Abstracts

Alcohol (Tinnitus)

Alcohol

Chronic tinnitus sufferers (# 100) attending an outpatient clinic completed self-report questionnaires assessing their alcohol consumption and its effect on their tinnitus.

Results showed a mixed effect: 22% reported that drinking worsened tinnitus, 62% reporting no effect and 16% reporting improved tinnitus.

Significantly more units of alcohol were consumed by those sufferers who reported that alcohol improved their tinnitus. However, overall, drinking behaviour was not significantly different to that of the general population.

Pugh R et al., Patients' reports of the effect of alcohol on tinnitus. Br J Audiol, 29(5):279-83 1995 Oct.

Characteristics (Tinnitus)

Characteristics

A profile of audiological and psychological characteristics, obtained before starting tinnitus management training, is presented for 96 subjects with tinnitus.

A history of headaches, neck or back pain, or balance problems was not related to the ability to cope with tinnitus. The coping strategies used were influenced by the beliefs held about tinnitus, but were not necessarily effective.

No gender differences were found in coping ability or overall stress levels, although there were gender differences on some psychological measures and stress influences.

Subjects who had previously sought assistance differed from those who had not in the complexity of the tinnitus sounds, the level of emotional reaction and the use of coping behaviours.

Dineen R et al., Audiological and psychological characteristics of a group of tinnitus sufferers, prior to tinnitus management training. Br J Audiol, 1997, 31(1):27-38.

Daily Life of Meniere Patients

Daily Life of Meniere Patients

Investigated the impact of the symptoms in Meniere's disease on the daily life of patients and analyzed the relationships between the cardinal symptoms and environmental, emotional and activity factors.

Results showed that vertigo, hearing impairment and tinnitus had a strong negative influence on the daily life of patients. 75% of the subjects avoided certain everyday activities, or situations, because of the disease.

Most of the subjects experienced premonitory symptoms of the attacks and 80% reported relations between external factors and vertigo attacks.

Melin L et al., The influence of vertigo, hearing impairment and tinnitus on the daily life of Meniere patients. Scand Audiol, 26(2):69-76 1997

Deafness & HRT

Deafness & HRT

Whilst the oral contraceptive pill (OC) has been implicated on a number of occasions as a cause of sensorineural hearing loss, there are no published reports linking hormone replacement therapy (HRT) to otological symptoms.

A case of sensorineural loss with tinnitus following commencement of HRT is described, followed by a discussion outlining the fundamental differences between the OC and HRT, thus explaining why a vascular etiology is unlikely.

Otological symptoms may be due to the effect of estrogens on electrolyte balance disturbing inner ear function and also a direct effect on the auditory pathways mediated in part by alterations in neurotransmitter receptor concentrations.

Strachan D: Sudden sensorineural deafness and hormone replacement therapy. J Laryngol Otol, 110(12):1148-50 1996 Dec

Electromagnetic Stimulation

Electromagnetic Stimulation

Determined whether pulsed e-stimulation, applied over the mastoid bone, caused an improvement in the level of tinnitus in long-standing tinnitus sufferers.

At the end of one week of treatment 45% of the patients were improved by the active device, but only 9% by placebo.

Electromagnetic stimulation may be an effective treatment.

Roland NJ et al., Electromagnetic stimulation as a treatment of tinnitus: a pilot study. Clin Otolaryngol, 1993 Aug, 18(4):278-81.

High Volume Music

High Volume Music

Students between 16 and 25 years of age (# 277), were questioned about their hearing behaviour and instructed in the consequences of hearing impairment resulting from listening to loud music. Furthermore audiometrics were offered and there was possibility to measure the loudness of the walkman used.

A majority visited "discos" and/or used walkman.

Over 80% claimed their hearing is good, over 75% knew that loud music can cause damage to hearing. The walkman users suffered more frequently from tinnitus and failed to hear a door bell more often.

After the instruction 75% of the pupils were willing to protect their hearing in future. Eight of 89 pupils had a hearing reduction of up to 40 dB(A). The average sound pressure level of the walkman was 104 dB(A).

Becher S et al., Risk of hearing loss caused by high volume music--presenting an educational concept for preventing hearing loss in adolescents]. Gesundheitswesen, 58(2):91-5 1996 Feb.

Pregnancy (Tinnitus)

Pregnancy

Investigated the presence of tinnitus in pregnancy by postal questionnaire.

Both pregnant and non-pregnant groups were similar in age, previous noise exposure and the presence of ear disease, or operations.

25% of the pregnant women reported tinnitus compared with 11% of controls.

There is significantly increased prevalence of tinnitus in pregnant women compared with a similar non-pregnant control group.

Gurr P et al., Tinnitus in pregnancy. Clin Otolaryngol, 18(4):294-7 1993 Aug

Treatments (Tinnitus)

Treatments

Tinnitus is a common problem for which many treatments have been proposed and implemented.

4 groups were obtained: No treatment (n = 24), acupuncture (n = 19), relaxation (n = 13), and other treatments (n = 13).

Clinicians should be aware of the fact that patients may have tried at least 1 treatment when entering the audiology clinic.

Andersson G: Prior treatments in a group of tinnitus sufferers seeking treatment. Psych. Psychosom, 1997, 66(2):107-10.

Update

Update

The study of a disorder such as tinnitus is fraught with difficulties. Tinnitus, like pain, is a subjective symptom. Therefore, it is difficult to measure any improvements in the condition, objectively.

For example, it has been reported that sectioning the VIII cranial nerve does not abolish tinnitus in a majority of patients; therefore, central mechanisms must act to preserve the tinnitus. Finally, we know that tinnitus can occur in a host of conditions other than ototoxicity, aging, and noise exposure, including: migraine headache with auditory aura, temporal lobe seizures, and head injuries.

It is naive to conceptualize that tinnitus has a unitary origin and a unitary "cure".

Seidman MD & Jacobson GP: Update on tinnitus. Otolaryngol Clin North Am, 29(3):455-65 1996 Jun

Vertigo

Vertigo

To characterize otologic causes for vertigo.

The diseases were: Meniere's disease, vestibular schwannoma, benign paroxysmal positional vertigo, vestibular neuritis, sudden deafness, and traumatic vertigo. The prevalence of tinnitus in the study population was 76%.

The most severe forms of vertigo and nausea were found in vestibular neuritis, whereas the most severe case of tinnitus appeared in Meniere's disease.

Of the patients with vestibular schwannoma, 49% had had vertigo.
A linear discrimination analysis using case history classified 90% of the patients into correct groups. The key questions concerned the frequency and duration of vertigo attacks, the duration of hearing loss and vertigo, and the occurrence of head injury.

Neurotologic and audiometric information was of minor value in distinguishing between these six diseases.

Kentala E: Characteristics of six otologic diseases involving vertigo. Am J Otol, 17(6):883-92 1996 Nov

Vitamin B12 Deficiency (Tinnitus)

Vitamin B12 Deficiency

Evaluated the incidence of "vitamin B12" deficiency in 3 groups of noise exposed subjects (army personnel).

Patients with tinnitus and noise-induced hearing loss exhibited vitamin B12 deficiency, defined as "blood" levels lesser than or equal to 250 pg/ml, in 47% of the cases.

This was significantly more compared to the noise-induced hearing loss individuals and normal subjects, who exhibited vitamin B12 deficiency in 27% and 19%, respectively.

There is a relationship between vitamin B12 deficiencies and dysfunction of the auditory pathway. There was some improvement in tinnitus and associated complaints in patients who received vitamin B12 replacement therapy.

These patients received 1,000 ugs of vitamin B12 per week until the levels were raised above 350 pg/ml in the blood. Vitamin B12 deficiency was only measured by "serum" levels of vitamin B12.

"Vitamin B12 Deficiency in Patients With Chronic-Tinnitus and Noise- Induced Hearing Loss", Shemesh, Z et al, American Journal of Otolaryngology, March-April 1993;14(2):94-99.

Well-being

Well-being

The Health and Nutrition Examination Survey of 1971-75 contains valuable information because it provides unbiased estimates of the state of hearing in the general population.

Examined 3 facets of the subjective aspects of hearing loss: frequent and bothersome tinnitus, ratings of hearing, and general well-being.

The period prevalence of frequent, bothersome tinnitus varied with race and gender (13 to 17%) with higher rates among blacks and females.

The mean air-conduction thresholds (0.5 to 4 kHz) of those reporting frequent and bothersome tinnitus did not exceed 32 dB HL.

There was no clear relationship between audiometric thresholds and well-being.

Cooper JC Jr: Health and Nutrition Examination Survey of 1971-75: Part II. Tinnitus, subjective hearing loss, and well-being. J Am Acad Audiol, 5(1):37-43 1994 Jan.

Zinc (Tinnitus)

Zinc

Patients with tinnitus may require 6 times more "zinc" than the "RDA". "Calcium" supplemented patients who do not take zinc have decreased zinc levels.

Calcium supplementation may interfere with mobilization of zinc from "bone" during resorption. Bone retains the largest store of zinc in the body.

"Vitamin A" is used as an adjunct to zinc at the level of the RDA since it is in very high concentration in the cochlea and sensory receptor cells of the "ear".

Reduction of "fat", "cholesterol" and "caffeine" avoidance, as well as balancing "electrolytes", "aids" in tinnitus treatment. "Potassium" iodide supplementation has produced and resolved tinnitus symptoms.

"Magnesium" imbalance may also cause tinnitus and "salicylate"-free diets have shown benefit in tinnitus.

"Zinc and Diet For Tinnitus", Debartolo, HM., Jr. Clinical Vignette, 1990.