Assessment of Executive Functions in Children with Sensorineural Hearing Loss and in Children with Specific Language Impairment: Preliminary Reports.

Executive functions (EFs) are related abilities, associated with the frontal lobes functions, that allow individuals to modify behavioral patterns when they become unsatisfactory. The aim of this study was to assess EFs in children with sensorineural hearing loss (SNHL) and in children with "specific language impairment" (SLI), compared with a control group of children with normal development, to identify specific skill deficits. Three groups of preschool children aged between 2 and 6 years were assessed: 19 children with normal hearing, cognitive, and language development, 10 children with SNHL, and 20 children with SLI. The FE-PS 2-6 Battery was used for the assessment of preschool EFs, supplemented with the Modified Bell Test for the analysis of selective attention. Statistically significant differences were found between the two experimental groups and the control one, regarding the investigated skills. Children with SNHL showed a clear deficit in flexibility, whereas children with SLI had greater problems in self-regulation and management of waiting for gratification. Selective attention was found to be deficient in all three groups, with no statistically significant differences. This study shows that the skills investigated were found to be deficient in both SNHL and SLI patients. It is essential to start targeted exercises based on specific deficient skills as part of the rehabilitation program. It is of great importance to understand the consequences of EF deficit in preschool children to achieve an accurate diagnosis and carry out customized rehabilitation programs.

Impact of the COVID-19 Lockdown on Patients with Chronic Tinnitus-Preliminary Results.

The COVID-19 pandemic and the lockdown measures are both causes of psychological distress. The aim of the current study was to evaluate the psychological effects of lockdown measures on patients with subjective chronic tinnitus diagnosed before the COVID-19 pandemic. A sample of n = 77 patients with chronic tinnitus was contacted by mail/phone for a survey between June 2021 and September 2021. All patients filled out questionnaires on tinnitus distress (Tinnitus Handicap Inventory, THI), anxiety (Beck Anxiety Inventory, BAI) and depression (Beck Depression Inventory, BDI) and eight items of the Tinnitus Sample Case History (TSCH) about tinnitus history (i.e., loudness, pitch, perception, tinnitus location), stress, and related conditions (noise annoyance, vertigo/dizziness, headache). Forty patients with chronic tinnitus filled out the survey. No significant differences of total THI mean scores (p > 0.05) were found compared to the results obtained before the COVID-19 pandemic and after lockdown. Regarding depression and anxiety, the female population showed a significant increase in scores obtained from the BDI (p < 0.0170) and the BAI (p < 0.049). Only two patients (0.5%) were infected by COVID-19 (positive RT-PCR), and they did not report any worsening of tinnitus. According to the data of the literature, our patients experienced a heterogeneous course of tinnitus, and the severity of tinnitus was not significantly affected by lifestyle changes during the COVID-19 pandemic and lockdown.

Consensus Definition of Misophonia: A Delphi Study.

Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, the authors conducted a study to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.

Tinnitus and Metacognitive Beliefs-Results of a Cross-Sectional Observational Study.

Recent research has highlighted the role of metacognitions as a moderator for psychological distress in patients with chronic diseases. The present study investigates the role of metacognitions and worry in the association between tinnitus distress, anxiety, and depression. A cross-sectional study was carried out with a sample of tinnitus-outpatients who completed the Tinnitus-Handicap Inventory, Beck Anxiety Inventory, Beck Depression Inventory, Metacognition Questionnaire-30, Penn-State-Worry-Questionnaire. Associations of metacognitions, worries, tinnitus distress, anxiety and depression were investigated using structural equation models (SEMs). A sample of n = 107 patients was included in the study. In the first SEM, tinnitus distress significantly predicted depression (ß = 0.68, p < 0.001) and anxiety (ß = 0.47, p < 0.001). In the second model, worries and meta-cognitions were added as moderators. The explained variance substantially increased for depression (46 to 53%) and anxiety (22 to 35%) and the association of tinnitus distress with depression (ß = 0.57, p < 0.001) and anxiety was weakened (ß = 0.32, p < 0.001). Negative beliefs significantly predicted worries (ß = 0.51, p < 0.001) and explained 41% of its variance. A good model fit for the final model was found (comparative fit index (CFI) = 0.98; (Tucker Lewis index) TLI = 0.96; root mean square error of approximation (RMSEA) = 0.067). Anxiety and depression in tinnitus patients might be influenced by worries, which is mainly predicted by negative beliefs about uncontrollability and danger of worries. Thus, psychotherapeutic approaches focused on alterations of metacognitions in patients with tinnitus should be investigated in future studies.3 (List three to ten pertinent keywords specific to the article yet reasonably common within the subject discipline.).

Gender Comparison of Psychological Comorbidities in Tinnitus Patients - Results of a Cross-Sectional Study.

BACKGROUND: In the last decades, research focused on gender-related features in patients with tinnitus has often led to controversial results. The complex clinical picture of tinnitus patients often consists of an interdependent relationship between audiological symptoms and co-occurrent psychological disorders, which can complicate the diagnostic evaluation. METHODS: Therefore, we studied 107 patients with tinnitus, investigating their psychological comorbidities in the light of gender differences. All patients were evaluated with ENT/audiological and psychological examination to consider presence/absence, type and gender distribution of psychopathological comorbidities. Patients completed questionnaires on tinnitus distress (Tinnitus Handicap Inventory, THI), anxiety (Beck Anxiety Inventory, BAI), depression (Beck Depression Inventory, BDI), metacognition (Metacognition Questionnaire-30, MCQ-30) and worry (Penn State Worry Questionnaire). The influence of gender on the relationship between tinnitus distress and psychological comorbidities was investigated with simple moderation analyses using the SPSS PROCESS macro. RESULTS: The total sample included 65 male and 42 female patients (60.7 vs. 39.3%), matched for age and duration of tinnitus. We found no significant differences for tinnitus distress (THI total score, THI subscales) and MCQ-30 subscales, except for the control over thoughts, where men showed significantly higher scores than women (p = 0.045). Also, in our sample women showed significantly higher values for depression (BDI total score, p = 0.019), anxiety (BAI total score, p = 0.010) and worries (PSQW total score, p = 0.015). Moderation analyses revealed a significant influence of gender on the relationship of tinnitus distress with depression: higher scores of tinnitus distress were associated with significantly elevated levels of depression amongst men. No further gender influences could be observed in our sample. DISCUSSION: In conclusion, our results indicate general gender differences for psychological comorbidities in tinnitus patients, with women reporting more depression, anxiety and worries. Men, on the other hand, showed a higher need to control their thoughts. Additionally, our results indicate that men might have more coping problems with increasing levels of tinnitus distress, leading to increased depressive symptoms. Nevertheless, several gender related aspects in tinnitus patients remain unclear, thus warranting the need future studies in this field.

Analysis of the audiological characteristics and comorbidity in patients with chronic tinnitus.

Tinnitus is defined as perception of a sound without sound stimulation. This study aims to investigate the correlation between chronic tinnitus and the most significant clinical comorbidities and pharmacological treatments. We recruited 130 consecutive outpatients with a tinnitus for least from three months and 100 subjects without tinnitus. All patients had a full medical and audiological evaluation and all filled in Tinnitus Handicap Inventory questionnaire and Khalfa's Hyperacusis questionnaire. We also analyzed the qualitative variables: audiometry exam, tinnitus characteristics and psychometric questionnaires. Univariate logistic regression was performed to evaluate the associations between the presence of tinnitus and the presence of comorbidities and drug intake. The statistical analysis provided the following results in the group of patients with tinnitus. We obtained an Odds Ratio statistically significant for the following categories taken into consideration: the presence of anxiety and depression, neurological diseases, headache, temporomandibular joint (TMJ) disorders, intake of levothyroxine and proton-pump inhibitor. In this study, we tried to evaluate the audiological characteristics in the subjects affected by chronic tinnitus in order to find a possible correlation with the comorbidities and any drugs intake. We found a statistically significant correlation between tinnitus and comorbidities like anxiety, depression, TMJ disorders, dysthyroidism, headache and levothyroxine and PPI intake.

Validation of the Italian Tinnitus Questionnaire Short Form (TQ 12-I) as a Brief Test for the Assessment of Tinnitus-Related Distress: Results of a Cross-Sectional Multicenter-Study.

Objectives: The use of reliable and valid psychometric tools to assess subjectively experienced distress due to tinnitus is broadly recommended. The purpose of the study was the validation of the Italian version of Tinnitus Questionnaire 12 item short form (TQ 12-I) as a brief test for the assessment of patient reported tinnitus-related distress. Design: Cross-sectional multicenter questionnaire study. Setting: Tinnitus Center, European Hospital (Rome), the Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital (Piacenza), and the Department of Audiology and Phoniatry, "Mater Domini" University Hospital (Catanzaro). Participants: One hundred and forty-three outpatients with tinnitus treated at one of the participating medical centers. Main Outcome Measures: Tinnitus Questionnaire Short Form (TQ 12-I), compared to the Tinnitus Handicap Inventory (THI), Brief Symptom Inventory (BSI), and Short Form (SF-36) Health Survey. Results: Our factor analysis revealed a two-factor solution (health anxiety, cognitive distress), accounting for 53.5% of the variance. Good internal consistency for the total score (α = 0.86) and both factors (α = 0.79-0.87) was found. Moderate correlations with the THI (r = 0.65, p < 0.001) indicated good convergent validity. Tinnitus distress was further correlated to increased psychological distress (r = 0.31, p < 0.001) and reduced emotional well-being (r = -0.34, p < 0.001). Conclusion: The study clearly showed that the TQ 12-I is a reliable and valid instrument to assess tinnitus-related distress which can be used in clinical practice as well as for research.

Cochlear Impairment and Autoimmune Ear Disorder in a Patient with Breast Cancer.

The purpose of this study was to consider the possible role of autoimmune diseases and paraneoplastic syndrome in the genesis of tinnitus. The incidence of autoimmune inner ear disease (AIED) is rare, accounting for <1% of all cases of hearing impairment and dizziness. In presence of auditory and vestibular deficit in oncological patients, a paraneoplastic syndrome with cochleovestibulopathy should be considered. We described a 50-year-old Caucasian woman came to our attention with complaints of severe disabling bilateral tinnitus (Tinnitus Handicap Inventory, THI: 96), ear fullness and headache. The onset of tinnitus was associated to the last breast implant and prolonged antibiotic therapy. Serological autoimmunity tests were positive and a diagnosis of mixed connective tissue disease with notes of fibromyalgia was made. Pure tone audiometry testing revealed bilateral fluctuating mild hearing loss on high frequencies. The tinnitus was successfully treated with bilateral wideband sound generators (listening 8-9 h for day) regulated at the mixing point. At 12 months follow up THI has shrunk considerably (THI: 4) and the patient has continued treatment only with the sound pillow. In conclusion significant progress is needed to better understand the role of autoantibodies in the pathogenesis and diagnosis of paraneoplastic cochleovestibulopathy. To our knowledge, our study is the first in which hearing loss and tinnitus is considered as a manifestation of a paraneoplastic syndrome.

Selective attentional impairment in chronic tinnitus: Evidence from an event-related potentials study.

OBJECTIVE: Tinnitus is an auditory phantom sensation experienced in the absence of a sound source. Cognitive dysfunctions, especially in working memory and attention, are frequently reported to be associated with tinnitus. The aim of this study was to investigate attentional functioning in a group of subjects with chronic tinnitus using ERPs, and in particular the P300 components. METHODS: We studied 20 patients with chronic tinnitus and 20 healthy subjects that performed a P300 Novelty task. RESULTS: P3a amplitude was significantly lower in tinnitus subjects than in controls. P3a latency was comparable in patients and controls. The P3b parameters were similar in the two groups. N1 latency for all the stimuli was significantly longer in tinnitus subjects than in controls. CONCLUSION: These results point to a general slowing in early stimulus perception in tinnitus subjects. Moreover, a specific difficulty emerged in attentional switching to unexpected events during an orienting response, probably owing to a dysfunction in the ventral attention network. SIGNIFICANCE: Psychophysiological approach reveals selective attentional impairment and could provide useful data for rehabilitative strategies in chronic tinnitus.

Severe Hyperacusis, Photophobia, and Skin Hypersensitivity.

We report a case of a patient with severe hyperacusis, photophobia, and skin hypersensitivity. The patient was initially treated with sound therapy and medical therapy for 4 months and successfully with a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy which improved her mood and the tolerance for sounds and light.

Olfactory Dysfunction, Olfactory Bulb Volume and Alzheimer's Disease: Is There a Correlation? A Pilot Study1.

BACKGROUND: Olfactory dysfunction is present since the earliest stage of Alzheimer's disease (AD). In AD patients, the olfactory impairment has been correlated with atrophy of some structures of the olfactory system, but the role of the olfactory bulb remains unclear. OBJECTIVE: The aim of our work is to test if patients suffering from AD exhibit a statistically significant reduction of the average volume of the olfactory bulb (OBV) compared to healthy subjects. METHODS: 78 subjects were enrolled in the study and divided into three groups: 28 healthy elderly (22 females, 6 males, mean age 69.4 ± 9.2), 25 patients with mild cognitive impairment (MCI) amnestic type (14 females, 11 males, mean age 74.5 ± 7.5), and 25 mild AD patients (14 females, 11 males, mean age 73.7 ± 6.8). Every subject underwent an MRI study of the olfactory bulb and an olfactory assessment with the Sniffin' Stick Extended Test. RESULTS: The statistical analysis showed no correlation between the OBV and MCI or AD. Moreover, olfactory function and OBV were not correlated in any of the three groups. CONCLUSION: The reduction of OBV does not seem to represent an index of neuronal damage in the earliest stages of AD.

Clinical management of a patient with advanced mucosal malignant melanoma in the sinonasal area.

We describe a case of mucosal malignant melanoma in the sinonasal area of a 65-year-old woman. She presented with a history of nasal obstruction and epistaxis with subsequent tenderness, facial anesthesia involving cranial nerve V2, red eye, proptosis, diplopia, and conjunctival chemosis. Computed tomography detected a nonspecific solid mass that had involved the left maxillary sinus and surrounding tissues, with extension into the nasal cavity and invasion of the orbital floor and eye muscles. Histopathologic examination of the neoplasm revealed that it was a malignant melanoma. We performed a radical hemimaxillectomy that extended to the orbit, which allowed for radical excision of the tumor. Postoperatively, the patient received adjuvant chemotherapy and radiotherapy. Mucosal melanoma in the head and neck is a rare and highly malignant neoplasm. We suggest that malignant melanoma be suspected when a small-round-cell tumor is found on light microscopy, and we confirm the usefulness of immunohistochemical investigations.

Olfactory deficit and hippocampal volume loss for early diagnosis of Alzheimer disease: a pilot study.

BACKGROUND: The aim of this pilot study was to verify the role of olfactory test and volumetric magnetic resonance imaging measure of hippocampus to predict conversion from mild cognitive impairment to Alzheimer disease (AD). MATERIALS AND METHODS: Eighteen patients with amnesic mild cognitive impairment, broadly defined, were followed at 12 months. Hypothesized baseline predictors for follow-up conversion to AD were olfactory deficit and hippocampal volumes loss. RESULTS: In the 1-year follow-up, 5 patients converted to AD. The 2 clinical predictors olfactory test and hippocampal volume loss showed the same sensitivity of 92.3% but the olfactory test showed a higher specificity than the hippocampal volume loss (75% vs. 60%). CONCLUSIONS: Our findings suggest the potential utility of olfactory test and hippocampal volume loss for early detection of AD.

Association between sleep disorders, hyperacusis and tinnitus: evaluation with tinnitus questionnaires.

Patients with tinnitus are heterogeneous and several factors influence the impact of this symptom on the quality of life. The aim of the study is to evaluate the relationship between age, gender, sleep disorders, hyperacusis and tinnitus annoyance and to demonstrate the utility of tinnitus questionnaires as screening tools for sleep disorders and hyperacusis in patients with tinnitus. 37 consecutive patients (18 males and 19 females) with subjective tinnitus lasting over 3 months were evaluated with a complete interview, otological examination, pure tone audiometry, Italian version of tinnitus sample case history (TSCH) and tinnitus handicap inventory (THI). Statistical analysis was performed with the Wilcoxon's rank sum test, the Spearman's rho non-parametric correlation and the logistic regression analysis. THI grades were slight (16%), mild (32%), moderate (30%), severe (19%) and catastrophic (3%). Based on the answers to TSCH 20 patients reported sleep disorders (54%) and 20 patients reported hyperacusis (54%). 11 patients (30%) reported sleep disorders and hyperacusis. No significant correlation was found between the severity of tinnitus and patients' age and gender. Significant correlation was found between sleep disorders (P = 0.0009) and tinnitus annoyance and between hyperacusis (P = 0.03) and tinnitus annoyance. TSCH and THI may be considered as screening tools in the clinical practice to evidence sleep disorders and hyperacusis in patients with tinnitus.

Suppression of tinnitus in a patient with unilateral sudden hearing loss: a case report.

We describe a case of a 67-year-old woman with severe disabling right-sided tinnitus, mild hyperacusis, and headache. The tinnitus was associated with sudden right hearing loss and vertigo, which occurred about 18 months before. Magnetic resonance imaging (MRI) resulted in normal anatomical structures of the cochlea and of the cranial nerves showing a partial empty sella syndrome with suprasellar cistern hernia. Angio-MR revealed a bilateral contact between the anterior-inferior cerebellar artery (AICA) and the acoustic-facial nerve with a potential neurovascular conflict. Surgery was considered unnecessary after further evaluations. The right ear was successfully treated with a combination device (hearing aid plus sound generator). Shortly after a standard fitting procedure, the patient reported a reduction of tinnitus, hyperacusis, and headache which completely disappeared at the follow-up evaluation after 3, 6, and 12 months. This paper demonstrates that the combination device resulted in a complete tinnitus and hyperacusis suppression in a patient with unilateral sensorineural sudden hearing loss. Our paper further supports the restoration of peripheral sensory input for the treatment of tinnitus associated with hearing loss in selected patients.

New trends in tinnitus management.

Tinnitus is a perception of sound in absence of sound stimulation. Tinnitus in many cases cannot be eliminated by conventional medical treatment with drugs or surgery. Some people who begin to notice tinnitus, whether spontaneous or induced by noise, trauma or other insult, will experience spontaneous resolution, but many patients will have persistent tinnitus. For some of them, tinnitus sensation will be joined by tinnitus suffering, with many adverse effects like anxiety, depression and sleep disorders. For these tinnitus sufferers the psychological and acoustic approach proposed by the Tinnitus Retraining Therapy and Acoustic Desensitization Protocol may be helpful. Periodically new treatments are suggested like low-frequency repetitive transcranial magnetic stimulation and sequential phase shift sound cancellation treatment based on the frequency and loudness matching of the tinnitus. The aim of this work is to review modern considerations for the treatment of tinnitus.

Smell and preclinical Alzheimer disease: study of 29 patients with amnesic mild cognitive impairment.

OBJECTIVES: To evaluate the olfactory function in patients with amnesic mild cognitive impairment (aMCI) and the relationship to the progression from aMCI to Alzheimer disease (AD). DESIGN: Cohort prospective study on aMCI patients at the first evaluation (T0) and at the 18-month follow-up (T1). SETTING: Alzheimer Unit of the University of L'Aquila, Italy. METHODS: Twenty-nine aMCI patients were enrolled in this study. MAIN OUTCOME MEASURES: Olfactory function was studied with the Sniffin' Sticks Screening Test (SSST) and the Sniffin' Sticks Extended Test (SSET). Olfactory functions were related to neurocognitive functions assessed by the Mini-Mental State Examination (MMSE) and the Mental Deterioration Battery (MDB). RESULTS: At T0, aMCI patients showed an olfactory impairment and all of the aMCI patients had lower olfaction scores at T1. At T1, 9 of the 29 aMCI patients (31%) developed AD and had lower mean SSST and SSET scores than 20 aMCI patients who did not develop AD. The most significant relationship was found between olfactory discrimination and visuospatial ability, language skill, and the Rey Immediate test of the MDB and between olfactory identification and the Rey Delayed test. CONCLUSION: Odour discrimination and identification performance correlated more prominently than detection thresholds with performance on neuropsychological tests. We concluded that the olfactory deficit occurs early in aMCI, so we suggest introducing the clinical routine use of the olfactory test for early identification of the progression of the decline from aMCI to AD.