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Ear Nose Throat J 1991 May;70(5):284-9

Idiopathic subjective tinnitus treated by biofeedback, acupuncture and drug therapy.

Podoshin L, Ben-David Y, Fradis M, Gerstel R, Felner H

Department of Otolaryngology, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
The effect of three treatment modalities of idiopathic-subjective tinnitus (IST): acupuncture (AP), biofeedback (BF) and Cinnarizine (Cin), was investigated in 58 randomly selected subjects. The findings show that at the end of treatment, 50% of the patients in the biofeedback group reported some amelioration in the level of the tinnitus, while 30% of the acupuncture group and only 10% of the group receiving Cinnarizine reported an amelioration of the tinnitus. Treatment by biofeedback caused a significant easing in the degree of discomfort caused by the tinnitus to patients during rest. Within the limitations of the sample study, our results indicate that the biofeedback method is more effective in comparison with acupuncture and Cinnarizine in the treatment of those suffering from tinnitus.


Acta Otolaryngol Suppl (Stockh) 1990;476:202-8

Tinnitus and disability with ageing: adaptation and management.

Hazell J

FRCS, RNID, London, UK.
Although tinnitus is a common phenomenon, reported by up to 17% of the population, only 14% of those experiencing tinnitus find that it bothers them a great deal (OPCS 1983) (1). Tinnitus often becomes a complaint when its emotional or learned significance demands the constant attention of the listener (2). This significance is most commonly represented by the belief that the tinnitus sounds cannot be cured or controlled, that they will continue for ever getting louder, or that they hearld the onset of serious intracranial disease. The techniques of symptom control used in our tinnitus clinic since 1976 are discussed briefly, together with the role of counselling. Demographic data and results of treatment with respect to age are presented in a group of 472 tinnitus patients studied over three years. There is no relationship between age and subjective complaint or management outcome. Audiometric measurements of tinnitus correlate with hearing loss rather than with age. Somatic anxiety shows a slight increase with age in this population of tinnitus patients.
PMID: 2087964, UI: 91206028

Lakartidningen 1989 Feb 22;86(8):625-8

[Tinnitus--examination, management and treatment].

[Article in Swedish]

Lyttkens L

PMID: 2921911, UI: 89158429

Audiology 1995 Nov-Dec;34(6):301-10

Tinnitus information: a study by questionnaire.

Axelsson A, Nilsson S, Coles R

Department of Audiology, Sahlgrenska University Hospital, Goteberg, Sweden.
The aim of the present study was to improve the information for patients with tinnitus. The investigation consists of three parts: a pilot study where 24 slightly informed tinnitus patients as well as 17 well-informed tinnitus patients and 9 audiological professionals suggested contents for a tinnitus information pamphlet. The second part consisted of scoring of the 74 most common suggestions by 36 of the original 50 people. The answers were graded according to importance. Three available tinnitus information folders from Sweden, Germany and the USA were also studied and taken into account in preparing recommendations on content and size for a tinnitus information pamphlet. This should probably not exceed 2500 words, and 35 items of information.
PMID: 8833310, UI: 96430182

Br J Audiol 1986 May;20(2):153-5

Low-powered ultrasound in the treatment of tinnitus: a pilot study.

Carrick DG, Davies WM, Fielder CP, Bihari J

The aim of this study was to determine whether a low dose of ultrasound, applied over the mastoid bone, caused a subjective improvement in the level of tinnitus in long standing tinnitus sufferers. Forty patients from the Swansea Tinnitus Association volunteered to take part in a double blind crossover trial. They received a 10-minute treatment with an ultrasound generator and an identical placebo device on two separate visits. The devices were randomly allocated on the first visit. At each visit the patient noted whether their tinnitus was completely improved, slightly improved, unchanged or made worse by the treatment. Forty per cent of patients who completed the trial were improved by ultrasound, 7% by placebo. Low powered ultrasound was significantly better at producing improvement than placebo (P less than 0.02 Binomial Test).

Otolaryngol Head Neck Surg 1984 Dec;92(6):689-96

The perceived severity of tinnitus. Some observations concerning a large population of tinnitus clinic patients.

Meikle MB, Vernon J, Johnson RM

Detailed information about tinnitus was obtained from over 1800 patients attending a tinnitus clinic. Patients rated their tinnitus severity on a scale from 1 to 10 and also provided information concerning the quality, duration, localization, and other attributes of their tinnitus. In addition to standard audiometric tests, patients received tests for tinnitus pitch, loudness, maskability, and residual inhibition, and provided a brief medical history. The severity ratings of over 90% were at or above the scale value of 5. There was no correlation between rated severity and the loudness of tinnitus (obtained by a loudness balance procedure using external sounds matching the tinnitus pitch), thus confirming earlier observations. The severity also was not related to the type, quality, or pitch of tinnitus sound heard. However, severity ratings were highly correlated with incidence of sleep disturbance. Additional observations concerning relationships between perceived severity and other patient characteristics are discussed.
PMID: 6440089, UI: 85087404

J Laryngol Otol 1996 Feb;110(2):117-20

Client centred hypnotherapy in the management of tinnitus--is it better than counselling?

Mason JD, Rogerson DR, Butler JD

Department of Otorhinolaryngology, Derbyshire Royal Infirmary, Derby, UK.
The aim of this study was to assess whether client centred hypnotherapy (CCH) which required three sessions with a trained therapist was superior to a single counselling session in reducing the impact of tinnitus. Patients were randomly allocated to receive either counselling (n = 42) or CCH (n = 44). The outcome measures were: tinnitus loudness match, subjective tinnitus symptom severity score, trend of linear analogue scale, request for further therapy and whether the patient had an impression of improvement in their tinnitus after treatment. CCH was no better than counselling in reducing the impact of tinnitus using the three quantative measures of tinnitus, and requests for further follow up. The only significant difference between the two therapies was that 20 (45.5 per cent) of the CCH group reported a general sense of improvement compared to six (14.3 per cent) in the counselling group, this is significant p < 0.01. The study did not demonstrate whether this was a genuine hypnotic effect or simply a response to the additional attention from the therapist.

J Laryngol Otol 1996 Feb;110(2):117-20

Client centred hypnotherapy in the management of tinnitus--is it better than counselling?

Mason JD, Rogerson DR, Butler JD

Department of Otorhinolaryngology, Derbyshire Royal Infirmary, Derby, UK.
The aim of this study was to assess whether client centred hypnotherapy (CCH) which required three sessions with a trained therapist was superior to a single counselling session in reducing the impact of tinnitus. Patients were randomly allocated to receive either counselling (n = 42) or CCH (n = 44). The outcome measures were: tinnitus loudness match, subjective tinnitus symptom severity score, trend of linear analogue scale, request for further therapy and whether the patient had an impression of improvement in their tinnitus after treatment. CCH was no better than counselling in reducing the impact of tinnitus using the three quantative measures of tinnitus, and requests for further follow up. The only significant difference between the two therapies was that 20 (45.5 per cent) of the CCH group reported a general sense of improvement compared to six (14.3 per cent) in the counselling group, this is significant p < 0.01. The study did not demonstrate whether this was a genuine hypnotic effect or simply a response to the additional attention from the therapist.

Am J Otolaryngol 1992 Nov-Dec;13(6):349-56

Is biofeedback effective for chronic tinnitus? An intensive study with seven subjects.

Landis B, Landis E

Department of Psychiatry, Cornell University Medical College, New York, NY 10021.
PURPOSE: This study was developed to test the hypothesis that intensive biofeedback and relaxation training may favorably affect chronic tinnitus. PATIENTS AND METHODS: Seven subjects with chronic tinnitus of moderate to severe intensity engaged in an intensive 5-month program of weekly, individual 90 minute sessions. All individuals attained a high standard of proficiency following training by a biofeedback specialist. A biofeedback unit was provided each subject for daily practice. Audiometric matching of tinnitus pitch and loudness and subjective comparisons of tinnitus loudness were conducted before and after every session. RESULT: Audiometric evaluation showed no changes in tinnitus loudness. Nevertheless, all subjects gained satisfaction from the training. Three reported substantial psychological benefits in coping with tinnitus, two described moderate improvement, and two experienced modest gains. CONCLUSIONS: These results highlight the role of psychological factors in tinnitus management and indicate that biofeedback-relaxation training may be useful therapy for coping with stresses of tinnitus.
PMID: 1443390, UI: 93072663

J Otolaryngol 1990 Feb;19(1):11-8

Tinnitus. III: The practical management of sensorineural tinnitus.

Hazell JW

Royal National Institute for the Deaf, London, England.
A weekly tinnitus clinic at University College Hospital, London, has been in existence since 1976. By developing a holistic and multidisciplinary approach to the management of tinnitus, we have been able to help the majority of patients referred with severe and disabling tinnitus. We have developed a protocol for the clinical assessment of tinnitus as a disability, and a strategy of investigation and reassurance based on the patient's understanding of the underlying mechanisms involved in tinnitus generation. Most treatment is aimed at bringing about a process of habituation (which occurs naturally in the majority of people experiencing tinnitus over a period of time). Symptom control is required in about half the patients referred, and various techniques are discussed including prosthetic masking devices, psychological approaches, drug therapy and electrical tinnitus suppression.

Ugeskr Laeger 1990 Aug 27;152(35):2473-5

[Zinc therapy of tinnitus. A placebo-controlled study].

[Article in Danish]

Paaske PB, Pedersen CB, Kjems G, Sam IL

Arhus Kommunehospital, horecentralen og ore-naese-halsafdelingen.
Forty-eight patients with tinnitus of various etiologies underwent a placebo-controlled, randomized, double-blind trial to assess whether treatment with zinc had any favourable effect on tinnitus. The trial tablets contained either 100 mg zinc sulphate as a depot tablet = 22 mg Zn++ (Zinclet) or placebo. The patients took tablets thrice daily for eight weeks. They indicated the severity of the tinnitus once weekly on a table graduated from 0 to 10. Serum zinc and serum albumin were measured before and after treatment. Out of the 48 patients with tinnitus, only one had hypozincaemia. During treatment, the serum zinc rose significantly in the group treated with zinc. No favourable effect of zinc treatment on tinnitus could be demonstrated. The fact that the serum zinc levels of the patients were within the normal range was probably an important reason for this.

J Laryngol Otol 1978 Feb;92(2):123-30

Tinnitus: a theoretical view and a therapeutic study using amylobarbitone.

Donaldson I

A hypothetical discussion of the mechanisms producing tinnitus has been described along with an outline of previous treatments given. A small group of 40 patients with troublesome tinnitus were studied, 20 of whom were treated with amylobarbitone, and the results have been presented. An attempt is made to compare the subjective assessment made by patients of their symptom with an audiometric assessment of the same symptom both before and after the study.
PMID: 627765, UI: 78110432

Scand Audiol 1984;13(4):287-91

Tinnitus--incidence and handicap.

Lindberg P, Lyttkens L, Melin L, Scott B

A questionnaire investigation, comprising 1091 patients, was conducted at a hearing centre. A majority of patients, 59%, claimed that they were troubled by tinnitus. A strong correlation was found between the laterality of tinnitus and that of subjective hearing loss. Neither a greater degree of hearing loss nor a longer duration of tinnitus was shown to be associated with more severe tinnitus. Among patients with both subjective hearing loss and tinnitus, 23% stated that tinnitus was the greater problem and 38% that their tinnitus and hearing loss were equally troublesome. The corresponding figures for patients with hearing impairment of such a degree that a hearing aid had been fitted were 9% and 41% respectively. Stress symptoms such as headache, tension of facial muscles and sleep disturbances were correlated to tinnitus. Psychosomatic complaints should therefore be taken into account in the treatment of tinnitus. Of patients with tinnitus, 83% were interested in obtaining treatment for their tinnitus. It is postulated that the previously reported predominance of left-sided tinnitus is due to a higher frequency of left-sided hearing impairment. A majority of patients with tinnitus and hearing impairment regarded their tinnitus as the major problem. Efforts towards investigation and treatment of tinnitus might therefore considerably improve the prospects for hearing rehabilitation.
PMID: 6523048, UI: 85115145

Psychother Psychosom Med Psychol 1991 Mar-Apr;41(3-4):115-22

[New aspects of complex chronic tinnitus. I: Assessment of a multi-modality behavioral medicine treatment concept].

[Article in German]

Goebel G, Keeser W, Fichter M, Rief W

Medizinisch-Psychosomatische Klinik Roseneck, Prien am Chiemsee im Verbund mit der Medizinischen Fakultat, Ludwig-Maximilians-Universitat Munchen.
"Complex tinnitus" is a diagnostic term denoting a disturbance pattern where the patient hears highly annoying and painful noises or sounds that do not originate from a recognisable external source and can be described only by the patient himself. It seems that the suffering mainly depends upon the extent to which the tinnitus is experienced as a phenomenon that is beyond control. Part I reports on an examination of the treatment success achieved with 28 consecutive patients who had been treated according to an integrative multimodal behavioural medicine concept. This resulted--despite continual loudness--in a decrease in the degree of unpleasantness of the tinnitus, by 17% (p less than 0.01) with corresponding normalisation of decisive symptom factors in Hopkins Symptom-Check-List (SCL-90-R) and Freiburg Personality-Inventary (FPI-R). On the whole, 19 out of the total of 28 patients showed essential to marked improvement of the disturbance pattern. Part II presents a multidimensional tinnitus model and the essential psychotherapeutic focal points of a multimodal psychotherapy concept in complex chronic tinnitus, as well as the parallel phenomena in the chronic pain syndrome.
PMID: 2057545, UI: 91279894

Br J Audiol 1990 Feb;24(1):51-62

Predictors of tinnitus discomfort, adaptation and subjective loudness.

Scott B, Lindberg P, Melin L, Lyttkens L

Department of Clinical Psychology, University of Uppsala, Sweden.
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.
PMID: 2317601, UI: 90199243

Nippon Jibiinkoka Gakkai Kaiho 1989 Apr;92(4):566-73

[The effect of intravenous administration of xylocaine for the treatment of tinnitus].

[Article in Japanese]

Yamanaka E, Gyo K, Saiki T, Yanagihara N

One hundreds and forty-nine patients (221 ears) suffering from tinnitus were treated by an intravenous administration of Xylocaine. Xylocaine, 1mg per kg, was administered once a week. The immediate effect of Xylocaine on tinnitus was evaluated subjectively for all the patients. The long term effect in 57 patients who received Xylocaine administration more than 12 times was also analyzed. The results can be summarized as follows. 1. Short and long term relief of tinnitus was obtained in 165 of 221 ears (74.7%) and in 35 of 57 cases (61.4%), respectively. 2. This therapy was more effective in old patients and in the patients with low pitch tinnitus, or with positive residual inhibition. 3. The numbers of the effective cases increased after the 8th time administration of Xylocaine. Thus we recommend the Xylocaine administration at least 8 times. 4. The results of the loudness balance test were not correlated with the change of the subjective improvements. 5. The suppressive effect of tinnitus by injecting saline solution intravenously was recognized in 24 of 73 cases. At present, repeated administration of Xylocaine would be one of the most significant therapies of tinnitus.
PMID: 2769474, UI: 89361843

Tidsskr Nor Laegeforen 1996 Jun 30;116(17):2009-12

[Tinnitus--etiology, diagnosis and treatment].

[Article in Norwegian]

Arnesen AR, Engdahl B

Ore-nese-halsaydelingen, Ulleval sykehus, Oslo.
Tinnitus is the sensation of sound, a sensation generated by the auditory system because of a pathology, without any external acoustic or electrical stimulation. 15% of the adult population have experienced shorter or longer periods of tinnitus. Three percent of these, in total about 7,000-10,000 persons in Norway, suffer from continuous tinnitus followed by symptoms that demonstrate handicap or occupational disability. The authors discuss the cause of tinnitus and its relation to different kinds of hearing loss. Treatment is dependent on a specific diagnosis. There is no universal medical or surgical treatment. Today, cognitive therapy is emphasised, to the tinnitus patients to understand what causes the tinnitus, to accept the condition and to inform them about relaxation techniques. Physical therapy and training are also emphasised. Active treatment with regular counselling can reduce the occupational and social disabilities.

J Speech Hear Res 1989 Jun;32(2):393-400

Alternating current at the eardrum for tinnitus reduction.

Kuk FK, Tyler RS, Rustad N, Harker LA, Tye-Murray N

University of Iowa Hospitals and Clinics.
The effectiveness of alternating current (AC) stimulus on tinnitus was investigated in 10 patients who reported constant tinnitus in at least one ear. Patients were first screened to determine their responsiveness to electrical stimulation in relation to tinnitus reduction. The responsive patients were then stimulated for a treatment period of at least 10 min, during which time the tinnitus was measured. The AC stimuli (62 Hz to 8000 Hz) were applied to the eardrum of the patients via a specially constructed electrode. Psychophysical measurements (pitch matching, loudness matching, minimum masking level, and loudness and annoyance scaling) of the patient's tinnitus were made before and after electrical stimulation. Minimal masking level was determined and tinnitus scaling was performed during the treatment period. Electrical stimulation was effective in tinnitus reduction in 5 of the 10 patients. These 5 patients reported that the loudness and the annoyance of their tinnitus decreased during the treatment period. These observations were consistent with psychophysical measures of contralateral broadband noise masking. Poststimulation reduction in tinnitus varied in duration among individuals from 40 s to about 4 hr.
PMID: 2786979, UI: 89294561

Br J Audiol 1995 Oct;29(5):279-83

Patients' reports of the effect of alcohol on tinnitus.

Pugh R, Budd RJ, Stephens SD

Welsh Hearing Institute, University Hospital of Wales.
One hundred chronic sufferers attending a tinnitus outpatient clinic completed self-report questionnaires assessing the quantity of alcohol they consumed weekly and its effect on tinnitus. The results showed a mixed effect of alcohol on tinnitus with 22% of the sample reporting that drinking worsened tinnitus, 62% reporting no effect of alcohol on tinnitus and 16% reporting that alcohol improved tinnitus. The reported effect of alcohol on tinnitus significantly influenced the reported change in the level of alcohol intake since tinnitus onset, with significantly more units of alcohol being consumed by those sufferers who reported that alcohol improved their tinnitus. However, for the sample as a whole, drinking behaviour was not significantly different to that of the general population.
PMID: 8838550, UI: 96435664

J Am Audiol Soc 1977 Jan-Feb;2(4):124-31

Attemps to relieve tinnitus.

Vernon J

The major effect here has been to present two forms of treatment which have provided relief of tinnitus for some patients. Use of a properly fitted hearing aid relieves tinnitus when that tinnitus is embedded within the frequency region of the hearing loss. When the use of a hearing aid is counterindicated, then use of the tinnitus masker can bring relief for certain kinds of tinnitus. At present the only tinnitus masker available presents a band of noise of moderate frequencies, and it is capable of relieving tinnitus in that frequency region or near it. When masking of tinnitus is effective it produces a suppresion of the tinnitus which extends beyond the duration of the masker. This is termed residual inhibition, a matter about which we need to know a great deal more. For tinnitus which is intractable to medical treatment it has become a practice to instruct the patient that he must learn to live with his affliction. It is hoped that this presentation will cast doubt upon that view, for it can be seen that there are many tinnitus sufferers for whom much can be done.
PMID: 845067, UI: 77140583

Laryngorhinootologie 1995 Oct;74(10):594-600

[Clinical aspects of coping with tinnitus].

[Article in German]

Nieschalk M, Winter B, Stoll W

HNO-Universitatsklinik Munster.
Forty-two patients suffering form chronic tinnitus participated in our psychologically oriented treatment last year. The following study presents the results of the psychological management of chronic tinnitus combining counselling with relaxation training. Furthermore individual therapy is compared with group therapy. The therapeutical efficiency can be tested using visual analog scales. The individual estimated loudness and annoyance of tinnitus are registered. A quantitative assessment of complaints is made via questionnaires (adapted to Back Depression Inventory). In most cases a reduction of tinnitus loudness and annoyance after individual and group therapy is seen directly. But a constant therapeutical effect is only found is individual therapy. In group therapy, many of our patients reported an increase in the pretherapeutical estimation of tinnitus loudness and annoyance. We believe that permanent confrontation with the tinnitus problem may advance the psychological conflict in many cases. Therefore, psychological management of tinnitus should be concentrated on temporary limited support aimed at overcoming tinnitus sensation.

Prim Care 1990 Jun;17(2):289-97


Alleva M, Loch WE, Paparella MM

Minnesota Ear, Head and Neck Clinic, Minneapolis.
Sound without external stimuli may warn of serious conditions. Accurate history and physical examination along with ancillary testing, including audiograms, are essential in evaluation of these patients. Evaluation of sudden tinnitus may save hearing. Extra-auditory tinnitus may arise from respiratory, vascular, and muscular sources that are often treatable. Conductive tinnitus may indicate treatable malformation of the external or middle ear. Sensorineural tinnitus may be drug-related, noise-related, of central origin, or due to cochlear deterioration. Comprehensive diagnostic procedures can be followed by medical, surgical, psychologic, or masking therapies. All patients with tinnitus can benefit from patient education and preventive measures, and oftentimes the physician's reassurance and assistance with the psychologic aftereffects of tinnitus can be the therapy most valuable to the patient.

Arch Otolaryngol Head Neck Surg 1992 Dec;118(12):1291-7

Tinnitus suppression following cochlear implantation. A multifactorial investigation.

Souliere CR Jr, Kileny PR, Zwolan TA, Kemink JL

University of Michigan Medical Center, Ann Arbor.
The effects of cochlear implant on loudness, annoyance, daily duration, location, and residual inhibition of tinnitus were evaluated by a closed-ended, quantifiable questionnaire in 33 postlingually deafened patients who had received implants at the University of Michigan, Ann Arbor, between 1986 and 1990. Preoperative tinnitus was present in 85% of patients. A statistical comparison of preoperative vs postoperative loudness and annoyance indicated a significant reduction in both of these complaints postoperatively. Loudness and annoyance were significantly correlated, both preoperatively and postoperatively. Fifteen patients (54%) with preoperative tinnitus demonstrated a loudness decrease of 30% or more; 43% demonstrated an annoyance decrease of 30% or more; and 48% demonstrated a decrease of 30% or more in daily tinnitus duration. Patients who experienced a loudness or annoyance decrease of 30% or more after implantation demonstrated significantly higher preoperative levels of these complaints, suggesting that degree of tinnitus reduction after implantation may be related to preoperative loudness and annoyance levels. Contralateral tinnitus suppression was reported by 42% of patients. Residual inhibition ranging from 60 seconds to several hours was reported by 50% of patients, predominantly in the ear with the implant. Age, gender, cause of hearing loss, duration of tinnitus, cochlear implant usage, and time after implantation were not predictive of tinnitus suppression. Overall, the majority of the patients (74%) thought that their cochlear implant was helpful in tinnitus suppression, especially in the ear with the implant. Contralateral residual inhibition and tinnitus suppression suggest a central mechanism contributing to these phenomena.
PMID: 1449687, UI: 93080848

Psychother Psychosom Med Psychol 1996 Mar-Apr;46(3-4):147-52

[Effects of relaxation therapy as group and individual treatment of chronic tinnitus].

[Article in German]

Winter B, Nieschalk M, Stoll W

HNO-Universitatsklinik Munster.
42 patients, suffering from chronic tinnitus, participated in our psychological orientated treatment consisting of relaxation therapy with autogenic training according to J. H. Schultz. The results of individual therapy are compared with group therapy. Using visual analogy scales the therapeutical efficiency can be tested. The individual estimated loudness and annoyance of tinnitus are registered as well as a general emotional status. The results show a positive short-time effect in most cases. A reduction of tinnitus loudness and annoyance after individual and group therapy is seen directly. A positive effect throughout the whole treatment is only found in individual therapy. Concerning the group therapy, many of our patients reported an increase of the pretherapeutical estimation of tinnitus loudness and -annoyance. We believe that the permanent confrontation with the tinnitus problem may advance the psychological conflict in many cases. Therefore psychological management of tinnitus should be concentrated on a temporary limited support aiming to the neglect of tinnitus sensation.

Br J Audiol 1992 Dec;26(6):381-6

Diaries of tinnitus sufferers.

Kemp S, George RN

Department of Psychology, University of Canterbury, Christchurch, New Zealand.
Nine tinnitus sufferers kept daily diaries of their tinnitus experiences for up to three months. Levels of the loudest and quietest tinnitus and tinnitus annoyance were moderately highly correlated with each other and weakly correlated with the degree of sleep disturbance. Fluctuations in tinnitus sensation were frequent and associated with higher perceived levels and annoyance. Results were complicated by individual differences in tinnitus and lifestyle.

Am J Otol 1993 Jan;14(1):24-30

Betahistine-induced vascular effects in the rat cochlea.

Laurikainen EA, Miller JM, Quirk WS, Kallinen J, Ren T, Nuttall AL, Grenman R, Virolainen E

Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan, Ann Arbor 48901-0506.
Betahistine (BH) has been used widely to treat cochlear disorders, such as tinnitus and Meniere's disease. The mechanism of action of BH in the cochlea is assumed to be based on its histamine-like effect on H1 receptors in the cochlear vasculature, leading to an increased cochlear blood flow (CBF). Recently it has been shown that BH can strongly affect H3 heteroreceptors (a novel histamine receptor subclass) in the periphery, via an autonomic ligand. This mechanism may also contribute to the BH effects on CBF. This study was to validate BH effects in the cochlear vasculature and to investigate the possible mechanisms of action of this drug in the inner ear vasculature. We assessed the effects of BH on CBF with the laser Doppler flowmeter in 23 rats and concluded that BH affects vascular conductivity in the cochlea in a dose-dependent fashion; betahistine diffuses through the round window, but does not have access to vascular receptors or ligands once in the labyrinthine fluids; and the H1 receptors mediate the systemic and peripheral vascular effects of BH, whereas the cochlear effect involves cholinergic receptors.
PMID: 8424471, UI: 93142871

Otolaryngol Clin North Am 1993 Oct;26(5):791-810

Ototoxicity of salicylate, nonsteroidal antiinflammatory drugs, and quinine.

Jung TT, Rhee CK, Lee CS, Park YS, Choi DC

Loma Linda University School of Medicine, California.
Salicylates and most NSAIDS in high doses cause mild to moderate temporary hearing loss, either flat or greater in the high frequencies. Hearing loss is accompanied by tinnitus and suprathreshold changes. Salicylates may or may not exacerbate hearing loss and cochlear damage induced by noise. The mechanism of salicylate ototoxicity seems to be multifactorial. Morphologic studies suggest that no permanent cochlear damage occurs with salicylate ototoxicity. Electrophysiologic, morphologic, and in vitro data conclusively demonstrate that salicylate affects outer hair cells. In addition, salicylates appear to decrease cochlear blood flow. Salicylates and NSAIDs inhibit PG-forming cyclooxygenase, and recent studies suggest that abnormal levels of arachidonic acid metabolites consisting of decreased PGs and increased LTs may mediate salicylate ototoxicity. As with salicylate, quinine ototoxicity appears to be multifactorial in origin. The mechanism includes vasoconstriction and decreases in cochlear blood flow, as measured by laser Doppler flowmetry, motion photographic studies, and histologic studies. Reversible alterations of outer hair cells also appear to play an important role, as demonstrated by histology, electron microscopy, isolated hair cell studies, and cochlear potential evaluations. Unlike with salicylate, however, the role of prostaglandins in quinine ototoxicity has not been clearly demonstrated. Also, one of quinine's principal actions, antagonism of calcium-dependent potassium channels, has yet to be investigated for its potential role in ototoxicity.

Otolaryngol Head Neck Surg 1993 Nov;109(5):839-43

The role of KTP laser in revision stapedectomy.

McGee TM, Diaz-Ordaz EA, Kartush JM

Michigan Ear Institute, Portsmouth.
In recent years, the safety and efficacy of revision stapedectomy has come under scrutiny. Experienced surgeons report that the results of such surgery are often worse than the results after primary surgery and that the risks of sensorineural hearing loss, tinnitus, and vertigo are increased. With the addition of laser technology to revision stapes surgery, the procedure to open the neomembrane over the oval window and gain access to the inner ear can now be performed safely. This allows positive identification of the oval window and assures placement of the prosthesis through the fenestra rather than on an intermediate segment of scar or bone in the region of the footplate. Our studies have shown the laser to be an important tool that enhances the safety and efficacy of revision stapedectomy.

Acupunct Electrother Res 1992;17(2):107-48

Common factors contributing to intractable pain and medical problems with insufficient drug uptake in areas to be treated, and their pathogenesis and treatment: Part I. Combined use of medication with acupuncture, (+) Qi gong energy-stored material, soft laser or electrical stimulation.

Omura Y, Losco BM, Omura AK, Takeshige C, Hisamitsu T, Shimotsuura Y, Yamamoto S, Ishikawa H, Muteki T, Nakajima H, et al

Heart Disease Research Foundation, New York.
Most frequently encountered causes of intractable pain and intractable medical problems, including headache, post-herpetic neuralgia, tinnitus with hearing difficulty, brachial essential hypertension, cephalic hypertension and hypotension, arrhythmia, stroke, osteo-arthritis, Minamata disease, Alzheimer's disease and neuromuscular problems, such as Amyotrophic Lateral Sclerosis, and cancer are often found to be due to co-existence of 1) viral or bacterial infection, 2) localized microcirculatory disturbances, 3) localized deposits of heavy metals, such as lead or mercury, in affected areas of the body, 4) with or without additional harmful environmental electro-magnetic or electric fields from household electrical devices in close vicinity, which create microcirculatory disturbances and reduced acetylcholine. The main reason why medications known to be effective prove ineffective with intractable medical problems, the authors found, is that even effective medications often cannot reach these affected areas in sufficient therapeutic doses, even though the medications can reach the normal parts of the body and result in side effects when doses are excessive. These conditions are often difficult to treat or may be considered incurable in both Western and Oriental medicine. As solutions to these problems, the authors found some of the following methods can improve circulation and selectively enhance drug uptake: 1) Acupuncture, 2) Low pulse repetition rate electrical stimulation (1-2 pulses/second), 3) (+) Qi Gong energy, 4) Soft lasers using Ga-As diode laser or He-Ne gas laser, 5) Certain electro-magnetic fields or rapidly changing or moving electric or magnetic fields, 6) Heat or moxibustion, 7) Individually selected Calcium Channel Blockers, 8) Individually selected Oriental herb medicines known to reduce or eliminate circulatory disturbances. Each method has advantages and limitations and therefore the individually optimal method has to be selected. Applications of (+) Qi Gong energy stored paper or cloth every 4 hours, along with effective medications, were often found to be effective, as Qigongnized materials can often be used repeatedly, as long as they are not exposed to rapidly changing electric, magnetic or electro-magnetic fields. Application of (+) Qi Gong energy-stored paper or cloth, soft laser or changing electric field for 30-60 seconds on the area above the medulla oblongata, vertebral arteries or endocrine representation area at the tail of pancreas reduced or eliminated microcirculatory disturbances and enhanced drug uptake.

Laryngorhinootologie 1993 Jan;72(1):28-31

[Soft laser therapy in combination with tebonin i.v. in tinnitus].

[Article in German]

Partheniadis-Stumpf M, Maurer J, Mann W

Univ. HNO-Klinik Mainz.
28 patients were treated with soft-laser therapy. Two-thirds of them had suffered from tinnitus for more than six months and had undergone different therapies before. Each patient was treated twelve times, treatment lasting ten minutes. Before therapy six ml of Tebonin were given i.v. Four minutes later, the laser was positioned at a distance of one centimetre from the patients' mastoid. The laser beam was directed two fingers above the mastoid tip aiming at the lateral wall of the contralateral orbit. Before and three weeks after treatment each patient underwent pure tone audiometry and determination of the tinnitus intensity. Patients were asked to score symptoms before and three weeks after therapy. Hearing levels before and after soft-laser therapy did not show any statistic difference. Three weeks after the last treatment, twenty patients denied any change in tinnitus. Two patients felt an improvement of tinnitus and one patient had recovered completely. Five patients remained undecided about the outcome of therapy. To sum up, according to our results, the trial so far failed to show clear benefits of soft-laser therapy for patients suffering from chronic tinnitus.
PMID: 8439353, UI: 93176235

Am J Otol 1994 May;15(3):299-305; discussion 305-6

Epinephrine-induced changes in human cochlear blood flow.

Miller JM, Laurikainen EA, Grenman RA, Suonpaa, Bredberg G

Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan, Ann Arbor 48109-0506, USA.
Cochlear blood flow (CBF) was monitored over the basal turn stria vascularis using laser Doppler flowmetry in five human subjects during middle ear surgery. The effects of systemically administered epinephrine (0.3 microgram/kg) and topically applied epinephrine (1:10,000) on the round window membrane (RWM) were examined. Topical epinephrine caused a mean reduction of 60 percent in CBF (maximum peak reduction 65-85% across subjects), which slowly recovered ( > 10 min) toward baseline following epinephrine removal from the RWM. The changes in CBF are similar to those found in animal studies, but are much larger, indicating a relatively more pronounced role of adrenergic agents in CBF control in humans. Systemic epinephrine caused a 40 percent decrease in skin blood flow, a 90 percent increase in blood pressure (BP), above a resting hypotensive mean level of 65 mmHg, and a 50 percent increase in CBF. The CBF change followed the change in BP, but recovered toward baseline more slowly. The dramatic and somewhat prolonged decreases in CBF with RWM application of epinephrine may compromise sensory function and could account for the occasional unexplained sensorineural hearing loss or tinnitus associated with middle ear procedures that use topical epinephrine. The semipermeability of the RWM may, on the other hand, offer a route for therapeutic increases in CBF with vasodilative agents and provide an appropriate treatment for some cases of sensorineural hearing loss.
PMID: 8579132, UI: 96148940

Adv Otorhinolaryngol 1995;49:101-4

Results of combined low-power laser therapy and extracts of Ginkgo biloba in cases of sensorineural hearing loss and tinnitus.

Plath P, Olivier J

Department for ENT, Head and Neck Surgery of the Ruhr University Bochum, Prosper Hospital Recklinghausen, Germany.
PMID: 7653339, UI: 95381864

Adv Otorhinolaryngol 1995;49:105-8

Soft-laser/Ginkgo therapy in chronic tinnitus. A placebo-controlled study.

von Wedel H, Calero L, Walger M, Hoenen S, Rutwalt D

ENT Department, University of Cologne, Germany.
PMID: 7653340, UI: 95381865

Ear Nose Throat J 1996 Aug;75(8):468-71, 474, 476 passim

Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report).

Silverstein H, Choo D, Rosenberg SI, Kuhn J, Seidman M, Stein I

Ear Research Foundation, Sarasota, FL 34239, USA.
Intratympanic instillation of Depo-Medrol (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment. Prior to treatment with intratympanic medication, laser assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date. This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.
PMID: 8828271, UI: 96425961

Auris Nasus Larynx 1997;24(1):39-42

Efficacy of transmeatal low power laser irradiation on tinnitus: a preliminary report.

Shiomi Y, Takahashi H, Honjo I, Kojima H, Naito Y, Fujiki N

Department of Otolaryngology, Faculty of Medicine, Kyoto University, Japan.
Thirty-eight patients suffering from tinnitus resistant to several medical therapies for more than 6 months were treated by low power laser irradiation. A 40 mW laser with a wavelength of 830 nm was irradiated via their external auditory meatus toward the cochlea for 9 min once a week, 10 times or more. Patients were asked to score their symptoms on a 5 point scale before and after the treatment for a subjective evaluation of the effect. The results were estimated by the change of the loudness and duration of tinnitus, and the degree of annoyance due to tinnitus. Although only 26% of the patients had improved duration, loudness and degree of annoyance were relieved in up to 58 and 55%, respectively, without major complication. Laser therapy seemed to be worth trying on patients with intractable tinnitus.
PMID: 9148726, UI: 97227051

Acta Otolaryngol (Stockh) 1997 Mar;117(2):229-31

Osmotic drugs in the treatment of cochlear disorders: a clinical and experimental study.

Filipo R, Barbara M, Cordier A, Mafera B, Romeo R, Attanasio G, Mancini P, Marzetti A

Department of Otolaryngology, University of Rome La Sapienza, Italy.
On the grounds of positive results obtained with Meniere's patients, agents such as glycerol and mannitol have been included in the therapeutical protocol of other cochlear disorders presenting with hearing loss either of sudden onset, but not observed at an early stage, or accompanied by tinnitus and aural pressure. Intravenous infusions of either 10% glycerol or 18% mannitol were given to selected patients 3 to 6 times with a time interval of 1 to 3 days. Hearing loss, tinnitus and aural pressure were evaluated as improved, unchanged or worsened. In 33% of the glycerol group and 23.8% of the mannitol group we observed hearing threshold improvement, while aural fullness improved in 45% of the glycerol and 56.2% of the mannitol groups, and tinnitus was only relieved in 13.1% of the glycerol and 5.8% of the mannitol group. A parallel experimental study was carried out on guinea-pigs in order to shed light on the effects of mannitol and glycerol on the inner ear. Cochlear blood flow was measured with a laser Doppler flowmeter at the level of the basal turn of the cochlear lateral wall, both in normal and hydropic guinea-pigs, before and after osmotic intraperitoneal infusion. Basal values in the normal cochlea were much higher than in the hydropic one, and both mannitol and glycerol markedly influenced the local blood flow in the normal cochlea, giving few or no changes in the hydropic one.

Lasermedizin. 1998;13 (3-4): 122.

Low-Level-Lasertherapie des Innenohres: eine dosimetrische Analyse der menschlichen Cochlea.

Taurer S, Beyer W, Baumgartner R E. al.

Laser Therapy. 1996; 8: 197-204

Penetration depths of 830 nm diode laser irridation in the head and neck assessed using a radiography phantom model and wavelength-specific imaging film.

Ohshiro T, Ogata H, Yoshida M, Tanaka Y, Sasaki K and Yoshimi K.

Proc BiOS Europe'98,
8-12 Sept 1998, Stockholm, Sweden

Dosimetric Analysis for Low-Level-Lasertherapy (LLLT) of the Human inner Ear

Beyer W, Baumgartner R, Tauber S.

The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity.
Neurology 1998 Jan; 50(1):114-120

Modulation of tinnitus by voluntary jaw movements.
Am J Otol 1998 Nov; 19(6):785-789

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