Tinnitus and hearing in 7-year-old children.

BACKGROUND: Tinnitus occurs with or without prior noise exposure (noise-induced tinnitus (NIT) and spontaneous tinnitus (ST)), and is considered a symptom related to permanent hearing impairment (HI) or temporary hearing threshold shift (TTS). OBJECTIVE: To carry out a cross-sectional interview study on TTS, ST and NIT during a standard audiometric screening of 756 7-year-old children in Gothenburg. RESULTS: 41% out of 756 children reported either NIT or ST on several occasions, 17% reported recurrent TTS and 7% failed the audiometry screening. The probability of ST was 27% for children with no HI or TTS (OR=1.23 (95% CI 1.12 to 1.34)) but 63% (OR=1.16 (95% CI 1.02 to 1.33)) if exhibiting both HI and TTS. CONCLUSION: This study confirms an increased occurrence of spontaneous tinnitus in children with TTS or HI and in children with both TTS and HI, in particular, but also in children with normal hearing. Possibly, tinnitus in young children correlates with stress as in adolescents and adults.

Tinnitus in the general population with a focus on noise and stress: a public health study.

OBJECTIVES: To evaluate the influence of noise and stress on the probability of tinnitus in the general population. DESIGN: Questionnaire data were obtained from 12,166 subjects. RESULTS: Each year of age increased the odds ratio of tinnitus by about 3%. Men generally showed a higher risk for tinnitus compared with women. Exposure to noise and stress emerged important for the probability of tinnitus. However, for the transition from mild to severe tinnitus, stress turned out to be especially important. CONCLUSIONS: Stress management strategies should be included in hearing conservation programs, especially for individuals with mild tinnitus who report a high stress load.

Fast-track care for patients with suspected hip fracture.

Patients over 65 years of age with suspected hip fracture following low-energy trauma often wait a long time for examinations, X-rays, tests and surgery. There may be a connection between long waiting times and complications, including severe pain, mental confusion, infection, pressure sores, and longer hospital stays. This study examines whether implementing prehospital preoperative procedures might lead to reduced waiting times, less postoperative pain, fewer complications and shorter length of care for this patient group. To "fast-track" care for hip fracture patients, the ambulance nurse starts the preoperative procedure (usually performed in the accident and emergency department [A&E]) and transfers patients directly to radiology, bypassing A&E. Results from the fast-track care group were compared to results from a control group, who had been admitted to A&E in the usual way. The study group experienced fewer complications and shorter hospital stays compared to the control group. This finding suggests that fast-track care for hip fracture patients can minimise complications, heighten priorities, and decrease overall length of care. Greater awareness of risk factors for hip fracture patients amongst hospital staff leads to improved patient care. Fast-track care may also decrease the workload in A&E and thus release more time for other patients.

Relationship between tinnitus severity and psychiatric disorders.

A close association between tinnitus and psychiatric disorders has been demonstrated, but little is known about how the severity of tinnitus is related to these disorders. The authors investigated the strength of the association between tinnitus and both the prevalence and severity of anxiety and depressive disorders. One study group consisted of 80 consecutive patients and another of 144 patients who were deemed by screening to be at high risk for severe and disabling tinnitus. The severity of tinnitus was assessed by clinical gradings on a 3-point scale and by the Tinnitus Severity Questionnaire. DSM-III-R criteria were used to identify psychiatric disorders by structured clinical interview. The Hospital Anxiety and Depression Scale (HADS) and the Comprehensive Psychopathological Rating Scale (CPRS-S-A) were used to assess the severity of anxiety and depression. There was a correlation between the severity of tinnitus and depression in both study groups; however, the corresponding correlations for anxiety disorders were lower, and reached statistical significance only in the high-risk group. Various measures found significant correlations between the severity of tinnitus and the severity of depression and anxiety. We conclude that the severity of tinnitus is associated with psychiatric disorders, as well as with the severity of anxiety and depression in tinnitus patients, and may account for approximately 20% of the variance of the observed association.

The suffering of tinnitus in childhood and adolescence.

OBJECTIVES: Investigate the profile of young patients complaining of tinnitus and study the prevalence and the severity of tinnitus in schoolchildren. DESIGN: Ninety-five consecutive patients (55 boys), 8-20 years old, seeking help for tinnitus at our clinic were studied using audiometry, structural interviews, Tinnitus Severity Questionnaire (TSQ) and Hospital Anxiety and Depression Scale (HAD), together with Visual Analog Scales (VAS) on tinnitus loudness and annoyance. RESULTS: The onset of tinnitus was twice as often sudden than gradual. In 54% of the children, tinnitus had started after noise exposure, most commonly listening to music. Correlations were found between the pure-tone average (PTA) of 3, 4, and 6 kHz and TSQ scores; between TSQ and HAD subscales; and between TSQ and VAS. According to the Hospital Anxiety Depression Scale, 32% and 14.5%, respectively, were above the cut level for clinical anxiety and depressive disorders. The girls showed more signs of anxiety disorders than the boys. CONCLUSIONS: The majority of the help seekers had been exposed to noise, mostly music. Predisposing factors for tinnitus severity are high-frequency hearing loss and anxiety and depressive disorders.

The effects of sertraline on severe tinnitus suffering--a randomized, double-blind, placebo-controlled study.

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.

The Hospital Anxiety and Depression Scale (HAD) as a screening instrument in tinnitus evaluation.

The identification of anxiety and depressive disorders in tinnitus patients is important from a therapeutic point of view. We have addressed this question by investigating the screening performance of the Hospital Anxiety and Depression Scale (HAD) in a consecutive series of tinnitus patients (n = 82) without severe socially disabling hearing loss referred to an audiological clinic. The structured clinical interview for DSM-III criteria was used as the gold standard. Receiver operating characteristic (ROC) curves were used to compare the screening abilities of the HAD subscales for anxiety and depression and the total HAD Scale. The ROC analysis showed that the HAD Scale was better at detecting depression than anxiety disorders in tinnitus patients. The optimal cut-off score for the subscales was > or = 5 when we were screening for any anxiety or depressive disorder as well as for major depression. The performance of the HAD depression subscale was superior, especially when we were screening for major depression only (sensitivity 1.00; specificity 0.75). The findings of the study suggest that the HAD Scale is more useful for screening for depression than for anxiety disorders in tinnitus patients

[Tinnitus treatment is guided by etiology. Noise, stress or anxiety/depression plausible causes]. / Tinnitusbehandling styrs av etiologin. Buller, stress eller ångest/depression tänkbara orsaker.

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.

Tinnitus in 7-year-old children.

UNLABELLED: The prevalence of tinnitus in children with normal hearing has been reported to be between 6% and 36% and much higher in children with hearing loss. The aim of the present study was to perform an epidemiological, cross-sectional study, on the prevalence of tinnitus in 7-year-old school children ( n=964) and to statistically analyse the relation of tinnitus to gender, noise exposure, intratympanic pressure and hearing parameters. Tinnitus was reported by 12% of the children and in contrast to other reports, hearing parameters, did not correlate to the prevalence of tinnitus and no gender differences were found. Noise induced tinnitus was reported in 2.5% of the children. CONCLUSION: persistent tinnitus in children may have similar causes to that in adults.

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

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.

Health profiles for patients with Ménière's disease.

The Nottingham Health Profile (NHP) has been used to investigate the health profiles for many medical conditions, such as herpes zoster infection, migraine, cancer and epilepsy. However, so far, it has not been used to investigate the health profile for patients suffering from Ménière's disease, but only for patients with dizziness, severe hearing loss and tinnitus. Each of these three symptoms have shown to have a significant impact on the quality of life. In the present study, 116 consecutive patients with Ménière's disease, diagnosed according to the AAO-HNS guidelines, visiting at the department of Audiology were included in the study. The NHP was used to measure the health related quality of life and includes the following subscales: "Sleep", "Energy", "Emotional reaction", "Pain", "Physical mobility", "Social isolation" and items concerning daily activity. The Tinnitus Severity Questionnaire (TSQ) was used to measure symptoms specific to tinnitus. The results showed that the perceived severity of tinnitus in patients with Ménière's disease had a significant negative influence on their health related quality of life. The patients with Ménière's disease suffered from more sleep disturbances and social isolation than patients referred to our clinic due to tinnitus. The quality of life was, on the whole, worse for patients of working age compared to retired pensioners. Emotional disturbances could explain 40.3 % of the variance of the tinnitus severity in patients with Ménière's disease. This can be compared with 20.6% in patients with tinnitus. This underscores the importance of providing psychological and psychiatric interventions and support to patients with Ménière's disease.

The impact of perceived tinnitus severity on health-related quality of life with aspects of gender.

The Nottingham Health Profile (NHP) has been used to investigate the health profiles in different medical conditions. It has, however, never been applied to tinnitus sufferers. The present study aimed at investigating relationships between the perceived severity of tinnitus, audiometric data, age, gender and non-disease specific health-related quality of life measured with the NHP divided into two sections; NHP I (topics related to health status) and NHP II (health induced problems in daily life). These parameters were statistically analysed to identify predictive factors to the perceived severity of tinnitus, described by the Tinnitus Severity Questionnaire (TSQ). A total of 186 consecutive tinnitus patients (57 females and 129 males) attending an audiological specialist clinic in Sweden were included in the study. The stepwise regression model used explained 37.8 per cent of the variance in the perceived severity of tinnitus, and the significant predictors were: "Emotions", "Sleep", and "Pain", three of the six dimensions of the NHP I. Differences between gender were found in NHP II and age-related differences emerged in NHP I when male and female patients were compared to normal controls.

A clinical evaluation of the hearing disability and handicap scale in men with noise induced hearing loss.

During the last 30 years several hearing disability and handicap questionnaires have been designed and used for clinical purposes. The present study includes a review of the most frequently used scales. The aim of the present study was to evaluate the reliability and validity of the Hearing Disability and Handicap Scale (HDHS), which is a shortened and modified version of the Hearing Measurement Scale. Correlations between the Hearing Handicap and Support Scale, the Communication Strategy Scale from the Communication Profile of the Hearing Impaired, pure tone audiometry and speech recognition scores in noise were analysed. Data from 168 men with noise induced hearing loss of different degrees was obtained. Also a test-retest was conducted. The disability section of the HDHS seemed accurate but offered no improvement of prediction compared to previous scales. Even though the reliability of the handicap section was sufficient, its validity and clinical use is discussed and suggestions about improvements given. Since standardised scales are necessary if results are to be compared worldwide, guidelines regarding the clinical use and benefit of hearing disability and handicap scales are required.