Mindfulness-Based Therapy in the Management of Tinnitus

Mindfulness-based interventions are one of the recent techniques that have proven to be very useful in tinnitus management. Mindfulness therapy refers to experiencing the present, which helps control the attention system, which significantly contributes to getting relief from the adverse reactions due to tinnitus. Several systematic reviews and randomized controlled trials report relief from tinnitus perception even with the heterogeneity of the patients with mindfulness therapy. The different study designs and outcome measures reported similar results suggesting the efficacy of mindfulness-based training. Thus, psychologists and audiologists dealing with individuals suffering from tinnitus can attempt this technique in management. The mindfulness-based training can be combined with formal Cognitive Behavioral Therapy (CBT) and Tinnitus Retraining Therapy (TRT) approaches to enhance tinnitus treatment.

Effectiveness of Pranayama (Yogic Breathing Exercise) on Management of Somatosensory Tinnitus: A Single Case Study

Somatic or somatosensory tinnitus is a subtype of subjective tinnitus, in which tinnitus perception is caused by an alteration in somatosensory afference from the cervical spine or temporo-mandibular area which changes patient’s tinnitus perception in terms of loudness, pitch and localization. A 30-year-old female reported with the complaint of tinnitus, vertigo and reduced hearing sensitivity in the left ear for 7 months. Enduring low frequency annoying tinnitus flare ups with vertigo, vomiting and speech understanding difficulty every 48-72hours. Successive audiological investigations and THI score revealed mild sensorineural hearing loss in the left ear with grade 5 catastrophic handicap. Tinnitus retraining Therapy (TRT) along with pranayama (yogic exercise) was used as a treatment protocol. Nadi Shodhana (Alternate-Nostril Breath- one of the most efficient strategies for calming nerves and settling mind fluctuations) was practised twice daily and during the treatment sessions. Effectiveness of TRT combined with Yoga on a patient with severe tinnitus & accompanying issues was investigated. This treatment strategy proved to be highly effective in lowering tinnitus severity and reducing the accompanying issues with long term effectiveness. As a result, present study enlightens the possible success rate of this treatment protocol for somatosensory tinnitus and its impact on tinnitus recurrence. Key words: Somatosensory tinnitus, TMJ, Pranayama, TRT, Catastrophic handicap.

Considerations on tinnitus retraining therapy and transcranial magnetic stimulation

Introduction. Tinnitus is a subjective perception of sound in the absence of an external acoustic stimulus. It has negative behavioral feelings associated, e.g., depression, insomnia, difficulty of concentration, anxiety, irritability, and panic. The feelings impact negatively on the social and economic life of individuals. Empirical data suggest that disorders in the auditory cortex and its neural pathways give rise to abnormal spontaneous activations associated with tinnitus. Understanding the causes remains challenging. However, the current hypothesis suggests that clusters of neural networks and subnetworks are involved in tinnitus generation. Central dynamic neuroplasticity induced by a peripheral loss of auditory input can cause tinnitus noise. To date, there is no widespread consensus about the most effective therapy for treating tinnitus. Objective. To reflect on two tinnitus therapies: Tinnitus Retraining Therapy (TRT) and Transcranial Magnetic Stimulation (TMS). Method. A narrative review. Explicit and systematic criteria were not adopted in searching for the theoretical framework. Results. TMS is promising compared to TRT because TMS acts on tinnitus neural mechanisms. TRT is effective on a behavioral level since it relieves mild and moderate tinnitus' negative feelings. Conclusion. TRT does not advance on the neural source, but only on the tinnitus perception. TMS acts directly on the neural causes. Both therapies have limitations and can work for some patients. However, the effect of TMS seems more efficient, although transient.

A comparative study on photobiological effects of low-level laser therapy and tinnitus retraining therapy in patients with acoustic trauma-induced tinnitus

Background and Aim: Tinnitus is a subjective auditory symptom referred to the perception of sound in the absence of external stimuli, and there is no definite treatment for it. Rehabilitation methods and laser therapy have been recommen­ded used for its management. This study aimed to investigate the photobiological effects of low-level laser therapy (LLLT) and tinnitus retraining therapy (TRT) in patients with acoustic trauma-induced tinnitus. Methods: This clinical trial was conducted on 60 patients suffering from acoustic trauma-induced tinnitus for more than six months, divided into three groups of LLLT, TRT and LLLT + TRT. The Persian version of tinnitus handicap inven­tory (P-THI), visual analog scale (VAS), and loudness match (LM) scale were used to collect data. The collected data were analyzed in SPSS version.22 software. The effect of time, group and time × group on the scores of VAS, LM, P-THI and its subscales were examined. Results: There was a statistically significant diff­erence between LLLT + TRT and LLLT groups after intervention in terms of LM (p = 0.002) and VAS (p = 0.001) variables, but no statistical sig­nificance for P-THI and its subscales (p = 0.442) was found. Conclusion: Combination of LLLT and TRT, as a therapeutic protocol, is recommended due to their remarkable effects in reducing acoustic trauma-induced tinnitus symptoms. The use of LLLT method alone, however, is not recommen­ded due to its lower effects. Keywords: Tinnitus; low-level laser therapy; tinnitus retraining therapy; tinnitus handicap inventory; loudness matching; visual analog scale

Evaluation and Management of Misophonia Using a Hybrid Telecare Approach: A Case Report

Decreased sound tolerance (DST) is a negative reaction to environmental sounds and is estimated to affect 3.5% of the population. This case report presents the evaluation and management of an adult female with severe, longstanding misophonia. Her evaluation included comprehensive audiometric testing (including uncomfortable loudness levels) and a detailed assessment of the impact of DST on her life. She enrolled in tinnitus retraining therapy and began receiving treatment aiming to facilitate habituation of bothersome environmental sounds. This case was complicated by the advent of the coronavirus disease 2019 (COVID-19) pandemic and a telemedicine hybrid approach was employed to increase access to audiologic care. Using this structure, some appointments occurred in person in the clinic and others occurred via a telemedicine video visit format. Telemedicine video visits facilitated in-depth discussions, afforded the opportunity to answer questions, and provided the option of cloud-based remote programming of on-ear devices. Future care will continue to employ a hybrid approach.

Purpose, Procedure, and Contents of Counseling according to Tinnitus Interventions

Tinnitus refers to the perception of ringing sounds in the ear that are not heard by others. Counseling plays a vital role in tinnitus intervention. Counseling provides correct information about tinnitus and hearing loss, corrects any misunderstandings related to tinnitus, and suggests precise alternative interventions for tinnitus. In this review, we aimed to examine the counseling contents in Tinnitus Retraining Therapy (TRT), Cognitive Behavioral Therapy (CBT), and Tinnitus Activities Treatment (TAT) to identify information that could be useful for counseling approaches and contents for the various tinnitus intervention methods. We searched Web of Science, Embase, Science Direct, and PubMed for relevant articles. Of the 5,283 articles, 31 were included in the final review of counseling contents for TRT, CBT, and TAT. Based on our findings, we were able to summarize the main contents of counseling in TRT, CBT, and TAT. Although the contents of counseling may vary depending on the individuals with tinnitus, our review provided information that may help audiologists or hearing professionals further understand the fundamentals of counseling for each tinnitus intervention. Our review may serve as a guideline for tinnitus counseling according to tinnitus interventions.

Auditory evoked potentials as yardstick for tinnitus

<p class="abstract"><strong>Background:</strong> Aiming to evaluate the recent theoretical postulates on tinnitus underscoring the role of thalamocortical neural tracts, the present study: explores middle latency response (MLR) as a possible physiological measure of tinnitus: thus investigates the predicted exaggeration of P_a-N_a, N_a-P_b interpeak amplitudes in tinnitus patients and; explores middle latency response (MLR) as a prognostic indicator of tinnitus retraining therapy (TRT), thus evaluates possible decrease in P_a-N_a and N_a-P_b amplitude after 2 weeks exposure to tinnitus retraining therapy.</p><p class="abstract"><strong>Methods:</strong> An experimental group was constructed by randomly assigning 30 patients with mean age 38.5 years and complaining of debilitating tinnitus but with normal hearing for the study. MLR was administered on patients with normal auditory brainstem response (ABR) and otoacoustic emission (OAE) both pre- and post-tinnitus retraining therapy. </p><p class="abstract"><strong>Results:</strong> Results demonstrated no significant effect on P_a, N_a and N_b absolute and interpeak latencies. However, significantly exaggerated P_a-N_a and N_a-P_b interpeak amplitudes between experimental and control groups as well as pre and post therapeutic groups were found.</p><p class="abstract"><strong>Conclusions:</strong> This proves that MLR may adequately reflect thalamocortical hyperactivity in cases with distressing tinnitus and demonstrable improvement post TRT warrants the use of MLR as its prognostic indicator.</p>