Etiology and Pathophysiology of Tinnitus - A Systematic Review.

INTRODUCTION: Prevalence of tinnitus range from 7.1% to 14.6% (National Center for Health Statistics, 2016), but the mechanisms responsible for the development of this abnormal sensory state remain poorly understood. OBJECTIVES: To determine the evidence for different etiologies and pathophysiology of tinnitus identified by clinical diagnostic tests in the adult population. STUDY DESIGN: Systematic literature review. METHODS: Review of data base using PRISMA guidelines: Google Scholar, Medline, Springer Link, Pubmed. In addition, manual reference search of identified papers. Randomized controlled trials, case control study, prospective cohort studies, and retrospective reviews of consecutive patients in which clear data were reported with respect to etiology and pathophysiology of tinnitus. RESULTS: Sixty seven articles met the inclusion criteria. The papers searched recent studies from 2004 to 2018 for different etiologies such as noise exposure, age, ototoxic drugs, hearing loss among patients with tinnitus. Multiple pathophysiology were identified, including inner ear pathology, auditory nerve synchronisation, central nervous system anomalies and limbic and autonomous nervous system problems. The group of papers evaluated tinnitus patients with specific diagnostic tests such as pure tone audiometry, Immitance audiometry, otoacoustic emission, Auditory brainstem response and diagnostic imaging of fMRI, MRI and PET study. CONCLUSIONS: The results indicate a high level of heterogeneity between the studies for all the assessed areas. These results support the need for greater stratification of the tinnitus population and the importance of a standardized Puretone audiometry with extended high frequency, OAE, ABR and diagnostic imaging (fMRI, MRI & PET) method to make comparisons between studies possible. Diagnostic imaging is an important useful method for identification of intracranial pathology that can present with tinnitus as a primary symptom. Establishment of a direct causal link between tinnitus and these etiologies and pathophysiology remains elusive.

Auditory System Synchronization and Cochlear Function in Patients with Normal Hearing With Tinnitus: Comparison of Multiple Feature with Longer Duration and Single Feature with Shorter Duration Tinnitus.

OBJECTIVE: To observe cochlear and brainstem function in normal hearing ears with tinnitus using DPOAE and ABR audiometry. DESIGN: Case-control study. SAMPLE SIZE: Included 60 normal hearing male patients with age less than 45 years; control group consisted of 30 patients without tinnitus and the study group consisted of those with unilateral tinnitus of at least 6 month duration. Pure tone audiometry, tinnitus matching (pitch & loudness), DPOAE (SNR & Amplitude) and ABR results of absolute latency of wave I, III and V, with IPL difference of I-III, III-V & I-V, and ILD-V were investigated. RESULTS: SNR and amplitude value of DPOAE were significantly different between tinnitus ears and without tinnitus ears. Abnormal prolonged absolute latencies of peak I, III, V suggesting presence of hearing loss above 8 kHz and significant difference of only IPL III-V in the tinnitus ear suggesting of upper brain steam lesion in tinnitus patients were found. The IPL of III-V and ILD-V findings were significantly different in longer duration with multiple features (more than one type of pitch) than shorter duration with single feature tinnitus. Thus whole brainstem function has significant relationship with the presence of tinnitus, longer duration with multiple nature of tinnitus perception. CONCLUSION: Abnormal OAE and ABR results were present in patients with tinnitus. It was more prominent in patients with longer duration with multiple features of tinnitus perception.

Treatment of Tinnitus: A Scoping Review.

BACKGROUND: Tinnitus is a perception of an auditory sensation without the presence of an external sound. It has devastating impact on the quality of life and psychosocial aspect of the sufferer. Mechanisms of tinnitus not clear; however, its management include counselling, hearing aids, tinnitus masking, relaxation therapy, cognitive behaviour therapy and tinnitus retraining therapy. OBJECTIVE: To conduct a scoping review to explore the role of counselling, hearing aids, tinnitus masking, relaxation therapy, cognitive-behavioural therapy and tinnitus retraining therapy in India. To also provide an overview of efficacy of these approaches in tinnitus management. RESEARCH DESIGN: Scoping review. STUDY SAMPLE: Experimental studies, follow-up assessments, and reviews assessing tinnitus treatment approaches were identified as a result of an electronic database met search. RESULTS: The evidence suggests that all tinnitus management programs have their unique benefits in the treatment of tinnitus. Given the confounding variables that include length of therapy, tinnitus severity and subject population, the overall level of evidence is equivocal. Nonetheless, the efficacy of CBT appears reasonably established and combined approach (masking + counselling + attention diversion) appears to be most promising for audiologists for future tinnitus management. A common ground of therapeutic elements was established and evidence was found to be robust enough to guide clinical practice. CONCLUSION: The use of more robust methodology with well-defined control groups, as well as randomization of clinical trials in future studies would increase the quality of evidence in the study of tinnitus management. CLINICAL RECOMMENDATION: Combined therapies (masking + counselling + attention diversion) appear more appropriate in the treatment of tinnitus as the evidence is not sufficient to support a specific treatment method.

The impact of tinnitus on sufferers in Indian population.

Tinnitus is a very common complain and affects 7% of population and has been associated with a range of physical and emotional disorders (Hallam et al. in Br J Clin Psychol 27:213-222, 1988). Hence to understand the distress caused by tinnitus and its relationship with the nature of tinnitus so as to suggest the appropriate treatment, there is the need to study the impact of tinnitus of a group of tinnitus sufferers. This study could be done on the basis of verbal description of tinnitus, Audiological measurement of tinnitus and psychological characteristics of tinnitus in terms of distress, anxiety, depression and disturbance of personality, to understand the impact of tinnitus on sufferers. Fifty adults in the age range of 18-60 years with subjective tinnitus with bilateral normal hearing or pure SNHL ranging from mild to moderately severe were selected. An audiological profile of each subject was prepared on the basis of brief case history of subject, otoscopic examination, pure tone audiometry, impedance audiometry, frequency (pitch) and intensity (loudness) of tinnitus. A psychometric profile was developed by using Tinnitus Reaction Questionnaire and Nature of Tinnitus Questionnaire. These questionnaires were translated and adopted in Hindi and Bengali language after appropriate standardization procedure. 60% reported that they do not have any idea regarding probable cause of their tinnitus. 74% subjects of this study reported that there is no fluctuation in the pitch of their tinnitus. However, 68% reported loudness of tinnitus is fluctuating. A weak co-relation has been seen between traditional audiological measures like pitch matching, loudness matching and subject's description of pitch and loudness of tinnitus. There was a significant correlation between the impact of tinnitus and disturbance of sleep caused by it with increase in depression and anger (0.483). However, no significant co-relation was seen between distressed caused by tinnitus and duration of tinnitus (-0.034). The multiple nature/sounds of tinnitus had far more devastating effects or serious impact on 'tinnitus sufferers' than the single sound/nature. Gender differences were also found among tinnitus sufferers while assessing the audiological and psychological measures of tinnitus. Female subjects also reported a higher level of emotional reaction with a mean of 35.9 to their tinnitus as compared to males with a mean of 31.7. Tinnitus has resulted in multifold effects/impacts on tinnitus sufferers where it has made them feel unhappy, tense, irritable, depressed, annoyed, distressed and frustrated. It has interfered with their enjoyment, their relaxation, their sleep, and forced them to avoid quiet environmental and social situations. These findings should further help in the overall management of the patient suffering from tinnitus.

Nature and onset of communication disorder in pediatrics with HIV.

American Speech-Language Association (ASHA) and the International Association of Physicians in AIDS Care (IAPAC) reported that speech-language and hearing disorders that occur as a direct or indirect consequence of HIV-infection are so common. However there has been little research into the nature and onset of such communication disorders in children living with HIV. Therefore the purpose of the study is to understand about the nature and onset of audiological and speech-language disorders of a group of children with HIV for the better management. In methodology 67 children (4-16 years, mean: 11.06) with HIV infection took part in the study. Otoscopic examination, Pure-tone and Impedance audiometry, REELS, SECS, PAT, FDA and BUFFALO-III was used to assess. In result, 22/67 individuals had hearing loss, 17/67 had swallowing disorder, 21/67 individuals had voice problems. Language development was delayed in 21/67 of the individuals at the pragmatic and syntactic level and 7/67 had the deviant language. There was negative correlation (r=-0.932) between the duration of HIV infection and degree of severity of communication disorders in the participants.

Status of the tinnitus management program in India-A Survey.

OBJECTIVE: The aim of the study is to figure out the status of tinnitus management program (TMP) being conducted in India, to estimate the use of different tinnitus management program, to study the role of various professionals involved and document the current practices of audiologist in country. DESIGN: A questionnaire on "tinnitus management survey" was developed and distributed to 150 institutions all over India. RESULTS AND CONCLUSION: The return rate of the Questionnaire was 32.6%, 7 were received from Medical Colleges (MCs) and 42 from speech and hearing clinics (SHCs). Hence, the rates of TMP have not taken up appropriately in the various hospitals and clinics as yet. 71.4% SHCs have the provision of TMP, 74.28% of the institutes have less than 50% of the patients improving with the TMP, involving Audiologists in 62.85% of the institutes. 54.28% of the institutes opted for Tinnitus Masking out of the various tinnitus management programs. Outside funding for TMP was not received by 91.42% of the institutes. 60% of the institutes were provided TMP with hearing aids. 71.42% of the SHCs feel TMP is partially helpful to tinnitus sufferers thus funding should be undertaken by the Government for ensuring effectual program all over India.