Search Results (181)

Background/Objectives: Tinnitus lateralization, a perceptual characteristic often neglected in clinical assessment, may reflect underlying auditory plasticity. This study aimed to investigate whether changes in tinnitus lateralization following a multimodal neuromodulation protocol are associated with improved clinical outcomes, particularly regarding tinnitus severity and discomfort. Methods: A retrospective interventional study was conducted with 104 adults diagnosed with chronic tinnitus. All participants underwent a combined protocol involving transcutaneous auricular vagus nerve stimulation (taVNS), cervical transcutaneous electrical nerve stimulation (TENS), and photobiomodulation (PBM) targeting auditory pathways. Clinical assessments included the Tinnitus Handicap Inventory (THI), Visual Analog Scales (VAS) for loudness and discomfort, and lateralization reports before and after treatment. Lateralization patterns were categorized and compared using ANOVA and Kruskal–Wallis tests. Linear models explored demographic and clinical predictors of symptom change. Results: Substantial changes in lateralization were observed post-treatment. Participants who shifted from bilateral to unilateral tinnitus or from unilateral to non-perception showed the greatest symptom reductions (p < 0.001). The Bilateral → Unilateral group presented the most marked THI reduction (−20.82 ± 7.12), while minimal changes were observed in the Bilateral → Bilateral group. Loudness and discomfort improvements followed similar trends. No significant influence of age or sex on clinical response was identified, whereas longer tinnitus duration showed a modest positive association with symptom improvement. Conclusions: Perceptual reorganization of tinnitus lateralization may serve as a clinical marker of response to neuromodulation. Tracking lateralization could provide a simple, cost-effective adjunct to outcome monitoring in tinnitus management. Full article

Background/Objectives: Tinnitus treatment is often based on coping strategies, as, still, no causal treatment is available. Based on our “Erlangen model” of tinnitus development, we treated tinnitus patients with individualized, non-masking low-intensity noise (LIN) to reduce the tinnitus loudness. Methods: A total of 72 adult patients with a tinnitus severity index below IV (tinnitus health questionnaire, THQ), a hearing loss not exceeding 40 dB up to 6 kHz, and without experience in hearing aid (HA) usage were included in this study. Their audiograms, tinnitus parameters, THQ scores, and optimal LIN were determined individually. Patients were double-blinded, assigned to a treatment-only (TO) or placebo-and-treatment (PT) group. The TO patients received treatment for four weeks while the PT patients initially received a placebo (low-intensity white noise) stimulation for two weeks and, hereinafter, treatment for four weeks. Every two weeks, the measurements listed above were repeated. The long-term effects on THQ were assessed four weeks after the end of treatment. The data were analyzed by parametric and nonparametric statistics. Results: We identified a significant decrease in the THQ score already after two (η² = 0.14) and four weeks of treatment (η² = 0.43), that was still present four weeks after the end of treatment (η² = 0.15) in the TO group. Subjective individual patient reports hint at a possible complete suppression of the percept by LINTS. The PT group profited much less, as the initial placebo treatment seemed to counteract the LIN effects. Conclusions: Individually fitted LIN treatment seems to be able to suppress tinnitus, in some cases completely. The optimal fitting of the LIN is crucial for treatment success. Full article

Background/Objectives: Hearing aids can be used as a treatment for tinnitus. There are indications that this treatment is most effective when the tinnitus pitch falls in the frequency range of amplification of the hearing aid. Then, the hearing aid provides masking of the tinnitus. Alternatively, it has been suggested that a gap in the amplification around the tinnitus pitch would engage lateral inhibition and thereby reduce the tinnitus. Methods: To test these ideas, we conducted a randomized controlled trial. Patients were fitted with hearing aids using three different amplification schemes: (1) standard amplification according to the NAL-NL2 prescription procedure, (2) boosted amplification at the tinnitus frequency to enhance tinnitus masking, and (3) notch-filtered amplification at the tinnitus frequency to engage lateral inhibition and suppress tinnitus. The goal was to compare the boosted and notched amplification schemes to standard amplification. The primary outcome measure was tinnitus handicap as measured by the Tinnitus Functional Index (TFI). The trial was designed as a double-blind Latin square balanced crossover study. Eighteen tinnitus patients with moderate hearing loss were included. All of them were experienced hearing aid users. After two weeks of initial adaptation to the new hearing aids with standard settings, each setting was tried for four weeks. Results: There was an average reduction of 6.9 points on the TFI score after the adaptation phase, possibly due to a placebo effect. The TFI score did not differ significantly from the standard setting after using the notched or the boosted settings. Although notched amplification performed better than boosted amplification, this difference did not reach the clinical significance level. Regardless of the TFI outcomes, most participants had an individual preference for a particular setting. This preference was approximately uniformly distributed across the three amplification schemes. Conclusions: Notch-filtered and boosted amplification did not provide better tinnitus suppression than standard amplification. The individual preferences highlighted the importance of tailor-made approaches to hearing aid amplification in clinical practice. Further studies should explore the differences among patient’s tinnitus and their preference for a hearing aid setting. Full article

Background: Orthostatic hypotension (OH) is identified by a significant decrease in blood pressure upon standing from a seated or supine position. A reduction in systolic blood pressure of 20 mmHg within three minutes of standing meets the criteria for clinical diagnosis. We hypothesized that venous outflow obstruction from jugular valvular dysfunction or extrinsic compression of the left brachiocephalic vein may cause OH. Improving venous return and reducing venous congestion of the autonomic pathways through endovascular intervention could alleviate symptoms. Methods: This retrospective review included six male patients (aged 63–87) with medically refractory OH who underwent venograms revealing jugular, brachiocephalic, or subclavian vein stenosis. Patients were treated with balloon angioplasty and/or stenting. Blood pressure was measured in supine, seated, and standing positions before and immediately after the procedure, with multiple readings per position (total n = 117 for supine-standing comparisons). Statistical analysis used Welch’s t-test to compare pre- and post-procedural systolic blood pressure disparities. Results: The patients showed improved post-procedural blood pressure and reduced OH symptoms. The average supine-standing systolic disparity decreased from 38.68 mmHg preoperatively to 24.61 mmHg postoperatively (p = 0.024). The seated-standing disparity was insignificant, possibly due to autonomic compensation. Patients also reported relief from associated symptoms like headaches, tinnitus, and vertigo. Conclusions: These findings suggest venous outflow obstruction may contribute to OH, and venoplasty/stenting can mitigate symptoms, potentially reducing reliance on medications with adverse effects. Further studies should explore the role of Venous Outflow Obstruction Disorders in neurological conditions. Full article

Objective: We aimed to explore the efficacy of repetitive transcranial magnetic stimulation (rTMS) for idiopathic sudden sensorineural hearing loss (ISSNHL) and evaluate the correlation between treatment courses of rTMS and hearing outcomes. Methods: A prospective observational study was conducted at West China Fourth Hospital, Sichuan University, from January 2018 to January 2025. The study enrolled 339 patients (342 affected ears) diagnosed with ISSNHL. Among them, 67 patients (group A) received standard therapy combined with rTMS, while the control group (group B) received conventional therapy only. To verify the correlation between different treatment courses of rTMS and hearing outcomes, patients in Group A were divided into Group A1 (treatment courses ≤ 10) and Group A2 (treatment courses > 10). Hearing thresholds and clinical characteristics were evaluated at admission, discharge day and 6 months post-treatment. The SDRG’s criteria were used for the grading of hearing recovery. Results: Tinnitus (79.89% vs. 75.32%, p = 0.361) and sleep disorders (33.70% vs. 41.14%, p = 0.178) were highly prevalent among patients in group A and group B. 1 Hz rTMS significantly improved these symptoms (PSQI: 52.32% vs. 44.44%, p = 0.032; THI: 16.67 ± 19.41 vs. 8.22 ± 12.77, p = 0.002). Compared to high-tone hearing loss patients, those with low-tone loss in groupA2 showed a more rapid improvement (250 Hz: 17.66 ± 16.59 vs. 14.09 ± 15.58, p = 0.041; 500 Hz: 21.20 ± 18.03 vs. 17.31 ± 16.24, p = 0.036) than grouA1, with benefits sustained at 6-month follow-up (250 Hz: 27.79 ± 18.74 vs. 22.71 ± 18.31, p = 0.012; 500 Hz: 31.89 ± 19.73 vs. 26.49 ± 20.08, p = 0.013). Conclusions: rTMS at 1 Hz, administered in courses > 10 sessions, demonstrated both short-term and long-term beneficial effects in the ISSNHL. Those with low-tone hearing loss exhibit better recovery but a higher chance of relapse than high-tone loss patients. As a non-invasive approach with minimal side effects, rTMS is suitable for routine ISSNHL treatment. Full article

Purpose: This study aimed to evaluate retrospectively self-reported changes in tinnitus severity and distress associated with the COVID-19 pandemic and vaccination using validated self-report instruments. It further explored patient-reported onset of tinnitus following vaccination, gender differences in symptom severity, and associations with psychological distress. Method: A cross-sectional online survey was completed by 189 adults between December 2023 and April 2024. Participants retrospectively self-reported tinnitus onset and severity before, during, and after the COVID-19 pandemic using the Tinnitus Handicap Inventory (THI) and the Tinnitus Reaction Questionnaire (TRQ). Additional items assessed COVID-19 vaccination history, infection status, and adverse vaccine reactions. Repeated measures ANOVAs and chi-square tests were used to examine retrospectively reported longitudinal changes and group differences. Results: Mean THI scores increased significantly over time—before (M = 9.57, SD = 16.00), during (M = 29.97, SD = 32.30), and currently (M = 36.92, SD = 28.04)—with large effect sizes across functional, emotional, and catastrophic subscales (p < 0.001). TRQ scores also were reported to rise from before (M = 7.86, SD = 15.29) to during (M = 26.38, SD = 29.58) and remained elevated at the current time (M = 29.79, SD = 24.00), p < 0.001. Approximately 25.9% and 27.0% of respondents reported new or worsened tinnitus after the first and second vaccine doses, respectively. No significant gender differences in symptom severity were observed. TRQ severity classification revealed a marked shift, with moderate or greater distress increasing from 5.8% (before) to 35.6% (current). Conclusions: Retrospective self-reports indicated that tinnitus burden significantly increased during the COVID-19 pandemic and remained elevated at the time of survey completion. A notable proportion of individuals reported new-onset tinnitus following vaccination, though causality cannot be inferred. These findings highlight the need for continued monitoring and comprehensive care addressing both audiological and psychological components of tinnitus. Full article

Objective: To analyze the effects of a somatosensory education intervention targeting temporomandibular disorders (TMD) and awake bruxism on subjective tinnitus. Methods: This study had a pre-post-design in a primary care practice for orofacial physical therapy. Twenty-eight participants with the presence of TMD and suffering from moderate to severe subjective tinnitus, for at least 3 months, received the following treatments: (a) comprehensive information about tinnitus and the factors influencing it; (b) bruxism reversal training via a smartphone application; and (c) treatment for TMD. The primary outcome was the Tinnitus Functional Index (TFI). Secondary outcomes were awake bruxism frequency and the TMD pain screener. The study was approved by the Ethics Committee of the University of Groningen, the Netherlands. Results: The mean (95% CI) reduction in TFI scores and awake bruxism frequency were 18.4 (13.2–23.5) and 16.6% (2.0–31.2%), respectively. A clinically relevant reduction of 13 points on the TFI was observed in 63% of the participants. Regression analysis revealed that factors associated with TFI change included the TFI initial score at T0 (0.3, 95% CI 0.0–0.6), the presence of daytime clenching (21.0, 95% CI 8.7–33.4), and stiffness or pain around the TMJ (10.6, 95% CI −1.9–23.0) at baseline. Conclusions: The findings suggest that tinnitus education, TMD treatment, combined with decreasing awake bruxism, can reduce tinnitus in a primary care setting. Full article

Background/Objectives: Tinnitus often occurs alongside the emotional symptoms of anxiety and depression. The Ginkgo biloba extract EGb 761^® was shown to be effective in reducing neuropsychiatric symptoms in elderly patients with both dementia and tinnitus, exerting direct effects on tinnitus severity and indirect effects mediated by improvement of anxiety, depression, and cognition. Whether the extent of the effects is influenced by the patient’s sex has not yet been investigated. We performed a conditional process analysis to evaluate this question. Methods: We analyzed the moderating role of sex on the direct and indirect effects of EGb 761^® on tinnitus severity using a first- and second-stage conditional process model. Results: Indirect effects of EGb 761^® on tinnitus severity mediated by improved cognition, anxiety, and depression did not differ between women and men (p > 0.05; all 95% bootstrap confidence intervals overlapped with zero). Moreover, direct treatment effects of EGb 761^® on tinnitus severity were statistically significant for both sexes (women, p < 0.0001; men, p = 0.0279). Conclusions: Beneficial effects of Ginkgo biloba extract EGb 761^® in dementia patients with tinnitus are likely to be unaffected by the patient’s sex. Further research into the influence of patient characteristics on the outcome of tinnitus drug treatment is encouraged. Full article

Background: This study assessed the efficacy and effectiveness of cochlear implants (CIs) by examining changes in speech recognition, self-reported hearing ability, hearing-related quality of life, and tinnitus over two years. Methods: A prospective two-year longitudinal study included 50 adult users of CI. Speech recognition in quiet and background noise was measured using Dantale I (with/without visual cues; fixed 0 dB SNR) and the adaptive Hearing in Noise Test (HINT). Self-reported outcomes were obtained using the Speech, Spatial, and Qualities of Hearing Scale (SSQ-12), Nijmegen Cochlear Implant Questionnaire (NCIQ), and Tinnitus Handicap Inventory (THI). Results: In post-lingually deafened users of CI ($N=46$), Dantale with visual cues improved from 74.2% to 94.9% (mean difference = 20.7% [95% CI: 15.8, 25.6], $p<0.001$, $d_z=1.83$), and without visual cues from 58.9% to 92.1% (33.1% [28.0, 38.2], $p<0.001$, $d_z=2.83$). Dantale with background noise improved from 23.4% to 61.7% (37.6% [32.4, 42.8], $p<0.001$, $d_z=3.13$), and adaptive HINT from 8.6 to 4.2 dB SNR ($-5.8$ [−7.0, −4.6], $p<0.001$, $d_z=3.10$). NCIQ scores increased from 292.6 to 436.3 points (145.3 [122.8, 167.8], $p<0.001$, $d_z=3.11$), and SSQ-12 improved by 0.60 points [0.18, 1.02] from 1 to 2 years ($p=0.015$, $d_z=0.86$). Tinnitus severity remained low at the group level, with individual fluctuations over time. Conclusions: Danish adult users of CI showed substantial and sustained improvements in speech recognition and hearing-related quality of life over two years, with adaptive speech-in-noise testing proving particularly sensitive for detecting long-term changes. Full article

Background: Numerous studies have demonstrated the beneficial effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on cardiovascular and renal outcomes in patients with heart failure and chronic kidney disease. However, whether SGLT2 inhibitors are also associated with a reduced risk of tinnitus has not been investigated. Objective: This study aimed to investigate the association between SGLT2 inhibitor therapy and the incidence of tinnitus in patients with type 2 diabetes. Methods: This retrospective cohort study was based on data from a nationally representative database of primary care practices in Germany from 2012 to 2023. Patients with type 2 diabetes who were treated with metformin and additionally received either an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP4) inhibitor were included. Patients with a previous diagnosis of tinnitus were excluded. The primary outcome was the first tinnitus diagnosis documented by a primary care physician. The SGLT2 and DPP4 cohorts were compared for tinnitus incidence using Kaplan–Meier analysis and multivariable Cox regression. Results: 66,750 patients with SGLT2 inhibitors and 82,830 with DPP4 inhibitors were analyzed. The cumulative 5-year incidence of tinnitus was 1.9% in both groups. The multivariable regression analysis did not show a significant association between SGLT2 therapy and the occurrence of a tinnitus diagnosis (HR: 1.04; 95% CI: 0.89–1.21). Conclusion: There was no difference in tinnitus incidence between patients with SGLT2 or DPP4 inhibitors. The causes could lie in the heterogeneous, not purely vascular, etiology of tinnitus in general practitioners’ practices. Future studies should include further clinical data, including confirmed hearing impairments. Full article

The Constrained Disorder Principle (CDP) characterizes systems by their inherent variability, which is regulated within dynamic boundaries to ensure optimal function and adaptability. In biological systems, this variability, or “noise”, is crucial for resilience and flexibility at various scales, ranging from genes and cells to more complex organ systems. Disruption of the boundaries that control this noise—whether through amplification or suppression—can lead to malfunctions and result in pathological conditions. White noise (WN), defined by equal intensity across all audible frequencies, is an exemplary clinical application of the CDP. It has been shown to stabilize disrupted processes and restore functional states by utilizing its stochastic properties within the auditory system. This paper explores WN-based therapies, specifically for the masking, habituation, and alleviation of tinnitus, a subjective perception of sound. It describes the potential to improve WN-based therapies’ effectiveness by applying the CDP and CDP-based second-generation artificial intelligence systems. Understanding the characteristics and limitations of these approaches is essential for their effective implementation across various fields. Full article

Objectives: Tinnitus, defined as the perception of sound without an external stimulus, is a complex condition with unclear etiology. Emerging evidence suggests a link between vascular dysfunction, particularly arterial stiffness, and tinnitus. This study aimed to evaluate vertebral artery stiffness in patients with idiopathic subjective tinnitus and assess the utility of Doppler ultrasonography as a non-invasive diagnostic tool. Materials and Methods: In this prospective study, 31 patients with idiopathic tinnitus (11 males, 20 females; mean age: 50.42 ± 9.64 years) and 24 healthy controls (12 males, 12 females; mean age: 39.67 ± 10.63 years) underwent comprehensive clinical evaluations, including pure tone audiometry, blood tests, and vertebrobasilar Doppler ultrasonography. Vertebral artery stiffness index (VAS), resistive index (RI), and pulsatility index (PI) were measured bilaterally. Results: A total of 31 patients with idiopathic subjective tinnitus and 24 healthy controls were evaluated. The mean age was significantly higher in the tinnitus group compared to controls (50.42 ± 9.64 vs. 39.67 ± 10.63 years, p < 0.001). Lipid profile analysis revealed significantly higher levels of total cholesterol (193.6 ± 47.28 vs. 167.5 ± 28.99 mg/dL, p = 0.021), LDL (149.4 ± 37.9 vs. 106.1 ± 10.7 mg/dL, p < 0.005), and triglycerides (202.2 ± 83.5 vs. 148.6 ± 26.4 mg/dL, p < 0.005) in tinnitus patients. Doppler ultrasonography demonstrated significantly higher vertebral artery stiffness values in the tinnitus group (left: 2.87 ± 0.72 vs. 2.12 ± 0.22; right: 2.99 ± 0.77 vs. 2.14 ± 0.5; both p < 0.005). Similarly, pulsatility index (PI) was significantly elevated in patients compared to controls (left: 2.45 ± 1.2 vs. 1.2 ± 0.43; right: 2.49 ± 1.02 vs. 1.19 ± 0.42; both p < 0.005). No significant differences were observed in resistive index (RI) or vertebral artery diameters between groups. Among tinnitus patients, PI and VAS were significantly higher on the side corresponding to reported tinnitus symptoms (p < 0.05), suggesting a lateralized vascular contribution. Conclusions: The findings suggested a potential relationship between idiopathic subjective tinnitus and vertebral artery stiffness. We demonstrated the utility of Doppler ultrasonography, a cost-effective and non-invasive imaging modality, for evaluating vascular parameters in tinnitus patients, paving the way for broader clinical applications. By uncovering a significant association between vertebral artery stiffness and tinnitus, our findings suggest that vascular health assessments could enhance diagnostic and therapeutic strategies for tinnitus management. Full article

Background/Objectives: This study aimed to (i) cross-culturally adapt the Inventory of Hyperacusis (IHS) into Danish and (ii) assess its usability, validity, and reliability in Danish adults with hyperacusis. Methods: The translation followed established guidelines for adapting hearing-related questionnaires. A two-phase design ensured linguistic and cultural adaptation and evaluated test–retest reliability and construct validity. The IHS, consisting of 25 items, was translated and tested in seven participants through cognitive debriefing. In phase two, temporal consistency was assessed in 32 patients. Results: Thirty-two participants (twenty-eight female; mean age 49.8 years) completed the study over 2–4 weeks (mean 22 days). Eight used hearing aids, and twenty-four reported tinnitus. The Danish IHS showed good reliability (Cronbach’s alpha = 0.95) and acceptable test–retest reliability, except for the General Loudness factor. While no systematic score changes occurred, significant variability in score changes were noted. Conclusions: The Danish IHS appears to be a reliable and valid tool for assessing hyperacusis. Further research is needed, but the IHS-DK shows potential as an effective clinical and research tool for evaluating hyperacusis impact and treatment outcomes. Full article

Objectives: Muscular dysfunction of the cervical spine is the most likely cause of somatosensory tinnitus and dizziness. Some patients can modulate their tinnitus through movement or palpation. This study aimed to investigate the effect of manual therapy on muscle pressure pain, range of motion in the cervical spine, and tinnitus and dizziness. Methods: A pilot randomized controlled trial with a waiting-group design was conducted in a university hospital setting. Participants in the intervention group received manual therapy to the head and neck region combined with stretching exercises and muscle relaxation techniques such as releasing tense muscles and myofascial trigger point therapy involving muscle and connective tissue techniques. The primary and secondary outcome measures were pressure pain, tinnitus modulation by head and neck muscles, and range of motion of the cervical spine. Tinnitus and dizziness were assessed before and after the intervention using the Tinnitus Handicap Inventory and the Dizziness Handicap Inventory. Results: After the intervention, significant differences were observed in pressure pain, tinnitus modulation, and range of motion as well as the Tinnitus Handicap Inventory (U = 644; p < 0.001) and the Dizziness Handicap Inventory (U = 133.5; p = 0.010), favoring the intervention group. Conclusions: The results demonstrate that manual therapy significantly altered pressure pain in the head and neck muscles as well as symptoms such as tinnitus and dizziness in the intervention group. Manual therapy may be beneficial in treating cervicogenic somatosensory tinnitus, provided that other potential causes such as otorhinolaryngological pathology have been ruled out. Full article

A single intratympanic application of the small-molecule drug AC102 was previously shown to promote significant recovery of hearing thresholds in a noise-induced hearing loss model in guinea pigs. Here, we report the effects of AC102 to revert synaptopathy of inner hair cells (IHCs) and behavioral signs of tinnitus in Mongolian gerbils following mild noise trauma. This experimental protocol led to minor hearing threshold shifts with no loss of auditory hair cells (HCs) but induced synaptopathy and a sustained and significant tinnitus percept. Treatment by intratympanic application of AC102 was evaluated in two protocols: 1. three weekly injections or 2. a single application. We evaluated hearing threshold changes using the auditory brainstem response (ABR) and the development of a tinnitus percept using the gap prepulse inhibition of acoustic startle (GPIAS) behavioral response. The number of IHC ribbon synapses along the cochlear frequency map were counted by immunostaining for the synaptic ribbon protein carboxy-terminal binding protein 2 (CTBP2). AC102 strongly and significantly reduced behavioral signs of tinnitus, as reflected by altered GPIAS. Noise-induced loss of IHC ribbon synapses was significantly reduced by AC102 compared to vehicle-treated ears. These results demonstrate that a single application of AC102 restores ribbon synapses following mild noise trauma thereby promoting recovery from tinnitus-related behavioral responses in vivo. Full article