Exploring the interplay of depression, sleep quality, and hearing in tinnitus-related handicap: insights from polysomnography and pure-tone audiometry.

BACKGROUND: Tinnitus affects approximately 740 million adults globally, involving hearing, emotion, and sleep systems. However, studies using polysomnography and pure-tone audiometry (PTA) are limited. We aimed to assess the correlation between tinnitus and hearing, sleep quality, characteristics, and depression using polysomnography and PTA. METHODS: In this cross-sectional study, we divided participants into tinnitus and non-tinnitus groups. We included 100 outpatients (65 with tinnitus, 35 without) from a medical center in Taiwan, who underwent polysomnography and completed rating scales including the Patient Health Questionnaire-9 (PHQ-9), Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and Chinese-Mandarin version of the Tinnitus Handicap Inventory (THI-CM). We analyzed correlations, conducted group comparisons, assessed factors related to THI-CM scores, constructed ROC curves to predict depression in the tinnitus group, and performed multinomial and logistic regression to explore associations. RESULTS: Descriptive statistics identified a cohort with mean age 53.9 ± 12.80 years, 63% exhibited PHQ-9 scores ≥ 10, and 66% had Apnea-Hypopnea Index (AHI) > 5. The ratio of rapid eye movement and deep sleep to stage 1 + 2 sleep was relatively low and non-significant. Likewise, leg movements was higher in the tinnitus group but not statistically significant. In the tinnitus group, 63.08% had depression, and 81.54% had AHI > 5. Univariate logistic regression linked tinnitus to AHI > 5 (Odds ratio (OR) 2.67, p = 0.026) and male sex (OR 2.49, p = 0.034). A moderate positive correlation was found between the THI-CM score and PHQ-9 score (rs = 0.50, p < 0.001). Further adjustment for obstructive sleep apnea showed associations between PHQ-9 (total score) or depression and THI-CM Grade 3-5 (OR = 1.28; OR = 8.68). Single- and multifactor regression analyses highlighted significant associations of PSQI scores > 13 (OR 7.06, p = 0.018) and THI-CM scores > 47 (OR 7.43, p = 0.002) with depression. CONCLUSIONS: Our study recruited tinnitus participants with slight or mild hearing loss and mild tinnitus handicap. Depression was identified as a predominant factor in tinnitus-related handicap. The mild tinnitus handicap in tinnitus participants may explain the lack of significant differences in depression, sleep quality, and polysomnographic sleep characteristics between tinnitus and non-tinnitus groups. Further extensive and prospective studies are needed to elucidate the complex links among depression, sleep, and tinnitus.

Tinnitus pitch does not always fall within the frequency range of hearing loss - a cross-sectional study on the mechanism of tinnitus production.

BACKGROUND: Clinically, we find that tinnitus patients often have hearing loss. According to the most accepted mechanism of tinnitus, that is, the spontaneous discharge and abnormal synchronization of neurons after afferent reduction, tinnitus frequency is closely related to the frequency of hearing loss. OBJECTIVE: The purpose of this study was to investigate the correlation of tinnitus pitch with the frequency of hearing loss. MATERIALS AND METHODS: A total of 500 patients with unilateral or bilateral chronic tinnitus were enrolled in this study. All patients underwent pure tone audiometry (PTA) and tinnitus acoustic examination. Hearing loss levels and frequencies were recorded. The relationship between tinnitus pitch and hearing loss level and frequency was statistically analyzed. RESULTS: Our results showed that 96.6% of the 500 tinnitus patients had hearing loss. Statistical analysis showed that low frequency (LF) tinnitus was correlated with LF hearing loss, but moderate frequency & high frequency (MF&HF) tinnitus was not significantly associated with MF&HF hearing loss. The coincidence of tinnitus pitch with the highest hearing threshold correlated with the degree of hearing loss. CONCLUSION AND SIGNIFICANCE: The vast majority of patients with chronic subjective tinnitus had hearing loss, and the frequency of tinnitus correlated with the degree and frequency of hearing loss but not exactly fall within the frequency range of hearing loss.

Confirmatory factor analysis of the Tinnitus Impact Questionnaire using data from patients seeking help for tinnitus alone or tinnitus combined with hyperacusis.

A confirmatory factor analysis (CFA) of the Tinnitus Impact Questionnaire (TIQ) was performed. In contrast to commonly used tinnitus questionnaires, the TIQ is intended solely to assess the impact of tinnitus by not including items related to hearing loss or tinnitus loudness. This was a psychometric study based on a retrospective cross-sectional analysis of clinical data. Data were available for 155 new patients who had attended a tinnitus and hyperacusis clinic in the UK within a five-month period and had completed the TIQ. The mean age was 54 years (standard deviation = 14 years). The TIQ demonstrated good internal consistency, with Cronbach's α = 0.84 and McDonald's ω = 0.89. CFA showed that two items of the TIQ had low factor loadings for both one-factor and two-factor models and their scores showed low correlations with scores for other items. Bi-factor analysis gave a better fit, indicated by a relative chi-square (χ2) of 18.5, a Root-Mean Square Error of Approximation (RMSEA) of 0.103, a Comparative Fit Index (CFI) of 0.97, a Tucker Lewis Index (TLI) of 0.92, and a Standardized Root-Mean Residual (SPMR) of 0.038. Total TIQ scores were moderately correlated with scores for the Visual Analogue Scale of effect of tinnitus on life and the Screening for Anxiety and Depression-Tinnitus questionnaire, supporting the convergent validity of the TIQ. The TIQ score was not correlated with the pure-tone average hearing threshold, indicating discriminant validity. A multiple-causes multiple-indicator (MIMIC) model showed no influences of age, gender or hearing status on TIQ item scores. The TIQ is an internally consistent tool. CFA suggests a bi-factor model with sufficient unidimensionality to support the use of the overall TIQ score for assessing the impact of tinnitus. TIQ scores are distinct from the impact of hearing impairment among patients who have tinnitus combined with hearing loss.

Impact of Migraine and Vestibular Migraine on Audiometric Profiles and Quality of Life in Patients With Tinnitus.

OBJECTIVE: To investigate the clinical manifestations and complete auditory function in primary tinnitus patients with and without migraine or vestibular migraine. DESIGN: Retrospective case-control study. SETTING: A tertiary referral center. PARTICIPANTS: This study enrolled 298 patients from the Kaohsiung Veterans General Hospital. All patients were diagnosed with primary tinnitus by a neurotologist between April 2020 and August 2021. Patients were excluded if they had histories of chronic otitis media, idiopathic sudden sensorineural hearing loss, Ménière's disease, skull base neoplasm, or temporal bone trauma. INTERVENTIONS: Twenty-five-item Tinnitus Handicap Inventory (THI), speech audiometry including speech recognition threshold, most comfortable level, uncomfortable loudness levels, dynamic range, and pure-tone audiometry. MAIN OUTCOMES MEASURES: Objective hearing loss is defined as a mean threshold greater than 25 dB. Extremely elevated THI is defined as a score greater than 1 standard deviation above the mean THI. RESULTS: Among the 298 patients with tinnitus, 149 were women and 149 were men, with a mean age of 57.06 (range, 19.22-94.58) years.A total of 125 patients completed the THI questionnaire during their initial visit. The median THI score was 32 (95% confidence interval: 13.98-56.00), and the mean score was 34.99 with a standard deviation of 21.01. The sole contributing factor significantly associated with higher total THI score was the diagnosis of migraine or vestibular migraine (p < 0.001, odds ratio = 19.41).Tinnitus patients with migraine or vestibular migraine exhibited significantly lower mean pure-tone auditory thresholds (right 22.2 versus 29.5, p = 0.002; left 22.5 versus 30.4, p < 0.001), speech recognition threshold (right 20.0 versus 25.2, p = 0.016; left 20.2 versus 25.5, p = 0.019), and most comfortable levels values (right 46.1 versus 51.4, p = 0.007; left 46.9 versus 51.4, p = 0.021) compared with the tinnitus patients without migraine. CONCLUSIONS: In this population-based study, patients with primary tinnitus experienced significantly higher THI scores and exhibited concurrent symptoms, including dizziness/vertigo, cervicalgia, and migraine or vestibular migraine. Among these parameters, the diagnosis of migraine or vestibular migraine was the sole contributor to significant higher THI score.

The Association Between Tinnitus Sensation-Level Loudness and Sleep Quality in Patients With Subjective Consecutive Tinnitus: A Mediation Analysis.

PURPOSE: So far, there have been no in-depth analyses of the connection between tinnitus sensation-level loudness and sleep quality. Accordingly, the present study was formulated as a mediation analysis focused on exploring this relationship. METHOD: Overall, 1,255 adults with consecutive subjective tinnitus who had sought outpatient treatment were enrolled in the present study. RESULTS: Direct effects of tinnitus sensation-level loudness on sleep quality were not statistically significant (95% confidence intervals [CI] include zero), as measured by the point estimate, -0.016. However, the 95% CI for indirect effects did not include zero when assessing the Self-Rating Anxiety Scale (SAS) scores, the Self-Rating Depression Scale (SDS) scores, the visual analogue scale (VAS) scores, and self-reported tinnitus annoyance. CONCLUSIONS: These results suggest that tinnitus sensation-level loudness does not directly have an effect on sleep quality. However, it indirectly impacts sleep quality, mediated by SAS scores, SDS scores, the impact of tinnitus on life measured using the VAS, and self-reported tinnitus annoyance. As such, alleviating anxiety and depression in patients with tinnitus may result in reductions in their insomnia even if there is no reduction in tinnitus loudness. Importantly, otolaryngologists and other clinicians treating tinnitus should refer patients with tinnitus suffering from insomnia with comorbid depression or anxiety for appropriate psychological and/or psychiatric treatment.

Evaluation of tinnitus in patients with Temporomandibular Disorders through Axis II of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the Tinnitus Handicap Inventory (THI).

BACKGROUND: Tinnitus is a quite common and bothersome disorder that results in a perceived sound or noise, without an external origin, often causing notable psychological distress. Some interconnections between tinnitus, bodily pain perception, and psychological well-being were previously reported, thus the relationships between tinnitus and temporomandibular joint (TMJ)-related muscle issues, resulting in somatosensory tinnitus, must be deeply investigated. This study aims to assess the prevalence of tinnitus in patients with temporomandibular disorders (TMD) and to examine the correlation between tinnitus and scales assessing the severity of TMD as well as psychological-related parameters. MATERIALS AND METHODS: In this cross-sectional study, a total of 37 adults with TMD symptoms were enrolled. Diagnostic data were collected using the Axis II of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the Tinnitus Handicap Inventory (THI) questionnaire. Statistical analysis included descriptive assessments and significance was set at p < .05. RESULTS: Individuals with tinnitus and TMD reported a significantly higher number of body pain areas, indicating a link between tinnitus and increased bodily pain perception. Tinnitus did not significantly impact TMJ-related functions. Significantly higher levels of psychological distress were observed in individuals with tinnitus, as evidenced by elevated scores in depression, generalised anxiety and somatic symptoms. CONCLUSION: Tinnitus is a complex condition with significant effects on health and well-being, requiring an interdisciplinary approach for effective evaluation and care. The study provides deep insights into the prevalence of tinnitus in TMD patients, underscoring the need for comprehensive treatment strategies addressing both TMD and tinnitus.

Standard and Extend High-Frequency Audiometry in Sudden Sensorineural Hearing Loss: Impacts on Tinnitus and Mental Health.

OBJECTIVE: To analyze the results of auditory assessment in standard (SA) and extended high-frequency (EHF) audiometry, associating the findings with sudden tinnitus and mental health of patients with unilateral sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Prospective, cohort study. SETTING: Outpatient otology clinic in a tertiary care hospital. SUBJECTS AND METHODS: Patients experiencing unilateral SSNHL were evaluated with pure-tone audiometry performed at frequencies of 250 to16,000 Hz, tinnitus pitch and loudness matching tests, Tinnitus Handicap Inventory (THI), Analog and Visual Scale (AVS) for bothersome tinnitus, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Eighteen patients with unilateral SSNHL were assessed. After starting treatment, there was a significant improvement in the SA (71.1 dB to 50 dB; p < 0.001*) and EHF audiometry (64.5 dB to 54.4 dB; p < 0.001*) thresholds at 15 days, and this persisted at 30 days of follow-up. Significant improvements were seen for tinnitus in loudness, VAS, and THI and for mental health in the realms of anxiety and depression by HADS. Despite improvements in SA, persistent EHF hearing loss was accompanied by persistent tinnitus, but it was of diminished loudness. CONCLUSION: Despite improvement in pure-tone thresholds by SA, a subset of unilateral SSNHL patients did not experience hearing recovery in EHF thresholds and reported persistent tinnitus. We postulate that their diminished anxiety and better mental health may be related to both hearing improvement in standard audiometry and reduction in tinnitus loudness. This pilot prospective study investigates the utility of performing EHF audiometry to better understand outcomes in patients with SSNHL.

Impact Of Sensorineural Hearing Loss On Subjective Tinnitus Quality In Patients With Bilateral Tinnitus.

INTRODUCTION: Tinnitus is a frequent condition that indicates the sensation of sound in the absence of a corresponding external stimulus and can significantly impair the quality of life. The main risk factor for developing tinnitus is hearing loss. The diagnosis of tinnitus is based on history, assessment of tinnitus severity, clinical examination, and audiological tests. The main purpose of this research was to examine the relationship between the presence and level of hearing loss and the characteristics of tinnitus in patients with bilateral subjective tinnitus. METHODS: Total number of 50 participants, 20 men, and 30 women were included in the research. Demographic data, data on hearing impairment obtained by tone audiometry, and data on difficulties caused by tinnitus obtained in two questionnaires - Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI) were used. RESULTS: Age above 30 years is significantly associated with tinnitus with hearing loss. Hearing impairment is also significantly more often associated with an auditory TFI index >6.7, a total THI index >20, and an emotional THI index >3. Hearing loss was noted in 76% of patients. CONCLUSION: Tinnitus represents a significant burden for patients, therefore it is important to assess the impact of tinnitus on daily activities and quality of life.

The Impact of Sleep Quality on Cognitive Function in Patients with Chronic Subjective Tinnitus.

BACKGROUND: The aim of this study was to explore the impact of sleep quality on cognitive function in patients with chronic subjective tinnitus. METHODS: The Pittsburgh Sleep Quality Index (PSQI) and the Montreal Cognitive Assessment Scale (MoCA) were used to assess sleep quality and cognitive function in patients with chronic subjective tinnitus, sleep disorder patients (SD), and normal controls (NC). The tinnitus evaluation questionnaire (TEQ) and tinnitus loudness were used to assess the severity in patients with chronic subjective tinnitus. Tinnitus patients were divided into two groups based on PSQI results: "tinnitus with sleep disorder (TwSD)" and "tinnitus without sleep disorder (TnSD)." The MoCA scores in TwSD and TnSD groups were compared with those in SD and NC groups, and the correlation between PSQI, TEQ, tinnitus loudness, and MoCA scores in subjective tinnitus patients were analyzed. RESULTS: Whether TwSD group or TnSD group, the MoCA score was significantly lower than those in the NC group and SD group. Meanwhile, there was no significant difference between TwSD and TnSD groups in MoCA score, and PSQI, TEQ, and tinnitus loudness were not significantly correlated with MoCA. CONCLUSION: Subjective tinnitus may be an independent risk factor for cognitive impairment. The underlying neural mechanisms between subjective tinnitus, sleep disorders, and cognitive impairment need to be further explored and clarified.

Prevalence of hearing loss, tinnitus, vertigo and sudden deafness among patients with polymyositis and dermatomyositis.

Little is known about a possible association of autoimmune inner ear disease among patients diagnosed with polymyositis (PM)/dermatomyositis (DM). This study aimed to explore differences in the prevalence of inner ear symptoms among patients with and without PM/DM using a nationwide population-based dataset. Data for this study were retrieved from the Taiwan National Health Insurance Research Database. The study sample included 1622 patients diagnosed with PM/DM and 8109 propensity-score matched comparison patients without PM/DM. We performed multivariate logistic regressions to calculate odds ratios (ORs) and 95% confidence interval (CI) for tinnitus, hearing loss, sudden deafness, and vertigo among patients with PM/DM versus comparison patients. Chi-square tests showed statistically significant differences between patients with PM/DM and comparison patients in the prevalence of tinnitus (16.1% vs. 12.7%, p < 0.001), non-conductive hearing loss (9.2% vs. 6.8%, p < 0.001), and vertigo (14.4% vs. 11.1%, p < 0.001). The adjusted ORs for tinnitus, non-conductive hearing loss, and vertigo, respectively, were 1.332 (95% CI = 1.147-1.547), 1.399 (95% CI = 1.154-1.696), and 1.374 (95% CI = 1.173-1.611) for patients with PM/DM when compared to comparison patients. Our study finds that patients with PM/DM have higher prevalence rates of tinnitus, non-conductive hearing loss, and vertigo than comparison patients.

Intermediate Cervical Plexus Block in the Management of Refractory Somatosensory Tinnitus Following Whiplash: Prospective Series in 30 Patients.

OBJECTIVE: Whiplash-associated disorder comprises of a constellation of persistent symptoms after neck trauma. Tinnitus that develops postwhiplash is termed somatosensory tinnitus. The objective is to assess the role of intermediate cervical plexus block (iCPB) in patients with somatosensory tinnitus secondary to whiplash. METHODS: Prospective service evaluation in adults with whiplash-associated disorder and concomitant somatosensory tinnitus. Patients underwent specialist otorhinolaryngology review before pain clinic referral. Patients were offered ultrasound-guided iCPB with steroids. Intensity of tinnitus was recorded on a numerical rating scale at baseline, 3 and 6 months posttreatment. Brief Pain Inventory Short Form and Hospital Anxiety Depression Scale questionnaires were also completed. RESULTS: Over a 36-month period, 32 patients with refractory somatosensory tinnitus following whiplash were offered iCPB(s). Two patients refused because of needle phobia. iCPB(s) was performed in 30 patients as an outpatient procedure. One patient (1/30, 3.3%) was lost to follow-up. Twenty-three patients (23/30, 77%) reported clinically significant reduction in intensity of tinnitus at 3 months postprocedure. Nineteen patients (19/30, 63%) reported ongoing benefit at 6-month follow-up. Six patients failed to report any benefit (6/30, 20%). CONCLUSION: The cervical plexus could play a significant role in the development of somatosensory tinnitus after whiplash. iCPB may have a role in the management of somatosensory tinnitus in this cohort.

Isolated bilateral tinnitus after spinal anesthesia: A case report.

Rarely, endolymphatic hydrops may occur after spinal anesthesia due to the perforation of the dural membrane and a decrease in cerebrospinal fluid pressure. Consequently, auditory complications such as tinnitus and hearing loss may arise. Tinnitus can be accompanied by headache and hearing loss. In this case report, isolated bilateral tinnitus, which occurred in the early intraoperative period and spontaneously regressed in a patient who underwent bilateral tubal ligation under spinal anesthesia, is presented.

Association of anatomical features of the petrotympanic fissure and presence of foramen of Huschke with otalgia and tinnitus.

The petrotympanic fissure (PTF) and foramen of Huschke (FH) are anatomical structures in the temporal bone that can connect the temporomandibular joint (TMJ) and the ear. The purpose of this retrospective study was to investigate the association between PTF morphology and otalgia and tinnitus, as well as the prevalence of the FH and otological symptoms, using cone beam computed tomography (CBCT). CBCT images from 114 patients presenting with symptoms of a temporomandibular disorder were examined retrospectively. The PTF was classified into three subtypes (open, semi-open, closed) and the presence of the FH was identified. Symptoms of otalgia and tinnitus were obtained from the patient files. The FH was observed in 12.3% of patients examined, and in 12.0% of those with otalgia and 18.9% of those with tinnitus. There was no significant association between the PTF subtypes or the presence of the FH and otalgia or tinnitus (all P > 0.05). The PTF subtype and presence of the FH alone do not appear to contribute to otalgia or tinnitus in patients with temporomandibular disorders.

The association of subjective and objective sleep measures with chronic tinnitus.

STUDY OBJECTIVES: Poor sleep is a prevalent complaint in the population with chronic tinnitus, but the relationship between the two is not well-characterized. The objective of this study was to understand how subjective and objective measures of sleep compare in patients with or without chronic tinnitus. METHODS: This prospective cohort study included consecutive adult patients who presented to a sleep laboratory between January 19, 2017, and January 10, 2020. All patients underwent an in-laboratory nocturnal polysomnogram and filled out questionnaires including the Pittsburgh Sleep Quality Index (PSQI), Tinnitus Screener, and Tinnitus Handicap Inventory, among others. RESULTS: The study included 1,968 participants, out of which 284 (14.4%) reported chronic tinnitus. Patients with chronic tinnitus were younger (51.6 years vs 54.1 years; P < .05) and more likely female (16.4% vs 11.7%; P < .005). They demonstrated worse subjective sleep quality (PSQI: 11.3 vs 9.5; P < .0005) and increased sleepiness (Epworth Sleepiness Scale: 9.8 vs 8.6; P < .005). In the objective sleep parameters only the total sleep time was increased in chronic tinnitus (311.5 vs 294.5 minutes; P < .05) and total arousals were decreased (41.7 vs 47; P < .005). Sleep stage N3 was higher in those with chronic tinnitus (14.9% vs 13.0%; P < .05). In multivariable analyses, as PSQI increases the odds of chronic tinnitus increases. This effect was modified by age: In those younger than 55 years of age, the odds of the presence of chronic tinnitus was 1.10 (95% confidence interval, 1.03, 1.17) times higher as PSQI increased. CONCLUSIONS: Chronic tinnitus is associated with significant changes in qualitative sleep (higher PSQI) but no major differences in quantitative sleep measures were observed. CITATION: Weingarten JA, Islam A, Dubrovsky B, Gharanei M, Coelho DH. The association of subjective and objective sleep measures with chronic tinnitus. J Clin Sleep Med. 2024;20(3):399-405.

Prevalence of Hyperacusis Diagnosis in Veterans Who Use VA Healthcare.

OBJECTIVES: The primary objective was to estimate the prevalence of hyperacusis diagnosis in treatment-seeking Veterans, paying attention to when it is diagnosed in conjuncture with common comorbid conditions. DESIGN: This retrospective observational study used Veteran electronic health records from January 2015 to July 2021. Hyperacusis and comorbid conditions were identified using International Classification of Disease diagnostic codes. RESULTS: The prevalence of hyperacusis diagnosis was 0.06%. Veterans diagnosed with tinnitus, posttraumatic stress disorder, headache, or traumatic brain injury were between two and seven times more likely to have an International Classification of Disease code for hyperacusis. CONCLUSIONS: The estimated prevalence of hyperacusis diagnosis using electronic health records is grossly below what is reported in the literature. This is likely due to lack of standardized methods to diagnosis hyperacusis and when present with comorbid conditions, uncertainty when it should be coded as a secondary diagnosis. Future clinical and research efforts prioritizing hyperacusis are desperately needed.

Resurfacing Dehiscence(s) Without Reducing Diverticulum Effectively Silences Pulsatile Tinnitus: Novel Surgical Techniques for Diverticulum and Intraoperative Microphone Monitoring.

OBJECTIVE: To emphasize the surgical importance of addressing dehiscence over diverticulum in resolving pulsatile tinnitus (PT) in patients with sigmoid sinus wall anomalies (SSWAs) and investigate anatomical differences. STUDY DESIGN: Retrospective data analysis. SETTING: Multi-institutional tertiary university medical centers. PATIENTS: Fifty participants (dehiscence/diverticulum, 29:21 cases) with SSWA-associated PT were included in the study. All 21 diverticulum participants underwent surgical intervention. INTERVENTIONS: 1) Surgical intervention with novel techniques monitored by intraoperative microphone. 2) Radiologic and ophthalmologic imaging methods. MAIN OUTCOME MEASURES: Quantitative and qualitative preoperative and postoperative alterations of PT and anatomical differences between dehiscence and diverticulum. RESULTS: Addressing dehiscence overlying diverticulum and sigmoid sinus wall dehiscences significantly reduced visual analog score and Tinnitus Handicap Inventory ( p < 0.01). Sinus wall reconstruction led to substantial PT sound intensity reduction in the frequency range of 20 to 1000 Hz and 20 to 500 Hz (paired-sample t test, p < 0.01). Diploic vein analysis showed a significant positive correlation in 85.7% of the diverticulum cohort compared with the dehiscence cohort ( p < 0.01). Eight percent of the participants exhibited papilledema, which was limited to the dehiscence cohort. CONCLUSION: 1) Effective reduction of PT can be achieved by addressing all dehiscences, including those overlying the diverticulum, without the need to exclude the diverticulum. 2) Diploic vein may involve in the formation of diverticulum, and loss of dura mater and vascular wall thickness are observed at the SSWA locations.

Initial Response to Combination Therapies for Tinnitus: Lessons Learned From a Retrospective Analysis.

OBJECTIVE: To investigate the initial reduction of tinnitus effects by combining common therapies applicable in general otology clinics and establishing optimal treatment strategies. STUDY DESIGN: Retrospective cohort study. SETTING: A tertiary university hospital. PATIENTS: Patients with nonpulsatile subjective tinnitus who visited the hospital between January and December 2022. INTERVENTIONS: Combination therapies consisting of at least one of the directive counseling based on the neurophysiological model, hearing aids, medication, and/or neuromodulation were performed. MAIN OUTCOME MEASURES: Tinnitus Handicap Inventory (THI) questionnaire at both their initial visit and 1-month follow-up. RESULTS: A total of 151 patients were enrolled. THI improvement of 20 points or more was observed in 31.8% of participants. One-way analysis of variance revealed that counseling had a significant reduction in THI, whereas neuromodulation, medication, and hearing aids did not. THI improvement was significantly associated with received counseling, severity of initial THI, and mean loudness discomfort level. Hearing aids and neuromodulation were not significant prognostic factors for improvement. CONCLUSION: Counseling alone is the best treatment for most patients with tinnitus. There will be other patients with tinnitus that, in addition to counseling, would benefit from hearing aids, medications, and/or certain forms of neuromodulation.

Clinical Features of Non-Lateralized Tinnitus.

BACKGROUND: We aimed to analyze and confirm the clinical features of patients with non-lateralized tinnitus and to identify clues that can be used in their management. METHODS: Data from 469 patients who visited a university hospital complaining of tinnitus between March 2020 and December 2021 were reviewed. The patients' medical histories, Tinnitus Handicap Inventory, Beck Depression Inventory, and numerical rating scale scores on tinnitus awareness, annoyance, loudness, and effect on life, audiological profiles, and quantitative electroencephalography findings were documented. RESULTS: Forty-nine (10.4%) patients had non-lateralized tinnitus. They were older and had a shorter duration of symptoms (13.91 ± 34.16 months) than patients with bilateral tinnitus (duration: 39.15 ± 80.82 months) (P -lt; .05). The accompanying symptoms, Tinnitus Handicap Inventory scores, and numerical rating scale scores were not significantly different between the 2 groups (P -gt; .05). Patients with non-lateralized tinnitus had worse hearing at 12 kHz on the left side than those with unilateral tinnitus. Hearing asymmetry was least common in non-lateralized tinnitus (n=11/49, 10.4%), followed by bilateral tinnitus (n=54/198, 42.2%) and unilateral tinnitus (n=97/222, 47.3%) (P-lt; .001). Regarding quantitative electroencephalography, there were significant differences in the absolute power of the theta, alpha, beta, gamma, and total frequency bands based on tinnitus lateralization (P -lt; .001). CONCLUSION: Non-lateralized tinnitus can be perceived in elderly patients with symmetric and extended high-frequency hearing loss before habituation is achieved at an early stage of tinnitus. However, there was no difference in the questionnaire scores and accompanying symptoms; therefore, it may not be worth managing non-lateralized tinnitus separately from tinnitus in the ear.

Chiari Type 1 Malformation: An Unusual Cause of Tinnitus.

Chiari Malformations are a group of conditions defined in 1891 with 5 degrees being described. These malformations present with several symptoms such as cervical protrusion and are associated with hydrocephalus. Also, they can also present with different clinical signs and symptoms, such as deafness and tinnitus. We present a case of a 45-year-old man with unilateral tinnitus evaluated in otolaryngology office. No other symptoms on otolaryngological physical exam were detected in the audiogram performed it was described a significant unilateral sensorineural hearing loss. During the study of this patient, Magnetic Resonance Imaging was requested, showing a type I Chiari malformation. The patient was then observed by Ophthalmology, Neurology, and Neurosurgery. No other neurological symptoms of malformation Chiari syndrome or cranial nerve abnormalities were presented at the respective exam. The surgical management of these pathologies takes into account an adequate CSF and venous blood flow - that was seen in this patient, therefore, there was no surgical indication for decompression. The patient maintains its follow-up in the otolaryngology, neurology, and neurosurgery office, and tinnitus was minimized after prosthetic adaptation was recommended to optimize the quality of life, which was achieved.

Temporomandibular treatments are significantly efficient in improving otologic symptoms.

Symptoms of temporomandibular disorders (TMD) could be present as otologic symptoms like earache and dizziness in some patients. In most cases, these symptoms are not recognized because otolaryngologists fail to diagnose TMD as a source of the problem. This investigation was conducted to evaluate the effect of TMD treatments on the otologic symptoms which after taking history and clinical examinations seemed to be related to TMD. In the present study, the patients who were complaining of otalgia, ear fullness, tinnitus, hearing loss, and dizziness were evaluated by an ear fellow. Forty patients who had no known otologic or other primary causes to explain their symptoms, were referred to the orofacial pain clinic with the possible diagnosis of TMD. If the diagnosis was confirmed by an orofacial pain specialist, a combination of TMD treatments was administered to each case and the patients were followed up. The results showed that following implementation of treatment protocols for TMD, more than 50% of the patients reported complete or partial recovery in the second follow-up (p < 0.05). The most common otologic symptom of the referred cases was earache, and the most common associated complaint was neck pain. All the patients had one or more parafunctional habits. This study showed that TMD treatments were significantly efficient in improving otologic symptoms partially or completely and the authors concluded that for the patients with otolaryngologic unexplained symptoms, an overhaul examination is needed to assess TMD as a possible cause of the patient complaint. It is recommended that in cases with unexplained otologic symptoms, otolaryngologists care more about the neck trigger points (TP) and ask about the patient's parafunctional habits. Otolaryngologists and dentists need to be aware of the risk of developing otologic symptoms caused by these habits or cervical TPs.