Enriched Acoustic Environment as a customized treatment for tinnitus: A non-controlled longitudinal study

Tinnitus is a heterogeneous hearing disorder with no cure at present,but some treatments,such as a combination of counselling and sound therapy,can alleviate the discomfort it causes.The sound therapy efficiency depends on both the type of sound stimulus and the time of exposure.This study describes the fundamentals of a personalized sound therapy that stimulates the auditory system with either continuous or sequential sounds whose spectra are adjusted to the hearing levels of the participants.This sound therapy is called Enriched Acoustic Environment and is assessed in a sample of 137 participants with tinnitus.Tinnitus-related distress relief was clinically relevant and statistically significant for 90%of these patients.This was quantified as a mean decrease of 24.3 points on the Tinnitus Handicap Inventory.31%of participants were treated with sequential stimuli and achieved greater relief of distress(29.4 points on their Tinnitus Handicap Inventory score)compared to those treated with continuous sound(69%).According to these results,sequential sound seems to be optimal compared to continuous sound.

Tinnitus prevalence and care experience among population of Almaty city

The prevalence of tinnitus is increasing worldwide along with the aging population.The absence of a gold standard for diagnosis and treatment makes it difficult to assess the health status of a patient with tinnitus.The aim was to determine the prevalence of tinnitus among older adults in Almaty city and to evaluate the healthcare experience among the respondents who received treatment for tinnitus.Methods:A cross-sectional study was conducted among people aged 18 years and above in Almaty city.The data were collected using a questionnaire sent via a Google form and/or as a printed version.Fully completed responses were received from 851 respondents.The questionnaire consists of 31 questions.Simple and multiple logistic regression analyses were performed to identify the risk factors of tinnitus.Results:The prevalence of tinnitus in Almaty was 23.3%.The data showed that smoking and sleep regimen were associated with tinnitus.Older respondents indicated more symptoms associated with tinnitus than younger respondents did.Additional consultation was needed as part of the treatment of tinnitus.In addition,49.4%of the respondents indicated a need of a support group for people with tinnitus.The respondents also indicated that the access to appropriate resources for the treatment of tinnitus was poor.Conclusion:Similar to other studies,this analysis confirmed that tinnitus is prevalent in the adult population of Almaty city.Future activities should include measures for the improvement of public awareness of the risk factors of tinnitus,and multidisciplinary teamwork among healthcare specialists should be improved.

Effects of traditional Chinese medicine on symptoms of patients with spleen and stomach deficiency-related tinnitus

BACKGROUND Tinnitus affects 10%-30%of the population.Recent evidence suggests that tinnitus is associated with spleen deficiency.However,compared with kidney deficiency-related tinnitus,less research has been conducted on the impact of spleen defi-ciency-related tinnitus.AIM To investigate the clinical efficacy of using Guipi Wan and dietary and lifestyle modification based on traditional Chinese medicine for treatment of patients with spleen and stomach deficiency-related tinnitus.METHODS We enrolled 110 patients with spleen and stomach deficiency-related tinnitus who were distributed into treatment(58 cases)and control(52 cases)groups.Tinnitus severity,sleep quality and emotional state were assessed by questionnaires[Tinnitus Evaluation Questionnaire(TEQ);Pittsburgh Sleep Quality Index(PSQI);Depression-Anxiety-Stress Scale-21(DASS-21)]that were used for analysis in the two groups during the initial and intervention and after.In the treatment group,patients were treated with oral administration of Guipi Wan and consulted for healthy dietary and lifestyle modification.In the control group,patients were only assessed and not treated.RESULTS At the end of the 6-months,TEQ scores decreased significantly in the treatment group(P=0.021)but not in the Control group.Significant effects in the treatment group were noted for PSQI total score(P=0.043)and several PSQI component scores in the treatment group(P<0.05).After treatment,the DASS-21 scores were significantly reduced in the treatment group(P<0.05).CONCLUSION Guipi Wan combined with dietary and lifestyle modification based on regulating the spleen and stomach can be considered core to the treatment of tinnitus related to spleen and stomach deficiency.

Cognitive Behavioral Therapy for Tinnitus in Adults: A Review of Efficacy in Quality-of-Life Enhancement

Background: Tinnitus, characterized by the perception of sounds without an external source, significantly affects quality of life. Cognitive Behavioral Therapy (CBT) has emerged as a promising approach for managing tinnitus-related distress and enhancing psychological well-being. Objectives: This review aims to analyze the effectiveness of CBT in tinnitus management, focusing on alleviating distress, enhancing coping mechanisms, and improving overall well-being. Methods: PubMed and World of Science databases were systematically searched using keywords related to tinnitus, CBT, and quality of life. English, peer-reviewed studies focusing on adult populations were included. Studies involving pediatric populations or not meeting inclusion criteria were excluded. Data extraction was performed using PRISMA guidelines, with a narrative synthesis approach for analysis. Methodological quality and risk of bias were assessed using appropriate tools. The search engine initially identified 155 studies that met the inclusion criteria for the systematic review. However, upon further evaluation, 140 of these studies were excluded due to their non-randomized design. Of the remaining 15 studies, 11 were found to be partially accessible but ultimately excluded from the review as they did not meet the full accessibility criteria. Therefore, only four studies remained in the review, deemed suitable for inclusion based on their randomized design and full accessibility. Results: Studies by Beukes et al. [1]-[3] and Simoes et al. [4] evaluated CBT’s effectiveness. With internet-based CBT, Beukes et al. demonstrated reductions in tinnitus distress, negative cognitions, and comorbidities. Simoes et al. proposed combination treatments for tinnitus management. The review outcome suggests that CBT is an effective treatment for tinnitus, as it can help reduce tinnitus distress and improve quality of life. However, limitations in sample sizes and follow-up durations highlight the need for further research to establish CBT’s long-term efficacy and optimal parameters. Integrating internet-based CBT into comprehensive care strategies can enhance the well-being of individuals affected by tinnitus.

Tinnitus characteristics and associated variables on Tinnitus Handicap Inventory among a Hungarian population

Background:Tinnitus is a sound precepted without an external sound stimulus.Its background can be categorised into primary and secondary cases.The secondary cases include pathologies of the external,middle and inner ear.Tinnitus can be objective or subjective;the latter can only identified by the sufferer.Previous research results have shown that tinnitus significantly affects the quality of life and daily functioning.Objectives:To analyse the impact of tinnitus on the daily functioning and the possible influence of demographical data and tinnitus duration on it.Methods:630 patients(265 males and 365 females,25e85 years of age)suffering from primary tinnitus were enrolled.In the Hungarian language,these patients completed the Tinnitus Handicap Inventory(THI)questionnaire and underwent a complete otorhinolaryngological examination.IBM SPSS V24 software was used for data processing;correlation tests,the Mann-Whitney U and Kruskal-Wallis nonparametric tests were used.Results:According to the THI questionnaires outcomes,most patients(62.5%)were presented with a mild handicap.Based on statistical analysis,no significant correlation was observed between the total THI points and the age of the patients,along with the duration and localisation of the symptoms.However,the total THI scores of male and female patients significantly differed,indicating higher THI values in the female group(p=0.00052*).Conclusions:The tinnitus severity was not affected by the duration,localisation of the symptoms and age but by gender,indicating higher values in the case of females.

Role of cerebral digital subtraction angiography in the evaluation of pulse synchronous tinnitus

Objectives: The aim of this study was to evaluate the value of digital subtraction angiography (DSA) in thediagnostic evaluation of a highly selected patient population presenting with pulse-synchronous tinnitus(PST).Methods: We retrospectively reviewed the charts of all patients referred for evaluation of possiblevascular etiology of pulsatile tinnitus. Patients were evaluated with regards to presenting signs,comorbidities, non-invasive imaging results, angiographic findings and outcomes.Results: Fifteen patients underwent cerebral DSA. Dural arteriovenous fistula (dAVF) was identified in sixpatients, and five patients had other significant vascular pathology identified on DSA. Seven patientswith ‘negative’ non-invasive imaging were found to have significant pathology on DSA.Conclusions: Catheter angiography may have a significant yield in appropriately selected patients presenting with pulse synchronous tinnitus.

Subjective tinnitus: lesion-induced pathological central homeostasis remodeling

Subjective tinnitus is the most common type of tinnitus, which is the manifestation of pathologicalactivities in the brain. It happens in a substantial portion of the general population and brings significantburden to the society. Severe subjective tinnitus can lead to depression and insomnia and severely affectspatients’ quality of life. However, due to poor understanding of its etiology and pathogenesis, treatmentof subjective tinnitus remains challenging. In recent decades, a growing number of studies have shownthat subjective tinnitus is related to lesion-induced neural plasticity of auditory and non-auditory centralsystems. This article reviews cellular mechanisms of neural plasticity in subjective tinnitus to providefurther understanding of its pathogenesis.

Neural metabolic activity in idiopathic tinnitus patients after repetitive transcranial magnetic stimulation

BACKGROUND The central mechanism of idiopathic tinnitus is related to hyperactivity of cortical and subcortical auditory and non-auditory areas.Repetitive transcranial magnetic stimulation(rTMS)is a well-tolerated,non-invasive potential treatment option for tinnitus.AIM To investigate the changes of neural metabolic activity after rTMS in chronic idiopathic tinnitus(IT)patients.ME THODS Eleven patients underwent rTMS(1 Hz,90%motor threshold,1000 stimuli/day for consecutive 10 d)on the left temporoparietal region cortex.Tinnitus handicap inventory(THI)and visual analogue score(VAS)were assessed at baseline and posttreatment.All patients underwent 18 F-fluorodeoxyglucose(FDG)positron emission tomography to evaluate the neural metabolic activity.Data were preprocessed using statistical parametric mapping and Gretna software to extract the regions of interest(ROls).The correlation between brain areas involved and THI scores was analyzed.RESULTS Baseline and posttreatment parameters showed no significant difference regarding THI score(t=1.019,P=0.342>0.05)and VAS(t=0.00,P=1.0>0.05).Regions with the highest FDG uptake were the right inferior temporal gyrus(ITG),right parahippocampa gyrus(PHG),right hippocampus,rectus gyrus,left middle frontal gyrus,and right inferior frontal gyrus in IT patients.After rTMS treatment,IT patients showed increased activities in the right PHG,right superior temporal gyrus,right superior frontal gyrus,anterior insula,left inferior parietal lobule,and left precentral gyrus,and decreased activities in the left postcentral gyrus and left ITG.The ROIs in the right parahippocampa gyrus and right superior frontal gyrus were positively correlated with THI scores(r=0.737,P=0.037<0.05;r=0.735,P=0.038<0.05).CONCLUSION Our study showed that 1-Hz rTMS directed to the left temporo-parietal junction resulted no statistically significant symptom alleviation.After treatment,brain areas of the limbic and prefrontal system showed high neutral metabolic activity The auditory and non-auditory systems together will be the target for rTMS treatment.

Analysis of Etiology,Diagnosis,and Treatment Strategy and Efficacy of Pulsatile Tinnitus Caused by Abnormal Vascular Anatomy

Objective To investigate the etiology,clinical characteristics,diagnosis,and treatment strategies and efficacy of pulsatile tinnitus(PT)caused by vascular anatomy abnormality.Methods The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed.Results All 45 patients had vascular anatomical abnormalities.The patients were divided into 10 categories according to the different locations of vascular abnormalities:sigmoid sinus diverticulum(SSD),sigmoid sinus wall dehiscence(SSWD),SSWD with high jugular bulb,pure dilated mastoid emissary vein,aberrant internal carotid artery(ICA)in the middle ear,transverse-sigmoid sinus(TSS)transition stenosis,TSS transition stenosis with SSD,persistent occipital sinus stenosis,petrous segment stenosis of ICA,and dural arteriovenous fistula.All patients complained of PT synchronous with heartbeat rhythm.Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions.Tinnitus disappeared in 41 patients,was significantly relieved in 3 patients,and was unchanged in 1 patient postoperatively.Except for one patient with transient headache postoperatively,no obvious complications occurred.Conclusion PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination.PT can be relieved or even completely alleviated after appropriate surgical treatments.

Influence of Acupuncture on Autonomic Balance in Adult Tinnitus Patients:An Exploratory Study

Acupuncture is an alternative therapy for tinnitus in clinical practice.The mechanism by which acupuncture can alleviate tinnitus is still unknown.Autonomic nervous system was reported to be responsible for tinnitus.The aim of this study was to explore the effect of acupuncture on autonomic balance in adult tinnitus patients.Thirty patients were randomly assigned into either the deep acupuncture(DA)group or the shallow acupuncture(SA)group.Each patient received 6 acupuncture sessions(a-f phase)over three weeks.Measures of heart rate variability and Tinnitus Handicap Inventory(THI)were obtained at baseline and after the sixth acupuncture session in all patients.The results showed that the low frequency/high frequency(LF/HF)pattern was increased at b-f phase until the sixth acupuncture session when compared with that at the first acupuncture session in DA group.However,it continuously increased at b-f phase in SA group even at the sixth acupuncture session,which was not significantly different from that at the first acupuncture session.The decrease in THI in DA group was greater than that in SA group after 3-week treatment(P=0.043).Our preliminary study suggests three-week deep acupuncture can improve tinnitus symptoms in adult tinnitus patients,which may be related to the regulation of autonomic nervous system balance.

Deep Brain Stimulation──A new treatment for tinnitus

Intractable tinnitus can lead to serious consequences. Study evidence indicates that the central nervous system is involved in generation and maintenance of chronic tinnitus and that tinnitus and other neurologic symptoms such as chronic pain may share similar mechanisms. Brain ablation and stimulation are used to treat chronic pain with success. Recent studies showed that ablation and stimulation in non-auditory areas resulted in tinnitus improvement. Deep brain stimulation (DBS) may be an alternative treatment for intractable tinnitus and deserves further study.

Regional homogeneity on resting state fMRI in patients with tinnitus

Objective:To study central functional network connections and their alterations in tinnitus patients using fMRI.Methods:Regional homogeneity(ReHo) values on fMRI were obtained from 18 tinnitus patients and 20 age and gender-matched control subjects.ReHo values were compared between tinnitus patients and control subjects to evaluate functional network connection differences.Results:Tinnitus patients showed increased ReHo values in gyrus frontalis inferior and decreased ReHo values in the anterior lobe of cerebellum in comparison with the controls.Analysis of functional network connection from the gyrus frontalis interior shows stronger connections to the middle brain(FWE,P < 0.001) and right ventral striatum(FEW,P < 0.05,small volume correction).Conclusions:The fMRI results indicate that both auditory and non-auditory centers play important roles in tinnitus.Functional connections among the auditory cortex,thalamus,medial temporal gyrus,parahippocampal gyrus and insula may be an underlying cause for the development of tinnitus.

The study on psychological resilience of tinnitus and associated influencing factors

The association between tinnitus and psychological resilience is an underdeveloped area of research.This cross-sectional study investigated such associations and factors potentially affecting resilience in 61 patients.Demographic and psychometric data were collected by questionnaires.The ConnoreDavidson Resilience Scale(CD-RISC),Medical Coping Modes Questionnaire(MCMQ),Satisfaction with Life Scale(SWLS),General Self-Efficacy Scale(GSES),Big Five Inventory(BFI)and Perceived Social Support Scale(PSSS)were completed by participants.Data were analyzed using independent t-test and Pearson's correlation analysis and multiple linear regression modeling.The CD-RISC score was relatively low(66.97±15.71),negatively correlated with tinnitus(r=0.276,p<0.001)and associated with age(r=0.270,P<0.001).As protective factors,SWLS(r=0.486,p<0.001),GSES(r=0.555,p<0.001),PSSS(r=0.538,p<0.001)and extraversion were positively correlated with CD-RISC and BFI scores(r=0.287,p<0.001).We also detected a negative correlation with neuroticism(r=0.395,p<0.001),which is a known risk factor for worse CD-RISC scores.Identifying protective and risk factors for psychological resilience can be used to predict treatment outcomes in tinnitus patients,which will help devise personalized solutions and improve patients'quality of life.

An Integrated Physical Regulation Theory and Classification of Acute Tinnitus

Tinnitus,acute or chronic,is one of the most common and refractory disorders.Acute tinnitus is a symptom that is a warning sign when compared with chronic tinnitus.Although hearing loss initiates acute tinnitus,the relationship between hearing loss and tinnitus is far from straightforward.Other factors beyond the auditory system may play important roles in the occurrence of acute tinnitus.To address this issue,we propose an integrated regulation theory of the possible physical causes of acute tinnitus,and summarize a classification system for acute tinnitus based on this regulation theory to help guide clinical treatment.

SUBJECTIVE TINNITUS AS FIRST PRESENTATION IN A PATIENT WITH METASTATIC LUNG CANCER IN TEMPORAL BONE-A CASE REPORT

Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the present-ing symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented with subjective tinnitus of three months, with no pulmonary disease symptoms. Pure tone audiometry indi-cated moderate conductive deafness in left ear with an air-bone gap of 21.3 dB. HRCT temporal bone scan-ning indicated high-density shadows in the left epitympanic cavity, sinus tympani and mastoid cavity. Chron-ic otitis media with cholesteatoma was suspected and surgical treatment recommended. However, preopera-tive chest x-ray revealed high-density millet lesions scattered widely in both lungs. HRCT lung scanning confirmed the lungs lesions and indicated lung cancer. In order to determine correlations between the tempo-ral bone and pulmonary lesions, a CT-guided trans-mastoid aspiration biopsy and immunohistochemical study were conducted, which confirmed that the temporal bone lesion was metastatic from the lungs. The pa-tient was given a series of chemotherapy immediately and his tinnitus significantly improved after three months of treatment, with full recovery of his hearing and complete resolution of shadows in the mastoid cavity. Unfortunately, he subsequently developed multiple bone metastases in the 9th month and cerebral metastasis in the 18th month. Multiple organ failure resulted in death in 2.5 years.

Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: A case report

BACKGROUND Pulsatile tinnitus(PT)is a potentially disabling symptom that has received increasing attention.Multiple causes of PT have been confirmed by targeted treatment.However,dynamic changes of related structures in PT patients with multiple causes after stenting for ipsilateral transverse sinus stenosis(TSS)have not been previously reported.We report such a case and present postoperative computed tomography venography(CTV)follow-up findings to demonstrate the decreased sigmoid sinus diverticulum and bone remodeling.CASE SUMMARY A 45-year-old man suffered from left-sided PT for 15 years that was occasionally accompanied by headache and dizziness.Pre-operative CTV revealed left-sided sigmoid sinus wall anomalies(SSWAs),TSS,outflow dominance,large posterior condylar emissary vein,and an empty sella turcica.A cerebrospinal fluid pressure of 270 mmH2O was further detected.The sound disappeared immediately after stenting for ipsilateral TSS,with no recurrence during 2 years of follow-up.After the procedure,the patient underwent four consecutive CTV examinations.The diverticulum decreased 6 mo after the procedure with new bone remodeling.The density of the remodeled bone was further increased 1 year later,and a hardened edge was formed 2 years later.CONCLUSION PT associated with SSWAs,TSS,and idiopathic intracranial hypertension can be cured by stenting for TSS alone.And bone remodeling around SSWAs is a more significant finding.

Role of the caudate-putamen nucleus in sensory gating in induced tinnitus in rats

Tinnitus can be described as the conscious perception of sound without external stimulation,and it is often accompanied by anxiety,depression,and insomnia.Current clinical treatments for tinnitus are ineffective.Although recent studies have indicated that the caudateputamen nucleus may be a sensory gating area involved in noise elimination in tinnitus,the underlying mechanisms of this disorder are yet to be determined.To investigate the potential role of the caudate-putamen nucleus in experimentally induced tinnitus,we created a rat model of tinnitus induced by intraperitoneal administration of 350 mg/kg sodium salicylate.Our results revealed that the mean spontaneous firing rate of the caudate-putamen nucleus was increased by sodium salicylate treatment,while dopamine levels were decreased.In addition,electrical stimulation of the caudate-putamen nucleus markedly reduced the spontaneous firing rate of neurons in the primary auditory cortex.These findings suggest that the caudate-putamen nucleus plays a sensory gating role in sodium salicylate-induced tinnitus.This study was approved by the Institutional Animal Care and Use Committee of Peking University Health Science Center(approval No.A2010031)on December 6,2017.

Gain adjustment at tinnitus pitch to manage both tinnitus and speech perception in noise

To investigate how much gain variation is required from prescription to effect tinnitus percept,and if this revised prescription affects speech recognition.Twenty participants who experienced catastrophic tinnitus even after fitted with hearing aid were included.Participants were grouped based on their tinnitus pitch and the prescriptive formula used to fit hearing aid.They were evaluated for handicap from tinnitus using Tinnitus Handicap Inventory(THI).Hearing aid was programmed using either NAL-NL2 or DSL(I/o)v5 prescriptive formula and gain at tinnitus pitch was adjusted till the tinnitus get suppressed.SNR 50 was determined soon after fitted with hearing aid and 30 days of hearing aid use.Further,THI and international outcome inventory for hearing aid(IOI-HA)were determined after 30 days of hearing aid use.A significant higher gain adjustment was needed at tinnitus pitch to reduce tinnitus precept using NAL-NL2 than DSL(I/o)v5 prescriptive formula.Further,SNR 50 was not affected by either tinnitus pitch or revised prescription formulas.However,SNR 50 improved after 30 days of hearing aid use.A 76% of the participants’experienced habituation to perception after 30 days of hearing aid use,10% had slight,10% had mild,and 4% had a moderate degree of tinnitus on THI.On IOA-HA,96%(N=19)of participants have reported satisfactory,and 4%(N=1)reported moderate benefit from hearing aid.Irrespective of prescriptive formula adjusting gain at tinnitus pitch is an efficient method to reduce tinnitus symptoms and improve speech perception.

Acoustic trauma-induced auditory cortex enhancement and tinnitus

There is growing evidence suggests that noise-induced cochlear damage may lead to hyperexcitability in the central auditory system(CAS)which may give rise to tinnitus.However,the correlation between the onset of the neurophysiological changes in the CAS and the onset of tinnitus has not been well studied.To investigate this relationship,chronic electrodes were implanted into the auditory cortex(AC) and sound evoked activities were measured from awake rats before and after noise exposure.The auditory brainstem response(ABR) was used to assess the degree of noise-induced hearing loss.Tinnitus was evaluated by measuring gap-induced prepulse inhibition(gap-PPI).Rats were exposed monaurally to a high-intensity narrowband noise centered at 12 kHz at a level of 120 dB SPL for 1 h.After the noise exposure,all the rats developed either permanent(>2 weeks) or temporary(<3 days) hearing loss in the exposed ear(s).The AC amplitudes increased significantly 4 h after the noise exposure.Most of the exposed rats also showed decreased gap-PPI.The post-exposure AC enhancement showed a positive correlation with the amount of hearing loss.The onset of tinnitus-like behavior was happened after the onset of AC enhancement.

Tinnitus and hyperacusis in children: clinic reports and basic research

Objective Tinnitus and hyperacusis are subjective symptoms which can be reponeu tJy p^t, lJ ： age. Although tinnitus and hyperacusis can have a negative effect on child development, these symptoms are commonly overlooked by their parents and clinicians. In this paper, we review clinical reports on tinnitus and hyperacusis in children and basic scientific studies on these disorders in order to provide updates of these disorders in the pediatric population. Recent studies have found that tinnitus and hyperacusis are not uncommon in children, especially in those with conductive and sensorineural hearing loss. The parents and clinicians should pay attention when children show abnormal behaviors and especially when they develop hearing loss. Since there is no objective measurement for tinnitus and hyperacusis, the diagnosis in children can be challenging. Tinnitus and hyperacusis are also common in Williams syndrome and autism but the mechanisms are still not clear. High doses of salicylate and noise exposure can in- duce tinnitus. Animal studies have determined lack of inhibition in the auditory cortex and the inferior colliculus may be critical for tinnitus and hyperacusis generation. The non-classic auditory system may also be involved in the aware- ness and tolerance of tinnitus and hyperacusis.