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Theodoroff SM, Reavis KM, Norrholm SD. Prevalence of Hyperacusis Diagnosis in Veterans Who Use VA Healthcare. Ear Hear 2024; 45:499-504. [PMID: 37752627 PMCID: PMC10868671 DOI: 10.1097/aud.0000000000001427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/06/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES The primary objective was to estimate the prevalence of hyperacusis diagnosis in treatment-seeking Veterans, paying attention to when it is diagnosed in conjuncture with common comorbid conditions. DESIGN This retrospective observational study used Veteran electronic health records from January 2015 to July 2021. Hyperacusis and comorbid conditions were identified using International Classification of Disease diagnostic codes. RESULTS The prevalence of hyperacusis diagnosis was 0.06%. Veterans diagnosed with tinnitus, posttraumatic stress disorder, headache, or traumatic brain injury were between two and seven times more likely to have an International Classification of Disease code for hyperacusis. CONCLUSIONS The estimated prevalence of hyperacusis diagnosis using electronic health records is grossly below what is reported in the literature. This is likely due to lack of standardized methods to diagnosis hyperacusis and when present with comorbid conditions, uncertainty when it should be coded as a secondary diagnosis. Future clinical and research efforts prioritizing hyperacusis are desperately needed.
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Affiliation(s)
- Sarah M. Theodoroff
- VA RR&D, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Kelly M. Reavis
- VA RR&D, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USAs
| | - Seth D. Norrholm
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
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Parameshwarappa V, Norena AJ. The effects of acute and chronic noise trauma on stimulus-evoked activity across primary auditory cortex layers. J Neurophysiol 2024; 131:225-240. [PMID: 38198658 DOI: 10.1152/jn.00427.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Exposure to intense noise environments is a major cause of sensorineural hearing loss and auditory perception disorders, such as tinnitus and hyperacusis, which may have a central origin. The effects of noise-induced hearing loss on the auditory cortex have been documented in many studies. One limitation of these studies, however, is that the effects of noise trauma have been mostly studied at the granular layer (i.e, the main cortical recipient of thalamic input), while the cortex is a very complex structure, with six different layers each having its own pattern of connectivity and role in sensory processing. The present study aims to investigate the effects of acute and chronic noise trauma on the laminar pattern of stimulus-evoked activity in the primary auditory cortex of the anesthetized guinea pig. We show that acute and chronic noise trauma are both followed by an increase in stimulus-evoked cortical responses, mostly in the granular and supragranular layers. The cortical responses are more monotonic as a function of the intensity level after noise trauma. There was minimal change, if any, in local field potential (LFP) amplitude after acute noise trauma, while LFP amplitude was enhanced after chronic noise trauma. Finally, LFP and the current source density analysis suggest that acute but more specifically chronic noise trauma is associated with the emergence of a new sink in the supragranular layer. This result suggests that supragranular layers become a major input recipient. We discuss the possible mechanisms and functional implications of these changes.NEW & NOTEWORTHY Our study shows that cortical activity is enhanced after trauma and that the sequence of cortical column activation during stimulus-evoked response is altered, i.e. the supragranular layer becomes a major input recipient. We speculate that these large cortical changes may play a key role in the auditory hypersensitivity (hyperacusis) that can be triggered after noise trauma in human subjects.
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Affiliation(s)
- Vinay Parameshwarappa
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Arnaud J Norena
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
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3
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Palk LE. Recognising and managing migraine. Nurs Stand 2024; 39:76-82. [PMID: 37994154 DOI: 10.7748/ns.2023.e12059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 11/24/2023]
Abstract
Migraine is a common neurological disorder characterised by a severe, pulsating headache, sometimes accompanied with photophobia or phonophobia and nausea and/or vomiting. The symptoms of migraine can have a significant adverse effect on a person's ability to undertake normal activities. Nurses have an important role in assisting patients in identifying migraine triggers and in supporting them to manage the symptoms of migraines through lifestyle changes and pharmacological treatments. This article describes different types of migraines and some differential diagnoses and 'red flag' symptoms that could indicate a more serious condition. The author also discusses non-pharmacological and pharmacological management strategies and treatments.
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Aazh H, Kartsonaki C, Moore BCJ. Psychometric evaluation of the 4C tinnitus management questionnaire for patients with tinnitus alone or tinnitus combined with hyperacusis. Int J Audiol 2024; 63:21-29. [PMID: 36426916 DOI: 10.1080/14992027.2022.2143430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the psychometric properties of a new questionnaire evaluating patients' confidence in managing their tinnitus, the 4C tinnitus management questionnaire (4C), which was designed to be used in the process of cognitive behavioural therapy. DESIGN Retrospective cross-sectional based on patient records. STUDY SAMPLES 99 consecutive patients who sought help for tinnitus (with or without hyperacusis) from an audiology clinic in the UK. Pure tone average (PTA) hearing thresholds, Uncomfortable Loudness Levels (ULLs), and responses to the 4C questionnaire, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T) questionnaire were gathered from the records of patients held at the audiology department. RESULTS Cronbach's alpha for the 4C was 0.91, indicating high internal consistency. Exploratory factor analysis suggested a one-factor solution. Discriminant validity was supported by weak correlations between 4C scores and PTA across ears and ULLmin (the across-frequency average ULL for the ear with lower average ULL). Convergent validity was supported by moderate correlations between 4C scores and scores for the THI, HQ, and SAD-T. CONCLUSIONS The 4C is an internally consistent questionnaire with high convergent and discriminant validity, which can be used to assess patients' confidence in managing their tinnitus.
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Affiliation(s)
- Hashir Aazh
- Audiology Department, Royal Surrey NHS Foundation Trust, Guildford, UK
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, USA
- Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK
| | - Christiana Kartsonaki
- MRC Population Health Research Unit, Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Brian C J Moore
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, UK
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Petersen PT, Bodilsen J, Jepsen MPG, Larsen L, Storgaard M, Helweg-Larsen J, Wiese L, Hansen BR, Lüttichau HR, Andersen CØ, Nielsen H, Brandt CT. Ramsay Hunt syndrome and concurrent varicella-zoster virus meningitis in Denmark: A nationwide cohort study. J Med Virol 2023; 95:e29291. [PMID: 38058258 DOI: 10.1002/jmv.29291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
Ramsay Hunt syndrome (RHS) is a manifestation of reactivated varicella-zoster virus (VZV) from the geniculate ganglion. Data on clinical features and outcomes of patients with RHS and concurrent VZV meningitis (henceforth RHS meningitis) are limited. Thus, we conducted a nationwide population-based cohort study of all adults hospitalized for RHS meningitis at the departments of infectious diseases in Denmark from 2015 to 2020. Patients with VZV meningitis without cranial nerve palsies were included for comparison. In total, 37 patients with RHS meningitis (mean annual incidence: 1.6/1 000 000 adults) and 162 with VZV meningitis without cranial nerve palsies were included. In RHS meningitis, the median age was 52 years (interquartile range: 35-64), and in addition to peripheral facial nerve palsy (100%), dizziness (46%), and hearing loss (35%) were common symptoms. The triad of headache, neck stiffness, and photophobia/hyperacusis was less common in RHS meningitis than in VZV meningitis without cranial nerve palsies (0/27 [0%] vs. 24/143 [17%]; p = 0.02). At 30 days after discharge, 18/36 (50%) patients with RHS meningitis had persistent peripheral facial nerve palsy, with no statistically significant difference between those treated with and without adjuvant glucocorticoids (6/16 [38%] vs. 12/20 [60%]; p = 0.18). Additional sequelae of RHS meningitis included dizziness (29%), neuralgia (14%), tinnitus/hyperacusis (11%), hearing loss (9%), headache (9%), fatigue (6%), and concentration difficulties (3%). In conclusion, clinical features and outcomes of RHS meningitis were primarily related to cranial neuropathies.
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Affiliation(s)
- Pelle T Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hillerød, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Micha P G Jepsen
- Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hillerød, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lothar Wiese
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Birgitte R Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | - Hans R Lüttichau
- Department of Infectious Diseases, Herlev Hospital, Herlev, Denmark
| | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Cederroth CR, Hong MG, Freydin MB, Edvall NK, Trpchevska N, Jarach C, Schlee W, Schwenk JM, Lopez-Escamez JA, Gallus S, Canlon B, Bulla J, Williams FMK. Screening for Circulating Inflammatory Proteins Does Not Reveal Plasma Biomarkers of Constant Tinnitus. J Assoc Res Otolaryngol 2023; 24:593-606. [PMID: 38079022 PMCID: PMC10752855 DOI: 10.1007/s10162-023-00920-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/22/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Tinnitus would benefit from an objective biomarker. The goal of this study is to identify plasma biomarkers of constant and chronic tinnitus among selected circulating inflammatory proteins. METHODS A case-control retrospective study on 548 cases with constant tinnitus and 548 matched controls from the Swedish Tinnitus Outreach Project (STOP), whose plasma samples were examined using Olink's Inflammatory panel. Replication and meta-analysis were performed using the same method on samples from the TwinsUK cohort. Participants from LifeGene, whose blood was collected in Stockholm and Umeå, were recruited to STOP for a tinnitus subtyping study. An age and sex matching was performed at the individual level. TwinsUK participants (n = 928) were selected based on self-reported tinnitus status over 2 to 10 years. Primary outcomes include normalized levels for 96 circulating proteins, which were used as an index test. No reference standard was available in this study. RESULTS After adjustment for age, sex, BMI, smoking, hearing loss, and laboratory site, the top proteins identified were FGF-21, MCP4, GDNF, CXCL9, and MCP-1; however, these were no longer statistically significant after correction for multiple testing. Stratification by sex did not yield any significant associations. Similarly, associations with hearing loss or other tinnitus-related comorbidities such as stress, anxiety, depression, hyperacusis, temporomandibular joint disorders, and headache did not yield any significant associations. Analysis in the TwinsUK failed in replicating the top candidates. Meta-analysis of STOP and TwinsUK did not reveal any significant association. Using elastic net regularization, models exhibited poor predictive capacity tinnitus based on inflammatory markers [sensitivity = 0.52 (95% CI 0.47-0.57), specificity = 0.53 (0.48-0.58), positive predictive value = 0.52 (0.47-0.56), negative predictive values = 0.53 (0.49-0.58), and AUC = 0.53 (0.49-0.56)]. DISCUSSION Our results did not identify significant associations of the selected inflammatory proteins with constant tinnitus. Future studies examining longitudinal relations among those with more severe tinnitus and using more recent expanded proteomics platforms and sampling of cerebrospinal fluid could increase the likelihood of identifying relevant molecular biomarkers.
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Affiliation(s)
- Christopher R Cederroth
- Section of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Ropewalk House, Nottingham, UK.
- Department of Otolaryngology, Head and Neck Surgery, Translational Hearing Research, Tübingen Hearing Research Center, University of Tübingen, Tubingen, Germany.
| | - Mun-Gwan Hong
- Affinity Proteomics, Science for Life Laboratory, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
- Science for Life Laboratory, Department of Biochemistry and Biophysics, National Bioinformatics Infrastructure Sweden, Stockholm University, Stockholm, Sweden
| | - Maxim B Freydin
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Niklas K Edvall
- Section of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Natalia Trpchevska
- Section of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Carlotta Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Jochen M Schwenk
- Science for Life Laboratory, Department of Biochemistry and Biophysics, National Bioinformatics Infrastructure Sweden, Stockholm University, Stockholm, Sweden
| | - Jose-Antonio Lopez-Escamez
- Faculty of Medicine & Health, School of Medical Sciences, Meniere's Disease Neuroscience Research Program, The Kolling Institute, University of Sydney, Sydney, NSW, Australia
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer, University of Granada, PTS, Junta de Andalucía, Granada, Spain
- Division of Otolaryngology, Department of Surgery, Instituto de Investigación Biosanitaria, ibs.GRANADA, Universidad de Granada, GranadaGranada, Spain
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara Canlon
- Section of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Jan Bulla
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
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Shin SH, Byun SW, Lee ZY, Kim MJ, Kim EH, Lee HY. Clinical Findings That Differentiate Co-Occurrence of Hyperacusis and Tinnitus from Tinnitus Alone. Yonsei Med J 2022; 63:1035-1042. [PMID: 36303312 PMCID: PMC9629898 DOI: 10.3349/ymj.2022.0274] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/03/2022] [Accepted: 08/27/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE We aimed to assess the characteristics of patients with concurrent tinnitus and hyperacusis, determine the best audiological criteria for predicting hyperacusis, and confirm whether objective evidence of changes in the brain exists. MATERIALS AND METHODS The medical records of patients with tinnitus who visited the hospital between March 2020 and December 2021 were reviewed. Data on accompanying hyperacusis, audiological profiles, and questionnaires including the Tinnitus Handicap Inventory (THI), Beck Depression Inventory, and numerical rating scale were analyzed. Resting-state quantitative electroencephalography (qEEG) using power spectral density (PSD) and event-related spectral perturbation (ERSP) were performed to objectively quantify changes in the brain. RESULTS A total of 194 patients were analyzed. Among them, 51 (26.3%) reported combined subjective hyperacusis with tinnitus. However, the proportions widely varied from 7.4% to 68.4% based on three audiological criteria for assessment. A higher score on the THI questionnaire was independently associated with the co-occurrence of tinnitus and hyperacusis. Fair agreement was observed between subjective hyperacusis and the audiological criterion based on a loudness discomfort level (LDL) of ≤90 dB at two or more frequencies for the diagnosis of hyperacusis. An increased beta-PSD and decreased levels of gamma-PSD, all-ERSP, and delta-ERSP were observed in patients with hyperacusis (p<0.05). CONCLUSION Patients with co-occurring tinnitus and hyperacusis had more severe tinnitus distress. An LDL of ≤90 dB at two or more frequencies may be applicable to predict accompanying hyperacusis in subjects with tinnitus, and qEEG also provides more objective information.
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Affiliation(s)
- Seung-Ho Shin
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Wan Byun
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Zoo Young Lee
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min-Jee Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea
| | - Eun Hye Kim
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Ewha Womans University School of Medicine, Seoul, Korea.
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Falcón González JC, Borkoski Barreiro S, Torres García de Celis M, Ramos Macías Á. Tinnitus suppression with electrical stimulation in adults: long-term follow-up. Acta Otorhinolaryngol Ital 2022; 42:176-181. [PMID: 35612510 PMCID: PMC9131997 DOI: 10.14639/0392-100x-n1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022]
Abstract
Objectives To investigate the long-term effects of cochlear implants as a treatment for patients with severe to profound neurosensory loss associated with severe tinnitus. Methods Prospective study in 17 adult patients with severe to profound sensorineural hearing loss associated with severe tinnitus, indicated with a Tinnitus Handicap Inventory (THI) score ≥ 58%, and hyperacusis. Measures were made on hearing, tinnitus, hyperacusis and quality of life up to 5 years after activation of the sound processor of the cochlear implant. It was evaluated by using the disyllabic test, THI, visual analogue scale and Glasgow Benefit Inventory questionnaire. Results 60 months after cochlear implantation, improvements in loudness and discomfort of tinnitus, speech discrimination and hyperacusis were observed. Subjects perceive an important subjective benefit upon receiving the cochlear implant. Conclusions Cochlear implants can be used as treatment for patients with severe to profound sensorineural hearing loss associated with severe tinnitus and hyperacusis with long-term benefits on quality of life and lasting relief of tinnitus.
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Affiliation(s)
- Juan Carlos Falcón González
- Department of Otolaryngology Head Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas, Spain
| | - Silvia Borkoski Barreiro
- Department of Otolaryngology Head Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas, Spain
| | - Margarita Torres García de Celis
- Department of Otolaryngology Head Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas, Spain
| | - Ángel Ramos Macías
- Department of Otolaryngology Head Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas, Spain
- Department of Otolaryngology, Faculty Medicine, University of Las Palmas de Gran Canaria, Spain
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Ralli M, Salvi RJ, Greco A, Turchetta R, De Virgilio A, Altissimi G, Attanasio G, Cianfrone G, de Vincentiis M. Characteristics of somatic tinnitus patients with and without hyperacusis. PLoS One 2017; 12:e0188255. [PMID: 29161302 PMCID: PMC5697853 DOI: 10.1371/journal.pone.0188255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/05/2017] [Indexed: 12/14/2022] Open
Abstract
Objective Determine if somatic tinnitus patients with hyperacusis have different characteristics from those without hyperacusis. Patients and methods 172 somatic tinnitus patients with (n = 82) and without (n = 90) hyperacusis referred to the Tinnitus Unit of Sapienza University of Rome between June 2012 and June 2016 were compared for demographic characteristics, tinnitus features, self-administered questionnaire scores, nature of somatic modulation and history. Results Compared to those without hyperacusis, patients with somatic tinnitus and hyperacusis: (a) were older (43.38 vs 39.12 years, p = 0.05), (b) were more likely to have bilateral tinnitus (67.08% vs 55.56%, p = 0.04), (c) had a higher prevalence of somatic modulation of tinnitus (53.65% vs 36.66%, p = 0.02) and (d) scored significantly worse on tinnitus annoyance (39.34 vs 22.81, p<0.001) and subjective hearing level (8.04 vs 1.83, p<0.001). Conclusion Our study shows significantly higher tinnitus modulation and worse self-rating of tinnitus and hearing ability in somatic tinnitus patients with hyperacusis versus somatic tinnitus patients without hyperacusis. These differences could prove useful in developing a better understanding of the pathophysiology and establishing a course of treatment for these two groups of patients.
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Affiliation(s)
- Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Richard J. Salvi
- Center for Hearing and Deafness, University at Buffalo, Buffalo, New York, United States of America
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Rosaria Turchetta
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Abstract
BACKGROUND Chronic migraine is a disabling, under-recognized, and undertreated disorder that increases health burdens. The aim of this study was to evaluate phenotypic features and the relevance of accompanying symptoms of migraine attacks in chronic migraine. METHOD This study was conducted as part of an ongoing Turkish Headache Database Study investigating the clinical characteristics and outcomes of headache syndromes in the Turkish population. The electronic database was examined retrospectively, and 835 patients with chronic migraine were included. RESULTS Patient group consisted of 710 women and 125 men (85 and 15 %, respectively). Mean patient age was 36.8 ± 13.5 years, median value of migraine onset was 60 months (18-120), median headache frequency was 25 days per month (16-30), median of attack duration was 12 h (4-24), and median of intensity was eight (7-9). Increasing headache days per month were inversely related with the presence of nausea, vomiting, phonophobia, and photophobia. Longer duration of headache (months) and higher visual analog scale (VAS) for headache intensity were associated with all accompanying symptoms. Phonophobia, nausea, photophobia, and vomiting were the most frequent accompanying symptoms (experienced by 80.2, 77.6, 71.2, and 40.9 % of patients, respectively). Osmophobia was also frequent in chronic migraine patients (53.4 %) and was closely associated with other accompanying symptoms. Vertigo and dizziness were observed less frequently, and they were not associated with accompanying symptoms. CONCLUSION Phenotype of chronic migraine may be associated with the course of chronification. Duration of illness and attack intensity were closely related with the presence of accompanying symptoms, although headache frequency was found to be inversely related to the presence of accompanying symptoms. Osmophobia was also a frequent symptom and was closely related with other accompanied symptoms, unlike vertigo and dizziness. Inclusion of osmophobia into the diagnostic criteria might improve accurate diagnosis of chronic migraine.
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Affiliation(s)
- Osman Özgür Yalın
- Neurology Department, Istanbul Education and Research Hospital, Kasap İlyas Mah. Org. Abdurrahman, Nafiz Gürman Cd, PK: 34098, Fatih, Istanbul, Turkey.
| | - Derya Uluduz
- Neurology Department, Istanbul University Cerrahpasa School of Medicine, İstanbul, Turkey
| | - Aynur Özge
- Neurology Department, Mersin University School of Medicine, Mersin, Turkey
| | - Mehmet Ali Sungur
- Biostatistics Department, Düzce University School of Medicine, Düzce, Turkey
| | - Macit Selekler
- Neurology Department, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Aksel Siva
- Neurology Department, Istanbul University Cerrahpasa School of Medicine, İstanbul, Turkey
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Guimarães AC, de Carvalho GM, Monteiro Zappelini CE, Mezzalira R, Stoler G, Paschoal JR. Study of the relationship between the degree of tinnitus annoyance the presence of hyperacusis✩✩Please cite this article as: Guimarães AC, Carvalho GM, Voltolini MM, Zappelini CE, Mezzalira R, Stoler G, et al. Study of the relationship between the degree of tinnitus annoyance and the presence of hyperacusis. Braz J Otorhinolaryngol. 2014;80:24-8. Braz J Otorhinolaryngol 2014; 80:24-8. [PMID: 24626888 PMCID: PMC9443979 DOI: 10.5935/1808-8694.20140007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/01/2013] [Indexed: 12/01/2022] Open
Abstract
Introdução A hiperacusia pode ser definida como uma manifestação de ganho central aumentado das vias auditivas, compreendida como um estado pré-zumbido. Em alguns casos, o zumbido pode ser secundário a esse ganho aumentado. Objetivo Avaliar a prevalência da hiperacusia em pacientes com zumbido e sua associação com o incômodo do zumbido. Materiais e métodos: Estudo retrospectivo envolvendo pacientes do ambulatório de otoneuro-logia com queixa principal de zumbido que foram submetidos a avaliação clínica, audiológica e a questionário de avaliação da hiperacusia e do zumbido. O grau de incômodo da hiperacusia e do zumbido foi classificado utilizando a Escala Visual Analógica. Resultados Foram analisados prontuários de 309 pacientes, 169 (54,7%) do sexo feminino e 140 (45,3%) do sexo masculino, com idade média de 53 anos. O grau de incômodo do zumbido apresentou mediana de sete. A hiperacusia esteve presente em 57 (18,4%) pacientes, com mediana de grau de incômodo de cinco. O grau de incômodo pelo zumbido nos pacientes com hiperacusia foi semelhante ao dos pacientes sem hiperacusia. Conclusão A hiperacusia esteve presente em 18,4% dos pacientes com zumbido. O grau de incômodo do zumbido não teve correlação com a presença da hiperacusia. © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.
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Affiliation(s)
| | | | | | - Raquel Mezzalira
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Guita Stoler
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Pace E, Zhang J. Noise-induced tinnitus using individualized gap detection analysis and its relationship with hyperacusis, anxiety, and spatial cognition. PLoS One 2013; 8:e75011. [PMID: 24069375 PMCID: PMC3771890 DOI: 10.1371/journal.pone.0075011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/10/2013] [Indexed: 01/12/2023] Open
Abstract
Tinnitus has a complex etiology that involves auditory and non-auditory factors and may be accompanied by hyperacusis, anxiety and cognitive changes. Thus far, investigations of the interrelationship between tinnitus and auditory and non-auditory impairment have yielded conflicting results. To further address this issue, we noise exposed rats and assessed them for tinnitus using a gap detection behavioral paradigm combined with statistically-driven analysis to diagnose tinnitus in individual rats. We also tested rats for hearing detection, responsivity, and loss using prepulse inhibition and auditory brainstem response, and for spatial cognition and anxiety using Morris water maze and elevated plus maze. We found that our tinnitus diagnosis method reliably separated noise-exposed rats into tinnitus(+) and tinnitus(−) groups and detected no evidence of tinnitus in tinnitus(−) and control rats. In addition, the tinnitus(+) group demonstrated enhanced startle amplitude, indicating hyperacusis-like behavior. Despite these results, neither tinnitus, hyperacusis nor hearing loss yielded any significant effects on spatial learning and memory or anxiety, though a majority of rats with the highest anxiety levels had tinnitus. These findings showed that we were able to develop a clinically relevant tinnitus(+) group and that our diagnosis method is sound. At the same time, like clinical studies, we found that tinnitus does not always result in cognitive-emotional dysfunction, although tinnitus may predispose subjects to certain impairment like anxiety. Other behavioral assessments may be needed to further define the relationship between tinnitus and anxiety, cognitive deficits, and other impairments.
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Affiliation(s)
- Edward Pace
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jinsheng Zhang
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Communication Sciences & Disorders, Wayne State University College of Liberal Arts & Sciences, Detroit, Michigan, United States of America
- * E-mail:
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Ertsey C, Vesza Z, Bangó M, Varga T, Nagyidei D, Manhalter N, Bozsik G. [Prospective study of the clinical features of cluster headache]. Ideggyogy Sz 2012; 65:307-314. [PMID: 23126215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Although cluster headache (CH) is one of the most severe human pain syndromes, its symptoms and therapeutic possibilities may be suboptimally recognised in current medical practice in Hungary. AIM To present the clinical characteristics of CH based on a prospective study of patients attending the Headache Service of the Department of Neurology, Semmelweis University. METHODS We collected information about the symptoms, diagnosis and previous treatment of CH patients by filling in a 108-item questionnaire during outpatient visits. RESULTS In the 5-year period between 2004 and 2008 we obtained data from 78 CH patients (57 males and 21 females; mean age: 44.6 +/- 14.6 years). The male:female ratio did not change in subgroups based on disease onset (calendar years). Ninety-three percent considered CH the most severe pain state of their life. The pain was strictly unilateral, affecting the territory of the 1st trigeminal division in all patients. The attacks were accompanied by signs of ipsilateral cranial parasympathetic activation (lactimation 83%, conjunctival injection 67%, rhinorrhea 56%, nasal congestion 43%); less frequently, signs of sympathetic dysfunction (ptosis 48%, miosis 7%) were also present. Two patients had attacks showing the typical localisation, severity and time course of CH attacks, but not accompanied by autonomic phenomena. A considerable part of the patients also observed symptoms that are usually ascribed to migraine (nausea 41%, vomiting 18%, photophobia 68%, phonophobia 58%). This may have been instrumental in the fact that, regardless of the characteristic clinical symptoms, the diagnosis of CH took 10 years on average. At the time of their examination 63% of patients were not using adequate abortive medications and 59% did not have an adequate prophylactic measure. DISCUSSION Cluster headache is characterised by attacks of devastating pain that warrant an early diagnosis and adequate treatment. Our study underlines that information about the diagnosis and therapy of CH should be emphasized on occasions of neurology specialty training and continuing medical education.
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Affiliation(s)
- Csaba Ertsey
- Semmelweis Egyetem, AOK, Neurológiai Klinika, Budapest.
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Abstract
UNLABELLED Despite recent research advances, the origin of nociception in migraine headaches remains unclear and continues to be a topic of intense examination. Experiments using animal models of dural neurogenic plasma extravasation (DNPE) as an index of meningeal inflammation provided the basis for the meningeal inflammation hypothesis of migraine pain. OBJECTIVE We explore the possibility that DNPE can be detected in humans during a migraine attack. METHODS DNPE single photon emission computerized tomography (SPECT) with an intravenous injection of technetium-99m (Tc-99m) human serum albumin (HSA) has been used in a 46-year-old migraine symptomatic patient who met the International Headache Society criteria for episodic migraine. The patient was injected with 10 mCi HSA and imaged by SPECT. A second (delayed) SPECT was done 3 hours later. After 3 days, following complete resolution of her migraine headache, the patient returned for the control SPECT. RESULTS All SPECT images were compared with the patient's self-recorded pictorial description of her migraine head pain epicenter. Tc-99m HSA extravasation appeared on the same side and approximately in the same region as the epicenter of the patient's head pain. CONCLUSION This observation suggests the occurrence of intracranial plasma extravasation during migraine attacks. Activity on SPECT scans suggests that tracer extravasation and not hyperemia is responsible for the positive finding.
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Affiliation(s)
- Helena Knotkova
- Research Division, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, Manhattan Campus for the Albert Einstein College of Medicine, New York, NY 10003, USA.
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15
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Kamiyama M, Kuriyama S, Watanabe M. [A clinical study of pyridoxine treatment for pervasive developmental disorders with hypersensitivity to sound]. No To Hattatsu 2006; 38:277-82. [PMID: 16859191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In our earlier study we conducted a randomized, placebo-controlled, triple blind trial, and showed that pyridoxine treatment of pervasive developmental disorders with expressive verbal disorders and hypersensitivity to sound as significantly effective in improving VIQ scores. This study analyzed the long-term changes of the subjects. We confirmed that their VIQ scores improved over time. An analysis of the reports of their daily life provided by their parents and teachers showed that the children's hypersensitivity to sound was also improved. They became able to adjust to their daily life at home and school without any panic. Our results indicate there are PDD subgroups whose expressive language capabilities and hypersensitivity to sound can be improved by pyridoxine treatment.
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Affiliation(s)
- Machiko Kamiyama
- Department of Education, Art and Science, Yamagata University, Yamagata.
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Herraiz C, Tapia MC, Plaza G. Tinnitus and Ménière's disease: characteristics and prognosis in a tinnitus clinic sample. Eur Arch Otorhinolaryngol 2006; 263:504-9. [PMID: 16555108 DOI: 10.1007/s00405-006-0019-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 10/05/2005] [Indexed: 10/24/2022]
Abstract
The aim of this study is to describe tinnitus epidemiological characteristics in Ménière's disease (MD), the prognosis and its interaction with other MD symptoms. It is a descriptive transversal study. One hundred two MD patients were referred to a tinnitus clinic. Tinnitus was evaluated according to psychoacoustical tinnitogram, visual analogue scale, and tinnitus handicap inventory (THI). All patients were diagnosed with definitive MD (following AAO-HNS' 95 criteria). Pitch was more commonly identified in low and medium frequencies. Psychoacoustical intensity was matched in 12.7 dB. The visual analogue scale showed a value of 7.1, while THI score reached an average of 49%. Compared with other aetiologies (acoustic trauma, otosclerosis), MD showed a statistical difference in tinnitus severity parameters (P<0.05). Tinnitus increased VAS and THI score as a function of duration and bilateral disease (P<0.01). We found a statistical association (P<0.05) between tinnitus intensity and worse hearing loss or hyperacusis, but it was not influenced by number of vertigo spells. Higher MD stage increased tinnitus intensity and handicap. Tinnitus in MD patients referred to our tinnitus clinic presents a high intensity and handicap levels and represents the most troublesome symptom. Severity is influenced by the longer duration of the disease, the bilateral affection, hearing impairment or hyperacusis and a higher MD stage.
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Affiliation(s)
- C Herraiz
- Unidad de Otorrinolaringología, Fundación Hospital Alcorcón, Madrid, C/Budapest, 1. Alcorcón, 28922, Madrid, Spain.
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Abstract
Tinnitus retraining therapy (TRT) is a method for treating tinnitus and decreased sound tolerance, based on the neurophysiological model of tinnitus. This model postulates involvement of the limbic and autonomic nervous systems in all cases of clinically significant tinnitus and points out the importance of both conscious and subconscious connections, which are governed by principles of conditioned reflexes. The treatments for tinnitus and misophonia are based on the concept of extinction of these reflexes, labeled as habituation. TRT aims at inducing changes in the mechanisms responsible for transferring signal (i.e., tinnitus, or external sound in the case of misophonia) from the auditory system to the limbic and autonomic nervous systems, and through this, remove signal-induced reactions without attempting to directly attenuate the tinnitus source or tinnitus/misophonia-evoked reactions. As such, TRT is effective for any type of tinnitus regardless of its etiology. TRT consists of: (1) counseling based on the neurophysiological model of tinnitus, and (2) sound therapy (with or without instrumentation). The main role of counseling is to reclassify tinnitus into the category of neutral stimuli. The role of sound therapy is to decrease the strength of the tinnitus signal. It is crucial to assess and treat tinnitus, decreased sound tolerance, and hearing loss simultaneously. Results from various groups have shown that TRT can be an effective method of treatment.
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Affiliation(s)
- Pawel J Jastreboff
- Tinnitus and Hyperacusis Center, Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Macedo A, Farré M, Baños JE. A meta-analysis of the placebo response in acute migraine and how this response may be influenced by some of the characteristics of clinical trials. Eur J Clin Pharmacol 2006; 62:161-72. [PMID: 16402240 DOI: 10.1007/s00228-005-0088-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2005] [Accepted: 10/24/2005] [Indexed: 11/27/2022]
Abstract
Migraine is the most common cause of vascular headache and a highly prevalent illness. In the last 20 years, the discovery of new agents has increased clinical research on migraine. In most of clinical trials that have been conducted, the efficacy was established using a placebo as a control treatment. The objective of the study reported here was to analyse the response rate in patients who received a placebo as well as to determine how a number of the methodological factors may affect the effect of the placebo in clinical trials of acute migraine. Computer-based information searches were conducted on the Medline database. Data analysis included the outcomes 'pain relief', 'pain-free', 'associated symptoms', 'recurrence', 'patients' opinion' about pain relief and 'adverse events'. Administration route, study design and country in which the study was carried out were the methodological factors that were analyzed. Meta-analysis was computed using Mantel-Haenszel, and a total of 98 papers were considered in the final analysis. After 2 h, 28.6% of the patients of the placebo group improved and 8.8% were pain-free. The percentage of pain-free patients was the highest in the placebo and active drug groups in which the placebo or drug had been administered subcutaneously, in parallel design studies (vs. cross-over trials) and in studies performed in Europe (vs. North America). Adverse events in the placebo group were significantly higher in studies performed in North America. These data reinforce the need for knowing the magnitude of the placebo response in each specific situation during the planning of clinical trials on acute migraine.
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Affiliation(s)
- Ana Macedo
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Abstract
Purpose:
This article is the first of 2 that present basic guidelines for audiologists to provide clinical management of tinnitus. The method, termed audiologic tinnitus management (ATM), was developed to incorporate management strategies that can be implemented most efficiently by audiologists.
Method:
Development of ATM has been drawn from the clinical and research experience of the authors and numerous audiologists. Certain elements of ATM are adapted from the methods of tinnitus masking and tinnitus retraining therapy. Procedures are described in the present article for performing the intake assessment, while the companion article (J. A. Henry, T. L. Zaugg, & M. A. Schechter, 2005) describes treatment methodology.
Results:
Development of ATM has resulted in defined procedures to conduct a basic tinnitus assessment that includes written questionnaires, an intake interview, audiologic evaluation, and a psychoacoustic assessment of tinnitus perceptual characteristics. If patients report a sound tolerance problem (hyperacusis), loudness discomfort levels are measured at audiometric frequencies. There are special procedures for selecting hearing aids, ear-level noise generators, combination devices (noise generator and hearing aid combined), and personal listening devices (i.e., portable radios and tape, CD, and MP3 players).
Conclusions:
This article explains each of these assessment components in detail. Adoption of the ATM assessment protocol by audiologists can contribute to the establishment of uniform procedures for the clinical management of tinnitus patients.
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Abstract
Purpose:
This article is the second of 2 that address the need for basic procedures that can be used commonly by audiologists to manage patients with clinically significant tinnitus, as well as hyperacusis. The method described is termed audiologic tinnitus management (ATM).
Method:
ATM was developed specifically for use by audiologists. Although certain procedural components were adapted from the methods of tinnitus masking and tinnitus retraining therapy, ATM is uniquely and specifically defined. A detailed description of the ATM assessment procedures is provided in the companion article (J. A. Henry, T. L. Zaugg, & M. A. Schechter, 2005). The present article describes a specific clinical protocol for providing treatment with ATM.
Results:
The treatment method described for ATM includes structured informational counseling and an individualized program of sound enhancement that can include the use of hearing aids, ear-level noise generators, combination instruments (noise generator and hearing aid combined), personal listening devices (wearable CD, tape, and MP3 players), and augmentative sound devices (e.g., tabletop sound generators). Ongoing treatment appointments involve primarily the structured counseling, evaluation, and adjustment of the use of sound devices, and assessment of treatment outcomes. The informational counseling protocol and an interview form for determining treatment outcomes are each described in step-by-step detail for direct clinical application.
Conclusion:
This article can serve as a practical clinical guide for audiologists to provide treatment for tinnitus in a uniform manner.
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Hesse G, Schaaf H, Laubert A. Specific findings in distortion product otoacoustic emissions and growth functions with chronic tinnitus. Int Tinnitus J 2005; 11:6-13. [PMID: 16419682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Chronic tinnitus has a very high prevalence in industrialized countries. Latest studies found chronic tinnitus in 4% of the German population, with almost 2% suffering severely in their daily life. Because no curative therapeutic approach is available--neither pharmacological nor surgical--the main focus lies in treatments that enhance the habituation of tinnitus. Habituation occurs in almost 50% of affected patients as a normal process, leading to a complete compensation. This finding is based on the ability of the auditory perception to habituate random noise and focus on important acoustic information. According to our audiological data, 90% of tinnitus patients have deficits in inner-ear function as a generator of tinnitus, mainly in the outer hair cells. This occurrence can be verified by registration of distortion products of otoacoustic emissions. Thus, the main origin of tinnitus is peripheral, and most patients suffer from accompanying hearing loss, even though it is sometimes mild or subjectively not even noticed. In almost 50% of our patients, we find hyperfunction of outer hair cells, again recorded via distortion products of otoacoustic emissions and their growth functions. Normal efferent reduction of distortion products through contralateral acoustic stimulation does not take place in most tinnitus patients. This finding shows that central auditory functions are also disturbed in chronic tinnitus patients, leading to reduced efferent effects on the hair cells and thus impeding habituation. Tests to verify these more central pathological findings have yet to be developed. We have data on diminished ability to distinguish stimuli from random noise by bilateral sound processing: The so-called bilateral masking difference test results are pathological in almost 30% of patients suffering from chronic tinnitus. We concluded from our audiological data that chronic tinnitus is primarily a cochlear dysfunction, but habituation is impeded by accompanying or consecutive deficits of the central auditory pathway. Regarding therapeutic approaches, these central functions can be trained by hearing therapy, as we know from patients' rehabilitation.
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Alpini D, Cesarani A, Giuliano DA, Capobianco S. Tinnitus: pharmacological topodiagnosis. Int Tinnitus J 2004; 10:91-3. [PMID: 15379358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The difficulty of accurately localizing the source of subjective tinnitus is well-known. Anamnesis and traditional audiological tests can often suggest a source if its origin as peripheral or merely central (or both). Therefore, several authors, such as Risey, Denk, and Shulman, recently proposed identifying the source of subjective tinnitus through the evaluation of the responses reported by patients to adequate pharmacological treatments. Our study presents a useful plan to perform tinnitus topodiagnosis, which consists of specific audiological tests evaluating the characteristics of symptoms (annoyance, pitch, loudness, hyperacusis) and of several pharmacological tests carried out through the administration of particular drugs, the pharmacodynamic mechanisms and meaningful side effects of which are described. On the basis of pharmacological effects on tinnitometry, some drugs will be combined.
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Affiliation(s)
- Dario Alpini
- Ear, Nose, and Throat-Otoneurology Service Scientific Institute, Don Gnocchi Foundation, Milan, Italy.
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Tkachuk GA, Cottrell CK, Gibson JS, O'Donnell FJ, Holroyd KA. Factors Associated With Migraine‐Related Quality of Life and Disability in Adolescents: A Preliminary Investigation. Headache 2003; 43:950-5. [PMID: 14511271 PMCID: PMC2128716 DOI: 10.1046/j.1526-4610.2003.03185.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study examined factors associated with impaired quality of life and functioning in a sample of treatment-seeking adolescent migraineurs. Subjects.-The 37 participants were 51.4% female, and averaged 14.3 years of age and 4.1 migraines per month for the previous 36 months. PROCEDURE The Migraine-Specific Quality of Life Questionnaire, questionnaire items inquiring about missed activities, and headache diary recordings of missed and impaired activity time served as dependent measures. Variables studied were age; gender; migraine frequency, duration, and severity; presence of nausea, photophobia, or phonophobia; and number of visits to an emergency department in the previous year. RESULTS Three hierarchical forward regressions and one logistic regression, controlling for age and gender, revealed that the presence of nausea and at least one emergency department visit predicted poorer quality of life and a greater number of missed activities in these adolescent migraineurs. The presence of migraine-related missed activity hours from headache diaries was predicted by being male, having higher combined photophobia and phonophobia sensitivity scores, as well as more frequent and severe migraines. Greater impairment was predicted by having longer average duration attacks. CONCLUSIONS These preliminary findings suggest that the continued development of effective treatment approaches to alleviate pain, suffering, and disability in adolescent migraineurs is required. In particular, evidence for the impact of nausea and sensitivities suggests that they may be important targets for treatment. As well, adolescent migraineurs with a history of a visit to an emergency department in the previous year likely experience greater individual and family distress, more disability, and poorer quality of life that require thoughtful, comprehensive treatment to prevent the development of more severe headache difficulties.
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Abstract
Our experience has revealed the following: (1) TRT is applicable for all types of tinnitus, as well as for decreased sound tolerance, with significant improvement of tinnitus occurring in over 80% of the cases, and at least equal success rate for decreased sound tolerance. (2) TRT can provide cure for decreased sound tolerance. (3) TRT does not require frequent clinic visits and has no side effects; however, (4) Special training of health providers involved in this treatment is required for this treatment to be effective.
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Affiliation(s)
- Pawel J Jastreboff
- Tinnitus and Hyperacusis Center, Department of Otolaryngology, Emory University School of Medicine, 1365A Clifton Road, NE, Atlanta, GA 30322, USA.
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Brookler KH. Electronystagmography in a woman with aural fullness, hyperacusis, and dizziness. Ear Nose Throat J 2003; 82:165-6. [PMID: 12696231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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de Magalhães SLB, Fukuda Y, Liriano RIG, Chami FAI, Barros F, Diniz FL. Relation of hyperacusis in sensorineural tinnitus patients with normal audiological assessment. Int Tinnitus J 2003; 9:79-83. [PMID: 15106278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Hyperacusis is mainly a consequence of the noise level in the twenty-first century, owing to dramatic changes in people's lifestyles. Of every 100 people with otological complaints (e.g., tinnitus and hyperacusis), 20 are affected by hyperacusis. Because of its high incidence, this symptom has long been the subject of investigation. Nine patients (eight female, one male) with sensorineural tinnitus voluntarily participated in this study. Among the evaluated patients, three were between 25 and 40 years of age and six were between 41 and 60 years. The patients did not report a history of acoustic trauma, use of drugs, or otological diseases. The duration of complaints at the time the study began varied from 3 months to 8 years. The patients answered a questionnaire, submitted to an ear, nose, and throat examination, and were evaluated by pure-tone and speech audiometry and otoacoustic emissions and laboratory tests. In all patients, ear, nose, and throat assessments and audiological tests were within the normal ranges. Of the nine subjects in our study, 100% had tinnitus, and 89% (n = 8) had hyperacusis as an associated symptom. Six subjects (67%) had severe tinnitus; among them, four had moderate hyperacusis, one had severe hyperacusis, and one was not affected by hyperacusis. In two subjects (22%) with moderate tinnitus, one had moderate hyperacusis and the other referred severe symptoms. Another patient (11%) reported mild tinnitus and mild hyperacusis. No patient classified his or her tinnitus as disabling. The findings of the present study led us to conclude that the most affected age range of patients with tinnitus and hyperacusis was 41-60 years and that women are affected significantly more often than men. Tinnitus preceded hyperacusis as a complaint in 78% of the subjects. Hyperacusis was present in eight (89%) of the patients. There was no direct correlation between the severity of tinnitus and of hyperacusis, although we noticed that the discomfort of tinnitus was generally perceived as equal to or worse than that of hyperacusis.
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Miani C, Passon P, Bracale AM, Barotti A, Panzolli N. Treatment of hyperacusis in Williams syndrome with bilateral conductive hearing loss. Eur Arch Otorhinolaryngol 2001; 258:341-4. [PMID: 11699823 DOI: 10.1007/s004050100364] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Williams syndrome (WS) is a rather rare congenital disorder characterised by a series of cardiovascular, maxillo-facial and skeletal abnormalities. It sometimes displays otorhinolaryngological symptoms because of the relatively high incidence of secretory otitis media and hyperacusis, which may be present in up to 95% of patients. The present paper describes a case of WS associated with bilateral conductive hearing loss which was not related to secretory otitis media. Hyperacusis was, moreover, present in spite of the conductive deafness. Surgical or prosthetic treatment of hearing loss was delayed because of hyperacusis. Treatment of the hyperacusis by acoustic training, instead, yielded excellent, long-lasting remission of the symptoms.
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Affiliation(s)
- C Miani
- Surgical Sciences Department, University of Udine School of Medicine, Italy.
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Abstract
In this study, increases in loudness with increases in bandwidth, termed loudness summation, were derived from loudness growth functions estimated using a loudness-scaling procedure. The results revealed that at equal loudness category, categorical loudness summation was generally larger in normal-hearing than in hearing-impaired subjects; furthermore, the increase in loudness summation at intermediate loudness levels observed in the former, was absent in the latter. These results, in broad agreement with recent data from the literature, can be explained in the light of physiological data on cochlear compression. One implication of these results regarding hearing aid fitting was that channel-by-channel loudness normalization was effective only when the incoming sound was closed in bandwidth to one of the test stimuli.
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Affiliation(s)
- S Garnier
- Neurosciences and Sensory Systems Laboratory, UPRESA CNRS 5020, Jouars-Pontchartrain, France.
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Abstract
BACKGROUND Patients with tinnitus very often suffer from hyperacusis also. METHODS AND PATIENTS In the present study a possible treatment for patients with bilateral hyperacusis is introduced and the therapeutical results of 41 patients suffering from bilateral hyperacusis combined with a uni- or bilateral tinnitus are discussed. Twenty-one of them also had a cochlear hearing loss. By means of white noise generators or hearing aids and a specific acoustic training the auditory input to the central nervous system was increased. All patients were taught a method to reduce stress (Progressive muscle relaxation according to Jacobson). Uncomfortable loudness levels were analysed before as well as 3 weeks and 6 months after beginning of the treatment. RESULTS By the time of 3 weeks the discomfort from ordinary sounds was distinctly reduced and the reduction progressed further after 6 months of treatment. In more than 50% of the participants the uncomfortable loudness levels could be raised to a normal range. Interestingly the improvement of hyperacusis was independent of an existing hearing loss. CONCLUSIONS The described method of treatment seems to be helpful for patients with hyperacusis and will be compared to other therapeutical regimes.
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Affiliation(s)
- E A Ziegler
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde, Mainz
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30
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O'Reilly MF, Lacey C, Lancioni GE. Assessment of the influence of background noise on escape-maintained problem behavior and pain behavior in a child with Williams syndrome. J Appl Behav Anal 2000; 33:511-4. [PMID: 11214027 PMCID: PMC1284275 DOI: 10.1901/jaba.2000.33-511] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined the influence of background noise on levels of problem behavior and pain behavior under functional analysis conditions for a child with a diagnosis of Williams syndrome and hyperacusis. Background noise was associated with increases in escape-maintained problem behavior and increases in pain behavior such as clasping ears and crying. When the child was fitted with earplugs, there were substantial reductions in both problem and pain behavior under the background noise condition.
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Affiliation(s)
- M F O'Reilly
- Department of Psychology, National University of Ireland, Dublin, Belfield.
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31
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Phillips DP, Carr MM. Disturbances of loudness perception. J Am Acad Audiol 1998; 9:371-9; quiz 399. [PMID: 9806411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This article reviews information on some auditory disorders that have in common a disturbance in loudness perception. The perceptual disturbances in these disorders have interchangeably been labeled "hyperacusis," "dysacusis," or "phonophobia." Our question concerns whether the loudness disturbances associated with these auditory disorders are sufficiently different as not to justify the equivalence implied by the labelling. Emphasis is placed on those articles that have given clear accounts of the phenomenology of the disturbed perceptual experience and have offered testable hypotheses about the mechanisms underlying it. Hypotheses about the origins of disturbed loudness perception are compared with independent experimental and clinical evidence on those mechanisms. The disturbances of loudness perception that occur in cochlear hearing loss, facial nerve paralysis and stapedectomy, and in more "central" disorders are phenomenologically different, have different underlying mechanisms, and merit different labels that most of them do not currently receive.
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Affiliation(s)
- D P Phillips
- Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
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32
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Abstract
A professional musician with intolerable hyperacusis and dysharmonic diplacusis in a severely deafened ear was successfully relieved of his symptoms by deliberate destruction of the cochlea.
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Affiliation(s)
- J R Cherry
- Department of Otolaryngology, Royal Lancaster Infirmary, U.K
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33
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Prinsely PR, Frootko N. Disarticulation of the ossicular chain for severe recruitment. Ear Nose Throat J 1991; 70:115, 117. [PMID: 2044475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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34
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Abstract
Using the method of Fridman and his colleagues, a statistical test of auditory brainstem responses (ABR) for detecting auditory thresholds is presented. The synchrony measure (SM) which represents the degree of reproducibility for group averages was used to calculate the selected Fourier components of the group averages from phase variance. The sensitivity of the test was demonstrated on 35 normal ABRs with 60 and 45 dB SL stimulus intensity and in the absence of stimulus from the ipsilateral recordings. The SM of all cases of normal ABRs at 60 and 45 dB SL exceeded those in the absence of stimulation. The same procedure was applied to 16 ears with cochlear hearing loss with (4 ears) and without (10 ears) recruitment and 2 ears with relatively normal hearing threshold (less than 30 dB HL). Seven out of 10 ears without recruitment had the SM value at 60 dB SL stimulus intensity significantly lower than those of normal ABRs.
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Affiliation(s)
- Y Y Chen
- Sixth People's Hospital, Shanghai, China
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35
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Abstract
Using the method of magnitude estimation, annoyance ratings of thirty-six different masking sounds obtained from a group suffering from tinnitus were compared with ratings from a normal-hearing group in an attempt to assess the acceptability of potential tinnitus maskers. The key findings were as follows: In both groups bandpass noise was rated as less annoying than tones or triangular waves. The annoyance value of bandpass maskers increased with bandwidth. Interrupted maskers were rated as more annoying than continuous maskers. Most of the differences between the tinnitus and normal group could be explained in terms of the high-frequency hearing loss and loudness recruitment associated with the tinnitus group. Control over the centre frequency and the bandwidth of a noise masker was important in optimising the acceptability of the tinnitus masker.
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36
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Moore BC, Laurence RF, Wright D. Improvements in speech intelligibility in quiet and in noise produced by two-channel compression hearing aids. Br J Audiol 1985; 19:175-87. [PMID: 4063555 DOI: 10.3109/03005368509078972] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Eight subjects suffering from bilateral sensorineural hearing losses with recruitment were fitted binaurally with two-channel compression hearing aids, worn behind the ear. After they had worn the aids for some time, measures of speech intelligibility were compared for two conditions: listening unaided, and listening aided. the dynamic range for speech, defined as the difference in level between the speech reception threshold in quiet and the highest comfortable level for speech, was substantially increased in the aided condition for seven of the eight subjects (the exception was a subject with almost normal low-frequency hearing). Speech reception thresholds were also measured in two levels of background noise ('babble'), 60 and 75 dB SPL. Seven of the eight subjects showed a reduced speech reception threshold (i.e. an improvement) in the aided condition for at least one of the two noise levels, although the size of the improvement differed considerably from one subject to another. The subjects were also given a battery of psycho-acoustical tests in an attempt to better characterise their hearing loss, and to gain more insight into individual differences. Results of measurements of frequency selectivity, frequency discrimination, temporal acuity and temporal masking are described and related to the measures of speech intelligibility.
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37
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Laurence RF, Moore BC, Glasberg BR. A comparison of behind-the-ear high-fidelity linear hearing aids and two-channel compression aids, in the laboratory and in everyday life. Br J Audiol 1983; 17:31-48. [PMID: 6860821 DOI: 10.3109/03005368309081480] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Eight patients suffering from sensorineural hearing losses with recruitment took part in a trial comparing their own hearing aids (or no aid if they did not normally wear one) with 'high-fidelity' linear aids and with aids incorporating two-channel syllabic compression. All aids were worn behind the ear. Speech intelligibility was measured both in quiet and in noise, and the patients were given questionnaires enquiring about the effectiveness of the aids in everyday situations. Both the intelligibility tests and the questionnaires indicated that the linear aids were substantially better than own/no aid, and the compressor aids were substantially better than the linear aids, allowing good speech discrimination over a wide range of sound levels. Six out of the eight patients derived significant benefit from being fitted with two aids rather than one. The use of directional microphones in the linear and compressor aids allowed a significant improvement for speech intelligibility in noise when the speech and noise were spatially separated.
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