Masking of tinnitus and mental activity.

The aim of this study was to investigate the effects of tinnitus on mental activity. In a mixed design study, the performance of 20 subjects with tinnitus and 20 healthy control subjects was compared on the digit-symbol test, completed in three auditory conditions: silence, masking and intermittent masking. Results showed marked overall differences between patients and controls on all three conditions. Lower scores on the digit-symbol test were observed during the intermittent masking condition compared with the masking condition for the patients. There was no difference between silence (e.g. tinnitus) and the masking condition, or between silence and the intermittent masking condition. The control subjects scored lower on the task when exposed to the intermittent masking compared to both silence and masking. The patients had higher depression and anxiety scores than the controls. These findings suggest that there is a link between masking sounds and how tinnitus affects cognitive capacity.

Longitudinal follow-up of tinnitus complaints.

OBJECTIVE: To investigate the long-term outcome of patients with tinnitus, the long-term effects of cognitive behavioral therapy, and what properties of tinnitus predict distress at follow-up. DESIGN: A longitudinal follow-up of a consecutive sample of patients with tinnitus initially seen by a clinical psychologist. SETTING: Department of Audiology, University Hospital, Uppsala, Sweden. PARTICIPANTS: A consecutive series of 189 patients with tinnitus treated between January 1988 and March 1995 were sent a postal questionnaire booklet. One hundred forty-six (77 women and 69 men) provided usable responses, in all yielding a 77% response rate. MAIN OUTCOME MEASURES: A questionnaire was derived from a structured interview "Questions About Your Tinnitus." Also included were the Tinnitus Reaction Questionnaire and tinnitus-matching data. RESULTS: Questionnaire data showed that many patients with tinnitus still experienced distress an average of 4.9 years after admission. Tolerance of tinnitus increased over time overall. For patients who had received cognitive behavioral therapy (59%), there was a reduction in tinnitus-related distress. Further, an open-ended question showed that the benefits from treatment outnumbered the deficits. Multiple regression analysis showed that tinnitus maskability at admission was a significant predictor of distress at follow-up. CONCLUSIONS: Severe tinnitus shows some signs of improvement over time, especially when psychological treatment has been given. Tinnitus maskability is an important prognostic factor of future tinnitus annoyance.

Tinnitus and cognitive interference: a stroop paradigm study.

The aim of this study was to investigate cognitive interference caused by tinnitus by means of a modified version of the Stroop color-word test. In a mixed-design study, the performances of tinnitus patients (n = 23) and healthy controls with normal hearing (n = 23) were compared on three versions of the Stroop test: the original version, a modified version including physical-threat words, and a tinnitus version for which tinnitus words (descriptors of tinnitus; e.g., peep) were derived empirically. Matched control conditions (words) were included for all three versions, yielding a total of six screens that were presented on a computer. Participants in the control group were matched with the patients for age and gender. Main dependent measures were performance on the Stroop tests in terms of total time for completing each test. Also included were the Tinnitus Questionnaire (TQ), the Beck Depression Inventory (BDI), the state version of the Spielberger Trait State Anxiety Inventory (STAI-S), and a subtest from the Wechsler Adult Intelligence Scale measuring verbal ability. Results showed that tinnitus patients performed significantly slower on all six test conditions. The classical Stroop color-word interference was replicated in both groups. Also, an effect for physical-threat words was found for both groups. Our expected tinnitus word interference could not be established. Patients scored significantly higher than controls on the BDI and the STAI, but these measures did not correlate with the Stroop results. In conclusion, the results indicate that tinnitus patients have impaired cognitive performance overall, as measured by these variations of the Stroop paradigm, but hearing impairment cannot be excluded as a possible confounder.

Regional cerebral blood flow during tinnitus: a PET case study with lidocaine and auditory stimulation.

Brain imaging of tinnitus has suggested central correlates of tinnitus perception. This study presents positron emission tomographic (PET) measurements of regional cerebral blood flow (rCBF) in a female tinnitus patient with bilateral left dominant tinnitus. Lidocaine infusion (75 mg during 5 min (0.2 mg/kg/min)) resulted in a 75% reduction of tinnitus and a temporary abolition of the dominant tinnitus in her left ear. Regional CBF was measured in four conditions: i) at rest while concentrating on tinnitus, ii) following maximum effect of lidocaine, iii) during sound stimulation, and iv) the following day at rest while concentrating on tinnitus. Subtraction analyses showed that tinnitus was associated with increased rCBF in the left parieto-temporal auditory cortex, including the primary and secondary auditory cortex with a focus in the parietal cortex (Brodmann areas 39, 41, 42, 21, 22). Activations were also found in right frontal paralimbic areas (Brodmann areas 47, 49 and 15). Sound stimulation resulted in bilateral activation of auditory areas. It is suggested that tinnitus is processed in primary, secondary and integrative auditory cortical areas. Tinnitus perception may involve areas related to auditory attention, while emotional processing relates to temporofrontal paralimbic areas.

A meta-analytic review of psychological treatments for tinnitus.

Meta-analysis is a technique of combining results from different trials in order to obtain estimates of effects across studies. Meta-analysis has, as yet, rarely been used in audiological research. The aim of this paper was to conduct a meta-analysis on psychological treatment of tinnitus. The outcomes of 18 studies, including a total of 24 samples and up to 700 subjects, were included and coded. Included were studies on cognitive/cognitive-behavioural treatment, relaxation, hypnosis, biofeedback, educational sessions and problem-solving. Effect sizes for perceived tinnitus loudness, annoyance, negative affect (e.g. depression) and sleep problems were calculated for randomized controlled studies, pre-post-treatment design studies and follow-up results. Results showed strong to moderate effects on tinnitus annoyance for controlled studies (d = 0.86), pre-post designs (d = 0.5) and at follow-up (d = 0.48). Results on tinnitus loudness were weaker and disappeared at follow-up. Lower effect sizes were also obtained for measures of negative affect and sleep problems. Exploratory analyses revealed that cognitive-behavioural treatments were more effective on ratings of annoyance in the controlled studies. It is concluded that psychological treatment for tinnitus is effective, but that aspects such as depression and sleep problems may need to be targeted in future studies.

Distinguishing levels of tinnitus distress.

Degrees of tinnitus distress were explored in a sample of 216 patients who completed audiological measures and were assessed in a structured interview conducted by a clinical psychologist. The Klockhoff and Lindblom grading system was used and its inter-rater reliability assessed in a subsample showing a high degree of correspondence. Results from the interview are reported in terms of variability of tinnitus, characteristics of problematic situations, distress caused by tinnitus, possibilities to cope, and other influencing factors. Finally, a set of discriminant analyses were conducted on the data set resulting in a final model which included pitch, minimal masking level (MML), tolerance in relation to onset, and avoidance of situations because of tinnitus. This model correctly classified 73% of the subjects into the two levels of distress (grade II and III). There may be a potential role for MML as an outcome variable in tinnitus treatment research.

The influence of vertigo, hearing impairment and tinnitus on the daily life of Menière patients.

The aim of this questionnaire study was to investigate the impact of the symptoms in Meniere's disease on the daily life of patients and to analyse the relationships between the cardinal symptoms and environmental, emotional and activity factors. The study comprised 514 patients, recruited from two different sources. The results showed that vertigo, hearing impairment and tinnitus had a strong negative influence on the daily life of patients. Seventy-five percent of the subjects avoided certain everyday activities or situations because of the disease. However, the correlation between discomfort and reported satisfaction with life was moderate. Most of the subjects experienced premonitory symptoms of the attacks and 80% reported relations between external factors and vertigo attacks.

An experimental evaluation of the effects of transcutaneous nerve stimulation (TNS) and applied relaxation (AR) on hearing ability, tinnitus and dizziness in patients with Menière's disease.

In 20 patients diagnosed with Menière's disease, transcutaneous nerve stimulation (TNS) and applied relaxation (AR) were used as a treatment aimed at reducing tinnitus and dizziness and increasing hearing ability. The main aim of the study was to examine whether TNS could be regarded as a more beneficial treatment regimen than AR. An experimental between-group cross-over design was used. The results from the experimental phase (group comparisons) showed a significantly increased ability to hear for the TNS group when measured on visual analogue scales. During the same period, the AR-group showed a significant hearing improvement for the ear not primarily affected by Menière's disease as measured with pure tone audiometry. The vestibular tests did not reveal any significant changes either after TNS or AR intervention. Tinnitus matching showed changes of pitch and loudness before and after both TNS and AR intervention. However, no statistically significant changes between treatment regimes were found on these measures. The results from this study did not show TNS to be superior to AR in reducing tinnitus, dizziness or increasing hearing ability.

Control and dispositional style among the hearing-impaired in communication situations.

Forty hearing-impaired subjects were exposed to three stressful communication situations in a laboratory setting. The communication patterns used and the extent to which the subjects succeeded in coping with the situations were studied. Measures, such as the life orientation test measuring dispositional style, a hearing questionnaire measuring the ability to cope with different hearing situations, degree of control and pure-tone audiometry were performed. Coping behaviour and expressed emotion during communication situations were also observed. The results showed that controllability together with dispositional style and aspects of expressed emotion played an important role in explaining the overall success rates of hearing-impaired individuals.

Sudden deafness: a retrospective evaluation of dextran therapy.

A retrospective evaluation was performed in 112 patients treated during a 10-year period as inpatients with the diagnosis idiopathic sudden hearing loss. Excluding all patients in whom later other diagnosis were established, like Ménière's disease, collagenoses, mumps etc., 101 patients remained. 80 of them had been treated consistently according to a protocol as having idiopathic sudden hearing loss. These patients had all 5-day treatment with low molecular weight dextran and nicotinic acid and vitamin B during 1 month. 68% did completely recover or were markedly improved (> 30 dB), another 19% were fairly improved (10-30 dB). Statistical analysis showed that all retrocochlear signs or nystagmus made the prognosis less favorable. To wake up with the hearing loss was more favorable than a daytime debut. A mid-frequency loss had always a good prognosis. Because no untreated controls were included in the study, it was not possible to evaluate the specific effect of the treatment. The results obtained from this study have changed the treatment policy in our clinic.

Acute peripheral facial palsy simulating Bell's palsy in a case of probable multiple sclerosis with a clinically correlated transient pontine lesion on magnetic resonance imaging.

A transient pontine lesion was demonstrated in a young adult male who had a complete acute peripheral facial nerve palsy due probably to multiple sclerosis. In the acute stage of the palsy. T2-weighted magnetic resonance imaging (MRI) revealed a high signal intensity in the ipsilateral pons in the region of the nucleus and pontine part of the facial nerve. The patient recovered completely 5 weeks after the onset of the palsy, and at this stage, the lesion in the brainstem was no longer demonstrable on MRI. The onset and course of the disease resembled the idiopathic form of facial palsy (Bell's palsy): the present findings along with recent MRI and topodiagnostic studies may indicate that in some cases of Bell's palsy the primary lesion is located centrally. By improved MRI techniques and intravenous contrast agents it may be possible to visualize and follow the disease process and ascertain more of the pathogenesis of Bell's palsy.

Predictors of tinnitus discomfort, adaptation and subjective loudness.

In a nation-wide investigation, covering all the hearing centres in Sweden, a study was made of adaptation processes, subjective discomfort from tinnitus, subjective loudness of tinnitus and psychological complaints in 3372 subjects by means of a questionnaire. The most important predictors of discomfort from and adaptation to tinnitus were found to be the controllability and the degree of maskability by external sounds, i.e. the subject's coping abilities or internal-external locus of control. Increased control and masking effects from the environment imply a decrease in discomfort and better adaptation. The most important predictor of worsened subjective loudness of tinnitus was the duration of the tinnitus. That is, subjects who had had tinnitus for a longer time perceived the loudness as more intense. The psychosomatic factors which most strongly predicted increased discomfort from and decreased tolerance to tinnitus were depression and insomnia. These findings have theoretical and practical implications for the management and treatment of tinnitus.

The psychological treatment of tinnitus: an experimental evaluation.

Disabling tinnitus in 27 patients was treated in an experimental setting with two different type of therapy aiming at the development of coping behaviour. One was focused on behavioural control procedures, while the other aimed at more cognitive control methods such as distraction. The results of the two forms of therapy were compared with each other and with observations of the untreated control subjects. Assessments of subjective loudness, discomfort from tinnitus and controllability were made on analogue scales and at a questionnaire follow-up. Psychoacoustic measures such as personal loudness units (PLU) were used in connection with these self-recordings and for evaluation of treatment effects. The results confirmed favourable reports on behavioural methods in tinnitus. However, no differences were found between therapies. The results are discussed in the light of the coping and adaptation theory.

Behavioural therapy in the clinical management of tinnitus.

Behavioural therapy was given to reduce discomfort and annoyance associated with severe tinnitus in 75 consecutive patients. Treatment was conducted within the routine clinical management. It included information and discussion about tinnitus, behavioural analysis and relaxation training combined with various cognitive strategies. The method of treatment was thus a form of coping technique. Self-recordings showed significant reductions of 'discomfort from tinnitus' as well as significant elevations in 'general mood' over a 3-month follow-up period. Interview findings indicated strong overall positive effects of treatment, as well as other positive side-effects on complaints such as tension headaches, dizziness, muscle tension and sleep disturbances. Implications for the clinical management of tinnitus sufferers are discussed.

Hearing aids and tinnitus--an experimental group study.

From a waiting list consisting of hearing-impaired patients waiting for hearing aids to be fitted, 39 subjects who at interview also stated that they had tinnitus took part in an experimental group study with the aim of investigating the effect of a hearing aid on tinnitus. No subject had any previous experience of hearing aids. The subjects were randomly allocated to a treatment and a waiting list control group. After an initial interview, the routine programme for the fitting of hearing aids started in the treatment group, while the waiting list control group had to wait for 6 weeks before starting the same hearing aid rehabilitation programme. The hearing aids were fitted exclusively for hearing purposes. As expected, the hearing aids improved the hearing capacity, but they did not reduce tinnitus as recorded on a visual analogue scale. According to information obtained at the final interview, there were significant differences in tinnitus between subjects who used their aid for more than 2 hours daily and those who used it for less than 2 hours. However, the results of scaling (pre- and post-fitting) did not support this finding. The discrepancy between the scaling and interview data is probably due to demand characteristics.

Long-term effects of psychological treatment of tinnitus.

Twenty patients with severe tinnitus who had undergone behavioural treatment, including applied relaxation and perceptual restructuring, were re-assessed 9 months after completion of treatment. Among the self-recorded variables, tinnitus loudness, discomfort from tinnitus, depression, and irritation, discomfort from tinnitus was the only variable which was still significantly reduced. As part of the 9-month follow-up assessment, the patients' recall of the loudness and discomfort from their tinnitus was studied. Correlations between original recordings and recall data were low.

Hearing damage in military service. A study on 38,294 conscripts.

In an audiometric study on 38,294 conscripts, noise-induced high-frequency hearing deterioration during basic training (mean 245 days) was studied. On reporting for training, 29% were found to have hearing defects, predominantly in the high-frequency area. After training, high-frequency deterioration, predominantly unilateral or asymmetrical, was found in 5%. In 0.5%, this deterioration had reached a symptomatic level, causing minor handicap. In 0.03% (12 conscripts), it fulfilled the criterion of "10% hearing disability" applied in Swedish industrial insurance. The incidence of high-frequency deterioration rose from 3% in conscripts having 'normal' hearing on reporting, to 17% among those with the greatest hearing loss on reporting. This means that the presence of sensorineural hearing loss implies an increased risk of noise-induced hearing deterioration. No correlation was found between hearing status on reporting and magnitude of deterioration during training. The results imply that hearing data obtained on reporting for training should be taken into account in deciding the assignability of conscripts to noisy training courses and posts.