碩士 / 國立臺北護理健康大學 / 語言治療與聽力研究所 / 107 / Background: The connection between psychology and tinnitus is important. The aim of this topic is to investigate the relationship between personality, hearing status and tinnitus. Material & Method: Patients with Sudden Sensorineural Hearing Loss (SSNHL) were recruited in Taipei Veterans General Hospital. All patients underwent steroid treatment and then follow-up for 3 months. The evaluation included standardized questionnaires, such as: personality: Big Five Inventory (BFI-44); tinnitus: Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS); emotion: Hospital Anxiety and Depression Scale (HADS) and hearing status: Pure Tone Audiometry (PTA). According to the THI scores, we divide patient into two groups: high impact (THI>=38) and low impact (THI<=36). And we also according to their hearing status, divide patient into two groups: recovery and non-recovery group. Mann-Whitney U test was used to analyze the difference between the two groups with personality traits. Hierarchical Regression Analysis was used to analyze the interaction with personality and hearing status to tinnitus. Results: In hospitalization, third-three patients were recruited it the study, however, high impact group (N= 17) were significant different with low impact group (N= 16) on the Neuroticism (p=0.020), anxiety (p<0.001), depression (p<0.001), loudness (p=0.009). But, there are no significant difference on the age (p= 0.149), sex (p= 0.373), PTA (p=0.090) and lesion side (p= 0.909). The correlation result shown that Neuroticism has significant positive correlation with tinnitus stress (r=0.561, p= 0.001). After 3 months’ follow up, thirty patient finished this study, but the only significant difference was shown on the Neuroticism (p<0.001) between recovery group (N= 16) and non-recovery (N= 14). After Hierarchical Regression Analysis, Neuroticism and hearing recovery were significant interaction effect for tinnitus stress (p=0.043). Conclusion: Personality will affect the acute tinnitus stress in our SSNHL patients. After 3 months’ follow-up, Neuroticism still effect tinnitus stress in the hearing recovery group, but for the non-recovery patients, there are no effect between personality and tinnitus.

碩士 / 國立台北護理學院 / 聽語障礙科學研究所 / 94 / The neurophysiological model postulates that the limbic and autonomic nervous systems are involved in mechanisms responsible for emergence of tinnitus and hyperacusis, meanwhile hyperacusis was considered as “pre-tinnitus status”. The purpose of the present study was to clarify the neurophysiological mechanism of tinnitus and hyperacusis. The premise of the study is to gain the highest spatial resolution, the most robust responses, and the shortest experimental time in high scanner noise environment of fMRI. It is a concern about the cortical activation regions of tinnitus and hyperacusis patients elicited by auditory stimulation using BOLD functional MRI. We use (1) 5 normal controls to investigate the cortical activation of different auditory stimuli (classical music, ocean waves, engineer noise, white noise and 1000Hz pure tone), different matrix sizes (64×64, 128×128) and different intensity to get the most optimal fMRI parameters and auditory stimulus in pilot study, (2) 12 normal controls to explore the activation regions of white noise binaurally , (3) 3 tinnitus and hyperacusis patients to probe the activation regions of white noise binaurally. The result of this qualitative pilot study demonstrated that the most optimal parameters were the white noise, 128×128 matrix size and 80-curve when compared to other auditory stimuli. Since white noise stimulation elicited activation of bilateral Heschl’s gyrus (HG) in normal controls. Under uniformed white noise stimuli, the first tinnitus patient revealed activation among multiple brain areas including HG, but not the limbic system. However, parahippocampal gyrus was activated during auditory stimulation in both the second and the third hyperacusis patients. These results suggest that the cortical activation patterns in response to loud sound are abnormal in tinnitus and hyperacusis patients. Our results were consistent with the neurophysiological model of tinntius and hyperacusis.

碩士 / 中國醫藥大學 / 中西醫結合研究所碩士班 / 100 / Background It is estimated that approximately 20% of adults suffer from tinnitus at some point in their lives; further, approximately a quarter of these individuals have severe tinnitus, which affects their daily activities. Moreover, medications for the treatment of tinnitus have not been successful. Only drugs that improve sleep quality or that have an antidepressant or anti-anxiety effect have been proved to be useful. However, these drugs have several side effects such as the risk of dependency on these drugs. Among herbal medicines, Chai Hu Jia Long Gu Mu Li Tang is the most preferred; it is widely used for tinnitus as it improves emotional health and sleep quality. In this study, we have aimed to establish the basic clinical efficacy and safety data for the use of Chai Hu Jia Long Gu Mu Li Tang in adult patients with chronic tinnitus. Methods This study was a randomized, open-label, controlled trial. Twenty-four adult patients with constant tinnitus who had suffered from tinnitus for more than 3 months were included in this study. Participants in the experimental group were administered western medicine in addition to the Chinese herbal formula, Chai Hu Jia Long Gu Mu Li Tang; whereas, those in the control group were administered only western medicine. The primary outcome measures that were included were the Tinnitus Handicap Inventory, Pittsburgh Sleep Quality Index, and visual analogue scale. The secondary outcome measures to be included were pure tone audiometry and speech reception threshold. Results Ten of the 12 participants in the experimental group and 11 of the 12 in the control group completed the study. Based on the Tinnitus Handicap Inventory and Pittsburgh Sleep Quality Index, the outcome of the experimental group was statistically superior to that of the control group. There was no significant difference between the groups regarding the visual analogue scale. However, 80%–90% of the experimental group participants experienced a reduction in the loudness and annoyance of their tinnitus; whereas, less than 60% of the control group participants showed improvement. Conclusion This study reveals that individuals who suffered from chronic tinnitus benefitted from the combined treatment with western medicine and the Chinese herbal formula, Chai Hu Jia Long Gu Mu Li Tang. However, these results were influenced strongly by the placebo effect. Further double-blinded, placebo-controlled trials are required to validate these results.

碩士 / 靜宜大學 / 食品營養研究所 / 99 / Salicylates, also known as aspirin, is known to induce tinnitus. However, the mechanism of generation of tinnitus induced by salicylate is still unclear. Tinnitus is a non-observable phantom sensation, and had no effective treatment until now. Spirulina platensis showed good antioxidant capacity, anti-inflammation and neuroprotective effect. The purpose of this study was to examine the effects of Spirulina platensis on salicylate-induced tinnitus in senescence accelerated prone mice (SAMP8), and evaluated the related gene expression of antioxidative, anti-inflammatory and ion channels. Three-month- old SAMP8 mice were randomly divided into three experimental groups, including normal control, tinnitus group with intrperitoneal injection of salicylate (300 mg/Kg BW), and Spirulina platensis (1000 mg/Kg BW) with salicylate injection tinnitus groups. The active avoidance test were performed during the last nine days of feeding period. After sacrificed, the serum biochemical parameters were analyzed and superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and Heme oxygenase-1 (HO-1) 、K+-Cl- cotransporter 2 (KCC2)、Na+-K+-2Cl- cotransporter 1(NKCC1)、5-hydroxytryptamine 2B recrptor (5-HT2B receptor) mRNA expsression of brainstem, hippocampus, temporal lobe, frontal lobe and inner ear were examined. The results showed that correct response score did not significantly different after salicylate injection while the number of false positive response was drastic increase, and spirulina platensis administration could improve the conscious tinnitus. There were not significant differences on GOT, GPT, BUN and creatinine levels among three groups. Salicylate inhibited the CAT mRNA expression and induced the over-expression of SOD mRNA in brain stem, hippocampus, temporal lobe, frontal lobe and inner ear. Spirulina platensis supplementation could increase the CAT mRNA expression and lower the SOD mRNA over-expression when compare with the salicylate only group. Spirulina platensis also could decrease the KCC2 mRNA over-expression in hippocampus, temporal lobe, frontal lobe and inner ear, whereas the difference did not found in the area brain stem. However, there were not significant differences on the GPx , HO-1, NKCC1 and 5-HT2B receptor mRNA expression among three groups. In summary, we concluded that Spirulina platensis could improve the salicylate-induced conscious tinnitus in SAMP8 mice. The mechanism might relate to promote the antioxidantive defense system and reduce the over-expression of KCC2 mRNA.

碩士 / 中國醫藥大學 / 職業安全與衛生學系碩士在職專班 / 106

碩士 / 國立臺北護理健康大學 / 聽語障礙科學研究所 / 102 / Tinnitus can be described as the perception of sound in the absence of external acoustic stimulation. The size of the tinnitus population in the United States is nearly 30 million or about 10% of their entire population and the incidence of tinnitus are as high as 26.7% for people ages 65-84 years. Within that population, 75 to 80 percent of patients with hearing loss may experience tinnitus symptoms. In this study, patients with hearing loss and tinnitus are evaluated to distinguish factors associated with the effectiveness of hearing aid use. Thirty four subjects were recruited between March and November 2013, at Mackay Memorial Hospital ENT outpatient department. Pure tone thresholds were assessed at 500, 1000, 2000 and 4000 Hz. Subjects with pure tone loss between 40dBHL with less 91dBHL were included in the study. These subjects experienced tinnitus symptoms with the use of hearing aids for at least three months. The study utilized questionnaires to survey the factors associated with the effectiveness of hearing aids use by subjects with hearing loss and tinnitus. Subjects received both Tinnitus Handicap Inventory and the Chinese version of State-Trait Anxiety Index. The study also used the SPSS 19 statistical software packages for descriptive statistics. Statistical analysis methods used include Chi-square test, Pearson correlation coefficient, Spearman Rank Correlation and simple linear regression analysis. The Pearson chi-square test was used to determine correlation of the lengths of time in which the hearing aids were in use by subjects with tinnitus symptoms. The significance value of .027 and Spearman Rank Correlation of .591(p=.000) were observed. The moderately positive correlation and the linear regression analysis showed that the average daily time of use for tinnitus hearing aids improve the symptoms have an explanatory power of 27.2%(p=.002), an explanatory power of statistical significance; THI and STAI-T Pearson correlation coefficient analysis of .633(p=.000) were also observed, reaching a moderate positive correlation. STAI-T predict THI with 43.9% of the explanatory power, F=25.065, p=.000, the explanatory power of statistical significance. The results of this study suggested that among patients with hearing loss, with the use of hearing aids, about 65% may exhibit improvements of tinnitus. In addition, it was observed that a prolonged period of hearing aid use produces higher improvements. Through the use of STIA-T, patient anxiety levels are assessed to predict the validity extent of THI. It was found that the patients with higher STAI-T scores also consumed higher THI scores.

碩士 / 國立高雄師範大學 / 溝通障礙教育研究所 / 93 / The purposes of the study were to investigate 1) the effect of tinnitus upon normal hearing people’s speech recognition performance, 2) relationships among patients’ self-rating tinnitus loudness, Tinnitus Handicap Inventory (THI) score, and speech recognition test scores, and 3) test-retest reliability of Chinese THI. Two groups of normal hearing subjects were included in the study, 20 with tinnitus and 20 without. Phonetically balanced speech recognition (PB) test was administered in the quiet. SPIN was tested in +6dB S/N (56 dB speech vs. 50dB noise) and 0dB S/N (50 dB speech vs. 50dB noise). Self-rating tinnitus loudness scale and THI were performed on subjects of tinnitus group. Results were as follows. 1) No significant difference was observed between subjects with and without tinnitus in PB scores (in quiet), HP scores and LP scores of SPIN test for +6dB S/N (p>.05). However, significant differences were found between these two groups in HP scores and LP scores of SPIN test for 0dB S/N (p<.05). Normal group revealed no significant difference between +6dB S/N and 0dB S/N for HP scores. So did LP scores (p>.05). Tinnitus group showed significant differences between +6dB S/N and 0dB S/N, both for HP scores and LP scores (p<.05). 2) No significant relationship was observed among patients’ self-rating tinnitus loudness, THI scores, and speech recognition tests (p>.05). 3) High test-retest reliability of Chinese THI scores was shown from this research (p<.05). It reveals that tinnitus subjects could not use context cues in poor listening environment (0 dB S/N) and they perform quite well and do not need contextual cues if the speech is 6 dB above the noise level. In order to improve tinnitus people’s communication, strategy and support from the communication partners’ are strongly recommended.

Patienten mit unbehandeltem Vestibularisschwannom (T1-3) zeigen keine geringere Lebensqualität auf als die gesunde Normalbevölkerung. Tinnitus und Schwindel beeinflussen die Lebensqualität signifikant negativ und sind nicht abhängig von der Tumorgrösse. Diese Erkenntnisse rechtfertigen eine abwartende Haltung bei kleinen, wenig symptomatischen Vestibularisschwannomen.:Inhaltsverzeichnis Abkürzungsverzeichnis 1. Einführung 1.1. Definition des Vestibularisschwannoms 1.2. Historie 1.3. Epidemiologie 1.4. Symptome und Lokalisation 1.5. Diagnostik des Vestibularisschwannoms 1.6. Therapie des Vestibularisschwannoms 1.7. Studienpopulation 1.8. Fragebögen und Untersuchungstechniken 1.9. Statistische Methoden 2. Ziel der Untersuchungen 2.1. Lebensqualität 2.2. Fragestellung 3. Publikationsmanuskript 4. Zusammenfassung der Arbeit 5. Literaturverzeichnis 6. Anlagen 7. Darstellung des eigenen Beitrags 8. Selbstständigkeitserklärung 9. Publikation 10. Danksagung

碩士 / 國立臺北護理健康大學 / 語言治療與聽力研究所 / 104 / Introduction: The physiological mechanisms of tinnitus and spontaneous cochlear mechanical activity may be related, but the underlying cause is complicated and still unknown. Previous studies of outer hair cells’ known mechanical activities related to otoacoustic emissions have indicated that the pathological activity of these cells is linked to tinnitus. This study focused on studying the contralateral suppression of distortion product optoacoustic emissions (DPOAEs) in tinnitus patients with normal pure-tone thresholds but elevated thresholds of extended high-frequency audiograms. Materials and Methods: A case-controlled study was carried out with 56 participants from the outpatient clinic of the ENT Department of the Tri-Service General Hospital, Taipei. None of the participants had any history of ear disease or vertigo episodes. All subjects initially underwent pure-tone audiometry (tested frequency range: 2508,000 Hz) and extended high-frequency audiometry (9,00014,000 Hz); they were then divided into a normal control group and a patient group. Normal controls had no complaint of tinnitus and normal hearing thresholds on the extended high-frequency audiogram (HFA;  25 dB HL at 911.2 kHz and  40 dB at 12.514 kHz), while patients reported a history of tinnitus for more than 6 months. Patients with tinnitus were further subdivided into two groups according to the hearing threshold of extended HFA: Group 1 (G1) presented normal hearing thresholds of extended HFA, and Group 2 (G2) presented abnormal elevated hearing thresholds of extended HFA. The DPOAEs were evaluated by means of the Bio-logic Scout OAE system in an acoustically insulated room using two pure-tone signals labeled f1 and f2, with an f2/f1 ratio equal to 1.22. The L1 stimulus intensity level was 65 dB SPL, while the L2 level was 55 dB SPL. The tested frequency range of f2 was 750–8,013 Hz, and three frequencies were sampled per octave. For each ear, the baseline distortion product (DP) amplitudes were measured first, and second, the DP amplitudes in response to 60 dB SPL broadband noise presented to the contralateral ear were determined. Data analyses were performed using the DP-gram, geometric mean of frequency f1 and f2, and DP amplitudes with and without contralateral suppression. Estimates of the contralateral DPOAE suppression effect were calculated by subtracting the signal/noise ratio acquired without the contralateral noise from the value of the noise/signal ratio with contralateral noise for each specific frequency. Positive values indicated DPOAE suppression, and negative values or zero indicated nonsuppression. Results: There was no significant variation in the thresholds between the right and left ears by group. In quiet conditions, the DP amplitudes in the control group were significantly higher than those in the tinnitus groups (G1 and G2), especially at frequencies of 7,250 Hz and 1,027 Hz in the left ear and 4,756 Hz, 4,196 Hz, 3,418 Hz, 2,378 Hz, 2,122 Hz, and 1,818 Hz in the right ear. Regarding the contralateral suppression effect, the DP amplitude in the control group was still significantly higher than the amplitudes in the tinnitus groups were, especially at frequencies of 7,250 Hz, 5,479 Hz, and 1,608 Hz in the left ear and 1,889 Hz in the right ear. There was a significant decrease in the suppression of DP amplitudes at high frequency in the tinnitus groups compared to that in controls. Conclusions: Tinnitus patients tend to present abnormal extended high-frequency audiometry, suggesting that a defect in the outer hair cells may be involved in the mechanism of tinnitus. In contrast, the decrease in the DP amplitude of the contralateral suppression effect and the diminished presence of the suppression effect in the tinnitus groups may suggest that there is a correlation between diminished effectiveness of the medial olivocochlear bundle and the presence of tinnitus.

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2012. / Submitted by Albânia Cézar de Melo (albania@bce.unb.br) on 2013-02-20T14:20:04Z No. of bitstreams: 1 2012_HelgaMouraKehrle.pdf: 2266423 bytes, checksum: 4d887f8ee40b17ed148c4b94e937d58e (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2013-02-20T16:00:08Z (GMT) No. of bitstreams: 1 2012_HelgaMouraKehrle.pdf: 2266423 bytes, checksum: 4d887f8ee40b17ed148c4b94e937d58e (MD5) / Made available in DSpace on 2013-02-20T16:00:08Z (GMT). No. of bitstreams: 1 2012_HelgaMouraKehrle.pdf: 2266423 bytes, checksum: 4d887f8ee40b17ed148c4b94e937d58e (MD5) / Introdução: O zumbido é um sintoma em que uma sensação auditiva ocorre sem a presença de um estímulo acústico externo. É mais comum em pacientes com algum grau de perda auditiva, porém pode estar presente em aproximadamente 10 a 20% das pessoas com audição normal. O incômodo causado pelo zumbido tem sido associado a distúrbios de ansiedade e depressão, com destaque ao papel das disfunções cognitivas na sua percepção e interpretação. Existem evidências da participação do sistema nervoso auditivo central e de intercâmbios com o córtex pré- frontal, com o sistema límbico e com outras áreas corticais, que podem estar envolvidas no mecanismo central do processamento dos sinais auditivos, da emoção e da atenção em pacientes com zumbido, indicando a coparticipação desses sistemas na percepção do zumbido. Objetivos: A proposta desta pesquisa é analisar o incômodo do zumbido em pacientes sem perda auditiva e correlacionar os achados com os transtornos de ansiedade e depressão e os potenciais evocados auditivos do tronco encefálico (PEATE). Foram selecionados 84 pacientes com zumbido e 47 indivíduos sem zumbido, com idade entre 18 a 48 anos e limiar auditivo menor ou igual a 25dB nas frequências entre 250 a 8.000Hz. Foi realizada a avaliação do incômodo zumbido com o Tinnitus Handicap Inventory (THI), dos níveis de ansiedade e depressão com as Escalas de Beck e o exame do PEATE. Resultados: Entre os 84 pacientes do Grupo Estudo, encontramos 35,7% de exames alterados em pelo menos um dos sete parâmetros avaliados, porém apenas a diferença interaural na latência da onda V teve diferença significativa entre os dois grupos. A maioria dos pacientes do Grupo Estudo apresentou zumbido não incomodativo ou incomôdo leve e em torno de 64,28% apresentaram distúrbios do sono. Nos pacientes com zumbido foram evidenciados sintomas de ansiedade e depressão em 48,8 % e 41,7 %, respectivamente, com diferença estatística significante quando comparados com o Grupo Controle. O incômodo do zumbido não mostrou correlação com os resultados dos PEATEs e com o tempo de zumbido, mas com a presença de ansiedade e depressão. Observamos que, quanto maior o escore para ansiedade e depressão, maior o incômodo do zumbido. Observamos ainda que não houve diferença entre os pacientes do Grupo Estudo com PEATEs normais e alteradas em relação à ansiedade e à depressão, concluindo que os PEATEs não se alteram na presença ou na ausência de ansiedade e depressão. Conclusões: Por fim, parece que o incômodo do zumbido pode ser desencadeado e interpretado por áreas corticais e subcorticais de forma semelhante entre pacientes com e sem perda auditiva. As condições cognitivas e psicológicas são questões que merecem atenção na avaliação e no manejo de pacientes com zumbido. ______________________________________________________________________________ ABSTRACT / Introduction: Tinnitus is a symptom in which a hearing sensation occurs without the presence of an external acoustic stimulus. This symptom is more common in patients with some degree of hearing loss, but may be present in approximately 10-20% of people with normal hearing. The discomfort caused by tinnitus has been associated with anxiety and depression disorders, with emphasis on the role of cognitive dysfunctions in their perception and interpretation. There is evidence of involvement of the central auditory nervous system and interrelation with the prefrontal cortex , the limbic system and other cortical areas, which may be involved in the mechanism of central processing of auditory signals, emotion and attention in patients with tinnitus, indicating the co-participation of these areas in the perception of tinnitus. Objective: The purpose of this research is to analyze the annoyance of tinnitus in patients without hearing loss and to correlate the findings with anxiety disorders and depression and auditory brainsteam response (ABR). Pacients and Method: We selected 84 patients with tinnitus and 47 patients without tinnitus, with ages ranging from 18 to 48 years old and hearing threshold less than or equal to 25 dB at frequencies between 250 and 8000Hz. We conducted the evaluation of tinnitus annoyance with the Tinnitus Handicap Inventory (THI), levels of anxiety and depression with the Beck Scales and examination of ABR. Results: Among the 84 patients in the study group, we found 35.7% of abnormal tests in at least one of the seven parameters tested, however only the difference in the interaural wave V latency in patients with unilateral tinnitus was significant difference between the study and control group. Most patients in the study group had mild or very mild tinnitus and around 64.28% had sleep disturbances. In patients with tinnitus was evidenced symptoms of anxiety and depression in 48.8% and 41.7% respectively, which was statistically significant when compared with the control group. The discomfort of tinnitus showed no correlation with the results of ABR and the time since tinnitus onset, but it showed correlation with the presence of anxiety and depression. We found that the higher the score for anxiety and depression, the greater the discomfort of tinnitus. We also observed that there was no difference between the patients in the study group with normal or altered ABR results and anxiety and depression, concluding that the ABR does not change in the presence or absence of anxiety and depression. Conclusions: Finally, it seems that the discomfort of tinnitus can be triggered and interpreted by cortical and subcortical areas in a similar way, by patients with and without hearing loss. Cognitive and psychological conditions are issues that deserve attention in the evaluation and management of patients with tinnitus.