canal occlusion (TSCO) with endolymphatic sac decompression (ESD). Various tests including pure tone audiometry (PTA), vestibular evoked myogenic potentials (VEMPs), the video head impulse test (v-HIT), caloric test data, the Dizziness Handicap Inventory (DHI), the Berg Balance Scale (BBS), and the Tinnitus Handicap Inventory (THI) were performed both before and after the surgery. The successful control rate of vertigo was 100% (9/9) in the average 23-month postoperative follow-up period, with complete control rate of 88.89% (8/9) and substantial control rate of 11.11% (1/9). Triple semicircular canal occlusion combined with ESD may be an effective treatment option for managing frequent vertigo attacks in patients with MD. This combination therapy has the potential to become a significant addition to the treatment framework for MD.

Evaluation of Sleep Quality in Patients with Tinnitus

Aim: Tinnitus is the perception of sound in the absence of auditory stimuli. Tinnitus may affect daily life activities and cause complaints of difficulty in concentration, emotional distress and sleep disturbance. The aim of this study was to evaluate the relationship between tinnitus and sleep quality. Materials and Methods: Eighty-one patients (42 females, 39 males) with subjective tinnitus lasting more than 6 months in the last 6 months were included. Tinnitus handicap index (THI), Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) questionnaires were used. Results: There was a moderate statistically significant positive correlation between THI and both PSQI (r=0.411; p=&lt;0.001) and ISI (r=0.436; p=0.003). As THI increased, PSQI and ISI increased. Conclusion: Evaluating sleep quality is important in treatment planning to control tinnitus and improve the quality of life in tinnitus patients. Keywords: Tinnitus; Sleep Quality; Questionnaire

Rare Deletions or Large Duplications Contribute to Genetic Variation in Patients with Severe Tinnitus and Meniere Disease.

Meniere disease (MD) is a debilitating disorder of the inner ear defined by sensorineural hearing loss (SNHL) associated with episodes of vertigo and tinnitus. Severe tinnitus, which occurs in around 1% of patients, is a multiallelic disorder associated with a burden of rare missense single nucleotide variants in synaptic genes. Rare structural variants (SVs) may also contribute to MD and severe tinnitus. In this study, we analyzed exome sequencing data from 310 MD Spanish patients and selected 75 patients with severe tinnitus based on a Tinnitus Handicap Inventory (THI) score > 68. Three rare deletions were identified in two unrelated individuals overlapping the ERBB3 gene in the positions: NC_000012.12:g.56100028_56100172del, NC_000012.12:g.56100243_56101058del, and NC_000012.12:g.56101359_56101526del. Moreover, an ultra-rare large duplication was found covering the AP4M1, COPS6, MCM7, TAF6, MIR106B, MIR25, and MIR93 genes in another two patients in the NC_000007.14:g.100089053_100112257dup region. All the coding genes exhibited expression in brain and inner ear tissues. These results confirm the contribution of large SVs to severe tinnitus in MD and pinpoint new candidate genes to get a better molecular understanding of the disease.

Resurfacing Dehiscence(s) Without Reducing Diverticulum Effectively Silences Pulsatile Tinnitus: Novel Surgical Techniques for Diverticulum and Intraoperative Microphone Monitoring.

To emphasize the surgical importance of addressing dehiscence over diverticulum in resolving pulsatile tinnitus (PT) in patients with sigmoid sinus wall anomalies (SSWAs) and investigate anatomical differences. Retrospective data analysis. Multi-institutional tertiary university medical centers. Fifty participants (dehiscence/diverticulum, 29:21 cases) with SSWA-associated PT were included in the study. All 21 diverticulum participants underwent surgical intervention. 1) Surgical intervention with novel techniques monitored by intraoperative microphone. 2) Radiologic and ophthalmologic imaging methods. Quantitative and qualitative preoperative and postoperative alterations of PT and anatomical differences between dehiscence and diverticulum. Addressing dehiscence overlying diverticulum and sigmoid sinus wall dehiscences significantly reduced visual analog score and Tinnitus Handicap Inventory ( p < 0.01). Sinus wall reconstruction led to substantial PT sound intensity reduction in the frequency range of 20 to 1000 Hz and 20 to 500 Hz (paired-sample t test, p < 0.01). Diploic vein analysis showed a significant positive correlation in 85.7% of the diverticulum cohort compared with the dehiscence cohort ( p < 0.01). Eight percent of the participants exhibited papilledema, which was limited to the dehiscence cohort. 1) Effective reduction of PT can be achieved by addressing all dehiscences, including those overlying the diverticulum, without the need to exclude the diverticulum. 2) Diploic vein may involve in the formation of diverticulum, and loss of dura mater and vascular wall thickness are observed at the SSWA locations.

Cognitive functioning and psychosomatic syndromes in a subjective tinnitus sample.

Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and psychosomatic symptoms and the occurrence or maintenance of chronic tinnitus. This study aimed to detect the prevalence and role of psychosomatic conditions, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), and cognitive functioning in a group of patients with tinnitus. Sixty-two patients with subjective tinnitus and 62 non-tinnitus controls were recruited from the Otorhinolaryngology Unit of the University of Bari. Pure-tone audiometry was performed in all tinnitus subjects, and sound level tolerance was evaluated. Additionally, tinnitus handicap (Tinnitus Handicap Inventory [THI]), psychopathological symptoms (Symptom Checklist-90, Revised [SCL-90-R]), anxiety (State-Trait Anxiety Inventory [STAI-Y1/2]), depression (Beck Depression Inventory [BDI]), cognitive impairment (Mini-Mental State Examination [MMSE]), executive functions (Frontal Assessment Battery [FAB]), and psychosomatic syndromes (DCPR) were evaluated. Parametric and non-parametric tests were used to detect cognitive and symptomatological differences between patients and controls. The predictivity of these factors for tinnitus severity was studied using multiple regression (Backward Elimination). All tests were considered significant at p < 0.05 (family wise error corrected for each comparison). 69.4% tinnitus patients met multiple DCPR criteria, compared to 32.3% of controls. Tinnitus patients exhibited elevated rates of illness denial (ꭓ2 = 9.02; p < 0.009), demoralization (ꭓ2 = 8.05; p < 0.018), somatization (ꭓ2 = 4.92; p < 0.063) and functional symptoms (ꭓ2 = 5.21; p < 0.06) scoring significantly higher on the BDI, STAI-Y1, and STAI-Y2, and SCL-90-R compared to controls. Patients with tinnitus showed lower MMSE scores, compared to controls (t = -2.282; p < 0.001). No association between tinnitus severity and global cognitive impairment emerged. Conversely, executive function deficits were associated to tinnitus severity. Among the cognitive and psychological factors, only trait anxiety, one or more psychosomatic syndromes, and somatization clusters were strongly correlated with tinnitus severity. Our findings suggest a relationship between tinnitus severity, psychological, psychosomatic symptoms, and frontal impairment. Additionally, the influence of tinnitus on cognitive functions paves the way for integrated, multidisciplinary diagnostic and treatment options for patients. Although preliminary, our findings highlight the importance of early cognitive and psychological screening to improve patients' quality of life.

Cognitive Behavioral Therapy for Tinnitus: Outpatient-Based Treatment

Background and Objectives Cognitive behavioral therapy (CBT) is a treatment option for subjective tinnitus. There are many reports on its clinical efficacy, but the protocol has not been well established. The purpose of this study was to set an outpatient-based CBT protocol and evaluate its clinical efficacy for tinnitus.Subjects and Method A total of 85 chronic tinnitus patients was assessed in this prospective study. After evaluating for eligibility, 30 patients completed CBT based on a protocol of 5 weekly sessions in an outpatient setting. Therapeutic efficacy was assessed by Tinnitus Handicap Inventory (THI) questionnaires and visual analogue scale (VAS) for tinnitus. The initial scores were compared with the final scores, which were assessed a month after the fifth CBT session.Results The results showed that CBT reduced THI and VAS scores significantly (&lt;i&gt;p&lt;/i&gt;&lt;0.05).Conclusion The results of the study suggest that an outpatient-based CBT protocol can be clinically beneficial for patients with tinnitus.