(AJ) Tinnitus is not seen as a separate disease, but in terms of symptoms accompanying various diseases. The emergence of tinnitus is involved in a variety of risk factors. Relationship between tinnitus and blood flow of the ear is described in a relation to impaired microcirculation, which plays a key role in the proper function of the inner ear and therefore we evaluated the relationship prothrombogenic factors for tinnitus. From the original group of 853 patients we excluded patients with organic cause problems. We excluded patients with hearing impairment, cardiovascular and other comorbidities and also patients taking ototoxic drugs or patients with laboratory abnormalities. Then we have a homogenous group of 40 patients without the evidence of an organic cause of tinnitus and without associated diseases and the effect of ototoxic medications. On this basis there has been created a control group matched by the age and sex. In our group as the main marker of protrombogenic state was used a level of 11- dehydrotromboxan B2. Patients with tinnitus have significantly higher values of 11- dehydrotromboxane-B2. The average concentration in tinnitus patients was 2.02±1.81 ng/ml compared to 1.32±1.33 ng/ml in the control group. At the same time we evaluated other coagulation parameters. We checked...

Subjektiver Tinnitus ist eine akustische Phantomwahrnehmung, d.h. ohne das Vorhandensein einer externen oder internen Geräuschquelle. Diese oft sehr belastende Störung steht aktuellen Studien zufolge in einem Zusammenhang mit pathologisch gesteigerter Aktivität und Erregbarkeit zentral-nervöser auditorischer Strukturen. Derartige Hyperaktivitäten und –exzitabilitäten konnten bereits experimentell durch eine repetitive transkranielle Magnetstimulation (rTMS) reduziert werden. Die vorliegende randomisierte, Placebo-kontrollierte Studie ging zwei Fragestellungen nach. Erstens sollte geprüft werden, ob sich das Aktivierungsmuster auf akustische Stimulation im auditorischen Kortex bei Tinnituspatienten von dem gesunder Kontrollpersonen unterscheidet. Zweitens sollte untersucht werden, ob durch eine rTMS eine Tinnitussymptomatik verbessert werden kann und dies in Form einer reduzierten kortikalen Hyperaktivität auch mit der Nah-Infrarot Spektroskopie (NIRS) nachweisbar ist. In der Verum-Gruppe wurden an 10 aufeinanderfolgenden Werktagen täglich je 2000 Stimuli mit einer Frequenz von 1 Hz über dem linken auditorischen Kortex appliziert. Die Tinnitussymptomatik wurde mit dem Tinnitusfragebogen nach Göbel & Hiller (TFB), dem Tinnitus-Handicap-Inventory-Score (THI) und dem Tinnitus-Schweregrad-Fragebogen (TSG) erfasst. Die NIRS-Messungen erfolgten vor und direkt nach der letzten Stimulation mit zwei verschiedenen akustischen Paradigmen und einer motorischen Kontrollaufgabe. Es konnten deutliche Unterschiede bezüglich des Aktivierungsmusters auf akustische Stimulation im auditorischen Kortex zwischen den Tinnituspatienten und gesunden Kontrollpersonen gefunden werden. Die Tinnituspatienten zeigten signifikant stärkere Aktivierungen als die gesunden Kontrollpersonen. Diese Ergebnisse unterstützen die „Hyperexzitabilitätstheorie“ von Melcher et al. (2009). Ferner konnte, wie in der Studie von Melcher et al. (2009), kein Zusammenhang zwischen der Tinnituslateralisation und dem Aktivierungsmuster gefunden werden. Bezüglich der Effektivität der rTMS gegenüber einer Placebo-Stimulation ließ sich kein eindeutiger Therapieerfolg nachweisen. Es konnte zwar anhand von NIRS-Messungen gezeigt werden, dass die rTMS eine kortikale Hyperexzitabilität stärker reduzierte als die Placebo-Stimulation. Es ließ sich jedoch kein Zusammenhang zwischen der geringeren Hyperexzitabilität und einer verbesserten Tinnitussymptomatik finden. Da jedoch die Fallzahlen dieser Studie klein waren, sollten diese Ergebnisse mit Vorsicht interpretiert werden. Außerdem deuten die Ergebnisse darauf hin, dass die NIRS eine erfolgversprechende Methode für den objektiven Nachweis Tinnitus-assoziierter zentral-nervöser Veränderungen und möglicherweise auch von Therapieeffekten ist. Sie bietet zahlreiche Vorteile gegenüber anderen bildgebenden Methoden: sie ist einfach in der Handhabung, wiederholt anwendbar, risikoarm, preisgünstig und nicht invasiv. Um die NIRS jedoch als etablierte Nachweismethode in der Klinik einsetzen zu können, sollten weitere Studien mit größeren Fallzahlen generiert werden. Auch sollten optimierte, allgemeingültige akustische Stimulationsparadigmen gefunden werden, um die Ergebnisse künftiger Studien besser miteinander vergleichen zu können. / Subjective Tinnitus is an acoustic phantom perception, i.e. without an external or internal source. According to the latest studies this mostly distressing complex of symptoms is related to a pathologically enhanced activity and excitability in central structures of the auditory system which could have been reduced by repetitive transcranial magnetic stimulation (rTMS) in clinical trials. This randomized, placebo-controlled study followed two questions. Firstly, the activity of the auditory cortex after acoustic stimulation in patients with chronic tinnitus was compared with the activity measured in healthy volunteers. Secondly, the study tried to evaluate, if a tinnitus could be reduced by rTMS and if this effect could be shown as a reduced cortical activity using NIRS. In the verum group 2000 pulses with a frequency of 1Hz were daily applied over the left auditory cortex on 10 consecutive weekdays. The severity of tinnitus was categorized by questionaires, such as Tinnitus-Fragebogen nach Goebel & Hiller (TFB), Tinnitus-Handicap-Inventory-Score (THI) and Tinnitus-Schweregrad-Fragebogen (TSG). The NIRS measurements proceeded before and immediately after the last rTMS during the presentation of two different acoustic stimulation patterns and one motoric task. This study could show considerable differences comparing the activation of the auditory cortex after acoustic stimulation in patients with chronic tinnitus and healthy volunteers. The activation in patients with chronic tinnitus was significantly higher compared to the healthy volunteers. These results support the “Theory of Hyperexcitability” invented by Melcher et al. (2009). Additionally, like Melcher et al. (2009), this study could not show a dependence of the cortical activation on the tinnitus lateralisation. This study could not show a significant benefit of the rTMS compared to the placebo stimulation. Though the NIRS measurements showed a reduced cortical hyperexcitability after the verum stimulation, this effect could not be related to a reduced tinnitus. However, these results should be interpreted carefully as the numbers of treated patients was very little. Furthermore this studie’s results suggest that NIRS is a promising, objective proof procedure for tinnitus related changes in central auditory structures and potentially even for therapeutical effects. Its’ benefits are: simple handling, repeatability, low-risk, low running costs and non-invasiveness. In order to use NIRS as an established method in clinical settings more studies including numerous patients should be generated. Furthermore optimized, universally valid acoustic stimulation patterns should be created and broadly used to be able to compare the different studies’ results.

<p>Tinnitus is common, and some individuals with tinnitus display high levels of distress. Cognitive behavioural therapy (CBT) is effective in reducing tinnitus distress, but is rarely available. CBT-based self-help, with or without guidance, has yielded positive results in other problem areas, and one initial randomized controlled trial (RCT) has shown promising results for tinnitus.</p><p>This thesis is based on four studies;</p><p>Study I showed that Internet-based self-help treatment with e-mail guidance alleviated tinnitus distress among consecutive patients and was rated as credible as traditional treatments. Active participation in treatment predicted outcome.</p><p>Study II, an RCT, showed that an extended and more interactive version of the Internet-based self-help treatment with e-mail therapist support appeared to be equally effective as a group treatment. In study III, another RCT, a self-help book with weekly telephone support was superior to a wait-list control group. No strong evidence for the importance of telephone contact on outcome was found. In both study II and III, the positive outcome remained after one year and self-help approaches appeared more therapist time-effective compared to group treatment. Also, the received treatment-dose for patients in guided self-help was not lower than in the group treatment.</p><p>Study IV found that the ‘Stages of Change’, from the transtheoretical model, are probably not the right theoretical framework to use with tinnitus patients. Predictors of outcome were found, but they were not in line with the theory behind the Stages of Change. The predictors were better understood when conceptualized as coping, showing that helplessness and less coping before treatment correlated with better outcome.</p><p>In sum, guided cognitive behavioural self-help can decrease tinnitus distress. It appears to be therapist time-effective and shows effects comparable to or slightly below traditional CBT for tinnitus. Effects remain one year after treatment and generalize to a routine clinical setting.</p>

Acoustic over exposure (AOE) triggers hearing loss alongside a decreased excitability in the dorsal cochlear nucleus (DCN) within 3 to 5 days post exposure. On a longer time scale (from 6 weeks onwards) AOE can also generate phantom auditory perceptions known as tinnitus alongside a spontaneous hyperactivity in the DCN. The delayed onset of this hyperactivity relative to the early onset of hearing loss and decreased excitability suggests intermediate plastic changes in the DCN that remain to be identified. The first aim of this thesis was to identify in vitro, AOE-induced changes in synaptic plasticity within the DCN that could underlie the subsequent development of tinnitus. The second aim was to identify means of reversing the in vitro changes in synaptic plasticity triggered by AOE. The final aim was to test whether reversing the identified AOE-induced changes in synaptic plasticity could prevent the onset of tinnitus. Wistar rats were exposed to a loud (110 dB SPL) single tone (15 kHz) for a period of 9 hours (AOE protocol). Auditory brainstem response recordings performed 3 to 5 days later showed a significant increase of the rat’s hearing threshold for frequencies above 8 kHz. Field potential recordings of auditory nerve compound action potentials revealed a decreased amplitude and conduction velocity which was confirmed using computational modelling studies. Whole cell recordings of auditory nerve evoked excitatory post synaptic currents (EPSCs) revealed a decrease in EPSC amplitudes after AOE due to a decreased number of release sites. Field potential recordings of parallel fibre evoked activity performed 3 to 5 days following AOE showed that AOE prevented the induction of long term potentiation (LTP) otherwise observed at multisensory DCN synapses. Whole cell recordings of parallel fibre evoked EPSCs in fusiform cells revealed this to be due to an increased release probability after AOE. Perfusion of D-AP5 (an NMDA receptor antagonist) promoted the induction of LTP otherwise deficient after AOE. Perfusion of D-AP5 or elevating the concentration of magnesium in the extracellular medium decreased the release probability after AOE. Based on these findings, subsets of rats were placed on a high magnesium diet (in combination with magnesium injections) immediately after AOE. This reduced the behavioural evidence of tinnitus measured as deficits in silent gap detection. In conclusion, following AOE, the absence of LTP induction in the DCN due to an increased release probability constitutes an in vitro deficit prior to the later onset of tinnitus. Decreasing release probability at DCN multisensory synapses after AOE allowed AOE induced tinnitus to be targeted and reversed in an animal model.

Approximately 15% of Swedish people experience tinnitus, but only 2.4% experience severe problems. Treatment modalities for tinnitus vary, but the most common treatment is counseling. The majority of patients with tinnitus report some degree of hearing loss, and hearing aids have been used for many years in patients who suffer from both tinnitus and hearing impairment. The aim of the present thesis was to investigate disease management, determine quality of life and identify treatment strategies for patients with tinnitus and sensorineural hearing loss. The first two studies described here are retrospective, descriptive studies of patients who sought care for tinnitus and hearing loss at two Ear-Nose-Throat (ENT) clinics in Östergötland County, Sweden, during the years 2004 - 2007. Study I showed that 70% of the cohort had tinnitus; however, many did not initially receive a diagnosis of tinnitus. Information about vertigo, heredity for hearing loss and tinnitus, diabetes history, cardiovascular disease history and other factors related to health was often missing from the patients’ medical records. The results could show that the overall scores using the Tinnitus Handicap Inventory (THI) were higher in female patients than in male patients. Although it is likely that hearing aids would be beneficial for the majority of these patients, 314 (44%) of the 714 total patients had hearing aids. Furthermore, the outcomes from study II demonstrated that a majority of the patients (61%) who were dissatisfied with the care they had obtained had no hearing aids. This finding may indicate that the fitting of hearing aids is an important treatment for patients with both tinnitus and hearing loss. Studies III and IV were prospective studies. Data collection was based on patients who sought care for tinnitus and/or hearing loss at the ENT clinic in Linköping during 2012-2013. In study III, 92 patients were divided into two groups: one group contained individuals with both tinnitus and hearing loss, and the other group contained patients with only hearing loss. The patients were assessed using the Reading Span test, the Hearing in Noise Test (HINT) and three questionnaires (the THI, the Hearing Handicap Inventory for Elderly and the Pittsburg Sleep Quality Index) at baseline and follow-up. The results from the age-matched subgroups (n=30+30) generated from the full clinical groups (46+46) showed significantly improved Reading Span test performance and sleep quality in patients with both tinnitus and hearing loss. Similar results were observed in our full clinical population (n=46+46). However, the interpretation of this finding is difficult due to age differences between the groups. In conclusion, hearing aid fitting had a significantly positive impact on working memory capacity and sleep quality in patients with both tinnitus and hearing loss compared with patients with only hearing loss. In study IV, a brief Motivational Interviewing (MI) guide was integrated into the hearing rehabilitation process for 23 patients with both tinnitus and hearing loss, and they were compared against a control group (n=23) of patients with both tinnitus and hearing loss who underwent traditional hearing rehabilitation. The results showed that the patients who received the brief MI guide required fewer visits to complete their hearing rehabilitation compared with the patients in the control group. In addition, there was a significant difference in THI scores between the groups, which indicated that the intervention reduced tinnitus annoyance more in the MI group. Furthermore, both groups showed higher scores at follow-up compared with baseline on the International Outcome Inventory for Hearing Aids (IOI-HA) scale, which indicated that both approaches showed a positive effect on hearing aid satisfaction. Study V was a retrospective, descriptive study that focused on a part of a Stepped Care model and included patients who participated in half-day tinnitus information meetings from 2004 to 2011 in the audiology clinic at Linköping University Hospital. A total of 426 tinnitus patients with complete questionnaires (the THI and the Hospital Anxiety and Depression Scale, HADS) were included in the study. The results showed significant decreases in scores on the THI and the anxiety module of the HADS before and after the information session. However, there were no statistically significant changes in the depression module of the HADS. In conclusion, this thesis underscores the importance of hearing impairment, cognitive variables and motivational procedures in the management of tinnitus. Multidisciplinary group information needs to be further validated.

Based on the former studies, there is evidence of tinnitus being associated with performance on cognitive ability tests (for example Andersson et al. 2009, Hallam et al. 2004). The topic of my bachelor thesis was to unravel how depression, stress and anxiety connected with tinnitus symptoms are related to cognitive abilities such as verbal fluency, inhibition ability and working memory capacity. In order to fill an existing gap of knowledge, the relationship of different severity of stress caused by tinnitus symptoms as measured with Tinnitus Handicap Inventory (THI) and cognitive abilities and depression and anxiety symptoms was emphasized. The experiment group was divided into two subgroups, those with lower and higher level of perceived tinnitus severity and the differences in test scores between groups were investigated with one-way analysis of variance. As a result, significant differences between the two tinnitus patient groups were found in the level of performance in inhibition task where participants were asked to give the font color of congruent color - word pair as an answer. It was also studied whether there were correlations between perceived severity of tinnitus symptoms, depression and anxiety symptoms, working memory capacity and inhibition ability. As a result of correlation analysis, this study confirmed the connection between tinnitus symptoms and anxiety and depression symptoms found in previous studies, and a significant correlation was found between THI scores and anxiety symptoms, and THI scores and C inhibition test scores where the participant was asked to name the font color from incongruent color-word pairs. The results of this study suggest that there is a connection between the level of perceived tinnitus severity and the ability to name font color of incongruent color - word pair. The current study found no evidence about the connection between THI scores and other cognitive abilities as well as anxiety and depression symptoms, even though the THI scores correlated with both anxiety symptom scores and with the reaction times of an inhibition task where the participants were asked to point out the font color from incongruent color - word pairs.

Introdução: O zumbido pode ser definido como a percepção consciente de um som, sem a participação de uma fonte sonora externa. A presença isolada do zumbido, sem a perda auditiva associada sugere que o mesmo pode ser o primeiro sintoma de alterações cocleares que somente serão percebidas depois do aparecimento da perda. Considerando que o zumbido está frequentemente relacionado a disfunções cocleares e mais especificamente a alterações nas células ciliadas, e que nesse caso as funções desempenhadas por elas podem estar comprometidas em algum grau, é possível que alterações nos mecanismos cocleares em pacientes com limiares auditivos ditos normais e queixa de zumbido sejam encontradas. Objetivo: O objetivo do presente estudo foi verificar as diferenças entre as respostas cocleares em mensurações eletroacústicas e psicoacústicas em indivíduos sem perda auditiva, com e sem queixa de zumbido. Método: Participaram do estudo 57 indivíduos com limiares audiométricos dentro dos padrões de normalidade, divididos em dois grupos: grupo-controle composto por 41 sujeitos (81 orelhas) sem queixa de zumbido, e grupo-zumbido composto por 16 sujeitos (31 orelhas) com queixa de zumbido. Os sujeitos foram submetidos à pesquisa das Curvas de Crescimento das Emissões Otoacústicas Produto de Distorção, pesquisa das Curvas Psicofísicas de Sintonia e aplicação do teste TEN. Resultados: Para as CC-EOAPD somente foi observada diferença estatística nas curvas de 3000 e 6000 Hz, para L2=45 dBNPS e L2=55 dBNPS, respectivamente. Para as curvas psicofísicas de sintonia, foram observadas diferenças estatísticas localizadas nas extremidades das curvas, isto é, para a CPS de 2000 Hz com ruído de 6000 e 8000, para a CPS de 3000 Hz, para 8000 Hz, para a CPS de 4000 Hz para o ruído de 2000 e 8000 Hz e para as CPS de 6000 e 8000 Hz para os ruídos de 3000 e 2000 Hz. Para o teste TEN, não foi encontrada presença de zonas mortas da cóclea, entretanto foi observado padrão diferente entre os grupos, caracterizado pelo limiar na presença de ruído ipsilateral estatisticamente mais elevado no grupo-zumbido do que no grupo-controle. Conclusão: Foi observado que apesar de audiologicamente normais, os grupos apresentam desempenhos estatisticamente distintos nos testes aplicados, principalmente nas Curvas Psicofísicas de Sintonia e no teste TEN, evidenciando funcionamentos cocleares diferentes que, possivelmente, comprometem em algum grau os mecanismos cocleares, principalmente a seletividade de frequência / Introduction: Tinnitus can be defined as the conscious perception of a sound without the participation of an external sound source. The association between tinnitus and hearing loss has been well described. The isolated presence of tinnitus, without hearing loss, suggests that it may be the first symptom of cochlear dysfunctions that will be noticed only after the emergence of the hearing loss. Whereas tinnitus is often related to cochlear dysfunction, specifically in hair cells, their mechanisms could be impaired to some degree. Thus, patients with normal hearing and tinnitus, could show some dysfunctions in cochlear mechanisms. Objective: The aim of this study was to investigate the differences between the cochlear responses in electroacoustic and psychoacoustic measurements in subjects with normal hearing, with and without tinnitus. Method: The study included 57 subjects with audiometric thresholds within normal limits, divided into two groups: control group consisted of 41 subjects (81 ears) without tinnitus and tinnitus group consisted of 16 subjects (31 ears) with tinnitus. The subjects were tested for DPOAE-I/O functions, Psychophysical Tuning Curves (PTC) and TEN test. Results: For DPOAE-I/O only statistical difference was observed in the curves of 3000 and 6000 Hz, for L2 = 45 dBSPL and L2 = 55 dBSPL respectively. For the psychophysical tuning curves, statistical differences were observed at the ends of the curves, i.e. for the PTC 2000 Hz with noise 6000 and 8000 to 3000 PTC Hz to 8000 Hz to 4000 Hz PTC for noise 2000 and 8000 Hz and the PTC 6000 and 8000 Hz for the noise of 3000 Hz and 2000 TEN For the TEN test, there were no presence of \"dead regions in the cochlea,\" however different pattern was observed among groups, characterized by the presence of noise threshold ipsilateral statistically higher in the tinnitus group than the control group. Conclusion: We found that despite normal hearing, the groups have statistically different performances in the test applied, especially in psychophysical tuning curves and the TEN test, showing that different runs cochlear possibly commit to some degree the cochlear mechanisms, mainly the frequency selectivity

Psychological treatment is effective at alleviating tinnitus distress when delivered by a psychologist. In the United Kingdom (UK), best practice guidance for tinnitus advises that audiologists should deliver Cognitive Behavioural Therapy (CBT) and other counselling techniques where psychologists are unavailable. However, there is a lack of evidence for the effectiveness of audiologist-delivered psychological tinnitus treatment, and no consensus among clinicians and researchers on what form, if any, this should take. Furthermore, training in CBT and other counselling techniques is not a part of standard audiologist training in the UK. The aims of this PhD were to define the components and measure the effects of an audiologist-delivered psychological tinnitus treatment for people with tinnitus. Potential treatment components to include were identified in two studies. The first study was a comprehensive scoping review in which components were extracted from 64 records on psychological tinnitus treatment delivered by psychologists. The components were predominantly extracted from studies of CBT. The second study was a Delphi survey of a panel of 39 patients and clinicians who were asked to rate the importance of 160 different treatment components for an audiologist-delivered psychological tinnitus treatment. These data were used to inform the development of a treatment manual, underpinned by a cognitive behavioural model of tinnitus distress. The manual comprised tinnitus education, psychoeducation, relaxation, graded exposure, thought challenging, physical exercise, sleep hygiene, an introduction to acceptance and defusion techniques, and sound enrichment, which could be implemented flexibly according to patient need. To measure the effects of the psychological tinnitus treatment, appropriate outcome domains and instruments were identified by applying template analysis to the treatment manual. Potential domains were selected from a list constructed by grounded theory using existing questionnaires. Outcome instruments were identified if they were responsive to therapeutic change and possessed good content validity and internal consistency. It was predicted that the treatment would affect tinnitus-specific emotional impact and negative thoughts. Based on current evidence, the Tinnitus Functional Index (TFI) and the Tinnitus Cognitions Questionnaire (TCQ) were identified to best measure these domains. A feasibility randomised controlled trial (RCT) was conducted over six months to determine the feasibility of a definitive RCT of audiologist-delivered psychological tinnitus treatment. Nineteen patients were recruited to the trial. Attrition rates were high, though all patient withdrawals occurred before their first appointment. The trial indicted that a definitive RCT of audiologist-delivered psychological tinnitus treatment is not feasible due to poor site compliance with returning questionnaires, and low recruitment rates in smaller trial sites. Patients and audiologists were invited to attend post-treatment semi-structured interviews to explore treatment fidelity and experience. Patients reported that the treatment was acceptable and effective in reassuring them about their tinnitus. Audiologists reported focusing on psychoeducation with limited use of specific techniques such as thought challenging and graded exposure. Patients and audiologists thought that the TFI and TCQ comprehensively measure the important tinnitus domains and are useful for planning treatment and encouraging discussion about patients’ negative thoughts. A lack of confidence due to the brevity of training was given by audiologists as a reason they avoided implementing certain treatment components.

No description available.

No description available.