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The causes of tinnitus may be manifold. Frequently, underlying factors defy treatment with conventional methods. Aside from rheological agents and cortisone, there is hardly a drug that lends itself to the treatment of tinnitus. In chronic cases, therapeutic interventions will frequently be the only remedy. Since the afflicted often sense an extreme degree of strain, complementary therapies like acupuncture or Chinese medication are looked for.

Based on a case presentation and a review of the current state of evidence, the effectiveness of TCM will be presented. Gleichzeitig trat bei Kopfbewegungen ein Missempfinden im Hinterkopf auf. Schmerzen im Sinne einer chronisch rezidivierenden Epicondylitis ulnaris beidseits begleiteten die Patientin schon 20 Jahre lang.

Sie gab an, immer gesund gewesen zu sein, keine Operationen, keine Einnahme von Medikamenten. Routineblute ohne pathologischen Befund. Antwort von Frau Dr. Bei chronischem Tinnitus ist das anders, da haben sich erstaunliche Erfolge erst durch Kombination von Akupunktur mit chinesischer Arzneitherapie eingestellt. Die Patienten kommen ja meistens nicht nur wegen ihres Tinnitus, sondern wegen mannigfacher Leiden.

Gertrude Kubiena Weimarer Str. Jochen Gleditsch Hetzendorfer Str. Der N. Ginseng — ren shen oder R. Codonopsis Pilosulae, dang shen , R. Glycyrrhizae Uralensis — gan cao, Rhizoma Cimicifugae — sheng ma, R. Puerariae — ge gen, Fructus Viticis — man jing zi, R. Antwort von Herrn Dr. The general index for tinnitus annoyance demonstrated a considerable reduction from the first consultation T0 to the final measurement T4. There was not only a reduction upon the treatment itself, but already earlier, i.

We assume that this reduction is the outcome of the extensive diagnostic procedures paired with a first, very brief counseling, reassuring the patient that no severe physical abnormality was detected. This information by itself obviously provided some relief. Support for this assumption is provided by a change in the subscales on emotional and cognitive distress as well as intrusiveness and sleep disturbance, but not in the scales addressing hearing and somatic problems. A meta-analysis of 11 studies included individuals with tinnitus distress that were randomly allocated to a waiting phase lasting 6—12 weeks Hesser et al.

Thus, already in response to a waiting period tinnitus patients improve slightly on psychometrically robust tinnitus-specific measures. In our study, the effect size of the overall change before the start of the day care treatment is considered as small. Consequently, at the beginning of treatment the mean tinnitus annoyance was on average still severe. This means that broad and interdisciplinary ENT doctor, psychologist and audiologist diagnostics and counseling leads to a significant reduction of tinnitus annoyance, but it does not lead to patients reaching the non-severe range.

Perhaps this is why many patients reported during treatment that they were already somewhat relieved after the primary consultation in our clinic or elsewhere, but that they did not know how to cope better with tinnitus in the future. The change in tinnitus annoyance from the beginning T1 to the end of treatment T2 is in comparison to the earlier effect considerable, reaching a large effect size with a change in the TQ sum score of further 15 points in total 18 points ; i. This clinically relevant improvement from a decompensated, clinically severe state to a compensated, moderate state remained stable at follow-ups 20 days as well as 6 months later.

In contrast to the different responsiveness of subscales for the early change, all TQ subscales reduced significantly upon treatment. Currently, we have no evidence on which of the modules proved more or less successful, but patients considered all modules important. In general, reported TQ changes in response to different therapeutic approaches differ widely: between 5.

Most often the changes at follow-up are smaller compared to the end of treatment, but still significantly larger compared to the onset of treatment Jakes et al. As such, JITT seems highly promising, but we also would like to point out several difficulties in directly comparing the different approaches. The efficacy of most tinnitus management interventions recommended for clinical practice remains to be demonstrated. Currently, only few studies allow making informed conclusions. The efficacy of therapist-delivered CBT appears to be reasonably established e.

A multidisciplinary CBT-based approach, in which professionals in audiology and psychology share treatment goals aimed at coping with tinnitus through education and counseling, is likely to optimize the benefit for patients Cima et al. Thus, multidisciplinary approach was recommended for some time Henry and Wilson, ; El Refaie et al.

Nevertheless, there are only few researchers reporting the effects of multidisciplinary treatment, often with the limitation that only inpatients of a specialized hospital were examined Goebel, , ; Hiller and Goebel, ; Goebel et al. These patients are known to be generally more severely impaired and suffer from more psychological complaints than the average patients of ENT practitioners or audiological outpatient departments Hiller and Goebel, Therefore, results obtained from inpatient treatment do not seem representative of an outpatient population.

Mazurek et al. Tinnitus annoyance was reduced significantly from A significant reduction in TQ was observed up to 3 years after treatment Seydel et al. In a large randomized clinical trial, a multidisciplinary stepped care approach involving counseling and elements of CBT and tinnitus retraining therapy TRT demonstrated a significant reduction in tinnitus severity from Even though the optimal exposure-response relation between number of hours in treatment and outcome remains unknown Andersson, , the burden for patients and clinicians, as well as the cost-benefit ratio are important Hoare et al.

JITT lasted 5 days with 2 follow-ups, while other authors report up to 2 years of contact with patients e. To describe the heterogeneity of tinnitus patients and in the search for factors related to tinnitus annoyance at T0, we found that patients with the following symptoms displayed higher tinnitus annoyance at the beginning of treatment: dizziness at tinnitus onset, tinnitus sound could not be masked with background noise, tinnitus worsening during physical stress e.

Additionally, higher tinnitus annoyance at the first appointment was correlated with higher age and greater hearing loss and tinnitus loudness only for the right ear. This relation is supported by a series of studies that we will briefly review below. The association between hearing loss and tinnitus corroborates earlier research and is a long standing finding.

Associated Data

Prevalence of hearing loss increases with age Davis, , hearing loss increases the risk for developing tinnitus Hoffman and Reed, , and on a population level there is a linear increase in tinnitus annoyance with increasing age Davis and El Rafaie, ; Andersson et al. Other studies also reported the positive link between higher hearing loss and higher tinnitus distress e. For example, Savastano investigated persons suffering from tinnitus and compared tinnitus patients with and without hearing loss.

Among subjects with normal hearing, the level of disturbance was mostly in the moderate range, whereas among subjects with hearing loss, the level of disturbance was mostly elevated. Savastano concluded that the presence of hearing loss increases the complaint of tinnitus considerably, even if the hearing deficit is not severe. Similarly, the correlation of tinnitus annoyance with otological symptoms reported here corroborates earlier research.

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Hallam and Stephens found that tinnitus patients who complained of dizziness also suffered from higher emotional distress. Both Erlandsson et al. The latter study also confirms our finding that loudness of the tinnitus perceived in the right ear correlated with higher tinnitus annoyance at the first appointment. Thus, the sound perceived in the right ear has a stronger impact on the associated emotional processes. This mechanism is not well understood and should be investigated in future studies. The association between high tinnitus annoyance and poor maskability was also reported in several studies.

Goebel and Hiller reported higher tinnitus annoyance when maskability was poor. Maskability of tinnitus at admission to CBT was a predictor of tinnitus-related distress at a 5-year follow-up Andersson et al. Stobik et al. The relationship between tinnitus and emotional distress or psychiatric problems has long been recognized and is well documented, at least in the help-seeking group Harrop-Griffiths et al.

Sixty-three to seventy-seven percent of tinnitus inpatients have at least one psychiatric diagnosis mostly mood or anxiety disorder; Kaldo, Other psychological causes of distress associated with tinnitus include anxiety, depression, irritability, anger, and insomnia Wilson et al. Belli et al. The most prevalent disorders were anxiety, somatoform and mood disorders.

Depression, sleep disorders and difficulties in concentration were significant predictors of tinnitus annoyance Scott et al. Erlandsson and Hallberg investigated in tinnitus inpatients which factors predict quality of life, and found that impaired concentration, feeling depressed and perceived negative attitudes were the most significant predictors and explained most of the variance in quality of life.

In the study from Langenbach et al. We conclude that our results of predicting tinnitus annoyance corroborate previous results. Taking Jastreboff's neurophysiological model of tinnitus into account, the negative impact of these symptoms on developing tinnitus annoyance is quite obvious. As the frequency of the individually perceived tinnitus is very likely to be in the range with the highest hearing loss Henry et al.

Habituation inhibits tolerance to a stimulus because of its unpredictability. This is possibly why the variability of tinnitus during physical stress attracts attention to the phantom sound, making it difficult to habituate, which in turn leads to higher annoyance. If a person experiences tinnitus onset simultaneously with dizziness, the fear evoked by dizziness will be associated with the noise according to the principles of classical conditioning. Whenever tinnitus is perceived as a danger, no habituation can be achieved.

This risk certainly gets higher, due to the belief that hearing loss or dizziness is caused by tinnitus, which is something that many of our patients reported. In the same direction, emotional distress or psychiatric problems are generally regarded as factors hindering habituation. Inspecting changes in tinnitus annoyance in response to treatment, data from patients with moderate, severe and very severe tinnitus annoyance reached high effect sizes.

But if we consider only a clinically significant change, JITT displays the strongest effects in patients with severe tinnitus grade 3. Although tinnitus annoyance is significantly reduced in patients with very severe tinnitus grade 4 , the 5-day treatment is not sufficient to lead to a clinically significant change in this group. Perhaps this group of patients needs an extended duration of JITT or some other outpatient therapeutic approaches.

Another possibility would be intensive inpatient care, which however removes patients from their daily routine. Demographic, tinnitus and strain variables explained only The 5-day treatment was perhaps too short for this subgroup. It is yet unclear if they would benefit from a longer treatment duration or a combination of treatments as suggested below. Early change has generally proven to be a strong predictor in psychotherapy and CBT in particular Schibbye et al. We did not include this variable in the first regression analysis, because it already requires knowledge about the responsiveness of a patient which was not given at T0.

Nevertheless, it constitutes an early and easy calculable indicator who will respond to treatment and who is more resilient. Providing knowledge about early change to therapists could result in more effective treatment Lambert and Ogles, Measuring early change seems well constituted for psychiatric disorders Schibbye et al. We propose to integrate such measures in clinical settings for tinnitus treatment. Even though the low predictability for treatment success is unsatisfactory, previous studies similarly failed to predict therapy outcome.

Rief et al. Baseline scores of tinnitus annoyance TQ , gender of the patient or comorbidity with mental disorders were not significant predictors of outpatient psychological treatment. Goebel conducted a year follow-up after inpatient tinnitus therapy on tinnitus patients. Noise-induced tinnitus, gender and comorbid psychopathology explained 7. Male tinnitus sufferers as well as patients with noise-induced tinnitus and high psychopathology reported higher tinnitus annoyance 15 years after the treatment.

Consequently, it appears that there is only little agreement on what can predict treatment outcome, but in no study was predictability good. The complexity of these processes was again stressed by Caffier et al. In their study, severely affected tinnitus sufferers showed clear improvements in TQ scores without any age-specific differences. In comparison, the groups of younger and older patients with mild tinnitus severity showed higher reductions in TQ scores in comparison to middle-aged patients between 46 and 56 years.

Regarding preexisting tinnitus duration, patients with mild tinnitus annoyance demonstrated a particularly strong reduction of annoyance when the tinnitus lasted for less than 1 year. In contrast, in severely affected tinnitus sufferers, preexisting tinnitus duration did not seem to play a role for treatment success. Therefore, the next milestone in tinnitus research should be to update large data registries, into which standardized variables can be entered by independent tinnitus researchers. Such a central database will enable the specification of subgroups of tinnitus patients worldwide, making it more possible to develop individually tailored treatments for tinnitus patients.

Due to the lack of a control group receiving a different treatment, we cannot indicate how effective the present approach is compared to other possible treatments or, in the worst case, if it is due to a placebo effect or the mere passing of time. The interdisciplinary treatment comprised several modules, but whether one of them or a specific combination contributed to the reported effects remains to be tested. Future studies might adopt a dismantling approach, leaving out potentially redundant treatment components.

Furthermore, cost-effectiveness studies and equivalence trials should be performed. Therefore, specific treatment approaches adapted to such patients should also be developed. We propose a combination of two therapeutic methods, one addressing tinnitus distress and the other the symptom itself.

As an example for the latter, some evidence was presented that tailor-made notched music training reduces tinnitus loudness Stein et al. Neurophysiological models Jastreboff et al. As an alternative, there are also non-invasive stimulation methods that seem to ameliorate tinnitus symptoms for a recent case study see Richter et al.

Our interdisciplinary day care tinnitus treatment represents a treatment for patients with chronic tinnitus that reduces tinnitus annoyance. After initial interdisciplinary diagnostic procedures and a first brief tinnitus-specific counseling, a small reduction in tinnitus annoyance was found. A clinically relevant change in tinnitus annoyance was observed between the beginning and the end of treatment and remained stable at least for 6 months. The best treatment outcome was reached by patients with moderate and severe tinnitus.

The improvement in tinnitus annoyance in patients with sick leave within 6 months before treatment onset or with very severe tinnitus annoyance was smaller than for the rest of the investigated population. Given the high heterogeneity of tinnitus, we predict that the development of adapted JITT to individual needs will be challenging. Additional measurements of neurophysiological correlates might help in understanding which aspects of the symptomatology and the underlying neural network undergo changes in response to treatment and which do not.

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DI: Substantial contributions to the conception and design of the work; the acquisition, analysis and interpretation of data for the work; drafting the work and revising it critically for important intellectual content. Wrote the manuscript. CD: Contribution to the analysis and interpretation of data; drafting the work and revising it critically for important intellectual content. GV, BM and DR: Substantial contributions to the acquisition and interpretation of data for the work; revising the work critically for important intellectual content.

US: Substantial contributions to the conception of the work; revising the work critically for important intellectual content. OG: Substantial contributions to the conception and design of the work; the acquisition, analysis and interpretation of data for the work; revising the work critically for important intellectual content. All authors gave their final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors would like to thank Marlen Hagemann for the support in acquisition of data and Holger Pickel for organizing the database. Abbott, J. A cluster randomized trial of an Internet-based intervention program for tinnitus distress in an industrial setting.

Abel, M. Muscle contractions and auditory perception in tinnitus patients and nonclinical subjects. Cranio 22, — Clinical Practice Guideline: Tinnitus. PubMed Abstract. Andersson, G. Psychological aspects of tinnitus and the application of cognitive—behavioral therapy. Tinnitus: A Multidisciplinary Approach. London: Whurr. Google Scholar.

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Patientin mit Tinnitus, Vertigo, Polyarthralgien - PDF Free Download

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Tinnitus Experte Dr. Greuel: Es gibt nur eine einzige Ursache für Tinnitus

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Erlandsson, S. Prediction of quality of life in patients with tinnitus. Psychological and audiological correlates of perceived tinnitus severity.

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Audiology 31, — Evans, C. Health 9, — Fabijanska, A. Berlin: International tinnitus seminar. Feldmann, H. Frenzel, A. Herdecke: GCA-Verl. Funk, C. Unpublished manual. Galazyuk, A. Tinnitus and underlying brain mechanisms. Goebel, F. Goebel, G. Oto Rhino Laryngologia Nova 5, — Therapie des chronischen Tinnitus. When tinnitus loudness and annoyance are discrepant: audiological characteristics and psychological profile.

Gulliver, A. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry Hall, D. Heidelberg neuro-music therapy for chronic-tonal tinnitus - treatment outline and psychometric evaluation. Tinnitus J. Hall, J. Hallam, R. Manual of the Tinnitus Questionnaire TQ. London: Psychological Corporation. Rachman Oxford: Pergamon Press , 31— Vestibular disorder and emotional distress.

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Hausotter, W. Neurologische und psychosomatische Aspekte bei der Begutachtung des Tinnitus. Hennig, T. Recognition of speech of normal-hearing individuals with Tinnitus and Hyperacusis. Henry, A. Henry, J. General review of tinnitus: prevalence, mechanisms, effects and management. Speech Lang. The psychological management of tinnitus: comparison of a combined cognitive educational program, education alone and a waiting-list control. PubMed Abstract Google Scholar. Hesse, G. Musiktherapie bei Tinnitus. HNO 55, — CrossRef Full Text. Hesser, H. A randomized controlled trial of Internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus.

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Jastreboff, P. Neurophysiological approach to tinnitus patients. Kaldo, V. Dissertation, Uppsala Universitet, Uppsala. Internet-based cognitive behaviour therapy for tinnitus patients delivered in a regular clinical setting: outcome and analysis of treatment dropout. Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: a randomized controlled trial. Koffmann, A. Has growth mixture modeling improved our understanding of how early change predicts psychotherapy outcome?

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Cognitive behavioural therapy for tinnitus Review : an update. Cochrane Database Syst.