Sound therapy in patients with tinnitus: traditional sound generators vs. mobile apps.

OBJECTIVE: Tinnitus Retraining Therapy (TRT) is a rehabilitation approach for tinnitus that is currently considered an effective treatment with an elevated response rate. TRT is usually delivered through sound generators; however, they are often difficult to find and expensive. Recently, mobile apps have been proposed for TRT. This study aims to verify the effectiveness of TRT performed using mobile apps in reducing the adverse effects of tinnitus on the quality of life. PATIENTS AND METHODS: A total of 80 patients affected by tinnitus in category 0 (mild tinnitus) and category 1 (moderate tinnitus), according to the Jastreboff classification, were included in the study. Patients of both classes were subsequently differentiated into two homogeneous groups; the first (Group A) was treated with a traditional sound generator, and the second (Group B) using a mobile app. The Tinnitus Handicap Inventory - the Italian version of the questionnaire - was used to investigate the impact of tinnitus on the quality of life in enrolled patients and evaluate their response to TRT. RESULTS: A significant improvement was found in THI scores in category 0 patients for both sound generator and mobile app groups; no difference was found between the two-treatment delivery technology (-1.186, p=0.783); conversely, tinnitus improvements in category 1 patients were only reported for subjects treated using a sound generator (-14.529, p<0.001), while no significant improvement was found in patients treated using the mobile app. CONCLUSIONS: This study confirms the value of TRT, which in patients with mild tinnitus (category 0), can also be delivered through mobile apps with results comparable to traditional sound generators. Further studies are necessary to confirm the effects of the different tinnitus treatments available and improve the knowledge on this topic.

Effect of acupuncture intervention time on the therapeutic effect in patients with sudden hearing loss. / é’ˆåˆºä»‹å ¥æ—¶æœºå¯¹çªå‘æ€§è‹æ‚£è€ ç–—æ•ˆçš„å½±å“.

OBJECTIVES: To observe the clinical efficacy of acupuncture intervention at different time for patients with sudden hearing loss. METHODS: According to the timing of acupuncture intervention, 86 patients were divided into early exposure group (n=43) and late exposure group (n=43) . The early exposure group was given acupuncture treatment within 14 days of onset, and the late exposure group was given acupuncture treatment after 14 days of onset. After propensity score matching (PSM, a statistical matching technique for observational data) processing by using SPSS26.0 software, outcomes of 30 cases in the early exposure group and 30 cases in the late exposure group were analyzed. In addition to receiving basic treatment with drugs for vascular dilatation, thrombolysis, nourishing nerve, etc., all patients of the two groups were treated with neck acupuncture ("Neck Seven Meridian Lines" acupuncture), once every other day except Sundays, for a total of 12 time. Before, after the treatment and 3 months after the treatment, the total score of the Tinnitus Handicap Inventory (THI, 0, 2 and 4 points for each of the 25 items, total scores = 100 points) scale was used to evaluate the improvement of tinnitus symptoms caused by hearing loss. The clinical therapeutic effect was evaluated according to the efficacy grading criteria in the Guidelines for Diagnosis and Treatment of Sudden Deafness (2015) and the changes of pure tone audiometry curve. Multivariate Logistic regression was used to analyze the effect of factors that might influence efficacy before propensity score matching. RESULTS: The THI scores of patients in both groups decreased strikingly after the treatment and 3 months' follow-up (P<0.05). Compared with the same time-points of the late exposure group, the total THI scores of post-treatment and 3 months' follow-up were evidently lower in the early exposure group (P<0.05). The effective rate of the early exposure group (22/30, 80.00%) was significantly higher (P<0.05) than that of the late exposure group (16/30, 53.33%). The classification of sudden deafness and the application of traditional Chinese medicine in this study were not independent factors affecting the total effective rate. CONCLUSIONS: The time point of acupuncture intervention is an important factor affecting the effect on hearing and tinnitus disability of patients with sudden deafness. The earlier acupuncture treatment is accepted, the better the therapeutic effect is.

[S3-Guideline Chronic Tinnitus - Update]. / Die S3-Leitlinie "Chronischer Tinnitus" ­ ein Update.

Chronic tinnitus is a symptom of disturbed auditory perception. More than 90% of tinnitus patients suffer from hearing loss. Many people experience tinnitus and seek for treatment, but suffering and actual burden of tinnitus is individually very different, sometimes it disappears after a certain time even without treatment. This process is called habituation. The actual suffering from tinnitus depends on stress symptoms and other psychosomatic comorbidities like depression, anxiety and sleeping disorders.Up-to-date there is no therapy that can completely switch off tinnitus, mainly because the origin and expression of tinnitus are individual and very different. This educational publication summarizes and evaluates scientific therapeutic approaches for chronic tinnitus, based on the newly elaborated S3-Guideline "Chronic Tinnitus", under the lead management of the German Society of ENT, Head and Neck-Surgery, published in 2021. It focusses on recommendations for counselling, interventions against hearing loss and psychotherapy, mainly cognitive behavioural therapy.

Tinnitus update: what can be done for the ringing?

Physicians will frequently encounter patients who report tinnitus. Tinnitus is a symptom whereby there is the perception of sound or sounds in the ear or head in the absence of an external source of sound. Most individuals experiencing tinnitus will have a neutral reaction to the percept, but in a small proportion of patients, tinnitus can be a debilitating symptom. When it causes burden, patients can be affected in multiple different facets of life, including impairment in sleep, hearing cognition and psychological and psychiatric well-being, often resulting in high healthcare utilisation and societal costs. Hence, chronic, disabling tinnitus is a complex condition with multifactorial causes and multiple perpetuating biopsychosocial factors. Despite efforts to increase knowledge about its pathophysiology and research into treatments, little impact on real-world clinical practice has been seen. There are no proven effective pharmacological treatments or complementary medicines specifically for chronic, disabling tinnitus. Despite this, there is a role for treating this condition through a multidisciplinary approach specifically targeting comorbid active psychiatric conditions, using hearing aids in appropriate clinical settings such as in those with a coassociated confirmed hearing loss, and specialised cognitive behavioural therapy for patients reporting bothersome tinnitus. Cognitive behavioural therapy remains the most valuable evidence-based intervention in this regard. This narrative review attempts to summarise the current understanding in terms of pathophysiology, assessment and treatment of tinnitus for the internal physician who may encounter patients with disabling, chronic tinnitus.

[Tongdu Tiaoshen acupuncture for subjective tinnitus:a randomized controlled trial].

OBJECTIVE: To observe the clinical effect of Tongdu Tiaoshen acupuncture (acupuncture for promoting the circulation of the governor vessel and regulating the spirit) for subjective tinnitus, and explore its potential mechanism. METHODS: A total of 92 patients with subjective tinnitus were randomly divided into an acupuncture group (46 cases, 5 cases dropped out) and a medication group (46 cases, 2 cases dropped out). The acupuncture group received Tongdu Tiaoshen acupuncture at Shuigou (GV 26), Yintang (GV 24+), Shenting (GV 24), Baihui (GV 20), Fengfu (GV 16), Dazhui (GV 14) and Zhongzhu (TE 3), Tinghui (GB 2), Yifeng (TE 17) on the affected side, 30 min each time, once every other day, 3 times a week. The medication group was orally administered ginkgo biloba leaves tablets (40 mg each time) and mecobalamin tablets (0.5 mg each time), 3 times a day. Both groups were treated for 4 weeks. The scores of tinnitus severity, tinnitus loudness visual analogue scale (VAS) and depression anxiety stress scale-21(DASS-21) before and after treatment were observed in the two groups, serum level of brain-derived neurotrophic factor (BDNF) before and after treatment in the two groups was detected, and the clinical effect was evaluated in the two groups. RESULTS: After treatment，the scores of tinnitus severity, tinnitus loudness VAS and DASS-21 were decreased compared with those before treatment in the two groups (P<0.01), and the scores in the acupuncture group were lower than those in the medication group (P<0.05). After treatment, the serum level of BDNF was decreased compared with that before treatment in the two groups (P<0.01), and the serum level of BDNF in the acupuncture group was lower than that in the medication group (P<0.05). The total effective rate of the acupuncture group was 82.9% (34/41), which was higher than 70.5% (31/44) in the medication group (P<0.05). CONCLUSION: Tongdu Tiaoshen acupuncture could improve the severity of tinnitus, tinnitus loudness and negative emotion in patients with subjective tinnitus. Its mechanism may be related to the regulation of serum level of BDNF and thus affect auditory central plasticity.

Tinnitus in Children.

This perspective reviews the current state of the art and literature on tinnitus in children, prevalence and risk factors, clinical management, and future priorities for healthcare provision and research. Most research in the field to date appears to be prevalence studies, which have reached dramatically different estimates; this reflects the lack of a standard language when asking about the presence of tinnitus, or how bothersome, distressing, or negatively impacting it is for the child. Estimates are also likely affected by a lack of awareness of tinnitus amongst children and parents. Children are less likely to spontaneously report tinnitus than adults, and parents are often unaware their child could even develop tinnitus, considering it a disease of older age for example. It is critical that children are asked and learn about tinnitus. In hearing clinics, clinicians should routinely ask about all children about tinnitus and offer tinnitus care and settings that are child- and family-friendly. As well as asking directly, clinicians should be alert to soft signs of tinnitus such as unexplained listening, speech perception, concentration difficulties, worry or anxiety, or difficulties completing hearing tests or using hearing aids. The recently developed impact of Tinnitus in Children Questionnaire (iTICQ) can then be used to assess problems that are most commonly core to children's experience of tinnitus. Clinical guidelines for tinnitus in children are few but provide recommendations for additional paediatric questionnaires and alternative assessments and for a range of treatment options. Of note, however, is the lack of clinical trials and, therefore, evidence of the effectiveness of any treatment for tinnitus in children. Significant and concerted work is therefore needed to raise awareness of tinnitus in children, understand the scale of clinical need, and standardise and evaluate clinical management options.

Investigating the effectiveness of music therapy combined with binaural beats on chronic tinnitus: A randomized controlled trial.

BACKGROUND: Binaural beat stimulation (BBS) involve presenting two sinusoidal waves with specific frequency differences to induce neural changes in the brain, often used for mental state induction and symptom reduction. However, there are limited studies on its effectiveness for tinnitus. This study aimed to assess the effectiveness of combining binaural beats with music containing nature sounds for chronic tinnitus. METHODS: A total of 30 men, aged 45.87 on average (SD = 8.09), who had chronic tinnitus and symmetrical mild to moderate hearing loss, were included in this study. The participants were randomly assigned to two groups: MT group (Music therapy; n = 15), which received relaxing music containing the sound of sea waves, and MT + BBS group (Music therapy plus binaural beats; n = 15), which received the same music combined with alpha frequency (8 Hz) binaural beats. The therapy sessions were conducted twice a day for 15 min, over a period of 4 weeks. Outcome measures, including the Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI), Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS) and the pitch and loudness of tinnitus were administered before, immediately after, and during the three-month follow-up period. RESULTS: The findings revealed improvements in loudness and annoyance VAS, as well as THI total and all subscale scores in both groups (p < 0.001). Additionally, TFI total score showed improvement in both groups (MT: p = 0.001; MT + BBS: p < 0.001) except for the sense of control subscale in both groups and the cognitive subscale in the MT group after the treatment and during the three-month follow-up period. Furthermore, both groups exhibited a decrease in scores for both subscales of HADS. However, there were no significant differences between the two groups in any of the measurement outcomes (p > 0.05), except for the emotional subscale scores of TFI (p = 0.049) and the functional subscale scores of THI (p = 0.034). In other words, during the follow-up period, the MT + BBS group exhibited lower scores in these two subscales compared to the MT group. CONCLUSION: Although our study failed to demonstrate the superiority of combining binaural beats with music, both groups experienced significant improvements. This suggest that there are potential benefits to be gained from these types of stimuli. Given the sustained effect of both methods and the even greater improvements in follow-up observed in the binaural beats group for some scales, it seems that the changes in neural response and brain waves caused by our stimulations are persistent. This necessitates further research involving brain mapping, especially with longer follow-up durations.

Causes of Pulsatile Tinnitus and Treatment Options.

Pulsatile tinnitus (PT) requires detailed workup to evaluate for an underlying structural cause. With advances in neuroimaging, structural venous abnormalities that can cause PT have becoming increasingly recognized. A number of anomalies, including dural arteriovenous fistulas, idiopathic intracranial hypertension, transverse sinus stenosis, sigmoid sinus wall abnormalities, jugular venous anomalies, and hypertrophied emissary veins, have been implicated in flow disruption and turbulence in the vicinity of auditory structures, resulting in PT. Endovascular treatment options, including stenting, coiling, and embolization with liquid agents, have demonstrated high efficacy and safety. These treatments can lead to symptomatic relief in carefully selected cases.

Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss.

OBJECTIVE: In previous animal studies, sound enhancement reduced tinnitus perception in cases associated with hearing loss. The aim of this study was to investigate the efficacy of sound enrichment therapy in tinnitus treatment by developing a protocol that includes criteria for psychoacoustic characteristics of tinnitus to determine whether the etiology is related to hearing loss. METHODS: A total of 96 patients with chronic tinnitus were included in the study. Fifty-two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment. RESULTS: There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p < .01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p < .01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p < .05) and at all months for VAS-1 (tinnitus severity) (p < .05) and VAS-2 (tinnitus discomfort) (p < .05). CONCLUSION: In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55 dB HL in a relatively short period of 1 month.

Efficacy and safety of transcutaneous auricular vagus nerve stimulation (ta-VNS) in the treatment of tinnitus: protocol for an updated systematic review and meta-analysis.

INTRODUCTION: With an increasing incidence and significant effects on patients, tinnitus has become a major disease burden. There is a dearth of therapies with established efficacy for tinnitus. Transcutaneous auricular vagus nerve stimulation (ta-VNS) is being investigated as a potential therapy for tinnitus, but the current body of evidence remains inconclusive due to conflicting results across different studies. As a result, this protocol aims to synthesise and update the evidence to clarify whether ta-VNS is effective and safe for alleviating tinnitus. METHODS AND ANALYSIS: To identify relevant randomised controlled trials (RCTs), seven representative bibliographical databases will be searched from their inception to December 2023: PubMed, Embase (via OVID), Cochrane Library, Chinese National Knowledge Infrastructure, Wangfang Database, Chinese BioMedical Literature Database, and Chongqing VIP Chinese Science and Technology Periodical Database. Publications in English or Chinese will be considered for inclusion. RCTs comparing ta-VNS with active treatments, no intervention, waitlist control or sham ta-VNS in adult patients with subjective tinnitus will be included. Studies on objective tinnitus will be excluded. Primary outcome is tinnitus symptom severity measured by validated scales. With all eligible trials included, when applicable, quantitative analysis via meta-analyses will be performed using RevMan V.5.4.1 software. Otherwise, a qualitative analysis will be conducted. The methodological quality of the included RCTs will be assessed using the Risk of Bias 2.0 tool. Sensitivity analyses, subgroup analysis and publication bias evaluation will also be performed. The Grading of Recommendations, Assessment, Development, and Evaluation approach will be used to grade the certainty of the evidence. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review, as no primary data will be collected. The results will be reported and disseminated through publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022351917.

Foundations of the Diagnosis and Management of Idiopathic Intracranial Hypertension and Pulsatile Tinnitus.

Venous sinus stenosis has garnered increasing academic attention as a potential etiology of idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). The complex anatomy of the cerebral venous sinuses and veins plays a crucial role in the pathophysiology of these conditions. Venous sinus stenosis, often found in the superior sagittal or transverse sinus, can lead to elevated intracranial pressure (ICP) and characteristic IIH symptoms. Stenosis, variations in dural venous anatomy, and flow dominance patterns contribute to aberrant flow and subsequent PT. Accurate imaging plays a vital role in diagnosis, and magnetic resonance (MR) venography is particularly useful for detecting stenosis. Management strategies for IIH and PT focus on treating the underlying disease, weight management, medical interventions, and, in severe cases, surgical or endovascular procedures. Recently, venous sinus stenting has gained interest as a minimally invasive treatment option for IIH and PT. Stenting addresses venous sinus stenosis, breaking the feedback loop between elevated ICP and stenosis, thus reducing ICP and promoting cerebrospinal fluid outflow. The correction and resolution of flow aberrances can also mitigate or resolve PT symptoms. While venous sinus stenting remains an emerging field, initial results are promising. Further research is needed to refine patient selection criteria and evaluate the long-term efficacy of stenting as compared to traditional treatments.

Outcome measures of brainwave entrainment using delta wave stimulation in individuals with tinnitus having normal hearing sensitivity.

OBJECTIVE: The current study aimed to evaluate the efficacy of delta frequency binaural beats stimulation in treatment of individuals with tinnitus having normal hearing sensitivity. METHOD: Twenty-four individuals who reported bothersome tinnitus in the presence of clinically normal hearing were grouped into two (I and II). The group was provided with delta frequency binaural beats and II was provided with white noise stimulation (both of 20 min duration) for 30 days. Post 30 days, the re-assessment of tinnitus handicap, depression, anxiety, and quality of life parameters were performed and compared with that of pre-treatment scores. RESULTS: A considerable reduction of tinnitus handicap scores, depression and anxiety levels were observed for both the groups, except for the quality-of-life parameters. However, few of the participants showed limited or negligible improvement post-treatment. On comparison of reduction of scores observed across the groups, there was a higher reduction of scores observed for group I when compared to group II. CONCLUSION: The current study was an initial attempt to study the efficacy of binaural beats in treatment of individuals with tinnitus having normal hearing. Apart from a few individuals, the delta wave stimulation acted as a helpful tool in improving tinnitus borne distress symptoms in such patients with normal hearing. The results of the present study put forward the scope of adapting binaural beats stimulation for the treatment of individuals presenting with tinnitus having normal hearing sensitivity. This technique could be adopted into clinical practice after extensive research involving an extended treatment duration on a larger population.

Investigation of the Effectiveness of Kinesio Tape Treatment in Adult Individuals with Subjective Tinnitus.

Objective: Tinnitus is one of the most common otologic symptoms and has a serious effect on the quality of life. The pathophysiology of tinnitus is not fully understood and no consensus has been reached on an effective treatment method for tinnitus. To evaluate the effectiveness of the kinesiotape (KT) method in subjective tinnitus treatment. Material and Method: KT is a method used for sensory simulation. It is a method that aims to increase muscle function, positively affect lymphatic fluid and blood circulation, and stimulate the neurological system. In this study, KT method was applied and the study was prospective. 34 individuals with subjective tinnitus, and normal hearing were included. The study group (n = 17) was informed about tinnitus and KT was applied for 4 weeks, the control group (n = 17) was only informed about tinnitus. The information about tinnitus given to both groups included verbal information about what tinnitus is, how to deal with tinnitus and basic recommendations. All individuals were initially administered tinnitus measurements (pitch, loudness, minimal masking level, residual inhibition), Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), SF-36, and Beck Depression Inventory (BDI). All evaluations were repeated after 4 weeks. Results: Tinnitus loudness and pitch decreased in the KT group (P < .05). In both groups, there was a significant difference between the first and last measurements of the severity of tinnitus, the degree of discomfort from tinnitus with VAS, and the catastrophic and total scores of THI (P < .05). KT group, the emotional sub-score of THI improved significantly with KT (P < .05), and significant improvement was achieved in the BDI scores (P < .05). There was a significant difference in the SF-36 after the application of KT (P < .05). Conclusion: In subjective tinnitus, the pathophysiology of which is unknown and there is no consensus on an effective treatment method, improvement in tinnitus severity, quality of life and depression perception in both audiologic and perceptual evaluations were obtained as a result of KT application. We believe that KT, which has no side effects and is easy to apply, is a method that can be easily used in individuals with subjective tinnitus.

Electrical safety assessment of a prototype device for electromagnetic stimulation of the ear in patients with tinnitus.

<b><br>Aim:</b> The aim of the study was to evaluate the results of electrical safety results of a prototype electromagnetic ear stimulation device in patients with tinnitus.</br> <b><br>Material and methods:</b> The electrical safety tests of the prototype device for electro- and magnetostimulation of the hearing organ were carried out at the Center for Attestation and Certification Tests in Gliwice. The tests concerned selected parameters including the PN-EN standard.</br> <b><br>Results:</b> Safety studies of the prototype electrical stimulation device for the ear in patients with tinnitus were necessary to perform the planned further preclinical studies. Obtained results regarding: identification and labeling of the device; protection against electric shock; checking protective earthing, functional earthing and potential equalization; checking the leakage current and auxiliary currents of the patient; checking the distances through the solid insulation and the use of thin insulating spacers; checking the electrical strength of the device insulation; checking protection against mechanical hazards of the device; checking the risk associated with surfaces, corners and edges, and checking the protection against excessive temperatures and other threats comply with the standard PN-EN.</br> <b><br>Conclusions:</b> No risk to the patient and medical staff. Tests of protection against mechanical hazards of the device have shown that the only movable part whose contact with the patient could cause an unacceptable risk is the fan installed inside the housing.</br>.

An Exploratory Study of Bimodal Electro-Aural Stimulation Through the Ear Canals for Tinnitus.

OBJECTIVE: The aim of this study was to explore the potential for bimodal auditory and noninvasive electrical stimulation at the ears to alleviate tonal, somatic tinnitus that was investigated in a small preliminary trial (11 participants). DESIGN: Auditory stimulation took the form of short "notched noise" bursts customized to each participant's tinnitus percept. Simultaneous pulsed electrical stimulation, intended to facilitate neuroplasticity, was delivered via hydrogel electrodes placed in opposite ears. RESULTS: After a 6-week intervention period, average Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ) scores were consistent with clinically meaningful improvements in the study population. Magnitudes and effect sizes of improvements in TFI and TPFQ are comparable to those reported in other recent bimodal therapy studies using different auditory and electrical stimulation parameters. CONCLUSIONS: Our results should be considered preliminary given the small sample size, lack of crossover data, and small subject pool. When considered alongside other recent bimodal therapy results, we do believe that there are therapeutic benefits of bimodal stimulation for tinnitus sufferers that have the potential to help some with tinnitus, with a variety of stimulation parameters and electrode placements. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25444546.

A Preliminary Analysis of the Clinical Effectiveness of Audiologist-Delivered Cognitive Behavioral Therapy Delivered via Video Calls for Rehabilitation of Misophonia, Hyperacusis, and Tinnitus.

PURPOSE: Cognitive behavioral therapy (CBT) is a key intervention for management of misophonia, hyperacusis, and tinnitus. The aim of this study was to perform a preliminary analysis comparing the scores for self-report questionnaires before and after audiologist-delivered CBT via video calls for adults with misophonia, hyperacusis, or tinnitus or a combination of these. METHOD: This was a retrospective cross-sectional study. The data for 37 consecutive patients who received CBT for misophonia, hyperacusis, or tinnitus from a private institute in the United Kingdom were analyzed. Self-report questionnaires taken as part of routine care were as follows: 4C Questionnaires for tinnitus, hyperacusis, and misophonia (4C-T, 4C-H, and 4C-M, respectively), Tinnitus Impact Questionnaire (TIQ), Hyperacusis Impact Questionnaire (HIQ), Misophonia Impact Questionnaire (MIQ), Sound Sensitivity Symptoms Questionnaire (SSSQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T). Responses were also obtained to other questionnaires related to tinnitus, hyperacusis, insomnia, and anxiety and mood disorders. A linear mixed-model method was used to assess the changes in response to the questionnaires pretreatment and posttreatment. RESULTS: Pretreatment-posttreatment comparisons showed that scores for the 4C-T, 4C-H, 4C-M, TIQ, HIQ, MIQ, SSSQ, and SAD-T improved, with effect sizes of 1.4, 1.2, 1.3, 2.6, 0.9, 0.7, 0.9, and 1.4, respectively (all p < .05). CONCLUSIONS: This preliminary analysis suggests that CBT via video calls may be effective in reducing the impact of misophonia, hyperacusis, and tinnitus. However, this study did not have a control group, so its results need to be interpreted with caution.

Left prefrontal intermittent theta burst stimulation ameliorates tinnitus distress and symptoms of depression - A feasibility study.

Tinnitus remains a notoriously difficult to treat clinical entity. 1-2% of the entire population report relevant emotional distress due to tinnitus, and causal treatments are lacking. Repetitive transcranial magnetic stimulation (rTMS), most commonly of auditory cortical areas, has shown mixed results in the past. Prefrontal rTMS, including intermittent theta burst stimulation (iTBS) has shown more promising results in the treatment of depression, and clinical data suggests a meaningful overlap between tinnitus and depression. Therefore, we performed a feasibility study of 28 consecutive patients with tinnitus treated with an iTBS protocol over the left dorsolateral prefrontal cortex for three weeks. After treatment, we observed significant ameliorations of tinnitus distress as measured by the Tinnitus Handicap Inventory Questionnaire (THI), the Tinnitus Functional Index (TFI), the Mini-Tinnitus Questionnaire (Mini-TQ) and also of depression as measured by the Major Depression Inventory (MDI). Effect sizes were small to moderate and short-lived. Treatment response rates, defined as improvement of the THI of at least 7 points, were 35.7%. At follow-up twelve weeks after end of treatment, severity of tinnitus and depression returned to approximately baseline level on a descriptive level. Amelioration of depressive symptoms correlated only with TFI change, but not that of other measures of tinnitus distress. The data suggest that a prefrontal iTBS protocol might be applied in the treatment of tinnitus and open avenues for future neurostimulatory treatments other than those of auditory regions.

Brain Network Evaluation by Functional-Guided Effective Connectivity Reinforcement Learning Method Indicates Therapeutic Effect for Tinnitus.

Using functional connectivity (FC) or effective connectivity (EC) alone cannot effectively delineate brain networks based on functional magnetic resonance imaging (fMRI) data, limiting the understanding of the mechanism of tinnitus and its treatment. Investigating brain FC is a foundational step in exploring EC. This study proposed a functionally guided EC (FGEC) method based on reinforcement learning (FGECRL) to enhance the precision of identifying EC between distinct brain regions. An actor-critic framework with an encoder-decoder model was adopted as the actor network. The encoder utilizes a transformer model; the decoder employs a bidirectional long short-term memory network with attention. An FGEC network was constructed for the enrolled participants per fMRI scan, including 65 patients with tinnitus and 28 control participants healthy at the enrollment time. After 6 months of sound therapy for tinnitus and prospective follow-up, fMRI data were acquired again and retrospectively categorized into an effective group (EG) and an ineffective group (IG) according to the treatment effect. Compared with FC and EC, the FGECRL method demonstrated better accuracy in discriminating between different groups, highlighting the advantage of FGECRL in identifying brain network features. For the FGEC network of the EG and IG per state (before and after treatment) and healthy controls, effective therapy is characterized by a similar pattern of FGEC network between patients with tinnitus after treatment and healthy controls. Deactivated information output in the motor network, somatosensory network, and medioventral occipital cortex may biologically indicate effective treatment. The maintenance of decreased EC in the primary auditory cortex may represent a failure of sound therapy, further supporting the Bayesian inference theory for tinnitus perception. The FGEC network can provide direct evidence for the mechanism of sound therapy in patients with tinnitus with distinct outcomes.

Evaluation of the Tinnitus Teleconsulting System's Back-Referral Program for National Health Insurance Patients with Diabetes Mellitus in Primary Care.

BACKGROUND: One of the techniques available through Social Security healthcare organizations to assist the government in the implementation of social distancing without restricting patients access to particular health treatments is primary healthcare Tinnitus Teleconsulting. The purpose of this research is to gather data on how well the City of South Jakarta's primary medical care Audiology Teleconsulting strategy was implemented during the COVID-19 pandemic. METHOD: This study uses a qualitative research method and was conducted during November 2022-Mei 2023 at the City of South Jakarta Primary Health Care, the social security agency of health's South Jakarta Branch, and the social security agency of health's Primary Health Care Guarantee Division at the Head Office. Data collection techniques were through Focus Group Discussions, in-depth interviews with key informants, and document review. RESULTS: The results showed that most of the informants already knew the process and output of FKTP Tinnitus Teleconsulting performance; only a few FKTPs did not understand the process and output of policy performance, so even though they acknowledged that they had implemented it, there were no documents recorded in the logbook or electronically recorded patient medical data through the social security agency's health care application. CONCLUSION: The findings of this study can be used by FKTP and other district or city social security agencies of health to improve the performance achievement of FKTP Tinnitus Teleconsulting implementation.