Multidisciplinary assessment of patients with musical hallucinations, tinnitus and hearing loss.

BACKGROUND: Although auditory hallucinations are considered a psychopathological phenomenon, musical hallucinations have been reported in individuals without psychosis but with auditory symptoms (tinnitus and/or hearing loss). Thus, a possible different cognitive functioning may be involved in musical hallucinations. The aim of the study was to characterize patients with tinnitus and musical hallucinations through a multidisciplinary assessment, allowing a better understanding of these concomitant phenomena. SAMPLING AND METHODS: As this sample is rare to find, all consecutive patients with tinnitus, hearing loss and musical hallucinations were included over a 3-year period, excluding those unable to respond. All subjects underwent the following assessments: (1) otolaryngological and audiological assessment (physical examination and audiometry), (2) neurological assessment (cognition, electroencephalogram and imaging examination) and (3) psychiatric assessment (structured interview). RESULTS: A total of 16 patients were included (87.5% women; mean age 61.43 ± 15.99 years). The otolaryngological examination was normal in all cases, but audiometry revealed that the degree of hearing loss was severe to profound in 68.75% of participants. Neurological assessment showed electroencephalogram changes in only 17.6% of cases, while 25% presented with mild attention deficit and 43.75% had small foci of gliosis or ischemia on the imaging examination. Psychiatric assessment showed that 68.75% of cases had depression, 6.25% had anxiety disorder and 25% had no psychiatric conditions. CONCLUSIONS: Musical hallucinations were strongly associated with female elderly adults and with mood disorders. Thus, in contrast to common auditory hallucinations, patients with musical hallucinations associated with tinnitus and hearing loss should be offered a more multidisciplinary assessment.

Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: a multi-clinic prevalence study.

UNLABELLED: Tonic tensor tympani syndrome (TTTS) is an involuntary, anxiety-based condition where the reflex threshold for tensor tympani muscle activity is reduced, causing a frequent spasm. This can trigger aural symptoms from tympanic membrane tension, middle ear ventilation alterations and trigeminal nerve irritability. TTTS is considered to cause the distinctive symptoms of acoustic shock (AS), which can develop after exposure to an unexpected loud sound perceived as highly threatening. Hyperacusis is a dominant AS symptom. Aural pain/blockage without underlying pathology has been noted in tinnitus and hyperacusis patients, without wide acknowledgment. This multiclinic study investigated the prevalence of TTTS symptoms and AS in tinnitus and hyperacusis patients. This study included consecutive patients with tinnitus and/or hyperacusis seen in multiple clinics. DATA COLLECTED: Symptoms consistent with TTTS (pain/numbness/burning in and around the ear; aural "blockage"; mild vertigo/nausea; "muffled" hearing; tympanic flutter; headache); onset or exacerbation from exposure to loud/intolerable sounds; tinnitus/hyperacusis severity. All patients were medically cleared of underlying pathology, which could cause these symptoms. 60.0% of the total sample (345 patients), 40.6% of tinnitus only patients, 81.1% of hyperacusis patients had ≥ 1 symptoms (P < 0.001). 68% of severe tinnitus patients, 91.3% of severe hyperacusis patients had ≥ 1 symptoms (P < 0.001). 19.7% (68/345) of patients in the total sample had AS. 83.8% of AS patients had hyperacusis, 41.2% of non-AS patients had hyperacusis (P < 0.001). The high prevalence of TTTS symptoms suggests they readily develop in tinnitus patients, more particularly with hyperacusis. Along with AS, they should be routinely investigated in history-taking.

Treatment options for subjective tinnitus: self reports from a sample of general practitioners and ENT physicians within Europe and the USA.

BACKGROUND: Tinnitus affects about 10-15% of the general population and risks for developing tinnitus are rising through increased exposure to leisure noise through listening to personal music players at high volume. The disorder has a considerable heterogeneity and so no single mechanism is likely to explain the presence of tinnitus in all those affected. As such there is no standardized management pathway nor singly effective treatment for the condition. Choice of clinical intervention is a multi-factorial decision based on many factors, including assessment of patient needs and the healthcare context. The present research surveyed clinicians working in six Westernized countries with the aims: a) to establish the range of referral pathways, b) to evaluate the typical treatment options for categories of subjective tinnitus defined as acute or chronic, and c) to seek clinical opinion about levels of satisfaction with current standards of practice. METHODS: A structured online questionnaire was conducted with 712 physicians who reported seeing at least one tinnitus patients in the previous three months. They were 370 general practitioners (GPs) and 365 ear-nose-throat specialists (ENTs) from the US, Germany, UK, France, Italy and Spain. RESULTS: Our international comparison of health systems for tinnitus revealed that although the characteristics of tinnitus appeared broadly similar across countries, the patient's experience of clinical services differed widely. GPs and ENTs were always involved in referral and management to some degree, but multi-disciplinary teams engaged either neurology (Germany, Italy and Spain) or audiology (UK and US) professionals. For acute subjective tinnitus, pharmacological prescriptions were common, while audiological and psychological approaches were more typical for chronic subjective tinnitus; with several specific treatment options being highly country specific. All therapy options were associated with low levels of satisfaction. CONCLUSIONS: Despite a large variety of treatment options, the low success rates of tinnitus therapy lead to frustration of physicians and patients alike. For subjective tinnitus in particular, effective therapeutic options with guidelines about key diagnostic criteria are urgently needed.

Total remission or persistence of tinnitus and decreased sound level tolerance in adolescents with normal audiograms: A follow-up study.

BACKGROUND: Tinnitus may reflect hidden cochlear synaptic injury that does not express in the audiogram, but leads to neuroplastic changes in auditory pathways that, in turn, reduce tolerance to sounds. Such injury may follow the exposure to loud sounds. The aim of this study was to follow-up adolescents enrolled in a private school to evaluate the prevalence of tinnitus and reduced sound level tolerance (SLT) with 1-year interval, as well as to observe rates of tinnitus persistence, remission and incidence of new cases by repeat measurements. METHODS: In Study 1 (Sanchez et al., 2016), we evaluated 170 adolescents by a questionnaire about tinnitus and reduced tolerance to ordinary sounds and by measurements in a sound booth: audiometry (0.25-16kHz), Loudness Discomfort Levels (LDL, 0.5-4kHz) and tinnitus pitch/loudness matching (if present). Tinnitus measured in the booth was then called "confirmed tinnitus." In Study 2, we revaluated 54 adolescents who returned voluntarily 1 year later to repeat all measurements. RESULTS: From Study 1 to 2, the prevalence of confirmed tinnitus reduced from 28.8% (49/170) to 14.9% (8/54) in retested subjects, which includes the cases of persisting tinnitus (confirmed tinnitus in both studies, n=6/54=11.2%) and the new cases of tinnitus (confirmed tinnitus just at Study 2, n=2/54=3.7%). Among the 15 adolescents with confirmed tinnitus at Study 1 who returned for Study 2, 40% had persistent tinnitus (n=6) and 60% did not (remitted tinnitus, n=9). SLT was reduced by 17.3dB in cases with persistent tinnitus (P<0.0002), similar to the findings of Study 1, and returned to normal levels in subjects with remitted tinnitus. Hearing thresholds averaged 4.37dBHL and were <20dBHL in 97% of ears and all frequencies. At 14 and 16kHz thresholds were bilaterally elevated at Study 1 (5.07dB) and 2 (5.56dB) in adolescents with confirmed tinnitus. CONCLUSIONS: Tinnitus and reduced sound tolerance could feature early signals of hidden synaptic injury that is prevalent among adolescents and hidden from the audiogram. The strong relationship between both symptoms, in addition to low-level increases in hearing thresholds at high frequencies in the extended audiogram, poses a challenge for future hearing health and should be further evaluated as a possible intrinsic vulnerability for lesions following exposure to loud sounds. Moreover, the relationship between their spontaneous remissions may signal a possible synaptic repair, which has been reported in animal models.

Long-lasting total remission of tinnitus: A systematic collection of cases.

BACKGROUND: Clinical observation suggests that total remission of tinnitus may exist, but a systematic analysis of these cases is missing. We aimed to identify subjects with long lasting total remission of tinnitus. METHODS: By publishing announcements, we included volunteers of any gender and age who have had daily perception of tinnitus for over 3 months and have been in total remission (lack of tinnitus perception, even in silence and with deliberate attention to it) for over 6 months. We excluded individuals in a state of habituation or masking. We applied a structured interview to standardize information about tinnitus and its remission. Follow-up interviews took place after 6, 12, and 18 months. RESULTS: Eighty individuals (56 females; age=54.2±16.8 years) were included. History of bilateral tinnitus accounted for 51.4% of cases. Total remission occurred in subjects whose tinnitus lasted for 49.0±73.5 months. Remission occurred gradually in 78.6% of cases and suddenly in 22%. During the further 18-month follow-up, 7.9% reported recurrence of tinnitus and 92.1% remained symptom free. CONCLUSION: Different than the knowledge obtained from clinical trials, this study showed that long-lasting total remission of tinnitus may occur. This status was reached by individuals of any gender and age range, with any location and duration of tinnitus, mostly as a gradual process. Future studies should better clarify how each treatment modality may achieve the best results.

Tinnitus and tinnitus disorder: Theoretical and operational definitions (an international multidisciplinary proposal).

As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: "Tinnitus" for the former and "Tinnitus Disorder" for the latter. The proposed definition then becomes "Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder "when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.". In other words "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder.

Influence of cochlear function on auditory temporal resolution in tinnitus patients.

Our aim was to analyze the influence of subtle cochlear damage on temporal auditory resolution in tinnitus patients. Forty-eight subjects (hearing threshold

Transcranial direct current stimulation improves tinnitus perception and modulates cortical electrical activity in patients with tinnitus: A randomized clinical trial.

OBJECTIVES: This study aims to determine whether transcranial direct current stimulation (tDCS): a) is effective in the treatment of tinnitus by decreasing its annoyance and severity; b) modulates the cortical electrical activity of such individuals. METHODS: A double-blind, placebo-controlled clinical trial was conducted with 24 patients with tinnitus, randomized into two groups: Group 1 (n = 12) received anodal tDCS over the left temporoparietal area (LTA) and cathodal tDCS over the right dorsolateral prefrontal cortex (DLPFC) and Group 2 (n = 12) received placebo intervention. Tinnitus perception using a visual analog scale (VAS) and the Tinnitus Handicap Inventory (THI) questionnaire, in addition to electroencephalogram (EEG) was measured with eyes opened and closed at baseline and after the intervention. For the treatment, patients were subjected to five consecutive sessions of tDCS with the anodal electrode over the LTA and cathodal electrode over the right DLPFC (7 × 5 cm, 2 mA for 20 min). tDCS was turned off after 30 s in the sham group. RESULTS: Active tDCS significantly improved tinnitus annoyance and severity. It was associated with decreased beta and theta EEG frequency bands with eyes opened and decreased alpha frequency with eyes closed. sLORETA identified changes in frequency bands in the frontal, temporoparietal, and limbic regions. Finally, there were negative correlations between baseline EEG frequency bands and tDCS-induced change in tinnitus annoyance and severity. CONCLUSIONS: These results demonstrate that tDCS modulates the EEG activity and alleviates tinnitus perception. This effect may be related to baseline EEG activity.

Selective auditory attention and silence elicit auditory hallucination in a nonclinical sample.

INTRODUCTION: Several investigations have shown that the occurrence of auditory hallucinations (AH) is not restricted to neuropsychiatric patients. The aim of this study is to analyse the effect of attention and sustained silence on the emergence of AH in a nonclinical sample. METHODS: Sitting in a silent sound booth, 66 adults were studied under different attention demands and then where asked about their auditory perception. RESULTS: While performing a Hanoi Tower in silence, 10.6% of the individuals had hallucination-like perceptions (music, voices, and others). This rate decreased to 6.0% during a visual attention task, but highly increased to 36.4% during auditory attention. CONCLUSIONS: Auditory hallucinations may occur in a nonclinical population in a silent environment. Concomitant auditory attention increases both the quantity and the quality of those perceptions.

Evaluation of selective attention in patients with misophonia.

INTRODUCTION: Misophonia is characterized by the aversion to very selective sounds, which evoke a strong emotional reaction. It has been inferred that misophonia, as well as tinnitus, is associated with hyperconnectivity between auditory and limbic systems. Individuals with bothersome tinnitus may have selective attention impairment, but it has not been demonstrated in case of misophonia yet. OBJECTIVE: To characterize a sample of misophonic subjects and compare it with two control groups, one with tinnitus individuals (without misophonia) and the other with asymptomatic individuals (without misophonia and without tinnitus), regarding the selective attention. METHODS: We evaluated 40 normal-hearing participants: 10 with misophonia, 10 with tinnitus (without misophonia) and 20 without tinnitus and without misophonia. In order to evaluate the selective attention, the dichotic sentence identification test was applied in three situations: firstly, the Brazilian Portuguese test was applied. Then, the same test was applied, combined with two competitive sounds: chewing sound (representing a sound that commonly triggers misophonia), and white noise (representing a common type of tinnitus which causes discomfort to patients). RESULTS: The dichotic sentence identification test with chewing sound, showed that the average of correct responses differed between misophonia and without tinnitus and without misophonia (p=0.027) and between misophonia and tinnitus (without misophonia) (p=0.002), in both cases lower in misophonia. Both, the dichotic sentence identification test alone, and with white noise, failed to show differences in the average of correct responses among the three groups (p≥0.452). CONCLUSION: The misophonia participants presented a lower percentage of correct responses in the dichotic sentence identification test with chewing sound; suggesting that individuals with misophonia may have selective attention impairment when they are exposed to sounds that trigger this condition.

Myofascial trigger point:a possible way of modulating tinnitus.

In order to investigate whether myofascial trigger points can modulate tinnitus, as well as the association between tinnitus and myofascial trigger points, 94 individuals with and 94 without tinnitus, matched by age and gender, were analyzed by means of bilateral digital pressure of 9 muscles. Temporary modulation of tinnitus was frequently observed (55.9%) during digital pressure, mainly in the masseter. The rate of tinnitus modulation was significantly higher on the same side of the myofascial trigger point subject to examination in 6 out of 9 muscles. An association between tinnitus and the presence of myofascial trigger points was observed (p < 0.001), as well as a laterality association between the ear with the worst tinnitus and the side of the body with more myofascial trigger points (p < 0.001). Thus, this relationship could be explained not only by somatosensory-auditory system interactions but also by the influence of the sympathetic system.

Influence of silence and attention on tinnitus perception.

OBJECTIVE: The purpose of this study was to study the effect of attention and sustained silence on the emergence of auditory phantom perception in normal-hearing adults. STUDY DESIGN: Cross-sectional survey. SUBJECTS AND METHODS: While sitting in a sound booth, 66 volunteers (age range, 18-65; mean age, 37.3) performed 3 experiments of 5 minutes each, consecutively and randomly presented. Two deviated attention from auditory system (Hanoi and visual attention experiments), and 1 drove attention to the auditory system (auditory attention). After each experiment, participants were asked about their auditory and visual perception. No sound or light change was given at any moment. RESULTS: Of the participants, 19.7% experienced tinnitus during Hanoi, 45.5% during visual attention, and 68.2% during auditory attention experiment, with no significant differences for studied variables. CONCLUSION: Tinnitus-like perceptions may occur in a nonclinical population in a silent environment. Concomitant auditory attention plays an important role on the emergence of tinnitus.

Familial misophonia or selective sound sensitivity syndrome : evidence for autosomal dominant inheritance?

INTRODUCTION: Misophonia is a recently described, poorly understood and neglected condition. It is characterized by strong negative reactions of hatred, anger or fear when subjects have to face some selective and low level repetitive sounds. The most common ones that trigger such aversive reactions are those elicited by the mouth (chewing gum or food, popping lips) or the nose (breathing, sniffing, and blowing) or by the fingers (typing, kneading paper, clicking pen, drumming on the table). Previous articles have cited that such individuals usually know at least one close relative with similar symptoms, suggesting a possible hereditary component. OBJECTIVE: We found and described a family with 15 members having misophonia, detailing their common characteristics and the pattern of sounds that trigger such strong discomfort. METHODS: All 15 members agreed to give us their epidemiological data, and 12 agreed to answer a specific questionnaire which investigated the symptoms, specific trigger sounds, main feelings evoked and attitudes adopted by each participant. RESULTS: The 15 members belong to three generations of the family. Their age ranged from 9 to 73 years (mean 38.3 years; median 41 years) and 10 were females. Analysis of the 12 questionnaires showed that 10 subjects (83.3%) developed the first symptoms during childhood or adolescence. The mean annoyance score on the Visual Analog Scale from 0 to 10 was 7.3 (median 7.5). Individuals reported hatred/anger, irritability and anxiety in response to sounds, and faced the situation asking to stop the sound, leaving/avoiding the place and even fighting. The self-reported associated symptoms were anxiety (91.3%), tinnitus (50%), obsessive-compulsive disorder (41.6%), depression (33.3%), and hypersensitivity to sounds (25%). CONCLUSION: The high incidence of misophonia in this particular familial distribution suggests that it might be more common than expected and raises the possibility of having a hereditary etiology.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group.

INTRODUCTION: Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life. OBJECTIVE: To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds. METHODS: Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described. RESULTS: The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results. CONCLUSION: A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.

Hyperacusis, sound annoyance, and loudness hypersensitivity in children.

The objective of the present study was to estimate the prevalence of hyperacusis among school-aged children. We define hyperacusis as lowered loudness discomfort levels (LDL) associated with an abnormal annoyance to sounds. We used questionnaires, interviews, and estimates of LDL in a study of 506 children from 5 to 12 years of age from 15 different schools. Participants with LDL in the lowest 5th percentile were classified as having loudness hypersensitivity; an abnormal annoyance to sounds if they responded "yes" to the question "Are you bothered by any kind of sounds or noise?" could describe the sound, and were able to identify at least 10 sounds from a list of 20 as being annoying. Phonophobia was defined as a fear of sound. Children with LDL in the lowest 5th percentile typically had LDLs lower than 90 dB HL; 42% of the participants in this group were bothered by sounds and 3.2% had hyperacusis. Fifty percent of the participants with hyperacusis had tinnitus and mild hearing loss in the left ear was an associated risk factor. Phonophobia was experienced by 9% of the children. It is concluded that hyperacusis in children is prevalent, and should be considered in clinical examinations.

Tinnitus in children and associated risk factors.

The objective of the study was to estimate the prevalence of tinnitus and explore the risk factors in school-aged children age 5-12 years. For that we asked "Do you hear a noise inside your ears/head?" and required children to be able to describe the sounds perceived and their location. We refer to this as tinnitus sensation. Additionally, we asked "Does it bother or annoy you?" and "In what situations does it bother or annoy you?" to determine if this experience was bothersome. We refer to this as tinnitus annoyance. Associations to demographic and audiological factors were studied. Approximately 37% of children reported tinnitus sensation and 17% reported tinnitus annoyance. Related factors were age, hearing loss, and history of noise exposure, motion sickness and hyperacusis. Estimates of the prevalence of tinnitus clearly depend on how tinnitus is defined. In the present study, participants were asked "Do you hear a noise inside your ears/head?" but we did not make distinctions regarding the duration or character of their tinnitus. Our estimates of tinnitus annoyance were also broad, and did not attempt to quantify the degree of annoyance.

Myofascial trigger points: another way of modulating tinnitus.

Tinnitus is a multifaceted symptom that may have many causes (otologic, neurological, metabolic, pharmacological, vascular, musculoskeletal and psychological) several of which often occur in the same patient. Tinnitus can often be modulated by different kinds of stimuli. In this chapter we describe the results of a study of modulation of tinnitus from stimulation of myofascial trigger points (MTPs). MTPs are small hypersensitive areas in palpable taut bands of skeletal muscles found in patients with the myofascial pain syndrome where stimulation of MTPs causes local and referred pain. We found a strong correlation between tinnitus and the presence of MTPs in head, neck and shoulder girdle (p<0.001). In 56% of patients with tinnitus and MTPs, the tinnitus could be modulated by applying digital compression of such points, mainly those of the masseter muscle. The worst tinnitus was referred to the side that had the most MTPs (p<0.001); Compression of the trigger point on the same side as the tinnitus was significantly more effective than the opposite side in six out of nine of the studied muscles. Compression of MTPs was most effective in patients who have had chronic pain earlier in the examined areas.

Endonasal approach of salpingopharyngeus muscle for the treatment of ear click related to palatal tremor.

Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.

Somatic modulation of tinnitus: test reliability and results after repetitive muscle contraction training.

OBJECTIVES: We sought to study the reliability of tinnitus modulation by muscle contractions and to observe the effect of their prolonged repetition. METHODS: Thirty-eight patients with tinnitus underwent 9 maneuvers of muscle contractions in test and retest situations. After a 2-month training period of repeating the maneuvers, tinnitus modulation and daily perception were evaluated. RESULTS: There was no difference between the occurrence of tinnitus modulation in test (57.9%) and retest (63.2%) situations. After 2 months, the occurrence of modulation during the maneuvers was similar (55.3%), but a new pattern showed an increase in tinnitus improvement and a decrease in tinnitus worsening. The daily perception of tinnitus was unchanged. CONCLUSIONS: Maneuvers of head and neck muscle contractions evoked tinnitus modulation in a frequent and reliable manner. Also, the repetition of such maneuvers for 2 months altered the pattern of modulation.

The efficacy of open molds in controlling tinnitus.

UNLABELLED: Hearing aids may be a option to improve tinnitus and hearing loss. AIM: to evaluate tinnitus after one month use of BTE hearing aids with open molds and pressure vent molds in patients with symmetric sensorineural hearing loss. METHODS: 50 patients seen at our Tinnitus Clinic who presented bilateral tinnitus and hearing loss underwent a randomized blind crossover clinical trial: 26 first used BTE hearing aids with open molds, and the remaining 24 first used pressure vent molds. After 30 days using the first mold and a wash-out period, the type of earmold was changed and was applied for another 30-day-period. Tinnitus evaluation was done qualitatively (improved, unchanged and worsened) and quantitatively (variation on a numeric scale from 0 to 10). RESULTS: 82% of the cases reported improvement of tinnitus with at least one type of earmold; there was no significant difference in the reduction of discomfort due to tinnitus in the quantitative and qualitative evaluations. Although similar tinnitus control was obtained with both methods, 66% of the patients preferred the open mold. CONCLUSION: In a short-term evaluation improvement of tinnitus by the use of hearing aids does not depend on earmold ventilation.