Auditory training for tinnitus treatment: a scoping review

Abstract Objectives Our study aimed to verify the evidence of auditory training employed in the audiological treatment of tinnitus in adults and older adults. Methods Scoping review based on a search for articles in journals available in MEDLINE (PubMed), Embase (Elsevier), LILACS (BVS), and Cochrane Library. Titles and abstracts of the retrieved articles were assessed by peers, following the eligibility criteria; they were afterward read in full text, and the references were hand searched in the results found. Studies' level of evidence was classified into very high (Level A+), high (Level A), moderate (Level B), limited (Level C), low (Level D), or very low (Level D−) based on the Critically Appraised Topics. Results 2160 records were identified in the searching stage and 15 studies were eligible for data extraction. Study design, sample characterization, auditory training tasks, sound stimuli, outcome measures, and results were extracted. Frequency discrimination training was the most frequent strategy, followed by auditory attentional skills training and multisensory training. Almost all studies with daily auditory training sessions reported significant benefits demonstrated in at least one outcome measure. Studies that used auditory discrimination training and attentional auditory skill stimulation to treat tinnitus obtained quality evidence levels ranging from limited to high (C‒A) and studies that applied multisensory training or attentional training combined with counseling and passive listening in tinnitus patients reached a high-quality evidence level (A). Conclusion Recent studies had higher levels of evidence and considered attentional factors and multisensory pathways in auditory training strategies.

White noise effect on listening effort among patients with chronic tinnitus and normal hearing thresholds

Abstract Objective This study investigated the effects of WN on LE in subjects with chronic tinnitus and normal hearing thresholds. The study was a prospective, non-randomized, before-and-after, intra-participant intervention. Methods Twenty-five subjects performed the following tests: conventional and high-frequency audiometry, acuphenometry, screening questionnaires for depression and anxiety symptoms, Tinnitus Handicap Inventory (THI), Montreal Cognitive Assessment, and high WM test from the Working Memory Assessment Battery, Federal University of Minas Gerais (WMAB) as the LE measure in two conditions: No Added Noise (NAN) and with Added Noise (AN). Results Seventeen participants (68%) performed better on AN condition. Data analysis revealed a 45% improvement in the WMAB total span count on AN setting, with a significant p value (p = 0.001). Conclusion The subgroup of participants without traces of anxiety symptoms, up to mild traces of depressive symptoms, having unilateral tinnitus, and a THI level up to grade 2, had improved WM performance in the presence of WN, which suggests a release of cognitive resources and less auditory effort under these combined conditions. Evidence level 4.

Audiometric evaluation in different clinical presentations of otitis media

Abstract Objectives To assess the hearing thresholds in acute otitis media, otitis media with effusion and chronic otitis media (non-suppurative, non-cholesteatomatous suppurative and cholesteatomatous) and to compare the hearing outcomes with non-diseased ears (in bilateral cases) or contralateral healthy ears (in unilateral cases), since hearing loss is the most frequent sequel of otitis media and there is no previous study comparing the audiometric thresholds among the different forms of otitis media. Methods Cross sectional, controlled study. We performed conventional audiometry (500-8000 Hz) and tympanometry in patients with otitis media and healthy individuals (control group). Hearing loss was considered when the hearing thresholds were > 25 dBHL. Results Of the 112 patients diagnosed with otitis media (151 ears), 48 were men (42.86%) and 64 were women (57.14%). The average age was 42.72 years. Of those, 25 (22.32%) were diagnosed as AOM, 15 (13.39%) were diagnosed with OME and the remaining 72 (63.28%) were diagnosed with COM (non-suppurative COM, n = 31; suppurative COM, n = 18; cholesteatomatous COM, n = 23). As compared with controls, all forms of otitis media had significantly higher bone-conduction thresholds (500-4000 Hz). Conductive hearing loss was the most frequent type of hearing loss (58.94%). However, the number of patients with mixed hearing loss was also relevant (39.07%). We noted that the presence of sensorioneural component occurred more frequently in 1) Higher frequencies; and 2) In groups of otitis media that were more active or severe in the inflammatory/infective standpoint (AOM, suppurative COM and cholesteatomatous COM). Conclusion All types of otitis media, even those with infrequent episodes of inflammation and otorrhea, had worse bone conduction thresholds as compared with nondiseased ears (p < 0.01). We observed worse hearing outcomes in ears with recurrent episodes of otorrhea and in ears with AOM, especially in high frequencies.

Self-Reported Voice-Related Quality of Life in Cochlear Implant Users

Objective: The aim of this study was to identify if cochlear implant (CI) users are perceiving a decrease in life quality due to voice problems. This study evaluated 43 CI user's perception of their voice and how it affects their quality of life through a survey. Approach: Forty-three CI users responded to a survey regarding their demographics, details about their CI, the Hearing Health Quick Test (HHQT), the Voice Related Quality of Life (V-RQOL), and the Voice Handicap Index-10 (VHI-10). The survey responses were analyzed using univariate linear regression analysis. Results: Few of the CI users scored below the cut off for normal voice related quality of life. CI users averaged 93.4 out of 100 on the V-RQOL and only four scored abnormally for the VHI-10. Lower scores on the V-RQOL were correlated with the participants having an associate degree and with participants visiting friends, family, and neighbors less often due to hearing loss. The VHI-10 scores were correlated with gender, education levels, difficulty in social situations due to hearing loss, noise exposure, and tinnitus. Limitations of the study: The small n was the primary limitation of this study. Originality: This study was one of the first to examine the voice-related quality of life in CI users. Conclusions: Overall, respondents did not perceive much voice-related difficulty. However, they were more likely to perceive voice-related difficulty if they experienced difficulty hearing in noise and avoided social situations due to hearing loss.

Objetivo: Este estudio identificó si los usuarios de implantes cocleares (IC) están percibiendo una disminución en la calidad de su vida debido a problemas de voz. Además, evaluó la percepción de la voz de 43 usuarios de IC y cómo afecta su calidad de vida a través de una encuesta. Enfoque: Cuarenta y tres usuarios de IC respondieron a una encuesta sobre su demografía, detalles sobre su IC, la Hearing Health Quick Test (HHQT), la Voice Related Quality of Life (V-RQOL) y el Voice Handicap Index-10 (VHI-10). Las respuestas de la encuesta se analizaron mediante un análisis de regresión lineal univariado. Resultados: Pocos usuarios de IC puntuaron por debajo del límite para calidad de vida relacionada con la voz. El promedio V-RQOL fue de 93,4/100; solo 4 participantes tuvieron puntuación anormal en VHI-10. Las bajas puntuaciones en V-RQOL se correlacionaron con título de asociado y menos visitas por pérdida auditiva; las puntuaciones VHI-10, con sexo, educación, dificultad en situaciones sociales, exposición al ruido y tinnitus. Limitaciones del estudio: La pequeña n fue la principal limitación de este estudio. Originalidad: Este estudio fue uno de los primeros en examinar la calidad de vida relacionada con la voz en usuarios de CI. Conclusiones: En general, los encuestados no percibieron mucha dificultad relacionada con la voz. Sin embargo, era más probable que percibieran dificultades relacionadas con la voz si tenían dificultades para oír en ruido y evitaban situaciones sociales debido a la pérdida auditiva.

Signos y Síntomas en 3557 Pacientes con Trastornos Temporomandibulares

Los trastornos temporomandibulares (TTM) tienen una alta frecuencia en la población y pueden presentar síntomas en la región de la cabeza, el oído y la región cervical. Este estudio evalúa la presencia de signos y síntomas en la región de la cabeza y el cuello, incluyendo: cefalea, trastornos del oído, y de la columna vertebral, en una población de 3557 pacientes con TTM. Para este estudio los datos consistieron en los registros de 3557 pacientes consecutivos de TTM referidos a una clínica privada de trastornos temporomandibulares y dolor craneofacial, en Santiago de Chile entre 1998 y 2019. El examen y los registros fueron efectuados por uno los autores (RW), en un programa computacional previamente diseñado. Los resultados fueron analizaron utilizando la distribución de la frecuencia de los datos para evaluar la prevalencia. En esta serie 72.67 % correspondieron a pacientes de sexo femenino. Los síntomas más prevalentes reportados por los 3557 pacientes estudiados fueron rigidez en el cuello 65,25 %, cefaleas 61,01 % y dolor lumbar 57,16 %. Los síntomas relacionados con el oído fueron: mareos en el 46,70 %, dolor de oídos en 32,64 % y tinnitus en el 33,60 % de los pacientes. La asimetría facial estuvo presente en el 74.08 % de los 3557 pacientes. Se observó desviación mandibular en apertura bucal, en el 74.44 % de los 3557 pacientes. Se presentó dolor a la palpación muscular en un alto porcentaje de los pacientes, en los músculos temporales, maseteros, esternocleidomastoideo y trapecio, Este estudio nos permite describir la frecuencia de los signos y síntomas que presentan los pacientes con TTM en una amplia casuística.

Temporomandibular disorders (TMD) are frequently associated with other conditions in the head, ear and neck region, including cervical spine disorders and headache. This study evaluates the presence of signs and symptoms in the head and neck region, including headache, ear disorders, cervical and spine disorders, on a population of 3557 patients with TMD. For this study data consisted of the records of 3557 consecutive TMD patients referred to a temporomandibular disorder and craniofacial pain private clinic in Santiago, Chile between 1998 and 2019. The examination and recordings were made by all the authors. The results were analyzed using the distribution of frequency of the data to asses prevalence. The most prevalent symptoms reported by the 3557 subjects were neck stiffness 65.25 %, headaches 61.01 % and low back pain 57.16 %, the most frequent ear symptom was dizziness 46.70 %. The present study analize the frecuency of signs and symptons presented in a big casuistic of patients with TMD.

The Benefit of YouTube Videos as a Source of Information on Tinnitus for Patients

Abstract Introduction Tinnitus is one of the most common otological complaints encountered. Patients often use the internet, especially YouTube videos, as a source of information regarding their health condition. There is a need to analyze the standard and quality of information in these videos so that the patients receive correct information. Objective The purpose of the present study was to evaluate the reliability and utility of YouTube videos on tinnitus. Methods The first 100 videos on YouTube using the search terms tinnitus and ringing in the ear were identified. Three subject experts assessed the reliability using the modified five-point DISCERN score and utility using a usefulness score. Various indices like view ratio, like ratio, video power index, and interaction index were also calculated. Results Out of the 100 videos selected, 34 were excluded; collectively the remaining 66 videos were viewed 12,797,730 times. The most common upload sources were hospital/physician (39%), paramedic health care providers (19%), and alternative medicine (19%). The discern score was the highest in hospital/physician group (mean 19.3) and lowest in patient experience group (mean 13.4). A negative correlation was observed between the number of views (correlation coefficient -0.214), number of likes (correlation coefficient -0.242), number of comments (correlation coefficient -0.242), and the usefulness score. Conclusion Although there are multiple videos on YouTube regarding tinnitus, the overall educational content and reliability of the videos are poor. Video popularity is not associated with usefulness. Healthcare providers should counsel patients regarding videos on YouTube and try to create more comprehensive videos.

Skarzynski Tinnitus Scale: Cultural Adaptation and Validation to Brazilian Portuguese

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

Remissão total do zumbido pediátrico: relato dos resultados de uma abordagem não medicamentosa da disfunção tubária / Total remission of pediatric tinnitus: reporting the results of a non-drug approach to tubal dysfunction / Remisión total del acufeno pediátrico: informe de los resultados de un enfoque no farmacológico a la disfunción tubárica

Introdução: Zumbido é um sintoma crescente na população pediátrica e sua multifatoriedade etiológica demanda amplas investigações para utilizar-se adequadas intervenções. Objetivos: relatar os efeitos de uma abordagem não medicamentosa em um caso de remissão total do zumbido pediátrico oriundo da disfunção tubária. Método: Este artigo apresenta um indivíduo com sete anos, do sexo feminino e com queixa de zumbido crônico associado a disfunção tubária, considerado escasso na literatura. Além disso, este estudo descreve as avaliações médicas (neurológica e otorrinolaringológica), a avaliação audiológica e psicoacústica do zumbido, o processo diagnóstico e a intervenção fonoaudiológica realizada. Utilizou-se uma abordagem não medicamentosa que contemplou exercícios miofuncionais orofaciais, Manobra de Valsalva e limpeza nasal. Resultados: Após um mês de intervenção, com a prática diária dos exercícios, o indivíduo estudado referiu ausência da percepção do sintoma e das demais queixas auditivas. Este resultado também foi constatado nas avaliações audiológicas. Conclusão: A abordagem não medicamentosa da disfunção tubária demonstrou bons resultados frente ao manejo do zumbido crônico, para o presente caso. (AU)

Introduction: Tinnitus is a growing symptom in the pediatric population and its etiological multifactorial demands extensive investigations to use appropriate interventions. Objective: report the effects of a non-medicated approach of a case of total remission of pediatric tinnitus from tube dysfunction. Methods: This article presents a seven-year-old female patient with a complaint of chronic tinnitus associated with tubal dysfunction, considered rare in the literature. Besides that, this study describes the medical evaluations (neurological and otorhinolaryngological), the audiological and psychoacoustic evaluations of the tinnitus, the diagnostic process and the speech-language intervention performed. It was used a non-medication approach that included orofacial myofunctional exercises, Valsalva maneuver and nasal cleaning. Results: After a month of intervention, with the daily practice of exercises, the studied subject reported the absence of perception of the symptom and other auditory complaints. This result was also verified in the audiological evaluations. Conclusion: The non-medication approach to tubal dysfunction has shown good results in relation to the management of chronic tinnitus for the present case. (AU)

Introducción: Acufeno es un síntoma creciente en la población pediátrica y su multifatoriedad etiológica demanda amplias investigaciones para utilizar adecuadas intervenciones. Objetivos: Informar los efectos de un enfoque no farmacológico de un caso de remisión total del acufeno pediátrico oriundo de la disfunción tubárica. Metodos: Este artículo presenta un sujeto con siete años, del sexo femenino y con queja de acufeno crónico asociado a disfunción tubárica, considerado escaso en la literatura. Además, este estudio describe las evaluaciones médicas (neurológica y otorrinolaringológica), la evaluación audiológica y psicoacústica del zumbido, el proceso diagnóstico y la intervención fonoaudiológica realizada. Se utilizó un abordaje no medicamentoso que contempló ejercicios miofuncionales orofaciales, Maniobra de Valsalva y limpieza nasal. Resultados: Después de un mes de intervención, con la práctica diaria de los ejercicios, el sujeto estudiado refirió ausencia de la percepción del síntoma y de las demás quejas auditivas. Este resultado también se constató en las evaluaciones audiológicas. Conclusión: El abordaje no medicamentoso de la disfunción tubárica demostró buenos resultados frente al manejo del acufeno crónico, para el presente caso. (AU)

Limiar Diferencial de mascaramento e potencial evocado auditivo de tronco encefálico em adultos normo-ouvintes com zumbido / Masking Level Difference and Auditory Brainstem ResponseIn Normal Hearing Adults With Tinnitus / Umbral de enmascaramiento diferencial y potencial evocado auditivo del tronco encefálico en adultos con audición normal y tinnitus

Introdução: O zumbido é uma ilusão auditiva consciente, uma sensação sonora não relacionada com uma fonte externa de estimulação. Objetivos: Caracterizar a Acufenometria, Limiar Diferencial de Mascaramento, o questionário de qualidade de vida Inventário de Desvantagem do Zumbido e Potencial Auditivo de Tronco Encefálico em adultos normo-ouvintes com zumbido, com a finalidade de comparar seus achados. Método: Vinte indivíduos do sexo feminino e masculino, entre 20 e 60 anos de idade, normo-ouvintes com queixa de zumbido, foram submetidos ao Acufenometria, Limiar Diferencial de Mascaramento, Inventário de Desvantagem do Zumbido e Potencial Evocado Auditivo de Tronco Encefálico. Resultados: AAcufenometriarevelou que o pitch médio foi de 4,3 KHz à orelha direita e 4,6 KHz à orelha esquerda. O loudness médio foi de 21,7 dBNS à orelha direita e 23,5 dBNS à orelha esquerda. O Limiar Diferencial de Mascaramento médio mostrou-se alterado. O Inventário de Desvantagem do Zumbido médio correspondeu à classificação de grau leve. O Potencial Evocado Auditivo de Tronco Encefálico apresentou parâmetros dentro da normalidade bilateralmente. Conclusão: Constatou-se que adultos normo-ouvintes com queixa de zumbido apresentam zumbido de pitch agudo bilateral com discreto impacto na qualidade de vida, condução adequada das vias auditivas até o tronco encefálico e comprometimento na identificação de sons na presença de ruído, demonstrando que o zumbido pode ter repercussões nas habilidades auditivas centrais. (AU)

Introduction: Tinnitus is a conscious auditory illusion, a sound perception unrelated to any external stimulus source. Objectives: To characterize the Acuphenometry, Masking Level Difference, the quality of life questionnaire Tinnitus Handicap Inventory and Auditory Brainstem Response in normal hearing adults with tinnitus, with the purpose of comparing the findings. Method: Twenty female and male individuals, between 20 and 60 years of age, normal hearing with complaints of tinnitus, underwent Acuphenometry, Masking Level Difference, Tinnitus Handicap Inventory and Auditory Brainstem Response. Results: The Acuphenometry showed the average pitch was 4.3 KHz to the right ear and 4.6 KHz to the left ear. The average loudness was 21.7 dBSL to the right ear and 23.5 dBs to the left ear. The average Masking Level Difference was altered. The average Tinnitus Handicap Inventory corresponded to the classification of mild grade. Auditory Brainstem Response showed parameters within normal range bilaterally. Conclusion: It was found that normal hearing adults with tinnitus complaints have bilateral acute pitch tinnitus with a slight impact on quality of life, appropriate conduction of auditory pathways to the brainstem and impaired identification of sounds in the presence of noise, demonstrating that tinnitus can have repercussions on central auditory skills. (AU)

Introducción: El tinnitus es una ilusión auditiva consciente, una sensación de sonido no relacionada con una fuente externa de estimulación. Objetivos: Caracterizar la coincidencia de tono y volumen, el umbral de enmascaramiento diferencial, el inventario de minusvalía para acúfenos y el potencial auditivo del tronco encefálico en adultos normoyentes con acúfenos, con el fin de comparar sus hallazgos. Método:Veinte sujetos masculinos y femeninos, con edades entre 20 y 60 años, audición normal con tinnitus, fueron sometidos a acúfenos, Umbral de Enmascaramiento Diferencial, Inventario de Desventajas de Tinnitus y Potenciales Evocados Auditivos del Tronco Encefalico. Resultados: La combinación de tono y volumen reveló que el tono promedio era de 4,3 KHz en el oído derecho y de 4,6 KHz en el oído izquierdo. Mientras que el volumen medio fue de 21,7 dBNS para el oído derecho y de 23,5 dBNS para el oído izquierdo. Se modificó el umbral diferencial de enmascaramiento promedio. El Inventario de Desventajas de Tinnitus promedio correspondió a la clasificación de grado leve. El Potenciales Evocados Auditivos del Tronco Encefalico presentó parámetros dentro del rango normal bilateralmente. Conclusión:Se encontró que los adultos normooyentes con quejas de tinnitus presentan tinnitus de tono alto bilateral con leve impacto en la calidad de vida, conducción adecuada de las vías auditivas al tronco encefálico y deterioro en la identificación de sonidos en presencia de ruido, demostrando que Tinnitus puede tener repercusiones en las habilidades auditivas centrales. (AU)

Effect of Tinnitus on Sleep Quality and Insomnia

Abstract Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objectives To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

Detección de novedad y codificación predictiva en el sistema auditivo: Impacto clínico en disfunciones auditivas y vestibulares. Revisión de la literatura

Una propiedad fundamental de los sistemas sensoriales es su capacidad para detectar estímulos novedosos en el entorno. El sistema nervioso posee neuronas que disminuyen su respuesta a los estímulos sonoros que se repiten a lo largo del tiempo y otras neuronas que aumentan su frecuencia de disparo ante estímulos novedosos, siendo la diferencia entre ambas respuestas conocida como adaptación-específica a estímulos. En las últimas décadas, se ha propuesto que el cerebro establece, continuamente, predicciones de los estímulos novedosos y del entorno basándose en sus experiencias previas y en modelos de representación internos, teoría denominada codificación predictiva. En esta revisión, abordaremos algunos conceptos de la adaptación-específica a estímulos y codificación predictiva, centrándonos principalmente en el sistema auditivo. Por último, propondremos una explicación teórica basada en el marco de la codificación predictiva para algunas disfunciones neuropsiquiátricas, auditivas y vestibulares.

A fundamental property of sensory systems is their ability to detect novel stimuli in the environment. The nervous system possesses neurons that decrease their response to sound stimuli that are repeated over time and other neurons that increase their firing rate to novel stimuli, the difference between the two responses being known as stimulus-specific adaptation. In recent decades, it has been proposed that the brain continuously makes predictions of novel stimuli and the environment based on its previous experiences and internal representational models, a theory called predictive coding. In this review, we will address some concepts of stimulus-specific adaptation and predictive coding, focusing mainly on the auditory system. Finally, we will propose a theoretical explanation based on the predictive coding framework for some neuropsychiatric, auditory, and vestibular dysfunctions.

Effect of tinnitus on sound localization ability in patients with normal hearing

Abstract Objectives To determine whether tinnitus negatively impacts the accuracy of sound source localization in participants with normal hearing. Methods Seventy-five participants with tinnitus and 74 without tinnitus were enrolled in this study. The accuracy of sound source discrimination on the horizontal plane was compared between the two participant groups. The test equipment consisted of 37 loudspeakers arranged in a 180° arc facing forward with 5° intervals between them. The stimuli were pure tones of 0.25, 0.5, 1, 2, 4, and 8 kHz at 50 dB SPL. The stimuli were divided into three groups: low frequency (LF: 0.25, 0.5, and 1 kHz), 2 kHz, and high frequency (HF: 4 and 8 kHz) stimuli. Results The Root Mean Square Error (RMSE) score of all the stimuli in the tinnitus group was significantly higher than that in the control group (13.45 ± 3.34 vs. 11.44 ± 2.56, p = 4.115, t < 0.001). The RMSE scores at LF, 2 kHz, and HF were significantly higher in the tinnitus group than those in the control group (LF: 11.66 ± 3.62 vs. 10.04 ± 3.13, t = 2.918, p = 0.004; 2 kHz: 16.63 ± 5.45 vs. 14.43 ± 4.52, t = 2.690, p = 0.008; HF: 13.42 ± 4.74 vs. 11.14 ± 3.68, t = 3.292, p = 0.001). Thus, the accuracy of sound source discrimination in participants with tinnitus was significantly worse than that in those without tinnitus, despite the stimuli frequency. There was no difference in the ability to localize the sound of the matched frequency and other frequencies (12.86 ± 6.29 vs. 13.87 ± 3.14, t = 1.204, p = 0.236). Additionally, there was no correlation observed between the loudness of tinnitus and RMSE scores (r = 0.096, p = 0.434), and the Tinnitus Handicap Inventory (THI) and RMSE scores (r = −0.056, p = 0.648). Conclusions Our present data suggest that tinnitus negatively impacted sound source localization accuracy, even when participants had normal hearing. The matched pitch and loudness and the impact of tinnitus on patients' daily lives were not related to the sound source localization ability. Level of evidence 4.

Musicoterapia y otorrinolaringología

La musicoterapia es el uso profesional, planificado y estructurado de la música como intervención terapéutica, con el objetivo de mejorar la salud y calidad de vida del paciente o el grupo intervenido. Esta herramienta se basa en la evidencia de efectos neuroplásticos, psicológicos y cognitivos de la música en las personas. En las últimas décadas se ha encontrado evidencia de múltiples beneficios de musicoterapia como tratamiento adyuvante en medicina, entre ellos se destacan: reducción del dolor en enfermedades crónicas, oncológicas, procedimientos quirúrgicos y trabajo de parto, disminución de síntomas depresivos y ansiosos en trastornos del ánimo y demencia, mejoría de la sincronización motora y perceptiva en enfermedad de Parkinson, entre otros. La otorrinolaringología se ha establecido, asimismo, como un nicho plausible para musicoterapia. Actualmente existen numerosas líneas de investigación que se han dedicado a generar evidencia científica en torno a musicoterapia y su utilidad en diversos campos de la especialidad; esta revisión pretende recopilar y analizar dicha evidencia. Los resultados obtenidos en los diferentes estudios sugieren, con evidencia de calidad baja a moderada, que existen beneficios significativos en la utilización de esta herramienta en el tratamiento multimodal de tinnitus, manejo del dolor y ansiedad en procedimientos médico-quirúrgicos, y en la rehabilitación de pacientes con hipoacusia e implantes cocleares. Si bien se ha encontrado que la música es una modalidad terapéutica segura, barata y con beneficios que parecen ser prometedores, se requieren más estudios clínicos de buena calidad y validez para recomendar el uso de musicoterapia en otorrinolaringología.

Music therapy is the professional, planned, and structured use of music as a therapeutic intervention, with the objective of improving the health and quality of life of the patient or the intervened group. This tool is based on the evidence of neuroplastic, psychological and cognitive effects of music in people. In the last decades there has been evidence of multiple benefits of music therapy as an adjuvant treatment in medicine, among them: reduction of pain in chronic diseases, oncology, surgical procedures and labor, reduction of depressive and anxious symptoms in mood disorders and dementia, improvement of motor and perceptual synchronization in Parkinson's disease, among others. Otorhinolaryngology has also been established as a plausible niche for music therapy. Currently there are numerous research lines that have been devoted to generate scientific evidence on music therapy and its usefulness in various fields of the specialty, this review aims to compile and analyze such evidence. The results obtained in the different studies suggest, with low to moderate quality evidence, that there are significant benefits in the use of this tool in the multimodal treatment of tinnitus, pain and anxiety management in medical-surgical procedures, and in the rehabilitation of patients with hypoacusis and cochlear implants. Even though music has been found to be a safe and inexpensive therapeutic modality with benefits that appear to be promising, more clinical studies of good quality and validity are required to recommend the use of music therapy in otorhinolaryngology.

Tinnitus: una revisión narrativa / Tinnitus: A narrative review / Tinnitus: uma revisão narrativa

El tinnitus o acúfeno es la percepción de sonido en ausencia de un estímulo acústico externo; es uno de los motivos de consulta más comunes en el área de otorrinolaringolo­gía. Se ha asociado a diversas etiologías tales como ototoxicidad, tumores, traumatismo craneoencefálico y trastornos psiquiátricos, siendo también las causas de carácter idio­pático ampliamente conocidas. Las características clínicas de los tinnitus son variables de paciente a paciente, por lo que su diagnóstico, tratamiento y seguimiento son un desafío clínico Si bien recientes estudios han propuesto distintos manejos clínicos y terapéuticos, estos continúan hoy en día en estudio. Esta revisión narrativa pretende realizar una actualización sobre el abordaje diagnóstico, clínico y terapéutico de los tinnitus en la última década.

Tinnitus, the perception of sound in the absence of an external acoustic stimulus, is one of the most common reasons for consultation in the area of otorhinolaryngology. It has been associated with various etiologies such as ototoxicity, tumors, head trauma, and psychiatric disorders; idiopathic causes are also widely known. The clinical characteristics of tinnitus are variable from patient to patient; therefore, its diagnosis, treatment, and follow-up are a clinical challenge. Although recent studies have proposed different clinical and therapeutic approaches, these are still under analysis today. This narrative review aims to update the diagnostic, clinical and therapeutic approach to tinnitus in the last decade.

Tinnitus ou zumbido é a percepção do som na ausência de um estímulo acústico externo; é um dos motivos mais comuns de consulta na área de otorrinolaringologia. Tem sido associada a várias etiologias, como ototoxicidade, tumores, traumatismo craniano e distúrbios psiquiátricos, sendo também amplamente conhecidas causas idiopáticas. As características clínicas do zumbido são variáveis de paciente para paciente, por isso seu diagnóstico, tratamento e acompanhamento são um desafio clínico, embora estudos recentes tenham proposto diferentes abordagens clínicas e terapêuticas, ainda hoje estão em estudo. Esta revisão narrativa visa atualizar a abordagem diagnóstica, clínica e terapêutica do zumbido na última década.

Factores asociados a un mayor grado de incapacidad por acúfenos en pacientes del servicio de Otorrinolaringología de una Clínica en Lima

Objetivo: Identificar los factores asociados a un mayor grado de incapacidad por acúfenos en pacientes del servicio de Otorrinolaringología en una clínica de Lima-Perú. El estudio: La muestra estuvo conformada por 100 pacientes que manifestaron sufrir de acufenos, a quienes se les aplicó el cuestionario Tinnitus Handicap Inventory (THI). Para el análisis comparativo se usó el test de Chi-Square o Kruskal-Wallis. Para determinar la asociación entre las variables de estudio se usaron modelos de regresión de Poisson, con intervalos de confianza al 95%. Hallazgos: El 94% de los participantes presentaron algún grado de incapacidad por acufenos, 40% de grado severo. Por cada año cumplido aumenta 7% la probabilidad de padecer incapacidad grave por acufenos, mientras que ser hipertenso y tener depresión aumentan esta probabilidad en 8 y 4.8 veces respectivamente. Conclusiones: La edad, la Hipertensión y la depresión son factores asociados a un mayor grado de incapacidad por acúfenos.

Objective: The goal of this investigation was to determine the factors associated with a higher degree of disability due to tinnitus in patients of the otorhinolaryngology service in a clinic in Lima-Peru. The study: The sample consisted of 100 patients who reported suffering from tinnitus, to whom the Tinnitus Handicap Inventory (THI) questionnaire was applied. For the comparative analysis, either the Chi-Square or the Kruskal-Wallis test was used. To determine the association between the study variables, Poisson regression models were used, with 95% confidence intervals. Findings: Of the participants, 94% exhibited some degree of disability due to tinnitus. For 40% of the patients the disability was found to be severe. For every subsequent year of age, the probability of suffering from severe disability due to tinnitus increases by 7%, while being hypertensive and having depression increased this probability by 8 and 4.8 times, respectively. Conclusions: age, hypertension and depression are factors associated with a higher degree of disability due to tinnitus.

Electroencephalographic microstates in vestibular schwannoma patients with tinnitus / 南方医科大学学报

OBJECTIVE@#To explore the biomarkers of tinnitus in vestibular schwannoma patients using electroencephalographic (EEG) microstate technology.@*METHODS@#The EEG and clinical data of 41 patients with vestibular schwannoma were collected. All the patients were evaluated by SAS, SDS, THI and VAS scales. The EEG acquisition time was 10-15 min, and the EEG data were preprocessed and analyzed using MATLAB and EEGLAB software package.@*RESULTS@#Of the 41 patients with vestibular schwannoma, 29 patients had tinnitus and 12 did not have tinnitus, and their clinical parameters were comparable. The average global explanation variances of the non-tinnitus and tinnitus groups were 78.8% and 80.1%, respectively. The results of EEG microstate analysis showed that compared with those without tinnitus, the patients with tinnitus had an increased frequency (P=0.033) and contribution (P=0.028) of microstate C. Correlation analysis showed that THI scale scores of the patients were negatively correlated with the duration of microstate A (R=-0.435, P=0.018) and positively with the frequencies of microstate B (R=0.456, P=0.013) and microstate C (R=0.412, P=0.026). Syntax analysis showed that the probability of transition from microstate C to microstate B increased significantly in vestibular schwannoma patients with tinnitus (P=0.031).@*CONCLUSION@#EEG microstate features differ significantly between vestibular schwannoma patients with and without tinnitus. This abnormality in patients with tinnitus may reflect the potential abnormality in the allocation of neural resources and the transition of brain functional activity.

Progress in neural network mechanism of tinnitus using functional magnetic resonance imaging / 临床耳鼻咽喉头颈外科杂志

Tinnitus refers to the perception of abnormal sound in the absence of external sound stimulation. It can have an impact on a person's mood, memory, attention, and mental state, although the mechanism of tinnitus is still unclear. In recent years, the research on the central neural mechanism of tinnitus has attracted the attention of scholars.Functional magnetic resonance imaging （fMRI）,as an effective imaging technology, has been actively employed in this field. This paper provides a systematic summary of studies on the central neural mechanism of tinnitus by fMRI in recent years,revealed the changes of functional connections among tinnitus-related neural networks,such as auditory network,limbic system,default mode network and salience network. The central neural mechanism of tinnitus involves multiple networks that interact with each other. By understanding this mechanism, we hope to develop more targeted prevention and treatment strategies to help patients alleviate long-term tinnitus.

Research advances in the correlation between chronic subjective tinnitus and anxiety state / 临床耳鼻咽喉头颈外科杂志

Tinnitus and anxiety disorder are common clinical symptoms. Comorbidity between tinnitus and anxiety state is increasing year by year. The relationship between tinnitus and anxiety state has always been a hot topic, and this paper reviews the literature on the relationship between chronic subjective tinnitus and anxiety state in recent years.

Prevalence of tinnitus in noise-exposed workers and its influencing factors / 环境与职业医学

Background Tinnitus is a common symptom in workers exposed to noise, and no specific treatment is available yet. Paying attention to the influencing factors of tinnitus is very important to prevent tinnitus. Objective To investigate the situation of tinnitus among noise-exposed workers and its influencing factors. Methods Using a cross-sectional study design, 1011 noise-exposed male workers in Hangzhou were studied. Tinnitus status, age, education, personal protection, smoking history, drinking history, and family history of the participants were surveyed by questionnaires. Binaural pure tone hearing threshold test was performed on all study subjects. The environmental noise in the workplace was measured. The relationships of tinnitus with noise exposure intensity, noise exposure time, noise exposure category, cumulative noise exposure, and wearing hearing protectors among the noise-exposed workers were analyzed by logistic regression. Results The prevalence of tinnitus among the noise-exposed workers was 36.1%. The mean hearing thresholds at 500, 3000, 4000, and 6000 Hz in the right and left ears were higher in the tinnitus group than in the non-tinnitus group (P<0.05); the hearing threshold at 2000 Hz in the right ear was higher in the tinnitus group than in the non-tinnitus group (P<0.05). There was no statistically significant difference between the two groups in the prevalence of monaural speech-frequency hearing loss or monaural high-frequency hearing loss (P>0.05). The on-site noise intensity was divided into three groups: ＜85, 85-＜95, and ≥95 dB(A); the prevalence of tinnitus in the three groups was 19.6%, 40.5%, and 66.7% respectively. The years of noise exposure was divided into three groups: ＜1, 1-＜5, and ≥5 years; the prevalence of tinnitus in the three groups was 17.9%, 34.0%, and 45.4% respectively. The cumulative noise exposure was divided into six groups: ＜80, 80-＜85, 85-＜90, 90-＜95, 95-＜100, and ≥100 dB(A)·year; the prevalence of tinnitus in the six groups was 6.8%, 25.0%, 31.0%, 39.6%, 43.1%, and 46.7% respectively. The prevalence of tinnitus was higher in the non-stationary noise group (42.5%) than in the stationary noise group (26.8%) (χ2=26.18, P<0.01), and the prevalence in the group without or with hearing protection was 39.7% and 35.5% respectively. The results of logistic regression showed that workers exposed to higher intensity, longer noise exposure, higher cumulative noise exposure, and non-stationary noise (reference: stationary noise) resulted in a higher risk of tinnitus (Ptrend<0.01 or P<0.01); workers wearing of hearing protection device versus those not showed a lower risk of tinnitus (P<0.05). Conclusion Higher intensity, longer exposure to noise, and more cumulative noise exposure associate with a higher risk of tinnitus. Wearing hearing protective device can reduce the risk of tinnitus. Tinnitus in noise-exposed workers can precede the presentation of abnormal hearing loss.

Teste de usabilidade do aplicativo Avazum / Avazum app usability testing

RESUMO Objetivo Verificar a efetividade, eficiência e satisfação no teste de usabilidade para o aplicativo de avaliação do zumbido. Método Trata-se de um estudo descritivo de teste de usabilidade, no qual será avaliado satisfação, eficácia e eficiência do aplicativo. O teste foi realizado virtualmente por meio de um formulário do Google Forms. Primeiramente, os participantes receberam as instruções de acesso e uso do avazum através de textos e imagens ilustrativas. Logo após, os usuários fizeram o uso do aplicativo, observando suas funções e usabilidade. Em seguida, os participantes responderam o questionário de usabilidade. A análise estatística foi realizada no software Statistics Package for the Social Sciences (SPSS) versão 21.0 para realizar a análise descritiva como frequência, percentagens dos dados do System Usability Questionnaire (SUS), além de análise do score do Net Promoter Score (NPS). Resultados Sendo assim, a média geral do score do SUS foi condizente com score de usabilidade satisfatório, o que implica dizer que o aplicativo não apresenta graves problemas de usabilidade, além da porcentagem geral NPS indicar uma satisfação muito boa dos usuários, com bom percentual de usuários promotores. No que diz respeito sobre a efetividade, foi possível observar que o Avazum atinge os objetivos propostos, além de ser eficiente, pois apresenta uma linguagem clara e confortabilidade durante o uso. Conclusão O Avazum obteve satisfação muito boa dos usuários, além de atingir os objetivos propostos, tornando-o efetivo, apresentou uma linguagem clara e confortabilidade durante o uso, aduzindo eficiência na avaliação multidisciplinar do zumbido.

ABSTRACT Purpose To verify the effectiveness, efficiency, and satisfaction in the usability test of the tinnitus assessment application. Methods This is a descriptive usability test study that assessed the satisfaction, effectiveness, and efficiency of the application. The test was carried out virtually via Google Forms. First, the participants received instructions on how to access and use Avazum, through texts and illustrative images. Afterward, the users used the application, observing its functions and usability. Next, the participants answered the usability questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences, version 21.0, to perform descriptive analysis such as frequency, percentages of data in the System Usability Questionnaire (SUS), and analysis in the Net Promoter Score (NPS). Results Thus, the overall mean SUS score was consistent with satisfactory usability, which implies that the application does not present serious usability problems. Also, the overall NPS percentage indicated very good user satisfaction, with a good percentage of promoting users. As far as effectiveness is concerned, it was found that Avazum reached its goals, besides being efficient, as it uses clear language and is comfortably used. Conclusion Avazum obtained very good satisfaction from users, in addition to achieving its goals. It proved to be effective, has clear language, and is comfortably used, adducing efficiency in the multidisciplinary evaluation of tinnitus.