Psychometric Evaluation of the Misophonia Impact Questionnaire (MIQ) Using a Clinical Population of Patients Seeking Help for Tinnitus, Hyperacusis and/or Misophonia.

BACKGROUND: Misophonia is a decreased tolerance of certain sounds related to eating noises, lip smacking, sniffing, breathing, clicking sounds, and tapping. While several validated self-report misophonia questionnaires exist, none focus solely on the impact of misophonia on the patient's life. Additionally, there are no available validated pediatric self-report measures of misophonia. Therefore, a tool was needed to assess the impact of misophonia on both adult and pediatric patients. PURPOSE: To evaluate the psychometric properties of the 8-item Misophonia Impact Questionnaire (MIQ). RESEARCH DESIGN: This was a retrospective cross-sectional study. STUDY SAMPLE: Patients who attended the Tinnitus and Hyperacusis Therapy Specialist Clinic (THTSC) in the UK seeking help for tinnitus, hyperacusis and/or misophonia (n = 256). A subsample of children aged 16 years or younger (n=15) was included for preliminary analyses of a version of the MIQ to be filled in by a parent (MIQ-P). DATA COLLECTION AND ANALYSIS: Data were collected retrospectively from the records of patients held at the audiology department. These included demographic data, audiological measures and self-report questionnaires taken as part of routine care. Descriptive statistics and psychometric analyses were conducted. The MIQ was analyzed for item difficulty, factor structure, reliability, and construct validity. RESULTS: Confirmatory factor analysis revealed that a one-factor model for the MIQ gave an excellent fit and its estimated reliability was excellent, with Cronbach's α = 0.94. The total MIQ scores were highly correlated with scores for the Hyperacusis Impact Questionnaire (HIQ) and Sound Sensitivity Symptoms Questionnaire (SSSQ). MIQ scores were not significantly correlated with scores for the Tinnitus Impact Questionnaire (TIQ) or average hearing thresholds. Preliminary data from the sub-sample indicated excellent internal consistency for the MIQ-P, with Cronbach's α = 0.92. CONCLUSIONS: The MIQ is a promising questionnaire for assessing the impact of misophonia. Future studies should focus on establishing test/re-test reliability, identifying clinically significant change in MIQ scores, defining the severity of misophonia impact categories, and further exploring the psychometric properties of the MIQ-P.

Cytokine Profiling of Cyst Fluid and Tumor-Associated Macrophages in Cystic Vestibular Schwannoma.

BACKGROUND: The vestibular schwannoma (VS) secretome can initiate monocyte recruitment and macrophage polarization to M1 (proinflammatory) and/or M2 (protumorigenic) phenotypes, which in turn secrete additional cytokines that contribute to the tumor microenvironment. Profiling cyst fluid and cerebrospinal fluid (CSF) in cystic VS provides a unique opportunity to understand mechanisms that may contribute to tumor progression and cyst formation. HYPOTHESIS: Cystic VSs secrete high levels of cytokines into cyst fluid and express abundant M1 and M2 macrophages. METHODS: Tumor, CSF, and cyst fluid were prospectively collected from 10 cystic VS patients. Eighty cytokines were measured in fluid samples using cytokine arrays and compared with normal CSF from normal donors. Immunofluorescence was performed for CD80 + M1 and CD163 + M2 macrophage markers. Demographic, audiometric, and radiographic information was obtained through retrospective chart review. RESULTS: Cyst fluid expressed more osteopontin and monocyte chemotactic protein-1 (MCP-1; p < 0.0001), when compared with normal CSF. Cyst fluid also expressed more protein ( p = 0.0020), particularly MCP-1 ( p < 0.0001), than paired CSF from the same subjects. MCP-1 expression in cyst fluid correlated with CD80 + staining in VS tissue ( r = 0.8852; p = 0.0015) but not CD163 + staining. CONCLUSION: Cyst fluid from cystic VS harbored high levels of osteopontin and MCP-1, which are cytokines important in monocyte recruitment and macrophage polarization. MCP-1 may have a significant role in molding the tumor microenvironment, by polarizing monocytes to CD80 + M1 macrophages in cystic VS. Further investigations into the role of cytokines and macrophages in VS may lead to new avenues for therapeutic intervention.

Transient decrease in sound tolerance levels following hearing deprivation in normal-hearing subjects.

Objective: To determine the circadian influence on sound sensitivity produced by temporal hearing deprivation in healthy normal human subjects. Design: Participants underwent bilateral earplugging before completion of anthropometry, the author's developed questionnaire, the Hamilton Anxiety and Depression Inventory, pure tone audiometry (PTA), stapedial reflex thresholds (SRT), distortion products otoacoustic emissions input/output (DPOAE-I/O), and uncomfortable loudness levels (ULLs). Afterward, the participants were randomly divided into group A, starting at 8:00 a.m. and finishing at 8:00 p.m., and group B, starting at 4:00 p.m. and ending at 4:00 a.m. Serum cortisol levels and audiological test results were obtained at the beginning and end of the session and 24-h free urinary cortisol levels were measured. Study sample: Thirty healthy volunteers. Results: PTA was 2.68 and 3.33 dB HL in groups A and B, respectively, with no statistical difference between them. ULLs were significantly lower in group A compared to group B, with an average of 8.1 dB SPL in group A and 3.3 dB SPL in group B (p < 0.0001). A SRT shift was observed in group A, with no difference in group B, and a night shift in DPOAE-I/O in group B. Conclusions: Reduced loudness tolerance is demonstrated during daytime hearing deprivation in contrast to nighttime; this may be due to increased central gain in the awake cortex.

Implications of Transcranial Magnetic Stimulation as a Treatment Modality for Tinnitus.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, neuromodulating technique for brain hyperexcitability disorders. The objective of this paper is to discuss the mechanism of action of rTMS as well as to investigate the literature involving the application of rTMS in the treatment of tinnitus. The reviewed aspects of the protocols included baseline evaluation, the total number of sessions, frequency and the total number of stimuli, the location of treatment, and the outcome measures. Even with heterogeneous protocols, most studies utilized validated tinnitus questionnaires as baseline and outcome measures. Low frequency (1 Hz) stimulation throughout 10 consecutive sessions was the most widely used frequency and treatment duration; however, there was no consensus on the total number of stimuli necessary to achieve significant results. The auditory cortex (AC) was the most targeted location, with most studies supporting changes in neural activity with multi-site stimulation to areas in the frontal cortex (FC), particularly the dorsolateral prefrontal cortex (DLPFC). The overall efficacy across most of the reviewed trials reveals positive statistically significant results. Though rTMS has proven to impact neuroplasticity at the microscopic and clinical level, further studies are warranted to demonstrate and support the clinical use of rTMS in tinnitus treatment with a standardized protocol.

Tinnitus Management: The Utilization of a Hybrid Telehealth and In-Person Delivery Model.

Telehealth, or the delivery of healthcare services from a distance, has historically been used to provide care to underserved populations and to those unable to visit a healthcare center. During the ongoing global COVID-19 pandemic, some providers of tinnitus healthcare services incorporated telehealth into their clinical protocols to allow for continued care for their patients while adhering to social distancing guidelines and safety measures. Bothersome tinnitus can negatively impact one's quality of life. Telehealth has been instrumental in treating this debilitating problem in a time when in-person care has not been easily available. The case of a patient with tinnitus is examined to demonstrate the use of a hybrid delivery model utilizing telehealth and in-person interactions to assess and manage her bothersome tinnitus. In-person services were used for audiological assessments and fitting of treatment devices, while telehealth was utilized for counseling, education, and remote programming of her treatment devices. This combined approach, which has allowed the patient to continue receiving care safely during the pandemic, can be continued for future care. Telehealth offers several advantages to patients and providers alike. While the COVID-19 pandemic will hopefully come to an end, telehealth services for tinnitus management may be here to stay.