From: BMC Ear Nose Throat Disord. 2008 Nov 3;8(1):7 [Epub ahead of print]

Tinnitus retraining therapy is aimed at removing negative associations of the tinnitus signal to enable the natural habituation process to occur. The goal is to achieve this through retraining counseling and sound therapy. Retraining counseling is a crucial part of tinnitus retraining therapy; it teaches patients the components of the neurophysiological model of tinnitus and encourages them to reclassify their tinnitus as a neutral signal. Sound therapy is assumed to facilitate tinnitus habituation by decreasing the strength of tinnitus signal. The tinnitus retraining therapy protocol requires that the patient adheres to the regimen for 12-24 months (typically attending for seven sessions over that time), except for patients experiencing weak tinnitus, which hearing aids little impact on everyday life.

Since the first description of tinnitus retraining therapy in the 1990s, clinicians have modified and customised the method of tinnitus retraining therapy to suit their practice and their patients. A simplified form of tinnitus retraining therapy hearing aids been used at Ealing Primary Care Trust (PCT) Audiology Department since 2005. This is different from tinnitus retraining therapy in the type and (shorter) duration of retraining counseling. Although the counseling used in simplified tinnitus retraining therapy also aims to get the patient to reclassify tinnitus as a neutral stimulus, it is different from the counseling used in tinnitus retraining therapy in the following ways: (1) there is no teaching about basic functions of the auditory system; (2) there is no presentation of the basics of brain function and the interactions of various systems of the brain; (3) there is no explanation of the theoretical basis of habituation based on the Jastreboff neurophysiological model; and (4) the duration of the initial counseling of simplified tinnitus retraining therapy is 30 minutes in comparison to 90 minutes for the initial tinnitus retraining therapy counseling.

Sound therapy for simplified tinnitus retraining therapy is the same as for the tinnitus retraining therapy except for patients in Jastreboff’s “category one”. Patients in this category have bothersome tinnitus, but no hearing loss, and no decreased sound tolerance. In simplified tinnitus retraining therapy, they are issued with a bedside/tableside sound generator but, in contrast to tinnitus retraining therapy, wearable sound generators (Wsound generator) are not offered unless the patient asks for them (for more details, see the procedures). The entire simplified tinnitus retraining therapy takes between 3 and 24 months (2-8 sessions). The first appointment lasts about 30 minutes, and then the patient is seen for follow ups (30 minutes) as required at 1 month, 2 month, 3 month, and 6 month intervals.

The aims of this observational study were: (1) to assess the effectiveness of simplified tinnitus retraining therapy, as carried out at Ealing PCT Audiology Department during 2005 and 2006 and (2) to determine the extent to which the success of simplified tinnitus retraining therapy is affected by the duration of tinnitus, the patient’s age, the use of hearing aids, and the use of sound generators.

Educational retraining counseling is generally regarded as an important component of tinnitus retraining therapy. The counseling in tinnitus retraining therapy is intended to explain the mechanisms underlying the tinnitus, based on the Jastreboff neurophysiological model, and to remove negative associations with the tinnitus. This is regarded as important for allowing habituation to the tinnitus to occur. The counseling used in Ealing PCT Audiology Department was also intended to reduce negative associations with the tinnitus, but was shorter in duration and simplified. The simplified counseling did not include any teaching about the interactions of various systems of the brain, there was no explanation of the Jastreboff neurophysiological model, and the duration of the initial counseling was only 30 minutes. The sound therapy used with simplified tinnitus retraining therapy for each patient category was essentially the same as for tinnitus retraining therapy, except that Wsound generators were not recommended to patients who exhibited tinnitus with no hearing loss and no decreased sound tolerance. However, Wsound generators were fitted to the patients who showed particular interest in making use of such devices.

Tinnitus retraining therapy is an established method of treating tinnitus patients and typically results in a decline (improvement) in Tinnitus Handicap Inventory scores of 25 to 35 points after 12-24 months of treatment. Studies on the psychometric adequacy of the Tinnitus Handicap Inventory questionnaire suggest that a decline in Tinnitus Handicap Inventory score of 20 points or more can be considered as a statistically significant improvement in perceived tinnitus handicap. Our results revealed that the Tinnitus Handicap Inventory score declined by approximately 45 points (SD= 22) after 3-24 months of simplified tinnitus retraining therapy. The cause of the greater mean effect in our study in comparison with earlier studies of tinnitus retraining therapy is not clear. It might reflect individual differences in the patients, differences in the way that patients were selected for inclusion in the studies, or individual differences in the clinicians’ personality and attitude. In any case, our results indicate that simplified tinnitus retraining therapy can produce benefits comparable to those produced by tinnitus retraining therapy.

The effectiveness of a substantially simplified version of tinnitus retraining therapy was assessed through an uncontrolled retrospective study on 42 patients seen at Ealing PCT Audiology Department during the period 2005-2006. Simplified tinnitus retraining therapy differs from tinnitus retraining therapy in the type and (shorter) duration of the counseling but is similar to tinnitus retraining therapy in the application of sound therapy. Although we did not include a control group to assess the extent to which patients would have improved without treatment, our results revealed that simplified tinnitus retraining therapy was successful in reducing tinnitus handicap. Tinnitus Handicap Inventory and VAS scores for tinnitus loudness, annoyance and effect on life declined (improved) significantly over a period of 3 to 23 months for patients who received simplified tinnitus retraining therapy. The mean decline of Tinnitus Handicap Inventory score was 45 (SD= 22) and the difference between pre- and post-treatment scores was statistically significant. The mean decline of the VAS score was 1.6 (SD= 2.1) for tinnitus loudness, 3.6 (SD= 2.6) for annoyance, and 3.9 (SD= 2.3) for effect on life. The differences between pre and post treatment VAS scores were statistically significant in all cases. The amount of improvement in Tinnitus Handicap Inventory scores tended to be greater for patients who used sound generators as a part of their treatment, but was not significantly associated with duration of tinnitus and age.

From: Prog Brain Res. 2007;166:215-9

In treating patients with temporomandibular joint (TMJ) dysfunction it was noticed that tinnitus and vertigo were common in such patients and there was also muscular tension in jaw and neck. During treatment of these patients it was also noted that injection of lidocaine in a jaw muscle reduced not only their muscular problems but also that the tinnitus was reduced while the local anesthetic was active. Evaluation of 39 patients with disabling tinnitus, and all suffered from tinnitus, revealed that 10 of them had bilateral tinnitus and TMJ disorders revealed that pain in the face, temples or jaw occurred often among these patients. Many of such patients had also symptoms of cervical spine disorders, head, neck and shoulder pain, and limitations in side bending and rotation were also frequent complaints. One-third of these patients could influence tinnitus by jaw movements and 75% could trigger vertigo by head or neck movements. Treatment of jaw and neck disorders in 24 patients with Ménière’s disease had a beneficial effect on not only their episodic vertigo but also on their tinnitus and aural fullness. At the 3-year follow-up, intensity of all symptoms were significantly reduced.

From: Pain Res Manag. 2006 Autumn;11(3):197-9

Whiplash trauma can result in injuries that are difficult to diagnose. Diagnosis is particularly difficult in injuries to the upper segments of the cervical spine (craniocervical joint complex). Studies indicate that neck injuries in that region may be responsible for the cervicoencephalic syndrome, as evidenced by headache, balance problems, vertigo, dizziness, eye problems, tinnitus, poor concentration, sensitivity to light and pronounced fatigue. Consequently, diagnosis of lesions in the craniocervical joint region is important.

Functional magnetic resonance imaging is a radiological technique that can visualize injuries of the ligaments and the joint capsules, and accompanying pathological movement patterns. Three severely injured patients that had been extensively examined without any findings of structural lesions were diagnosed by functional magnetic resonance imaging to have injuries in the craniocervical joint region. These injuries were confirmed at surgery, and after surgical stabilization the medical condition was highly improved. It is important to draw attention to the urgent need to diagnose lesions and dysfunction in the craniocervical joint complex and also improve diagnostic methods in whiplash injuires.

From: HNO. 2008 Jul;56(7):673-7 Article in German

The causes of tinnitus, vertigo, and hearing disturbances may be pathological processes in the cervical spine - neck and temporomaxillary joint. In these cases, tinnitus is called somatosensory tinnitus. For afferences of the cervical spine, projections of neuronal connections in the cochlear nucleus were found. A reflex-like impact of the cervical spine on the cochlear nucleus can be assumed. The tinnitus treatment concept of the Charité University Hospital in Berlin involves the cooperation of ENT specialists with many other disciplines in an outpatient clinic. A standardized examination protocol has been established, and physical therapy has been integrated into the interdisciplinary tinnitus treatment. For tinnitus modulating therapy of muscular trigger points, local anesthetics as well as self-massage or treatment by a physiotherapist or osteopath are useful.

This is a first post in a new category - Tinnitus. There has been evidence of a relationship between tinnitus and the neck along with temporomadibular dysfunction (tmj or tmd), which will also be a new category in the near future.