An improved system for grading and treating tinnitus.

OBJECTIVE: Tinnitus is an auditory sensation that can cause discomfort or even pain. Because patients with tinnitus frequently have psychological problems, self-reporting of the severity of tinnitus is unreliable. We developed a new grading system and practical protocol for the systematic treatment of tinnitus that accounts for its severity, patients' psychological problems, and the frequency of catastrophic episodes. The aim of this study is to employ and validate the new system in patients with tinnitus. METHODS: This study comprised two parts: (i) We identified 113 patients, who were then analyzed in terms of severity of tinnitus, psychological problems, and catastrophic episodes. They were then classified into 5 grades, and the records of their previous treatments were scrutinized. From these records, we designed a practical treatment protocol suitable for each of the 5 grades. (ii) We then identified 82 new patients, and graded and treated them according to the system developed in part (i). Patients were followed-up for at least 6 months; treatment efficacy was evaluated using the pre- and post-treatment scores on the Tinnitus Handicap Inventory (THI) and Hospital Anxiety and Depression Scale (HADS). Psychological status was also assessed with the DSM-IV. RESULTS: (i) The overall patient group was categorized as follows: Grade I, 38 patients, average THI=37.6 points, average HADS=10.9 points, catastrophic episodes=0 points; Grade II, 24 patients, THI=70.6, HADS=13.1, catastrophic episodes=0; Grade III, 5 patients, THI=73.2, HADS=28.4, catastrophic episodes=0; Grade IV, 33 patients, THI=63.5, HADS=18.8, catastrophic episodes=1.0; Grade V, 13 patients, THI=73.2, HADS=22.4, catastrophic episodes=2.2. The treatment records revealed treatment via psychotropic drugs for 40% of Grade III, 45.5% of Grade IV, and 84.6% of Grade V patients; psychiatric consultation was provided for 20% of Grade III, 12.5% of Grade IV, and 53.8% of Grade V patients. (ii) THI scores improved significantly in Grades II, IV, and V after treatment using the new protocol; HADS scores improved significantly in Grades IV and V. Catastrophic episode scores improved significantly in Grades IV and V. CONCLUSION: We found large enough differences in THI and HADS scores to successfully classify patients with tinnitus into 5 distinct grades that accounted for tinnitus severity, psychological problems, and catastrophic episodes. We found significant improvements in tinnitus severity and psychological problems in the higher (more severe) grades when this system was used to guide treatment. This system not only provided a reasonably reliable categorization system, it simplified treatment without sacrificing efficacy.

Spiral crack patterns observed for melt-grown spherulites of poly(L-lactic acid) upon quenching.

In this paper, we demonstrate the characteristic spiral cracking that appears on the surface of melt-grown poly(L-lactic acid) (PLLA) spherulites with relatively large sizes (greater than 0.4mm in diameter). The crack occurs via thermal shrinkage upon quenching after crystallization. Although concentric cracks on polymer spherulites have been found to occur in quite a few studies, spiral crack patterns have never been reported so far. The present spiral crack was observed for thick spherulites (> 10 µm), whereas the concentric crack pattern was frequently observed for thin spherulites (typically 5 µm). The present PLLA spherulites exhibited a non-banded structure with no apparent structural periodicity at least on the scale of the spiral pitch, and thus no direct correlation between the crack pattern and the spherulitic structure was suggested. The spiral was revealed to be largely Archimedean of which the spiral pitch increases with an increase in the thickness of the spherulite. This may be interpreted in terms of a classical mechanical model for a thin layer with no delamination from the substrate.