Effectiveness of transcutaneous vagus nerve stimulation for the treatment of tinnitus: an interventional prospective controlled study

OBJECTIVES

The aim of this interventional non-randomised prospective controlled study was to assess the effectiveness of transcutaneous vagus nerve stimulation (tVNS) in human subjects with tinnitus.

DESIGN

The ParasymTM tVNS device was paired with an auditory stimulation. Treatment and observations were conducted over 12 weeks. Audiological evaluation was performed. Responses from a set of questionnaires and quantitative electroencephalography (qEEG) before and after treatment were collected. Voice measurements were done to assess possible side-effects of tVNS.

STUDY SAMPLE

The study involved 29 adults who had chronic tinnitus (15 patients who underwent tVNS paired with sounds and a control group of 14 patients who did not).

RESULTS

In general, subjective and objective measurements of tinnitus showed no improvement in the study group compared to the controls, although certain parameters as gauged by the questionnaires did statistically improve. The loudness and frequency of tinnitus remained the same in both groups. For the qEEG, activity in the theta band increased significantly in the study group compared to the control group.

CONCLUSIONS

The tVNS was not effective in reducing tinnitus symptoms in our study group. However, changes in the theta band suggest there might be cortical effects that might, with sustained treatment, lead to improvements.

Effect of the COVID-19 Pandemic on Resting-State Brain Activity in Individuals with Tinnitus

This study looked at the possible effect of the COVID-19 pandemic on individuals who came to our clinic seeking relief from tinnitus. The performance of the subjects during the COVID-19 pandemic was compared with similar individuals who came to our clinic before the pandemic began. The study involved 50 adults with chronic tinnitus, made up of a study group (24 subjects tested during the COVID-19 pandemic of 2020-2021) and a control group before the pandemic began (26 subjects tested from 2013 to 2017). None of the 24 reported having contracted COVID-19. Data collection involved the Tinnitus Handicap Inventory (THI) questionnaire, audiological tests, and quantitative electroencephalography (qEEG). In terms of THI scores, there were no statistically significant differences between the two groups. However, with regard to qEEG, some changes were observed, with significant decreases in alpha and beta band activity in the study group compared to the control group, particularly over the auditory cortex. We conclude that COVID-19 did not have a discernible impact on the general well-being of individuals with tinnitus. However, it did appear to alter brain activity, specifically in the alpha and beta bands over the auditory cortex, and these reults warrant further investigation.

Hyperacusis Assessment Questionnaire-A New Tool Assessing Hyperacusis in Subjects with Tinnitus

Hyperacusis, a kind of decreased sound tolerance, is difficult to measure objectively. It often co-occurs with tinnitus. There is a need for valid and reliable patient-reported outcome measures to capture this subjective phenomenon. The aim of the study was to create a questionnaire capturing hyperacusis in terms of loudness, fear, and pain and to evaluate its psychometric properties. The study sample consisted of 106 adult patients with hyperacusis and tinnitus with a mean age of 45.2 years. A medical interview, an audiological examination, and several questionnaires (the Tinnitus Handicap Inventory, the Hyperacusis Questionnaire, the State-Trait Anxiety Inventory, and Visual Analog Scales) were applied. The final 14-item Hyperacusis Assessment Questionnaire showed an appropriate three-factor structure with 70.5% of the variance explained. Convergent and divergent validity were confirmed by correlations with other measures of hyperacusis, anxiety, tinnitus severity, misophonia, and hearing thresholds. The internal consistency assessed with Cronbach's alpha was excellent (α = 0.91), as was reproducibility (intraclass correlation, ICC = 0.96). The new Hyperacusis Assessment Questionnaire is a psychometrically sound and brief tool assessing the severity of hyperacusis in terms of loudness, fear, and pain. It can be used in clinical practice and scientific research for patients with hyperacusis and tinnitus.

Hyperbaric oxygen therapy as an adjunct to corticosteroid treatment in sudden sensorineural hearing loss: a retrospective study

Background

A retrospective clinical study was conducted to test the impact of including hyperbaric oxygen therapy in the treatment of patients with sudden sensorineural hearing loss (SSNHL).

Materials and methods

A total of 63 adult patients with sudden sensorineural hearing loss diagnosed between 2015 and 2023 were divided into two groups: 36 patients treated with intratympanic glucocorticoid and orally administered glucocorticoid who also underwent hyperbaric oxygen therapy and 27 patients treated with intratympanic glucocorticoid and prolonged orally administered glucocorticoid (without hyperbaric oxygen therapy). An audiological evaluation was performed using pure-tone audiometry.

Results

Average hearing gain as measured by pure tone average was 12.5 dB HL (+/- 19.9 dB HL) in the patients treated with steroids combined with HBOT, and was 14.1 dB HL (+/- 17.9 dB) in the patients treated with steroids alone. Successful treatment (complete recovery or marked improvement) was observed in 27.8% of the patients in the first group and in 25.5% in the second group. There was no statistically significant difference between the groups.

Conclusion

Both groups of patients-those treated with glucocorticoids and those treated with glucocorticoids and HBOT-had similar hearing outcomes. A prospective, controlled, and randomized study would provide more reliable knowledge about the efficacy of HBOT in treating SSNHL.

Skarzynski Tinnitus Scale: Cultural Adaptation and Validation to Brazilian Portuguese

Introduction  Tinnitus is a prevalent condition among many different populations. Since tinnitus is subjective, self-report questionnaires are one way of assessing how much the condition interferes with the quality of life of an individual. Objective  The aim of the present study was to translate and cross-culturally adapt the Skarzynski Tinnitus Scale (STS) into Brazilian Portuguese and validate its psychometric properties. Methods  The STS was translated and cross-culturally adapted using five main steps. Fifty-eight individuals who had continuous tinnitus were invited to complete the questionnaire. Pure tone audiometry (air and bone conduction) were also done. Results  No major changes were necessary in translating the scale. The overall score was 1.3 (range 0-4). Internal consistency was tested by Cronbach α, which ranged from 0.54 to 0.85. Differences between genders and between subscales and the total score were not significant. A statistically significant difference was only found in the coping subscale, in which normal hearing subjects had higher scores than those with hearing loss. Conclusion  The translation and adaptation of the STS established linguistic and cultural equivalence with the original. In addition, it exhibited good internal consistency. Our results suggest that the STS is suitable for use in a clinical setting.

Differential item functioning of the tinnitus handicap inventory across gender groups and subjects with or without hearing loss

OBJECTIVES

Tinnitus is a phantom sound sensation without an external sound source. Due to its subjective and multifaceted nature it is measured using multi-item self-reported instruments. Many well-validated tinnitus-related questionnaires are available for clinical practice and scientific research, but so far no attention has been paid to their measurement invariance. The study aimed to examine measurement invariance of the Tinnitus Handicap Inventory with regard to gender and hearing impairment, and to identify the items that show differential item functioning (DIF) across the groups.

DESIGN

This is a retrospective study using medical data from patients with tinnitus. They completed the Tinnitus Handicap Inventory (THI) and underwent pure-tone audiometry.

STUDY SAMPLE

1106 adult patients with tinnitus (554 women and 552 men; 320 with normal hearing and 786 with hearing loss), aged 19-84 years.

RESULTS

In the analysis, multi-group confirmatory factor analysis, hybrid ordinal logistic regression, Kernel smoothing in Item Response Theory, and lasso regression were applied. Measurement invariance was demonstrated across gender, but across hearing status the measurement was non-invariant. Five items were found to have DIF.

CONCLUSIONS

Researchers and clinicians should be aware of the potential risk of response bias when tinnitus severity is evaluated.

Validation of the Polish Version of Voice Handicap Index-10

PURPOSE

The aim of this study was to adapt and evaluate the psychometric properties of the Polish version of the VHI-10.

METHODS

We enrolled 183 subjects-118 patients with voice disorders and 65 without voice disorders.

RESULTS

All items were correlated with each other and were strongly correlated with the total score (rho ≥ 0.70), the only exception being item five (rho = 0.56). Internal consistency was very high, with Cronbach's alpha = 0.92. There was a statistically significant difference between patients with voice disorders and healthy controls in terms of VHI-10 global score (U = 251.0; P < 0.001). There was a statistically significant negative correlation between mean phonation time (MPT) and VHI-10 (rho = -0.30; P < 0.01). Only the amplitude perturbation quotient (APQ) was correlated positively with the global score (rho = 0.22; P = 0.020). There were statistically significant and positive correlations between VHI-10 scores and GRBAS evaluation. Correlations between global scores of VHI-30 and VHI-10, and between VHI-30 subscales and the corresponding items from VHI-10, were very strong (respectively 0.97 and 0.89-0.94). In the patient group, there was high test-retest reproducibility (intraclass correlation = 0.91). A cut-off value of 8.5 points was estimated.

CONCLUSION

The Polish version of VHI-10 showed excellent internal consistency, good test-retest reproducibility, and had clinical validity. It is a useful brief tool for self-reported evaluation and reliable assessment of patients with voice disorders.

The Stimulation of Polymodal Sensory Perception by Skarżyński (SPPS-S): comparison of stationary and remote therapy results

Hearing is a sense, which has a significant impact on a child’s development. Disorders connected with hearing can have impact in a various form and affect each area of life. Hearing disorders may concern peripheral auditory system as well as its parts responsible for central processing. It is estimated that central auditory processing disorders in its isolated form concern 2-3% of the population of school-age children, however, the problem co-occurring with other disorders may affect even several dozen percents of children. According to the available recommendations, there are three main therapeutic approaches in the treatment of patients with auditory processing disorders: transforming the school environment, teaching the child strategies how to compensate his or her difficulties or using hearing trainings focused on a specific deficit. The main aim of the study is to present the results of SPPS-S therapy dedicated to patients with central auditory processing disorders who have completed the remote version of the method in comparison with patients performing therapy in a rehabilitation center. The Stimulation of Polymodal Sensory Perception by Skarżyński (original name in polish SPPS-S) is a treatment applicable for many different groups of disorders showing comorbidity with central auditory processing disorders. Solutions present in SPPS-S offer multifaceted therapy activating different perceptual modalities (hearing, vision and touch) at the same time, as well as their integration and coordination. Patient may receive the SPPS-S therapy either in the rehabilitation center or at home. The material used to assess the effectiveness of SPPS-S-based therapy included the results of 100 patients who received remote SPPS-S therapy compared to the results of 100 patients who performed therapy at a specialized center. Statistical analysis of the results obtained, which showed that the therapy used resulted in a statistically significant improvement in all auditory functions studied. Results confirm the high effectiveness of The Stimulation of Polymodal Sensory Perception by Skarżyński, both in stationary and remotely implemented form. The quality of telerehabilitation interventions was maintained at the same level as in therapeutic work at the therapeutic center, which was confirmed by the results of patients. Remote SPPS-S therapy as an effective telerehabilitation method has become an effective form of supporting patients in their own homes.

The Role of Religiosity and Spirituality in Helping Polish Subjects Adapt to Their Tinnitus

This study aims to assess whether religiosity and spirituality might be significant internal resources that help people with tinnitus to adapt to their condition. The study group comprised 256 Polish patients with tinnitus (123 women and 133 men) who answered the Tinnitus Handicap Inventory and Tinnitus Functional Index (both of which measure tinnitus annoyance) and the Self-Description Questionnaire (which measures: religious attitudes, ethical sensitivity, and harmony). Significant positive correlations between religious attitudes and tinnitus annoyance were found in subjects with tinnitus. The higher the religiosity, the higher tinnitus the annoyance, at least in the two TFI questionnaire dimensions: sense of control and quality of life (although these correlations were statistically significant only for men). Religiosity was found to be a positive predictor of tinnitus annoyance. Also, ethical sensitivity positively predicted tinnitus annoyance, whereas harmony was a negative predictor. We suggest that psychologists and audiologists should, in their diagnostic and therapeutic work with patients with tinnitus, pay attention to the religious and spiritual aspects of their patients' lives.

Latency and Interpeak Interval Values of Auditory Brainstem Response in 73 Individuals with Normal Hearing

Background

Auditory brainstem response (ABR) potential is important for audiological diagnosis, reflecting the integrity of the structures of the auditory system up to the brainstem. The click stimulus is the best known and is most used in clinical practice. However, different devices and examiners may yield distinct results, and each institution tends to use its own parameters. We aimed to analyze the latency values of wave I, III, V, and interpeak intervals I–III, III–V, I–V values obtained in assessing ABR using a new device.

Material/Methods

We performed a cross-sectional study of 73 participants with normal hearing thresholds and no hearing problems. All underwent basic audiological (air and bone conduction, Speech Recognition Threshold, Speech Recognition Index, acoustic reflex, and tympanometry) and electrophysiological evaluation (ABR assessment).

Results

Absolute latency and interpeak values from ABR showed earlier responses in women, faster than international standards suggest. The responses were similar to other studies carried out previously, with the exception of wave I values, which were a little earlier in females.

Conclusions

We assessed normative data from measurement of latency values of wave I, III, V, and interpeak intervals I–III, III–V, and I–V applying 2 standard deviations in the assessment of ABR using the new Neuro-Audio/ABR device created by Neurosoft.

The Clinical Effect of Steroids for Hearing Preservation in Cochlear Implantation: Conclusions Based on Three Cochlear Implant Systems and Two Administration Regimes

The main aim of this study was to assess the clinical effect of steroids (dexamethasone and prednisone) on hearing preservation in patients who underwent cochlear implantation with different cochlear implant systems (Oticon®, Advanced Bionics®, Med-El®). 147 adult patients met the inclusion criteria and were enrolled to the study and divided into three groups depending on the brand of cochlear implant they received and participated in all follow-up visits regularly. They were also randomly divided into three subgroups depending on the steroid administration regime: (1) intravenous dexamethasone (0.1 mg/kg body weight twice a day for three days); (2) combined intravenous and oral steroids (dexamethasone 0.1 mg/kg body weight twice a day plus prednisone 1 mg/kg weight once a day); and (3) no steroids (control group). The results were measured by pure tone audiometry (PTA) at three time points: (i) before implantation, (ii) at processor activation, and (iii) 12 months after activation. A hearing preservation (HP) figure was also calculated by comparing the preoperative results and the results after 12 months. Further measures collected were electrode impedance and hearing threshold in the non-operated ear. The highest HP measures (partial and complete) were obtained in the subgroups who were given steroids. Of the 102 patients given steroids, HP was partial or complete in 63 of them (62%). In comparison, partial or complete HP was achieved in only 15 patients out of 45 (33%) who were not given steroids. There were differences between the three cochlear implant groups, with the Med-El and Advanced Bionics groups performing better than the Oticon group (45% and 43% of the former two groups achieved partial or complete HP compared to 20% in the latter). Hearing thresholds in the non-operated ear were stable over 12 months. Generally, impedance was slightly lower in the 12 month follow-up in comparison with the activation period, with the exception of the Oticon group. (4) Conclusions: Pharmacological treatment with steroids in patients undergoing cochlear implantation helps to preserve residual hearing.

Polish Translation and Validation of the Voice Handicap Index (VHI-30)

Traditional voice evaluations, including imaging techniques, auditory-perceptual ratings, and acoustic and aerodynamic analyses, fail to assess the global handicap that a patient experiences as a result of a voice disorder. The Voice Handicap Index (VHI) is currently one of the most widely used and psychometrically robust instruments for measuring voice disability. The aim of the study is to translate and validate a Polish version of the VHI. The original English-language version of VHI-30 was translated into Polish. We enrolled 188 subjects-123 patients (91 women and 32 men) with voice disorders and 65 controls (53 women and 12 men) without voice disorders. Results obtained by the patients were significantly higher than those obtained by the controls on the Emotional subscale (U = 519.0; p < 0.001), Functional (U = 829.0; p < 0.001), Physical (U = 331.0; p < 0.001), and the global score (U = 390.0; p < 0.001). There were statistically significant negative correlations between maximum phonation time and global score (rho = -0.31; p < 0.01) as well as all three subscales. Shimmer and Smoothed Amplitude Perturbation Quotient were correlated positively with the global score (rho = 0.22; p < 0.05; rho = 0.25; p < 0.01, respectively) and with all three subscales. There were also statistically significant correlations between VHI scores and auditory perceptual evaluation. In the patient group, there was excellent internal consistency (α = 0.97) and strong test-retest reliability (intraclass correlation = 0.94). The cut-off value equal to 17 points was estimated. The Polish VHI showed excellent internal consistency, good test-retest reproducibility, and clinical validity. It is a useful tool for evaluating the voice disability perceived by a patient.

Ego-resiliency and Tinnitus Annoyance

BACKGROUND

Tinnitus is a common and, in many cases, chronic condition. Coping with a chronic ailment is a long-term process, which also depends on the personality of the individual. One important personality resource is ego-resiliency, that is, how flexible the person is in adapting to the impulse to control their environment.

PURPOSE

The aim of the study was to determine whether ego-resiliency affects the perceived level of tinnitus annoyance.

RESEARCH DESIGN

This was a questionnaire study combined with a retrospective analysis of medical data.

STUDY SAMPLE

The study involved 176 people with diagnosed chronic tinnitus who volunteered to participate (53 men and 123 women aged 31-80 years).

DATA COLLECTION AND ANALYSIS

The following tools were used: Ego-Resiliency Scale to measure ego-resiliency, Tinnitus Functional Index to assess the impact of tinnitus on daily life, and a survey of sociodemographics and tinnitus history.

RESULTS

The conducted research showed that men had higher ego-resiliency than women. Older subjects (older than 60 years) had higher ego-resiliency than younger ones. There was a negative correlation between ego-resiliency and the perceived annoyance of tinnitus. Regression analysis showed that a person's ability to cope and to tolerate negative emotions were the only factors of ego-resiliency that were a significant predictor of tinnitus annoyance.

CONCLUSION

People with a high level of personal ability to cope and to tolerate negative emotions are likely to experience decreased tinnitus annoyance. Ego-resiliency levels should be considered when diagnosing and planning interventions for people with tinnitus. In psychological intervention programs for people with tinnitus, it is worthwhile developing ego-resiliency, paying particular attention to positive emotions which are crucial in building it. Research should be continued on other personal resources affecting perceived tinnitus annoyance.

Chronic Tinnitus and the Positive Effects of Sound Treatment via a Smartphone App: Mixed-Design Study

Background

Tinnitus is a phantom auditory sensation in the absence of an external stimulus. It is accompanied by a broad range of negative emotional symptoms and a significantly lower quality of life. So far, there is no cure for tinnitus, although various treatment options have been tried. One of them is mobile technology employing dedicated apps based on sound therapy. The apps can be managed by the patient and tailored according to their needs.

Objective

The study aims to assess the effect of a mobile app that generates background sounds on the severity of tinnitus.

Methods

The study involved 68 adults who had chronic tinnitus. Participants were divided into a study group (44 patients) and a control group (24 patients). For 6 months those in the study group used a free mobile app that enriched the sound environment with a background sound. Participants were instructed to use the app for at least 30 minutes a day using their preferred sound. The participants in the control group did not use the app. Subjective changes in the day-to-day functioning of both groups were evaluated using the Tinnitus Handicap Inventory (THI) questionnaire, a visual analog scale, and a user survey.

Results

After 3 months of using the app, the THI global score significantly decreased (P<.001) in the study group, decreasing again at 6 months (P<.001). The largest improvements were observed in the emotional and catastrophic reactions subscales. A clinically important change in the THI was reported by 39% of the study group (17/44). Almost 90% of the study participants (39/44) chose environmental sounds to listen to, the most popular being rain and ocean waves. In the control group, tinnitus severity did not change over 3 or 6 months.

Conclusions

Although the participants still experienced limitations caused by tinnitus, the advantage of the app was that it led to lower negative emotions and thus reduced overall tinnitus severity. It is worth considering whether a mobile app might be incorporated into the management of tinnitus in a professional setting.

The Clinical Effect of Steroid Therapy on Preserving Residual Hearing after Cochlear Implantation with the Advanced Bionics HiRes Ultra 3D Cochlear Implant System

(1) Background: The main aim of this study was to assess the clinical effectiveness of two different schemes of administration of steroids ((1) dexamethasone administered intravenously in comparison with (2) combination of steroid treatments: orally administered prednisone and intravenously administered dexamethasone) in comparison with a control group (no steroid administration) on hearing preservation (HP) in patients who underwent an Advanced Bionics cochlear implantation. (2) Methods: Thirty-five adult patients met the inclusion criteria. All patients were randomly divided into three subgroups depending on the scheme of steroid administration: (1) the first subgroup with only intravenously administered dexamethasone (0.1 mg per kg body weight twice a day for three days), (2) the second subgroup with a combination of methods of administration of steroids (intravenous and oral steroid therapy (dexamethasone, 0.1 mg/kg body weight twice a day plus prednisone, 1 mg/kg weight once a day for three days before surgery and after administration of dexamethasone (4th, 5th, 6th day) and after this time the dose of prednisone was reduced)) and (3) the third subgroup without steroid therapy (control group). The results were measured by pure tone audiometry (PTA) in three periods: (1) before implantation, (2) during activation of the processor (one month after implantation), and (3) 12 months after activation. Patients’ hearing thresholds before implantation were on average 82 dB HL, 77 dB HL, and 88 dB HL, respectively. (3) Results: The majority of the patients from the first subgroup had hearing preserved partially (77.8%). A similar result was observed in the second study group (oral + i.v.) (partial hearing preservation was found in 61.5% of the participants). The opposite was true in the control group; a plurality of control patients (38.5%) had no measurable hearing 12 months after the activation of the processor. (4) Conclusions: Pharmacological treatment consisting of the administration of steroids in patients who had undergone cochlear implantation with the Advanced Bionics HiRes Ultra 3D cochlear implant system may be beneficial for preserving residual hearing in patients.

Effectiveness of Various Treatments for Sudden Sensorineural Hearing Loss-A Retrospective Study

(1) Background: A retrospective clinical study was conducted to compare the effectiveness of different pharmacological and non-pharmacological regimens for treating sudden sensorineural hearing loss (SSNHL). (2) Methods: Adult patients (n = 130) diagnosed with sudden sensorineural hearing loss (SSNHL) and hospitalized between 2015 and 2020 were enrolled in this study. Depending on the treatment regimen applied, patients were divided into five groups. Inclusion criteria were as follows: (i) hearing loss of sudden onset; (ii) hearing loss of at least 30 dB at three consecutive frequencies; (iii) unilateral hearing loss; (iv) age above 18 years. Exclusion criteria were as follows: (i) no follow-up audiogram; (ii) bilateral hearing loss; (iii) recognized alternative diagnosis such as tumor, disorder of inner ear fluids, infection or inflammation, autoimmune disease, malformation, hematological disease, dialysis-dependent renal failure, postdural puncture syndrome, gene-related syndrome, mitochondrial disease; and (iv) age below 18 years. (3) Results: Complete recovery was found in 14% of patients (18/130) and marked improvement was found in 6% (8/130), giving an overall success rate of 20%. The best results were obtained in the second group (i.e., patients given intratympanic glucocorticoid + prolonged orally administered glucocorticoid) where the success rate was 28%. In general, the older the patient, the smaller the improvement in hearing, a correlation that was statistically significant. (4) Conclusions: In treating SSNHL, the highest rate of hearing recovery-28%-was in the group of patients given intratympanic corticoid plus prolonged treatment with orally administered glucocorticoid.

Comparison of 24-month voice outcomes after injection laryngoplasty with calcium hydroxylapatite or hyaluronic acid in patients with unilateral vocal fold paralysis

PURPOSE

The objective was to evaluate the long-term voice outcomes in pa-tients with unilateral vocal fold paralysis treated with injection laryngoplasty using either cal-cium hydroxylapatite (CaHA) or hyaluronic acid (HA).

METHODS

A single-centre retrospective study was performed. There were 75 patients with dysphonia due to unilateral vocal fold paralysis: injected with CaHA or injected with HA. We analysed Voice Handicap Index-30 (VHI), videostroboscopic images, auditory-perceptual (GRBAS), and acoustic measures (MDVP) in 6, 12, and 24 months after augmentation.

RESULTS

The mean change in VHI 24 months after augmentation was 29.14 in the CaHA group, and 22.88 in the HA group. There was an improvement of glottal gap 6, 12, and 24 months after augmentation in both groups. The GRBAS parameters were similar in both groups throughout the whole period. The MDVP pa-rameters decreased 6 and 12 months after augmentation and were similar in both groups. There were 4 patients augmented with CaHA (12.5%) who needed reintervention within 2 years of surgery and another 4 (9.3%) augmented with HA.

CONCLUSION

This study demonstrates that there are no long-term differences in voice outcomes or number of reaugmentations for injection laryn-goplasty with CaHA compared to HA.

Job satisfaction in a group of patients with tinnitus

BACKGROUND

Tinnitus is an auditory impression without any external auditory stimulus. It may cause negative symptoms (anxiety, insomnia, depression) significantly affecting work performance and job satisfaction.

OBJECTIVE

To evaluate the job satisfaction in tinnitus sufferers.

METHODS

Cross-sectional study were conducted and 51 individuals (23-70 years) were recruited. Participants completed two questionnaires: Tinnitus Handicap Inventory and Job Satisfaction Scale.

RESULTS

People affected by tinnitus report higher job satisfaction than healthy people. Job satisfaction was significantly related to age: r = 0.31; p < 0.05 in all tinnitus patients. There was a correlation between job satisfaction and tinnitus severity but only in people with normal hearing (-0.69; p < 0.05).

CONCLUSIONS

The results show that job satisfaction is affected by the level of tinnitus annoyance (from both its emotional and functional aspects), but only in people with normal hearing. In future research it is recommended that additional factors be investigated, both work and non-work related, to thoroughly explore the impact of tinnitus on job satisfaction.

Self-help interventions chosen by subjects with chronic tinnitus - a retrospective study of clinical patients

OBJECTIVE

Self-help (without specialist support) can play an important role in tinnitus therapy. The purpose of this study was to investigate what fraction of subjects with tinnitus use self-help, what techniques are most commonly used to reduce tinnitus severity, and what distinguishes patients that use self-help from others.

DESIGN

retrospective, observational study.

STUDY SAMPLE

Adult patients admitted to our hospital clinic (460 participants) aged 19-83 years and reporting chronic tinnitus. The survey concerned therapy attempts prior to the clinic visit as well as self-help techniques chosen freely by the patient to reduce tinnitus severity.

RESULTS

Data showed that 40.9% of the respondents chose some action themselves to reduce their tinnitus severity. Among the reported self-help techniques, acoustic stimulation was the most popular. In addition, patients chose distraction attention, relaxation, meditation, yoga, and physical activity. The likelihood of undertaking self-help increases with better education and higher tinnitus severity.

CONCLUSIONS

Knowledge about patients' preferences of forms of self-help may help the health practitioner suggest a more suitable form of therapy. Due to the great interest in using sound therapy in tinnitus, it would be worthwhile looking at new forms of this therapy, for example increasingly popular mobile applications.

Voice aspects in sulcus coexisting with benign lesions of the vocal folds

The purpose of this study was to measure the clinical profile of patients with sulcus who had concomitant benign lesions such as polyp, oedema, cyst, nodules, or fibrous mass of the vocal fold. We reviewed the medical charts of 38 patients who had a diagnosis of sulcus type 2 or 3 (according to Ford). The patients were classified into two groups. The study group consisted of 16 subjects who had sulcus and associated benign lesion; 22 patients diagnosed with sulcus alone were enrolled in a control group. We analysed psychosocial (Voice Handicap Index-30), auditory-perceptual (GRBAS), acoustic measures and videostroboscopic images. In the study group, the mean VHI-30 scores of all subscales ranged from moderate to severe handicap. The difference between groups was significant on the emotional (p = 0.004) and physical (p = 0.007) subscales. On GRBAS scale, the majority of patients from both groups exhibited mild hoarseness, breathiness, asthenic or strained voice, although roughness was more frequently rated moderate; the differences between groups were not statistically significant. The most abnormally increased values were achieved for amplitude values of acoustic parameters, but significant difference between groups was found in Soft Phonation Index only (p = 0.049). Concerning glottal closure, the most frequent finding was irregular chink in the study group, and spindle glottic chink in controls; we found significant differences between groups (p = 0.004). In both series of patients, the most frequent abnormal findings were moderately diminished amplitude and moderately restricted mucosal wave, with no significant difference between groups. Patients with sulcus and coexisting benign lesions were more handicapped on the emotional and physical subscales of VHI-30. The most characteristic shape of the glottal gap was irregular chink in the study group, and spindle chink in the control group. Acoustic evaluation of voice showed that the most severe disturbances affected amplitude parameters. The clinical characteristics indicated that the presence of sulcus primarily determines the quality of voice, and that additional benign pathologies do not drastically affect further voice deterioration. The coexistence of secondary benign vocal fold lesions aggravates the difficulties in making a preoperative diagnosis of sulcus. It is important to clinically suspect the possibility of coexistent sulcus to plan the correct treatment and obtain better voice outcomes.

Voice disorders in children starting school education

&lt;b&gt;Introduction: &lt;/b&gt;Voice disorders in children especially in the school-age period comprise a major and challenging medical, social and educational issue. There is a lack of epidemiological data regarding children's voice in Poland which limits the development of preventive and medical pediatric procedures in our country. &lt;br&gt;&lt;b&gt;Objective:&lt;/b&gt; The aim of study was to determine the prevalence of voice disorders in children starting school education in Mazovia. &lt;br&gt;&lt;b&gt;Material and method:&lt;/b&gt; The study was a retrospective analysis of survey data from parents of children attending the first grade of primary school. The survey consists of five questions describing the voice. A statistical analysis of 7891 questionnaires was carried out. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Analysis of the survey showed a prevalence of dysphonia in 12.8% children aged 7 starting primary school. In this study, voice disorders were observed more often in boys (14.6%) than girls (10.8%). The authors presented the correlation between voice disorders and the expression of emotions. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Studies have shown that the percentage of children with voice disorders is significant in our country. The survey regarding voice in school children in Mazovia shows preliminary results of voice disorders in the pediatric population in Poland.

Can preoperative results predict the need for future reintervention following injection laryngoplasty for unilateral vocal fold paralysis?

Purpose

The objective was to investigate whether a patient’s preoperative test results can predict the need for future reoperation in unilateral vocal fold paralysis (UVFP).

Methods

A single-centre retrospective study was performed. The study group consisted of 18 patients with UVFP who had been treated with injection laryngoplasty but who required further treatment and were augmentated again within 36 months. The control group consisted of 33 injected patients who had not required reintervention up to 36 months later.

Results

Only glottal gap was associated with a relative risk for reinjection. Glottal gap was found to be severe in 77.8% of the patients from the study group compared to 42.4% of the controls, and the difference was statistically significant. The kind of injected material (calcium hydroxylapatite or hyaluronic acid), age, and voice assessment (perceptual, objective, or subjective) did not seem to affect the likelihood of reoperation being needed. There were no between-group statistically significant differences in individual aspects of the GRBAS scale. The global score was slightly higher in the study group, but it did not reach statistical significance (U = 198.5; p = 0.09). A comparison of VHI scores did not yield statistically significant differences between the study and control groups. No significant differences in objective acoustic voice parameters were observed between the groups.

Conclusion

Only glottal gap occurred to be associated with a relative risk for reinjection. A kind of injected material (CaHA or HA), age, perceptual, objective and subjective voice assessment do not seem to impact the likelihood of reoperation in patients with UVFP.

Organizational Aspects and Outcomes of a Hearing Screening Program Among First-Grade Children in the Mazovian Region of Poland

Purpose The purpose of this study is to describe and assess a hearing screening program of first-grade children in Poland. The program aimed to detect hearing disorders and increase awareness among parents of hearing problems. Method A hearing screening program was conducted in all elementary schools of the biggest region in Poland. A total of 34,618 first-graders were screened. The hearing screening protocol included video otoscopy and pure-tone audiometry. The program also included an information campaign directed to the local community and educational meetings between parents and medical staff. Results The estimated prevalence of hearing loss was 11%. Unilateral hearing loss was more common than bilateral hearing loss. Mild hearing loss was more frequent than moderate (or worse) hearing loss. In otoscopy, the most common positive result was otitis media with effusion. Parents and medical staff took part in 1,608 educational meetings, broadening the parents' knowledge of how to care for hearing. Conclusions A hearing screening program not only provides data on the prevalence of childhood hearing problems but is also an avenue for providing the local community with valuable knowledge about how to care for hearing. This study demonstrated the importance for systematic monitoring of children's hearing status and of increasing awareness among parents and teachers of the significance of hearing loss. The hearing screening of children starting school should become a standard part of school health care programs.

Role of personal resources from the perspective of experiencing tinnitus annoyance in adults

Purpose

Occurrence of tinnitus can be, for a person who experiences it, a disorder affecting the overall equilibrium of the organism. To cope with it a variety of personal resources, such as positive orientation and basic hope, are mobilized. The aim of this study was to determine whether these resources are associated with the evaluation of the impact of tinnitus on the functioning of the study participants.

Methods

Study involved 176 tinnitus sufferers, including 123 women and 53 men. The results were compiled using: Positivity Scale (P-scale) for measuring positive orientation, Basic Hope Inventory (BHI-R) for measuring basic hope, the questionnaires: Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI) evaluating the impact of tinnitus on the daily functioning of the subjects, as well as a survey designed for the study, comprising questions about sociodemographic data and tinnitus history.

Results

Results of regression analysis indicated that positive orientation is the most important for the perceived tinnitus annoyance. However, no significant influence of basic hope on tinnitus annoyance was found. Among other variables taken into account in regression analysis, age and presence of additional diseases proved to be important predictors of tinnitus annoyance.

Conclusions

Personality determinants (positive orientation) are related to the perception of tinnitus annoyance. When working with a tinnitus patient, it is justified to pay attention to the existence of the positive orientation and to work on its development. Research should also be continued to search for other personal resources that affect the perceived tinnitus annoyance.

Prevalence of hearing loss among polish school-age children from rural areas - Results of hearing screening program in the sample of 67 416 children

BACKGROUND

Hearing loss in children is a relevant health issue, both for its prevalence and for its physical, emotional and social consequences. Our aim was to estimate the national prevalence of hearing loss in school-age children from rural areas in Poland.

METHODS

The study was conducted in the general, pediatric, nonclinical population of school-age children from rural areas in Poland. It was a population-based, epidemiological study. The participants were 67416 children (32630 girls and 34786 boys) aged from 6 to 13 years old (M = 8.65; SD = 2.54). Pure-tone air-conduction hearing threshold were obtained at 0.5-8 kHz. Hearing loss was defined as a pure-tone average higher than 20 dB in one or both ears in at least one of the following pure-tone average: four-frequency pure-tone average (FFPTA), high-frequency pure-tone average (HFPTA) and low-frequency pure-tone average (LFPTA).

RESULTS

The rate of positive results of hearing screening was 16.4% and it was significantly higher in younger children than in older children. Mild hearing loss was more frequently than moderate or worse hearing loss. The children more often experienced unilateral than bilateral hearing loss.

CONCLUSIONS

This study reveals that hearing problems are common in this population, especially among younger children. It shows a strong need for systematic monitoring of hearing status among children and increasing awareness of parents and educators of the significance of hearing loss, including unilateral and mild hearing loss. Further studies conducted among children in urban areas are needed to compare the prevalence of hearing loss in children from various environments.

Cross-Cultural Adaptation of the Scale of Auditory Behaviors Questionnaire

Purpose

Children with (central) auditory processing disorder [(C)APD] exhibit many cognitive difficulties and receive negative psychosocial consequences from their disorder. Diagnosis of (C)APD relies on multidisciplinary assessment, including psychological testing. There is a strong need for valid and reliable questionnaires to identify children who are at risk of (C)APD. This work aims to establish the psychometric properties of the Polish version of the Scale of Auditory Behaviors (SAB; Domitz & Schow, 2000 ; Krzeszewska & Kurkowski, 2015 ; Miranda, Bruera, & Serra 2016 ; Musiek & Chermak, 2007 ; Nunes et al., 2013 ) as a screening tool in children.

Method

The SAB was administered to parents of 326 children (152 girls and 174 boys) aged from 6 to 12 years ( M = 8.24, SD = 1.56). The questionnaire consists of 12 items related to various symptoms of (C)APD and allows the frequency of particular behaviors to be assessed. In addition, the questionnaire Children's Home Inventory for Listening Difficulties was administered to parents, and 3 other psychoacoustic behavioral tests (Frequency Pattern Test, Duration Pattern Test, Dichotic Digit Test; Czajka et al., 2012 ) were conducted on the children to evaluate their auditory abilities.

Results

The Polish version of SAB demonstrated high internal consistency (Cronbach's α = .93), confirmed by interitem correlations. Intraclass correlation, which was used to determine reproducibility, was .95. There were also significant and positive relationships, ranging from r = .17 to .68, between the SAB score and scores of other measures, indicating convergent validity of the tool. Girls demonstrated higher SAB scores than boys ( p < .05); however, age was not statistically significant. A ceiling effect was detected, but no floor effect.

Conclusions

Results of psychometric and statistical analyses suggest the Polish version of SAB appears to be a valid and reliable questionnaire to evaluate symptoms of (C)APD in children, especially as a screening tool.

Results of stapedotomy in otosurgical treatment of adult patients with osteogenesis imperfecta

OBJECTIVE

This is a retrospective study of hearing results and characteristics of osteogenesis imperfecta (OI) patients treated for hearing loss by stapedotomy at tertiary reference center.

METHODS

This study enrolled 20 patients with a clinical diagnosis of OI- (11M:9F). 18 patients (90%) underwent surgery due to hearing loss in the period 2003-16. The audiometric analysis provides the pure tone audiometry results of stapedotomy in adult patients in 2 periods (≤12 months and >12 months). Air-bone gap (ABG), hearing gain (HG), and changes in air and bone conduction thresholds after surgical treatment were analyzed.

RESULTS

In short-time follow-up we noted statistically significant improvement in mean AC thresholds and ABG (p < 0.001 for both), change in mean BC thresholds was statistically negligible. Comparing the observation periods short-term and long-term, it was found that AC thresholds, ABG, HG, ABG closure did not significantly change, although BC thresholds and BC closure deteriorated significantly (p < 0.05).

CONCLUSION

Stapes surgery for OI can be considered as a method of treating the conductive and/or mixed hearing loss suffered by these patients; however, the surgery is more difficult than that for otosclerosis because OI cases often have extremely difficult anatomical conditions. The hearing results of OI stapes surgery differ from typical otosclerosis cases, with the ABG closure not being as good. In addition, sensorineural hearing loss inevitably progresses.

Clinical Evaluation of a Polish Translation and Cross-Cultural Adaptation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale

Background

Nasal obstruction is the most common rhinologic complaint in ear, nose, and throat (ENT) clinical practice and septal deviation is the leading cause. The Nasal Obstruction Symptom Evaluation (NOSE) scale is a brief, self-administered questionnaire that has been widely used to assess symptoms and quality of life related to nasal obstruction, and is commonly used in clinical outcome studies. The aim of this study was to undertake a clinical evaluation of a Polish translation and cross-cultural modification of the NOSE scale for nasal obstruction.

Material/Methods

A controlled clinical validation study was conducted in a tertiary referral center. The Polish version of the NOSE scale was developed according to cross-cultural adaptation guidelines. The psychometric properties of the Polish version of the NOSE scale (internal consistency, reproducibility, validity, responsiveness, interpretability) were assessed in 51 patients with nasal obstruction and 51 controls matched according to gender and age.

Results

Internal consistency of the Polish version of the NOSE scale was 0.80 as assessed by Cronbach’s alpha, and an intraclass correlation of the reproducibility was 0.98. Construct inter-item and item-total correlations confirmed validity. Correlation confirmed appropriate criterion validity with a visual analog scale (VAS) and discriminant validity was confirmed between patients and controls. Responsiveness and interpretability were also confirmed.

Conclusions

The Polish version of the NOSE scale is a brief and reproducible clinical evaluation tool for use in clinical practice in Polish-speaking patients with nasal obstruction.

Clinically important change in tinnitus sensation after stapedotomy

Background

When measuring the treatment effect in tinnitus with multi-item outcome instruments, it is crucial for both clinical and research purposes to take into consideration clinical importance of the outcome scores. The aim of the present study is to determine minimal important change (MIC) in tinnitus which is clinically meaningful to patients with otosclerosis.

Methods

The study population was 95 patients with otosclerosis, suffering from tinnitus. They completed the Tinnitus Functional Index before stapedotomy and 3 months after the surgery. The minimal important change was estimated with the Clinical Global Impression Scale as the external criterion (anchor). The mean change method and the receiver operating characteristic (ROC) method were used to determine minimal important change in tinnitus sensation.

Results

The improvement in tinnitus after stapedotomy was reported by 69.4% of the patients with otosclerosis. Minimal important change in tinnitus was estimated as reduction of 8.8 points in the Tinnitus Functional Index.

Conclusions

The anchor-based approach using an external criterion (anchor) allows to determine change in tinnitus sensation which is meaningful to patients after stapedotomy. The value of 8.8 points in Tinnitus Functional Index could be used as benchmark of stapedotomy effectiveness in otosclerosis patients suffering from tinnitus. Hearing difficulties comorbid with tinnitus could affect the perception of tinnitus change.

Skarzynski Tinnitus Scale: validation of a brief and robust tool for assessing tinnitus in a clinical population

BACKGROUND

Many tinnitus scales are available, but all of them have certain limitations. The aim of the current study was to present a psychometric data of a new brief and reliable questionnaire that could be conveniently used for evaluating tinnitus complaint in adults (either with normal or impaired hearing)-Skarzynski Tinnitus Scale (STS).

METHODS

The study included 125 participants with at least 1 month of tinnitus duration. All participants were asked to complete the STS, Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), and Beck Depression Inventory. Psychometric properties of the new tool were tested using exploratory factor analysis (EFA), Pearson bivariate correlation with other tinnitus questionnaires, Pearson bivariate correlation with pure-tone audiometry, Cronbach's alpha coefficient, limits of agreement, smallest detectable change, and floor and ceiling effects. Norms for tinnitus severity as measured by the STS are proposed.

RESULTS

As a whole, the STS has excellent reliability (ICC = 0.94) and good internal consistency (α = 0.91). The results of EFA and content analysis of wording of the items justified the three-factorial structure. The convergent validity was proven by a significant positive correlation with THI, TFI and THS Subscale A scores. Additionally, the authors proposed norms dividing the results into four tinnitus severity grades.

CONCLUSIONS

Statistical analysis shows that STS is a brief but robust tool well-suited to clinical practice. A feature of STS is that it takes into account the impact of tinnitus on the patient's psychological (emotional, cognitive) and functional domains as well as their ability to cope with tinnitus-related distress.

Self-esteem in the deaf who have become cochlear implant users as adults

Objective

Self-esteem is a good predictor of mental health and is crucial for well-being and psychological functioning. It is especially important in situations where there are potential mental health problems, such as in people suffering from hearing loss or total deafness. This study aims to gauge the level of self-esteem in adults with hearing problems, in particular those who, in adulthood, had received a cochlear implant (CI). The subjects had different onset (pre-lingual/post-lingual) and amount (deafness/partial deafness) of hearing loss, and their current level of self-esteem was compared to that of the general population. The association of self-esteem with other deafness-related variables (e.g. satisfaction with their CI or whether they also used a hearing aid) and sociodemographic factors was also investigated.

Methods

Data were obtained from questionnaires mailed to patients who, when adult, had received a CI. The subjects were divided into four subgroups: subjects with pre-lingual deafness, post-lingual deafness, pre-lingual partial deafness, and post-lingual partial deafness. To evaluate their self-esteem, the Rosenberg Self-Esteem Scale (RSES) was used. For data on sociodemographic status and information related to deafness and CI, we used our own Information Inquiry form. For statistical analysis of the results, we compared means (t-test, ANOVA), investigated correlations, and applied linear regression.

Results

The self-esteem of deaf and partially deaf CI users was significantly lower than in the general population, especially for post-lingually deafened subjects. The only factor related to deafness and CIs that explained self-esteem was self-rated satisfaction with the CI–meaning that higher satisfaction was associated with higher self-esteem. The major sociodemographic factor that explained self-esteem was marital/partnership status (being in a relationship was helpful). Also men had higher self-esteem than women. Those with higher levels of education, and those working or studying, had higher self-esteem than those who did not. RSES was found to have a single-factor structure.

Conclusion

Deafness and partial deafness appear to be risk factors for lower self-esteem, a finding that rehabilitation, medical, educational, and employment communities should be made aware of. Medical intervention in the form of a CI supplies the person with improved hearing, but it is not a panacea: their self-esteem is still vulnerable, and reinforcement of self-esteem is an aspect that professionals should focus on. Psychological, psycho-educational, and psychotherapeutic interventions have important roles to play for CI recipients.

Preservation of Hearing Following Cochlear Implantation Using Different Steroid Therapy Regimens: A Prospective Clinical Study

Background

A prospective clinical study was conducted to assess different regimens of steroid therapy and preservation of hearing following cochlear implantation.

Material/Methods

Study participants were ≥18 years-of-age, with a cochlear duct length ≥27.1 mm measured by computed tomography (CT), with hearing sound levels in the range of 10–120 decibels (dB) and sound frequencies of 125–250 hertz (Hz); sound levels of 35–120 dB and frequencies of 500–1,000 Hz; sound levels of 75–120 dB and frequencies of 2,000–8,000 Hz. Study exclusion criteria included diseases with contraindications for steroid therapy or medications that increased the effects of steroids. Patients had cochlear implantation and were divided into three treatment groups: intravenous (IV) steroid therapy (standard steroid therapy): combined oral and IV steroid therapy (prolonged steroid therapy); and a control group (cochlear implantation without steroid therapy). Hearing preservation was established by pure tone audiometry based on the pre-operative and postoperative average hearing thresholds according to the formula developed by the HEARRING Network.

Results

There were 36 patients included in the study. In all cases, the cochlear implant electrode was inserted via the round window approach with a straight electrode length of 28 mm. Patients with combined oral and IV steroid therapy (prolonged steroid therapy) had better results when compared with patients with intravenous (IV) steroid therapy (standard steroid therapy) and the control group.

Conclusions

Prolonged steroid therapy using combined oral and IV steroids stabilized hearing thresholds and preserved hearing in adult patients following cochlear implantation.