[Long-term Development of Acute Tinnitus]. / Langzeit-Entwicklung von akutem Tinnitus.

BACKGROUND: Aim was to assess correlations between hearing threshold and mental health measures at tinnitus onset and tinnitus severity after 6 months. Short self-report questionnaires were used to permit later use in ENT-practices. METHOD: 28 patients with tinnitus of no longer than 4 weeks filled out questionnaires at inclusion (T1), and at 6 weeks (T2), 3 (T3) and 6 months (T4) after tinnitus onset. An audiogram was recorded at T1. Tinnitus loudness and sound sensitivity were assessed by numeric rating scales, tinnitus-distress was recorded with the short form of the tinnitus questionnaire. Mental health and personality factors were measured by the depressivity, anxiety and somatic severity scales of the Patient Health Questionnaire, and the resilience scale. RESULTS: Tinnitus loudness and distress were stable throughout the investigation period whereas sound sensitivity decreased. Resilience did not represent a predictor for tinnitus severity after 6 months. Depressivity and hearing loss at T1 had an effect on later tinnitus loudness, while depressivity and age at T1 showed an effect on sound sensitivity and tinnitus-related distress at T4. CONCLUSION: Stability of tinnitus severity during the 6 months after onset supports the hypothesis of early manifestation. RESULTS also support the hypothesis that later tinnitus severity is related to psychological distress and hearing impairment at onset. RESULTS suggest to use hearing aids to alleviate tinnitus loudness, and to include tools for the identification of depressive disorders at an early stage to identify patients that might benefit from psychotherapeutic interventions.

[On the interdisciplinary S3 guidelines for the treatment of chronic idiopathic tinnitus]. / Zur interdisziplinären S3-Leitlinie für die Therapie des chronisch-idiopathischen Tinnitus.

INTRODUCTION: Tinnitus is a frequent symptom, which, particularly in combination with comorbidities, can result in a severe disease-related burden. Chronic idiopathic tinnitus (CIT) is the most frequent type of tinnitus. A considerable number of treatment strategies are used to treat CIT-for many of which there is no evidence of efficacy. In order to enable scientific evidence-based treatment of CIT, German interdisciplinary S3 guidelines have recently been constructed for the first time. Here we present a short form of these S3 guidelines. MATERIALS AND METHODS: The guidelines were constructed based on a meta-analysis of the treatment of chronic tinnitus performed by the authors. Additionally, a systematic literature search was performed in the PubMed and Cochrane Library databases. Furthermore, a systematic search for international guidelines was performed in Google, as well as in the Guidelines International Network and National Guideline Clearinghouse (USA) database. Evidence was classified according to the Oxford Centre for Evidence-Based Medicine system. RESULTS: According to the guidelines, alongside counselling, manualized structured tinnitus-specific cognitive behavioral therapy (tCBT) with a validated treatment manual is available as evidence-based therapy. In addition, the guidelines recommend concurrent treatment of comorbidities, including drug-based treatment, where appropriate. Particularly important is treatment of anxiety and depression. Where a psychic or psychiatric comorbidity is suspected, further diagnosis and treatment should be performed by an appropriately qualified specialist (psychiatrist, neurologist, psychosomatic medicine consultant) or psychological psychotherapist. In cases accompanied by deafness or hearing loss bordering on deafness, cochlear implants may be indicated. CONCLUSION: No recommendations can be made for drug-based treatment of CIT, audiotherapy, transcranial magnetic or electrical stimulation, specific forms of acoustic stimulation or music therapy; or such recommendations must remain open due to the lack of available evidence. Polypragmatic tinnitus treatment with therapeutic strategies for which there is no evidence of efficacy from controlled studies is to be refused.

[Laryngeal lead shot injury: therapy and follow-up]. / Laryngeale Schrotschussverletzung : Therapie und Verlauf.

Laryngeal shot injuries are rare. The case of a 65-year-old man who suffered from an injury with lead pellets is reported. After exploration with removal of the pellet from the lateral cricoarytenoid muscle, an immobility of the vocal fold developed, accompanied by impaired vocal function. Despite persisting immobility of the vocal fold, after 12 weeks voice compensation was achieved by voice therapy.

[Expiratory vocal cord dysfunction? Case report and review of the literature]. / Exspiratorische Vocal Cord Dysfunction? Falldarstellung und Literaturübersicht.

Wood and Milgrom defined vocal cord dysfunction (VCD) as paradoxical adduction of the vocal folds during inspiration or during inspiration and expiration. We describe the case of a patient with attacks of dyspnea with an isolated expiratory paradoxical adduction of the vocal folds. A review of the literature reveals many factors associated with VCD. Because of the similar risk factors and order of events concerning VCD, we believe that even expiratory laryngeal dysfunctions could be denoted as subtypes of VCD.

[Psychological distress associated with acute tinnitus]. / Akuter Tinnitus. Psychische Korrelate und Ausmass der Belastung bei Patienten.

BACKGROUND: We question whether patients with acute tinnitus can be differentiated in their perceived handicap and emotional distress. Dysfunctional mechanisms for coping with stress and illness in patients with acute tinnitus were investigated. METHODS: Twenty patients (symptoms for less than 1 week) were examined for distress due to tinnitus (TF), degree of depression (BDI), global distress (SCL- 90-R) and coping with stress (SVF). RESULTS: Patients could be differentiated in terms of their psychological distress and annoyance caused by the symptoms. There is a high correlation between the degree of depression, dysfunctional way of coping with stress and emotional distress caused by tinnitus. Dysfunctional stress coping strategies are found more frequently in highly affected patients. CONCLUSION: Patients with acute tinnitus can be differentiated in terms of their distress and the psychological impairment caused by their symptoms. These results suggest that the immediate reaction to the manifestation of tinnitus might be of prognostic value for the level of emotional distress experienced in chronic tinnitus. The question arises of whether psychological intervention in the acute stage of tinnitus might be beneficial.

Effectiveness of a TEOAE-based screening program. Can a patient-tracking system effectively be organized using modern information technology and central data management?

It has been shown that detecting and treating children with hearing loss at an early age will improve their speech and language development. The implementation of universal hearing screening programs is therefore one of the major goals in pediatric audiology. One problem of present screening programs is high lost to follow-up rates. The aim of this paper was to evaluate the effectiveness of a patient tracking system based on central data management and data transmission via the internet. The screening program was organized as a TEOAE (transitory evoked otoacoustic emissions)-based three-stage procedure and covered a complete German federal state (Saarland). The measurements of the first stage took place in well-baby nurseries (WBNs) as well as neonatal intensive care units (NICUs). Measurements of the second stage were performed by pediatricians and ENT physicians on an outpatient basis. The third stage comprised diagnostic ABR (auditory brainstem response) measurements performed by pediatric audiologists. Using a central data management system we were able to identify and follow every child not screened or with negative results. The overall coverage in the first stage was 93% of all newborns. A screening result of the second stage could be obtained for 90% of the children. Four out of 3,830 children screened turned out to have a relevant hearing loss and were fitted with hearing aids. A TEOAE-based newborn hearing screening system can be organized effectively. Central data management as well as interdisciplinary organization of the follow-up are important prerequisites for the success of a hearing screening program. A follow-up system as proposed in this paper can also be implemented in AABR (automated auditory brainstem response)-based programs.

[Evaluation of the tinnitus retraining therapy as combined with a cognitive behavioral group therapy]. / Kombinierte Anwendung von Tinnitusretrainingtherapie (TRT) und Gruppenverhaltenstherapie.

BACKGROUND: The study evaluates the effectiveness of a Tinnitus Retraining Therapy as combined with a cognitive behavioral group therapy. PATIENTS AND METHODS: 95 patients suffering from chronic tinnitus (mean age 49,3 years) were included. 16 of these 95 participants served as a waiting list control group. The participants were divided into 3 treatment groups. Group 1 was fitted with wideband noise generators, group 2 with hearing aids. The 3rd group was not supplied with any device. After a detailed audiological and psychological examination and tinnitus counseling all patients took part in a cognitive behavioral therapy for a period of 3 months. RESULTS: 64,5% of our patients improved significantly after the initial group therapy. In contrast, the patients of the waiting list control group showed no significant improvement. This initial treatment effect could be maintained over the period of control. We were unable to show significant advantages of noise generators as compared to cognitive behavioural group therapy alone. CONCLUSION: The Tinnitus Retraining Therapy combined with a cognitive behavioral group therapy is an effective treatment in patients with chronic tinnitus.

[Influence of interaural time- and level differences on the binaural interaction components in normal adults]. / Binaurale Differenzpotenziale: Normalwertebestimmung und Einfluss einer interauralen Zeit- und Pegeldifferenz.

BACKGROUND: Binaural interaction components of auditory brainstem responses have long been studied and its beta-wave has been shown to be correlated with directional hearing ability. As patients with auditory processing disorders such as patients with some sorts of learning disabilities frequently have difficulties with binaural processing it seems sensible to use binaural interaction components in the diagnosis of these disorders. METHODS: In order to obtain normal values and to investigate the influence of interaural time (ITD) and level differences (ILD) binaural interaction components were measured in 21 adults. Interaural time differences varied between 0 and 1.2 ms and interaural level differences between 0 and 30 dB. RESULTS: beta-latencies increased significantly as interaural time differences increased while beta-amplitudes did not change significantly. In measurements with higher interaural time differences detection of the beta-wave was only rarely possible. The effect of interaural level differences on beta-latencies was less pronounced and not significant as well as the influence of interaural level differences on beta-amplitudes. CONCLUSIONS: In the present study it could be shown that the beta-wave of the binaural interaction waveform is present in almost every normal hearing subject. As amplitudes show a considerable variation beta-latencies seem to be of higher diagnostic value than amplitudes.

[Rare audiometry findings in progressive, monosymptomatic low frequency deafness]. / Seltene audiometrische Befundkonstellation bei progredienter, monosymptomatischer Tieftonschwerhörigkeit.

BACKGROUND: Objective audiometric methods such as the measurement of otoacoustic emissions and auditory evoked potentials (click evoked and notched-noise auditory evoked brainstem potentials, auditory evoked cortical potentials) can provide helpful information. However, information derived from the individual test is limited and each method contains specific restrictions. To illustrate the possible audiometric pitfalls this work presents a case history. CASE REPORT: The puretone audiometry showed a severe hearing loss at low frequencies up to 2 kHz, a slight hearing loss for higher frequencies up to 6 kHz and almost normal hearing thresholds above 6 kHz. Transitory evoked otoacoustic emissions could not be detected. While the auditory evoked brainstem responses (ABR) using click-stimuli showed a normal pattern no reproducible responses could be derived using the notched-noise technique. Auditory evoked cortical potentials exhibited a normal N1/P2-complex and were detectable down to stimulus levels 0-20 dB above the individual hearing threshold. DISCUSSION: Click-evoked auditory evoked brainstem potentials are widely regarded as the "gold-standard" of objective audiometry. The example presented in this work shows that in special cases it may provide false negative results. In these special cases auditory tone-evoked cortical potentials may provide better objective information. When objectively assessing the determination of the hearing threshold it may be necessary not only to use all electrophysiological measurements but also to know their methodical restrictions and pitfalls.