Neck Solutions Blog

Prevalence and Characteristics of Tinnitus among US Adults

From: Am J Med. 2010 Aug;123(8):711-8

Tinnitus, derived from the Latin word tinnire meaning “to ring,” is the perception of noise in the absence of an acoustic stimulus. It is a common condition that is usually subjective, perceived only by the patient, and therefore diagnosis and monitoring rely on self-report. Data from the 1996 National Health Interview Survey (NHIS) showed tinnitus was experienced by approximately 35-50 million adults in the US, with 12 million seeking medical care, and 2-3 million reporting symptoms that were severely debilitating. Cases and proposed etiologies of tinnitus are clinically heterogeneous and, although several treatment options have been tried, no single cure exists for the condition.

Patients who experience tinnitus often report significant associated morbidities. Lifestyle detriment, emotional difficulties, sleep deprivation, work hindrance, interference with social interaction, and decreased overall health have been attributed to tinnitus. Although causative relations are yet unknown, patients with tinnitus can have increased risk for depression, anxiety, and insomnia.

A limited number of risk factors for tinnitus have been suggested, the best described of which include increasing age, hearing loss, and loud noise exposure. These associations merit further exploration in a large cohort. Furthermore, the relations between tinnitus and other demographic and health factors are minimally characterized in the current literature. Therefore, the authors examined the relation between tinnitus and several potential risk factors using data from the National Health and Nutrition Examination Survey (NHANES), a large nationally representative survey.

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Assessing audiological, pathophysiological and psychological variables in tinnitus patients with or without hearing loss.

From: Eur Arch Otorhinolaryngol. 2010 Jun 25. [Epub ahead of print]

The aim of this work is to study the characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss. The study considered tinnitus sufferers, ranging from 21 to 83 years of age, who were referred to the Audiology Section of Palermo University in the years 2006-2008. The following parameters were considered: age, sex, hearing threshold, tinnitus laterality, tinnitus duration, tinnitus measurements and subjective disturbance caused by tinnitus. The sample was divided into Group1 (G1), 115 subjects with normal hearing, and Group2 (G2), 197 subjects with hearing loss. Especially for G2, there was a predominance of males compared to females; the highest percentage of tinnitus resulted in the decades 61-70 and >70 with a significant difference for G2 demonstrating that the hearing status and the elderly represent the principal tinnitus-related factors.

The hearing impairment resulted in most cases of sensorineural hearing loss type and was limited to the high frequencies; the 72.1% of the patients with sensorineural hearing loss had a high-pitched tinnitus, while the 88.4% of the patients with a high-frequency sensorineural hearing loss had a high-pitched tinnitus. As to the subjective discomfort, the catastrophic category was the most representative among G1 with a significant difference between the two groups; no correlation was found between the level of tinnitus intensity and the tinnitus annoyance confirming the possibility that tinnitus discomfort is elicited by a certain degree of psychological distress as anxiety, depression, irritability and phobias.

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Polysomnographic and quantitative electroencephalographic correlates of subjective sleep complaints in chronic tinnitus.

From: J Sleep Res. 2010 Jun 16. [Epub ahead of print]

Chronic tinnitus, or the perception of hearing sounds without the presence of external stimulation, is estimated at about 10-15% of the population, with highest prevalence after 50 years of age. Sleep complaints are among the most prominent complaints accompanying tinnitus, but objective data are rare. In this study, we examined prospectively the subjective and objective sleep parameters of this patient population in order to determine differences in sleep disturbances associated with chronic tinnitus compared to matched controls. Forty-four subjects (22 with tinnitus and 22 controls without tinnitus), unselected with respect to sleep complaints, participated in this study. The analysis involved 1-week sleep diaries, subjective sleep questionnaires and 1 night of polysomnographic (PSG) assessment. Compared to matched controls, the tinnitus group showed lower subjective sleep quality as measured with the Pittsburgh Sleep Quality Index (PSQI) and sleep diaries, but no significant difference in objective polysomnograph sleep parameters (i.e. sleep latency, efficiency). However, quantitative non-rapid eye movement sleep analysis revealed lower spectral power in the delta frequency band in the tinnitus group compared to controls, and this decrease was correlated with subjective sleep complaints (the lower the delta spectral power, the greater the complaints). This is the first report of an electrophysiological correlate of sleep difficulties supportive of subjective sleep complaints in the tinnitus population.

Transcutaneous electrical nerve stimulation (TENS) of upper cervical nerve (C2) for the treatment of somatic tinnitus

From: Exp Brain Res. 2010 May 28. [Epub ahead of print]

Somatic tinnitus has been defined as tinnitus temporally associated to a somatic disorder involving the head and neck. Several studies have demonstrated the interactions between the somatosensory and auditory system at the dorsal cochlear nucleus, inferior colliculus, and parietal association areas. The objective is to verify the effect of transcutaneous electrical nerve stimulation of the upper cervical nerve (C2) in the treatment of somatic tinnitus. As electrical stimulation of C2 increases activation of the dorsal cochlear nucleus through the somatosensory pathway and enlarges the inhibitory role of the dorsal cochlear nucleus on the central nervous system, C2 TENS can be considered for tinnitus modulation. A total of 240 patients in whom tinnitus is modulated by somatosensory events (e.g., tinnitus change with rotation, retro- and antiflexion of neck) or modulated by pressure on head or face were included in this study. Both a real and a sham TENS treatment were applied for 30 min (10 min of 6 Hz, followed by 10 min of 40 Hz and 10 min of sham). Significant tinnitus suppression was found. Only 17.9% (N = 43) of the patients with tinnitus responded to C2 TENS. They had an improvement of 42.92%, and six patients had a reduction of 100%.

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Cochlear changes in presbycusis with tinnitus.

From: Am J Otolaryngol. 2010 Apr 29. [Epub ahead of print]

The pathophysiology of tinnitus is obscure and its treatment is therefore elusive. Significant progress in this field can only be achieved by determining the mechanisms of tinnitus generation, and thus, histopathologic findings of the cochlea in presbycusis with tinnitus become crucial. We revealed the histopathologic findings of the cochlea in subjects with presbycusis and tinnitus.

The subjects were divided into 2 groups, presbycusis with tinnitus (tinnitus) group and presbycusis without tinnitus (control) group, with each group comprising 8 temporal bones from 8 subjects. We quantitatively analyzed the number of spiral ganglion cells, loss of cochlear inner and outer hair cells, and areas of the stria vascularis and spiral ligament.

There was a significantly greater loss of outer hair cells in the tinnitus group compared with the control group in the basal and upper middle turns. The stria vascularis was more atrophic in the tinnitus group compared with the control group in the basal turn. Tinnitus is more common in patients with presbycusis who have more severe degeneration of outer hair cells and stria vascularis.

Note: We have changed the format of our Tinnitus Handicap Inventory to a form which generates scores and definitions online for immediate results.

Temporo-insular enhancement of EEG low and high frequencies in patients with chronic tinnitus.

From: BMC Neurosci. 2010 Mar 24;11(1):40. [Epub ahead of print]

Tinnitus is an auditory phantom perception, reported subjectively as a tone and/or a noise, in the absence of an external stimulus. Approximately 5-15 % of the general population experience tinnitus. In 1-3% of the general population the tinnitus affects the quality of life, involving sleep disturbance, work impairment and psychological distress. The underlying physiological mechanisms that lead to phantom sensation are still being explored. In most cases, tinnitus is accompanied by an audiometrically measurable hearing loss, and even in a majority of those cases with normal audiograms abnormal outer or inner hair-cell function has been reported correlating with the presence of tinnitus.

Contemporary views of tinnitus emphasize the role of the central auditory system. Studies in anaesthetized animals suggest enhanced firing rate and /or synchronized firing to be a necessary neurophysiological mechanism underlying tinnitus. A reduction of tinnitus intensity in patients has been correlated to reduction of delta band power.

Alterations in spontaneous central neuronal activity patterns after peripheral deafferentations have recently been proposed to be essential in the genesis of tinnitus. A relevance for peripheral deafferentation has also been proposed in the field of neurogenic pain, which prompted some authors to envisage that a similar mechanism might be at the source of tinnitus and neurogenic pain. Peripheral deafferentation leads to thalamic deactivation, which in turn disrupts normal thalamocortical interaction, thus leading to the appearance of tinnitus. The effects of an abnormal thalamocortical interaction can be analysed at the cortical level using magnetoencephalogram or electroencephalogram. This sequential view integrates both the induction in the periphery and the generation at the thalamocortical level of tinnitus. In the following, the authors refer to a mechanism that focuses on thalamocortical interplay. First evidence for this mechanism in tinnitus was the finding of low-threshold calcium spike bursts in the medial thalamus. 50% of neuronal activity in the medial thalamus (central lateral nucleus, central lateral nucleus) was characterized as low-threshold calcium spike bursts. Low-threshold calcium spike bursts displayed a delta/theta rhythmicity, with a mean interburst discharge rate of 4 Hz. low-threshold calcium spikes have been described intracellularly in in vitro and in vivo experiments and have been related to a state of membrane hyperpolarization. In tinnitus this would be a consequence of auditory deprivation caused by peripheral damage.

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Tinnitus Retraining Therapy (TRT) for tinnitus.

From: Cochrane Database Syst Rev. 2010 Mar 17;3:CD007330

Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. Although an outright cure for tinnitus remains elusive, various management strategies have been developed to help to lessen the impact of the symptom. Following the publication of a neurophysiological model of tinnitus, Tinnitus Retraining Therapy was developed. Using a combination of directive counselling and sound therapy in a strict framework, this is one of the most commonly used treatment modalities for tinnitus. Many studies refer to the use of Tinnitus Retraining Therapy where in fact a modified version of this therapy is actually being implemented. It is therefore important to confirm the use of authentic Tinnitus Retraining Therapy when reviewing any study that reports its use.

To assess the efficacy of Tinnitus Retraining Therapy in the treatment of tinnitus, the search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and reference lists of identified publications. The date of the most recent search was 26 August 2009. Randomised controlled trials of Tinnitus Retraining Therapy versus no treatment, or other forms of treatment, in adult patients with tinnitus were selected. Both authors critically appraised the retrieved studies for risk of bias and extracted data independently. Where necessary, we contacted the original study authors for further information.

Only one trial (123 participants) was included in the review. Several excluded trials did not follow the strict protocol for Tinnitus Retraining Therapy, evaluating instead a modified form of Tinnitus Retraining Therapy. The included trial showed Tinnitus Retraining Therapy to be more effective than a tinnitus masking approach. In this study outcome data for tinnitus severity were presented using three instruments (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index) for patients in three groups (participants’ tinnitus being a ‘moderate problem’, big problem’ or ‘very big problem’).

At 18 months, improvements for the three groups in the three scores (Tinnitus Retraining Therapy versus Tinnitus Masking) were respectively: ‘moderate problem’ – Tinnitus Handicap Inventory: 18.2 versus 4.6, Tinnitus Handicap Questionnaire: 489 versus 178, Tinnitus Severity Index 7.5 versus 1.6; ‘big problem’ – Tinnitus Handicap Inventory: 29.2 versus 16.7, Tinnitus Handicap Questionnaire: 799 versus 256, Tinnitus Severity Index: 12.1 versus 6.7; and ‘very big problem’ – Tinnitus Handicap Inventory: 50.4 versus 10.3, Tinnitus Handicap Questionnaire; 1118 versus 300, Tinnitus Severity Index: 19.7 versus 4.8.

A single, low-quality randomised controlled trial suggests that Tinnitus Retraining Therapy is much more effective as a treatment for patients with tinnitus than tinnitus masking.

Related Sources:

Tinnitus retraining therapy: implementing the neurophysiological model |
Guide to conducting tinnitus retraining therapy initial and follow-up interviews | Tinnitus Retraining Therapy | The TRT method in practice

Exploring the reasons why melatonin can improve tinnitus.

From: Med Hypotheses. 2010 Mar 6. [Epub ahead of print]

Melatonin has been proposed as a treatment for tinnitus, especially on the basis of its favourable effects on sleep and its vasoactive and antioxidant properties. However, to the authors knowledge no attempts of interpretation have been advanced through a detailed analysis of the various specific properties of melatonin possibly cooperating in a coincidental way to relieve tinnitus: among these, its modulatory effect on central nervous system resulting in a protective mechanism against an exaggerated sympathetic drive; its capacity to induce a more steady hemodynamic condition, through a multifactorial and multi-organ activity, resulting in a more regular labyrinthine perfusion; a possible action on the skeletal muscle tending to a reduction of the muscular tone, which could relieve tinnitus of muscular origin deriving from tensor tympani tonic contractions; its possible reported antidepressive effect, which could indirectly act on tinnitus; a direct regulation of inner ear immunity as proposed in literature when melatonin was reported to be present in the inner ear.

All these observations seem to indicate melatonin as a tool deserving a greater attention than other antioxidants in the attempt of relieving tinnitus, justifying its application from a more precise rationale based on a series of physio-pathological aspects.

Tinnitus and psychological comorbidities

From: HNO. 2010 Mar 4. [Epub ahead of print] [Article in German]

Comorbidity is the presence of one or more disorders in addition to the main disorder. Comorbidities negatively influence the development of the main disease. For patients with tinnitus a comorbidity is an additional component complicating the habituation of ear noise and patients with decompensated tinnitus often have psychological comorbidities, e.g. affective, somatoform or anxiety disorders. At the time of first presentation and also during further follow-up, it is essential to pay particular attention to the presence of potential comorbid mental disorders. This is of special importance for patients with decompensated ear noise (severity grades 3 and 4). For ENT specialists it is important that the mental discomfort of patients must be taken seriously and should be identified through a targeted diagnosis. Effective treatment of the co-symptoms using cognitive behavior therapy (CBT) in conjunction with medication often reduces the severity of tinnitus perception and discomfort.