Tinnitus impairs cognitive efficiency.

Many people who complain of tinnitus say that the noises impair their mental concentration. This complaint was investigated by self-report (primarily the Cognitive Failures Questionnaire) and by means of five cognitive tasks, four presented via laptop computer and one given manually. The tasks measured performance under single- and dual-task conditions and included tests of sustained attention, reaction time, verbal fluency and immediate and delayed memory. Two groups of outpatients attending audiological clinics (tinnitus, n = 43; hearing impairment, n = 17) were compared with non-clinical volunteers (n = 32). The results replicated earlier findings that tinnitus outpatients report significantly more everyday cognitive failures than do controls. The tinnitus group responded significantly more slowly than the two control groups on the variable fore-period reaction time task under dual-task conditions. In general, comparisons between the groups on other tasks showed equivalent performance, but both clinical groups performed more poorly than non-clinical controls on verbal fluency. We conclude that cognitive inefficiency in tinnitus participants is related to the control of attentional processes, consistent with our earlier theoretical speculation about the nature of tinnitus complaint and with published findings on the effects of chronic pain on cognitive processes.

A dialogical approach to obsessions.

Cognitive conceptualizations of obsessions based on the information-processing metaphor are contrasted with a dialogical approach to understanding obsessive compulsive disorder (OCD). The dialogical approach views obsessions as one-sided conversations. The unit of analysis is the narrative or 'voice', which engages the person in the neutralizing behaviour. The dialogical approach accommodates well the apparent paradox that obsessions are both self and other generated, and that people can be positioned differently regarding the senselessness of their obsessions at different times. Also, people themselves characterize their obsessions in dialogical terms as: voice, conversation, or argument. The focus of therapy is the language and power of the narrative rather than discrete cognitive biases or representations, and dialogical therapy emphasizes role-play and narrative techniques. Cognitive therapy has already shown signs of adopting a narrative turn, and cognitive and dialogical conceptualizations of OCD are alternative perspectives rather than competing explanations.

The effects on significant others of providing a hearing aid to the hearing-impaired partner.

Communication is a shared experience which can be substantially affected by hearing impairment. Significant others may experience difficulties not only in direct communication but also in personal and social relationships. The present study was designed to investigate the impact on significant others of hearing loss in a partner and the benefits that accrued from the provision of personal amplification. The results suggested that before the provision of a hearing aid significant others experienced difficulties with person-to-person conversation, with group conversation and in viewing (listening to) television of the same order as did the hearing impaired individual. After appropriate intervention the difficulties were greatly reduced with resultant improvement in quality of life for both parties.

Interaction of the influenza virus nucleoprotein with the cellular CRM1-mediated nuclear export pathway.

Influenza virus transcription occurs in the nuclei of infected cells, where the viral genomic RNAs are complexed with a nucleoprotein (NP) to form ribonucleoprotein (RNP) structures. Prior to assembly into progeny virions, these RNPs exit the nucleus and accumulate in the cytoplasm. The mechanisms responsible for RNP export are only partially understood but have been proposed to involve the viral M1 and NS2 polypeptides. We found that the drug leptomycin B (LMB), which specifically inactivates the cellular CRM1 polypeptide, caused nuclear retention of NP in virus-infected cells, indicating a role for the CRM1 nuclear export pathway in RNP egress. However, no alteration was seen in the cellular distribution of M1 or NS2, even in the case of a mutant virus which synthesizes greatly reduced amounts of NS2. Furthermore, NP was distributed throughout the nuclei of infected cells at early times postinfection but, when retained in the nucleus at late times by LMB treatment, was redistributed to the periphery of the nucleoplasm. No such change was seen in the nuclear distribution of M1 or NS2 after drug treatment. Similar to the behavior of NP, M1 and NS2 in infected cells, LMB treatment of cells expressing each polypeptide in isolation caused nuclear retention of NP but not M1 or NS2. Conversely, overexpression of CRM1 caused increased cytoplasmic accumulation of NP but had little effect on M1 or NS2 distribution. Consistent with this, NP bound CRM1 in vitro. Overall, these data raise the possibility that RNP export is mediated by a direct interaction between NP and the cellular CRM1 export pathway.

A critical analysis of directive counselling as a component of tinnitus retraining therapy.

Tinnitus retraining therapy (TRT) has been presented as a new approach to tinnitus management. In this paper a number of theoretical and practical problems with TRT are identified. These problems relate to the distinction between directive counselling and cognitive therapy, the adequacy of the cognitive therapy components, the nature of the outcome data which have been presented to date, the theoretical basis for the treatment, and the conceptual clarity of terms such as perception, attention and coping. The stated goal of removal of the perception of tinnitus may lead to confusion about the likely outcome of TRT for most patients. Methodological limitations in the research which has been published to date preclude any claims about the efficacy of TRT at the present time. It is suggested that randomized, controlled studies which include no-treatment and placebo conditions need to be undertaken. Studies are required in which the efficacy of the counselling and white noise components can be clearly isolated. Suggestions are made about the role of psychologists and non-psychologists in the provision of counselling and cognitive therapy services to tinnitus patients.

Attitudes to hearing difficulty and hearing aids and the outcome of audiological rehabilitation.

First time hearing aid candidates (N = 135) in a NHS setting were administered the Hearing Attitudes in Rehabilitation Questionnaire (HARQ) designed to assess attitudes to acquired hearing loss and hearing aids and 92% of them were followed up 3-9 months after fitting. Attitude scores, age, sex and sensory thresholds were related to six self-report outcome measures by use of logistic regression. The major findings were that patients who were least distressed by their hearing difficulties and reported not wanting or needing a hearing aid used their aids least frequently and evaluated them less highly in listening situations. An attitude that wearing a hearing aid was stigmatizing was not predictive of outcome except a report of more difficulty in handling the aid. There were some low but significant correlations between attitudes and sensory thresholds and thresholds also contributed to the prediction of outcome in a few instances.

Development of the Hearing Attitudes in Rehabilitation Questionnaire (HARQ).

A questionnaire devised by Brooks to measure attitudes towards hearing impairment and provision of a hearing aid in older people was factor analysed and subsequently enlarged and modified into a new 40 item self-report scale. The Hearing Attitudes in Rehabilitation Questionnaire (HARQ) assesses three attitudes towards hearing impairment (personal distress/inadequacy, hearing loss stigma and minimization of loss) and four attitudes towards provision of a hearing aid (hearing aid stigma, aid-not-wanted, pressure to be assessed and positive expectation). Scale development, reliability and other psychometric properties are reported. Potential uses of the scale include identification of patients who may require counselling, evaluation of audiological rehabilitation and further empirical investigations of attitudes in this area.

Correlates of sleep disturbance in chronic distressing tinnitus.

Sleep disturbance was recorded for a 1-week period prior to a follow-up assessment of 26 patients who had completed a study of psychological therapy reported elsewhere (Davies et al., 1995). The absence of reported sleep disturbance was associated with essentially normal hearing over the range 250 Hz to 2 kHz; hearing impairment was present in mild or severe sleep disturbance. Patients whose sleep was most disturbed rated significantly greater tinnitus annoyance in the evening. Measures of mood and emotional distress did not relate to degree of sleep disturbance.

Mental health work rehabiliation services in the United States-innovation and good practice.

During the spring of 1994, the author visited innovative and good practice, mental health rehabilitation schemes in the United States. Current practice and the training of staff especially in the field of work rehabilitation, was observed, and comments are made on the positive features of these exemplary schemes and their programs. There are both striking similarities and differences in the philosophy and delivery of mental health work rehabilitation services in the United States and United Kingdom. The move away from the traditional workshop model to placing people in competitive employment, strongly emphasized in the United States in recent years, has shown promising results. The employment models used, and their relevance to services in the United Kingdom, are discussed. Ideas and information generated by the visit will be used to develop work rehabilitation services within the author's organization and in Oxfordshire as a whole.

The prevalence of psychological disturbance in neurotology outpatients.

This study assesses the prevalence of psychological disturbance among a consecutive series of 120 neuro-otology outpatients, using a structured interview conducted by a clinical psychologist. 42% of all patients were found to be in need of, and were offered, psychological help (27% of those with hearing loss, 45% of those with tinnitus and 64% of those with dizziness). 86% of those offered psychological help accepted it. Current psychological distress was associated with the number of symptoms complained of and past psychiatric history. Patients completed the General Health Questionnaire which was found to have a sensitivity rate of 82% and a specificity rate of 87% in this setting. Physicians were also asked to rate patients' psychological state; close agreement was found between these ratings and those of a psychologist. The contribution of psychological assessment of neuro-otology patients is discussed.

The effect of written reassuring information on out-patients complaining of tinnitus.

The study investigated the effect of a two-page leaflet designed to reassure patients complaining of tinnitus. One half of new attenders at a tinnitus clinic received the leaflet while the other half did not. Clinic staff were blind to the condition to which patients were assigned. Tinnitus distress was assessed at the second appointment by means of a standardized questionnaire. Results indicated that questionnaire scores for the informed and non-informed subjects did not differ. However the informed group reported having significantly fewer 'unfulfilled needs'. They were less likely to want a medical cure or professional guidance. The level of general emotional distress as measured by the General Health Questionnaire did not moderate these effects.

Emotional stability; its relationship to confidence in maintaining balance.

Previous failures to find an association between postural test results and the complaints of dizziness/imbalance were further investigated in neuro-otology out-patients, testing in a range of everyday situations requiring balance. Three matched groups of patients were compared: those complaining of dizziness/imbalance; those reporting but not complaining of dizziness/imbalance; and those who had never experienced these symptoms as noteworthy. No difference was found between the groups in measures of postural performance, self-reported confidence in balance, or in several trait measures of fear/anxiety. However, confidence in balance was significantly correlated with fear/anxiety measures across the sample. The correlations were strongest in complaining patients and weakest in patients reporting but not complaining of dizziness/imbalance. The results suggest that psychological characteristics are likely to influence the reporting of symptoms of dizziness/imbalance. The contribution of vestibular and other balance disorders is unclear given that the three groups performed equally well on postural tests.

Acute and chronic effects of once-daily isosorbide-5-mononitrate on the exercise capacity of patients with angina pectoris treated with a beta-blocking drug.

Forty-four patients with stable effort angina pectoris were included in a double-blind, randomised, placebo-controlled, parallel group study to compare the effect of two slow-release forms of isosorbide-5-mononitrate ('Ismo-Retard' 40 mg and 'Imdur' 60 mg) on exercise capacity when given as an adjunctive treatment to beta adrenoreceptor blocking therapy. In a symptom-limited exercise test performed three hours after the first dose, Ismo-retard increased the total duration of exercise by 92 seconds (confidence interval (CI) 5.1-116.9) p less than 0.006, and the time of onset to anginal pain by 117 seconds (CI 27.8, 156.1) p less than 0.004. A similar improvement in total duration of exercise (by 87 seconds) was noted three hours following 15 consecutive once-daily doses (CI 16.8-128) p less than 0.02, and in the time of onset to anginal pain by 101 seconds (CI 19.8-139.6) p less than 0.01. For Imdur the corresponding results were 53 seconds (CI 12.7-56.3), 84 seconds (CI 15.4-103.7), p less than .02, 54 seconds (CI 1.4-78.4) and 85 seconds (CI 6.9-120.5) respectively. These results would suggest that both active treatments were effective anti-anginal agents.

Soldering technique for osseointegrated implant prostheses.

This article describes a method for making changes in the alignment of superstructures for osseointegrated implants. After a cast is made from a transfer impression, the teeth and plastic are removed from the framework. The framework is sectioned into as many pieces as necessary to realign it on the analogs in the cast. The pieces are held in soldering investment with guide pins and abutment screws for soldering in the new position. The prosthesis is completed, finished, and replaced in the mouth.

Evaluation of a computer interview system for use with neuro-otology patients.

The effectiveness, feasibility and credibility of a computer assessment package was evaluated in a group of 60 neuro-otological outpatients. The computer system was compared with a standard questionnaire and used to elicit basic neuro-otological information prior to clinical interview. The majority of patients (81%) preferred computer assessment. There were no differences in attitude or difficulties between diagnostic groups. Older patients had more difficulties and took longer than younger patients. The computer system was also more efficient than the form from an information handling and administrative point of view.

Cognitive variables in tinnitus annoyance.

Two new questionnaires were devised to investigate dimensions of complaint about tinnitus. Following a factor analysis of data provided by a sample of tinnitus patients who were administered the first questionnaire, the second questionnaire was developed. This included questions concerning coping attitudes and beliefs about tinnitus. The results of the two analyses were similar and they indicated the presence of three main dimensions of complaint (emotional distress, auditory perceptual difficulties, and sleep disturbance). However several smaller factors suggested that complaint was more complex than originally predicted. The second questionnaire successfully discriminated complaining from non-complaining patients.

Dizziness: behavioural, subjective and organic aspects.

The aim of the study was to investigate the relationship between medical and behavioural aspects of dizziness, and the subjective experiences before, during and after an 'attack'. Clinical and self-report data were collected on 60 patients who attended a neuro-otology clinic and whose main complaint was dizziness. The results indicated little direct correlation between subjective experience and organic severity, though there was some correlation between types of movement provocation and both subjective and organic factors. Correspondence analysis of self-reported dizzy sensations revealed four principal clusters. There was a clear distinction between attacks characterized by sensations of actual loss of balance and those preceded by autonomic sensations. Two types of mainly psychologically generated dizziness were proposed: one characterized by inhibition of sensory-motor processes and breathing problems; the other by a range of sympathetic signs. It is suggested that the reporting of sensations should be considered as an independent part of dizziness behaviour and not as a by-product of the physiological disturbance.