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Tinnitus has the potential to influence a wide range of routine and important activities in a person's life. It can impair sleep, communication, concentration, and in severe cases can be affected by depression, anxiety, and other mental health issues. Perhaps more important, tinnitus may influence the patient's psychological state; its bidirectional effects, although well established, often challenge patients and providers across a variety of clinical settings. Management of tinnitus requires audiologists to be adept at communicating and supporting coping strategies that may include, but should not be limited to, patient-centered counseling and delivery of sound therapy or hearing aids. In the short term, patient care may benefit from interprofessional collaborations and effective referral networks. In the long term, the inclusion of tinnitus clinic rotations, classes, and interprofessional opportunities for students in Audiology programs should provide AuD students the experiences and competencies to provide for patients with tinnitus.

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Introduction: Due to our actual knowledge tinnitus in most cases results from abnormal neural activity elicited at any level of auditory pathways and is interpreted in auditory cortex as a perception of sound, which is not accompanied by any mechanic activity within the cochlea. Tinnitus patients usually present various degrees of cochlear dysfunction, which can be manifested as sensorineural hearing loss, loudness intolerance, a distinct decrease of the DPOAE amplitude, recruitment or abnormal efferent reduction of OAEs through contralateral acoustic stimulation. But 8-15% of tinnitus patients present normal audiometric profiles. In these patients the mechanism of tinnitus generation remains unclear. Aim of the study: The aim of the study was to assess DPOAE levels and EHF thresholds in tinnitus subjects with normal hearing and compare the data with those from a normally hearing control group without tinnitus, in order to evaluate if any detectable high frequency cochlear dysfunction might be responsible for the tinnitus generation. Material and methods: 175 tinnitus patients (group 1 – tinnitus in left ear - 47 patients, group 2 – tinnitus in right ear – 23 patients, group 3 – bilateral tinnitus – 105 patients) and 60 controls (group 4). Inclusion criteria: age up to 40, normal otoscopic examination, type A tympanometry, normal hearing (up to 20 dB) in PTA (250-8000 Hz), no loudness intolerance, constant tinnitus for at least 6 months of stable localization (site of tinnitus has not changed from the previous localization). In each patient high frequency audiometry (at 10, 12.5, 14 and 16 kHz) and DPOAE registration (L1=65 dB SPL, L2=55 dB SPL, f2/f1= 1.2, S/N≥3 dB) were performed. Then statistical analysis was applied for comparison between left and right ears in the same group and also across different group of patients. Results: statistically significant differences were observed mainly in unilateral tinnitus group. These differences were more evident in audiometric data than DPOAE data. Leftsided tinnitus was twice more frequent than right-sided tinnitus. Few statistically significant differences were found between bilateral tinnitus group and controls. Conclusions: Unilateral tinnitus in normally hearing individuals may be caused by the damage of the basal region of the cochlea. There is greater incidence of high frequency hearing loss (above 8 kHz) in the ear with tinnitus in comparison to control group. In unilateral tinnitus group, the organ of Corti at the site of tinnitus is more seriously damaged than in the opposite ear. The asymmetry of cochlear damage may be crucial for tinnitus lateralization. Bilateral tinnitus, more frequently than unilateral one, can result from other pathologies, not connected with the organ of Corti.

Background: Self-efficacy refers to the beliefs (i.e., confidence) individuals have in their capabilities to perform skills needed to accomplish a specific goal or behavior. Research in the treatment of various health conditions such as chronic pain, balance disorders, and diabetes shows that self-efficacy beliefs play an important role in treatment outcomes and management of the condition. This article focuses on the application of self-efficacy to the management of tinnitus. The first step in formally incorporating self-efficacy in existing treatment regimens or developing a self-efficacy approach for tinnitus treatment is to have a valid and reliable measure available to assess the level of tinnitus self-efficacy. Purpose: The objective of this study was to develop the Self-Efficacy for Tinnitus Management Questionnaire (SETMQ) and to obtain the psychometric properties of the questionnaire in a group of patients with tinnitus. Research Design: Observational study. Study Sample: A total of 199 patients who were enrolled in the Tinnitus Clinic at the James H. Quillen Veterans Affairs Medical Center participated in the current study. Data Collection and Analysis: The SETMQ was mailed to patients enrolled in the Tinnitus Clinic. The participants who completed one copy of the SETMQ were mailed a second copy to complete approximately 2 weeks later. An exploratory factor analysis was conducted to identify the most coherent subscale structure of the SETMQ. The internal consistency and test‐retest reliability for each of the subscales and the questionnaire as a whole were assessed. The validity of the SETMQ also was evaluated by investigating the relations between the SETMQ and other clinical measures related to tinnitus. Results: Five components emerged from the factor analysis that explained 75.8% of the variance related to the following areas: (1) routine tinnitus management, (2) emotional response to tinnitus, (3) internal thoughts and interaction with others, (4) tinnitus concepts, and (5) use of assistive devices. Four items failed to load on any factor and were discarded, resulting in 40 items on the final SETMQ. The internal consistency reliability of the overall questionnaire and for each subscale was good (Chronbach's α ranged from .74 to .98). Item-total correlations ranged from .47 to .86, indicating that each item on the SETMQ correlated at a moderate or marked level with the SETMQ aggregate score. Intraclass correlation coefficients were computed to determine the test‐retest reliability of the SETMQ total scale and separately for each subscale, which were all above .80, indicating good test‐retest reliability. Correlations among the SETMQ subscales and various tinnitus-related measures (e.g., Tinnitus Handicap Inventory, tinnitus loudness rating, tinnitus distress rating, etc.) were significant, albeit indicative of fair to good relations overall (range r = ‐.18 to ‐.53). Conclusions: The results of the current study suggest that the SETMQ is a valid and reliable measure that may be an insightful instrument for clinicians and investigators who are interested in assessing tinnitus self-efficacy. Incorporating self-efficacy principles into tinnitus management would provide clinicians with another formalized treatment option. A self-efficacy approach to treating tinnitus may result in better outcomes compared with approaches not focusing on self-efficacy principles.

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Millions of people suffer from tinnitus, a disorder for which there is currently no effective treatment or cure. My dissertation work provides insight into the neural correlates of this pervasive hearing disorder and examines how a newly emerging therapy, transcranial magnetic stimulation (TMS), affects the central auditory system in the generation of the tinnitus percept. This work has a multifold focus of: i) developing and modeling the function of a miniature magnetic coil that can be used for TMS in rodents, ii) establishing a reliable mouse model of tinnitus that can be used for assessing TMS treatment-induced changes, iii) measuring the behavioral alterations and neural changes induced by TMS throughout the auditory system in mice with tinnitus, and iv) to assay underling molecular changes in the auditory cortex (AC) related to TMS and tinnitus. Chapter 1 gives an overview of the current research on tinnitus and TMS. Chapter 2 establishes a reliable neural and behavioral assay of verifying tinnitus in a mouse model and provides further evidence that the underlying hyperactivity associated with tinnitus is initiated in the brainstem following reduced afferent input. The remainder of the dissertation examines the modulation of tinnitus in the auditory central nervous system using a miniature TMS coil. Chapter 3 of the dissertation details the creation and evaluation of a rodent-sized TMS coil, which could increase the overall effectiveness and applicability for human treatment. TMS is currently an FDA approved treatment of depression and has been shown to decrease tinnitus perception in human clinical trials, albeit with variable results. There have been few published studies of tinnitus modulation by TMS using animal models and therefore little is known about the molecular and neural bases of this potential tinnitus treatment. TMS is thought to be therapeutic because the magnetic flux generated from the electromagnetic coil induces an electric field in the brain, altering ion flow and subsequently neural function, as the excitation and inhibition of cortical networks become synchronized to the magnetic pulse. Chapter 4 demonstrates that TMS with our custom-designed miniature rodent coil can successfully reduce behavioral evidence of tinnitus in a mouse model, mainly through activating inhibitory networks in the AC. It also shows that presynaptic activity is altered in the upper layers of the AC responsible for intralaminar processing and sound perception. Finally, chapter 5 describes an in-depth proteomic analysis of over 3000 proteins from the AC, which shows that TMS and noise-induced tinnitus alter the expression of several key proteins and pathways that play a critical role in cortical excitatory and inhibitory activation. The results of this work are also important because they are the first animal model to demonstrate neural changes during TMS-treated tinnitus, creating a paradigm that can be used for optimizing parameters to improve clinical outcomes in human trials.

<p>The purpose of this thesis was to develop novel ways to study tinnitus, to investigate the course of tinnitus, and to study the effects of cognitive-behaviour therapy on tinnitus related distress. Data from 377 tinnitus patients were collected.</p><p>A group of 216 patients completed audiological measures and were assessed in a structured interview. The Klockhoff and Lindblom's grading system was used and its inter-rater reliability assessed in a subsample showing a high degree of correspondence. A discriminant analysis showed that a substantial proportion of patients could be correctly classified into grade II or III, by measures of pitch, minimal masking level of tinnitus, avoidance of situations because of tinnitus, and tolerance in relation to onset.</p><p>Using tests developed in cognitive psychology, it was found that tinnitus patients had impaired performance. There was no evidence for an attentional bias towards tinnitus related words using a computerized emotional Stroop task, but masking sounds of an "on-and-off" character were more disruptive than constant masking when patients performed the digit-symbol test. It is suggested that tinnitus distress may be increased by the 'changing-state' character of the tinnitus signal, or alternatively by intermittent masking sounds.</p><p>In a case-study a patient received an i.v. injection of lidocaine while Positron Emission Tomograpy was conducted. The brain activity associated with tinnitus included the left primary, secondary and integrative auditory brain areas, as well as right paralimbic areas related to negative feelings. The precuneus (Brodmann area 7) might be a brain area involved in the aversiveness associated with tinnitus.</p><p>Using a tinnitus questionnaire as the dependent measure it was found that tinnitus maskability at admission predicted distress at follow-up for an average of five years following admission. Some improvement in tinnitus occurred over time, but this was more evident in patients who had received a cognitive-behavioural treatment program.</p><p>The effect of an Internet based cognitive-behavioural self-help treatment program for tinnitus was investigated showing a high dropout rate, but with positive results in that the treated patients improved.</p>