Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research.

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2-3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation (r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

Survey on the Effectiveness of Dietary Supplements to Treat Tinnitus.

PURPOSE: We surveyed the benefit of dietary supplements to treat tinnitus and reported adverse effects. METHOD: A website was created for people with tinnitus to complete a variety of questions. RESULTS: The 1,788 subjects who responded to questionnaires came from 53 different countries; 413 (23.1%) reported taking supplements. No effect on tinnitus was reported in 70.7%, improvement in 19.0%, and worsening in 10.3%. Adverse effects were reported in 6% (n = 36), including bleeding, diarrhea, headache, and others. Supplements were reported to be helpful for sleep: melatonin (effect size, d = 1.228) and lipoflavonoid (d = 0.5244); emotional reactions: melatonin (d = 0.6138) and lipoflavonoid (d = 0.457); hearing: Ginkgo biloba (d = 0.3758); and concentration Ginkgo biloba (d = 0.3611). The positive, subjective reports should be interpreted cautiously; many might have reported a positive effect because they were committed to treatment and expected a benefit. Users of supplements were more likely to have loudness hyperacusis and to have a louder tinnitus. CONCLUSIONS: The use of dietary supplements to treat tinnitus is common, particularly with Ginkgo biloba, lipoflavonoids, magnesium, melatonin, vitamin B12, and zinc. It is likely that some supplements will help with sleep for some patients. However, they are generally not effective, and many produced adverse effects. We concluded that dietary supplements should not be recommended to treat tinnitus but could have a positive outcome on tinnitus reactions in some people.

Manganese and Lipoflavonoid Plus(®) to Treat Tinnitus: A Randomized Controlled Trial.

BACKGROUND: Several tinnitus sufferers suggest that manganese has been helpful with their tinnitus. PURPOSE: We tested this in a controlled experiment where participants were committed to taking manganese and Lipoflavonoid Plus(®) to treat their tinnitus. RESEARCH DESIGN: Randomized controlled trial. STUDY SAMPLE: 40 participants were randomized to receive both manganese and Lipoflavonoid Plus(®) for 6 months, or Lipoflavonoid Plus(®) only (as the control). DATA COLLECTION AND ANALYSIS: Pre- and postmeasures were obtained with the Tinnitus Handicap Questionnaire, Tinnitus Primary Functions Questionnaire, and tinnitus loudness and annoyance ratings. An audiologist performed the audiogram, the tinnitus loudness match, and minimal masking level. RESULTS: Twelve participants were dropped out of the study because of the side effects or were lost to follow-up. In the manganese group, 1 participant (out of 12) showed a decrease in the questionnaires, and another showed a decrease in the loudness and annoyance ratings. No participants from the control group (total 16) showed a decrease in the questionnaires ratings. Two participants in the control group reported a loudness decrement and one reported an annoyance decrement. CONCLUSIONS: We were not able to conclude that either manganese or Lipoflavonoid Plus(®) is an effective treatment for tinnitus.

Effect of Cigarette Smoking and Passive Smoking on Hearing Impairment: Data from a Population-Based Study.

OBJECTIVES: In the present study, we aimed to determine the effect of both active and passive smoking on the prevalence of the hearing impairment and the hearing thresholds in different age groups through the analysis of data collected from the Korea National Health and Nutrition Examination Survey (KNHANES). STUDY DESIGN: Cross-sectional epidemiological study. METHODS: The KNHANES is an ongoing population study that started in 1998. We included a total of 12,935 participants aged ≥19 years in the KNHANES, from 2010 to 2012, in the present study. Pure-tone audiometric (PTA) testing was conducted and the frequencies tested were 0.5, 1, 2, 3, 4, and 6 kHz. Smoking status was categorized into three groups; current smoking group, passive smoking group and non-smoking group. RESULTS: In the current smoking group, the prevalence of speech-frequency bilateral hearing impairment was increased in ages of 40-69, and the rate of high frequency bilateral hearing impairment was elevated in ages of 30-79. When we investigated the impact of smoking on hearing thresholds, we found that the current smoking group had significantly increased hearing thresholds compared to the passive smoking group and non-smoking groups, across all ages in both speech-relevant and high frequencies. The passive smoking group did not have an elevated prevalence of either speech-frequency bilateral hearing impairment or high frequency bilateral hearing impairment, except in ages of 40s. However, the passive smoking group had higher hearing thresholds than the non-smoking group in the 30s and 40s age groups. CONCLUSION: Current smoking was associated with hearing impairment in both speech-relevant frequency and high frequency across all ages. However, except in the ages of 40s, passive smoking was not related to hearing impairment in either speech-relevant or high frequencies.

Is Hypozincemia Related to Tinnitus?: A Population Study Using Data From the Korea National Health and Nutrition Examination Survey.

OBJECTIVES: The aim of present study was to determine the relationship between serum zinc level and tinnitus using data from the Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: The present study examined the relationship between serum zinc level and tinnitus using data from the KNHANES. A total of 2,225 KNHANES participants responded to the tinnitus questionnaire and provided blood samples to measure serum zinc concentration. Based on questionnaire responses, participants were categorized into control, mild tinnitus, moderate tinnitus, and severe tinnitus subgroups. RESULTS: There were no significant differences between groups in serum zinc level after adjustment for sex, age, and hearing loss. CONCLUSION: It was concluded that hypozincemia is not related to tinnitus in a large population.

Validation of a Korean Version of the Tinnitus Handicap Questionnaire.

OBJECTIVES: The goal of the present study was to evaluate the reliability and validity of the Korean version of the tinnitus handicap questionnaire (THQ-K). METHODS: A total of 60 patients were included in this study. Patients responded to the THQ-K, the tinnitus handicap inventory (THI), Beck's depression index (BDI), and the visual analogue scale (VAS) for loudness and pitch, loudness match, and minimum masking level (MML) test were performed. RESULTS: Internal consistency of the THQ-K was examined using Cronbach coefficient alpha. Cronbach alpha was 0.96. The THQ-K showed a significant correlation with THI, BDI, VAS for distress, and VAS for loudness, but no significant correlation with psychoacoustic measurement of tinnitus, such as loudness match, pitch match, and MML. CONCLUSION: The THQ-K is a reliable and valid test for evaluating the degree of handicap due to tinnitus for both research and clinical use.

Lymphoma of the Internal Auditory Canal Presenting as Facial Palsy, Vertigo, and Hearing Loss.

The combined symptoms of vertigo, hearing loss, and facial palsy indicate the presence of lesions in the internal auditory canal (IAC). Differential diagnoses, such as inner/middle ear infections and IAC neoplasms, can make the definitive diagnosis of IAC lymphomas challenging. Lymphomas can infiltrate the central nervous system at various sites; however, IAC involvement in metastatic lymphomas is very rare. Herein we report the case of a patient with IAC lymphoma presenting with aural fullness of the left ear and intractable otalgia followed by symptoms of facial weakness, hearing loss, and vertigo within 48 h. The uncharacteristic clinical manifestations and concurrent middle ear infection meant that the conclusive diagnosis of IAC lymphoma was delayed.

A review of hyperacusis and future directions: part II. Measurement, mechanisms, and treatment.

PURPOSE: Hyperacusis can be extremely debilitating, and at present, there is no cure. In this detailed review of the field, we consolidate present knowledge in the hope of facilitating future research. METHOD: We review and reference the literature on hyperacusis and related areas. This is the 2nd of a 2-part review. RESULTS: Hyperacusis encompasses a wide range of reactions to sounds, which can be grouped into the categories of excessive loudness, annoyance, fear, and pain. Reasonable approaches to assessing the different forms of hyperacusis are emerging, including brain-imaging studies. Researchers are only beginning to understand the many mechanisms at play, and valid animal models are still evolving. There are many counseling and sound-therapy approaches that some patients find helpful, but well-controlled studies are needed to measure their long-term efficacy and to test new approaches. CONCLUSIONS: Hyperacusis can make life difficult in this increasingly noisy world, forcing sufferers to dramatically alter their work and social habits. We believe this is an opportune time to explore approaches to better understand and treat hyperacusis.

A review of hyperacusis and future directions: part I. Definitions and manifestations.

PURPOSE: Hyperacusis can be extremely debilitating, and at present, there is no cure. We provide an overview of the field, and possible related areas, in the hope of facilitating future research. METHOD: We review and reference literature on hyperacusis and related areas. We have divided the review into 2 articles. In Part I, we discuss definitions, epidemiology, different etiologies and subgroups, and how hyperacusis affects people. In Part II, we review measurements, models, mechanisms, and treatments, and we finish with some suggestions for further research. RESULTS: Hyperacusis encompasses a wide range of reactions to sound, which can be grouped into the categories of excessive loudness, annoyance, fear, and pain. Many different causes have been proposed, and it will be important to appreciate and quantify different subgroups. Reasonable approaches to assessing the different forms of hyperacusis are emerging, including psychoacoustical measures, questionnaires, and brain imaging. CONCLUSIONS: Hyperacusis can make life difficult for many, forcing sufferers to dramatically alter their work and social habits. We believe this is an opportune time to explore approaches to better understand and treat hyperacusis.

Protective role of edaravone against neomycin-induced ototoxicity in zebrafish.

Aminoglycosides such as neomycin are one of the most commonly prescribed types of antibiotics worldwide. However, these drugs appear to generate free radicals within the inner ear, which can result in permanent hearing loss. We evaluated the effects of edaravone, a neuroprotective agent, on neomycin-induced ototoxicity in transgenic zebrafish. The 5-day post fertilization (dpf) zebrafish larvae were exposed to 125 µM neomycin and various concentrations of edaravone for 1 h. Hair cell survival was calculated as average numbers of the hair cells in the control group, which was not exposed to neomycin. Ultrastructural changes were evaluated using a scanning electron microscope (SEM) and transmission electron microscope (TEM). Edaravone protected against neomycin-induced hair cell loss in the neuromasts (1000 µM: 11.6 ± 1.1 cells, neomycin only: 5.5 ± 0.5 cells; n = 10, P<0.05) and decreased the TUNEL reaction for detecting apoptosis. In ultrastructural analysis, structures of mitochondria and hair cells within neuromasts were preserved in zebrafish exposed to 125 µM neomycin and 1000 µM edaravone for 1 h. Edaravone protected against neomycin-induced hair cell loss by preventing apoptosis.

A new patch material for tympanic membrane perforation by trauma: the membrane of a hen egg shell.

CONCLUSION: The egg shell membrane (ESM) patch may promote tympanic membrane (TM) healing in acute traumatic TM perforation. OBJECTIVE: To evaluate the use of ESM for treating acute traumatic TM perforation. METHODS: We reviewed charts of patients with traumatic TM injury from 2008 to 2011. Treatments were an ESM patch or a perforation edge approximation. We divided patients into two groups according to the treatment used. Each patient was matched by treatment onset and perforation size. We compared healing ratio, healing time, and frequency of otorrhea between the perforation edge approximation group and the ESM patch group. Matched t tests were used for analysis. RESULTS: The healing ratio of the TM showed no significant difference between the two groups, but the time to heal was significantly shorter in the ESM patch group than in the perforation edge approximation group.

Cognitive behavioral therapy for tinnitus: evidence and efficacy.

Tinnitus is defined as auditory perception without external sound. There is currently no cure for tinnitus. Cognitive behavioral therapy (CBT) is a tinnitus treatment that addresses the affected individual's reaction to tinnitus. It aims not to eliminate auditory perception as sound but to reduce or correct one's negative response to tinnitus. CBT identifies negative automatic thought and then evaluates its validity with the patient. It also aims to change negative automatic thought to more positive and realistic thought. In this way, tinnitus sufferers can function well despite the presence of tinnitus. Many studies have supported the efficacy of CBT for treating tinnitus. A meta-analysis of CBT for tinnitus also concluded that CBT is effective in treating tinnitus. Thus, CBT is considered a good option for treating tinnitus. We herein discuss the use of CBT for tinnitus with a literature review.

Ciglitazone inhibits cigarette smoke solution-induced inflammatory responses in human middle ear epithelial cells.

OBJECTIVE: Peroxisome proliferator activated receptor-γ (PPAR-γ), a member of the nuclear hormone receptor superfamily, plays an important role in the regulation of mucosal inflammation. The aim of this study was to investigate the anti-inflammatory effect of a PPAR-γ agonist, ciglitazone, on cigarette smoke solution (CSS)-induced inflammation in human middle ear epithelial cell lines (HMEECs). DESIGN: HMEECs with or without ciglitazone pre-treatment were exposed to CSS in order to induce the inflammatory response. The suppressive effect of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and cyclooxygenase-2(COX-2), were evaluated using real-time polymerase chain reaction and Western blotting. RESULTS: Stimulation with CSS at 40 µg/ml for 6 h resulted in a 4.1-fold increase in the expression of TNF-α mRNA in the HMEECs. CSS-induced up-regulation of TNF-α mRNA was decreased by more than 2.8-fold in cells pre-treated with ciglitazone. The up-regulation of COX-2 mRNA and increased COX-2 protein expression induced by CSS were also inhibited by more than 3.7-fold with ciglitazone pre-treatment. CONCLUSIONS: These findings suggest that the inflammatory response induced by CSS could be inhibited by ciglitazone, a PPAR-γ agonist, in HMEECs. As such, PPAR-γ agonists may have therapeutic potential for the treatment of otitis media.

Analysis of frequency loss as a prognostic factor in idiopathic sensorineural hearing loss.

CONCLUSION: The combination of systemic steroids with intratympanic dexamethasone injection (ITDI) did not result in significantly different outcomes from steroid treatment only and did not have any additional beneficial effects. OBJECTIVE: To evaluate hearing recovery in idiopathic sudden sensorineural hearing loss (ISSNHL) according to frequency and to compare treatment responses between patients treated with systemic steroids and systemic steroids with ITDI. METHODS: Ninety-nine patients with ISSNHL were selected to participate in the study by a retrospective medical chart review. Patients were divided into two groups, systemic steroid treatment only and systemic steroid with adjunctive ITDI. Hearing recovery was evaluated by pure tone audiometry (PTA). All patients underwent PTA examination before treatment and after 3 months. Thresholds were analyzed by frequency along with other factors. RESULTS: Low frequency hearing loss responded better than high frequency loss to PTA. When we analyzed pure tone audiogram patterns, all patterns except for the descending type showed better improvement in patients with lower frequency hearing loss than in patients with higher frequency hearing loss.

Correlating the head shake-sensory organizing test with dizziness handicap inventory in compensation after vestibular neuritis.

OBJECTIVE: Despite complaints of dizziness, some patients with unilateral compensated vestibular weakness show normal results on Sensory Organization Test (SOT), which is being widely used for the evaluation of vestibular function compensation. The head shake-sensory organization test (HS-SOT) has been suggested to increase the sensitivity of SOT. In HS-SOT, the patient is required to shake head under Conditions 2 and 5 of traditional SOT. However, the sensitivity of HS-SOT remains unelucidated in patients with vestibular neuritis. The aim of this study was to determine the sensitivity of HS-SOT and SOT and compare them with the Dizziness Handicap Inventory (DHI) in detecting balance problems in patients with vestibular neuritis complaining of dizziness. SETTING: Tertiary referral center. PATIENTS: A prospective analysis was conducted on all vestibular neuritis patients between September 2009 and April 2011. Thirty-two patients with uncompensated vestibular neuritis were enrolled in this study. Patients with acute symptoms of dizziness, orthopedic problems, or any other severe underlying conditions were excluded. MAIN OUTCOME MEASURES: Equilibrium and vestibular scores of SOT and equilibrium score ratios of HS-SOT and DHI were obtained from each patient after 1 week and 1, 2, and 6 months of the first attack of vestibular neuritis. RESULTS: HS-SOT is more correlated with the DHI than SOT by periods. One month after vestibular neuritis, the correlation between DHI and SOT, HS-SOT Conditions 2 and 5 were -0.301, -0.385, and -0.625, respectively. Six months after vestibular neuritis, the correlation between DHI and SOT, and HS-SOT Conditions 2 and 5 were -0.053, -0.337, and -0.394, respectively. CONCLUSION: HS-SOT was more sensitive than SOT during the compensation of vestibular neuritis. Specifically, during the compensation of vestibular neuritis, HS-SOT Condition 5 was more correlated with DHI than HS-SOT Condition 2. The results suggest that HS-SOT provides more useful measures for the evaluation of vestibular compensation in vestibular neuritis.