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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tinnitus is not a single entity but a rather diverse group of disorders. Despite symptoms that indicate the ear is the site of the pathology, there is strong evidence that most forms of severe tinnitus are caused by functional changes in the central nervous system. The changes are induced through expression of neural plasticity, some of which may have been caused initially by abnormalities in the ear or the auditory nerve. The involvement of the nonclassical ascending auditory pathway with its subcortical connections to limbic structures (the amygdala) may explain some of the symptoms of some forms of tinnitus including hyperacusis and affective disorders, such as phonophobia and depression, which often accompany severe tinnitus.
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PMID:Pathophysiology of tinnitus. 1285 95

A 50-year-old African American woman presented with bilateral lower extremity pain, a history of falls during the past several months, and personality and behavior changes. She had been in good health until approximately 5 months before admission, when she began to fall with increasing frequency, often while going down a flight of stairs. She described these falls as her "legs giving out" and feeling very heavy and unsteady. There was no head trauma or loss of consciousness. Her daughter noticed that her gait had become somewhat unsteady during the last several months. Her family also noted a change in her personality at this time. Previously, she had been a very tidy person who took great care with her appearance, who was working as a customer service representative. However, she had become less social and very withdrawn. She had been observed putting on dirty clothes after showering, as well as eating constantly. The patient denied any fevers, chills, night sweats, headaches, vision changes, or tinnitus. She also denied any rashes, muscle pain, or intolerance to heat or cold. There was no history of seizure disorder or depression. Her past medical history was notable only for hypertension and being a passenger in a motor vehicle crash 1 year before admission. She denied any alcohol, tobacco, or illicit drug use, and had no travel history other than coming to the United States, as she was originally from Trinidad. On physical examination, she was a moderately obese African American woman with a flat affect, psychomotor slowing, and alopecia of the scalp. She was alert and oriented to person, place, and time, but had a score of 26 out of 30 on the Mini-Mental State Examination. She lost points only for recall; she had no difficulty with serial 7s. Her cranial nerves were intact and her speech was fluent, although sparse, and she did not make any paraphasic errors. Her muscle strength was 5/5 in both the upper and lower extremities. Reflexes were 2+ in the upper extremities and 1+ in the lower extremities, and toes were downgoing bilaterally. She had intact sensation to light touch and pinprick, but markedly diminished proprioception of her lower extremities bilaterally. She had a wide-based gait with a positive Romberg sign and was markedly ataxic. Rectal examination yielded a positive guaiac test with brown stool, normal tone, and no masses. The remainder of the physical examination was normal. Laboratory studies revealed pancytopenia with a hematocrit of 22.7% and a mean corpuscular volume of 118.2 fL. A peripheral smear that was performed on admission, prior to transfusion, revealed macrocytic red cells and hypersegmented neutrophils.
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PMID:Cases from the Osler Medical Service at Johns Hopkins University. 1465 20

As regards the symptom of a predominantly central tinnitus of the severe, disabling type, it has been hypothesized that a deficiency in the benzodiazepine receptor exists in the medial temporal lobe system of brain and is directly related to affect impairments including anxiety, stress, depression, and fear. This hypothesis has been investigated with single-photon emission computed tomography using the benzodiazepine radioligand 123I Iomazenil. Visual analysis revealed preliminary results of diminished benzodiazepine-binding sites in the medial temporal cortex of all patients with severe tinnitus (N = 6), a finding that is consistent with the hypothesis implicating GABAergic mechanisms in the pathophysiology of the disorder. An abnormal gamma-aminobutyric acid--A benzodiazepine receptor density may be an objective neurochemical measure of the severity of a central-type tinnitus and a rationale for treatment. Clinical correlation with the history, clinical course of the patient, and stress questionnaire are presented.
Int Tinnitus J 2000
PMID:Benzodiazepine receptor deficiency and tinnitus. 1468 26

Ginkgo biloba extracts (EGb) are well-defined plant extracts. It has several indications as dementia, macula degeneration, tinnitus and winter depression. A review of the current and past literature about older people with Alzheimer's dementia or vascular dementia or age-associated memory impairment treated with Ginkgo biloba extract, reveals that EGb has reproducible effects on cognitive functions in Alzheimer's disease. The drug is well tolerated.
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PMID:Review about Ginkgo biloba special extract EGb 761 (Ginkgo). 1475 86

We carried out a retrospective survey of 25 years of clinical experience with the use of clonazepam as a vestibular and tinnitus suppressant in the pharmacological treatment of vestibular or cochleovestibular disorders due to different causes. We reviewed the medical records of 3,357 outpatients treated with a 0.5 or 1.0-mg daily dosage of oral clonazepam during 60-180 days. Complete or substantial control of vertigo or nonvertiginous dizziness was achieved in 77.4% of the vertigo patients. Tinnitus was improved in 32.0% of the tinnitus patients. Light or mild drowsiness, depression, nightmares, or lowering of libido, reported by 16.9% of the patients as adverse side effects, tended to subside with continued therapy. We concluded that clonazepam is a very useful and safe drug for the symptomatic treatment of patients suffering from cochleovestibular disorders.
Int Tinnitus J 2002
PMID:Clonazepam in the pharmacological treatment of vertigo and tinnitus. 1476 36

This reports recommends the consideration of development of additional outcome measures to be used as a battery of subjective self-assessment questionnaires for patients with tinnitus. The goal is improved overall care for the tinnitus patient. Five existing outcome measurements have been incorporated into this profile, which is called the tinnitus outcome profile: the tinnitus intensity index, the tinnitus annoyance index, the tinnitus stress test, the tinnitus handicap inventory, and the measurement of depression scale. Frequently, there is an inconsistency between the self-report outcomes and the patient's subjective report to the doctor. This study reports outcomes based on the tinnitus outcome profile for 19 patients who were seen for evaluation and treatment of subjective idiopathic tinnitus of the severe disabling type and who completed a treatment protocol called receptor-targeted therapy directed to the GABAA receptor. The drugs used were gabapentin and clonazepam. Using the 0.05 significance level, the tinnitus intensity index, tinnitus annoyance index, and tinnitus stress test scores all declined significantly over time. In contrast, there was no significant change in either the tinnitus handicap inventory or the measurement of depression scale. The percent of tinnitus control reported to the doctor by the patient did not appear to be correlated with the degree of change measured on the tinnitus outcome profile.
Int Tinnitus J 2003
PMID:Tinnitus outcome profile and tinnitus control. 1476 26

We sought to ascertain the importance of psychological manifestations of vertigo and psychogenic vertigo among a Portuguese population. Sixty patients complaining of vertigo and imbalance were studied over a 2-year period. At each assessment, the patients underwent a general examination, a neurootological evaluation, psychiatric interviews, and psychopathological assessments conducted by a multidisciplinary team. Overall, 38 patients (63.4%) were given diagnoses of some form of psychopathological complaint. A more detailed analysis revealed panic disorder in 9, moderate depressive episode in 42, and mixed anxiety and depressive disorder in 7, whereas the remaining patients (2) suffered from subclinical symptoms of anxiety or depression. Patients with vertigo demonstrate a high incidence of psychopathological complaints, the most common being anxiety disorders. Somatization, obsessive-compulsive behaviors, and depression tend to lessen over time, whereas few changes are seen in anxiety.
Int Tinnitus J 2003
PMID:Psychological manifestations of vertigo: a pilot prospective observational study in a Portuguese population. 1476 29

Tinnitus is an otological symptom that is encountered often, yet its treatment is difficult. If tinnitus is of cochlear origin, a reasonable assumption is that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic infusion of a local anesthetic (4% lidocaine) to anesthetize the inner ear was conducted in a patient suffering from tinnitus. Transtympanic infusion of 4% lidocaine was performed as a treatment for cochlear tinnitus, and its efficacy was investigated. The overall efficacy rate for the 292 patients with 369 affected ears was 81%. In the investigation of the treatment results in cases of different underlying ear diseases, the efficacy rate was high for tinnitus accompanying sudden deafness and labyrinthine vertigo. However, vestibular symptoms, such as vertigo and nausea, developed after lidocaine infusion. No permanent side effects were noted. Lidocaine infusion is thought to be a useful treatment option for tinnitus and should be considered before surgical treatment. Inner ear anesthesia into the tympanic cavity has been carried out in patients who had cochlear tinnitus and in whom conservative methods of therapy, such as oral medication, had proved unsuccessful. This treatment method is useful as a local therapy for cochlear tinnitus.
Int Tinnitus J 2001
PMID:Treatment of cochlear tinnitus with transtympanic infusion of 4% lidocaine into the tympanic cavity. 1496 56

Depression is often coincident with chronic tinnitus, and several studies have suggested that antidepressant medications may play a role in relieving tinnitus as well as depression. We conducted a retrospective study of the use of selective serotonin reuptake inhibitors (SSRIs) by patients at a large tinnitus clinic to assess the effects of these antidepressants on tinnitus severity. We focused on a subgroup of 30 patients with depression who had begun taking SSRI medication after the onset of their tinnitus; these patients had also been treated with psychotherapy by a mental health clinician. At a mean follow-up of 20.6 months, only 10 of the 30 patients reported that they were still experiencing major depression. Moreover, this group as a whole demonstrated a statistically significant improvement in tinnitus symptoms as reflected by a reduction in their Tinnitus Severity Index scores. We conclude that SSRIs represent one category of tools that can be used to help patients with severe tinnitus and depression. Like all antidepressant medications, SSRIs should be used in conjunction with psychotherapy to facilitate patient improvement.
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PMID:SSRI use by tinnitus patients: interactions between depression and tinnitus severity. 1500 44

Twenty percent of people endure tinnitus to a degree that their quality of well-being and productivity in life are impaired, and up to 60% report depression. Four measures are widely used to assess tinnitus-related distress, yet the relationship among all four measures or their relationship to relevant psychiatric variables has yet to be studied. This study assessed the association between the four commonly used measures of tinnitus and their relationship to depressive symptoms, quality of well-being, and internal focus. Sixty-five people with tinnitus completed the following measures: Iowa Tinnitus Handicap Questionnaire (THQ); Tinnitus Reaction Questionnaire (TRQ); Tinnitus Handicap Inventory (THI); Tinnitus Questionnaire (TQ); Hamilton Rating Scale for Depression (HRSD); Beck Depression Inventory (BDI); Quality of Well-Being Scale (QWBS); Modified Somatic Perception Questionnaire (MSPQ); and Private Self-Consciousness Scale (PSCS). All the tinnitus measures were highly intercorrelated (r = .76-.90; all p values < .001), and related to depressive symptoms (r = .48-.66; p < .001) and QWBS (r = .37-.48; all p values < 0.008). The tinnitus measures correlated with the MSPQ (r = .37-.52; all p values < .01) but not with the PSCS. When controlling for the shared variance between tinnitus measures, the THQ independently predicted the HRSD, whereas the TRQ independently predicted the BDI.
Int Tinnitus J 2003
PMID:Relationship of tinnitus questionnaires to depressive symptoms, quality of well-being, and internal focus. 1510 82


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