Tinnitus Severity Index 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.

Impact of SARS-Cov-2 Virus and The Pandemic on Tinnitus Patients: A Comparative Cross-sectional Study

The WHO declared Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) a "Public Health Emergency" before the end of January 2020. Over 6M people have died out of 593 million recorded cases. Objective: To determine the effect of the COVID-19 and the pandemic on tinnitus patients. Methods: Comparative Cross-sectional study was conducted at Mayo Hospital, Lahore. Total 110 patients with tinnitus were included in this study using convenience sampling. Sample included both genders, aged 17 and above with Group A including patients who were inflicted from SARS-COV-2 and group B who did not encounter the virus. Tinnitus Severity Index and a questionnaire was used for data collection. A relationship between the tinnitus severity scale scores obtained before suffering from the coronavirus and after suffering from it. Similarly, a relationship between tinnitus severity scale scores obtained before the occurrence of pandemic and after it, was determined in COVID-19 negative group. T-test, Chi-square and ANOVA statistics were utilized to determine difference between groups with p&lt;0.05 considered significant. Results: Tinnitus was significantly (p=0.000) more bothersome during pandemic compared to before COVID-19 became pandemic, however having COVID-19 infection or not before (p=0.067) and during (p=0.234) pandemic did not reveal significant difference. TSI scores were higher in patients who picked COVID-19 infection compared to living in pandemic though not significant (p=0.375), however there was differences in characteristics of tinnitus. Conclusions: COVID-19 pandemic has produced a significant impact on tinnitus patients with more impact resulting from COVID-19 infection compared to pandemic itself, however this was not significant.

Correlation of Tinnitus Severity Index and Tinnitus Handicap Inventory with Hematological Parameters in Patients with Subjective Tinnitus.

Introduction Tinnitus etiopathogenesis is still unclear and treatment options are controversial despite current advances in medicine. Objectives To analyze the correlation between patients' symptom scores, systemic inflammation, and trombosis biomarkers. Methods In this prospective study, we evaluated the degree of complaints of subjective tinnitus patients with the tinnitus severity index (TSI) and tinnitus handicap inventory (THI), and correlated these symptom scores with hematological parameters such as the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean thrombocyte volume (MPV), and platelet distribution width (PDW). Results A total of 44 patients with subjective tinnitus, 25 (56.8%) men and 19 (43.2%) women, were included in this study. The mean age of the patients was 42.3 ± 14.8 years. When the correlation between TSI and NLR, PLR, PDW, and MPV values of the patients were analyzed, no statistically significant correlation was found between TSI, NLR, and PLR ( p > 0.05). However, there was a statistically weak positive correlation between TSI, MPV, and PDW.( p < 0.05). When the correlation between THI and NLR, PLR, PDW, and MPV values of the patients were analyzed, no statistically significant correlation was found between THI, NLR, and PLR ( p > 0.05). There was a statistically weak positive correlation between THI, MPV, and PDW ( p < 0.05). Conclusion We were unable to detect any relationship between systemic inflammation markers (NLR and PLR) and symptom scores, but a weakly positive correlation was observed between thrombosis markers (MPV and PDW) and symptom scores, and as the subclinical thrombosis markers elevated, so did the symptom scores.

Association of Vitamin D Deficiency in Patients with Tinnitus with Normal Audiogram.

In the present study we aim to evaluate serum vitamin D levels in participants having tinnitus with normal audiometric findings. Total 98 participants in the age range 20-70 year were included in the study. Participants underwent detail case history, ear examination, pure tone audiometry and impedance audiometry. 68 participants with subjective tinnitus for more than 3 months and with normal audiometric thresholds and "A" type tympanogram were included in study group and 30 participants without tinnitus in the control group. The participants fullfillng the inclusion criteria underwent thorough tinnitus evaluation which included administration of tinnitus severity index tinnitus handicap inventory, psychophysical evaluation of tinnitus (pitch matching, loudness matching) and assessment of Vitamin D levels. It was seen that the mean Vitamin D levels were significantly lower in study group, and out of 68 participants only 11 had optimal Vitamin D levels, 57 (83%) had Vitamin D levels less that 30mg/dl. In the control group 20 (66%) had vitamin D deficiency. The difference came out to be statistically significant. Our study suggests that there is a link between vitamin D and tinnitus, in view of these findings we recommend evaluating serum Vitamin D levels in patients of chronic idiopathic tinnitus, especially in adults with normal hearing. Our study suggests vitamin D deficiency may be one of the risk factor for tinnitus in people with normal hearing in the absence of other manifestations.

Estimation of Tinnitus-Related Socioeconomic Costs in Germany.

Despite the high prevalence of tinnitus in Germany of nearly 12% of the general population, there have been no systematic studies on the socioeconomic costs for German society caused by tinnitus so far. Here we analyzed data from 258 chronic tinnitus patients—namely tinnitus severity and health utility index (HUI)—and correlated them with their tinnitus-related public health care costs, private expenses, and economic loss due to their tinnitus percept as assessed by questionnaires. We found correlations of the HUI with health care costs and calculated the mean socioeconomic costs per tinnitus patient in Germany. According to our most conservative estimate, these sum up to EUR 4798.91 per year. Of that EUR 2206.95 account for the public health care, EUR 290.45 are carried by the patient privately and the remaining EUR 2301.51 account for economical loss due to sick leave. With a prevalence of 5.5% with at least bothersome tinnitus, this sums up to 21.9 billion Euro per year and with 25.82 sick leave days; tinnitus patients miss work more than double the time of the average German employee (10.9 days). The findings fit within the cost ranges of studies from other European countries and the USA and show that the socioeconomic burden of this disease-like symptom is a global problem. In comparison with the costs of other major chronic diseases in Germany—such as chronic obstructive pulmonary diseases (ca. 16 billion Euro) or diabetes mellitus (ca. 42 billion Euro)—the relevance of the ‘symptom’ tinnitus for the German social economy becomes even more obvious.

Amplification Strategies to Reduce Tinnitus: A Paired Comparison Method.

Background : The study investigates the best amplification strategy that provides tinnitus relief in a quiet environment, for individuals with sensorineural hearing loss with bothersome tinnitus.Methods: The repeated measures research design was utilized. Twenty participants (age range 25 years to 65 years; mean: 48.28 years) with bilateral symmetrical sloping sensorineural hearing loss with bothersome unilateral tinnitus were recruited. They were sub-grouped into low- and high-pitched tinnitus groups. A preference score was obtained for each of the strategies in hearing aid fitting, using the paired comparison method. The 4 strategies used were the desired sensation level (input/output) and the National Acoustic Laboratories’ nonlinear fitting method (version 1), at each of the low (30 dB SPL) and high (50 dB SPL) compression thresholds. Besides, the severity of tinnitus was assessed using the tinnitus severity index before and after 1 month of using the hearing aid in the best-selected strategy. Results: A repeated-measure ANOVA revealed no significant effect of the group on the preference score but was significant for strategies on relief from tinnitus. The desired sensation level (input/output) at a low compression threshold was the best strategy for alleviating tinnitus. Thirty-five percent of the study participants preferred the desired sensation level (input/output) strategy at low and high compression threshold, respectively. The remaining 25% preferred the National Acoustic Laboratories’ nonlinear hearing aid (version 1) at low compression threshold, and 5% selected the same device at high compression threshold. Furthermore, a significant association was observed in the severity of tinnitus before and after the hearing aid fitting set at the preferred program. Conclusion: The desired sensation level (input/output) method at the low compression threshold is the best program to alleviate bothersome tinnitus.

Effect of acupuncture on tinnitus severity index in the elderly with non-pulsating tinnitus

IntroductionIdiopathic subjective non-pulsating tinnitus (ISNPT) is a frustrating diagnosis to physicians owing to the limited effectiveness of traditional pharmacological approaches. This study aimed to investigate the effect of acupuncture on quality of life in elderly people with ISNPT.MethodsOverall, 40 patients of both sexes with ISNPT lasting for &gt; 3 consecutive months and aged 65 years participated in this study. They were assigned into the study and the control groups, 20 patients each. The study group received the prescribed medications in addition to manual acupuncture on the following acupoints: SJ 3, SJ 5, SJ 17, SJ 18, SJ 19, SJ 20, SJ 21, SJ 22, GB 2, GB 8, GB 20, LI 4, KI 3, and ST 36, for 30 minutes, 3 times/week for 4 weeks, while the control group received their prescribed medications only. All participants in both groups were assessed with the visual analogue score of tinnitus loudness (VASTL) and tinnitus severity index (TSI).ResultsNo statistically significant changes were reported in VASTL or TSI in the control group, while in the study group, VASTL showed a high statistically significant decrease from 8.27 ± 1.45 to 3.20 ± 1.36 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and TSI revealed a decrease from 44.30 ± 3.40 to 27.95 ± 4.18 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001).ConclusionsAcupuncture is a good adjunctive complementary therapy to ISNPT in the elderly.

Проблемно-ориентированный личностный тип у пациентов с шумом в ушах: специфика и практическая значимость в диагностике

The article presents the results of an empirical study of personality characteristics of the presence or absence of a problem-oriented personality type in 55 patients with (average age 49.6±11.2 years, 60% of men and 40% of women) and without (average age 48.5±12.2 years; 55% of men and 45% of women) subjective idiopathic tinnitus. The use of the Tinnitus Severity Index (TSI), the type-D Scale (DS-14), the Eysenck Personality Questionnaire (EPQ) and the Emotional stability assessment subscale from the Five-Factor Personality Inventory (FFPI) made it possible for the first time to describe the affective style of patients with tinnitus. Compared to people without tinnitus, patients with tinnitus have statistically and clinically significant higher levels of neuroticism, negative affectivity and social inhibition (isolation), on the one hand, and lower levels of extraversion and emotional stability, on the other hand. Patients with tinnitus and severe tinnitus distress are more likely to have a problem-oriented personality type, a problem-oriented personality type is associated with the presence of tinnitus and contributes to its perceived severity. Negative affectivity, as one of the dimensions of a problem-oriented personality type, has an adverse effect on the severity of tinnitus, and is a risk factor for tinnitus distress. In this regard, the article provides practical recommendations for the psychological examination of patients with tinnitus and the tactics of cognitive behavioral therapy.

Investigating the efficacy of fluoxetine vs. fluoxetine plus alprazolam (single therapy vs. combination therapy) in treatment of chronic tinnitus: A placebo-controlled study

ObjectiveTo investigate the effect of combination therapy (fluoxetine + alprazolam) and fluoxetine alone in treatment of tinnitus. Material and methods147 participants with chronic tinnitus were divided into three groups (fluoxetine, fluoxetine+ alprazolam, and placebo). Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), Tinnitus Severity Index (TSI), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) used to assess tinnitus. Effect size according to partial Eta square calculated and level of significance was considered as P < 0.05. ResultsFluoxetine reduced VAS, THI, BDI, and increased BAI. The combination therapy significantly reduced VAS, THI, BAI, and BDI. None of them reduced the TSI. The effect size for BAI and BDI were 0.135 (medium) and 0.075 (small), respectively. There was no significant difference between combination and single-drug therapy. ConclusionBoth groups improved THI and VAS. Combination therapy was not significantly different from single-drug treatment. Combination therapy can be considered only according to the psychiatric needs of patients.

Perception of Tinnitus Handicap And Stress Across Age Groups in Normal Hearing.

This research was conducted to investigate the severity of tinnitus, its impact on subject's daily, personal and emotional life, which varies widely across the age groups. Sample population of 60 unilateral tinnitus subjects with normal hearing between the age ranges of 15-55years were divided into four age groups. Tinnitus severity was measured using tinnitus severity index, impact of tinnitus on daily life was documented through tinnitus handicap inventory and the stress levels through perceived stress scale. A high frequency tinnitus was observed in age group of 56-65years, in contrast to noise like tinnitus in subjects aged 15-25years. The tinnitus was found to be most handicapping (38-56; moderate handicap) in Group 4(56-65years), the perceived stress levels were also falling in very high range (21 and over). Tinnitus severity index did not show any significant difference between the Group 1:15-25yrs, Group 2: 26-40yrs, Group 3:41-55yrs, and however group 4(56-65 yrs) did report with mild severity. The outcomes of present study demonstrated that elderly subjects certainly require modifications in the test protocols and referrals to address to their significant responses to tinnitus.

The Role of Manganese, Cadmium, Chromium and Selenium on Subjective Tinnitus.

Elevated levels of heavy metals like cadmium (Cd) and manganese (Mn) are known to lead to oxidative damage-related oto-toxicity and decreased levels of chromium (Cr) and selenium (Se) are known to lead to oto-toxicity due to reduced anti-oxidant activity. The aim of the present study was to evaluate serum levels of Cd, Mn, Cr, and Se and their relationship with tinnitus. A total of 48 patients with tinnitus (Group 1) and 40 healthy controls (Group 2) were included in the study. All participants were applied audiology tests. Severity of tinnitus was measured with Tinnitus Severity Index Questionnaire (TSIQ) in group 1. Serum Mn, Cd, Cr, and Se measurements were done by using The Agilent ICP-MS system consisted of a 7700 coupled plasma mass spectrometry (ICP-MS). Serum Cd, Mn, and Cr levels were higher in group 1 and Se level was lower in group 1 than that of group 2. We may conclude that Cd, Mn, Cr, and Se levels could play an important role in etio-pathogenesis of tinnitus, and thereby supplementation or reduction of these elements could be considered as novel therapeutic goals.

Acupuncture for tinnitus: a systematic review and meta-analysis of randomized controlled trials.

To evaluate the efficacy/effectiveness of acupuncture for the treatment of tinnitus. Four English and four Chinese databases were searched for randomized controlled trials (RCTs) of acupuncture for tinnitus published before 30 September 2018. RCTs applying acupuncture alone compared with conventional treatments, sham acupuncture, or no treatment, as well as acupuncture plus conventional treatments compared with conventional treatments alone, were included. The primary outcome was the visual analogue scale (VAS). Secondary outcomes included tinnitus handicap inventory (THI) and tinnitus severity index (TSI) scores. Meta-analysis was conducted using RevMan V5.3 software. The protocol was registered in the PROSPERO database (ref. CRD42018108692). Eight studies involving 504 participants were included. Meta-analysis showed no significant differences in the VAS score (mean difference (MD) = -1.81, 95% confidence interval (CI) = -3.69 to 0.07; p = 0.06) between the acupuncture and control groups. However, favorable effects of acupuncture on changes in THI score (MD = -10.11, 95% CI = -12.74 to -7.48; p < 0.001) and TSI score (MD = -8.36, 95% CI = -8.87 to -7.86; p < 0.001) were found. Acupuncture had no significant effect on the primary outcome of VAS score compared with control treatment; however, positive effects on secondary outcomes (THI and TSI score) were observed in acupuncture versus control groups. Due to the low quality and small sample size of the included trials, the level of evidence was insufficient to draw any definitive conclusions. Further rigorous and high-quality studies with larger sample sizes should be conducted to confirm the efficacy/effectiveness of acupuncture for tinnitus.

Anxiety sensitivities, anxiety and depression levels, and personality traits of patients with chronic subjective tinnitus: a case-control study

Objectives: Tinnitus is a condition that commonly affects individuals’ daily activities. We aimed to evaluate the anxiety sensitivity, levels of anxiety and depression, and personality traits of patients with chronic subjective tinnitus.Methods: The study included 42 patients, who visited the Otorhinolaryngology Clinic, complained of having tinnitus for at least 1 year and did not have any previous peripheral vestibular diseases or psychiatric treatment history. Forty-five healthy individuals volunteered to be in the control group. We administered the Tinnitus-Severity-Index (TSI), Anxiety-Sensitivity-Index-3 (ASI-3), Beck-Anxiety Inventory (BAI), Beck-Depression-Inventory (BDI) and Eysenck-Personality- Questionnaire (EPQ) to the study participants.Results: The BDI score was significantly higher in the patient group. The ASI-3, EPQ, and BAI scores of the patients did not differ statistically. A positive correlation was found between the EPQ neuroticism subscale scores and the ASI-3, BDI, and BAI scores of the patient cases. There was also a positive correlation between the TSI scores and the BAI, ASI-3, and neuroticism scores of the tinnitus group.Conclusion: To the best of our knowledge, few studies have evaluated anxiety sensitivity, anxiety and depression levels, and personality traits and no studies evaluating patients and controls together. In cases where tinnitus and psychiatric diseases are comorbid, both conditions should be treated to achieve the best outcomes for the patients’ quality of life.KEY POINTSAlthough patients with tinnitus were selected among cases without any psychiatric treatment history, we found that depressive symptoms in this group were high.The participants’ anxiety sensitivity, anxiety, and neuroticism scores increased as the severity of their tinnitus increased.The anxiety sensitivity, anxiety, and depressive scores increased along with the increase in the neuroticism scores of the patients with chronic subjective tinnitus.

Effect of statins on hearing function and subjective tinnitus in hyperlipidemic patients.

It is known that hyperlipidemia reduces hearing functions. In this study, we aimed to study the effect of antihyperlipidemic drugs on hearing functions and tinnitus. Eighty-four patients aged 18 to 84, who were diagnosed with hyperlipidemia and started treatment with the statin group (atorvastatin 20 mg and 40 mg, rosuvastatin 10 mg and 20 mg, and simvastatin 20 mg) of antihyperlipidemic drugs, were included in this study. All patients underwent pure-tone audiometry before starting treatment with antihyperlipidemic drugs. Patients with tinnitus were evaluated by Tinnitus Severity Index and Visual Analogue Scale. In the 6th month of therapy, otologic examination, pure-tone audiometry and tinnitus evaluation of the patients were repeated. No significant difference was found in the pure-tone averages of the patients before and after statin use (p > 0.05). However, it was found in the audiometry that, after statin use, all drugs caused to statistically significant decrease in the hearing thresholds at 6000 Hertz (p < 0.05). Also, a strong increase was found in the Speech Discrimination percentages after treatment in patients using rosuvastatin 10 mg (p = 0.022). A significant decrease was found in the tinnitus frequency, duration, severity and degree of annoyance in patients using rosuvastatin 10 mg and 20 mg (p < 0.05). Statin group of drugs can have a positive effect on the hearing functions and subjective tinnitus. In particular, it is seen that rosuvastatin group of statins has a more notable effect on tinnitus. It was considered that further studies with larger patient groups are needed.

Is tinnitus a major concern in individuals with auditory neuropathy spectrum disorder? - Questionnaire based study.

ObjectiveOur study attempted to determine if tinnitus is a major concern in individuals with auditory neuropathy spectrum disorder (ANSD). The study also attempted to determine if pure tone average (PTA), speech identification scores (SIS), or reported duration of hearing loss could predict the tinnitus severity and functional handicap in adults with ANSD.MethodsTinnitus functional index (TFI) and tinnitus severity index (TSI) were administered on all the 40 participants diagnosed with ANSD.ResultsThe mean TFI score was 44.3, which suggested moderate degree of tinnitus related functional impairment. The mean TSI score was found to be 33.3, which suggested moderate degree of severity in individuals with ANSD. The study also showed that tinnitus causes functional impairment that leading to sleep disturbances, emotional problems, and affecting the quality of life. There was no significant correlation (P > 0.05) between PTA, SIS, reported onset of hearing loss and scores of TFI or TSI.ConclusionTinnitus in individuals with ANSD should also be given priority during assessment and provide appropriate tinnitus management.

Betahistine for tinnitus.

Tinnitus is a symptom defined as the perception of sound in the absence of an external source. In England alone there are an estimated ¾ million general practice consultations every year where the primary complaint is tinnitus, equating to a major burden on healthcare services. Clinical management strategies include education and advice, relaxation therapy, tinnitus retraining therapy, cognitive behavioural therapy, sound enrichment using ear-level sound generators or hearing aids, and drug therapies to manage co-morbid symptoms such as sleep difficulties, anxiety or depression. As yet, no drug has been approved for tinnitus by a regulatory body. Nonetheless, over 100,000 prescriptions for betahistine are being filled every month in England, and nearly 10% of general practitioners prescribe betahistine for tinnitus. To assess the effects of betahistine in patients with subjective idiopathic tinnitus. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL, via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 July 2018. Randomised controlled trials (RCTs) recruiting patients of any age with acute or chronic subjective idiopathic tinnitus were included. We included studies where the intervention involved betahistine and this was compared to placebo, no intervention or education and information. We included all courses of betahistine, regardless of dose regimens or formulations and for any duration of treatment. We used the standard methodological procedures expected by Cochrane. Our primary outcomes included tinnitus loudness and significant adverse effects (upper gastrointestinal discomfort). Our secondary outcomes included tinnitus symptom severity as measured by the global score on a multi-item tinnitus questionnaire, depressive symptoms, symptoms of generalised anxiety, health-related quality of life, other adverse effects (e.g. headache, drowsiness, allergic skin reactions (pruritis, rashes) and exacerbation of tinnitus) and tinnitus intrusiveness. We used GRADE to assess the quality of evidence for each outcome; this is indicated in italics. This review included five studies (with a total of 303 to 305 participants) comparing the effects of betahistine with placebo in adults with subjective idiopathic tinnitus. Four studies were parallel-group RCTs and one had a cross-over design. The risk of bias was unclear in all of the included studies.Due to heterogeneity in the outcomes measured and measurement methods used, very limited data pooling was possible. When we pooled the data from two studies for the primary outcome tinnitus loudness, the mean difference on a 0- to 10-point visual analogue scale at one-month follow-up was not significant between betahistine and placebo (-0.16, 95% confidence interval (CI) -1.01 to 0.70; 81 participants) (very low-quality evidence). There were no reports of upper gastrointestinal discomfort (significant adverse effect) in any study.As a secondary outcome, one study found no difference in the change in the Tinnitus Severity Index between betahistine and placebo (mean difference at 12 weeks 0.02, 95% CI -1.05 to 1.09; 50 participants) (moderate-quality evidence). None of the studies reported the other secondary outcomes of changes in depressive symptoms or depression, anxiety symptoms or generalised anxiety, or health-related quality of life as measured by a validated instrument, nor tinnitus intrusiveness.Other adverse effects that were reported were not treatment-related. There is an absence of evidence to suggest that betahistine has an effect on subjective idiopathic tinnitus when compared to placebo. The evidence suggests that betahistine is generally well tolerated with a similar risk of adverse effects to placebo treatments. The quality of evidence for the reported outcomes, using GRADE, ranged from moderate to very low.If future research into the effectiveness of betahistine in patients with tinnitus is felt to be warranted, it should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the development of validated, patient-centred outcome measures for research in the field of tinnitus.

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus

ABSTRACTObjectives: Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus.Methods: This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.Results: Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1–5).Conclusion: This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.

Acupuncture for chronic nonpulsatile tinnitus: A randomized clinical trial.

Background:There is challenge to find an effective treatment for tinnitus. Few studies were done on the effects of acupuncture on tinnitus. This study evaluated the effect of acupuncture on chronic non-pulsatile tinnitus.Methods:This randomized double-blind clinical trial was conducted from December 2014 to September 2015. Patients suffering from chronic non-pulsatile tinnitus were randomly allocated into two groups: acupuncture vs. placebo. They were treated in 15 sessions and at the end of the fifteenth sessions and 3 weeks after completion of the treatment, visual analog scale (VAS) for tinnitus loudness and tinnitus severity index (TSI) questionnaires were completed.Results:The case group included 26 males and 18 females, and in the control group there were 27 males and 17 females: with mean age of 49.11±1.07 and 55.20±8.33 years, respectively (p=0.005). TSI and VAS before treatment were 43.84±2.81 and 9.56±0.43 in cases and 43.52±2.94 and 9.54±0.45 in controls, respectively. Both measures improved after 15 sessions in cases to 24.82±1.04 and 2.88±0.33, and to 33.16±1.24 and 7.86±0.23 in controls. The changes of TSI and VAS were significant in all groups (p<0.001). TSI and VAS in acupuncture group were lower than placebo group in each session (p<0.001), except TSI in the tenth session (p=0.392).Conclusions:Acupuncture is effective in reducing the loudness and severity of tinnitus and can be a useful treatment for nonpulsatile chronic tinnitus.

Relationship between serum magnesium level and subjective tinnitus.

This study aims to assess the relationship between serum magnesium level and bilateral subjective tinnitus. The study included a total of 76 patients (36 males, 40 females; mean age 48.5±6.5 years; range 43 to 65 years) suffering from severe bilateral subjective tinnitus (accepted as severe and catastrophic according to tinnitus severity index) as the study group and 86 healthy participants (42 males, 44 females; mean age 43.8±7.3 years; range 40 to 61 years) as the control group. Serum magnesium levels of both groups were measured and compared statistically. The serum magnesium concentration was significantly lower in the study group compared to the control group (1.8±0.2 vs. 2.3±0.4 mg/dL, p=0.03). The significant association between serum magnesium level and tinnitus shows the importance of magnesium in the pathophysiology of subjective tinnitus.

Therapeutic role of Vitamin B12 in patients of chronic tinnitus: A pilot study.

True tinnitus is a phantom auditory perception arising from a source or trigger in the cochlea, brainstem, or at higher centers and has no detectable acoustic generator. The most accepted is the famous neurophysiologic model of Jastreboff, which stresses that tinnitus, is a subcortical perception and results from the processing of weak neural activity in the periphery. The aim of this study is to determine the role of Vitamin B12 in treatment of chronic tinnitus. In this randomized, double-blind pilot study, total 40 patients were enrolled, of which 20 in Group A (cases) received intramuscular therapy of 1 ml Vitamin B12 (2500 mcg) weekly for a period of 6 weeks and Group B (20) patients received placebo isotonic saline 01 ml intramuscular. The patients were subjected to Vitamin B12 assay and audiometry pre- and post-therapy. Of the total patients of tinnitus, 17 were Vitamin B12 deficient that is 42.5% showed deficiency when the normal levels were considered to be 250 pg/ml. A paired t-test showed that in Group A, patients with Vitamin B12 deficiency showed significant improvement in mean tinnitus severity index score and visual analog scale (VAS) after Vitamin B12 therapy. This pilot study highlights the significant prevalence of Vitamin B12 deficiency in North Indian population and improvement in tinnitus severity scores and VAS in cobalamin-deficient patients receiving intramuscular Vitamin B12 weekly for 6 weeks further provides a link between cobalamin deficiency and tinnitus thereby suggestive of a therapeutic role of B12 in cobalamin-deficient patients of tinnitus.