[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.

[Psychosomatic medicine for patients with Meniere's disease]. / Psychosomatik bei an M. Menière Erkrankten.

BACKGROUND: Unpredictable attacks of vertigo with or without emesis, unilateral hearing loss, and tinnitus characterize the inner ear disorder that is classified as part of Meniere's disease (MD). While the pathological final stage with cochleovestibular hydrops seems to be certain as a component of MD, there are many uncertainties with respect to the multifactorial pathogenesis. It is certain that the disease can have effects in addition to the attack, which questions the treatment of things that were previously taken for granted. Persistent perceptual and postural dizziness [19] and reactive psychogenic dizziness [18] can occur, so that during the course of the disease, a mixed picture of organic and psychogenic dizziness can develop. In addition, there is an increased anxiety and depression comorbidity. The course, suffering, and experience of the disease depend essentially on the processing and the active acquisition of coping strategies as well as-also the medical-treatment of the patient(s), who in their distress seek and need a knowledgeable and reliable practitioner at their side. OBJECTIVE: The effects on the affected persons and suggestions for the most helpful treatment of Meniere's disease sufferers shall be described here in detail.

[Stress and suffering from tinnitus-a psychosomatic approach]. / Stress und Leiden am Tinnitus aus psychosomatischer Sicht.

The development and processing of tinnitus is often associated with stress. There are many publications on this subject that have investigated possible connections between stress perception and tinnitus symptoms using different concepts and different test inventories. In this review, we present the development of Selye's concept of stress using the transactional stress model of Lazarus and its transfer to patients suffering from tinnitus. The literature evaluating the influence of stress on tinnitus symptoms with partly very different concepts is critically reviewed. For example, it is suggested that psychosocial stress has the same likelihood of contributing to tinnitus as noise in the workplace. However, what is striking in previous studies is that "stress" as an influencing variable could not be clearly verified with suitable psychometric test procedures or that no significant differences-to very different comparison groups-could be shown. Finally, a possible therapeutic approach to stress management is outlined.

[Tinnitus counseling in a specialized ambulanz and a attempt to identify relevant "interactional" factors for outcome]. / Tinnitus Counselling in einer Spezialambulanz und ein (gescheiterer) Versuch, relevante "interaktionelle" Faktoren für den Erfolg zu identifizieren.

One aim of our large-scale catamnesis was to prove that neuro-otological diagnostics and knowledge are a fundamental prerequisite in counseling, but also that the counterpart, the patient, has to be reached in his or her distress. For this purpose, we had developed an own 6-part scaled questionnaire on the understanding of the counseled and on the feeling of being understood as a patient. Through its evaluation we had hoped to obtain reliable findings with regard to individual effect factors.Therefore we had mailed to 699 outpatients who had been counseled by us. In 295, the hearing findings, the Mini-Tinnitus Questionnaire (TF 12) and the Hospitality Anxiety and Depression Scores (HADS) could be compared at two measurement points at least 6 months apart.While counseling was found to be sustainable in symptom reduction and compliance to implement recommended interventions, no significant single interactional factor in counseling was detected by our examiation after proper statistics were obtained.In the article, the steps taken and corrections made are also pointed out with regard to the appropriate statistical approach, also to point out that primarily clinicians often need the support of trained statisticians.

[Catamnesis after a single intervention for tinnitus patients in a specialized clinic]. / Katamnese nach einmaliger Intervention bei Tinnituspatienten in einer Spezialambulanz.

BACKGROUND: Patients suffering from tinnitus require individualized clarification (counseling), sometimes going beyond the scope of the field of ENT and the initiation of specific interventions. AIM: To investigate if patients who had a specific neurotological assessment including a psychosomatic medical history follow the recommendations provided to them. In addition, it should be examined whether compliance with the treatment suggestions has led to any psychological improvement in the suffering from tinnitus, evaluated by psychological tests. MATERIAL AND METHOD: In295 out of 699 patients audiological tests were evaluated using the mini-questionnaire (TF 12) according to Hiller and Goebel and the German language version of the Hospitality Anxiety and Depression Scale (HADS) at 2 points in time with an interval of a least 6 months. The group of those who followed the recommendations were compared to the group of those who did not follow the recommendations. RESULTS: A total of 180 patients (64.5%) followed at least 1 of the recommendations made to them. Patients who followed at least one recommendation benefited significantly more than the whole group in the TF 12 and in both HADS categories compared to the group that did not follow the recommendations. CONCLUSION: In addition to counseling it was shown that the implementation of a specific measure has a positive effect, detectable for the Progressive Muscle Relaxation (PMR). Specific for ENT, a hearing aid can initiate an improvement even if no statistically significant difference to the comparison group was found.

[Often not considered during Expert opinion: Patients after accidents or noise traumata - A patient-focused, complementary perspective]. / Bei der Begutachtung oft nicht bedacht: Unfallpatienten und Patienten nach einem Lärmtrauma ­ Eine patientenzugewandte, komplementäre Sichtweise.

Patients who have acquired tinnitus in the context of an accident, a noise trauma or other external influences have important distinctive features in treatment. Although their suffering was in general caused by external circumstances or other people and mostly without own fault, they suffer from a permanent damage, difficult to be realized externally. Additionally they must concentrate their remaining resources to deal adequately with their suffering from tinnitus and very often permanent hearing loss. Legal disputes and the assessment processes necessary in this context can have an unfavorable and perpetuating effect. These influences and patient's reception is laid down here.

[Neuro-otology counseling for patients with chronic tinnitus]. / Neurootologisches Counseling bei chronischem Tinnitus.

The diagnosis and treatment of tinnitus requires professional competence in neuro-otology and also an appropriate and comprehensible clarification for the individual patient.According to the Tinnitus-Guidelines of 2015 the counselling by the physician in charge is essential regarding the individual aetiopathogenesis, as well as the patient's individual coping mechanism with tinnitus, the prognosis, exacerbating factors and also as to the damaging impact on the ear.Therefore the therapeutic aim is to depathologize the symptom tinnitus and to provide an explanation and a context in the contemporary approved and scientific conception.The requirements of the guidelines are necessary and reasonable, however it is often very difficult to implement this in the daily routine in a doctor´s practice, especially in the outpatient medical care.Subsequently we are going to present a four-to-five step-model to communicate the most important issues - analogous the guidelines and coherent for the outpatient or clinic patient in the one-to-one or group medical counselling. This furthermore addresses aspects of mental health.For that diagnosis as well as evaluation the mini-tinnitus-questionnaire (Mini-TF12) is available. It can be filled out and interpreted via homepage of the German Tinnitus-Liga (DTL) without charge.

Treatment of tinnitus needs a combined neurootological and psychosomatic approach.

In this study the results of the examination of 100 successive patients with Tinnitus, M. Menière or vertigo, who were referred to a specialised neurootological and psychosomatic centre, are presented. The study focuses on the results of the audiological tests and the question of the related hearing impairment as well as on psychological diagnosis and the possible connection between biographical details and symptom development.

Specific findings in distortion product otoacoustic emissions and growth functions with chronic tinnitus.

Chronic tinnitus has a very high prevalence in industrialized countries. Latest studies found chronic tinnitus in 4% of the German population, with almost 2% suffering severely in their daily life. Because no curative therapeutic approach is available--neither pharmacological nor surgical--the main focus lies in treatments that enhance the habituation of tinnitus. Habituation occurs in almost 50% of affected patients as a normal process, leading to a complete compensation. This finding is based on the ability of the auditory perception to habituate random noise and focus on important acoustic information. According to our audiological data, 90% of tinnitus patients have deficits in inner-ear function as a generator of tinnitus, mainly in the outer hair cells. This occurrence can be verified by registration of distortion products of otoacoustic emissions. Thus, the main origin of tinnitus is peripheral, and most patients suffer from accompanying hearing loss, even though it is sometimes mild or subjectively not even noticed. In almost 50% of our patients, we find hyperfunction of outer hair cells, again recorded via distortion products of otoacoustic emissions and their growth functions. Normal efferent reduction of distortion products through contralateral acoustic stimulation does not take place in most tinnitus patients. This finding shows that central auditory functions are also disturbed in chronic tinnitus patients, leading to reduced efferent effects on the hair cells and thus impeding habituation. Tests to verify these more central pathological findings have yet to be developed. We have data on diminished ability to distinguish stimuli from random noise by bilateral sound processing: The so-called bilateral masking difference test results are pathological in almost 30% of patients suffering from chronic tinnitus. We concluded from our audiological data that chronic tinnitus is primarily a cochlear dysfunction, but habituation is impeded by accompanying or consecutive deficits of the central auditory pathway. Regarding therapeutic approaches, these central functions can be trained by hearing therapy, as we know from patients' rehabilitation.