Tinnitus Severity In Patients Research Articles

Development and Validation of a Nomogram to Predict the Risk of Tinnitus Severity in Patients With Unilateral Subjective Tinnitus.

Purpose: To develop and validate a nomogram for predicting the risk of tinnitus severity in patients with unilateral subjective tinnitus. Methods: The objective of this study was to establish and validate a nomogram specifically designed for patients with unilateral subjective tinnitus. We collected data on unilateral subjective tinnitus from the Air Force Medical Center, including 146 participants between January 2021 and June 2022. Risk factors for unilateral subjective tinnitus severity were evaluated by least absolute shrinkage and selection operator (LASSO) and binary logistic regression analysis. Internal verification was used to evaluate the performance of the nomogram. The discriminative ability was measured by the consistency index (C-indices) and the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. Results: All included patients were randomized according to a 7:3 ratio into the training cohort (104 patients) and the validation cohort (42 patients). The LASSO regression model identified sex, tinnitus loudness, and hearing loss as candidate variables. Binary logistic regression analysis showed that gender (OR: 0.76; 95% CI: 0.6-0.95; P = 0.021) and tinnitus loudness (OR: 1.37; 95% CI: 1.09-1.72; P = 0.009) were significant predictors of unilateral subjective tinnitus severity, while age, tinnitus matching frequency, and tinnitus duration were not. The significant predictors were included in the nomogram. Hearing loss was included in the nomogram based on prior clinical experience and previous studies. The training and validation cohorts C-indexes were 0.707 (95% CI: 0.607-0.806) and 0.706 (95% CI: 0.548-0.863), respectively. The training and validation cohort's AUC of the ROC curves were 0.692 and 0.705, respectively. Conclusion: We have developed and validated a nomogram based on gender, hearing loss, and tinnitus loudness, which can effectively predict the risk of tinnitus severity in patients with unilateral subjective tinnitus. The nomogram provides personalized prediction results for patients with unilateral subjective tinnitus, which is beneficial for clinical decision-making and treatment plan development.

A PhD completed. Positive effects for multidisciplinary orofacial treatment on tinnitus complaints

Tinnitus can be influenced by somatosensory input from the temporomandibular area and is then called somatic tinnitus. However, not much research has been conducted on whether orofacial treatment can decrease tinnitus severity in patients with somatic tinnitus. Therefore, the purpose of this thesis was 1) to evaluate the effect of orofacial treatment on tinnitus complaints, 2) to investigate potential prognostic indicators for a positive treatment outcome after orofacial therapy, and 3) to explore to what extent a decrease in temporomandibular disorder contributes to a reduction in tinnitus severity. In this thesis, it was found that orofacial therapy can reduce tinnitus severity in 61% of the patients with temporomandibular-related somatic tinnitus. Specifically, young female patients with a shorter duration of their tinnitus have the best prognosis. The analysis showed that 35% of the decrease of the tinnitus severity can be explained by the reduction in temporomandibular disorder.

Hypnotic suggestion for the treatment of tinnitus

Aim of study. Considering the high spreading of tinnitus in population, the purpose of our research was to study the possibility and expediency of using hypnosuggestive therapy in treatment of tinnitus. Material and methods. The study included 55 people with tinnitus complaints. We divided three groups of patients depending on the severity of the manifestations, audiometry results, Tinnitus Handicap Inventory (THI) score according to this scale of severity, results of GAD-7 test and the PHQ-9 (Patient Health Questionnaire -9). Results. In the first group of patients, according to the tinnitus severity scale the score was up to 19 points and was considered as insignificant and mild. The score of the GAD-7 questionnaire was less than 8 points, PHQ-9 - up to 5 points. In the second group the severity of tinnitus was moderate and severe and counted more than 38 points. The GAD-7 questionnaire score was less than 8 points, PHQ-9 - up to 5 points. In the third group, 12 people complained of chronic tinnitus, sleep disturbances, nervousness, and reduced work capacity. The score of tinnitus severity in patients of this group was more than 58 points and was assessed as severe and catastrophic. According to the results of the GAD-7 and PHQ-9 questionnaires, all 12 people were diagnosed with anxiety disorders and depression, two parients even had suicidal thoughts. In the third group of patients with +++ hypnotability, after ten sessions of individual hypno-suggestive therapy, it was possible to reduce the severity of tinnitus to the third moderate degree in 7 people. 4 patients reported about complete regress of tinnitus. Conclusions. Tinnitus is a common problem and can negatively affect work, family and social life. It requires the individual approach and involvement of specialists of various profiles in the diagnostic process. The diagnostic algorithm for patients with tinnitus should include questionnaires to estimate the psychosomatic profile. The use of hypno-suggestive therapy can significantly reduce the severity of tinnitus and improve the quality of lives of patients.

Analysis of tinnitus severity and associated factors in patients with chronic otitis media in a low- to middle-income country

Objective This study aimed to describe the tinnitus severity in patients with chronic otitis media (COM) and describe the sociodemographic and clinical variables associated with tinnitus severity. Design Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Sociodemographic, clinical associated factors and quality of life questionnaires were applied. Otoscopic evaluation and audiometric data were collected. Study sample About 231 adults with COM. Results Up to 51.5% of the patients reported severe tinnitus discomfort, 21.7% moderate discomfort, and 26.8% minor discomfort. Factor associated with increased tinnitus severity in patients with COM were older age (aOR: 1.02; 95% CI: 1.01–1.05), higher education (aOR: 2.24; 95% CI: 1.03–4.87), ear discharge during childhood (aOR: 1.88; 95% CI: 1.02–3.45), cholesteatoma in one ear (aOR: 2.26; 95% CI: 1.05–4.88), and pure-tone air average over 15 dB (aOR: 2.08; 95% CI: 1.28–3.36). Differences of 10-points in symptoms severity and 15-points in the total score of the “Chronic Suppurative Otitis Media Questionnaire-12” were found between the tinnitus severity groups. Conclusions Our results highlight the need for further research on the associated factors of tinnitus severity on COM patients. COM patients with higher tinnitus severity presented worse audiometric results and worse quality of life outcomes.

Cerebellar Gray Matter Volume in Tinnitus.

Tinnitus is the perception of sound without an external source. The flocculus (FL) and paraflocculus (PFL), which are small lobules of the cerebellum, have recently been implicated in its pathophysiology. In a previous study, the volume of the (P)FL-complex correlated with tinnitus severity in patients that had undergone cerebellopontine angle (CPA) tumor removal. In this study, the relation between tinnitus and gray matter volume (GMV) of the (P)FL-complex, GMV of the other cerebellar lobules and GMV of the cerebellar nuclei is investigated in otherwise healthy participants. Data was processed using the SUIT toolbox, which is dedicated to analysis of imaging data of the human cerebellum. GMV of all cerebellar lobules and nuclei were similar between tinnitus and non-tinnitus participants. Moreover, no relation was present between tinnitus severity, as measured by the Tinnitus Handicap Inventory, and (P)FL-complex GMV, tonsil GMV, or total cerebellar cortical GMV. These results suggest that in otherwise healthy participants, in contrast to participants after CPA tumor removal, no relation between the GMV of neither the (P)FL-complex nor other cerebellar lobules and tinnitus presence and severity exists. These findings indicate that a relation only exists when the (P)FL-complex is damaged, for instance by a CPA tumor. Alternatively, it is possible that differences in (P)FL-complex GMVs are too small to detect with a voxel-based morphometry study. Therefore, the role of the (P)FL-complex in tinnitus remains to be further studied.

Reduction of Somatic Tinnitus Severity is Mediated by Improvement of Temporomandibular Disorders.

Successful orofacial treatment can reduce tinnitus severity in patients with somatic tinnitus (ST). However, it is still unclear to what extent the degree of reduction in temporomandibular disorders (TMD) actually contributes to the decrease in tinnitus severity after orofacial treatment. Therefore, the aim of this study was to analyze the mediating effect of reduction in TMD pain on the improvement of tinnitus severity after multidisciplinary orofacial treatment. A total of 80 patients with moderate to severe ST attributed to the temporomandibular region, were recruited from a tertiary tinnitus clinic. At baseline, patients were randomly assigned to the orofacial treatment group or to the control group. Both groups received a minimum of information and advice regarding their tinnitus complaints. The orofacial treatment group received orofacial physical therapy complemented with occlusal splints when needed, while the control group received no other treatment. A mediation analysis was performed according to the steps described by Baron and Kenny and the proportion of the mediating effect was calculated for the potential mediator: "change in TMD pain," measured by a one-point decrease in TMD pain screener score. Our analysis showed that 35% of the observed decrease in tinnitus severity can be attributed to a reduction in TMD pain. A significant total effect of orofacial treatment compared with control on the change in tinnitus functional index (TFI) score was found (B = 0.253 p = 0.025 Cl for B = 1.265-18.576). Orofacial treatment was also significantly related to the change in TMD pain (Exp (B) = 2.800, p = 0.034 Cl for Exp B 1.081-7.251). Additionally, the change in TMD pain screener score was significantly related to the change in TFI score (B = -0.273 p = 0.016 Cl for B = -19.875 to -2.119). Reduction of TMD pain is a mediating factor in the decrease of tinnitus severity after multidisciplinary orofacial treatment. Orofacial treatment can be used to decrease tinnitus severity in patients with TMD related somatic tinnitus.

Analysis of tinnitus severity and associated risk factors in patients with chronic otitis media: data from the multinational collaborative Chronic Otitis Media Questionnaire-12 study.

Subjective tinnitus is a common symptom, and there is often an underlying otological cause. This study investigated the degree of tinnitus-related annoyance in patients with chronic otitis media and analysed whether associations with tinnitus severity exist. The multinational collaborative Chronic Otitis Media Questionnaire-12 study collected prospective data on 478 adult patients suffering from chronic otitis media across 9 otology referral centres in 8 countries. Based on this dataset, we investigated tinnitus severity using participant responses to item 7 of a native version of the Chronic Otitis Media Questionnaire-12. With respect to tinnitus severity, 23.8 per cent, 17.4 per cent, 15.5 per cent, and 43.4 per cent of participants reported no, minor, moderate, and major inconvenience or greater, respectively. The absence of ear discharge, absence of cholesteatoma, and poorer disease-specific health-related quality-of-life were associated with increased tinnitus severity in patients with chronic otitis media, whereas age, hearing disability and geographical region showed no association. This analysis provided novel insight into potential risk factors for tinnitus in patients with chronic otitis media.

A comparison of the severity of tinnitus in patients with and without hearing loss using the tinnitus functional index (TFI)

Objective The objective of this study was to compare the severity of tinnitus in tinnitus patients with and without hearing loss. Design and study sample 73 tinnitus patients were included in this study at an audiology clinic in Amman, Jordan. Participants were assigned to two groups according to their hearing status. The severity of tinnitus was evaluated using the Tinnitus Functional Index questionnaire. All participants were interviewed, followed by an otoscopic examination, pure tone audiometry, and tests for admittance and tinnitus matching. Results The normal hearing group included 34 participants (46.6%) whose TFI scores were divided as follows: mild annoyance (17), significant annoyance (14), and severe annoyance (3). The sensorineural loss group included 39 participants (53.4%) with mild annoyance (11), significant annoyance (12), and severe annoyance (16). A statistically significant association was found between hearing status and the severity of tinnitus using a Chi-Squared test (x2 = 0.487, p = 0.007). There was no association between tinnitus severity and age or gender. Conclusion Tinnitus severity was significantly worse in tinnitus patients with a hearing loss than tinnitus patients with normal hearing thresholds. This should be taken into consideration when clinicians are planning counselling and management protocols for individual patients.

Treatment of Somatosensory Tinnitus: A Randomized Controlled Trial Studying the Effect of Orofacial Treatment as Part of a Multidisciplinary Program.

Background: Tinnitus, or ringing in the ears, is a perception of sound in the absence of overt acoustic stimulation. In some cases, tinnitus can be influenced by temporomandibular somatosensory input, then called temporomandibular somatosensory tinnitus (TST). It is, however, not entirely known if orofacial treatment can decrease tinnitus severity. The purpose of this study was to evaluate the effect of orofacial treatment on tinnitus complaints in patients with TST. Methods: Adult patients with TST were included, and all patients received information and advice about tinnitus and conservative orofacial treatment consisting of physical therapy, and, in case of grinding, occlusal splints were applied. Included patients were randomly assigned to an early start group and a delayed start group according to our delayed treatment design. Results: In total, 40 patients were included in each group. The treatment effect on tinnitus severity was investigated using the tinnitus questionnaire (TQ) and Tinnitus Functional Index (TFI). Regarding the TQ score, no clinically relevant reductions were observed, and no significant differences in the decrease were observed between the early start group and delayed start group. Contrarily, a significantly higher percentage of patients showed a decrease in the TQ degree in the early start group compared to the delayed start group (30.0% versus 2.8%, p = 0.006). The TFI score did show a significantly greater and clinically relevant reduction in the early start group compared to the delayed start group (p = 0.042). Conclusion: A multidisciplinary non-invasive orofacial treatment was able to reduce tinnitus severity in patients with temporomandibular related somatosensory tinnitus.

The use of distortion product otoacoustic emissions (DPOAE) records to estimate effect of vitamin B complex on changing severity of tinnitus.

IntroductionPatients that are complaining from tinnitus but have normal hearing comprise an uncommon group and there is rare literature about them. Deficiency in B-complex vitamins has been shown to result in tinnitus and supplementation may improve the symptom which means manipulation of cochlear status. Distortion Product Otoacoustic emissions (DPOAEs) used frequently to assess cochlear status.ObjectivesThe uses of DPOAE changing amplitude as a parameter to estimate effect of vitamin B complex on changing the severity of tinnitus in patients with tinnitus only in comparison to patients have tinnitus with Sensory Neural Hearing Loss (SNHL) and a control group.MethodsProspective observational cohort study was performed in AL-Karama Teaching Hospital as a secondary medical care center, from 01/01/2012 to 31/12/2016. A three groups had been evaluated clinically and by OAE device (ECHOLAB) to study the DPOAE changing amplitude before and after one month of supplementation of B-complex vitamins to 25 patients in study group (1) have (tinnitus only) and also to 25 patients in study group (2) have (Tinnitus + SNHL) but leaving control group who were a 25 medical staff (No Tinnitus and nor SNHL) without treatment.ResultsIt has been found that among Study group 1 (patients had Tinnitus only), Study group 2 (patients had Tinnitus + SNHL) and the control group: 16 patients (44%), P-value = 0.000 HS; 28 patients (78%) P-value = 0.000 HS; and 0% respectively, they had low Amplitude of DPOAE recorded by OAE device (ECHOLAB). After one month from treatment with Neurobine ampules for study group 1& 2 but not control group (whom receive no treatment), those who got clinical improvement + increase Amplitude of DPOAE (i.e. subjective + objective changes) after treatment were 10 patients (28%) P-value = 0.000 HS in study group1, and two patients (5%) P-value 0.321 NS in study group 2, and there was no changes (zero) among control group.ConclusionsThe uses of DPOAE changing amplitude could be used as a parameter to estimate effect of vitamin B complex on changing the severity of Tinnitus in patients with tinnitus only or those have Tinnitus with SNHL. The supplementation of vitamin B complex could improve the tinnitus severity especially in patients with tinnitus without SNHL.

Is Presence of Vascular Loop in Magnetic Resonance Imaging Always Related to Tinnitus?

One of the most common otological complaints is tinnitus in adults. When there is a complaint of unilateral tinnitus and retrocochlear pathology is suspected, imaging methods are applied. However, the imaging findings obtained may not always be compatible with the severity and localization of the tinnitus. The aim of the present study was to determine whether or not there was a significant correlation between the findings on magnetic resonance imaging (MRI) and the presence and severity of tinnitus in patients with the complaint of unilateral tinnitus. The study included 44 patients with no loss of hearing who presented with the complaint of unilateral tinnitus. The relationship between tinnitus severity and vascular loop presence was investigated. Various types of vascular loop were determined in 14 patients. No statistically significant relationship was determined between the presence of vascular loop and the Tinnitus Handicap Inventory scores. The results of this study showed no significant difference in respect of the presence of vascular loop on the MRI findings of symptomatic and healthy ears. The presence of vascular loop on MRI is not always a pathological event and should be considered only as an examination finding that could be an anatomic 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.

Psychometric Evaluation of Visual Analog Scale for the Assessment of Chronic Tinnitus

The development of therapeutic interventions for chronic tinnitus requires sensitive and clinically responsive tools to measure treatment-induced changes in tinnitus loudness and annoyance. In this study, the authors evaluated the psychometric properties of patient-reported visual analog scales (VAS) for measuring subjectively perceived tinnitus loudness and annoyance. The authors analyzed data from a single-blind, randomized, placebo-controlled study of acoustic coordinated reset (CR) neuromodulation in patients with chronic tinnitus (trial registration: "Randomized Evaluation of Sound Evoked Treatment of Tinnitus [RESET] study"; ClinicalTrials.gov identifier: NCT00927121) to assess the reliability, validity, and minimally clinically identifiable difference (MCID) of the VAS loudness and VAS annoyance. The VAS loudness and VAS annoyance were completed at screening, at baseline, and at 5 visits during the 16 weeks of the clinical study. Data were analyzed with respect to test-retest reliability, validity, and MCID. VAS loudness and VAS annoyance showed good test-retest reliability of .8 and .79, respectively. In terms of convergent validity, VAS loudness and VAS annoyance correlated well with the tinnitus questionnaire at all clinical visits (max r = .67, p < .05). MCID estimates clustered between 10 and 15 points. VAS loudness and VAS annoyance are valid and effective measurements for capturing reductions in tinnitus severity in patients with chronic tinnitus.

Clinical associations between tinnitus and chronic pain

We sought to estimate the prevalence and severity of tinnitus in patients with chronic pain. We conducted a prospective nonrandomized study in which a survey and the Tinnitus Handicap Inventory (THI) were distributed at a tertiary chronic pain clinic. Seventy-two patients participated. 50 women (mean age, 53 years) and 22 men (mean age, 47.5 years); 54.2% reported having tinnitus. There was an even distribution of patients reporting the onset of tinnitus as before versus after the onset of pain. Four patients reported a direct association between tinnitus and pain. The mean THI score was 27 (of 100) (n = 35). Fifteen subjects scored less than 16, indicating no handicap, and 4 scored over 58, indicating a severe handicap. The study results suggest a high incidence of tinnitus within this population. There were few strong associations between pain and tinnitus. Tinnitus does not significantly handicap the majority of these patients. Tinnitus is a common symptom in the chronic pain population but is not a significant problem for these patients.

Clinical associations between tinnitus and chronic pain.

We sought to estimate the prevalence and severity of tinnitus in patients with chronic pain. We conducted a prospective nonrandomized study in which a survey and the Tinnitus Handicap Inventory (THI) were distributed at a tertiary chronic pain clinic. Seventy-two patients participated. 50 women (mean age, 53 years) and 22 men (mean age, 47.5 years); 54.2% reported having tinnitus. There was an even distribution of patients reporting the onset of tinnitus as before versus after the onset of pain. Four patients reported a direct association between tinnitus and pain. The mean THI score was 27 (of 100) (n = 35). Fifteen subjects scored less than 16, indicating no handicap, and 4 scored over 58, indicating a severe handicap. The study results suggest a high incidence of tinnitus within this population. There were few strong associations between pain and tinnitus. Tinnitus does not significantly handicap the majority of these patients. Tinnitus is a common symptom in the chronic pain population but is not a significant problem for these patients.