THE DIAGNOSIS AND ASSESSMENT OF THE QUALITY OF LIFE IN TINNITUS PATIENTS. A LITERATURE REVIEW

Highlight:1. Assessment of the patient’s quality of life is used to establish the diagnosis of tinnitus.2. The assessment is performed using several types of questionnaires: Tinnitus Handicap Inventory (THI), Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ). 3. THI is the questionnaire that has been translated into Indonesian so that it is easier to use in Indonesia.Background: Tinnitus is a symptom with many different causes that can interfere with daily life. The diagnosis of tinnitus can be carried out, starting by examining the history, physical examination, and audiology, and assessing the quality of life of the patient. Assessment of the patient’s quality of life and the severity of tinnitus was carried out using a questionnaire. Objective: This study aimed to explain the frequency of use of several questionnaires to assess the quality of life of patients with tinnitus, including Tinnitus Handicap Inventory (THI), Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ). Discussion: The use of THI as a research tool has been recommended for assessing the severity of tinnitus functional, emotional, and catastrophic responses. THS is used as a screening instrument to evaluate tinnitus complaints because of a hearing problem and how frequently it happens. TFI was used for identifying the functional impact on tinnitus patients, to evaluate how tinnitus affects a person’s life, while TPFQ was applied as it is a new questionnaire designed specifically for this objective. Conclusion: Many questionnaires can be used as an assessment of the quality of life of patients with tinnitus. Each questionnaire can be used and has its advantages. THI is a questionnaire that has been translated into Indonesian so that it is easier to assess.

ANXIETY AND DEPRESSION IN PATIENTS WITH TINNITUS

Objective: To determine the presence and severity of depression and anxiety in patients with tinnitus. Study Design: Cross sectional study. Place and Duration of Study: This study was conducted at department of Psychiatry, Combined Military Hospital Multan in collaboration with ENT department, Combined Military Hospital Multan, from Sep 2019 to Mar 2020. Methodology: All diagnosed cases of tinnitus in ENT out-patient department Tinnitus Handicap inventory (THI) was applied to assess the severity of tinnitus. Diagnosis of depression and Anxiety was done based on diagnostic criteria of ICD10 of WHO and symptom severity was assessed using Beck Depressive Inventory (BDI) for depression and Beck Anxiety Inventory (BAI) for Anxiety. Results: A total of 88 participants were included in this study. Fifty-three (60.2%) were male, 35 (39.7%) were females. Twentythree (20.2%) ranged between 18-40 years of age, 65 (57.2%) participants ranged between 41-60 years of age. Seven (12.5%) participants scored less than 38 on tinnitus handicap inventory showing mild severity of tinnitus, 3 (5.3%) individuals scored moderate while 19 (33.9%) had severe level of tinnitus. Thirty-three (37%) participants had depression 55 (62%) out of total 88 participants had anxiety. Conclusion: Studies show presence of anxiety and depression in patients with tinnitus so it seems prudent to screen all patients of tinnitus for psychiatric co morbidity. A multidisciplinary approach is required for the treatment of patients with tinnitus so that physical as well as psychiatric/psychological management of these patients is provided well in time.

ROLE OF GINKGO BILOBA IN TINNITUS BASED ON TINNITUS HANDICAP INVENTORY

ABSTRACT AIMS AND OBJECTIVES To evaluate whether there is role of Ginkgo biloba in treatment of tinnitus or not, using Tinnitus Handicap Inventory MATERIAL METHODS: The present prospective study, after approval by Institutional Ethics Committee, was conducted in Department of ENT, GMC Jammu from January 2019 to January 2020 on 90 patients with primary complaint of tinnitus. Inclusion criteria- Age: 20 years or above, Duration of tinnitus > 3 months. Informed consent was taken and all patients were asked to complete the THI-Tinnitus Handicap Inventory. All patients were given 50mg of Ginkgo biloba standardized extract LI 1370 (containing 25% flavonoids, 3% ginkgolides and 5% bilobalides). Patients were advised to take three tablets daily for 12 weeks. RESULTS The mean pre-treatment THI score was 43.6 and mean post-treatment THI score (at 12 weeks) was 39.4; the mean change in THI score was 4.2, the result being statistically insignificant (p-value= 0.43). Out of 90 patients, 51 reported unchanged severity of tinnitus, 27 patients reported improvement in severity of tinnitus and 12 patients reported worsening of condition. CONCLUSION According to our study, Ginkgo biloba has no significant therapeutic role in tinnitus. However, the aetiology of tinnitus is multifactorial and Ginkgo biloba could benefit patients with ischemic aetiology. KEYWORDS Ginkgo, biloba, handicap, inventory, tinnitus

Manejo del tinnitus con estimulador de sonido con especificidad frecuencial

Introducción: El tinitus tiene efectos deletéreos sobre la calidad de vida de un paciente. Cuando la lesión está a nivel coclear se puede usar acondicionamiento acústico para su tratamiento. Objetivo: Determinar el cambio en la percepción del tinitus antes y después de la intervención terapéutica. Metodología: Se planteó un estudio de serie de casos. Pacientes con tinitus no-pulsátil de moderado a catastrófico tratados con estimulador REVE 134™. Se incluyeron pacientes que no mejoraron luego de 3 meses con tratamiento médico. Se les practicó microaudiometría (67 frecuencias) para definir la región coclear afectada. Se excluyeron pacientes con umbrales audiométricos >60dB, aquellos con lesiones retrococleares y quienes no desearon participar. Las variables de desenlace fueron THI (“Tinnitus Handicap Inventory”), EVA (Escala Visual Análoga) y TQR (“Tinnitus Reaction Questionnaire”), que se midieron pretratamiento, 3/6meses postratamiento. Resultados: 11 pacientes (hombres=5, mujeres=6) fueron incluidos. En 5 casos el tinitus fue bilateral y en 6 unilateral. Los valores pretratamiento fueron: THI=61.4±27.4, EVA=6.9±2.7 y TQR=43.2±31.9 (Kolmogorov-Smirnov, p>0.05). Hubo mejoría estadísticamente significativa con el tratamiento, THI (3meses=30.6±21.1; 6meses=19±19.2), EVA (3meses=5.6±2.3; 6meses=3.5±2.0), TQR (3meses=25.6±20.0; 6meses=14.3±19.9); ANOVA de medidas repetidas (p=0.007, p=0.027, p=0.037; respectivamente). Conclusión: El tratamiento con REVE 134™ fue efectivo en pacientes con tinitus no pulsátil de moderado a catastrófico.

Effectiveness of Dry Needling in Bothersome Chronic Tinnitus in Patients with Myofascial Trigger Points

Introduction Therapeutic dry needling (DN) is effective in reducing the discomfort of chronic somatosensory tinnitus in patients with myofascial trigger points (MTP)s. Objective To evaluate the efficacy of DN in chronic somatosensory tinnitus discomfort in patients with MTP. Methods Placebo-controlled paired trial that included 16 patients with a diagnosis of somatosensory chronic tinnitus and with the presence of at least one active or latent MTP. Treatment was performed in two phases: (1) four sessions (one session per week for four consecutive weeks) of placebo DN and (2) four sessions of therapeutic DN with a gap (washout) of 15 days between these phases. Results The Tinnitus Handicap Inventory (THI) variable and its emotional domain had a statistically significant reduction in therapeutic DN when compared with placebo DN (p = 0.024 and p = 0.011, respectively).The tinnitus visual analogic scale (VAS) signaled a reduction in tinnitus discomfort when compared with moments before and after therapeutic DN (p < 0.05). Conclusion The therapeutic DN technique for MTP in patients with chronic tinnitus of somatosensory origin proved effective in reducing symptom discomfort, as measured by the THI (total score) and its emotional domain when compared with placebo DN.

LINKING TINNITUS HANDICAP INVENTORY - THI WITH THE INTERNATIONAL CLASSIFICATION OF FUNCTIONALITY, DISABILITY AND HEALTH – ICF: AN EXPLORATORY STUDY FOR THE APPLICATION OF THE LINKING RULES OF THE WORLD HEALTH ORGANIZATION

A Classificação Internacional de Funcionalidade, Incapacidade e Saúde – CIF é um importante instrumento para descrever da funcionalidade de pessoas com zumbido. Já o Tinnitus Handicap Inventory (THI), instrumento para a caracterização e quantificação do zumbido e devido à sua praticidade e diversas possibilidades de aplicação, já foi traduzido para diversos idiomas. Este estudo qualitativo, descritivo e exploratório pretende apresentar a aplicação das regras de ligação do THI com a CIF, e propor o aprimoramento de técnicas para interpretação dos resultados, elaboração de laudos e planejamento terapêutico multiprofissional conforme a perspectiva e os domínios estabelecidos pela CIF para uso clínico e ocupacional.

Aconselhamento Fonoaudiológico: um formato único e personalizado para sujeitos com zumbido crônico

Introdução: O zumbido é uma percepção auditiva na ausência de um estímulo acústico externo. Por ser um crescente na clínica audiológica, é necessário buscar estratégias de tratamento rápidas e eficazes. Objetivo: Verificar o resultado de um formato único de Aconselhamento Fonoaudiológico na redução da percepção do zumbido. Método: Estudo de caráter prospectivo e transversal, registrado sob o número 776111417.5.0000.5346, composto por conveniência. Os critérios de elegibilidade contemplaram sujeitos de 18 a 59 anos, com limiares auditivos normais e zumbido crônico, Escala Visual Analógica (EVA) (mínimo nota cinco), sem histórico de doenças neurológicas e psiquiátricas. Foram submetidos à anamnese, EVA e Tinnitus Handicap Inventory (THI) antes e pós-tratamento. Para o tratamento foi realizada uma divisão em dois grupos de forma randomizada. Um, denominado Grupo Aconselhamento Fonoaudiológico (grupo alvo), recebeu Aconselhamento Fonoaudiológico (personalizado e por escrito) baseado na Tinnitus Activities Treatment e acrescentaram-se, ainda, orientações referentes a alterações metabólicas, musculares, hábitos alimentares, entre outras. Outro, o Grupo Música, foi orientado a ouvir música ao perceber o sintoma. Após o intervalo de um mês, foram reaplicados a EVA e o THI. Resultados: Participaram 11 sujeitos de ambos os gêneros. O Grupo alvo apresentou melhora e diferenças estatisticamente significantes antes e pós-tratamento. Conclusão: O Aconselhamento Fonoaudiológico em formato único e personalizado mostrou-se eficaz na redução da percepção do sintoma podendo, assim, ser implementado em diferentes centros auditivos.

Repercusión del acúfeno en pacientes con enfermedad de Ménière

Introducción y objetivo: El acúfeno conforma junto con los episodios de vértigo, hipoacusia neurosensorial y la sensación de plenitud ótica los síntomas cardinales de la Enfermedad de Ménière. No alcanzando la importancia que le corresponde en el manejo de esta enfermedad, el acúfeno repercute profundamente en la vida de los pacientes, sobre todo en la esfera psicológica. Método: Se seleccionaron 15 pacientes con Enfermedad de Ménière diagnosticados según los criterios de la Sociedad de Bárány en Hospital Universitario de Salamanca. Se registraron variables específicas para el análisis de los síntomas cardinales de la enfermedad de Ménière. Se recogieron datos sobre la edad de aparición y años de evolución de la enfermedad y de la misma manera para el acúfeno, la afectación bilateral o unilateral de la misma y en este último supuesto, el oído afecto. Se sometió a los pacientes a estudio audiométrico junto con acufenometría. Se valoraron los principales parámetros definitorios del acúfeno: frecuencia (Hz), intensidad (dB), umbral de enmascaramiento (dB) e inhibición residual (segundos). Los pacientes realizaron el test Tinnitus Handicap Inventory (THI) y Escala visual analógica (VAS). La valoración de alteraciones en el estado de ánimo se obtuvo a través de la Escala Hospitalaria de Ansiedad y Depresión (HADS). Resultados: La edad media de diagnóstico de la Enfermedad de Ménière es 47,47 años. Las medias de pérdida auditiva en cada frecuencia por la enfermedad de Ménière se sitúan en torno a los 50 dB. El acúfeno no predomina en ninguno de los oídos (p>0,05). Se determinó una relación fuertemente significativa entre THI y VAS (r=0,72; p<0,01). Tanto THI como VAS no se relacionaron con los valores de la media de las pérdidas auditivas de ambos oídos. Los pacientes con más de dos años de evolución de la enfermedad se corresponden estadísticamente con puntuaciones mayores en THI y en la subescala de depresión del HADS (r= 0,821; p=0,001). Discusión: La intensidad del acúfeno, cuantificada de manera subjetiva con THI, no se relaciona con el grado de pérdida auditiva en los pacientes con Enfermedad de Ménière. El estudio de la esfera psicológica a través de la escala HADS demuestra la existencia de trastornos del ánimo en estos pacientes, prevaleciendo la patología depresiva en aquellos que presentan acúfenos de larga evolución.