Profiling intermittent tinnitus: a retrospective review.

Objective: We conducted a retrospective review of medical records of tinnitus patients at a tertiary ENT clinic in Groningen, Netherlands. Our goal was to identify factors that differentiated the intermittent subgroup from the larger continuous group with chronic tinnitus. Design: Tinnitus-related factors such as hearing loss, emotional aspects, and demographics were used to advance our understanding of the subgroups. We analysed the data using descriptive statistics and binomial logistic regression, supplemented by random forests classification. Study sample: Patients presenting with tinnitus visiting the tinnitus clinic. We examined 1575 medical intake records obtained at a tertiary ENT hospital. Results: Duration, total Tinnitus Handicap Inventory (THI), and THI Functional subscale scores differed significantly between the two groups. Increasing age and higher THI Emotional subscale scores were associated with an increased likelihood of intermittent tinnitus. Increases in duration, depressive scores and THI Functional and Catastrophic subscale scores, decreased the likelihood of intermittent tinnitus. Conclusions: Results from this study dissociate the factors affecting those with intermittent and those with continuous tinnitus and point to potentially different mechanisms underlying the two conditions.

Tinnitus Holistic Simplified Classification (THoSC): A New Assessment for Subjective Tinnitus, With Diagnostic and Therapeutic Implications.

OBJECTIVE: One of the most debated topics in tinnitus is its standard and practical classification. The most popular classification distinguishes subjective from objective tinnitus. Other classifications are based on different features. On the whole, they seem incomplete, and the diagnostic and therapeutic algorithms are often difficult for practical purposes. The aim of this work is to develop a new diagnostic and therapeutic algorithm. METHODS: Our model is based on 10 years of experience. In particular, the starting point is the data retrieved from 212 consecutive patients in our Tinnitus Unit between May and December 2013: We found a clear auditory disorder in 74.5% of the population, muscolo-skeletal disorders and/or trigeminal disease in 57.1%, and psychiatric comorbidities in 43.8%. Different features coexisted in 59.9% of the population. RESULTS: Following such data we propose the Tinnitus Holistic Simplified Classification, which takes into account the different tinnitogenic mechanisms and the interactions between them. It differentiates tinnitus that arises from: (1) auditory alterations (Auditory Tinnitus), (2) complex auditory-somatosensory interactions (Somatosensory Tinnitus), (3) psychopathological-auditory interactions (Psychopathology-related Tinnitus), and (4) 2 or all of the previous mechanisms (Combined Tinnitus). CONCLUSIONS: In our opinion this classification provides an accurate and easy tailored path to manage tinnitus patients.

Validation of the Greek version of Mini Tinnitus Questionnaire as a Brief Screening Test for Assessment of Tinnitus-related Distress: our experience in 301 adult patients.

OBJECTIVES: Validation of the Greek version of Mini Tinnitus Questionnaire (Mini-TQ-GR) as a Brief Screening Test for Assessment of Tinnitus-related Distress. DESIGN: Questionnaire study. SETTING: 401 General Military Hospital of Athens/Department of Audiology - Neurootology, Athens, Greece. PARTICIPANTS: Three hundred and one participants have anonymously completed the Mini-TQ-GR, comparing it to the Perceived Stress Scale (PSS 14) and Multidimensional Health Locus of Control Scale (MΗLoC) from November 2013 until May 2014. MAIN OUTCOME MEASURE: Mini-TQ-GR, compared to PSS 14 and MΗLoC. RESULTS: Factor analysis, has shown that the Mini-TQ-GR includes three main factors (Distress, Health pre-occupation and Depression), which explains the 59.05% of the total variance. The Cronbach alpha index was 0.865 approaching the respective reliability factor of the original validation (0.9). The test-retest correlation (intraclass correlation coefficient) was 0.9 (P < 0.01), close to the results of the original study (0.89). We found a positive correlation between tinnitus and perceived stress (r = 0.349**) and negative correlation between tinnitus and external locus of control (r = -0.124*, r = -0.198**) (chance, others). CONCLUSIONS: This study demonstrated that the Mini-TQ-GR has good internal consistency and reliability becoming a useful, validated measurement tool for tinnitus-induced distress.

[The Königsteiner Empfehlung of 2012 - essential alterations and modifications]. / Die Königsteiner Empfehlung von 2012 - Wesentliche Neuerungen und Änderungen.

BACKGROUND: Since 1974, the recommendation for assessment of hearing impairment caused by noise - formerly known as "Königsteiner Merkblatt" (now: "Königsteiner Empfehlung") - has been representing the state of the art for the assessment of the occupational disease BK-No. 2301. It was updated several times, the last time in 2012. It provides a summary of the current medical knowledge. A new measurement for the entire working life - the Effective Noise Dose by Liedtke - was introduced. Otoacoustic emissions (OAE) are now the crucial tests in order to detect a hair cell dysfunction. As from now the tinnitus has to be put under a more comprehensive examination. On the strength of post experience the previous speech audiometry (Freiburger Test) is reliable, it was retrained. In future the indication for hearing aids will be oriented towards the aid guidelines of the legal health insurance. The questionnaire for the expert opinion was revised and the fee was adapted.

[Expert opinion of ORL for private accident insurance]. / HNO-ärztliche Begutachtung für private Unfallversicherungen.

The provisions and the aims of private accident insurance are not comparable to those of the statutory accident insurance. The ear nose throat- (ENT-)specialist is often consulted on the question of a possible causality between an accident and sequelae. Loss of smell, taste disorder and loss of hearing are specified in a table with a fixed percentage for compensation. The individual invalidity for ear ringing, vertigo and other disorders have to be determined separately from this table. In private accident insurance a probability bordering on absolute certainty must be given when establishing a possible causal connection whereby mental reactions are excluded from compensation and all sequelae have to have continued for at least 3 years. The occupation or specific skills of the injured person are not essential for the judgement. The current jurisdiction and conditions of private accident insurance for tinnitus and vertigo have to be taken into consideration.

[Expert assessment of tinnitus in statutory accident insurance]. / Die Bewertung von Tinnitus in der gesetzlichen Unfallversicherung.

Tinnitus is defined as hearing sensation without external noise source. The aetiology contains also occupational causes such as noise industrial pollution and inner ear trauma, nevertheless the origin of tinnitus is vastly unexplained. For the expert assessment in the public insurance a step-by-step procedure is recommended: Is there a tinnitus? Was the accused cause able to provoke tinnitus? How profound is the insured person hindered in his individual work ability by the tinnitus and potential psycho vegetative reactions? In this publication hints for tinnitus-matching and for expert opinion related questions are given: is there a noise-caused tinnitus in the low frequencies? Is it possible that a noise-induced tinnitus worsens after retirement? Can stress be a potential candidate to evoke tinnitus? Under which circumstances a psychiatric assessment can be necessary? In the assessment of tinnitus crucial differences between public accident insurance, civil right, public health and handicap right are explained.

Medicolegal aspects of neurotology.

In their professional capacity, physicians interact with the legal profession in a variety of ways. The interaction occurs most often in the situation where an individual suffering from a bodily injury seeks the recovery of monetary benefits through the legal system. This article reviews the manner in which physicians are contacted by attorneys in connection with workers' compensation cases and civil tort cases. It will also set forth various definitions of disability and contrast those definitions with the concept of impairment as that term is used in the medical profession. Suggestions for patient evaluation and a summary of the legal basis for the recovery of benefits are also presented.

[The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire]. / Tinnitus-Fragebogen (TF). Standardinstrument zur Graduierung des Tinnitusschweregrades. Ergebnisse einer Multicenterstudie mit dem Tinnitus-Fragebogen (TF).

The clinical examination of patients with severe and chronic tinnitus must include associated psychological disturbances. The present paper describes traditional diagnostic methods of ENT practice as well as the Tinnitus Questionnaire (TQ) which has been evaluated in a number of studies. This instrument differentiates between emotional and cognitive distress, auditory perceptual difficulties and self-experienced intrusiveness produced by the tinnitus. The results of a German multicenter study are presented which show that the TQ can be used to demonstrate differences of tinnitus distress under different clinical conditions (e.g., ENT clinic vs psychosomatic clinic and in- vs out-patient care). The TQ can be employed for comparative studies in different tinnitus-related institutions and for the evaluation of the relative effects of different treatment approaches.

Tinnitus classification: medical audiologic assessment.

Medical-audiologic assessment for tinnitus classification is essentially an attempt to objectivize the subjective complaint. An attempt is made to classify the symptom by a pattern of test results including: 1. Audiologic test findings; 2. Vestibular test findings; 3. Tinnitus description, by frequency spectrum and intensity level; 4. Residual inhibition, both its presence or absence, and its duration; 5. Masking-curve data and typing of homolateral and contralateral curves of narrow band and pure tone where applicable. The collection of these data is necessary to establish etiology in terms of the medical site of the lesion, audiological site, and tinnitus site. The audiologist and the otologist must work together to establish the proper diagnosis and develop the most effective treatment for the patient who presents tinnitus as the chief complaint.