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

Hearing in noise is facilitated by the auditory system’s ability to separate sound into small auditory segments. Separation of sound is achieved using an auditory mechanism called temporal resolution that codes for small silent gaps in an acoustic stimulus. This thesis proposes a new method for measuring temporal resolution and applied it to a small pilot group of individuals with tinnitus. Previous studies have postulated that tinnitus can “fill” in silent gaps thereby making gap detection more difficult. This was shown in studies using the gap prepulse inhibition acoustic startle where the amplitude of a startle response indicates the subject’s ability to detect a small silent gap. However studies using behavioural gap detection do not show significant differences in people with reported tinnitus. Thus the behavioural evidence does not appear to support the hypothesis that tinnitus can “fill” in silent gaps. In this thesis a new method was proposed for measuring neural gap detection: the mismatch negativity response (MMN). The mismatch negativity responses were compared to behavioural measures of gap detection in thirty-five normal hearing adults: five with reported tinnitus and thirty without tinnitus. They underwent recordings to gapped stimuli ranging from 2- to 40-ms gap durations. The stimuli were either a broadband or narrowband noise presented in the absence or presence of a filler noise. Results of these experiments found the broadband and narrowband noises elicited MMNs to silent gaps. The amplitude of the MMN increased with larger gap durations. When filled, the amplitude of the entire waveform was proportionally reduced for all gap durations. However, for the tinnitus group the filler reduced the largest gap durations elicited MMNs amplitudes disproportionately more than for the smaller gap durations. The high and low filler noise reduced the amplitude of the 40-ms gap MMNs. This was not reflective in the behavioural performance of gap detection as there were no significant group differences. These studies show that neural gap detection can be measured using mismatch negativities. Reduced behavioural gap detection performance is reflected by a smaller amplitude of the MMN for suprathrehold gaps. This was shown in both normal hearing participants with elevated behavioural gap detection thresholds and participants with tinnitus. Therefore, electrophysiological recordings to gaps may provide further information on the underlying mechanisms involved in impaired gap detection that may not be captured by behavioural measures alone.

This study examined the effects of attentional focus, anxiety, and fatigue on tinnitus distress, intensity and pitch in a group of 60 adults with tinnitus. Subjects were randomly allocated to one of three experimental groups or to a group performing a control task. In order to provide a naturalistic parallel to the laboratory manipulation, subjects kept a diary of similar variables for one week. The experimental manipulations showed that an increase in attentional focus on tinnitus led to a significant increase in perceived tinnitus intensity. There was an indication that increased anxiety had a similar effect on tinnitus intensity. Interestingly, tinnitus pitch was relatively unaffected by manipulations compared to tinnitus intensity. Naturalistic diary analyses indicated significant positive correlations between the mood variables, bored, anxious, and fatigue on the one hand and tinnitus distress, intensity and pitch on the other. The strongest correlation appeared to be between tinnitus distress and anxiety. A multiple regression procedure found that tinnitus distress was positively correlated with tinnitus intensity, age, and complexity of the tinnitus sound; and negatively correlated with duration since onset. There was a high degree of variability among subjects in range of tinnitus distress and its temporal patterning. Implications for tinnitus treatment, measurement and a proposed model of tinnitus distress are discussed. / Arts, Faculty of / Psychology, Department of / Graduate

Background to the study: Cochlear implants (CI) can help to suppress tinnitus and often make existing tinnitus more bearable. However, a number of patients still suffer from tinnitus afterwards. In some cases the implantation makes existing tinnitus worse, or tinnitus may occur as a result of cochlear implantation. Because of the inconclusive aetiology of tinnitus it is difficult to treat its effects. So far, one of the most popular treatments for tinnitus is the widely used Cognitive Behavioural Therapy (CBT), which aims to influence dysfunctional emotions, behaviours and cognitions though a goal-orientated, systematic procedure. CBT aims to minimize the side-effects of tinnitus and help to manage it in a more efficient way. CBT has been investigated in several studies and shows promising results in reducing the debilitating effect of tinnitus. CBT has not yet been used specifically for, or investigated in, relation to treating CI users suffering from tinnitus. Aims and outline of the study: Our research aimed to investigate CBT’s effectiveness for cochlear implant users. Using a randomized control trial, we investigated whether two-hour Tinnitus Workshops for the control group were as equally as effective as CBT for the research group. We also explored if either type of treatment for cochlear implant users needed any modifications to make them more suitable for this group of tinnitus sufferers. Using Open Questions, we investigated tinnitus in cochlear implant users. We analysed the Open Questions from both groups, creating a profile of a typical cochlear implant user who suffers from tinnitus, and we also explored whether both interventions (Tinnitus Workshop or CBT) were suitable for this kind of patient. Data was gathered, pre- and post-interventions, by questionnaires; these were Tinnitus Questionnaires (TQ), Visual Analogue Scale (VAS), Quality of Life Short Form 36 Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). Results: In the control group, we found no significant differences between the TQ scores pre- and post-intervention. VAS scores post-intervention were lower than pre-intervention, indicating some improvement in individual tinnitus perception; however, the difference was not significant. In the research group, we found small, but not significant, differences in both TQ pre- and post-intervention (z =1.83, p>.05) and in VAS (z=0.14, p>.05). No significant differences were found between the control and the research group pre- and post-intervention. Conclusions: The questionnaires used in this study, such as TQ or VAS, showed a decrease in general tinnitus distress, but a larger-sized sample group may be needed for greater statistical certainty. The results from the Open Questions showed that cochlear implant users were affected by tinnitus in a similar way to non-cochlear implant users. Overall, both interventions need further, small modifications and adjustments to their protocols in order to be more effective for this type of tinnitus sufferer.

Tinnitus is the perception of sound in the absence of an external sound source and is estimated to be experienced by 10-15% of the population. The majority of tinnitus patients present with some form of hearing loss and intervention aimed at reducing the effects of auditory pathology is indicated in tinnitus management. A significant number of tinnitus patients are also suffering from psychological distress. Psychological interventions aimed at addressing the emotional distress caused by the tinnitus and helping the patient to reclassify his/her thoughts and beliefs about tinnitus are becoming more popular. The optimal model for tinnitus intervention may be a team approach between audiology and clinical psychology. The objective of the study was to determine the effect of a combined multidisciplinary approach in the treatment of tinnitus, using psychological and audiological intervention methods, in comparison to a single approach on tinnitus severity. The study followed a quantitative research approach, employing a randomised quasi-experimental within-subject, repeated measures design with a varied order of procedures. Eleven participants were assigned to three different treatment groups based on counter-balanced assignment. Each group received in a different order psychological intervention comprising cognitive behavioural therapy (CBT), audiological intervention involving hearing aid fitting and the counselling component of tinnitus retraining therapy (TRT) and a combination of audiological and psychological interventions. Intervention periods were each two months long, with a one-month rest period between each intervention. In total, seven tinnitus assessments were conducted during the course of data collection to evaluate the changes in Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI) scores, along with tinnitus pitch, tinnitus loudness, minimum masking levels (MML) and residual inhibition (RI) before and after interventions. The results indicated that both the singular approaches as well as the combined intervention approach lead to clinically relevant shifts in the THI and TFI scores. Although the study results support the evidence for audiological intervention and for psychological intervention, it was not successful in proving that a combination of audiological and psychological intervention was more successful than a singular approach. It did, however, still indicate that a combination approach yielded clinically relevant reductions in THI and TFI scores and, therefore, that a combination approach is successful and effective. The assessment results of the psychoacoustic properties of tinnitus did not yield any relevant results, and failed to identify any patterns or trends with regard to the effect of intervention on the psychoacoustic properties of tinnitus. None of the results indicated statistical significance of the findings. The study serves as another stepping stone in the direction of tinnitus intervention to be delivered as a conscious multidisciplinary effort where psychology and audiology complement each other. Further research to determine the effects of a collaborative intervention approach for tinnitus is recommended. / Dissertation (MCommunication Pathology)--University of Pretoria, 2017. / Speech-Language Pathology and Audiology / MCommunication Pathology / Unrestricted

Hearing loss and tinnitus are the two most common service-connected disabilities in Veterans. Patients with a chief complaint of hearing loss and/or tinnitus typically undergo a hearing evaluation to determine the severity and type of hearing loss. The standard treatment for sensorineural hearing loss is the fitting of personal amplification.Up to 95% of tinnitus patients have an underlying hearing loss and could benefit from hearing aids for both improved communication and as an effective treatment to reduce the impact of tinnitus, ((Shargorodsky, Curhan, & Farwell, 2010). It is not uncommon, however, for some of these patients to decline hearing aids although they elect to undergo tinnitus counseling. The observation that some of these patients elected to obtain hearing aids following tinnitus counseling compelled an investigation of tinnitus counseling’s role in the patient’s revised decision to accept hearing aid fitting. An electronic medical records review (2015- 2020) identified Veterans meeting the following criteria: (1) diagnosis of sensorineural hearing loss and tinnitus, (2) declined hearing aids at the time of the hearing evaluation, (3) received tinnitus counseling, (4) elected to obtain hearing aids following tinnitus counseling, and (5) affirmed regular use of the hearing aids for more than one year. 30 qualified veterans provided informed consent to participate. Enrolled participants were interviewed using a brief survey that allowed patients to report a variety of tinnitus and hearing-related challenges. Participants also completed a validated tinnitus intake form, the tinnitus handicap inventory (THI), which reports a patient’s self-assessed tinnitus handicap. A total of six Veterans (white males, average age of 60 years, with bilateral sensorineural hearing loss and bothersome tinnitus) participated. The number of hours of daily hearing aid use was related to the self-perceived benefit of hearing aids for the management of tinnitus, as the 5 participants who wore their hearing aids >5 hours/day reported benefit in contrast to the single participant who wore their hearing aids /day. The reported benefit of tinnitus counseling, however, was not reflected as a significant improvement in the post-counseling THI score. All participants reported the counseling was useful and recommended that other veterans experiencing tinnitus and hearing loss undergo a trial with hearing aids . A narrative analysis of additional information provided by participants was made to identify counseling elements that supported the use of hearing aids for tinnitus management. In general, the analysis indicated that when patients were provided accurate information regarding tinnitus management strategy options, then they might be more likely than uninformed patients to accept and act upon hearing aid recommendations in a timely manner. All participants suggested that the provision of more information regarding tinnitus and management options at the time of the hearing evaluation would have likely expedited hearing aid acceptance. The preliminary findings of this survey suggest that patients with a diagnosis of sensorineural hearing loss and tinnitus might benefit from some form of tinnitus management counseling at the time of the initial hearing evaluation, and that the counseling might facilitate uptake of hearing aids.

Objectives: Although tinnitus is one of the most commonly-reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related accessibility of care, and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence- based interventions are necessary. This presentation focuses on the adaptation of an Internet-based Cognitive Behavioral Therapy (ICBT) intervention, originally used in Sweden and in the UK, for individuals with tinnitus in the United States. Elements of the ICBT program requiring consideration included (a) adaptations to the platform’s features and functionalities, (b) translation into Spanish to extend the reach of the program (c) user acceptability and satisfaction of the program, (d) outcomes from a pilot trial from which it was hypothesized that patients would demonstrate a reduction in tinnitus distress and associated difficulties as measures using standardized self-reported outcome measures, and (e) discussion of the relative merits and appropriateness of the intervention. Design: The iTerapi platform developed in Sweden was adopted for use in the US. The platform required functional and security features modifications to confirm its compliance with both institutional and governmental regulations, and to ensure it was suitable for the US population. Acceptability and suitability of the materials were evaluated by both hearing healthcare professionals (n=11) andindividuals with tinnitus (n=8). A pilot study followed as adults with bothersome tinnitus completed the 8-week program (n=30). Results: Cultural adaptations included word substitutions, adapting counseling examples for a US population, and modifying the spelling of certain words. The materials were then translated into Spanish and cross-checked. Professional review ensured the suitability of the chapters. Literacy level analysis confirmed all chapters were within the guidelines to be below the 6th grade level for readability. Healthcare professionals and individuals with tinnitus reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability and exercises provided in the ICBT platform. Preliminary analyses of pilot data indicated a reduction in tinnitus distress and associated difficulties (i.e., anxiety, depression, insomnia) and an improvement in quality of life. Conclusions: Ensuring that the ePlatform offers the appropriate features and functionalities for the intended population is an essential part of developing Internet-based intervention. The user evaluations and pilot trial outcomes indicated that clinical trials can be performed to assess the effectiveness of ICBT for tinnitus in the US.

Objective: The objective of this study was to improve the range of standardised tinnitus Spanish Patient-Reported Outcome Measures (PROMS) available by translating and ensuring cross-cultural adaptation of three English PROMs to Spanish. Design: The Tinnitus and Hearing Survey, Tinnitus Cognition Questionnaire, and Tinnitus Qualities Questionnaire were translated to Spanish using recently established good practice guidelines. Study sample: The translation process addressed 22 items included in six main steps specified in the guidelines. The translated PROMs were field tested on a sample of tinnitus patients who were recruited through convenience sampling using cognitive debriefing (n = 5) and pilot testing (n = 10) methods. Results: The translation process employed the required steps and provided specific details about the process and procedures. In addition, practical issues encountered while translating and adapting the questionnaires that may influence future translations were revealed. Conclusions: This is the first account of translating and adapting PROMs from one language to another using the good practice guidelines specific to hearing-related questionnaires. Following the rigorous procedures should ensure that the translated PROMs have linguistic and cultural equivalence to the original versions, although psychometric evaluation would remain necessary to confirm the functional equivalence.

INTRODUCTION: Despite evidence showing that tinnitus can have a detrimental impact on significant others (SOs), no standardized self-reported measure is currently available that specifically assesses the presence of third-party disability for tinnitus. The aim of this study was to develop and assess the psychometric properties of a newly developed self-reported measure for SOs of tinnitus and assess how scores could be meaningfully interpreted. METHODS: The research consisted of two phases. During Phase I, the Consequences of Tinnitus on Significant Others Questionnaire (CTSOQ) was developed using the The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Phase II included the assessment of psychometric properties of the CTSOQ including the construct validity, internal consistency, interpretability, and responsiveness. Pairs of 194 individuals with tinnitus and their SOs completed a series of online questionnaires. SOs completed the CTSOQ measure while individuals with tinnitus completed measures related to tinnitus distress, anxiety, depression, insomnia, and quality of life. RESULTS: A 25 item CTSOQ was developed using a formative model. The questionnaire validation process indicated good psychometric properties with an internal consistency of 0.93 and inter-item correlation of 0.60. Support was found for the construct and discriminative validity of the measure. Floor and ceiling effects were negligible. Scores can be meaningfully interpreted to indicate mild, significant, or severe effect of tinnitus on SOs. The questionnaire was also found to be responsive to treatment-related changes. CONCLUSIONS: The CTSOQ was found to have sufficient measurement properties suggesting that it is a suitable measure of third-party disability for SOs of individuals with tinnitus. Further research should be initiated to measure face validity and what scores reflect clinically meaningful change.

Tinnitus is experienced by as many as 50 million Americans and is clinically significant for approximately 12 million Americans. Tinnitus is often chronic and can evoke or exacerbate numerous psychological problems. No cure is available for tinnitus, thus treatment must focus on helping people learn to cope with tinnitus and its associated problems. The present study examined the efficacy of biodesensitization, biofeedback-controlled systematic desensitization, to decrease perceived tinnitus handicap, anxiety, depression, sleep difficulty, and daily assessments of distress in participants with tinnitus using a multiple-baseline design across 3 participants. The Tinnitus Handicap Inventory, Beck Depression Inventory, and Spielberger State-Trait Anxiety Inventory were administered at baseline and follow-up to determine changes in perceived handicap, depression, and anxiety. Also, the Tinnitus Monitoring Scale and Sleep Assessment Inventory were used to measure daily changes in tinnitus perception. It was hypothesized that biodesensitization therapy would produce significant decreases in participants' perceived tinnitus handicap, depression, and anxiety. It was also hypothesized that biodesensitization would yield improvements in daily and nightly tinnitus assessments. Results suggest that biodesensitization therapy related with decreases in scores on the Tinnitus Handicap Inventory and on Spielberger State-Trait Anxiety Inventory. No substantial change was observed on the Beck Depression Inventory. Results also showed a relationship between biodesensitization therapy and improvements in daily assessments of tinnitus and sleep for all participants. Findings are interpreted and future research is suggested.