Aquí se hallan recogidos varios artículos completos sobre el tratamiento del tinitus con diferentes terapias. Es interesante revisar su eficacia ya que los pacientes suelen probar con muchas de ellas ya que su solución definitiva es difícil.

HNO. 2006 Oct;54(10):781-92.
[Inpatient infusion treatment for acute tinnitus with and without adjuvant psychotherapeutic intervention : A comparison of psychological effectiveness.]
[Article in German]
Schildt A, Tonnies S, Bottcher S.
Fachbereich Psychologie, Universitat Hamburg, .

Two groups of tinnitus patients (n=93) were recruited, one of which was treated with standard infusion therapy and further acute medical intervention, while the other obtained an additional psychotherapeutic intervention. Questionnaires and interviews were taken at beginning of the treatment, and 9 days and 3 years after treatment. The accompanying psychotherapeutic intervention consisted primarily of client-centered counseling, guided relaxational techniques from clinical hypnosis, and some standard and tinnitus-related methods for a better coping with stress. After 9 days, both treatment groups showed significant improvement in several psychological characteristics. However, there was no evidence for the superiority of the combined treatment with psychological intervention. Psychotherapeutic treatment accompanying the acute medical treatment probably shows better effectiveness in an ambulant setting with both patients and medical healthcare professionals rating it as ‘very helpful’.This pilot study has contributed initial results for the integrated treatment of the acute tinnitus and has helped in the development of further therapeutic strategies as well as an evidence based concept for further evaluation. This study received one of the two scientific first prizes of the «German Tinnitus League».

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Presse Med. 2006 Sep;35(9 Pt 1):1213-21.
[Tinnitus and cognitive-behavioral therapy: results after 1 year]
[Article in French]
Londero A, Peignard P, Malinvaud D, Avan P, Bonfils P.
Laboratoire de Recherche sur l’Audition, Unite CNRS UPRESSA 7060, Departement d’ORL et de Chirurgie Cervico-Faciale, Universite Paris-Descartes, Faculte de Medecine, Hopital Europeen Georges Pompidou, Paris.

INTRODUCTION: Tinnitus is a common auditory symptom that interferes with activities of daily living and is often associated with anxiety and depression. METHOD: This study included consecutive patients with chronic intense tinnitus for more than six months who were treated with Tinnitus Retraining Therapy (TRT), a cognitive-behavioral therapy, after previous treatment failed and after a clinical evaluation based on standardized questionnaires, including the Tinnitus Handicap Questionnaire (THQ). One year after the end of the TRT, the treatment was evaluated by the same standardized questionnaires. RESULTS: This prospective study included 96 consecutive patients (49 women, 47 men, mean age: 48 years). Tinnitus improved significantly in 75%, where significant improvement was defined as a final THQ score of less than 500 after CBT. This improvement varied according to initial THQ scores and was seen in: all patients with moderate (THQ<500), 70.3% of the patients with intermediate (500<THQ>1001), and 34.8% of patients with severe (THQ>1000) tinnitus. CONCLUSION: CBT shows promise as a treatment of tinnitus-related distress.

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Hear Res. 2006 Sep 12; [Epub ahead of print]
Antidepressant therapy in tinnitus.
Robinson SK, Viirre ES, Stein MB.
Department of Psychiatry, University of California, San Diego School of Medicine, Veterans Administration San Diego Healthcare System, 3350 La Jolla Village Dr., Mail Code 116A, La Jolla, CA 92161, USA.

Objective: Review the literature on the co-morbidity of depression and anxiety with tinnitus. Briefly consider proposed mechanisms by which antidepressants might be helpful for tinnitus, including treatment of co-morbid depression and anxiety and a more direct serotonergic mechanism of tinnitus. Survey the literature on antidepressants and tinnitus including tinnitus reported as a side effect of antidepressants (phenelzine, amitriptyline, protriptyline, doxepin, imipramine, fluoxetine, trazadone, bupropion, venlafaxine), tinnitus associated with withdrawal of antidepressants (venlafaxine and sertraline) and antidepressants as a treatment for tinnitus (case reports – fluoxetine and paroxetine, retrospective reviews – imipramine and selective serotonin reuptake inhibitors, single blind trials of amitriptyline and double blind placebo controlled trials of trimipramine, nortriptyline, paroxetine and sertraline). Provide suggestions on future directions, specifically replication of prior studies and a dose finding study of paroxetine for the treatment of tinnitus.

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Eur J Neurol. 2006 Sep;13(9):996-1001.
Transient tinnitus suppression induced by repetitive transcranial magnetic stimulation and transcranial direct current stimulation.
Fregni F, Marcondes R, Boggio PS, Marcolin MA, Rigonatti SP, Sanchez TG, Nitsche MA, Pascual-Leone A.
Harvard Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. ffregni@bidmc.harvard.edu

Modulation of activity in the left temporoparietal area (LTA) by 10 Hz repetitive transcranial magnetic stimulation (rTMS) results in a transient reduction of tinnitus. We aimed to replicate these results and test whether transcranial direct current stimulation (tDCS) of LTA could yield similar effect. Patients with tinnitus underwent six different types of stimulation in a random order: 10-Hz rTMS of LTA, 10-Hz rTMS of mesial parietal cortex, sham rTMS, anodal tDCS of LTA, cathodal tDCS of LTA and sham tDCS. A non-parametric analysis of variance showed a significant main effect of type of stimulation (P = 0.002) and post hoc tests showed that 10-Hz rTMS and anodal tDCS of LTA resulted in a significant reduction of tinnitus. These effects were short lasting. These results replicate the findings of the previous study and, in addition, show preliminary evidence that anodal tDCS of LTA induces a similar transient tinnitus reduction as high-frequency rTMS.

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Ear Nose Throat J. 2005 Jul;84(7):412-4.
The effect of stapedotomy on tinnitus in patients with otospongiosis.
Lima Ada S, Sanchez TG, Marcondes R, Bento RF.
 
Stapedotomy is primarily performed to treat hearing loss secondary to otospongiosis, although some patients find that the accompanying tinnitus is more bothersome than the hearing loss. We prospectively studied 23 consecutive patients with tinnitus secondary to otospongiosis who had undergone stapedotomy, and we compared their pre- and postoperative medical and audiologic findings. Patients’ annoyance with their tinnitus was quantified by means of a visual analog scale, and their air-conduction thresholds were determined by measurements of a 4-frequency pure-tone average (0.5, 1, 2, and 4 kHz). Statistical analysis was performed using the paired Student’s t test and Fisher’s exact test. In the group as a whole, the mean tinnitus annoyance visual analog scores were 8.34 preoperatively and 1.56 postoperatively, a highly significant difference. Clinically, 22 of the 23 patients (95.7%) achieved satisfactory control of their tinnitus (improvement or complete resolution) following stapedotomy. With respect to hearing loss, all patients clinically improved postoperatively, and audiometry confirmed improvement at all 4 frequencies between 0.5 and 4 kHz. An air-bone gap of less than 10 dB was noted in 17 patients (73.9%). We conclude that in addition to improving hearing, stapedotomy also provides good control of tinnitus.

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Int J Audiol. 2006 Jul;45 Suppl:99-107.
Self-reported benefits from successive bilateral cochlear implantation in post-lingually deafened adults: randomised controlled trial.
Quentin Summerfield A, Barton GR, Toner J, McAnallen C, Proops D, Harries C, Cooper H, Court I, Gray R, Osborne J, Doran M, Ramsden R, Mawman D, O’driscoll M, Graham J, Aleksy W, Meerton L, Verschure C, Ashcroft P, Pringle M.
City Hospital, Belfast, UK.

Adult users of unilateral Nucleus CI24 cochlear implants with the SPEAK processing strategy were randomised either to receive a second identical implant in the contralateral ear immediately, or to wait 12 months while they acted as controls for late-emerging benefits of the first implant. Twenty four subjects, twelve from each group, completed the study. Receipt of a second implant led to improvements in self-reported abilities in spatial hearing, quality of hearing, and hearing for speech, but to generally non-significant changes in measures of quality of life. Multivariate analyses showed that positive changes in quality of life were associated with improvements in hearing, but were offset by negative changes associated with worsening tinnitus. Even in a best-case scenario, in which no worsening of tinnitus was assumed to occur, the gain in quality of life was too small to achieve an acceptable cost-effectiveness ratio. The most promising strategies for improving the cost-effectiveness of bilateral implantation are to increase effectiveness through enhanced signal processing in binaural processors, and to reduce the cost of implant hardware.

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Laryngoscope. 2006 May;116(5):675-81.
Effect of gabapentin on the sensation and impact of tinnitus.
Bauer CA, Brozoski TJ.
Division of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9662, USA. cbauer@siumed.edu

OBJECTIVES/HYPOTHESIS: This study evaluated the effectiveness of gabapentin in treating chronic tinnitus in two populations: participants with tinnitus with associated acoustic trauma and participants with tinnitus without associated acoustic trauma. The hypothesis was that gabapentin would decrease both subjective and objective features of tinnitus in the trauma group but would be less effective in the nontrauma group. STUDY DESIGN: Prospective, placebo-controlled, single-blind clinical trial. METHODS: Pure-tone audiograms and personal histories were used to categorize tinnitus etiology as either secondary to acoustic trauma or not associated with acoustic trauma. Participants were restricted to those with moderate to severe tinnitus for at least 1 year. All participants received gabapentin in a graduated ascending-descending dose series extending over 20 weeks (peak dose of 2,400 mg/d). RESULTS: There was a significant improvement in tinnitus annoyance for the trauma group (P = .05). Other subjective aspects of tinnitus were not significantly affected in either group. Between-subject variability of therapeutic response was considerable. Nevertheless, in consideration of subjective loudness ratings, 4 of 19 nontrauma participants and 6 of 20 trauma participants showed an improvement of 20% or better. In consideration of psychoacoustic loudness estimates, 3 of 19 nontrauma and 6 of 20 trauma participants showed an improvement of 20 dB HL or greater. Evenly dividing each group into high and low responders revealed significant improvement in loudness at 1,800 and 2,400 mg/day for the trauma high-response subgroup (P = .007). No significant improvement was obtained for other subgroups. CONCLUSION: Gabapentin is effective in reducing subjective and objective aspects of tinnitus in some individuals, with the best therapeutic response obtained in individuals with associated acoustic trauma.

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Otolaryngol Head Neck Surg. 2006 May;134(5):809-15.
Sudden sensorineural hearing loss: Long-term follow-up results.
Psifidis AD, Psillas GK, Daniilidis JCh.
ENT Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.

OBJECTIVE: This study describes the long-term outcome of patients suffering from sudden sensorineural hearing loss (SSHL) after an initial combined therapy of steroids with vasodilators. STUDY DESIGN AND SETTING: Eighty cases were retrospectively reviewed to evaluate the long-term audiometric data and to statistically assess the value of specific clinical parameters. The persistent long-term otoneurologic manifestations associated with SSHL were also reported. RESULTS: In the long-term period, hearing level remained stable 2 months after the onset of SSHL. Patients complained of persistent tinnitus (36%), fluctuant hearing loss (8.7%), dizziness (8.7%), and classical Meniere’s triad in 2.5% of cases. Profound and total SSHL associated with vertigo are poor prognostic indicators. CONCLUSIONS: In terms of cost-effectiveness, a steroid-vasodilator therapy for SSHL for >2 months is not recommended because no additional effect was evidenced. Persistent otoneurologic manifestations, mainly tinnitus or dizziness are relatively common, particularly in patients with severe to total SSHL. EBM rating: C-4.

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Laryngorhinootologie. 2006 Apr 10; [Epub ahead of print]
[Cognitiv Group Therapy for Tinnitus – a Retrospecive Study of their Efficacy.]
[Article in German]
Storb SH, Strahl HM.
Gemeinschaftspraxis Dr. med. H. Michael Strahl und Dr. med. Tatjana von Stackelberg, Arzte fur Hals-, Nasen-, Ohrenheilkunde, Dusseldorf.

BACKGROUND: At the moment there are various possible therapy forms for ear noises, for example medicamentous, acoustical, electrical, surgical, radiological, behaviour-medical and «alternative» strategies, though a reliable curative therapy is not known up to now. However by combination of several therapy forms an improvement of the tinnitus aurium is possible. METHOD: Most participants of this study first received an infusion therapy for 5 to 15 days which improved the blood circulation. In case of an insufficient improvement of the patient’s discomfort, participation in the psychological support at the Tinnitus-Therapy-Centre was recommended. Both a psychological immunization (Psychologisches Immunisierungstraining(R)) and the auditive stimulation therapy(R) were part of the measures of intervention. The patients acquired methods of relaxing and easing, like Progressive Muscle Relaxation according to Jacobson, cognitive restructuring methods as well as attention-steering techniques. Beyond that the healing process was strengthened with relaxing music. PATIENTS: In retrospective view in a period of nearly 6 years over 500 patients were asked about their discomfort by the Tinnitus questionnaire (TQ) by Goebel and Hiller at the beginning and at the end of their group therapy. RESULTS: The evaluation shows an improvement of the score at 93,2 % of all treated patients, whereby with 6,8 % of the participant a stagnation and/or adegradation of the scores could be detected in the TQ. On average the value after the treatment improved at around 16 points. CONCLUSION: In comparison with the stationary treatment this therapy represents ameaningful treatment alternative, which is accepted by health insurance companies.

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Psychiatry Clin Neurosci. 2006 Apr;60(2):133-8.
Transcranial magnetic stimulation: potential treatment for tinnitus?
Pridmore S, Kleinjung T, Langguth B, Eichhammer P.
Discipline of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia. spridmore@iprimus.com.au

Tinnitus is a common and often severely disabling disorder for which there is no satisfactory treatment. Transcranial magnetic stimulation (TMS) is a new, non-invasive method of modifying the excitability of the cerebral cortex, which has proven effective in auditory hallucinations and other disorders. Some early studies have been published in which TMS has been trialed in the treatment of tinnitus. The aim of the present paper was to examine the literature and consider the potential for TMS as a therapy in tinnitus. A thorough search of the tinnitus and TMS literature was conducted, and all available relevant material was examined. Discussions were held with leaders in both fields. Tinnitus is common and there are no effective treatments. It is frequently associated with deafness, and may be the result of a pathological plastic process, secondary to loss of innervation of the outer hair cells of the cochlea. Neuroimaging studies demonstrate increase blood flow to the primary and secondary auditory cortices, particularly on the left side. Transcranial magnetic stimulation is a non-invasive method of perturbing and inducing change in the cerebral cortex. It uses electromagnetic principles and has been successfully employed in the treatment of other conditions associated with increased activity of the cerebral cortex. A small number of studies have suggested that TMS may be effective in the treatment of tinnitus. There is a good theoretical basis and early research evidence suggesting that TMS may have treatment potential in tinnitus. Further, larger studies are necessary.

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ORL J Otorhinolaryngol Relat Spec. 2006;68(1):48-54; discussion 54-5. Epub 2006 Mar 3.
Primary and secondary auditory cortex stimulation for intractable tinnitus.
De Ridder D, De Mulder G, Verstraeten E, Van der Kelen K, Sunaert S, Smits M, Kovacs S, Verlooy J, Van de Heyning P, Moller AR.
Department of Neurosurgery and Otorhinolaryngology, University Hospital Antwerp, Antwerp, Belgium.

INTRODUCTION: Recent research suggests tinnitus is a phantom phenomenon based on hyperactivity of the auditory system, which can be visualized by functional neuroimaging, and transiently modulated by transcranial magnetic stimulation (TMS). We present the results of the first implanted electrodes on the primary and secondary auditory cortex after a successful TMS suppression. METHODS AND MATERIALS: Twelve patients underwent an auditory cortex implantation, 10 for unilateral and 2 for bilateral tinnitus, based on >50% suppression applying TMS. Results were analyzed for pure tone tinnitus and white noise tinnitus. RESULTS: TMS results in 77% pure tone tinnitus and 67% white noise reduction. Electrical stimulation via an implanted electrode results in a mean of 97% pure tone tinnitus and 24% white noise suppression. Mean Visual Analogue Scale score decreases from 9.5 to 1.5 for pure tone and from 8.8 to 6.8 for white noise postoperatively. DISCUSSION: Pure tone tinnitus might be the conscious percept of focal neuronal hyperactivity of the auditory cortex. Once visualized, this hyperactivity can be modulated by neurostimulation. CONCLUSION: The preliminary results of the first implantations suggest that patients with unilateral pure tone tinnitus are good surgical candidates for electrode implantation and permanent electrical stimulation of the auditory cortex, provided that the tinnitus is of recent origin and can be suppressed by TMS. Copyright (c) 2006 S. Karger AG, Basel.

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ORL J Otorhinolaryngol Relat Spec. 2006;68(1):23-9; discussion 29-30. Epub 2006 Mar 3.
Tinnitus retraining therapy: a different view on tinnitus.
Jastreboff PJ, Jastreboff MM.
Tinnitus and Hyperacusis Center, Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA. pjastre@emory.edu

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. Copyright (c) 2006 S. Karger AG, Basel.

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ORL J Otorhinolaryngol Relat Spec. 2006;68(1):14-19; discussion 20-2. Epub 2006 Mar 3.
Tinnitus: standard of care, personality differences, genetic factors.
Tyler RS, Coelho C, Noble W.
Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, Iowa 52242-1078, USA. rich-tyler@uiowa.edu

We comment on three areas related to tinnitus. The standard of care should include counseling that is collaborative and that addresses the overall emotional well-being of the patient. Utilizing management and coping strategies is desirable. Our new tinnitus activities treatment is an example of such a protocol. We believe that the notions of fearfulness and acceptance have the potential to be integrated into tinnitus treatment. Some patients reject, control or accept their tinnitus. We believe in some instances there may be a common genetic cause of tinnitus and depression. A potential candidate is the serotonin transporter gene SLC6A4. Copyright (c) 2006 S. Karger AG, Basel.

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Complement Ther Med. 2006 Mar;14(1):39-46. Epub 2005 Sep 19.
Acupuncture for tinnitus: A series of six n=1 controlled trials.
Jackson A, Macpherson H, Hahn S.
Northern College of Acupuncture, York, UK.

OBJECTIVE: To explore patient perceived benefits of acupuncture for tinnitus. DESIGN: Controlled n=1 trials, with two phases A and B. SUBJECTS: Six patients with tinnitus. OUTCOME MEASURES: Primary outcome was Daily Diary records related to four tinnitus symptoms: loudness of tinnitus; pitch of tinnitus; waking hours affected with tinnitus; quality of sleep. Secondary outcomes were the Tinnitus Handicap Inventory (THI) and Measure Your Medical Outcome Profile (MYMOP). METHODS: Patients received a course of 10 acupuncture treatments over a 2-week period. Daily Diary entries related to the four tinnitus symptoms were recorded by patients for 14 days pre-treatment (phase A) and 14 days post-treatment (phase B). A hierarchical Bayesian model was used to combine the results from the individual patients to obtain estimates of the population and individual patient treatment effects, incorporating random variations at both levels (between patients and within patient). Tinnitus Handicap Inventory (THI) and Measure Your Medical Outcome Profile (MYMOP) were recorded at assessment points pre-treatment and post-treatment. RESULTS: Six patients participated in the trials, each receiving 10 treatments and completing all Daily Diary entries and outcome measures. For the of symptoms of loudness and pitch, there were variable treatment effects between patients, with a trend for the median overall reduction for loudness of -2.49 (-5.04, 0.02) and for pitch -1.39 (-3.74, 0.89), 95% credibility intervals being shown in brackets. For the other two symptoms, the waking hours affected and quality of sleep, patients’ responses were more consistent, with amore credible overall median reduction for affected waking hours of -2.76 (-3.94, -1.63) and for quality of sleep -2.72 (-3.45, -2.03). The THI and MYMOP measures showed a trend of improvement after treatment. CONCLUSION: The n=1 trial methodology, with an AB design and Bayesian analysis, can be considered of value in exploring treatment effects for small numbers of patients receiving individualised treatments, as is common within complementary medicine. When the treatment effects from six patients were synthesized, the results of this study suggest that acupuncture may have a beneficial role in the treatment of tinnitus.

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Otolaryngol Head Neck Surg. 2006 Feb;134(2):210-3.
The effects of melatonin on tinnitus and sleep.
Megwalu UC, Finnell JE, Piccirillo JF.
Clinical Outcomes Research Office, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri.

GOAL: To determine if melatonin improves tinnitus and if this improvement is related to improvement in sleep. STUDY DESIGN AND SETTING: Prospective open-label study of 24 patients with tinnitus. The patients took 3 mg of melatonin per day for 4 weeks, followed by 4 weeks of observation. The Tinnitus Handicap Inventory (THI) and the Pittsburgh Sleep Quality Index (PSQI) were administered. RESULTS: The mean THI score decreased significantly between weeks 0 and 4, and between weeks 0 and 8. The mean PSQI significantly decreased between weeks 0 and 4 (P < 0.0001), and between weeks 0 and 8 (P = 0.0003). The change in PSQI was significantly associated with the change in THI between weeks 0 and 4. The change in PSQI was not significantly associated with the change in THI between weeks 0 and 8. The change in the PSQI in the first 4 weeks was associated with the initial PSQI. There was no association between the initial THI and the change in the THI in the first 4 weeks. CONCLUSION: Melatonin use is associated with improvement of tinnitus and sleep. There was an association between the amount of improvement in sleep and tinnitus. The impact of melatonin on sleep was greatest among patients with the worst sleep quality, but its impact on tinnitus was not associated with the severity of the tinnitus. SIGNIFICANCE: Melatonin may be a safe treatment for patients with idiopathic tinnitus, especially those with sleep disturbance due to tinnitus. EBM rating: C-4.

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J Clin Psychopharmacol. 2006 Feb;26(1):32-9.
The effects of sertraline on severe tinnitus suffering–a randomized, double-blind, placebo-controlled study.
Zoger S, Svedlund J, Holgers KM.
Institute of Clinical Neuroscience, Psychiatry Section , Sahlgrenska Academy, Sahlgrenska University Hospital, Goteborg University, Goteborg, Sweden.

OBJECTIVE: The relationship between tinnitus and anxiety and depressive disorders has been frequently alluded to, but there are few studies on antidepressants in the treatment of tinnitus, and the efficacy of sertraline on severe refractory tinnitus has not been reported. METHOD: Consecutive tinnitus patients (n = 76) considered to be at high risk for severe and disabling tinnitus according to a recently developed screening procedure were randomly assigned to 16 weeks of double-blind treatment with placebo (n = 38) or sertraline (n = 38) at a fixed dose (25 mg/d on the first week and 50 mg/d on the following 15 weeks). Between-group comparisons of Tinnitus Severity Questionnaire scores over 16 weeks were made as the primary outcome measure. Secondary outcomes of tinnitus loudness and tinnitus annoyance were also measured using a visual analogue scale. Severity of depressive and anxiety symptoms was evaluated using the Hamilton rating scales (Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, interview-based ratings) and the Comprehensive Psychopathological Rating Scale (self-ratings). RESULTS: The intention-to-treat analysis showed sertraline to be more effective than placebo (P = 0.024) in decreasing reported tinnitus severity according to the Tinnitus Severity Questionnaire at 16 weeks’ follow-up. There was also more improvement (P = 0.014) in perceived tinnitus loudness. There were significant correlations between reduction of tinnitus according to the Tinnitus Severity Questionnaire over 16 weeks and improvements in depressive (r = 0.42-0.46) and anxiety symptoms (r = 0.34-0.42). Sertraline was well tolerated after a somewhat high (17%) dropout rate within the first 2 weeks. CONCLUSIONS: Sertraline is more effective than placebo in the treatment of severe refractory tinnitus.

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Otolaryngol Head Neck Surg. 2006 Jan;134(1):132-137.
Long-term effectiveness of ear-level devices for tinnitus.
Folmer RL, Carroll JR.
OHSU Tinnitus Clinic, Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. folmerr@ohsu.edu

OBJECTIVE: This study was undertaken to assess long-term changes in tinnitus severity exhibited by patients who purchased and used ear-level devices (hearing aids or sound generators). STUDY DESIGN AND SETTING: Patients were evaluated and treated within a comprehensive tinnitus management program. Follow-up questionnaires were mailed to patients 6 to 48 months after their initial appointment. RESULTS: Follow-up questionnaires from 150 patients were reviewed. Fifty patients purchased and used hearing aids, 50 patients purchased and used in-the-ear sound generators for an average of 18 months after their initial appointment; 50 patients did not use ear-level devices. At follow-up, all 3 groups of patients exhibited significant reductions in Tinnitus Severity Index scores and self-rated tinnitus loudness. Patients who used ear-level devices reported greater improvement than patients who did not use hearing aids or sound generators. CONCLUSIONS: Ear-level devices such as hearing aids or sound generators can help a significant number of patients who experience chronic tinnitus. Both types of devices reduce patients’ perception of tinnitus and can facilitate habituation to the symptom. Amplification provides additional benefits of improved hearing and communication.

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Int Tinnitus J. 2005;11(1):34-7.
Topical administration of Caroverine in somatic tinnitus treatment: proof-of-concept study.
Ehrenberger K.
Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. klaus.ehrenberger@meduniwien.ac.at

This prospective study, which conformed with good clinical practice (GCP-conform), tested the concept that the topical transtympanic administration of the quinoxaline derivative Caroverine promises a new approach to the treatment of tinnitus. The rationale for the study is the hypothesis that tinnitus reflects sequelae of auditory neurotoxicity that can prevented and repaired by the neuroprotective and neuroregenerative activities of quinoxaline derivatives exhibited in previous preclinical tests. In a representative patient cohort, the probability of a long-lasting tinnitolytic effect of lipophilic eardrops containing 1% Caroverine as their active ingredient gained in significance, crossing from low-intensity levels to high-intensity levels of individual tinnitus sensations. These results encouraged us to design consequential GCP-conform phase 2 and phase 3 studies.

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Int Tinnitus J. 2005;11(1):14-22.
Tinnitus improvement with ultra-high-frequency vibration therapy.
Goldstein BA, Lenhardt ML, Shulman A.
Department of Otolaryngology, State University of New York, Downstate Medical Center, Brooklyn, New York 11203, USA. metrc@inch.com

This study reports on the long-term benefit of ultra-high-frequency masking with the UltraQuiet device. A commercial product, UltraQuiet provides a new form of high-frequency bone conduction therapy. To assess its effectiveness in tinnitus treatment, we selected 15 patients with problematic tinnitus and randomly assigned them to three variations of the medical-audiological tinnitus patient protocol modified for the UltraQuiet study. We assessed tinnitus relief by questionnaires directed at weighing patient response to overall effectiveness, tinnitus loudness, tinnitus severity, and tinnitus annoyance. Additionally, we performed audiological measures (including pure-tone and speech audiometry, minimal masking levels, pitch and loudness matching, and residual inhibition). All patients showed some long-term gains, and most exhibited relief in at least one measurement parameter, providing support for the use of high-frequency vibration in the treatment of tinnitus.

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Psychosom Med. 2005 Nov-Dec;67(6):981-8.
Randomized placebo-controlled trial of a selective serotonin reuptake inhibitor in the treatment of nondepressed tinnitus subjects.
Robinson SK, Viirre ES, Bailey KA, Gerke MA, Harris JP.
Department of Psychiatry, University of California, San Diego School of Medicine, Veterans Administration San Diego Healthcare System, La Jolla, CA 92161, USA. skrobinson@ucsd.edu

OBJECTIVE: To assess the efficacy of a selective serotonin reuptake inhibitor (paroxetine) for relief of tinnitus. DESIGN: One hundred twenty tinnitus sufferers participated in a randomized double-blind placebo-controlled trial. Paroxetine or placebo was increased to a maximally tolerated dose (up to 50 mg/day), and patients were treated for a total of 31 days at the maximal dose. METHODS: Patients with chronic tinnitus were recruited from our university-based specialty clinic by referral from otolaryngologists and audiologists in the local community and by advertisement. Patients with psychotic or substance use disorders or suicidal ideation were excluded, as were those using psychoactive medications (this resulted in only 1 subject with major depression in the study) or any other medications that interact with paroxetine and those with inability to hear at one’s tinnitus sensation level. Fifty-eight percent of patients were male, 92% were Caucasian, and the average age was 57. OUTCOMES MEASURES: Tinnitus matching, the Tinnitus Handicap Questionnaire, the question: How severe (bothered, aggravating) is your tinnitus? Quality of Well-Being and other psychological questionnaires. RESULTS: Paroxetine was not statistically superior to placebo on the following tinnitus measures (tinnitus matching, 5- or 10-db drop, Tinnitus Handicap Questionnaire, quality of well-being measures, how severe, how bothered, positive change). There was a significant improvement in the single item question, How aggravating is your tinnitus? for those in the paroxetine group compared with the placebo group. CONCLUSIONS: These results suggest that the majority of individuals in this study did not benefit from paroxetine in a consistent fashion. Further work remains to be done to determine if subgroups of patients (e.g., those who tolerate higher doses, those who are depressed) may benefit.

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Otolaryngol Head Neck Surg. 2005 Nov;133(5):774-9.
Long-term clinical trial of tinnitus retraining therapy.
Herraiz C, Hernandez FJ, Plaza G, de los Santos G.
Unidad de Acufenos, Instituto ORL Antoli-Candela, Madrid, Spain. cherraizp@seorl.net

OBJECTIVE: To demonstrate the efficacy of tinnitus retraining therapy (TRT) for tinnitus relief compared to a waiting list group and a partially treated group (patients that refused prosthesis adaptation). STUDY DESIGN: Prospective non-randomised clinical assay (n = 158). Visual analogue scale (VAS) for intensity and the Tinnitus Handicap Inventory (THI) were evaluated at 12-month period. RESULTS: Eighty two percent of the patients that followed TRT improved their tinnitus according to their self-evaluation. THI score was reduced from 48% to 32% and VAS decreased from 6.6 to 5.3 after one year (p < 0.05). TRT patients showed a higher improvement on their tinnitus, THI and VAS scores when compared with the waiting list patients and with patients that refused prosthesis adaptation when recommended (p < 0.05). CONCLUSIONS: TRT improved tinnitus in 82% of the subjects and statistically reduced THI and VAS scores after 12 months. TRT has shown to be more effective than a waiting list group and partially treated patients. EBM RATING: B-2.

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J Laryngol Otol. 2005 Oct;119(10):791-8.
Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss and tinnitus: a systematic review of
randomized controlled trials.
Bennett M, Kertesz T, Yeung P.
Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital and University of NSW, Australia. m.bennett@unsw.edu.au

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSHL) and tinnitus are common. Hyperbaric oxygen therapy (HBOT) may improve hearing loss and/or reduce the intensity of tinnitus. METHODS: We performed a systematic search of the literature for randomized controlled trials, and made pooled analyses of pre-determined clinical outcomes where possible. RESULTS: Six trials contributed to this review (304 subjects). Pooled analysis suggested a significantly increased chance of a 25 per cent improvement in hearing threshold on pure tone average with HBOT (relative risk (RR) 1.39, 95 per cent confidence interval (CI) 1.05-1.84, p = 0.02; number-needed-to-treat 5, 95 per cent CI 3-20), but not a 50 per cent increase (RR 1.53, 95 per cent CI 0.85-2.78, p = 0.16). The significance of any improvement in tinnitus following HBOT could not be assessed due to poor reporting. CONCLUSIONS: HBOT improved hearing, but the clinical significance of the level of improvement is not clear. Routine application of HBOT to patients with ISSHL is not justified by this review. More research is needed.

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Rev Med Suisse. 2005 Oct 19;1(37):2381-3.
[Chronic tinnitus]
[Article in French]
Barras FM, Maire R.
Service d’ORL et de chirurgie cervico-faciale CHUV, Lausanne. florian.barras@chuv.hospvd.ch

Chronic tinnitus is a frequent symptom in the current medical practice. Patients presenting with chronic tinnitus have to be evaluated by comprehensive examination, including ENT status, audiometry and complete neuro-otological evaluation if required, to exclude an organic cause of tinnitus, as an external–or middle ear lesion, or a retro-cochlear process. Most often, chronic tinnitus is only associated with a sensorineural hearing-loss. Overall, no drug treatment can be proposed. However, the patient needs help and two techniques can be proposed to make the symptom more tolerable: the bio-psycho-social model, with a medical and psychological sustain, and the habituation auditory therapy, using noisers to mask the tinnitus.

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Drug Discov Today. 2005 Oct 1;10(19):1283-90.
Tinnitus: neurobiological substrates.
Eggermont JJ.
Departments of Physiology, Biophysics and Psychology, University of Calgary, 2500 University Drive N.W., Alberta, Calgary T2N 1N4, Canada. eggermon@ucalgary.ca

Tinnitus is an auditory phantom sensation of ringing in the ears that is experienced when no external sound is present. It is a prevalent disorder that is frequently caused by insults to the peripheral auditory and somatosensory systems, especially in the elderly. This creates an imbalance between inhibitory and excitatory transmitter actions in the midbrain, auditory cortex and brainstem (where neural activity from somatosensory and auditory stimuli interact). This imbalance causes hyperexcitability often leading to the perception of phantom sounds. Although changes in transmitter-receptor systems have become better documented, there are currently no proven drug treatments for humans. Methods for preventing tinnitus have been demonstrated in animal studies.

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Psychosom Med. 2005 Sep-Oct;67(5):833-8.
Psychophysiologic treatment of chronic tinnitus: a randomized clinical trial.
Rief W, Weise C, Kley N, Martin A.
Department of Clinical Psychology, University of Marburg, Germany. rief@staff.uni-marburg.de

BACKGROUND: Tinnitus seems to be associated with psychophysiological over-activation (e.g., of head and shoulder muscles). Therefore we aimed to develop and evaluate a new intervention program including a psychophysiological approach. METHODS: Forty-three tinnitus sufferers were randomized to 2 groups, one receiving a psychophysiologically oriented intervention lasting 7 intervention sessions (plus 2 assessment sessions), whereas the other group waited for a comparable time period. Afterward, patients on the waiting list also received the intervention. Physiological variables were muscle activity of head and shoulders and electrodermal activity. Psychological assessments took place at pretreatment, post-treatment, and 6 months later. Follow-up data were available from 95% of participants. Major outcome variables were self-rating scales (e.g., tinnitus annoyance assessed by the Tinnitus Questionnaire), and diary data (self-control, daily time of perceiving the tinnitus). RESULTS: On most tinnitus specific variables, patients in the treatment group improved significantly more than patients on the waiting list. Main effect sizes for tinnitus-specific variables were up to 0.89. Muscle reactivity of head muscles at the beginning predicted significant treatment effects. CONCLUSION: Compared with meta-analytical reviews of psychological interventions for tinnitus sufferers, the presented treatment is brief and in the upper range of effectiveness.

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HNO. 2005 Sep 17; [Epub ahead of print]
[Treatment of chronic tinnitus with neuronavigated repetitive Transcranial Magnetic Stimulation (rTMS).]
[Article in German]
Kleinjung T, Steffens T, Langguth B, Eichhammer P, Marienhagen J, Hajak G, Strutz J.
Klinik fur HNO-Heilkunde der Universitat Regensburg, .

BACKGROUND AND OBJECTIVE: Idiopathic tinnitus is a frequent and debilitating disorder of largely unknown pathophysiology. Focal brain activation in the auditory cortex has recently been demonstrated in chronic tinnitus. Low-frequency rTMS can reduce cortical hyperexcitability.PATIENTS AND METHODS: In 12 patients with chronic tinnitus, fusion of [(18)F]deoxyglucose-PET and structural MRI (T1, MPRAGE) scans allowed the area of increased metabolic activity in the auditory cortex to be exactly identified; this area was selected as the target for rTMS. A neuronavigational system adapted for TMS positioning enabled the relative positions of the figure-8 coil and the target area to be monitored. Repetitive TMS (110% motor threshold; 1 Hz; 2000 stimuli per day over 5 days) was performed using a placebo-controlled crossover design. A sham coil system was used for the placebo stimulation. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller).RESULTS: In all 12 patients an asymmetrically increased metabolic activation of the gyrus of Heschl was detected. The tinnitus score was significantly improved after 5 days of active rTMS, an effect not seen after placebo stimulation.CONCLUSION: These preliminary results show that neuronavigated rTMS may improve our understanding and treatment of chronic tinnitus.

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Otol Neurotol. 2005 Sep;26(5):1061-3.
Change in tinnitus handicap after translabyrinthine vestibular schwannoma excision.
Baguley DM, Humphriss RL, Axon PR, Moffat DA.
Department of Neuro-Otology, Addenbrooke’s Hospital, Hills Road, Cambridge, UK. dmb29@cam.ac.uk

OBJECTIVE: To evaluate the change in tinnitus handicap after translabyrinthine vestibular schwannoma excision. STUDY DESIGN: Prospective administration of the Tinnitus Handicap Inventory (THI) preoperatively and at 3 and 12 months postoperatively. SETTING:: A tertiary referral neuro-otology clinic. PATIENTS: A total of 149 patients from a series of 170 consecutive patients who had vestibular schwannomas excised between May 1998 and July 2002 and who had completed THIs preoperatively and at 3 and 12 months postoperatively. INTERVENTIONS: Translabyrinthine excision of a unilateral sporadic vestibular schwannoma. MAIN OUTCOME MEASURES: THI scores. RESULTS: The number of patients with moderate or severe handicap was 21 (14%) in the preoperative group and 21 (14%) in the 12-month postoperative group. No significant differences in group data were found comparing (by Wilcoxon signed rank test) preoperative data with 3 months postoperative data (p = 0.09), preoperative data with 12 months postoperative data (p = 0.09), and 3 months postoperative data with 12 months postoperative data (p = 0.33). Considering group data, tinnitus handicap is neither alleviated nor exacerbated by translabyrinthine surgery. The application of the validated 20-point criteria for significant change in the status of an individual patient indicates that tinnitus handicap was worse in 10 (6.5%), unchanged in 129 (87%), and better in 10 (6.5%). CONCLUSIONS: The findings of the current study can be used during preoperative patient counseling. In particular, the clinician is now able to take an informed and positive stance about the tinnitus handicap to be expected postoperatively.

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HNO. 2005 Aug 17; [Epub ahead of print]
[Acute tinnitis: pharmacotherapy and the role of hypoxia and ischemia in pathogenesis.]
[Article in German]
Mazurek B, Haupt H, Gross J.
HNO-Klinik und Poliklinik Charite – Universitatsmedizin Berlin, Campus Charite Mitte, .

Hypoxia/ischemia may play an important role in the pathogenesis of sensorineural tinnitus due to the characteristics of the cochlear blood supply. In addition, hypoxia modulates molecular processes both in the acute and chronic forms of tinnitus. Transcription factor HIF-1 (hypoxia-inducible factor) may play a key role in the cells’ adaptation to hypoxia and ischemia, while under hypoxic/ischemic conditions, HIF-1 induces changes in the gene expression which may contribute to the remodeling of particular structures within the cochlea.Disturbances in the cochlear blood supply may result in membrane changes, perineural edema, inflammation, disturbances in ion homeostasis and in the formation of reactive oxygen species. Thus, the pharmacotherapy of acute tinnitus may be aimed at the improvement of cochlear blood supply and the prevention of acute processes leading to cell damage. Pharmacotherapies with colloidal plasma substitutes, vasodilators, calcium antagonists, procaine, and cortisone have been described in the literature and are discussed here.Many of the pharmacological treatments have not been validated in double blind studies. Although it is impossible to deduce the cause of tinnitus from a drug’s efficiency, there is some evidence that it can be effectively suppressed by improving blood supply, at least at certain stages. The aim is to achieve an improved pharmacotherapy by means of sophisticated diagnostic instruments for classifying particular types of tinnitus.

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Am J Audiol. 2005 Jun;14(1):21-48.
Clinical guide for audiologic tinnitus management I: Assessment.
Henry JA, Zaugg TL, Schechter MA.
VA Medical Center, Portland, OR 97207, USA. james.henry@med.va.gov

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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Am J Audiol. 2005 Jun;14(1):49-70.
Clinical guide for audiologic tinnitus management II: Treatment.
Henry JA, Zaugg TL, Schechter MA.
VA Medical Center, Portland, OR 97207, USA. james.henry@med.va.gov

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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Otolaryngol Head Neck Surg. 2005 Aug;133(2):251-9.
Intratympanic steroid injection for treatment of idiopathic sudden hearing loss.
Slattery WH, Fisher LM, Iqbal Z, Friedman RA, Liu N.
House Ear Institute, House Ear Clinic, Los Angeles, California 90057, USA. wslattery@hei.org

OBJECTIVE: To conduct a clinical trial of intratympanic steroid injection for idiopathic sudden sensorineural hearing loss in subjects who failed oral steroid therapy. STUDY DESIGN AND SETTING: Open-label methylprednisolone injection clinical trial in a tertiary neurotologic referral center. Twenty subjects (14 males; 6 females) received 4 injections within a 2-week period (4 days apart). Hearing, dizziness, and tinnitus were evaluated before and after treatment. RESULTS: There were no serious unexpected adverse events and 2 types of expected adverse events (tympanic membrane perforation, nausea after injection). No increases in dizziness or tinnitus lasting longer than 24 hours were observed after injections. One of 20 (5%) improved to near-normal hearing. In addition, there was statistically significant improvement in 4-frequency pure-tone average and speech discrimination score at 1 month after treatment. CONCLUSION: Four intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids. SIGNIFICANCE: A clinical trial of intratympanic injections for idiopathic sudden hearing loss was successfully completed and promising results were found.

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J Ethnopharmacol. 2005 Aug 22;100(1-2):95-9.
Ginkgo biloba extracts for tinnitus: More hype than hope?
Smith PF, Zheng Y, Darlington CL.
Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, Dunedin, New Zealand. paul.smith@stonebow.otago.ac.nz

The investigation into the effects of Ginkgo biloba extracts on tinnitus has suffered from a dearth of effective animal models as well as systematic clinical trials employing double-blind and placebo-controlled designs. Some clinical trials have yielded positive results, however, these studies are few and have been limited either by design flaws, the small size of the significant effects, or else the results have not been published in peer-reviewed journals and therefore the quality of the research is not assured. By contrast, the two most systematic clinical trials, both double-blind and placebo controlled, and published in respected peer-reviewed journals, have yielded negative results and suggest that Ginkgo biloba extracts are of little more use in the treatment of tinnitus than a placebo. Treatments for tinnitus that do not have therapeutic efficacy not only waste money but can potentially prevent patients from seeking therapy that is efficacious. Furthermore, the unsupervised use of Ginkgo biloba extracts with other medications could lead to adverse side effects which are unnecessary and not justified in terms of therapeutic benefit.

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Curr Opin Investig Drugs. 2005 Jul;6(7):712-6.
Drug treatments for subjective tinnitus: serendipitous discovery versus rational drug design.
Smith PF, Darlington CL.
Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, Dunedin, New Zealand. paul.smith@stonebow.otago.ac.nz

Progress has been made in understanding the neural basis of subjective tinnitus (ST); however, this has not, as yet, translated into many new drug treatments. One reason for this is that realistic behavioral models of ST in animals have been developed only recently, and are still not widely used. Nonetheless, some significant pharmacological advances have been made. At present, there is evidence to support the efficacy of transtympanic gentamicin administration in the treatment of tinnitus associated with Meniere’s disease; there is also some evidence to support the efficacy of intratympanic steroid and lidocaine application in the management of ST. Although benzodiazepines and anti-epileptic drugs appear to be effective in many cases of this condition, there is concern about their adverse side effect profile. Based on well-controlled clinical trials, vasodilators such as misoprostol, and histamine receptor ligands should be further investigated. Finally, given the evidence that ST is a form of sensory epilepsy, new antiepileptic drugs should be tested for potential efficacy as they are developed; such drugs may include novel N-methyl-D-aspartate receptor antagonists, as well as cannabinoids.

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Otol Neurotol. 2005 Jul;26(4):616-9.
Transcranial magnetic stimulation for tinnitus: influence of tinnitus duration on stimulation parameter choice and maximal tinnitus suppression.
De Ridder D, Verstraeten E, Van der Kelen K, De Mulder G, Sunaert S, Verlooy J, Van de Heyning P, Moller A.
Department of Neurosurgery and Otorhinolaryngology, University Hospital Antwerp, Belgium. dirk.de.ridder@uza.be

OBJECTIVE: Tinnitus is a distressing symptom for which few treatments exist. It leads to an important decrease in quality of life in 2 to 3% of the population. Tinnitus is considered a phantom sound, the result of cortical reorganization. Transcranial magnetic stimulation (TMS) is a noninvasive method to modulate cortical reorganization and has been shown to be able to influence tinnitus perception. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary referral center. PATIENTS: The effect of TMS of the contralateral auditory cortex in 114 patients with unilateral tinnitus is investigated as one of the selection criteria used for surgical implantation of electrodes on the auditory cortex. INTERVENTION: TMS is performed at 90% of motor threshold at 1, 3, 5, 10, and 20 Hz, with each stimulation session consisting of 200 pulses. Results were classified as no effect (0-19% improvement), partial effect (20-79% improvement), and good effect (80-100 suppression). MAIN OUTCOME MEASURES: TMS had a good effect in 25% of the patients studied, partial effect in 28% patients, and no effect in 47%. RESULTS: TMS at 200 pulses is capable of tinnitus suppression for seconds only. The results were influenced by tinnitus duration: the longer the tinnitus exists, the lower the stimulation frequency that yields maximal tinnitus suppression (p < 0.001). The maximal amount of tinnitus suppression decreases in time (p < 0.01), resulting in a 2% decrease of potential tinnitus suppression per year. CONCLUSION: TMS of the auditory cortex is capable of modifying tinnitus perception for a very short time. The maximal amount of suppression and best stimulation frequency depends on the tinnitus duration.

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Otolaryngol Head Neck Surg. 2005 Jun;132(6):883-9.
Evaluation of botulinum toxin A in treatment of tinnitus.
Stidham KR, Solomon PH, Roberson JB.
California Ear Institute, San Ramon, CA 94583, USA. krs@calear.com

OBJECTIVES: The purpose of this study was to evaluate the potential benefit of botulinum toxin A in treatment of tinnitus with a prospective, double-blinded study design. STUDY DESIGN: Double-blinded, prospective clinical study. METHODS: Thirty patients with tinnitus were randomly placed into 1 of 2 treatment arms. Patients either received botulinum toxin A (20 to 50 units) or saline injection at the first treatment, and the opposite treatment 4 months later. Prospective data including tinnitus matching test, tinnitus handicap inventory (THI), tinnitus rating scale (TRS), and patient questionnaires were obtained over a 4-month period after each injection. RESULTS: Twenty-six patients completed both injections and follow-up and were included in data analysis. After botulinum toxin A, subjective tinnitus changes included 7 patients improved, 3 worsened, and 16 unchanged. Following placebo, 2 patients were improved, 7 worsened, and 17 unchanged. Comparison of the treatment and placebo groups was statistically significant (P < 0.005) when including better, worse, and same effects. A significant decrease in THI scores between pretreatment and 4 month postbotulinum toxin A injection (P = 0.0422) was recorded. None of the other comparisons of pretreatment to 1 month, or pretreatment to 4 months were significantly different. CONCLUSIONS: This small study found improvement in THI scores and patient subjective results after botulinum toxin A injection compared with placebo, suggesting a possible benefit of botulinum toxin A in tinnitus management. Larger studies need to be completed to further evaluate potential benefits of botulinum toxin A in treatment of this difficult problem.

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Otolaryngol Pol. 2005;59(1):91-6.
[Tinnitus in elderly patients]
[Article in Polish]
Zagolski O.
Specjalistyczne Centrum Diagnostyczno-Zabiegowe Medicina w Krakowie.

Tinnitus is the perceived sensation of sound in the absence of acoustic stimulation. Spontaneous idiopathic tinnitus is a significant interdisciplinary therapeutic problem. In elderly patients it most frequently coexists with sensorineural hearing loss. The chief idea of tinnitus retraining therapy (TRT) in treatment of chronic tinnitus consists of following strategies: low level and broad band noise surroundings, diversion of the attention to other things and psychological counseling and therapy. The purpose of this study was to verify the benefits and ramifications of tinnitus retraining therapy in elderly patients suffering from chronic tinnitus with sensorineural hearing loss. Methods 30 subjects aged 65-90 years suffering from chronic tinnitus and sensorineural hearing loss were questioned about features of the tinnitus using a set of standardised questions. All of them were fitted with modern digital hearing aids and questioned about subjective hearing results after a month of follow-up. Main result 24 of the patients declared to have had considerable improvement in tolerance of the tinnitus. Main conclusion Fitting with hearing aids is an effective way of treatment in the majority of elderly patients with chronic tinnitus. The effectiveness of supplying elderly patients with hearing aids for tinnitus management depended in our group of patients on whether the patient had good speech understanding prior to fitting with hearing aids (speech discrimination score below and above 80%).

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Int J Audiol. 2005 Jun;44(6):370-8.
Evidence of psychosomatic influences in compensated and decompensated tinnitus.
Stobik C, Weber RK, Munte TF, Walter M, Frommer J.
Westerwaldklinik Waldbreitbach, Clinic for Neurology and Neurological Psychosomatics, Germany

The purpose of this study was to evaluate the role and interaction of individual factors on decompensated tinnitus. Subjects consisted of 53 adult patients with chronic tinnitus. They were selected and assigned to two groups, compensated (n = 28) and decompensated (n = 25), according to the results of an established tinnitus questionnaire. Both groups were evaluated and compared. The patients with decompensated tinnitus suffered from more pronounced social disabilities, were more prone to depression, and used less effective techniques to cope with their illness. They showed a higher degree of somatic multimorbidity, with particularly strong correlations between tinnitus and the incidence of cardiovascular diseases and hypoacusis. As a consequence, in the psychosomatic tinnitus therapy, greater attention should be given to the treatment of the somatic complaints in addition to psychological and psychosocial aspects.

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Int J Pediatr Otorhinolaryngol. 2005 Jun;69(6):817-21. Epub 2005 Feb 24.
Idiopathic sudden sensorineural hearing loss in children.
Chen YS, Emmerling O, Ilgner J, Westhofen M.
Department of Otorhinolaryngology, Plastic Head and Neck Surgery, University Hospital of Aachen, Pauwelsstrasse 30, D-52057 Aachen, Germany.

OBJECTIVE:: Although idiopathic sudden sensorineural hearing loss (ISSHL) is a frequent disease in adults, less is known about incidence and treatment of ISSHL in children. METHOD:: A retrospective chart analysis was performed to evaluate the frequency of ISSHL in children aged under 18 years between 2000 and 2003, who were treated in our department. Children received prednisolone intravenously at an initial dose of 3mg/kg bodyweight. Prednisolone dose was reduced to half every second day. The medication was given for a maximum of 14 days or finished 2 days after the hearing normalized in pure-tone audiometry. The follow-up was continued between 3 and 14 months. RESULTS:: The complete recovery rate was 57%, and the partial recovery was 36%. Initial hearing loss of 50dB and more was predictive for poor outcome in children (p=0.028). Presence of tinnitus was without relevance for the outcome. The incidence of ISSHL in the local area of about 250,000 inhabitants was 1/10,000 in children. CONCLUSION:: ISSHL seems to be a less frequent disease in children than in adults. Severe initial hearing loss is coupled with poor outcome. Under treatment with prednisolone hearing improvement was found in 13 of 14 patients.

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Otol Neurotol. 2005 May;26(3):425-428.
Neurostimulation as a New Treatment for Severe Tinnitus: A Pilot Study.
Holm AF, Staal MJ, Mooij JJ, Albers FW.
*Departments of Otorhinolaryngology and daggerNeurosurgery, University Hospital, Groningen, The Netherlands.

BACKGROUND:: Tinnitus is an uncomfortable symptom for the patient and an embarrassing one for the consulted physician. So far, there is no treatment that can be considered well established in terms of providing long-term reduction of tinnitus in excess of placebo effects. There is considerable evidence of pathophysiological similarity between tinnitus and chronic pain. Some forms of chronic pain can be treated by neurostimulation. OBJECTIVE:: This study was designed to investigate the feasibility of neurostimulation of the cochlear nerve in order to reduce tinnitus. STUDY DESIGN:: Pilot study. SETTING:: Tertiary referral center. PATIENTS:: Five patients with therapeutically refractory tinnitus were selected for this study. INTERVENTION:: Placing a stimulation lead around the cochlear nerve through the suboccipital approach and connecting the stimulation lead to a pulse generator. MAIN OUTCOME MEASURES:: The patients experienced 1) an absence of major or minor complications, such as death, meningitis, cranial nerve deficit, and vestibular problems; 2) tolerance of the procedure as considered by the patient; 3) relief of tinnitus in at least one patient. RESULTS:: Implantation of the neurostimulation system was accomplished in each patient without any difficulty. None of the patients considered the treatment unbearable. No major or minor complications occurred in this study. Subjective tinnitus reduction was accomplished in four patients. CONCLUSION:: Our preliminary data show that neurostimulation of the cochlear nerve is feasible, is bearable for the patient, and is a safe treatment modality without major complications. The effects on tinnitus are promising.

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Behav Res Ther. 2005 May;43(5):595-612.
Does sound stimulation have additive effects on cognitive-behavioral treatment of chronic tinnitus?
Hiller W, Haerkotter C.
Department of Clinical Psychology, University of Mainz, Staudingerweg 9, D-55099 Mainz, Germany.

Psychological and physiological habituation are major goals in the treatment of patients suffering from chronic tinnitus. This study evaluates whether sound stimulation provided by use of low level white noise generators (NG) enhances the effects of cognitive-behavioral treatment (CBT). 124 outpatients with tinnitus of >6 months received manualized group treatment and were randomly assigned to the NG/no NG conditions. Those with moderate tinnitus-related distress obtained four sessions focusing on education, while severely distressed subjects were treated according to a full 10-session CBT program. Outcome was assessed at post-treatment and at 6- and 18-month follow-up. No additive effects due to the NGs could be demonstrated. All groups improved significantly on measures of tinnitus-related distress, dysfunctional cognitions, general psychopathology, depression, hypochondriasis and psychosocial functioning. Beneficial effects of the NGs were only observed for patients with concurrent tinnitus and hyperacusis. As systematic physical stimulation of the auditory system does not further improve the effects of CBT, the importance and strength of psychological interventions are emphasized. The clinical relevance of recently developed «retraining» approaches accentuating physical stimulation should be reconsidered.

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Otol Neurotol. 2005 Mar;26(2):169-76.
The inhibitory effect of intravenous lidocaine infusion on tinnitus after translabyrinthine removal of vestibular schwannoma: a double-blind, placebo-controlled, crossover study.
Baguley DM, Jones S, Wilkins I, Axon PR, Moffat DA.
Department of Neuro-Otology, Addenbrooke’s Hospital, Cambridge, UK. dmb29@cam.ac.uk

OBJECTIVE: Intravenous infusion of lidocaine has previously been demonstrated to have a transient inhibitory effect on tinnitus in 60% of individuals. The site of action has variously been proposed as the cochlea, the cochlea nerve, and the central auditory pathways. To determine whether a central site of action exists, this study investigated the effect of intravenous infusion of lidocaine in individuals with tinnitus who had previously undergone translabyrinthine excision of a vestibular schwannoma, which involves division of the cochlear nerve. STUDY DESIGN: Double-blind, placebo-controlled, crossover study. SETTING: University hospital. PATIENTS: Patients who had undergone translabyrinthine removal of a unilateral, sporadic, and histologically proven vestibular schwannoma in the last decade and who had reported postoperative tinnitus at follow-up were identified from a departmental database. Sixteen patients participated (12 men and 4 women). The mean age (+/- standard deviation) of the patients was 58 +/- 8.6 years, and the meantime since operation was 24.3 +/- 7.3 months. INTERVENTION: Solutions of 2% lidocaine hydrochloride and sodium chloride 0.9% were prepared in identical randomized vials. The volume required for 1.5 ml/kg body weight lidocaine was calculated, and this volume was given over 5 minutes for either vial. Blood pressure, pulse oximetry, and cardiac monitoring were set up and performed throughout the infusions. All investigators were blinded. OUTCOME MEASURES: Patient-completed visual analogue scale measures of tinnitus intensity, pitch, and distress, performed before infusion, 5 minutes after infusion onset, and 20 minutes after infusion onset. RESULTS: A significant difference (Wilcoxon signed-rank test, p < 0.05) between placebo and lidocaine infusion conditions was demonstrated for change in visual analogue scale estimates (preinfusion versus 5 min postinfusion) of tinnitus loudness (p = 0.036), pitch (p = 0.026), and distress (p = 0.04). No significant difference between placebo and lidocaine infusion conditions was demonstrated for change in visual analogue scale estimates (preinfusion versus 20 min postinfusion) of tinnitus loudness (p = 0.066), pitch (p = 0.173), and distress (p = 0.058). The indication is of a short-lasting inhibitory effect on tinnitus of lidocaine infusion compared with saline placebo in patients who have undergone translabyrinthine excision of a vestibular schwannoma. CONCLUSION: Intravenous infusion of lidocaine has a statistically significant inhibitory effect on tinnitus in patients who have previously undergone translabyrinthine removal of a vestibular schwannoma. The site of action of lidocaine in this instance must be in the central auditory pathway, as the cochlear and vestibular nerves are sectioned during surgery, and this finding has important implications for the task of identifying other agents that will have a similar tinnitus-inhibiting effect.

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Arch Otolaryngol Head Neck Surg. 2005 Feb;131(2):113-7.
Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus: does it work?
Araujo MF, Oliveira CA, Bahmad FM Jr.
Department of Otolaryngology, Brasilia University Medical School, Brasilia, Brazil.

OBJECTIVE: To test the effectiveness of intratympanic dexamethasone injections as a treatment for severe disabling cochlear tinnitus. DESIGN: Randomized, prospective, single-blind study. SETTING: Academic tertiary referral hospital. PATIENTS: Thirty-six patients with severe disabling tinnitus predominantly of cochlear origin were randomly assigned to receive intratympanic injections of a dexamethasone solution or isotonic sodium chloride (saline) solution. INTERVENTIONS: Under topical anesthesia and after randomization, 36 patients received 0.5-mL intratympanic injections once per week for 4 weeks of either a 4-mg/mL dexamethasone solution or saline solution. Five patients were excluded from analysis because they did not complete the treatment or did not return for follow-up. MAIN OUTCOME MEASURE: Improvement of tinnitus measured with a visual analog scale. RESULTS: The 2 groups were similar in age, sex, tinnitus laterality, measurement of tinnitus intensity on the visual analog scale, and main otologic diagnosis. We considered a 2-point improvement on the visual analog scale to be significant. Twenty-nine percent of the ears in the saline group and 33% of the ears in the dexamethasone group showed significant improvement immediately after completion of treatment. These measurements were not significantly different from each other. Follow-up varied from 13 to 31 months, and the patients with improved tinnitus returned to the initial measurements over time. CONCLUSIONS: There was no advantage in intratympanic injections of dexamethasone over saline solution in the treatment of severe, disabling tinnitus. Both solutions produced a placebolike improvement.

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Int Tinnitus J. 2004;10(2):113-25.
Ultra-high-Frequency acoustic stimulation and tinnitus control: a positron emission tomography study.
Shulman A, Strashun AM, Avitable MJ, Lenhardt ML, Goldstein BA.
Department of Otolaryngology-Head and Neck Surgery, King’s County Hospital, Brooklyn, New York, USA. metrc@inch.com

Ultra-high-frequency (UHF) external acoustic stimulation with the UltraQuiet device (UQ) has been reported to provide significant relief of severe disabling-type tinnitus. The nuclear medicine imaging technique of positron emission tomography (PET) was selected as a monitoring system to compare objectively metabolic alterations in brain function before and after UHF/UQ and to correlate the PET data with the subjective behavioral response of patients reporting tinnitus relief. PET of brain was completed on 6 patients randomly selected from a cohort of 15 patients included in a protocol to establish long-term tinnitus relief with UHF/UQ. Twelve specific regions of interest (ROI) were selected for PET of brain examination on the basis of results obtained with single-photon emission computed tomography (SPECT) of brain examinations recommended for patients with severe disabling-type tinnitus and demonstrating significant perfusion asymmetries in the right and left brain ROI of the primary auditory cortex; frontal, temporal, parietal, and medial temporal lobes; and cerebellum. PET of brain results included ratios of post- and pre-UHF/UQ stimulation that demonstrated no random response in the selected PET of brain ROI and ratios of post- and pre-UHF/UQ stimulation that demonstrated three categories of response in the selected PET brain ROI for all six patients: hypermetabolism in three patients; hypometabolism in two; and a mixed response in one. Correlation was established for each patient among PET and electrophysiological responses of alteration in minimal masking levels, the residual UHF neuronal response as reflected in the UHF audiogram, and the subjective reported behavioral responses of patients (obtained from outcome questionnaires for tinnitus relief, which focused on tinnitus intensity, annoyance, severity index, and a subjective scale of value of the UHF/UQ device for tinnitus relief. The subjective behavioral response for tinnitus relief with UHF/UQ was found to reflect a dual effect: acoustic stimulation of the residual neuronal function in the UHF range (10-14 kHz) and audiometric thresholds of 40-50 dB sound pressure level (SPL), and the metabolic activity at brain cortex for neuronal reprogramming. The PET of brain categories of response suggested that the UHF/UQ «masking» is predominantly reflective of neuronal reprogramming at the brain cortex. Nuclear medicine PET of brain imaging has provided an objective monitoring system for attempting to establish the efficacy of UHF/UQ for tinnitus relief. No complication of the tinnitus was reported secondary to the PET of brain examination. This limited PET of brain study supports the clinical recommendation of the efficacy of UHF/UQ external acoustic stimulation for a selected population of patients with tinnitus of the severe disabling type.

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Cochrane Database Syst Rev. 2005 Jan 25;(1):CD004739.
Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus.
Bennett M, Kertesz T, Yeung P.
Diving and Hyperbaric Medicine, Prince of Wales Hospital, Barker St., Randwick, NSW, AUSTRALIA, 2031.

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSHL) with or without tinnitus is common and presents a health problem with significant effect on quality of life. Hyperbaric oxygen therapy (HBOT) may improve oxygen supply to the inner ear and thereby result in an improvement in hearing and/or a reduction in the intensity of tinnitus. OBJECTIVES: To assess the benefits and harms of HBOT for treating ISSHL and tinnitus. SEARCH STRATEGY: We searched the Cochrane ENT Specialist Register (June 2004), CENTRAL (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to 2004), EMBASE (1974 to 2004), CINAHL (1982 to 2004), DORCTHIM (1996 to 2004), and reference lists of articles. Researchers in the field were contacted. SELECTION CRITERIA: Randomised studies comparing the effect on ISSHL and/or tinnitus of therapeutic regimens which include HBOT with those that exclude HBOT. DATA COLLECTION AND ANALYSIS: Three reviewers independently evaluated the quality of the relevant trials using the validated Jadad 1996 Oxford-Scale and extracted the data from the included trials. MAIN RESULTS: Five trials contributed to this review (254 subjects, 133 receiving HBOT and 120 control). Pooled data from two trials involving 114 patients (45% of the total) suggested there was a trend towards, but no significant increase in, the chance of a 50% increase in hearing threshold on Pure Tone Average (PTA) over four frequencies when HBOT was used (relative risk (RR) for good outcome with HBOT 1.53, 95% confidence interval (CI) 0.85 to 2.78, P = 0.16). The chance of achieving a 25% increase with HBOT was, however, statistically significant (RR 1.39, 95% CI 1.05 to 1.84, P = 0.02). Fifty-six per cent of the control subjects achieved this outcome versus 78% of the HBOT subjects, with the number-needed-to-treat (NNT) to achieve one extra good outcome being 5 (95% CI 3 to 20). A single trial involving 50 subjects (20% of the total) also suggested a significant improvement in the mean PTA threshold expressed as a percentage of baseline (61% improvement with HBOT, 24% with control, WMD 37%, 95% CI 22% to 53%).The effect of HBOT in tinnitus could not be assessed due to poor reporting.There were no significant improvements in hearing or tinnitus reported in the single study to examine the effect of HBOT on a chronic presentation (six months) of ISSHL and/or tinnitus. AUTHORS’ CONCLUSIONS: For people with early presentation of ISSHL, the application of HBOT significantly improved hearing loss, but the clinical significance of the level of improvement is not clear. We could not assess the effect of HBOT on tinnitus by pooled analysis. The routine application of HBOT to these patients cannot be justified from this review. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powered trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT.There is no evidence of a beneficial effect of HBOT on chronic presentation of ISSHL and/or tinnitus.

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Otolaryngol Head Neck Surg. 2005 Jan;132(1):5-10.
Oral steroid regimens for idiopathic sudden sensorineural hearing loss.
Slattery WH, Fisher LM, Iqbal Z, Liu N.
House Ear Institute, Los Angeles, CA 90057, USA. wslattery@hei.org

OBJECTIVE: To determine hearing recovery in patients with idiopathic sudden hearing loss treated with varying amounts of oral steroids. STUDY DESIGN AND SETTING: A retrospective chart review (n = 75) in a tertiary care clinic examined sudden hearing loss patients treated with 1 60-mg prednisone taper, 1 course of steroid less than a 60-mg taper, or any 2 courses of oral steroid. RESULTS: Overall, 35% of the patients recovered a clinically significant amount of hearing. Recovery was associated with immediate treatment (within 2 weeks from onset), better hearing at the onset of treatment, and treatment with the higher dose of prednisone in patients with just 1 additional symptom (dizziness or tinnitus). Patients tended to continue to experience some recovery in hearing up to 4 months after treatment. CONCLUSION: Immediate treatment of patients with unilateral idiopathic sudden hearing loss and additional symptoms (dizziness or tinnitus) with a 14-day course of 60 mg prednisone (with taper) is recommended. EBM rating: B-3.

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Hear Res. 2005 Jan;199(1-2):81-8.
Objective evaluation of the effects of intravenous lidocaine on tinnitus.
Tayyar Kalcioglu M, Bayindir T, Erdem T, Ozturan O.
Department of Otorhinolaryngology; Inonu University, School of Medicine, Turgut Ozal Medical Center, Malatya 44069, Turkey. mtkalcioglu@hotmail.com

OBJECTIVE: Tinnitus is one of the most common and distressing otological symptoms. Although numerous therapeutic modalities have been tried, there is no consensus regarding effective therapeutic agents up to now. The effects of lidocaine on tinnitus have been reported in literature using either subjective or audiologic tests. Nevertheless, the otoacoustic emissions (OAEs) have not been utilized to demonstrate lidocaine’s effect on the cochlea in the English literature. The aim of this study was to evaluate the effect of lidocaine on tinnitus by considering the alterations with tinnitus, it induces on OAEs and subjective symptoms. METHODS: This study was performed in 30 patients with tinnitus. Twenty-eight of the patients had normal hearing and two of them evidenced mild sensorineural hearing loss. To determine the severity of tinnitus, the patients were required to fill out a tinnitus scoring scale before lidocaine infusion on the same day. Then, lidocaine was administered intravenously to each patient at a dose of 1.5 mg/kg body weight over a period of 30 min. Spontaneous otoacoustic emissions (SOAEs) and distortion product otoacoustic emissions (DPOAEs) were measured three times; namely before lidocaine injection, at 25 min after injection and on the next day. The severity of tinnitus was scored again 1 d, 1 wk and 1 mo after lidocaine administration. RESULTS: Immediately after infusion, four patients (13.3%) declared total suppression of tinnitus, whereas three patients (10%) reported only partial relief in tinnitus subjectively. The patients, who had a subjective improved response (group 1) were compared with the patients, who had no response (group 2). Statistically significant changes (p<0.05) in DPOAE response/growth or input/output (I/O) functions were observed at 1, 2, 3, 4 and 6 kHz frequencies in lidocaine responders and at 1, 2, 3, 4 and 5 kHz frequencies in no responders at different primary stimulus levels. Statistically significant changes (p<0.05) were seen at 2 kHz for 53 dB and at 3 kHz for 62 dB SPL primaries in both groups. When the significant results of these two groups were compared with each other, differences were found insignificant. CONCLUSION: Systematic OAE measurements revealed that no changes occurred in SOAE and DPOAE levels in that alterations disappeared the next day. Subjective relief from tinnitus was stated in some of the patients and lasted for 4 wk at longest.

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Cogn Behav Ther. 2004;33(4):187-98.
Treating chronic tinnitus: comparison of cognitive-behavioural and habituation-based treatments.
Zachriat C, Kroner-Herwig B.
Department of Clinical Psychology and Psychotherapy, University of Gottingen, Gottingen, Germany.

Using a randomized control group trial the long-term efficacy of a habituation-based treatment as conceived by Jastreboff, and a cognitive-behavioural tinnitus coping training were compared. An educational intervention was administered as a control condition. Both treatments were conducted in a group format (habituation-based treatment, 5 sessions; tinnitus coping training, 11 sessions). Educational intervention was delivered in a single group session. Patients were categorized according to their level of disability due to tinnitus (low, high), age and gender and then randomly allocated to the treatment conditions (habituation-based treatment, n = 30; tinnitus coping training, n = 27; educational intervention, n = 20). Data assessment included follow-ups of up to 21 months. Several outcome variables including disability due to tinnitus were assessed either by questionnaire or diary. Findings reveal highly significant improvements in both tinnitus coping training and habituation-based treatment in comparison with the control group. While tinnitus coping training and habituation-based treatment do not differ significantly in reduction of tinnitus disability, improvement in general well-being and adaptive behaviour is greater in tinnitus coping training than habituation-based treatment. The decrease in disability remains stable throughout the last follow-up in both treatment conditions.

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Psychiatr Prax. 2004 Nov;31 Suppl 1:S52-4.
[Low frequency repetitive transcranial magnetic stimulation (rTMS) for the treatment of chronic tinnitus–are there long-term effects?]
[Article in German]
Langguth B, Eichhammer P, Zowe M, Marienhagen J, Kleinjung T, Jacob P, Sand P, Hajak G.
Klinik fur Psychiatrie und Psychotherapie der Universitat am Bezirksklinikum Regensburg. berthold.langguth@medbo.de

OBJECTIVE: Clinical, neurophysiological and neuroimaging data suggest that chronic tinnitus resembles neuropsychiatric syndromes characterised by focal brain activation. Low frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an efficient method in treating brain hyperexcitability disorders. METHODS: Patients suffering from chronic tinnitus underwent a [ (18)F]deoxyglucose-PET (positron emission tomography). Fusioning of the individual PET scan with the structural MRI-scan (magnetic resonance imaging, T1, MPRAGE) revealed an increased metabolic activation in the primary auditory cortex as target point for rTMS. A neuronavigational system enabled the positioning of the figure of eight coil in relation to the target area. rTMS (110 % motor threshold; 1 Hz; 2000 stimuli/day over 5 days) was performed using a placebo controlled cross-over design. RESULTS: Following active rTMS there was a moderate improvement of tinnitus perception. Treatment effects lasted up to six months in some patients. CONCLUSIONS: Neuronavigated rTMS offers new possibilities in the understanding and treatment of chronic tinnitus.

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Otolaryngol Pol. 2004;58(4):821-30.
[Sudden sensorineural hearing loss: a treatment protocol including glucocorticoids and hyperbaric oxygen therapy]
[Article in Polish]
Narozny W, Sicko Z, Przewozny T, Stankiewicz C, Kot J, Kuczkowski J.
Katedra i Klinika Otolaryngologii AM w Gdansku. naroznyw@wp.pl

The aim of this study was to evaluate the efficacy of pharmacological treatment (corticosteroids, vasodilators, vitamins, Betaserc) combined with hyperbaric oxygen therapy (HBO) in the sudden sensorineural hearing loss (SSNHL). We reviewed 52 patients with SSNHL treated pharmacologically and with HBO (group A) between 1997 and 2000. All patients in this group received once daily, five days a week, 100% oxygen in a multiplace chamber under pressure of 2.5 ATA for 60 minutes (plus two 5 minutes air breaks). The other group (group B) consisted of 81 patients treated only pharmacologically between 1980 and 1997. Both groups were similar regarding age, season of the year in which deafness occurred, presence of vestibular symptoms and tinnitus, therapeutic delay from initial symptoms to start of treatment, and initial hearing loss, however there were significant differences in gender and shape of hearing loss. The improvement after treatment was measured by tonal audiometry. The retrospective analysis of audiometries performed in all patients was conducted. The improvement of hearing loss was statistically significantly better for group A (vasodilators, high-dose of corticosteroids, vitamins, Betaserc, HBO) than group B (vasodilators, lower-dose of corticosteroids, vitamins) in any single frequency (500-1000-2000-3000-4000-6000-8000 Hz) and in 4 ranges of frequencies (PTA, HTA, PMTA, OAA) both for relative and absolute values. We concluded that the combined therapy of high-dose corticosteroids and HBO improved the clinical results of treatment in the SSNHL, and therefore should be performed in such cases. We also observed that therapeutic delay and flat hearing loss are predictors of poor clinical outcome.

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Otol Neurotol. 2004 Nov;25(6):1034-1039.
Intratympanic Steroid Treatment: A Review.
Doyle KJ, Bauch C, Battista R, Beatty C, Hughes GB, Mason J, Maw J, Musiek FL.
*Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A., daggerMayo Clinic, Rochester, MN, U.S.A., double daggerRush Medical Center, Chicago, IL, U.S.A., section signCleveland Clinic, Cleveland, OH, U.S.A., and University of Connecticut, Storrs, CT, U.S.A.

OBJECTIVE:: To review published literature regarding the use of intratympanic steroids in the treatment of Meniere’s disease and sudden sensorineural hearing loss and to make recommendations regarding their use based on the literature review. DATA SOURCES:: Literature review from 1996 to 2003, PubMed, Medline Plus, and Web of Science. STUDY SELECTION:: Retrospective case series and uncontrolled prospective cohort studies were the only types of studies available for review. CONCLUSION:: On the basis of the available literature, a weak recommendation is made to use intratympanic steroid treatment of sudden hearing loss if oral steroid therapy fails or is con-traindicated. The available studies regarding intratympanic steroid treatment of Meniere’s disease and tinnitus are inadequate to answer the question of the efficacy of this treatment for these conditions. Higher quality studies are needed.

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Otol Neurotol. 2004 Nov;25(6):916-923.
Usefulness of High Doses of Glucocorticoids and Hyperbaric Oxygen Therapy in Sudden Sensorineural Hearing Loss Treatment.
Narozny W, Sicko Z, Przewozny T, Stankiewicz C, Kot J, Kuczkowski J.
*ENT Department and daggerNational Center for Hyperbaric Medicine in Gdynia, Medical University of Gdansk, Gdansk, Poland.

OBJECTIVE:: We investigated the effect of pharmacologic (steroids, vasodilators, vitamins, and Betaserc) and hyperbaric oxygen therapy on patients with sudden sensorineural hearing loss. METHODS:: The pharmacologic arm of the study consisted of 52 patients with defined sudden sensorineural hearing loss treated simultaneously in the ENT Department and National Center for Hyperbaric Medicine of the Medical University of Gdansk, Poland, from 1997 to 2000 (Group A). The hyperbaric oxygen therapy consisted of exposure to 100% oxygen at a pressure of 250 kPa for a total of 60 minutes in a multiplace hyperbaric chamber. The control group included 81 patients with defined sudden sensorineural hearing loss treated in the ENT Department, Medical University of Gdansk, from 1980 to 1996 (Group B). Both groups were comparable regarding the age of the patients, season of hearing loss occurrence, tinnitus and vestibular symptom frequency, delay before therapy, and average threshold loss before the start of treatment. The treatment results (hearing gain) were estimated using pure-tone audiometry. We retrospectively analyzed the audiograms of all patients. RESULTS:: Patients from Group A (blood flow-promoting drugs, glucocorticoids in high doses, betahistine, and hyperbaric oxygen therapy) showed significantly better recovery of hearing levels compared with those from Group B (blood flow-promoting drugs and glucocorticoids in low doses) at seven frequencies (500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz) (p < 0.05) and four groups of frequencies (pure-tone average, high-tone average, pure middle-tone average, and overall average) (p < 0.05). Percentage hearing gain in all investigated frequencies was also better in Group A versus Group B, and the differences were statistically significant (p < 0.05). CONCLUSION:: We conclude that hyperbaric oxygen therapy with high doses of glucocorticoids improves the results of conventional sudden sensorineural hearing loss treatment and should be recommended. In addition, the best results are achieved if the treatment is started as early as possible.

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Auris Nasus Larynx. 2004 Sep;31(3):226-32.
Efficacy of misoprostol in the treatment of tinnitus in patients with diabetes and/or hypertension.
Akkuzu B, Yilmaz I, Cakmak O, Ozluoglu LN.
Department of Otolaryngology Head and Neck Surgery, Bas kent University Faculty of Medicine, Ankara, Turkey.

OBJECTIVE: To determine the efficacy of the prostaglandin E1 analogue misoprostol in the treatment of tinnitus in diabetic and/or hypertensive patients. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTINGS: Tertiary care referral center. METHODS: The subjects were 42 patients with hypertension and/or diabetes mellitus who had chronic tinnitus and had experienced tinnitus symptoms for a minimum of 6 months. Twenty-eight patients were randomly assigned to Group I (misoprostol treatment), and 14 patients to the Group II (placebo treatment). Misoprostol therapy was started at 200 microg per day, and was increased 200 microg every 7 days until a dose of 800 microg per day was reached. The same numbers of placebo tablets were given to the control group using the same schedule. Both groups were treated for 1 month. The changes in objective and subjective tinnitus findings from baseline to 1 month were assessed, and the group results were compared. The chi(2)-test, student’s t-test and paired-samples t-test were used to analyze the study. RESULTS: At the completion of treatment, objective assessment showed that tinnitus loudness decreased in 13 (46%) of the 28 patients in the experimental group, whereas this was observed in only two (14%) of the 14 subjects in the placebo group. Subjective tinnitus scoring revealed improvement rates of 29 and 14% for the misoprostol and placebo groups, respectively. When t-test relating to difference between rates were performed, the difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant (P = 0.05), but difference between improvement rate based on subjective tinnitus scoring was insignificant (P = 0.22). CONCLUSION: Misoprostol is an effective and safe treatment for chronic tinnitus in hypertensive and/or diabetic patients. Our results are encouraging, but further studies of larger series are needed.

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Int Tinnitus J. 2004;10(1):73-7.
Effects of stapedectomy on tinnitus in patients with otosclerosis.
Sparano A, Leonetti JP, Marzo S, Kim H.
University of Pennsylvania Health Systems, Department of Otorhinolaryngology-Head and Neck Surgery, Philadelphia 19107, USA. amsparano@yahoo.com

Tinnitus frequently accompanies hearing loss in patients with otosclerosis and has been correlated with distinct otosclerotic pathologies. The objective of our study was to evaluate the effect of stapedectomy on tinnitus in patients with otosclerosis. Forty patients were retrospectively interviewed for assessment of preoperative versus postoperative levels of tinnitus distress using the standardized Klockhoff-Lindblom (K/L) classification system. Audiometric data also were examined with respect to tinnitus grades. Of the 40 patients, 34 (85%) had improved K/L tinnitus grades after stapedectomy, 5 (12.5%) had no change, and 1 (2.5%) had a worse K/L grade postoperatively. Twenty-one (52.5%) patients reported complete resolution of tinnitus. Postoperative air-bone gap was less for patients with decreased tinnitus than for those with no change. Significant improvement was seen in the degree of tinnitus distress after stapedectomy for otosclerosis.

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Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2004 Jul;18(7):406-7.
[Adjuvant treatment of anisodamine to acute serous otitis media]
[Article in Chinese]
Jiang Z, Liu W, Zhao C, Zhang L.
Department of Otolaryngology, PUMC Hospital, CAMS and PUMC, Beijing, 100730, China.

OBJECTIVE: To evaluate the adjuvant treatment of anisodamine to acute serous otitis media. METHOD: Sixty-one acute otitis media patients were divided randomly into two groups. Group A with 30 patients were treated with 1% ephedrine nosedrop, antibiotic and antihistamine. Group B with 30 patients were treated with 1% ephedrine nose drops, antibiotic, antihistamine and anisodamine. They took anisodamine 10 mg twice a day. Then the treating efficiency of group A was compared with that of group B in 5 days and 10 days respectively. RESULT: The symptoms including hearing loss, tinnitus, hydrotympanum and eustachian tube function of group B recover more guickly than that of group A. CONCLUSION: Anisodamine adjuvant treatment of acute serous otitis media by improving the function of eustachian tube and microcirculation.

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J Altern Complement Med. 2004 Jul;10(3):468-80.
Clinical research on acupuncture: part 1. What have reviews of the efficacy and safety of acupuncture told us so far?
Birch S, Hesselink JK, Jonkman FA, Hekker TA, Bos A.
Foundation for the Study of Traditional East Asian Medicine, Amsterdam, The Netherlands.

Overview and methods: This paper discusses those medical conditions in which clinical trials of acupuncture have been conducted, and where meta-analyses or systematic reviews have been published. It focuses on the general conclusions of these reviews by further examining official reviews conducted in the United States, United Kingdom, Europe, and Canada each of which examined available systematic reviews. While all reviews agree that the methodological rigor of acupuncture clinical trials has generally been poor and that higher quality clinical trials are necessary, this has not completely hampered the interpretation of the results of these clinical trials. In some conditions the evidence of efficacy has clearly reached a sufficient critical mass from enough well-designed studies to draw clear conclusions; for the rest, the evidence is difficult to clearly interpret. This paper also examines conclusions from the same international reviews on the safety and adverse effects of acupuncture. Here, conclusions are more easily drawn and there is good agreement about the safety of acupuncture. Results and conclusions: General international agreement has emerged that acupuncture appears to be effective for postoperative dental pain, postoperative nausea and vomiting, and chemotherapy-related nausea and vomiting. For migraine, low-back pain, and temporomandibular disorders the results are considered positive by some and difficult to interpret by others. For a number of conditions such as fibromyalgia, osteoarthritis of the knee, and tennis elbow the evidence is considered promising, but more and better quality research is needed. For conditions such as chronic pain, neck pain, asthma, and drug addiction the evidence is considered inconclusive and difficult to interpret. For smoking cessation, tinnitus, and weight loss the evidence is usually regarded as negative. Reviews have concluded that while not free from serious adverse events, they are rare and that acupuncture is a relatively safe procedure.

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Appl Psychophysiol Biofeedback. 2004 Jun;29(2):113-20.
Auditory discrimination training for the treatment of tinnitus.
Flor H, Hoffmann D, Struve M, Diesch E.
Department of Cognitive and Clinical Neuroscience, University of Heidelberg, Central Institute of Mental Health, Quadrat J5, 68159 Mannheim, Germany. flor@zi-mannheim.de

This paper presents a series of 12 cases of chronic tinnitus patients who participated in 4 weeks of auditory discrimination training either close to or far removed from the tinnitus frequency. The training was based on the assumption that tinnitus is related to a shift of the representation of the tinnitus frequency in auditory cortex outside of the normal tonotopic map and that training close to but not removed from the tinnitus frequency should result in a reduction in the severity of the tinnitus. Tinnitus severity was measured 4 times per day during the entire treatment and other tinnitus-related variables were assessed 1 week before and 1 month posttreatment. The comparison of the training close to as compared to remote from the tinnitus frequency did not yield a statistically significant difference. However, a post hoc analysis revealed that patients who engaged in regular training as compared to those who practiced irregularly were significantly more successful in reducing tinnitus severity independent of the trained frequencies. Treatment success was best predicted by days of training and general activity levels. The data suggest that auditory discrimination training shows a dose response effect irrespective of training location and that treatment success is also related to psychological variables. For more substantial changes in multiple variables an extended training period with additional consideration of emotional variables would be necessary. In addition, controls for nonspecific training effects need to be implemented.

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Clin Otolaryngol. 2004 Jun;29(3):226-31.
Ginkgo biloba does not benefit patients with tinnitus: a randomized placebo-controlled double-blind trial and meta-analysis of randomized trials.
Rejali D, Sivakumar A, Balaji N.
Department of Otolaryngology, Monklands Hospital, Airdrie, UK. dariusrejali@hotmail.com

The objective was to ascertain if Ginkgo biloba benefits patients with tinnitus. The study design was: 1. Randomized double blind trial of Ginkgo biloba versus placebo; 2. A meta-analysis of randomized placebo controlled double blind trials. Participants included 66 adult patients with tinnitus and six (including our study) randomized placebo controlled double blind trials were meta-analysed.The main outcome measures were the Tinnitus Handicap Inventory (THI), Glasgow Health Status Inventory (GHSI) and average of hearing threshold at 0.5, 1, 2, 4 kHz. In the meta-analysis the proportion of patients gaining benefit and an overall odds ratio were determined. The results showed the mean difference in change of the THI, GHSI and hearing between Ginkgo biloba (n = 31) and placebo group (n = 29) was 2.51 (CI -10.1, 5.1, P = 0.51), 0.58 (CI-4.8, 3.6, P = 0.38) and 0.68 db (CI -4.13, 2.8, P = 0.69). Meta-analysis revealed 21.6% of Ginkgo biloba treated patients (n = 107/552) gained benefit versus 18.4% (n = 87/504) of placebo treated patients with an odds ratio of 1.24 (CI 0.89, 1.71). In conclusion, Ginkgo biloba does not benefit patients with tinnitus.

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Cochrane Database Syst Rev. 2004;(2):CD003852.
Ginkgo biloba for tinnitus.
Hilton M, Stuart E.
Royal Devon & Exeter Hospital, Barrack Rd, Exeter, Devon, UK, EX2 5DW.

BACKGROUND: Tinnitus can be described as the perception of sound in the absence of external acoustic stimulation. At present no specific therapy for tinnitus is acknowledged to be satisfactory in all patients. There are a number of reports in the literature suggesting that Ginkgo biloba may be effective in the management of tinnitus. However, there also appears to be a strong placebo effect in tinnitus management. OBJECTIVES: To assess the effect of Ginkgo biloba in patients who are troubled by tinnitus. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 4 2003), MEDLINE (1966 – 2003), EMBASE (1974 – 2003), and reference lists of identified publications. Date of the most recent search was December 2003. SELECTION CRITERIA: Adults (18 years and over) complaining of tinnitus.Adults with a primary complaint of cerebral insufficiency where tinnitus forms part of the syndrome. DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data and assessed trials for quality. MAIN RESULTS: Twelve trials were identified from the search as being relevant to the review. Ten trials were excluded on methodological grounds. No trials of tinnitus in cerebral insufficiency reached a satisfactory standard for inclusion in the review. There was no evidence that Ginkgo biloba was effective for the primary complaint of tinnitus. The incidence of side effects was small. REVIEWERS’ CONCLUSIONS: The limited evidence did not demonstrate that Ginkgo biloba was effective for tinnitus which is a primary complaint. There was no reliable evidence to address the question of Ginkgo biloba for tinnitus associated with cerebral insufficiency.

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Eur J Vasc Endovasc Surg. 2004 Jun;27(6):651-3.
Carotid endarterectomy relieves pulsatile tinnitus associated with severe ipsilateral carotid stenosis.
Kirkby-Bott J, Gibbs HH.
Department of Transplant Surgery, St Mary’s Hospital, London W2 1NY, UK.

OBJECTIVES: Pulsatile tinnitus is a rare and often disabling condition. Pulsatile tinnitus sometimes occurs in patients with severe atherosclerotic carotid stenosis. It is uncertain whether carotid endarterectomy (CEA) relieves pulsatile tinnitus in patients with severe carotid stenosis. DESIGN, MATERIALS AND METHODS: This is a retrospective study of 14 patients with pulsatile tinnitus who underwent CEA. Demographic and clinical features and pre-operative duplex results were recorded. Operative results in this group were assessed. RESULTS: CEA relieved symptoms of pulsatile tinnitus in 10 out of 14 cases (70%). Of 10 patients that had lateralisable tinnitus and ipsilateral surgery, 9 (90%) reported symptomatic improvement. CONCLUSIONS: CEA is effective in improving pulsatile tinnitus in patients with unilateral symptoms and severe ipsilateral carotid stenosis.

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HNO. 2004 May;52(5):431-9.
[Attention diversion in tinnitus therapy. Comparison of the effects of different treatment methods]
[Article in German]
Eysel-Gosepath K, Gerhards F, Schicketanz KH, Teichmann K, Benthien M.
Romerwallklinik, Mainz. pek.eysel@t-online.de

BACKGROUND: Diversion or distraction of auditory attention is a core principle of tinnitus retraining therapy as introduced by P. Jastreboff and J. Hazell. The aim of this study was to evaluate the effectiveness of a different form of attention diversion in tinnitus therapy. METHODS AND PATIENTS: In a prospective and randomized study, 40 patients suffering from chronic tinnitus were assigned to two different groups, A or B. All patients received appropriate counselling and were instructed in relaxation training. Patients in group A learned to distract attention away from the tinnitus by using sound or music. White noise generators or hearing aids were applied in this group. Patients in group B were instructed to direct their attention away from the tinnitus using imagination that was facilitated by the use of light and warmth stimuli as distracters. Different standardized questionnaires were used for an evaluation of therapy effectiveness. RESULTS: In both groups, patients were significantly less annoyed and disabled by their tinnitus immediately after therapy and after 6 months. Tinnitus annoyance still proved to be reduced 1 year after the end of the therapy. There were no significant differences in the effects of each treatment. CONCLUSIONS: Attention diversion is an important method for decreasing tinnitus-related distress. Patients should be instructed to use not only auditory but also visual and thermal sensations in order to distract attention away from their tinnitus.

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Otolaryngol Head Neck Surg. 2004 May;130(5):604-10.
Misoprostol in the treatment of tinnitus: a double-blind study.
Yilmaz I, Akkuzu B, Cakmak O, Ozluoglu LN.
Department of Otolaryngology–Head and Neck Surgery, Baskent University School of Medicine, Ankara, Turkey.

OBJECTIVE: To test the efficacy of misoprostol as a treatment for tinnitus. DESIGN: A prospective, placebo-controlled, double-blind study. SETTING: Baskent University Otolaryngology Clinic. PATIENTS: Forty adult patients who had had tinnitus for a minimum of 6 months and were free of systemic or otolaryngologic disease. Twenty-eight patients were randomly assigned to the experimental group (group I) and 12 to the control group (group II). INTERVENTION: The respective groups received active drug and placebo in increasing doses for 4 months. The effect of medications on tinnitus were evaluated by determining improvement rates in tinnitus loudness and subjective tinnitus scoring. RESULTS: In the experimental group, 18 of 28 patients showed improvement in tinnitus loudness, representing an improvement rate of 64%. The improvement rate based on subjective tinnitus scoring was 36% (10 of 28 patients). In the control group, the improvement rate for tinnitus loudness was 33% (n = 4), and the rate for subjective tinnitus scoring was 17% (n = 2). The difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant (P = 0.039), but difference between improvement rate based on subjective tinnitus scoring was insignificant (P = 0.119). When results in the experimental group were analyzed according to etiological factors, the improvement rate was highest in the sudden-onset subgroup (77%). CONCLUSIONS: Misoprostol provided therapeutic relief for some patients with tinnitus we studied, but further investigation of larger groups is needed.

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Laryngoscope. 2004 Mar;114(3):495-500.
High-frequency pulsed electromagnetic energy in tinnitus treatment.
Ghossaini SN, Spitzer JB, Mackins CC, Zschommler A, Diamond BE, Wazen JJ.
Departments of Otolaryngology-Head and Neck Surgery, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York, USA.

OBJECTIVES/HYPOTHESIS: Electromagnetic therapy has been used with reported success in multiple clinical settings, including the treatment of seizure disorders, brain edema, migraine headaches, revascularization of burn wounds, and diabetic ulcers. The purpose of the study was to investigate the effect of pulsed high-frequency electromagnetic therapy on chronic tinnitus. STUDY DESIGN: A randomized, prospective, double-blind, placebo-controlled pilot study was conducted to evaluate the effectiveness of high-frequency pulsed electromagnetic energy using the Diapulse device in the treatment of chronic tinnitus. Thirty-seven adult patients with chronic tinnitus of at least 6 months’ duration were recruited and randomly assigned to either a treatment or a placebo group. METHODS: Patients received 30-minute treatments with the Diapulse device three times a week for 1 month. The unit was set to deliver electromagnetic energy at a frequency of 27.12 MHz at a repetition rate of 600 pulses per second. All subjects had pretreatment and post-treatment audiological testing, including tinnitus frequency and intensity matching. They responded to a tinnitus rating questionnaire and the Tinnitus Handicap Inventory before and after treatment. RESULTS: There was no significant change in the pretreatment and post-treatment audiometric thresholds in either group. There were no significant differences between the pretreatment and post-treatment Tinnitus Handicap Inventory scores or the tinnitus rating scores in either subject group (Student t test). No diagnosis-specific differences were identified. CONCLUSION: High-frequency pulsed electromagnetic energy (Diapulse) at the settings used in the study showed no role in the therapy of patients with chronic tinnitus.

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Neurosurgery. 2004 Apr;54(4):876-83.
Endoscope-assisted Microsurgery for Microvascular Compression Syndromes.
Rak R, Sekhar LN, Stimac D, Hechl P.
Department of Neurosurgery, North Shore University Hospital, Great Neck, New York.

OBJECTIVE: To discuss the results of endoscope-assisted surgery in microvascular decompression (MVD) of Cranial Nerves (CNs) V, VII, and VIII. METHODS: Neuroendoscopy was used as an adjunct to the surgical microscope in the MVD of the trigeminal (17 patients), facial (10 patients), and vestibulocochlear (1 patient) nerves in a series of 28 consecutive patients. After a standard microsurgical approach to CNs V, VII, and VIII, the endoscope was used to inspect all aspects of neural anatomy, to assess vascular compression, and to check the results of the decompression. Endoscope use was graded in four categories: Grade I, used but no definite role; Grade II, visualization assisted; Grade III, procedure assisted; and Grade IV, primary role. The usefulness of the endoscope was evaluated in each case. RESULTS: The endoscope was useful in visualizing the anatomy in all cases. It was especially useful in establishing trigeminal vein compression of CN V in Meckel’s cave; observing multiple sources of vascular compression; ensuring adequate decompression after cauterization of vein, insertion of the Teflon felt, or a pexy procedure; and permitting observation of the compression of CN VII at the root exit zone by small arteries and veins. In six patients with trigeminal neuralgia, the trigeminal vein was cauterized and divided by using endoscopic vision only because the venous compression was not completely visualized with the microscope. During a follow-up period of 6 to 52 months (mean, 29 mo; median, 40 mo), all patients were asymptomatic and receiving no medication. CONCLUSION: The endoscope is a useful adjunct to MVD in the treatment of trigeminal neuralgia, hemifacial spasm, and disabling positional vertigo or tinnitus.

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HNO. 2004 Mar;52(3):242-7.
[Counselling versus cognitive group therapy for tinnitus. A retrospective study of their efficacy]
[Article in German]
Schmidt A, Lins U, Wetscher I, Welzl-Muller K, Weichbold V.
Klinische Abteilung fur Hor-, Stimm- und Sprachstorungen, Universitatskliniken Innsbruck, Austria. annette.schmidt@uklibk.ac.at

BACKGROUND: Both counselling and group therapy have been recommended for supporting patients with chronic tinnitus. It is unclear which of these treatments is superior. SCIENTIFIC QUESTION: This retrospective study aimed at comparing relief from tinnitus distress following counselling with that following cognitive group therapy. Distress relief was also compared to the distress level of the waiting group patients. METHOD: Tinnitus distress was assessed through the Tinnitus Questionnaire (TQ, Goebel and Hiller) at three different times: before treatment (in waiting list patients: at initial contact) and at 3 and 6 months after initial assessment. Data from 21 patients per group were included in the analysis. RESULTS: The initial tinnitus distress scores were similar in all groups (about 48 TQ points out of a maximum of 84). After 3 months, both counselling subjects and group therapy participants exhibited a significant distress reduction of 13 TQ points, which remained stable after 6 months. Patients on the waiting list experienced no distress relief over time. CONCLUSION: Results from our data demonstrate the need for a future prospective study on the comparison of efficacy of counselling vs cognitive group therapy.

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HNO. 2004 Mar;52(3):227-34.
[The efficiency of spinal manipulation in otorhinolaryngology. A retrospective long-term study]
[Article in German]
Hulse M, Holzl M.
Abt. Phoniatrie, Padaudiologie und Neurootologie, Univ.-HNO-Klinik Mannheim. manfred.huelse@hno.ma.uni-heidelberg.de

BACKGROUND: The vertebral genesis of many functional disorders in otorhinolaryngology, such as dizziness, hearing-impairment, ear-pressure, ear-pain, foreign body sensation in the throat and dysphonia, is suggested by the success of spinal manipulative therapy, particularly of the atlanto-occipital joint. Up to now, there are no retrospective investigations which show the duration of the therapeutic effect. METHODS: We examined 220 patients with cervical otorhinolaryngological disorders (100 patients with dizziness, 49 with hearing impairment, 47 with tinnitus and 24 with dysphonia) after cervical manipulation lasting more than 6 months. RESULTS AND CONCLUSIONS: The extraordinary satisfaction with the manipulative therapy in 82% of patients with dizziness (46% total relief, 36% high improvement) reflects the high efficiency of this manual therapy. In contrast to these results, only 10% of patients with tinnitus showed an improvement (P<0.001). This retrospective investigation demonstrates that a successful outcome after manual therapy is not based on a «placebo effect».

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J Clin Psychol. 2004 Feb;60(2):171-8.
Internet-based cognitive behavioral therapy for tinnitus.
Andersson G, Kaldo V.
Department of Psychology, Uppsala University, Sweden. gerhard.andersson@psyk.uu.se

Tinnitus is a common otological problem that is often resistant to surgical or medical interventions. In common with chronic pain, cognitive-behavioral treatment has been found to alleviate the distress and improve the functioning of tinnitus patients. Recently, a self-help treatment has been developed for use via the Internet. In this article, we describe the self-help program and apply it to a middle-aged woman with tinnitus. We report the case formulation, which was done in a structured interview, and the treatment interactions, which were conducted via e-mail. The self-help program was presented on Web pages, and weekly diaries were submitted to follow progress and give feedback. The treatment was successful with reductions of tinnitus-related annoyance and anxious and depressive mood. Implications for Internet administration of self-help treatment are discussed. Copyright 2003 Wiley Periodicals, Inc.

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Ther Umsch. 2004 Jan;61(1):15-20.
[Tinnitus]
[Article in German]
Kompis M, Neuner NT, Hemmeler W, Hausler R.
Klinik fur Hals-, Nasen- und Ohrenkrankheiten, Hals- und Kopfchirurgie, Inselspital, Universitat Bern, Bern.

Tinnitus is an auditory perception without adequate axternal acoustic sources. The incidence of tinnitus in the general population is high, and can lead to total decompensation in some of the affected patients. Tinnitus is a symptom of an unspecific lesion of the ear or the central auditory system. In many cases, the cause of tinnitus can be inferred from the medical history and from the results of specific medical examines. Nevertheless, in many cases there is still no causal therapy available. As a result, for most patients approaches such as proper counselling, the fitting of hearing aids or tinnitus retraining therapy are adopted.

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Lakartidningen. 2003 Nov 13;100(46):3744-9.
[Tinnitus treatment is guided by etiology. Noise, stress or anxiety/depression plausible causes]
[Article in Swedish]
Holgers KM.
Sahlgrenska Universitetssjukhuset, Sahlgrenska Akademin, Goteborg. kajsa-mia.holgers@vgregion.se

Tinnitus may be a clinical symptom of disturbances in the auditory system but also of stress. Noise exposure may be a trigger. Severe tinnitus may have an impact on the working capacity, and in the management of tinnitus. It is essential to differ between the etiologies to the emergence of tinnitus and to the suffering of it. The majority of the adults, and a third of the children seeking help for tinnitus have anxiety and/or depressive disorders. Consequently, it is of great importance to early identify and treat these conditions.

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Ear Nose Throat J. 2003 Oct;82(10):781-4.
Assessment of intravenous lidocaine for the treatment of subjective tinnitus.
Otsuka K, Pulec JL, Suzuki M.
Department of Otolaryngology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, Japan 160-0023. otsukaent@aol.com

Despite the development of sophisticated diagnostic procedures and treatments for other otologic and neurotologic conditions, tinnitus remains difficult to manage. Several investigators have shown that lidocaine has an effect on temporarily (for several minutes) relieving subjective tinnitus, but few reports have described the response to lidocaine according to different individual patient characteristics. Over a 24-year period, we administered either 60 or 100 mg of intravenous lidocaine to 117 ears in 103 patients with subjective tinnitus (14 patients received treatment bilaterally). Within 5 minutes of treatment, 83 ears (70.9%) experienced either complete or partial relief. The 100-mg dose was more effective than the 60-mg dose in completely eliminating tinnitus (34.9 vs 20.6%), but the two doses were comparable when elimination rates were combined with rates of reduction of tinnitus (71.1 and 70.6%, respectively). With respect to individual patient characteristics, ears with low- to middle-tone tinnitus had a better response, as did ears in which the hearing level was 40 dB or higher and ears of patients aged 60 years and older. The response to lidocaine was not correlated with the baseline loudness of tinnitus or to its duration.

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Int Tinnitus J. 2003;9(1):32-6.
Use of high-frequency and muscle vibration in the treatment of tinnitus.
Lenhardt ML, Goldstein BA, Shulman A, Guinta R.
Program in Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA. lenhardt@hsc.vcu.edu

Although tinnitus is defined as an internal auditory sensation, external auditory stimuli can mask tinnitus under some circumstances. High-frequency vibration delivered as bone conduction stimulation is effective in masking high-pitched tinnitus. In this preliminary report, somatosensory stimulation in the form of low-frequency muscle vibration can also mask high-frequency tinnitus. Somatosensory stimulation provides fast, immediate relief, whereas high-frequency vibration provides longer-lasting benefit. Either modality can stand alone or can be used in conjunction for tinnitus treatment. A clinically feasible technique has been identified for more wide-scale evaluation.

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Int Tinnitus J. 2003;9(1):3-10.
Gene-based diagnostic and treatment methods for tinnitus.
Martin DM, Raphael Y.
Departments of Pediatric Genetics and Human Genetics, University of Michigan, 9220B MSRB-3, Ann Arbor, MI 48109-0648, USA.

The etiology of tinnitus combines hereditary and environmental factors. To help develop optimal therapies for tinnitus, it is necessary to characterize the genetic contributors to the pathophysiology and to design treatments at the level of the gene. Inner ear gene therapy involves delivery of genes into the vestibular or auditory portions of the inner ear for preventive or reparative therapies at the level of the sensory epithelium or the eighth nerve neurons. BDNF and GDNF are among the neurotrophic factors shown to be overexpressed with gene therapy and to protect the inner ear against trauma. Combined treatment with Ad.GDNF and electrical stimulation provided enhanced preservation of denervated spiral ganglion neurons. The use of viral vectors for gene therapy may involve side effects, including immune response to the viral proteins. Treatment with immunosuppressive medications can reduce the negative consequences of adenovirus-mediated gene therapy.

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Am Fam Physician. 2003 Sep 1;68(5):923-6.
Ginkgo biloba.
Sierpina VS, Wollschlaeger B, Blumenthal M.
Dept. Family Medicine, University of Texas Medical Branch, Galveston, Texas 77555-1123, USA. vssierpi@utmb.edu

Ginkgo biloba is commonly used in the treatment of early-stage Alzheimer’s disease, vascular dementia, peripheral claudication, and tinnitus of vascular origin. Multiple trials investigating the efficacy of ginkgo for treating cerebrovascular disease and dementia have been performed, and systematic reviews suggest the herb can improve the symptoms of dementia. Ginkgo is generally well tolerated, but it can increase the risk of bleeding if used in combination with warfarin, antiplatelet agents, and certain other herbal medications. Clinical issues of safety, dosing, use in the perioperative period, and pharmacology are addressed in this review.

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Lasers Med Sci. 2003;18(3):154-61.
Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: a feasibility study for
chronic tinnitus.
Tauber S, Schorn K, Beyer W, Baumgartner R.
Department of Otolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, D-81377 Munich, FRG. drtauber@yahoo.de

Low-level-laser-therapy (LLLT) targeting the inner ear has been discussed as a therapeutic procedure for cochlear dysfunction such as chronic cochlear tinnitus or sensorineural hearing loss. Former studies demonstrate dose-dependent biological and physiological effects of LLLT such as enhanced recovery of peripheral nerve injuries, which could be of therapeutic interest in cochlear dysfunction. To date, in patients with chronic tinnitus mastoidal and transmeatal irradiation has been performed without systematic dosimetric assessment. However, light-dosimetric studies on human temporal bones demonstrated that controlled application of laserlight to the human cochlea depends on defined radiator position within the external auditory meatus. This feasibility study first presents a laser application system enabling dose-controlled transmeatal cochlear laser-irradiation (TCL), as well as preliminary clinical results in patients with chronic cochlear tinnitus. The novel laser TCL-system, consisting of four diode lasers (lambda=635 nm-830 nm) and a new specific head-set applicator, was developed on the basis of dosimetric data from a former light-dosimetric study. In a preliminary clinical study, the TCL-system was applied to 35 patients with chronic tinnitus and sensorineural hearing loss. The chronic symptoms persisted after standard therapeutic procedures for at least six months, while retrocochlear or middle-ear pathologies have been ruled out. The patients were randomised and received five single diode laser treatments (lambda=635 nm, 7.8 mW cw, n=17 and lambda=830 nm, 20 mW cw, n=18) with a space irradiation of 4 J/cm2 site of maximal cochlear injury. For evaluation of laser-induced effects complete otolaryngologic examinations with audiometry, tinnitus masking and matching, and a tinnitus-self-assessment were performed before, during and after the laser-irradiation. The first clinical use of the TCL-system has been well tolerated without side-effects and produced no observable damage to the external, middle or inner ear. Changes of tinnitus loudness and tinnitus matching have been described. After a follow-up period of six months tinnitus loudness was attenuated in 13 of 35 irradiated patients, while two of 35 patients reported their tinnitus as totally absent. Hearing threshold levels and middle ear function remained unchanged. Further investigations by large double-blind placebo-controlled studies are mandatory for clinical evaluation of the presented TCL-system and its therapeutic effectiveness in acute and chronic cochlear dysfunction.

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Psychother Psychosom Med Psychol. 2003 Aug;53(8):344-52.
[Psychosomatic stress factors in compensated and decompensated tinnitus]
[Article in German]
Stobik C, Weber RK, Munte TF, Frommer J.
Westerwaldklinik Waldbreitbach, Schwerpunktklinik fur Neurologie und Neurologische Psychosomatik.

AIMS: In modern medical practice, chronic decompensated tinnitus is defined as a complex psychosomatic process in which mental and social factors are considered to have a determining effect on the patient’s subjective response to the impairment of otological or other somatic functions attributed to tinnitus. What is still largely unknown is the interaction of the individual factors and their impact on the patient’s ability to cope with tinnitus. The impact of psycho-social and somatic factors on the subjective experience of patients with compensated and decompensated tinnitus is evaluated. PATIENTS AND METHODS: 53 patients with chronic tinnitus were divided into two groups, compensated and decompensated, on the basis of their subjective experience of the disorder, established according to the tinnitus questionnaire published by Goebel and Hiller. Self-assessment instruments and a survey of symptoms of somatic stress disorders were used to compare the two groups in terms of differences in the patients’ mental and psycho-social behaviour, in their strategies for coping with tinnitus and in the incidence of co-morbidity. RESULTS: The patients with decompensated tinnitus suffered from more pronounced mental and social disabilities, were more prone to depression and used less effective techniques to cope with their illness. The principal difference between the two groups, however, appeared to lie in a significantly higher degree of somatic multi-morbidity, where a particularly strong correlation was found between tinnitus and the incidence of cardiovascular diseases and hypacusis. 81 percent of the total sample of patients suffered from impaired hearing. Patients with decompensated tinnitus experienced greater communication difficulties as a result of their auditory impairment. CONCLUSIONS: In the diagnosis and therapy of tinnitus, in addition to psychic and psycho-social aspects greater attention ought to be paid to somatic factors, influencing the patient’s ability to cope with the disorder.

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Pharmacopsychiatry. 2003 Jun;36 Suppl 1:S44-9.
Magnitude of effect and special approach to Ginkgo biloba extract EGb 761 in cognitive disorders.
Le Bars PL.
New York University Medical Center, New York, NY, USA.

In the early 70’s, improvements in methodical procedures of extraction and standardization of ginkgo preparation allowed the production of a highly concentrated and stable extract (EGb 761) (definition see editorial) by the company Dr. Willmar Schwabe, which could be systematically tested in scientific programs. Consequently, numerous studies have been undertaken and provided replicable outcomes to demonstrate its efficacy in human population. EGb 761 is currently registered as an ethical drug in more than 50 countries around the world, and is prescribed for a range of neurological and vascular disorders including dementia, arterial occlusive disease, retinal deficit, and tinnitus. The following chapter will focus on the relevant data that support EGb 761 efficacy in the treatment of cognitive disorders in general, and dementia in particular. Besides the published data, the author will provide original results unveiling different factors that could interfere with EGb 761 efficacy and may be the source of the variations observed among studies in the EGb 761 literature. In the author’s opinion, such factors should be taken into consideration when implementing the design of future research and optimizing individual EGb 761 response in the clinical practice. Within the framework of this new approach, the author will not only answer the question as to whether EGb 761 works over placebo in cognitive disorders, but also attempt to estimate how well it works in particular conditions.

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Kulak Burun Bogaz Ihtis Derg. 2003 May;10(5):183-7.
[The incidence of hyperinsulinemia in patients with tinnitus and the effect of a diabetic diet on tinnitus]
[Article in Turkish]
Basut O, Ozdilek T, Coskun H, Erisen L, Tezel I, Onart S, Hizalan I.
Department of Otolaryngology, Medicine Faculty of Uludag University, Bursa, Turkey. basut@uludag.edu.tr

OBJECTIVES: We investigated the incidence of hyperinsulinemia in patients presenting with tinnitus and evaluated the effect of diabetic diet on tinnitus. PATIENTS AND METHODS: Serum insulin levels were measured and oral glucose tolerance test was performed in 52 patients (26 males, 26 females; mean age 50 years; range 20 to 80 years) with idiopathic tinnitus. Those with hyperinsulinemia were given a diabetic diet for four months. A questionnaire was administered to all the patients and the complaint of tinnitus was assessed according to a rating scale before and after treatment. The results were compared with those of 15 age-and sex-matched controls. RESULTS: Hyperinsulinemia was detected in 76% and 27% of the patients and the controls, respectively (p<0.05). Oral glucose tolerance test was normal in 48% of the patients, and in 80% of the controls (p<0.05). Following a diabetic diet, the severity of tinnitus complaints significantly decreased in patients with hyperinsulinemia (p<0.0001). CONCLUSION: Hyperinsulinemia may play an etiologic role in tinnitus and a diabetic diet may result in significant improvement in tinnitus complaints in this population.

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Otol Neurotol. 2003 May;24(3):478-85.
Electrical suppression of tinnitus with high-rate pulse trains.
Rubinstein JT, Tyler RS, Johnson A, Brown CJ.
Department of Otolaryngology, University of Iowa, Iowa City, Iowa 52242, USA. jay-rubinstein@uiowa.edu

HYPOTHESIS: Application of high-rate pulse trains (e.g., 4800 pps) to the cochlea may represent an effective treatment of tinnitus. BACKGROUND: Tinnitus is a widespread clinical problem with multiple treatments but no cure. A cure for tinnitus would restore the perception of silence. One plausible hypothesis for the origin of tinnitus associated with sensorineural hearing loss is that it is due to loss or alteration of the normal spontaneous activity in the deafferented regions of the cochlea. Electrical stimulation of the cochlea with 5000-pps pulse trains can produce spontaneous-like patterns of spike activity in the auditory nerve. METHODS: Eleven volunteer human subjects with bothersome tinnitus and high-frequency sensorineural hearing loss underwent myringotomy and temporary placement of a round window electrode. High-rate pulse train stimuli were presented at various stimulus intensities and tinnitus, and stimulus perception were scaled by the subject. Three cochlear implant recipients with tinnitus in the implanted ear underwent similar stimulation. RESULTS: Five of 11 (45%) of transtympanic subjects showed substantial or complete tinnitus suppression with either no perception or only a transient perception of the stimulus. Three showed tinnitus suppression only in association with the perception of the stimulus. Three showed no effects on tinnitus. A similar pattern of responses was seen in the cochlear implant subjects. CONCLUSIONS: Although the study lacked an ideal placebo control, the results are promising and support further research to develop a clinically useful intervention for this troubling disorder.

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Lakartidningen. 2003 May 8;100(19):1708-13.
[Tinnitus affects 15 percent–today’s environmental noise a risk factor. Early treatment can prevent chronic problems]
[Article in Swedish]
Andersson G, Kaldo-Sandstrom V, Larsen HC.
Audiologavdelningen, Akademiska sjukhuset, Institutionen for psykologi, Uppsala universitet, Uppsala. gerhard.andersson@psyk.uu.se

A substantial proportion of individuals in the general population have tinnitus and 1-3% suffer from severe tinnitus affecting sleep, concentration, and mood. For a majority of patients with tinnitus degree of hearing loss plays a significant role. Several potential causes and aggravating factors have been suggested, but there is still not a single theory available to explain why tinnitus is so bothersome for some individuals. Recent research has investigated neural correlates of tinnitus, mainly involving primary and secondary auditory cortex. Several treatments have been tested with modest results. However, for the alleviation of tinnitus-related distress there is now empirical support for the use of cognitive-behavioural treatment methods. Future efforts should focus on prevention of noise-induced hearing loss and ways to foster habituation to tinnitus.

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Otolaryngol Clin North Am. 2003 Apr;36(2):353-8.
Transtympanic management of tinnitus.
Hoffer ME, Wester D, Kopke RD, Weisskopf P, Gottshall K.
Department of Defense Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center San Diego, San Diego, CA 92134-2200, USA. mehoffer@nmcsd.med.navy.mil

Transtympanic therapy is becoming and important treatment modality for many inner ear disorders. The current therapies aimed at Meniere’s disease, sudden sensorineural hearing loss, noise-induced hearing loss, and the tinnitus associated with these disorders and idiopathic tinnitus, however, represents simply an evolutionary step in this treatment modality and must be validated by further scientific study. A number of promising developments including newer more targeted neuroactive medicines, a better understanding of medicine delivery, and the knowledge of the site, origin, and pathophysiology of the symptoms complex will make this therapy more effective. In the future it is possible that many inner ear disorders will be amenable to inner ear medical therapy. Ideally in the future with knowledge of the disease and its etiology the physician will simply pick the established medicine, the established dose, and the established route of administration and achieve a relatively predictable result.

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J Psychosom Res. 2003 Apr;54(4):381-9.
The management of chronic tinnitus: comparison of an outpatient cognitive-behavioral group training to minimal-contact interventions.
Kroner-Herwig B, Frenzel A, Fritsche G, Schilkowsky G, Esser G.
Department of Clinical Psychology and Psychotherapy, University of Gottingen, Gosslerstr. 14, Federal Republic of Germany. bkroene@uni-goettingen.de

OBJECTIVE: Using a randomized group design, the efficacy of an outpatient cognitive-behavioral Tinnitus Coping Training (TCT) was compared to two minimal-contact (MC) interventions. METHODS: TCT was conducted in a group format with 11 sessions (total n=43). One MC [MC-E (education), n=16] consisted of two group sessions in which education on tinnitus was presented and self-help strategies were introduced. The second MC [MC-R (relaxation), n=16] comprised four sessions. Besides education, music-supported relaxation was suggested as self-help strategy and audiotapes with relaxing music were provided. Furthermore, a waiting-list control group was installed (WC, n=20). Data were assessed at baseline (pretherapy) and at posttherapy period. Only TCT was additionally evaluated at a 6-month and a 12-month follow-up. Several outcome variables (e.g., awareness of tinnitus) were recorded in a tinnitus diary. Tinnitus coping and disability due to tinnitus were assessed by questionnaires. Subjective ratings of improvement were also requested from the patients. Furthermore, inventories of psychopathology were given to the patients. RESULTS: Findings reveal highly significant improvements in TCT in comparison to the control group (WC). MC interventions do not differ significantly from each other, but are superior to WC in a few domains of outcome. Outcome in TCT is somewhat superior to combined MC interventions in two domains of data, but not regarding disability reduction. Effect sizes, nevertheless, indicate distinct differences in degree of improvement, with TCT achieving the best results. CONCLUSIONS: A sequential scheme for the treatment of chronic tinnitus is discussed on the basis of cost-effectiveness considerations.

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Otolaryngol Clin North Am. 2003 Apr;36(2):345-52.
Cochlear implantation for tinnitus suppression.
Miyamoto RT, Bichey BG.
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 702 Barnhill Drive, #860, Indianapolis, IN 46202, USA.

A high prevalence of tinnitus in cochlear implant users has been demonstrated, but fortunately a large percentage of patients do report some degree of tinnitus suppression postoperatively. Improvements in the duration and intensity and the annoyance level and loudness of the perceived tinnitus postimplant have been demonstrated. The risk of worsening of the tinnitus percept after cochlear implantation is small.

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Otolaryngol Clin North Am. 2003 Apr;36(2):337-44.
Tinnitus reduction using transcutaneous electrical stimulation.
Steenerson RL, Cronin GW.
Atlanta Ear Clinic, 980 Johnson Ferry Road, Suite 470, Atlanta, GA 30342, USA. earclinic@mindspring.com

Electrical stimulation as a treatment for tinnitus seems to be effective in about 50% of patients with tinnitus of various causes. Electrical stimulation as a treatment for tinnitus is safe, if delivered within the parameters described in this article.

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Otolaryngol Clin North Am. 2003 Apr;36(2):321-36.
Tinnitus retraining therapy for patients with tinnitus and decreased sound tolerance.
Jastreboff PJ, Jastreboff MM.
Tinnitus and Hyperacusis Center, Department of Otolaryngology, Emory University School of Medicine, 1365A Clifton Road, NE, Atlanta, GA 30322, USA. pjastre@emory.edu

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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Otolaryngol Clin North Am. 2003 Apr;36(2):307-20, vii.
Masking devices and alprazolam treatment for tinnitus.
Vernon JA, Meikle MB.
Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, Portland, OR 97239-3098, USA. vernonj@ohsu.edu

Effective tinnitus relief can be achieved in a large percentage of patients using appropriately selected wearable devices that provide masking of the tinnitus. Guidelines are presented for selecting between three types of devices for that purpose: (1) tinnitus maskers; (2) hearing aids; and (3) tinnitus instruments (units that combine hearing aid and masker in the same case). For patients whose tinnitus cannot be masked, oral administration of alprazolam may be an effective alternative, which should be done with the knowledge and cooperation of the patient’s primary care physician. Dosages and guidelines for administering alprazolam are presented.

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Acta Otorrinolaringol Esp. 2003 Apr;54(4):237-41.
[Sulpiride as initial treatment in tinnitus retraining therapy]
[Article in Spanish]
Lopez Gonzalez MA, Muratori Leon ML, Moreno Vaquera J.
Servicio ORL, Hospitales Universitarios Virgen del Rocio, Sevilla. malopez@cica.es

With this study we try to find out the interaction of sulpiride in tinnitus pathology. This, could help us to control better the tinnitus through tinnitus retraining therapy. MATERIAL AND METHODS: A hundred patients with tinnitus were divided into two groups of 50. Fifty milligrams of sulpiride or placebo were administered for three months, three time per day, with monthly controls. Clinical response, audiometry, tympanometry and acufenometry were registered. RESULTS: In the first month of treatment, only 58% of patients treated with sulpiride improved, and 17% of those treated with placebo, with statistical significance. In the second month, 41% and 20% respectively, and in the third month, 42% and 17% respectively. CONCLUSION: In patients with tinnitus, treatment with sulpiride has improved more than half of them in the first month of treatment. This time is crucial to begin tinnitus retraining therapy and to obtain a greater efficacy.

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J Laryngol Otol. 2003 Apr;117(4):261-4.
Effect of stapedectomy on subjective tinnitus.
Szymanski M, Golabek W, Mills R.
Department of Otolaryngology, Medical University of Lublin, Poland. marcinszym@poczta.onet.pl

A series of 149 patients, who had tinnitus associated with otosclerosis, and who underwent stapedectomy by a single operator were questioned about their tinnitus one to 19 years after surgery. Of these, 73 per cent reported that their tinnitus had ceased following surgery, 17 per cent that it had improved and only 10 per cent that it was unchanged. No pre-operative audiometric or patient data were associated with a favourable outcome in terms of tinnitus improvement. Patients who had poor hearing outcomes reported abolition of their tinnitus, suggesting that this was due to the improvement in the fluid mechanics of the cochlea resulting from stapedectomy. The tinnitus status was unrelated to the length of follow-up time.

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Geriatrics. 2003 Feb;58(2):28-34.
Tinnitus. Diagnosis and treatment of this elusive symptom.
Noell CA, Meyerhoff WL.
Department of Otorhinolaryngology, University of Texas Southwestern Medical Center, Dallas, USA.

More than 37 million Americans experience tinnitus, and adults age 40 to 70 are most often affected. Tinnitus is a symptom, not a disease, and as such has many different causes. Tinnitus is classified as vibratory and nonvibratory and is further subdivided into objective and subjective categories. The evaluation of tinnitus always begins with a thorough history and physical examination, with further testing performed when indicated. Many medical and nonmedical treatments exist, with varying degrees of success and safety. Once the physician determines that the patient does not have a life-threatening or obviously treatable underlying condition, the patient should be counseled, reassured that the tinnitus is not a life-threatening disease, and offered appropriate treatment. The degree to which the tinnitus bothers the patient will help determine the extent of treatment necessary.

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Otol Neurotol. 2003 Jan;24(1):86-9.
The role of zinc in the treatment of tinnitus.
Arda HN, Tuncel U, Akdogan O, Ozluoglu LN.
Department of Ear, Nose, Throat, Head and Neck Surgery, Ankara Numune Research andf Education Hospital, Turkey. nedard@yahoo.com

OBJECTIVE: This study was designed to investigate the role of zinc administration in treatment of tinnitus. STUDY DESIGN: Randomized, prospective, placebo-controlled study. SETTING: Patients with tinnitus were admitted to the ear, nose, and throat clinic of the authors’ hospital. PATIENTS: Patients with tinnitus with no know pathologic conditions of the ear, nose, and throat; the mean age of 28 patients receiving zinc was 51.2 years, and that of 13 patients given placebo was 55 years. INTERVENTION: Blood zinc levels were measured. Frequency was detected by audiometry, and loudness of tinnitus was screened by tinnitus match test. A questionnaire that scored tinnitus subjectively between 0 and 7 was given to patients before zinc treatment. After 2 months of treatment (zinc 50 mg daily to zinc group, placebo pill containing starch to placebo group), all of the tests were performed again. There was no difference in age, sex, duration of tinnitus, and affected ears between the patients treated with zinc and those treated with placebo. Blood zinc levels were lower than normal in 31% of patients before treatment. MAIN OUTCOME MEASURES: A decrease in tinnitus loudness by at least 10 dB was accepted as clinically favorable progress. A decrease of more than 1 point in subjective tinnitus scoring was accepted as valid. RESULTS: Clinically favorable progress was detected in 46.4% of patients given zinc. Although this decrease was not statistically significant, the severity of subjective tinnitus decreased in 82% of the patients receiving zinc. The mean of subjective tinnitus decreased from 5.25 +/- 1.08 to 2.82 +/- 1.81 ( < 0.001). However, the decrease in severity of the tinnitus was not significant in patients receiving placebo. CONCLUSION: It can be concluded that patients with tinnitus may have low blood zinc levels (31%) and clinical and subjective improvement can be achieved by oral zinc medication. However, it remains to be seen whether the longer duration of treatment has more significant results.

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Zhonghua Yi Xue Za Zhi. 2002 Nov 10;82(21):1464-7.
[Tinnitus retraining therapy: a clinical control study of 117 patients]
[Article in Chinese]
Wang H, Jiang S, Yang W, Han D.
Department of Otolaryngology and Head Neck Surgery, Institute of Otolaryngology, General Hospital of Chinese People’s Liberation Army, Beijing 100853, China.

OBJECTIVE: To investigate the clinical effects of tinnitus retraining therapy (TRT) on tinnitus. METHODS: 225 tinnitus patients were divided into two groups. 117 patients in the TRT group were treated with TRT and drugs, and 108 patients in the control group were treated with only tinnitus masking and drugs. The TRT is consisted of four strategies: (1) tinnitus masking with low level and broad band noise; (2) deep relaxation of the whole body; (3) diversion of the attention to other things; and (4) psychological counseling and therapy. Drugs, such as vasodilator, neurotrophic drug, and sedative of the similar dose and duration of pharmacotherapy were administered to the 2 groups. Effect evaluation was conducted thrice 2, 6, and 12 months after the beginning of therapy to see if the tinnitus was attenuated or disappeared and if the patients’ emotion, sleep, and work were disturbed by tinnitus. RESULTS: The relief rate was 17.09%, 82.05%, and 88.03% in the TRT group 2, 6, and 12 months after respectively; and 2.78%, 26.85%, and 41.6% in the control group 2, 6, and 12 months after respectively (chi(2) = 12.54, 69.30, and 63.64, all P < 0.01). CONCLUSION: TRT is effective in treatment of tinnitus.

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HNO 2002 Nov;50(11):997-1004
[Evaluation of the tinnitus retraining therapy as combined with a cognitive behavioral group therapy]
[Article in German]
Delb W, D’Amelio R, Boisten CJ, Plinkert PK.
Klinik und Poliklinik fur Hals-Nasen-Ohren-Heilkunde, Universitatskliniken des Saarlandes, Homburg.

BACKGROUND. The study evaluates the effectiveness of a Tinnitus Retraining Therapy as combined with a cognitive behavioral group therapy. PATIENTS AND METHODS. 95 patients suffering from chronic tinnitus (mean age 49,3 years) were included. 16 of these 95 participants served as a waiting list control group. The participants were divided into 3 treatment groups. Group 1 was fitted with wideband noise generators, group 2 with hearing aids. The 3rd group was not supplied with any device. After a detailed audiological and psychological examination and tinnitus counseling all patients took part in a cognitive behavioral therapy for a period of 3 months. RESULTS. 64,5% of our patients improved significantly after the initial group therapy. In contrast, the patients of the waiting list control group showed no significant improvement. This initial treatment effect could be maintained over the period of control. We were unable to show significant advantages of noise generators as compared to cognitive behavioural group therapy alone. CONCLUSION. The Tinnitus Retraining Therapy combined with a cognitive behavioral group therapy is an effective treatment in patients with chronic tinnitus.

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Audiol Neurootol 2002 Nov-Dec;7(6):370-5

The Influence of Voluntary Muscle Contractions upon the Onset and Modulation of Tinnitus.

Ganz Sanchez T, Guerra GC, Lorenzi MC, Brandao AL, Bento RF.

Otolaryngology Department, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.

Objective: To evaluate the frequency of tinnitus onset (in normal subjects) and modulation (in tinnitus patients) during muscle contractions, estimating possible risk factors. Material and Method: This case-control study enrolled 121 tinnitus patients and 100 healthy volunteers who underwent medical history, ENT examination and 16 maneuvers of muscular contraction (head, neck and limbs). Modulation data were compared between patients with and without normal audiometry, well-defined diagnosis and symptoms of craniomandibular disorders. Results: The ability to modulate tinnitus (65.3%) was significantly higher than that to originate tinnitus (14.0%). The head and neck musculature was significantly more efficient than that of the limbs. Audiometric pattern, well-defined etiology and symptoms of craniomandibular disorders showed no relation to tinnitus modulation. Conclusions: Somatic modulation is a characteristic aspect of tinnitus. Copyright 2002 S. Karger AG, Basel

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Audiol Neurootol 2002 Nov-Dec;7(6):358-69

Psychoacoustic characterization of the tinnitus spectrum: implications for the underlying mechanisms of tinnitus.

Norena A, Micheyl C, Chery-Croze S, Collet L.

Laboratoire ‘Neurosciences et systemes sensoriels’, Hopital Edouard-Herriot, CNRS UMR 5020, Lyon, France.

In this study, an original psychometric procedure was used in order to characterize in more detail than in previous studies the different perceptual components of tinnitus, i.e. auditory sensations which are perceived in the absence of a corresponding external acoustic stimulus. Ten subjects with chronic tinnitus were asked to rate on a numeric scale the contribution of elementary pitch sensations evoked by isolated frequency components to their overall tinnitus sensation. The resulting ‘internal tinnitus spectra’, which represented the estimated perceptual contribution to the tinnitus sensation as a function of frequency over a large range of frequencies, were found to occupy a wide frequency range corresponding largely to that at which hearing thresholds were abnormally elevated. In most cases, they exhibited a broad peak falling within the hearing loss range. This pattern of result suggests that in subjects with high-frequency hearing loss, tinnitus sensations, when present, resemble those evoked by high-frequency noise bands with, in some cases, a superimposed tonal-like pitch. These results confirm and extend earlier results in the literature and agree with the patients’ reports; their practical implications for the design of future studies on tinnitus and theoretical implications for the understanding of the neurophysiological mechanisms underlying tinnitus are discussed. The results of an additional experiment showed that the internal tinnitus spectrum could be altered by perceptual training in a fine frequency discrimination task with tones in the frequency range of the main peak of the tinnitus spectrum. Copyright 2002 S. Karger AG, Basel

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Auris Nasus Larynx 2002 Oct;29(4):329-33

The role of zinc in management of tinnitus.

Yetiser S, Tosun F, Satar B, Arslanhan M, Akcam T, Ozkaptan Y.

Department of ORL and HNS, Gulhane Medical School, Etlik, 06018 Ankara, Turkey. syetiser@yahoo.com

OBJECTIVE: Several therapeutic modalities have been tried in patients with tinnitus. These trials have given rise to unsatisfactory results in most of the patients since the etiology and pathophysiology of tinnitus is unclear. Significant correlation between tinnitus and decreased zinc level and also reduction in severity of tinnitus after zinc therapy has been reported in some clinical studies. The aim of this study is to find out the prevalence of hypozincemia in patients suffering from tinnitus of various origins (presbyacusis, acoustic trauma and ototoxicity) at young and elderly population and to investigate the effect of zinc therapy upon the severity of tinnitus. METHODS: Forty consecutive patients with severe tinnitus were included in this study between April 1998 and May 2000. There were 32 men (80%) and eight women (20%) with an age ranging between 19 and 67 (mean 40.6 years). Eleven patients were over the age of 50. The zinc level was measured in non-diluted serum by flame atomic absorption spectrophotometry (normal values; 50-120 microg/dl) from fasting blood samples. All the patients were given zinc pills 220 mg each, once a day and 2 h before lunch for 2 months. The patients were required to fulfill a tinnitus scoring scale and a handicap questionnaire before and after treatment. The Wilcoxon rank sum test and McNemar test were used for the statistical analysis. RESULTS: Six patients were hypozincemic and seven patients had decreased serum zinc levels. No significant change has been observed in frequency and severity of tinnitus measured by audiologic tests after zinc therapy. Twenty-three (57.5%) of these patients reported some relief of tinnitus in the tinnitus scoring scale but the rate of improvement was minor (P>0.05). Decrease in severity of tinnitus after zinc therapy in elder group was better than the younger ones. CONCLUSION: Our study could not confirm the high incidence of hypozincemia in patients with tinnitus as reported previously. Zinc therapy for 8 weeks presented no promising effect on tinnitus in three groups of patients and the difference between the rate of improvement in severity of tinnitus after zinc intake in patients with normal and low serum zinc level was not significant. Zinc supplement provided relief of tinnitus in some of the elder people who apparently had dietary zinc deficiency.

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Arch Otolaryngol Head Neck Surg 2002 Oct;128(10):1153-7

Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy.

Berry JA, Gold SL, Frederick EA, Gray WC, Staecker H.

Tinnitus and Hyperacusis Center, Division of Otolaryngology-Head and Neck Surgery, University of Maryland Medical System, Baltimore 21201-1619, USA.

OBJECTIVE: To determine whether the Tinnitus Handicap Inventory (THI), a validated patient-based outcomes measure, may improve our ability to quantify impact and assess therapy for patients with tinnitus. DESIGN: Nonrandomized, prospective analysis of 32 patients undergoing tinnitus retraining therapy (TRT). Assessment tools included comprehensive audiology, a subjective self-assessment survey of tinnitus characteristics, and the THI. Tinnitus Handicap Inventory scores were assessed at baseline and 6 months following TRT. RESULTS: Baseline analysis revealed significant correlation between the subjective presence of hyperacusis and higher total, emotional, and catastrophic THI scores. Tinnitus Handicap Inventory scores correlated with subjective perception of overall tinnitus effect (P<.001). Mean pure-tone threshold average was 17.4 dB, and mean speech discrimination was 97.0%. There were no consistent correlations between baseline audiologic parameters and THI scores. Following 6 months of TRT, the total, emotional, functional, and catastrophic THI scores significantly improved (P<.001). Loudness discomfort levels also significantly improved (P< or =.02). CONCLUSIONS: There is significant improvement in self-perceived disability following TRT as measured by the THI. The results confirm the utility of the THI as a patient-based outcomes measure for quantifying treatment status in patients with primary tinnitus.

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Hear Res 2002 Oct;172(1-2):137-43

Effects of cochlear ablation on noise induced hyperactivity in the hamster dorsal cochlear nucleus:
implications for the origin of noise induced tinnitus.

Zacharek MA, Kaltenbach JA, Mathog TA, Zhang J.

Department of Otolaryngology, 540 E. Canfield, 5E-UHC, Wayne State University School of Medicine, Detroit, MI 48201, USA.

Chronic increases in multiunit spontaneous activity are induced in the dorsal cochlear nucleus (DCN) following exposures to intense sound. This hyperactivity has been implicated as a neurophysiological correlate of noise induced tinnitus. However, it is not known whether this hyperactivity originates centrally, or instead, reflects an increase in the level of spontaneous input from the auditory nerve. In the present study we addressed this issue by testing whether hyperactivity, induced in the DCN by previous exposure to intense sound, persists after ipsilateral cochlear input to the DCN has been removed. To induce hyperactivity, Syrian golden hamsters were exposed under anesthesia to an intense pure tone (122-127 dB SPL at 10 kHz) for 4 h. Additional hamsters, which were anesthetized for 4 h, but not tone exposed, served as controls. Electrophysiological recordings of spontaneous activity were performed on the surface of the left DCN in animals in which the ipsilateral cochlea was either intact or ablated. The degree of cochlear removal was determined by microdissection and histologic evaluation of the cochlea after completion of each recording session. Comparisons between the levels of activity recorded in animals with and without intact cochleas revealed that the induced hyperactivity in the DCN persisted after both partial and complete cochlear ablations. These results indicate that the maintenance of hyperactivity is not dependent on input from the ipsilateral cochlea, implying that hyperactivity originates centrally.

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Int J Audiol 2002 Sep;41(6):363-70

Intratympanic gentamicin in Meniere’s disease: the impact on tinnitus.

Yetiser S, Kertmen M.

Gulhane Medical School, Department of ORL & HNS, Etlik, Ankara. syetiser@yahoo.com

Intratympanic administration of gentamicin for the treatment of intractable Meniere’s disease can achieve relief of vertigo. However, the effect of gentamicin on tinnitus has been less well identified. and conflicting results have been reported. Intratympanic gentamicin therapy was given to 25 patients with Meniere’s disease for the control of vertigo, and the effect of the therapy on tinnitus was evaluated by a 10-point scale and a modified tinnitus questionnaire. It was found that the tinnitus decreased in four patients (16%) and disappeared in three patients (12%) at follow-up. The effect of gentamicin on tinnitus presented intersubject variability, and no correlation was found between the amount of gentamicin injected and its effect on tinnitus.

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Br Med Bull 2002;63:195-212

Mechanisms of tinnitus.

Baguley DM.

Audiology Department, Addenbrooke’s Hospital, and Centre for the Neural Basis of Hearing, Physiological Laboratory, University of Cambridge, UK.

The generation of tinnitus is a topic of much scientific enquiry. This chapter reviews possible mechanisms of tinnitus, whilst noting that the heterogeneity observed within the human population with distressing tinnitus means that there may be many different mechanisms by which tinnitus can occur. Indeed, multiple mechanisms may be at work within one individual. The role of the cochlea in tinnitus is considered, and in particular the concept of discordant damage between inner and outer hair cells is described. Biochemical models of tinnitus pertaining to the cochlea and the central auditory pathway are considered. Potential mechanisms for tinnitus within the auditory brain are reviewed, including important work on synchronised spontaneous activity in the cochlear nerve. Whilst the number of possible mechanisms of tinnitus within the auditory system is considerable, the identification of the physiological substrates underlying tinnitus is a crucial element in the design of novel and effective therapies.

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Psychosom Med 2002 Sep-Oct;64(5):810-6

Randomized controlled trial of internet-based cognitive behavior therapy for distress associated with tinnitus.

Andersson G, Stromgren T, Strom L, Lyttkens L.

Department of Audiology, University Hospital, Uppsala, Sweden. Gerhard.Andersson@psyl.uu.se

OBJECTIVE: The aim of this study was to investigate if cognitive behavior therapy (CBT) provided via the Internet results in significant decreases of distress in individuals with tinnitus. METHODS: Participants were recruited through Web pages and newspaper articles and thereafter randomly allocated to a CBT self-help manual in six modules or to a waiting-list control group (WLC). All treatment and contact with participants were conducted via the Internet with Web pages and E-mail correspondence. Participants were 117 individuals with tinnitus of duration of more than 6 months. In the first randomized controlled phase of the study, 26 completed all stages of treatment (51% dropout), and 64 of the WLC group completed measures. At 1-year follow-up, all participants had been offered the program and 96 provided outcome measures (18% dropout rate from baseline). Tinnitus-related problems were assessed before and after treatment and at the 1-year follow-up. Daily diary ratings were included for 1 week before and 1 week following the treatment period. RESULTS: Tinnitus-related distress, depression, and diary ratings of annoyance decreased significantly. Immediately following the randomized controlled phase (with a WLC), significantly more participants in the treatment group showed an improvement of at least 50% on the Tinnitus Reaction Questionnaire. At the uncontrolled follow-up, 27 (31%) of all participants had achieved a clinically significant improvement. CONCLUSIONS: CBT via the Internet can help individuals decrease annoyance associated with tinnitus. High dropout rates or delay in completing treatment can be a characteristic of treatment studies using the Internet but should be contrasted with the cost effectiveness and accessibility of the Internet.

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BMC Ear Nose Throat Disord 2002 Sep 16;2(1):3

Long-term reductions in tinnitus severity.

Folmer RL.

OHSU Tinnitus Clinic, Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, Portland, USA. folmerr@ohsu.edu

BACKGROUND: This study was undertaken to assess long-term changes in tinnitus severity exhibited by patients who completed a comprehensive tinnitus management program; to identify factors that contributed to changes in tinnitus severity within this population; to contribute to the development and refinement of effective assessment and management procedures for tinnitus. METHODS: Detailed questionnaires were mailed to 300 consecutive patients prior to their initial appointment at the Oregon Health & Science University Tinnitus Clinic. All patients were then evaluated and treated within a comprehensive tinnitus management program. Follow-up questionnaires were mailed to the same 300 patients 6 to 36 months after their initial tinnitus clinic appointment. RESULTS: One hundred ninety patients (133 males, 57 females; mean age 57 years) returned follow-up questionnaires 6 to 36 months (mean = 22 months) after their initial tinnitus clinic appointment. This group of patients exhibited significant long-term reductions in self-rated tinnitus loudness, Tinnitus Severity Index scores, tinnitus-related anxiety and prevalence of current depression. Patients who improved their sleep patterns or Beck Depression Inventory scores exhibited greater reductions of tinnitus severity scores than patients who continued to experience insomnia and depression at follow-up. CONCLUSIONS: Individualized tinnitus management programs that were designed for each patient contributed to overall reductions in tinnitus severity exhibited on follow-up questionnaires. Identification and treatment of patients experiencing anxiety, insomnia or depression are vital components of an effective tinnitus management program. Utilization of acoustic therapy also contributed to improvements exhibited by these patients.

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Clin Psychol Rev 2002 Sep;22(7):977-90

Psychological aspects of tinnitus and the application of cognitive-behavioral therapy.

Andersson G.

Department of Psychology, Uppsala University, Box 12 25, SE-751 42 Uppsala, Sweden. gerhard.andersson@psyk.uu.se

This article presents an overview of tinnitus (ringing or buzzing in the ears), its psychological effects, and the application of cognitive-behavioral therapy (CBT) for its treatment. Several studies have confirmed an association between psychological factors, such as anxiety and depression, and severe tinnitus and preliminary reports suggest that a proportion of tinnitus patients suffer from mental illness. Assessment strategies used in CBT for tinnitus include structured interviews, daily diary ratings, and validated self-report questionnaires. The treatment approach described in this article includes applied relaxation, imagery and distraction techniques, advice regarding environmental sounds, management of sleep, cognitive restructuring of thoughts and beliefs associated with tinnitus, and relapse prevention. The literature pertinent to CBT approaches to treating tinnitus is reviewed, and it is concluded that CBT shows promise as a treatment of tinnitus-related distress. Future research directions are discussed.

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Hear Res 2002 Sep;171(1-2):43-50

Brain imaging of the effects of lidocaine on tinnitus.

Reyes SA, Salvi RJ, Burkard RF, Coad ML, Wack DS, Galantowicz PJ, Lockwood AH.

Department of Communicative Disorders and Sciences, State University of New York at Buffalo, Buffalo, NY 14214, USA. sareyes@acsu.buffalo.edu

Using a single-blind placebo-controlled design, we mapped lidocaine related changes in neural activity, measured by regional cerebral blood flow (rCBF) with (15)O-H(2)O positron emission tomography. Intravenous lidocaine produced both increases and decreases in the loudness of tinnitus. The change in tinnitus loudness was associated with a statistically significant change in neural activity in the right temporal lobe in auditory association cortex. Decreases in tinnitus loudness resulted in larger changes in rCBF than increases. The unilateral activation pattern associated with tinnitus, in contrast with the bilateral activation produced by a real sound, suggests that tinnitus originates in the central auditory system rather than the cochlea. In addition, generalized lidocaine effects were found in the basal ganglia, thalamus, and a region spanning the Rolandic fissure.

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Aust Fam Physician 2002 Aug;31(8):712-6

Tinnitus. More can be done than most GPs think.

Tonkin J.

St Vincent’s Private Hospital, Sydney, New South Wales. jptonkin@bigpond.com

BACKGROUND: Tinnitus is the appreciation of sound arising from an internal source. The sound may be pulsating and arising from a vascular cord near the ear or it may arise from pathology in the inner ear. When pathology in the inner ear is the cause of the tinnitus, the tinnitus is nonpulsating, continuous and may have variable frequencies and intensity. OBJECTIVE: This article aims to outline the diagnostic features of tinnitus to determine causes and aggravators, and provide an overview of treatment. DISCUSSION: Assessment of tinnitus involves distinguishing objective from nonobjective tinnitus, pulsatile from nonpulsatile tinnitus and the investigation of features that will determine the cause of tinnitus and any aggravating factors. Management of the condition involves the treatment of the underlying cause, attention to any contributing aggravators and the control of symptoms.

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Clin Otolaryngol 2002 Aug;27(4):270-4

Masking of tinnitus and mental activity.

Andersson G, Khakpoor A, Lyttkens L.

Department of Psychology, Uppsala University, Sweden Department of Audiology, Uppsala University Hospital, Uppsala, Sweden. gerhard.Andersson@psyk.uu.se

The aim of this study was to investigate the effects of tinnitus on mental activity. In a mixed design study, the performance of 20 subjects with tinnitus and 20 healthy control subjects was compared on the digit-symbol test, completed in three auditory conditions: silence, masking and intermittent masking. Results showed marked overall differences between patients and controls on all three conditions. Lower scores on the digit-symbol test were observed during the intermittent masking condition compared with the masking condition for the patients. There was no difference between silence (e.g. tinnitus) and the masking condition, or between silence and the intermittent masking condition. The control subjects scored lower on the task when exposed to the intermittent masking compared to both silence and masking. The patients had higher depression and anxiety scores than the controls. These findings suggest that there is a link between masking sounds and how tinnitus affects cognitive capacity.

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Clin Otolaryngol 2002 Aug;27(4):219-26

The effect of vestibular nerve section upon tinnitus.

Baguley DM, Axon P, Winter IM, Moffat DA.

Department of Audiology, University of Cambridge, Cambridge, UK. dmb29@cam.ac.uk

This paper reviews the published evidence regarding the effect of vestibular nerve section upon tinnitus. This is of relevance not only for those performing and undergoing this procedure, but also for those considering the hypothesis that auditory efferent system dysfunction may be influential in tinnitus perception. The auditory medial efferent fibres within the internal auditory canal run within the inferior vestibular nerve, only joining the cochlear nerve at the anastomosis of Oort, a bundle of 1300 fibres running from the saccular branch of the inferior vestibular nerve to the cochlear nerve. Vestibular nerve section procedures therefore section this efferent olivocochlear pathway, and ablate efferent influence upon that cochlear. If auditory efferent dysfunction is involved in tinnitus perception, this ablation might influence the tinnitus status of that patient. A literature search identified 18 papers mentioning tinnitus status after vestibular nerve section, describing the experiences of a total of 1318 patients. The proportion of patients in whom tinnitus was said to be exacerbated postoperatively ranged from 0% to 60%, with a mean of 16.4% (standard deviation 14.0). The proportion of patients in whom tinnitus was unchanged was 17% to 72% (mean 38.5%, standard deviation 15.6), and in whom tinnitus was said to be improved was 6% to 61% (mean 37.2%, standard deviation 15.2). In the majority of patients undergoing this procedure, ablation of auditory efferent input (and thus total efferent dysfunction) to the cochlea was not associated with an exacerbation of tinnitus. The finding of this review is that efferent dysfunction after vestibular nerve section does not consistently worsen tinnitus.

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Int J Audiol 2002 Jul;41(5):301-7

Support for the central theory of tinnitus generation: a military epidemiological study.

Attias J, Reshef I, Shemesh Z, Salomon G.

Institute for Noise Hazards Research and Evoked Potentials Laboratory, Medical Corps, Petach-Tikva, Israel. attiasj@clalit.org.il

Tinnitus is poorly reflected by audiometric (cochlear) data, indicating that central nervous system (CNS) components are involved in its development. This study aimed to provide support for the neurophysiological theory of tinnitus as a result of combined peripheral and central nervous dysfunctions. Our main findings were the sudden. significant, stepwise increase in tinnitus after 10 years of service, as opposed to the almost linear increase in noise-induced hearing loss (NIHL) with age. Furthermore, the absence of a correlation between the incidence of tinnitus and the severity of tinnitus was linked to the NIHL. We suggest that, in tinnitus, the central screening apparatus which normally inhibits conscious awareness of irrelevant, spurious and non-informative internal and external noise shows a possibly fatigue- or age-related deterioration over time. Further support was provided by low blood levels of vitamin B1 and B12. which are essential to CNS function.

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Int J Audiol 2002 Jul;41(5):293-300

Sound stimulation via bone conduction for tinnitus relief: a pilot study.

Holgers KM, Hakansson BE.

Department of Audiology, University of Goteborg, Sweden.

For some patients suffering from tinnitus, an external sound stimulator can offer some mitigation. Based on our positive experience with the bone-anchored hearing aid (BAHA), it seems possible to transmit a masking or habituating sound via bone conduction. A potential advantage of bone-conducted sound is that it is transmitted to the cochlea without affecting the normal hearing via the external and middle ear. The present pilot study, on patients who use a conventional BAHA and who experience mild-to-moderate tinnitus, shows that bone-conducted sound has the potential to relieve tinnitus in the same way as air-conducted sound. It was also found that these patients, having a significant conduction hearing loss, required conventional sound amplification via a BAHA simultaneously with the stimulus provided by the bone-anchored sound stimulator (BASS). Further studies on patients with more severe tinnitus must be conducted in order to justify the use of a BASS for tinnitus relief.

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J Neurophysiol 2002 Aug;88(2):699-714

Cisplatin-induced hyperactivity in the dorsal cochlear nucleus and its relation to outer hair cell loss:
relevance to tinnitus.

Kaltenbach JA, Rachel JD, Mathog TA, Zhang J, Falzarano PR, Lewandowski M.

Department of Otolaryngology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. jkalten@med.wayne.edu

Cisplatin causes both acute and chronic forms of tinnitus as well as increases in spontaneous neural activity (hyperactivity) in the dorsal cochlear nucleus (DCN) of hamsters. It has been hypothesized that the induction of hyperactivity in the DCN may be a consequence of cisplatin’s effects on cochlear outer hair cells (OHCs); however, systematic studies testing this hypothesis have yet to appear in the literature. In the present investigation, the relationship between hyperactivity and OHC loss, induced by cisplatin, was examined in detail. Hamsters received five treatments of cisplatin at doses ranging from 1.5 to 3 mg. kg(-1). day(-1), every other day. Beginning 1 mo after initiation of treatment, electrophysiological recordings were carried out on the surface of the DCN to measure spontaneous multiunit activity along a set of coordinates spanning the medial-lateral (tonotopic) axis of the DCN. After recordings, cochleas were removed and studied histologically using a scanning electron microscope. The results revealed that cisplatin-treated animals with little or no loss of OHCs displayed levels of activity similar to those seen in saline-treated controls. In contrast, the majority (75%) of cisplatin-treated animals with severe OHC loss displayed well-developed hyperactivity in the DCN. The induced hyperactivity was seen mainly in the medial (high-frequency) half of the DCN of treated animals. This pattern was consistent with the observation that OHC loss was distributed mainly in the basal half of the cochlea. In several of the animals with severe OHC loss and hyperactivity, there was no significant damage to IHC stereocilia nor any observable irregularities of the reticular lamina that might have interfered with normal IHC function. Hyperactivity was also observed in the DCN of animals showing severe losses of OHCs accompanied by damage to IHCs, although the degree of hyperactivity in these animals was less than in animals with severe OHC loss but intact IHCs. These results support the view that loss of OHC function may be a trigger of tinnitus-related hyperactivity in the DCN and suggest that this hyperactivity may be somewhat offset by damage to IHCs.

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Presse Med 2002 Jul 13;31(24):1137-43

[Treatment of tinnitus. New perspectives]

[Article in French]

Puel JL, Nicolas-Puel C, Londero A, Bonfils P.

Laboratoire de Neurobiologie de l’Audition-Plasticite synaptique, Inserm U. 254 et Universite de Montpellier I, Montpellier.

A FREQUENTLY MISUNDERSTOOD AFFECTION: Because of its high prevalence and the considerable alteration it often provokes in quality of life, tinnitus aurium is an important public health problem. Current treatment of tinnitus aurium is limited by the lack of knowledge of the physiopathological processes that generate it. THE VARIOUS LEADS EXPLORED: Analysis of the data in the literature and our recent works suggests that external ciliated cells of the cochlea are probably not a major source of tinnitus, but an important role is attributed to lateral efferent innervation and glutamatergic synapses situated beneath the internal ciliated cells. PERSPECTIVES: Experimental models of tinnitus are presently being developed in order to test these hypotheses, and pharmacological clinical trials should be set-up during the year to come, in order to apply these fundamental results to humans.

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Otolaryngol Pol 2002;56(3):361-4

[Unilateral tinnitus–diagnostics and treatment]

[Article in Polish]

Kaczmarek JP, Szymiec E, Dabrowski P, Szyfter W.

Katedra i Klinika Otolaryngologii AM im. Karola Marcinkowskiego w Poznaniu.

900 patients with tinnitus were treated between January 1998 and August 2000 in ENT Rehabilitation Center in Poznan. Unilateral tinnitus was observed in more than 50% of the patients. In all the patients a history was taken paying a special attention to the loudness estimation by the patient and to the influence of the tinnitus on the everyday life. Laryngological, audiological and neurological examinations and laboratory tests were performed. In some cases endocrinological examination was performed. In the group of patients with unilateral tinnitus a special attention was paid to the possibility of ponto-cerebellar angle tumour. After audiological diagnostics CT or MRI examinations were performed. Authors emphasize, that in patients with unilateral tinnitus a proper observation is required to exclude expansive process within the acoustic nerve.

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J Am Acad Audiol 2002 Jun;13(6):323-31

Prevalence and 5-year incidence of tinnitus among older adults: the epidemiology of hearing loss study.

Nondahl DM, Cruickshanks KJ, Wiley TL, Klein R, Klein BE, Tweed TS.

Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, USA.

Tinnitus (ringing or buzzing in the ear or head) can range from barely noticeable to debilitating. Although a few studies have estimated the prevalence of this condition in adult populations, we know of no population-based estimates of incidence. As part of a population-based study of hearing loss in adults aged 48 to 92 years at baseline in Beaver Dam, Wisconsin, self-reported data on tinnitus were obtained at the baseline examination (1993-1995; N = 3753) and again 5 years later (1998-2000; N = 2800). A person was classified as having tinnitus if their tinnitus was at least moderate in severity or caused difficulty in falling asleep. The prevalence of tinnitus at baseline was 8.2 percent. The 5-year incidence of tinnitus among the 2513 participants at risk was 5.7 percent. Risk factors for prevalent and incident tinnitus were evaluated. The results suggest that tinnitus is a common problem for older adults and is associated with some modifiable risk factors.

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J Med Assoc Thai 2002 Mar;85(3):392-5

Botulinum toxin injection for objective tinnitus from palatal myoclonus: a case report.

Srirompotong S, Tiamkao S, Jitpimolmard S.

Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Thailand.

Objective tinnitus may be caused by many etiologies-palatal myoclonus being one of them. We report one patient of voluntary palatal myoclonus presenting with objective tinnitus treated with botulinum toxin injection. Five units of botulinum toxin A were injected into each side of the soft palate at the palatal muscles (levator veli palatini and tensor veli palatini muscle). The tinnitus disappeared within two days of injection and no side effect was observed.

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Eur Arch Otorhinolaryngol 2002 Jul;259(6):299-301

Acoustic neuroma surgery and tinnitus.

Fahy C, Nikolopoulos TP, O’Donoghue GM.

Skull Base Unit, Department of Otorhinolaryngology, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom.

The objectives of this study were to assess the effect that acoustic neuroma surgery has on tinnitus and to investigate possible predictors (tumour size and patients’ ages at operation) as well as to ascertain if the overall quality of life in patients with acoustic neuromas is affected by their tinnitus. A questionnaire was sent to randomly selected patients post acoustic-neuroma surgery. This was based on the Glasgow Benefit Inventory and contained a standardised series of four functional gradings for tinnitus. In this study, 51 patients from a total of 68 returned the questionnaire, and there was a follow-up period of between 1 and 3 years following the acoustic neuroma surgery. The age at operation, size of the tumour and overall quality of life were correlated with the impact of surgery on tinnitus. Statistical analysis used the one-way analysis of variance, chi-square test, one-way analysis by ranks and Spearman Rank Correlations. Significance was accepted at the P<0.05 level. Overall, 30 (58.8%) of the patients had tinnitus preoperatively in comparison to 34 (66.6%) postoperatively. After surgery, tinnitus became better in 8 (16%) patients, 28 (55%) did not experience any change, and 15 (29%) became worse. Neither tumour size nor age at the time of the operation had a statistically significant association with the impact of surgery on tinnitus. There was no statistically significant association between changes in tinnitus status and changes in the quality of life following the operation ( P>0.05). A significant percentage of patients with acoustic neuromas, approximately 60%, suffer from tinnitus preoperatively, and this number may increase slightly postoperatively. It remains unpredictable which patients will improve, which will show no change and which will deteriorate as age and tumour size do not seem to be associated with the impact of surgery on tinnitus. The results also suggest that tinnitus may be of relatively minor importance in the overall quality of life of patients following acoustic neuroma surgery. However, candidates for surgery should be thoroughly informed about the possible effect of the operation on their tinnitus status.

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Otolaryngol Pol 2002;56(2):213-6

[Tinnitus in systemic diseases]

[Article in Polish]

Nowak K, Banaszewski J, Dabrowski P, Szymiec E, Szyfter W.

Katedra i Klinika Otolaryngologii AM im. K. Marcinkowskiego w Poznaniu.

Permanent or temporary degenerative changes in the internal ear causing tinnitus may occur with particular intensity in patients suffering from systemic disease (diabetes, hypertension, rheumatic diseases, kidney and thyroid gland diseases). Pathomechanisms of hearing impairment and the risk of tinnitus and its character in particular cases are discussed in the paper. The research was carried out on 1200 patients treated in the Laryngological Rehabilitation Centre in Poznan between 1.1.1998 and 04.2001 due to tinnitus. The analysis included the diagnosis of general health condition, general laryngological examination as well as additional tests. In the examined group 34% suffered from systemic diseases. Among them the highest percentage (47%) suffered from hypertension, 41% from hypercholesterolaemia, 22% from rheumatic diseases and 16% from diabetes. 96% of the patients had a long family history of diseases. The additional factor causing damage of the internal ear may be ototoxic drug used in the treatment of many systemic diseases.

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Int J Clin Pharmacol Ther 2002 May;40(5):188-97

The efficacy of Ginkgo special extract EGb 761 in patients with tinnitus.

Morgenstern C, Biermann E.

Allgemeines Krankenhaus St. Georg. Hamburg, Germany.

OBJECTIVE: The objective of the present study in 60 patients with chronic tinnitus aurium was to confirm the efficacy of oral treatment with 2 x 80 mg Ginkgo special extract EGb 761 per day subsequent to 10-day EGb 761 infusion treatment. METHODS: Patients with chronic tinnitus aurium underwent 10 days of in-patient infusion treatment with 200 mg/day EGb 761, after which they were randomized to double-blind, oral out-patient treatment with either 2 x 80 mg/day EGb 761 or placebo, given over a scheduled treatment period of 12 weeks. The primary outcome measure was the change in tinnitus volume in the more severely affected ear during randomized treatment. RESULTS: Fifty-two of 60 patients (89.7%) completed the infusion treatment; complete sets of data were available for 40 (66.7%), 30 (50.0%) and 22 (36.7%) patients after 4, 8 and 12 weeks of randomized treatment, respectively. For the primary outcome measure, significant superiority of EGb 761 over placebo was demonstrated in the intention-to-treat analysis data set after 4, 8 and 12 weeks of out-patient treatment (p < 0.05, 1-tailed), although the absolute treatment group difference was moderate. The results were supported by the secondary outcome measures for efficacy (e.g. decreased hearing loss, improved self-assessment of subjective impairment). During out-patient treatment, there were no attributable adverse events under EGb 761. CONCLUSIONS: A combination of infusion therapy followed by oral administration of Ginkgo special extract EGb 761 appears to be effective and safe in alleviating the symptoms associated with tinnitus aurium.

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Audiol Neurootol 2002 Mar-Apr;7(2):122-30

Characteristics of tinnitus induced by acute acoustic trauma: a long-term follow-up.

Mrena R, Savolainen S, Kuokkanen JT, Ylikoski J.

Central Hospital of Central Finland, Jyvaskyla, Finland. roderik.mrena@ksshp.fi

We investigated the prevalence, characteristics and subjective perceived handicap caused by long-term tinnitus induced by acute acoustic trauma (AAT) in 418 former military conscripts. They had been treated between 1984 and 1989 because of AAT from exposure to impulse noise caused by firearm shooting. All 418 patients reported tinnitus after the AAT. At discharge from the military service, 122 (29%) still reported tinnitus. In 1999, of these 122 patients, 101 were reached and 66 still had tinnitus. The Tinnitus Handicap Questionnaire demonstrated various difficulties in life because of tinnitus, not attributable only to tinnitus loudness. Psychological factors also seem to play an important role. The effects of AAT and possible compensation have been evaluated so far mostly by audiometric findings, but in some cases tinnitus may be an even more serious threat to life satisfaction than mild hearing impairment. Copyright 2002 S. Karger AG, Basel

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J R Soc Health 2002 Mar;122(1):21-3

Tinnitus: an update.

Roy D, Chopra R.

Royal Liverpool University Hospital, Liverpool L7 8XP, England. devtanya@yahoo.com

Tinnitus is the perceived sensation of sound in the absence of acoustic stimulation. It is the commonest otological disorder referred to either the general practitioner or ear-nose-throat surgeon. This short review examines prevalence, aetiology, associated clinical symptoms, investigations and management. Despite current usage of a vast number of treatment modalities there remains no specific cure for the condition. However, there is currently great emphasis on tinnitus retraining therapy (TRT) in its management. The applications and results of TRT have, indeed, been encouraging–and are also briefly discussed here.

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Otol Neurotol 2002 May;23(3):296-300

Transmeatal low-power laser irradiation for tinnitus.

Nakashima T, Ueda H, Misawa H, Suzuki T, Tominaga M, Ito A, Numata S, Kasai S, Asahi K, Vernon JA, Meikle MB.

Department of Otorhinolaryngology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.

OBJECTIVE: To evaluate effectiveness of 60-mW laser irradiation in the treatment of tinnitus. STUDY DESIGN: Prospective, randomized double-blind study. METHODS: This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. The active or placebo laser treatment was administered transmeatally once a week for 6 minutes. Laser irradiation was performed four times during a 4-week period. A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. The loudness and pitch match for tinnitus were obtained, and distortion product otoacoustic emissions were also examined. RESULTS: No significant difference was observed between the active and placebo laser groups with regard to outcome of loudness, duration, quality, and annoyance of tinnitus. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation. CONCLUSION: Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus.

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Neuroreport 2002 Mar 25;13(4):443-6

Lateral inhibition in the auditory cortex: an EEG index of tinnitus?

Kadner A, Viirre E, Wester DC, Walsh SF, Hestenes J, Vankov A, Pineda JA.

Department of Cognitive Science, University of California, San Diego, La Jolla, CA 92093-0515, USA.

Auditory ERPs were recorded from eight tinnitus patients and 12 controls. Tone pips of 1000 and 2000 Hz, as well as the patient’s tinnitus pitch (around 4000 Hz) were used. Controls received tone pips at 1000, 2000, and 4000 Hz. Tones were presented at 30, 36, 42, 48 and 54 dB/SL. The intensity dependence of the auditory N100 was calculated for each frequency in each group. Patients showed a steeper response to the tinnitus frequency than responses to the 4000 Hz tone in controls. In contrast, intensity-dependence to the 2000 Hz tones was significantly decreased in patients (two-tailed Wilcoxon-Mann-Whitney U-test, p < 0.05). Responses to the 1000 Hz tones were similar for both groups. This reduced intensity dependence is hypothesized to result from lateral inhibition arising from tinnitus related activity in the 4000 Hz isofrequency region.

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Curr Neurol Neurosci Rep 2001 Sep;1(5):492-9

Tinnitus.

Sismanis A.

Department of Otolaryngology-Head and Neck Surgery, Medical College of Virginia/Virginia Commonwealth University, 1201 E. Marshall Street, Suite 401, Richmond, VA 23298, USA. Asismanis@aol.com

Tinnitus is a common otologic symptom secondary to numerous etiologies, such as noise exposure, otitis, Meniere’s disease, otosclerosis, trauma, medications, and presbycusis. A thorough evaluation is necessary to rule out less common causes, which may include acoustic neuromas, glomus tumors, atherosclerosis of the carotid arteries, arteriovenous fistulae (AVFs), arteriovenous fistulae malformations (AVMs), and intracranial hypertension. Treating physicians need to have a very compassionate attitude towards these patients, and statements such as «there is nothing that can be done» are very inappropriate and should be strongly condemned. Reassurance, hearing aids, masking devices, retraining methods, antidepressants, intratympanic medications, and management of underlying pathologies such as carotid artery atherosclerosis, skull base tumors, intracranial hypertension, and AVMs/AVFs provide relief for the majority of these patients.