Tinnitus Is Associated With Extended High-frequency Hearing Loss and Hidden High-frequency Damage in Young Patients

Altered auditory brainstem responses are post-acute sequela of SARS-CoV-2 (PASC)

The Post-acute Sequela of SARS-CoV-2 (PASC) syndrome, also known as Long-COVID, often presents with subjective symptoms such as brain fog and cognitive fatigue. Increased tinnitus, and decreased hearing in noise ability also occur with PASC, yet whether auditory manifestations of PASC are linked with the cognitive symptoms is not known. Electrophysiology, specifically the Auditory Brainstem Response (ABR), provides objective measures of auditory processing. We hypothesized that ABR findings would be linked to PASC and with subjective feelings of cognitive fatigue. Eighty-two individuals, 37 with PASC (mean age: 47.5, Female: 83%) and 45 healthy controls (mean age: 38.5, Female: 76%), were studied with an auditory test battery that included audiometry and ABR measures. Peripheral hearing thresholds did not differ between groups. The PASC group had a higher prevalence of tinnitus, anxiety, depression, and hearing handicap in addition to increased subjective cognitive fatigue. ABR latency findings showed a significantly greater increase in the wave V latency for PASC subjects when a fast (61.1 clicks/sec) compared to a slow click (21.1 clicks/sec) was used. The increase in latency correlated with cognitive fatigue scores and predicted PASC status. The ABR V/I amplitude ratio was examined as a measure of central gain. Although these ratios were not significantly elevated in the full PASC group, to minimize the cofounding effect of age, the cohort was median split on age. Elevated V/I amplitude ratios were significant predictors of both predicted PASC group classification and cognitive fatigue scores in the younger PASC subjects compared to age-matched controls providing evidence of elevated central gain in younger individuals with PASC. More frequent tinnitus also significantly predicted higher subjective cognitive fatigue scores. Our findings suggest that PASC may alter the central auditory pathway and lead to slower conduction and elevated auditory neurophysiology responses at the midbrain, a pattern associated with the typical aging process. This study marks a significant stride toward establishing an objective measure of subjective cognitive fatigue through assessment of the central auditory system.

Consensus Statements on Tinnitus Assessment and Treatment Outcome Evaluation: A Delphi Study by the Korean Tinnitus Study Group

BACKGROUND

Tinnitus is a multifactorial condition with no universally accepted assessment guidelines. The Korean Tinnitus Study Group previously established consensus statements on the definition, classification, and diagnostic tests for tinnitus. As a continuation of this effort, this study aims to establish expert consensus on tinnitus assessment and treatment outcome evaluation, specifically tailored to the Korean clinical context.

METHODS

A modified Delphi method involving 26 otology experts from across Korea was used. A two-round Delphi survey was conducted to evaluate statements related to tinnitus assessment before and after treatment. Statements were rated on a scale of 1 to 9 for the level of agreement. Consensus was defined as ≥ 70% agreement (score of 7-9) and ≤ 15% disagreement (score of 1-3). Statistical measures such as content validity ratio and Kendall's coefficient of concordance (W) were calculated to assess agreement levels.

RESULTS

Of the 46 assessment-related statements, 17 (37%) reached consensus, though overall pre-treatment assessments showed weak agreement (Kendall's W = 0.319). Key areas of agreement included the use of the visual analogue scale, numeric rating scale, and validated questionnaires for pre-treatment evaluation. Five statements, such as the use of computed tomography, magnetic resonance imaging, and angiography for diagnosing pulsatile tinnitus, achieved over 90% agreement. For treatment outcome measurements, 8 of 12 statements (67%) reached a consensus, with moderate agreement (Kendall's W = 0.513). Validated questionnaires and psychoacoustic tests were recommended for evaluating treatment effects within 12 weeks. While standardized imaging for pulsatile tinnitus and additional clinical tests were strongly recommended, full consensus was not achieved across all imaging modalities.

CONCLUSION

This study provides actionable recommendations for tinnitus assessment and treatment evaluation, emphasizing the use of standardized tools and individualized approaches based on patient needs. These findings offer a practical framework to enhance consistency and effectiveness in tinnitus management within Korean clinical settings.

Hybrid statistical and machine-learning approach to hearing-loss identification based on an oversampling technique

BACKGROUND AND OBJECTIVES

Hearing loss is a crucial global health hazard exerting considerable social and physiological effects on spoken language and cognition. Patients affected by this condition may experience social and professional hardships that dominate occupational injuries. Therefore, the identification of the features of recessive hearing loss is important for clinicians to prevent further disease progression. This work aimed to develop a hybrid statistical and machine-learning approach as a decision-support mechanism. We expect the proposed model to help predict hearing-loss disorders and support clinical diagnosis.

METHODS

A three-phase hybrid approach was proposed to implement classification models. A stepwise method and a random forest (RF) technique were utilized as filters during feature selection. Phase I involved reducing the number of input variables and selecting the most influential features. Phase II included the use of an oversampling technique called synthetic minority oversampling technique (SMOTE) to oversample the minority class and balance the sample size between the target and nontarget classes. Phase III focused on the final model selection based on three supervised classification models, namely, the logistic regression, multilayer perceptron, and support vector machine (SVM), for the target identification and prediction of the case of interest (i.e., hearing loss).

RESULTS

The analysis of phase I involved the selection and acquisition of three and seven features through the stepwise technique and RF method, respectively. The SMOTE technique alleviated the imbalanced data issue and improved the predictive capability substantially in phase II and III. Accordingly, in terms of accuracy, precision, recall, and F1 score, our empirical results demonstrated that the proposed hybrid approach involving the SVM method combined with a stepwise technique was competitive against the logistic model featuring all variables. Furthermore, the SVM models that cooperated with the stepwise and RF technique showed superiority to other approaches in terms of the area under the curve (AUC).

CONCLUSION

Compared with multivariate models, the hybrid approach combining the SVM method coupled with a stepwise technique and/or an RF technique is an excellent alternative with a higher efficiency. This approach requires fewer predictors in the model and can be competitive in terms of the accuracy, precision, recall, F1 score, and AUC. This work highlights the potential of hybrid statistical and machine-learning approaches. Our model can be used as a screening tool for upfront forecasting in clinical practice. The proposed hybrid approach also demonstrates a powerful capability to identify vital features and predict hearing loss.

The Effectiveness of Cognitive Behavioral Therapy versus Notched Sound Therapy in Adults with Chronic Subjective Tinnitus and Normal Hearing

Introduction  Tinnitus can be distressing, and it affects the quality of life (QoL) through psychological and cognitive impairments. Cognitive behavioral therapy (CBT) and notched sound therapy (NST) are tinnitus management approaches aiming to reduce symptoms and improve QoL via two different mechanisms. The CBT attains the cognitive principle, whereas the NST initiates tinnitus habituation. Objective  To evaluate the effect of CBT and NST and compare their results in the management of chronic subjective tinnitus. Methods  The present prospective study involved 64 adults with normal hearing and chronic subjective tinnitus. They were subjected to history taking, basic audiological evaluation, and extended high-frequency audiometry at 10 and 12.5 kHz. The participants were divided into two equal groups, the first treated with CBT and the second treated with NST. The psychoacoustic measures of tinnitus and the Arabic Questionnaire for Tinnitus Reaction (Arabic-QTR) were used to monitor the outcomes of both therapies. Results  Both groups showed significant reduction in tinnitus severity according to the Arabic-QTR and tinnitus loudness matching. Improvement in the Arabic-QTR was better in the CBT group, while tinnitus loudness improvement was better in the NST group. Conclusion  Both CBT and NST are effective in the management of chronic subjective tinnitus. In a comparison of the effect of the two therapies, CBT was found to be more effective in decreasing tinnitus-related distress, whereas SNT was found to be more helpful in reducing tinnitus loudness.

Evaluation of Subjective Tinnitus Severity and Distortion Product Otoacoustic Emissions and Extended High-Frequency Audiometry

OBJECTIVE

Tinnitus is a multifactorial phenomenon with quality-of-life detriments for those affected by it. We aim to establish a relationship between subjective tinnitus severity with objective audiometric data in the extended high frequency (EHF) from 9 to 16 khz and with distortion product otoacoustic emissions (DPOAE). We hypothesize that severe subjective tinnitus as measured by the Tinnitus Handicap Inventory (THI) does not correlate with increased hearing thresholds in the EHF range.

STUDY DESIGN

Prospective.

SETTING

Single Tertiary Care Center.

METHODS

Patients identified with tinnitus and normal hearing thresholds within standard frequency range (250-8000 Hz) were consented for participation. Those with underlying otologic disease, trauma, radiotherapy, or ototoxic drug use were excluded. The THI questionnaire was given to eligible patients and audiometric test results were collected. THI scores were categorized by severity groups. An n = 20 to 30 was determined to have an effect size of 0.7 with a significance level of P = .05.

RESULTS

THI and audiometric data were collected for 38 patients and categorized into mild (n = 18, 47.4%), moderate (n = 8, 21.1%), slight (n = 7, 18.4%), and severe (n = 5, 13.2%) tinnitus severity groups. Mean THI score was 32.3 ± 19.6 with a statistically significant difference in scores by assigned THI severity group (P < .01). There were no significant differences or linear relationship among hearing thresholds in EHF range or DPOAE stratified by subjective tinnitus group (P = .49, r2 = 0.10) CONCLUSION: Subjective tinnitus severity is not predictive of audiometric outcomes. This finding can be used as a counseling tool to help tinnitus patients manage symptoms, expectations, and overall treatment outcomes.

Comprehensive Characterization of Hearing Loss and Tinnitus in Military-Affiliated and Non-Military-Affiliated Individuals

PURPOSE

Military-affiliated individuals (MIs) are at a higher risk of developing hearing loss and tinnitus. While these disorders are well-studied in MIs, their impact relative to non-military-affiliated individuals (non-MIs) remains understudied. Our study compared hearing, speech-in-noise (SIN) perception, and tinnitus characteristics between MIs and non-MIs.

METHOD

MIs (n = 84) and non-MIs (n = 193) underwent hearing threshold assessment and Quick Speech-in-Noise Test. Participants with tinnitus completed psychoacoustic tinnitus matching, numeric rating scale (NRS) for loudness and annoyance, and Tinnitus Functional Index. Comorbid conditions such as anxiety, depression, and hyperacusis were assessed. We used a linear mixed-effects model to compare hearing thresholds and SIN scores between MIs and non-MIs. A multivariate analysis of variance compared tinnitus characteristics between MIs and non-MIs, and a stepwise regression was performed to identify predictors of tinnitus severity.

RESULTS

MIs exhibited better hearing sensitivity than non-MIs; however, their SIN scores were similar. MIs matched their tinnitus loudness to a lower intensity than non-MIs, but their loudness ratings (NRS) were comparable. MIs reported greater tinnitus annoyance and severity on the relaxation subscale, indicating increased difficulty engaging in restful activities. Tinnitus severity was influenced by hyperacusis and depression in both MIs and non-MIs; however, hearing loss uniquely contributed to severity in MIs.

CONCLUSIONS

Our findings suggest that while MIs may exhibit better or comparable listening abilities, they were significantly more affected by tinnitus than non-MIs. Furthermore, our study highlights the importance of assessing tinnitus-related distress across multiple dimensions, facilitating customization of management strategies for both MIs and non-MIs.

Artificial intelligence approaches for tinnitus diagnosis: leveraging high-frequency audiometry data for enhanced clinical predictions

This research investigates the application of machine learning to improve the diagnosis of tinnitus using high-frequency audiometry data. A Logistic Regression (LR) model was developed alongside an Artificial Neural Network (ANN) and various baseline classifiers to identify the most effective approach for classifying tinnitus presence. The methodology encompassed data preprocessing, feature extraction focused on point detection, and rigorous model evaluation through performance metrics including accuracy, Area Under the ROC Curve (AUC), precision, recall, and F1 scores. The main findings reveal that the LR model, supported by the ANN, significantly outperformed other machine learning models, achieving an accuracy of 94.06%, an AUC of 97.06%, and high precision and recall scores. These results demonstrate the efficacy of the LR model and ANN in accurately diagnosing tinnitus, surpassing traditional diagnostic methods that rely on subjective assessments. The implications of this research are substantial for clinical audiology, suggesting that machine learning, particularly advanced models like ANNs, can provide a more objective and quantifiable tool for tinnitus diagnosis, especially when utilizing high-frequency audiometry data not typically assessed in standard hearing tests. The study underscores the potential for machine learning to facilitate earlier and more accurate tinnitus detection, which could lead to improved patient outcomes. Future work should aim to expand the dataset diversity, explore a broader range of algorithms, and conduct clinical trials to validate the models' practical utility. The research highlights the transformative potential of machine learning, including the LR model and ANN, in audiology, paving the way for advancements in the diagnosis and treatment of tinnitus.

Predictive factors of tinnitus after vestibular schwannoma surgery: a case-control study

BACKGROUND

Tinnitus is very common in patients with vestibular schwannoma (VS). We analyzed the related factors of tinnitus after surgery.

METHODS

One hundred seventy-three patients diagnosed with unilateral VS operated via the retrosigmoid approach were included in the study. All patients underwent relevant examinations and completed the THI scale before surgery and 6 months after surgery. The prognosis of tinnitus was evaluated according to the changes in THI.

RESULTS

Of the 129 preoperative tinnitus patients, postoperative tinnitus resolved in 12.4%, improved in 29.5%, remained unchanged in 28.6%, and worsened in 29.5%. 18.2% of 44 patients without preoperative tinnitus appeared new-onset tinnitus postoperatively. Thirty-six patients never had tinnitus. Patients with smaller tumor sizes (≤ 3 cm) were more likely to experience preoperative tinnitus. Younger patients and those with serviceable hearing preoperatively were more likely to report their tinnitus unchanged or worsened. A new onset of postoperative tinnitus in the preoperative non-tinnitus group was found in better preoperative hearing function.

CONCLUSIONS

In this study, 70% of patients had persistent tinnitus after vestibular schwannoma resection. The prognosis of tinnitus was influenced by age and preoperative hearing function. Tinnitus is a bothersome symptom and is often underestimated by doctors. Assessment of tinnitus is mandatory during the management of vestibular schwannoma.

Tinnitus: A Dimensionally Segregated, yet Perceptually Integrated Heterogeneous Disorder

OBJECTIVES

Tinnitus subtypes are proposed to lie on a continuum of different symptom dimensions rather than be categorical. However, there is no comprehensive empirical data showing this complex relationship between different tinnitus symptoms. The objective of this study is to provide empirical evidence for the dimensional nature of tinnitus and how different auditory and non-auditory symptoms interact with each other through complex interactions. We do this using graph theory, a mathematical tool that empirically maps this complex interaction. This way, graph theory can be utilised to highlight a new and possibly important outlook on how we can understand the heterogeneous nature of tinnitus.

DESIGN

In the current study, we use the screening databases of the Treatment Evaluation of Neuromodulation for Tinnitus-Stage A1 (TENT-A1) and A2 (TENT-A2) randomised trials to delineate the dimensional relationship between different clinical measures of tinnitus as a secondary data analysis. We first calculate the empirical relationship by computing the partial correlation. Following this, we use different measures of centrality to describe the contribution of different clinical measures to the overall network. We also calculate the stability of the network and compare the similarity and differences between TENT-A1 and TENT-A2.

RESULTS

Components of the auditory subnetwork (loudness discomfort level, sound sensitivity, average hearing loss and high frequency hearing loss) are highly inter-connected in both networks with sound sensitivity and loudness discomfort level being highly influential with high measures of centrality. Furthermore, the relationship between the densely connected auditory subnetwork with tinnitus-related distress seems to vary at different levels of distress, hearing loss, duration and age of the participants.

CONCLUSION

Our findings provide first-time evidence for tinnitus varying in a dimensional fashion illustrating the heterogeneity of this phantom percept and its ability to be perceptually integrated, yet behaviourally segregated on different symptomatic dimensions.

The significance of extended high-frequency audiometry in tinnitus patients with normal hearing as evaluated via conventional pure tone audiometry

OBJECTIVE

This study was designed to determine whether extended high-frequency audiometry was capable of better differentiating between participants with normal hearing who did or did not have subjective tinnitus.

METHODS

A total of 96 study participants were enrolled: 36 patients with unilateral tinnitus, 28 patients with bilateral tinnitus and 32 volunteers as controls. All 96 participants exhibited normal audiometry findings and hearing thresholds. Extended high-frequency audiometry was used to evaluate these patients.

RESULTS

There were differences between the extended high-frequency hearing thresholds of affected and unaffected ears in those with unilateral tinnitus, and in the 20-29-year-old bilateral tinnitus group, at 11.2, 12.5 and 14 kHz. Unilateral tinnitus subgroups had higher extended high-frequency hearing thresholds than those in control subjects, at all extended high frequencies.

CONCLUSION

Extended high-frequency audiometry can offer additional information regarding the hearing status of patients with tinnitus who exhibit normal pure tone thresholds when analysed via conventional hearing thresholds.

Tinnitus pitch does not always fall within the frequency range of hearing loss - a cross-sectional study on the mechanism of tinnitus production

BACKGROUND

Clinically, we find that tinnitus patients often have hearing loss. According to the most accepted mechanism of tinnitus, that is, the spontaneous discharge and abnormal synchronization of neurons after afferent reduction, tinnitus frequency is closely related to the frequency of hearing loss.

OBJECTIVE

The purpose of this study was to investigate the correlation of tinnitus pitch with the frequency of hearing loss.

MATERIALS AND METHODS

A total of 500 patients with unilateral or bilateral chronic tinnitus were enrolled in this study. All patients underwent pure tone audiometry (PTA) and tinnitus acoustic examination. Hearing loss levels and frequencies were recorded. The relationship between tinnitus pitch and hearing loss level and frequency was statistically analyzed.

RESULTS

Our results showed that 96.6% of the 500 tinnitus patients had hearing loss. Statistical analysis showed that low frequency (LF) tinnitus was correlated with LF hearing loss, but moderate frequency & high frequency (MF&HF) tinnitus was not significantly associated with MF&HF hearing loss. The coincidence of tinnitus pitch with the highest hearing threshold correlated with the degree of hearing loss.

CONCLUSION AND SIGNIFICANCE

The vast majority of patients with chronic subjective tinnitus had hearing loss, and the frequency of tinnitus correlated with the degree and frequency of hearing loss but not exactly fall within the frequency range of hearing loss.

Utility of Extended High-Frequency Audiograms in Clinical Practice

OBJECTIVES

Extended high-frequency (EHF) audiometry elicits pure-tone thresholds at frequencies above 8 kHz, which are not included in routine clinical testing. This study explores the utility of EHF audiometry in patients with various audiologic symptoms despite normal-hearing thresholds at ≤8 kHz.

METHODS

A retrospective review was performed of all patients receiving conventional (250-8 kHz) and EHF (9-20 kHz) audiometry at a tertiary otological referral center between April 2021 and August 2022. Only patients with audiologic symptoms and pure-tone thresholds ≤25 dB HL at ≤8 kHz bilaterally on routine testing were included in subsequent analysis. EHF-PTA was defined for each ear as an average of the air conduction thresholds at 9.0, 10.0, 11.2, 12.5, 14.0, 16.0, 18.0, and 20.0 kHz.

RESULTS

Of the 50 patients who received EHF testing, 40 had audiologic symptoms and normal conventional audiograms at ≤8 kHz. Twenty-five of the 40 (62.5%) were found to have hearing loss in the highest frequencies. Patients with EHF hearing loss (EHF-HL) were more likely to report subjective hearing loss. Age was significantly greater in those with EHF-HL compared with those without EHF-HL, and age was positively correlated with the degree of EHF-HL.

CONCLUSION

EHF testing correlates with audiologic symptoms in patients with normal testing at ≤8 kHz and may be considered when standard audiometry is normal. Additional data are warranted to create an evidenced-based, clinical algorithm for EHF audiometry that can guide treatment, direct mitigation strategies, and potentially identify those at higher risk of hearing loss over time.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:907-910, 2024.

Differential cortical activation patterns: pioneering sub-classification of tinnitus with and without hyperacusis by combining audiometry, gamma oscillations, and hemodynamics

The ongoing controversies about the neural basis of tinnitus, whether linked with central neural gain or not, may hamper efforts to develop therapies. We asked to what extent measurable audiometric characteristics of tinnitus without (T) or with co-occurrence of hyperacusis (TH) are distinguishable on the level of cortical responses. To accomplish this, electroencephalography (EEG) and concurrent functional near-infrared spectroscopy (fNIRS) were measured while patients performed an attentionally demanding auditory discrimination task using stimuli within the individual tinnitus frequency (fTin) and a reference frequency (fRef). Resting-state-fMRI-based functional connectivity (rs-fMRI-bfc) in ascending auditory nuclei (AAN), the primary auditory cortex (AC-I), and four other regions relevant for directing attention or regulating distress in temporal, parietal, and prefrontal cortex was compiled and compared to EEG and concurrent fNIRS activity in the same brain areas. We observed no group differences in pure-tone audiometry (PTA) between 10 and 16 kHz. However, the PTA threshold around the tinnitus pitch was positively correlated with the self-rated tinnitus loudness and also correlated with distress in T-groups, while TH experienced their tinnitus loudness at minimal loudness levels already with maximal suffering scores. The T-group exhibited prolonged auditory brain stem (ABR) wave I latency and reduced ABR wave V amplitudes (indicating reduced neural synchrony in the brainstem), which were associated with lower rs-fMRI-bfc between AAN and the AC-I, as observed in previous studies. In T-subjects, these features were linked with elevated spontaneous and reduced evoked gamma oscillations and with reduced deoxygenated hemoglobin (deoxy-Hb) concentrations in response to stimulation with lower frequencies in temporal cortex (Brodmann area (BA) 41, 42, 22), implying less synchronous auditory responses during active auditory discrimination of reference frequencies. In contrast, in the TH-group gamma oscillations and hemodynamic responses in temporoparietal regions were reversed during active discrimination of tinnitus frequencies. Our findings suggest that T and TH differ in auditory discrimination and memory-dependent directed attention during active discrimination at either tinnitus or reference frequencies, offering a test paradigm that may allow for more precise sub-classification of tinnitus and future improved treatment approaches.

Subjective and Objective Hearing Loss Among US Adult Cancer Survivors

Importance

Cancer survivors are at a higher risk of developing hearing loss (HL) due to older age, chemotherapy, and radiotherapy. However, the prevalence of HL among US cancer survivors remains unknown. Additionally, there is a lack of uniform HL screening guidelines for this enlarging population.

Objective

To estimate the prevalence of subjective HL and objective HL by audiometry test among cancer survivors and compare them with the general population as well as to assess the performance of subjective HL questions in detecting true (ie, audiometry-confirmed) HL.

Design, Setting, and Participants

In a cross-sectional design, adults between ages 20 and 80 years who had audiometry testing and responded to a hearing questionnaire from the National Health and Nutrition Examination Survey (2011-2012, 2015-2016, and 2017 to March 2020 prepandemic survey cycles) were selected. Data analysis was conducted from August 13, 2022, to July 26, 2023.

Main Outcomes and Measures

The weighted prevalence of subjective HL (troublesome hearing and tinnitus) and objective HL (speech-frequency HL and high-frequency HL) by audiometry were calculated. Analyses with χ2 testing and multiadjusted logistic regression models were used to compare HL between cancer survivors and the general population. To evaluate the performance of subjective HL questions as a tool to screen for objective HL by audiometry, areas under the curve were estimated using age- and gender-adjusted logistic regression.

Results

Among the total 9337 participants (weighted n = 90 098 441; 51.2% women), 10.3% were cancer survivors. Compared with the general population, cancer survivors had a higher prevalence of troublesome hearing (adjusted odds ratio [AOR], 1.43; 95% CI, 1.11-1.84), tinnitus (AOR, 1.28; 95% CI, 0.94-1.74), speech-frequency HL (AOR, 1.43; 95% CI, 1.11-1.85), and high-frequency HL (AOR, 1.74; 95% CI, 1.29-2.34). When using the subjective HL tool and questioning regarding whether the participants were having troublesome hearing and/or tinnitus in screening for HL, the age- and gender-adjusted area under the curve was 0.88 in detecting speech-frequency HL and 0.90 in detecting high-frequency HL.

Conclusion and Relevance

The findings of this study suggest that cancer survivors have a significantly higher prevalence of HL than the general population. Two subjective HL questions could potentially accurately identify those who have true HL and provide a simple and efficient screening tool for health care professionals. Cancer survivors and their families should be educated and encouraged to discuss hearing concerns, and health care professionals should facilitate raising awareness and provide early screening and timely referral when HL is identified.

[Somatosensory tinnitus]

BACKGROUND

Somatosensory tinnitus represents a clinically significant subgroup of chronic tinnitus. Although not completely understood, increasing evidence suggests interactivity between the somatosensory and auditory systems is responsible for both the development and maintenance of tinnitus.

OBJECTIVES

The aim of this study is to provide an overview of the evaluation of somatosensory tinnitus and to propose an examination protocol to support the diagnosis and treatment of this patient group.

MATERIALS AND METHODS

In addition to patient history, various clinical examination maneuvers are presented to establish the diagnosis of somatosensory tinnitus.

RESULTS

The maneuvers can be divided into examinations of the cervical spine, temporomandibular joint, and soft tissue near the jaw. The maneuvers should be performed in a quiet environment and usually in comparison between sides.

CONCLUSION

Accurate and efficient diagnosis of somatosensory tinnitus is essential to initiate appropriate treatment. The clinical maneuvers presented here are well suited for this purpose.

Association of Alopecia Areata with Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

BACKGROUND

Immune-mediated melanocyte-related pathogenesis in alopecia areata (AA) may cause sensorineural hearing loss (SNHL). However, the relation between AA and SNHL has been unclear. Therefore, we aimed to investigate this association between AA and SNHL.

METHODS

We performed a systematic review and searched MEDLINE and Embase on July 25, 2022, for cross-sectional, case-control, or cohort studies that examined the association of AA with SNHL. The Newcastle-Ottawa Scale was used to evaluate their risk of bias. A random-effects model meta-analysis was performed to obtain the mean differences in frequency-specific hearing thresholds between AA patients and age-matched healthy controls and the pooled odds ratio for SNHL in relation to AA.

RESULTS

We included 5 case-control studies and 1 cohort study, with none of them rated with high risk of biases. The meta-analysis showed AA patients had significantly higher mean differences in pure-tone hearing thresholds at 4,000 Hz and 12,000-12,500 Hz. The meta-analysis also found increased odds for SNHL among patients with AA (OR: 3.18; 95% CI: 2.06-4.89; I2 = 0%).

CONCLUSIONS

AA is associated with an increase of SNHL, especially at high frequencies. Otologic consultation may be indicated if AA patients present with hearing loss or tinnitus.

Audiological and psychological assessment of tinnitus patients with normal hearing

Introduction

This study was performed to assess identifiable abnormalities in tinnitus patients with normal hearing.

Methods

The medical records of subjective non-pulsatile tinnitus patients with normal hearing confirmed by conventional pure-tone audiometry who visited our tinnitus clinic between March 2020 and May 2022 were reviewed. The loudness discomfort level (LDL), extended high-frequency hearing loss (EHFHL), summating potential (SP)/action potential (AP) ratio, distortion product otoacoustic emission (DPOAE), thresholds of auditory brainstem response (ABR) wave V, somatic modulation, and psychiatric symptoms, such as anxiety, depression, and stress were evaluated by questionnaires.

Results

Decreased LDL (n = 48, 59.8%) was the most frequent finding, followed by EHFHL (n = 29, 35.4%), increased SP/AP ratio (n = 27, 32.9%), psychiatric symptoms (n = 24, 29.3%), decreased DPOAE (n = 17, 20.7%), somatic modulation (n = 8, 9.8%), and increased ABR threshold (n = 3, 3.7%); 75.6% of patients had one or more of these findings. The presence of psychiatric symptoms was independently associated with the Tinnitus Handicap Inventory (THI) score.

Conclusion

Tinnitus in patients with normal hearing may be accompanied by a combination of various subclinical abnormal audiological findings. However, the presence of psychiatric symptoms alone was independently associated with tinnitus distress.

A Systematic Review and Meta-Analysis of Extended High-Frequency Hearing Thresholds in Tinnitus With a Normal Audiogram

OBJECTIVES

Current evidence supports the growing application of extended high-frequency (EHF: 9 to 20 kHz) audiometry in hearing research, which likely results from the high vulnerability of this frequency region to damage induced by known auditory risk factors. The present systematic review and meta-analysis were performed to investigate whether adults with a normal audiogram and tinnitus show increased EHF hearing thresholds relative to control peers.

DESIGN

A comprehensive search was undertaken on electronic databases consisting of PubMed, ScienceDirect, Wiley, and Google Scholar using combined keywords: "tinnitus," "extended high frequency," "normal audiogram," and "hidden hearing loss."

RESULTS

From 261 articles found by searching databases, nine studies met the inclusion criteria for the meta-analysis. A significant difference was observed between tinnitus and control groups in the effect size analysis of hearing thresholds at 10, 12.5, 14, 16, and 18 kHz ( p ≤ 0.001), and the I-square heterogeneity analysis was below 50% in all studies ( p ≥ 0.131). Visual inspection by the Funnel plot and Egger's regression test ( p ≥ 0.211) also exhibited no publication bias in the meta-analyses.

CONCLUSIONS

Our findings are in support of the idea that in most cases, tinnitus is associated with some degree of cochlear mechanical dysfunction, which may not be detected by conventional audiometry alone. This finding underscores the significance of EHF audiometry in clinical practice, which may help both early identification of individuals susceptible to developing tinnitus and reduce the number of new cases through preventive counseling programs.

Hidden hearing loss: current concepts

PURPOSE OF REVIEW

The purpose of this review is to offer a concise summary of current knowledge regarding hidden hearing loss (HHL) and to describe the variety of mechanisms that contribute to its development. We will also discuss the various diagnostic tools that are available as well as future directions.

RECENT FINDINGS

Hidden hearing loss often also called cochlear synaptopathy affects afferent synapses of the inner hair cells. This description is in contrast to traditional models of hearing loss, which predominantly affects auditory hair cells. In HHL, the synapses of nerve fibres with a slow spontaneous firing rate, which are crucial for locating sound in background noise, are severely impaired. In addition, recent research suggests that HHL may also be related to cochlear nerve demyelination. Noise exposure causes loss of myelin sheath thickness. Auditory brainstem response, envelope-following response and middle-ear muscle reflex are promising diagnostic tests, but they have yet to be validated in humans.

SUMMARY

Establishing diagnostic tools for cochlear synaptopathy in humans is important to better understand this patient population, predict the long-term outcomes and allow patients to take the necessary protective precautions.

Extended high-frequency audiometric analyses of tinnitus patients exhibiting normal hearing on conventional pure-tone audiometry

BACKGROUND

While hearing loss is the greatest risk factor associated with developing tinnitus, some tinnitus patients exhibit no hearing loss on conventional pure-tone audiometry (PTA).

OBJECTIVES

This study was developed to assess whether tinnitus patients with normal hearing as measured via conventional PTA would exhibit differences from normal controls upon extended high-frequency (EHF) audiometric evaluation.

METHODS

In total, 102 tinnitus patients were separated into unilateral and bilateral tinnitus groups. Age- and sex-matched controls without tinnitus were enrolled.

RESULTS

No significant differences were observed when comparing EHF audiometry results in the 9-14 kHz range between controls and tinnitus patients, with only left-sided tinnitus ears exhibiting higher hearing thresholds than contralateral ears at 9, 10, and 14 kHz. Relative to normal controls, the hearing thresholds in the 2-8 kHz range for tinnitus ears were significantly increased.

CONCLUSIONS AND SIGNIFICANCE

Relative to controls, tinnitus patients with normal hearing did not exhibit any significant hearing loss in the EHF range. Unexpectedly, tinnitus patients with normal hearing exhibited significant hidden hearing loss in the conventional frequency range rather than in the EHF range. For patients with normal hearing, it appears to be unnecessary to conduct EHF examinations to detect hearing loss in the EHF range.

Examining the Profile of Noise-Induced Cochlear Synaptopathy Using iPhone Health App Data and Cochlear and Brainstem Electrophysiological Responses to Fast Clicks Rates

Little is known about objective classifying of noise exposure risk levels in personal listening device (PLD) users and electrophysiologic evidence of cochlear synaptopathy at very fast click rates. The aim of the study was to objectively classify noise exposure risk using iPhone Health app and identify signs of cochlear synaptopathy using behavioral and electrophysiologic measures. Thirty normal-hearing females (aged 18-26 years) were grouped based on their iPhone Health app's 6-month listening level and noise exposure data into low-risk and high-risk groups. They were assessed using a questionnaire, extended high-frequency (EHF) audiometry, QuickSIN test, distortion-product otoacoustic emission (DPOAE), and simultaneous recording of electrocochleography (ECochG) and auditory brainstem response (ABR) at three click rates (19.5/s, 97.7/s, 234.4/s). A series of ANOVAs and independent samples t -test were conducted for group comparison. Both groups had within-normal EHF hearing thresholds and DPOAEs. However, the high-risk participants were over twice as likely to suffer from tinnitus, had abnormally large summating potential to action potential amplitude and area ratios at fast rates, and had slightly smaller waves I and V amplitudes. The high-risk group demonstrated a profile of behavioral and objective signs of cochlear synaptopathy based on ECochG and ABR recordings at fast click rates. The findings in this study suggest that the iPhone Health app may be a useful tool for further investigation into cochlear synaptopathy in PLD users.

Phenotypic Profiling of People With Subjective Tinnitus and Without a Clinical Hearing Loss

Our objective was to study the characteristics of patients with subjective tinnitus and normal hearing and to investigate whether the features correlated to different shapes on audiograms. In this retrospective study, 313 patients with subjective tinnitus and clinically normal hearing were enrolled from the tinnitus outpatient department of the Eye and ENT Hospital of Fudan University. The following phenotypic variables were collected: age, dominant tinnitus pitch (TP), tinnitus loudness, tinnitus duration, tinnitus severity, sex, education, hearing thresholds, tinnitus position, and tinnitus condition. The dominant TPs of patients with normal hearing were mostly high-pitched, with a mean of 4866.8 ± 2579.6 Hz; thus, we speculated that the condition is related to high-frequency hearing threshold elevations. We further divided the patients into four subgroups based on the matched TP: (i) TP ≤ 500 Hz (n = 34), (ii) 500 Hz < TP ≤ 3,000 Hz (n = 15), (iii) 3,000 Hz < TP ≤ 8,000 Hz (n = 259), and (iv) TP > 8,000 Hz (n = 5). We studied the phenotypic profiling of different audiograms and found that the group with TP of ≤500 Hz had an average “inverted-U” shaped audiogram, and the group with TP between 500 and 3,000 Hz had a slowly ascending slope audiogram below 2,000 Hz, followed by a drastically descending slope audiogram ranging from 2,000 to 8,000 Hz; further, the high-frequency (3,000–8,000 Hz) and ultra-high-frequency (>8,000 Hz) groups had flat curves below 2,000 Hz and steeper slope audiograms over 2,000 Hz. Our findings confirmed a consistency ratio between the distributions of dominant TPs and the frequencies of maximum hearing thresholds in both ears. The dominant TP was positively correlated with the maximum hearing threshold elevation frequency (left ear: r = 0.277, p < 0.05; right ear: r = 0.367, p < 0.001). Hearing threshold elevations, especially in high frequency, might explain the appearance of dominant high-frequency TP in patients without clinically defined hearing loss. This is consistent with the causal role of high-frequency coding in the generation of tinnitus.

[A cross-sectional study and risk factors analysis of tinnitus in flight support personnel of PLA air force]

Objective:The aim of this study is to understand the epidemiological characteristics of tinnitus among flight support personnel and analyze its audiological characteristics and related risk factors. Methods:The information of tinnitus was collected by a method of cross-sectional investigation using questionnaire survey and audiology test among the flight support personnel of two stations of PLA air force. Results:The incidence of tinnitus among 666 subjects included was 24.2%, the THI grade was mainly grade 1 and grade 2. There were differences in THI scores among groups with different working years, but only differences in tinnitus incidence among groups with different frequency of hearing loss. Multivariate logistic regression analysis showed that grade of high frequency hearing loss（OR=1.39）, conscious hearing loss（OR=1.79） and frequency of asking others to repeat words（OR=1.64） were independent risk factors of tinnitus. The incidence of HF-HL and EHF-HL in ears with tinnitus among 0-5 working years was higher than that without tinnitus, while the incidence of EHF-HL in ears with tinnitus was not different from that without tinnitus among 6-10 and >10 working years. There was moderate correlation between THI scores and SAS standard scores（r=0.759）, and weak correlation between THI scores and PSQI scores（r=0.445）. Conclusion:The risk of tinnitus in high-frequency hearing loss and recessive hearing loss is increased; working years can affect the severity of tinnitus, while hearing conditions at different frequencies only affect the incidence of tinnitus; with increasing age, noise exposure plays a role in the occurrence of tinnitus decreasing gradually.

Measures of Subjective Tinnitus: What Does Visual Analog Scale Stand for?

BACKGROUND

Patients with tinnitus may have different severity levels of tinnitus distress. Visual analog scale (VAS) is a simple method to measure the extent of subjective distress caused by tinnitus. It includes ratings of tinnitus loudness, awareness, annoyance, and impact of tinnitus on life.

PURPOSE

The purpose of this study was to evaluate what led to different distress levels in patients with bilateral tinnitus by analyzing the relationships among all subscales of VAS scores for tinnitus distress and the documented variables.

RESEARCH DESIGN

This study was a retrospective cohort study.

STUDY SAMPLE

The medical records of 268 patients who visited a tinnitus clinic between March and December 2020 were reviewed.

DATA COLLECTION AND ANALYSIS

Epidemiologic characteristics, subjective tinnitus distress factors including tinnitus loudness, awareness, annoyance, and impact of tinnitus on life, questionnaire results including those from the Tinnitus Handicap Inventory (THI) and Beck Depression Inventory (BDI), and audiometric profiles were documented. Based on a bivariate analysis between variables and subtypes of subjective tinnitus distress, stepwise logistic regression was performed to identify potential influencing factors for aggravating each subtype.

RESULTS

Data from a total of 122 patients with bilateral tinnitus were collected. The cohort included 77 males and 45 females with a mean age of 51.16 ± 13.50 years. Tinnitus loudness was associated with an accompanying headache (p < 0.001), the BDI score (p = 0.001), and the duration of tinnitus (p = 0.006). A high THI (p < 0.001) and an accompanying headache (p = 0.016) were both associated with tinnitus annoyance. Hearing thresholds at 250 Hz (p = 0.011) and 500 Hz (p = 0.002) on the left side were associated with an impact of tinnitus on life. The hearing threshold at 4 kHz on the left side alone was associated with tinnitus awareness (p = 0.013).

CONCLUSION

Psychologic complaints are mainly associated with tinnitus loudness and annoyance. On the other hand, hearing loss is linked with tinnitus awareness and its impact on life. Thus, an individualized, sequential approach that considers different subtypes of tinnitus severity to assess subjective tinnitus distress is needed.