Tinnitus has been evaluated according to the pitch (Hz) and loudness (dB) of tinnitus sounds or subjective expression of tinnitus sounds heard by the patients. The latter is usually expressed by onomatopoeic simulation of the timbre felt by the patients. Few systematic studies on this method have been carried out. These methods of evaluation of tinnitus have not been sufficiently utilized in the clinical field. The purpose of the present study is to focus attention on onomatopoeia. Based on the structural factors representing the background of the onomatopoeic expression, systematic consolidation and the objective evaluation of the subjective tinnitus by the use of onomatopoeia were attempted. For these purposes, a scale for evaluation of the tones of tinnitus by means of onomatopoeia was introduced, and the experiments on the evaluation of the timbre quality was also conducted. On the basis of the values observed in this experiment, a correlation matrix was obtained among various onomatopoeia for factor analysis by the main factor method, and the onomatopoeic expressions were systematically arranged and grouped. As a result, 33 representative onomatopoeia were chosen. When a patient with tinnitus expresses the timbre of his own tinnitus, he could choose an adequate onomatopoeia from among the 33 representative ones. It will then be possible to provide the objectivity to the onomatopoeia of tinnitus sounds complained by the patient.
In order to estimate the clinical values of loudness balance test by pure tone audiometer as the objective method for evaluating tinnitus and to find out how we can use this method in the future, the results of loudness balance test in 168 cases who complained of the unilateral tinnitus were analyzed and presented in this study. Furthermore, in order to differentiate the tinnitus associated with endolymphatic hydrops and that of other causes, and to confirm the consistency and repeatability of the result of the loudness balance test by pure tone audiometer, the loudness balance test was coducted before and after the oral administration of glycerol (glycerol loading tinnitus balance test). This test was performed in 44 confirmed cases of Meniere's disease and 10 sensorineural hearing loss without fluctuation for a long duration. It was concluded that although by the loundness balance test with a pure tone audiometer the exact pitch of the tinnitus is not determined, many informations about the tinnitus can be given. Also since there is no significant difference between the pitch of the tinnitus obtained by pure tone audiometer and that by Bekesy audiometer in most cases, and the loudness balance test by pure tone audiometer is the easiest way to evaluate tinnitus clinically this method has the meaningful and clinical value to evaluate the tinnitus objectively. After the glycerol administration several changes in the pitch and loudness of the tinnitus with or without changes of hearing were found in cases of Meniere's disease, but not in the sensorineural hearing loss without fluctuation. The glycerol loading tinnitus balance test can be a good tool to differentiate the tinnitus associated with endolymphatic hydrops from that of the other causes, and therefore this test will be useful in the future as a new tinnitus test.
Fine pitch match test for subjective tinnitus in 44 patients was performed by using Békésy type audiometer. First, the pitch of tinnitus was examined roughly by conventional pitch match technique at seven frequencies by pure tone audiometer, and then fine pitch was determined by pure tone stimulus with 10dB above threshold over the full range by Békésy type audiometer between one octave higher and lower in the frequencies already examined. The tinnitus of 33 out of 44 patients seemed to be consisted of pure tones and in the other 11 patients tinnitus did not match to pure tone. Most patients with high tone loss had a tinnitus of pure tone or alike. And most patients who had suffered from hearing impairment of sensory type, especially hair cell lesion, showed pure tone like tinnitus. However fine pitch match test by pure tone was failed in patients of acoustic tumor or presbycusis. These patients noted that their tinnitus was similar to white noise or band-noise. In the cases having tinnitus without hearing impairment in conventional audiogram, it was concluded that there were the patients with tinnitus similar to pure tone and hearing impairment only over 8000Hz on Békésy audiogram, and the patients with white noise like tinnitus and normal audiogram.
In order to clarify the mechanism of residual inhibition (RI), the influence of the method of masking, quality of tinnitus, and other factors on the incidence of RI were studied in 111 patients suffering from tinnitus. The incidence of RI was most influenced by the pitch of tinnitus, and was significantly higher in tonal tinnitus of 4kHz than in other tonal tinnitus. In 17 normal subjects, loudness change in the simulative sound of tinnitus after the cessation of masking were also measured. Temporary suppression of the simulative sound (simulative RI) was again observed. Dependence of RI and simulative RI on the method of masking, and quality of tinnitus or its simulative sound were similar to each other, suggesting that these are essentially the same phenomena. These phenomena might be explained by the short term TTS which is reported to originate from the neural adaptation of the auditory pathway.
A hundred and three ears with tinnitus were examined neurotologically and tinnitus matching tests were carefully carried out using tinnitus sythesizer (Norwest Acoustics SG-1). Then the residual inhibition (RI) was checked with one minute masking test of Vernon. RI was detected in 67% of the ears with tinnitus, and their durations were widely distributed from 3 seconds to over 2 hours, although 78% of them were within 1 minute. No correlation was observed between the “loudness of tinnitus” and the RI duration, nor between the hearing level at the tinnitus frequency and the RI duration. Mean age of the RI positive patients was 54.0 years, which was considerably higher than that of RI negative patients (47.2 years). The great majority of the RI positive patients had high frequency (>2kHz) tonal tinnitus. Further additional work seemed to be necessary to make the RI test one of the standard tests of tinnitus.
The results of survey of tinnitus in hearing impaired children of primary and junior high school pupils in Yokohama City are reported. The questionaires were obtained from teachers of 6 special classes for training of the hearing impaired pupils. 58 children with 75dB of the mean hearing level in the primary (6 to 12-year-old) and the jounior high (12 to 15-year-old) schools were inquired about tinnitus. In a sample of the children aged 6 to 8, tinnitus was found in only one patient because of the difficulty to make them understand about tinnitus. In the other sample, 11 patients with tinnitus (31%) were found. Among the 12 cases, only 2 cases had constant tinnitus and the remainder had intermittent tinnitus. Tinnitus were expressed as /pi:/ by 8 cases. Many children claimed the tinnitus was annoying.
349 patients with tinnitus were studied. The incidence of tinnitus incresed with age, and the greatest number was the sixth decade. Sex dintribution was approximately equal between both sexes. High-tone tinnitus was found in 140 ears (55.4%), and the most tinnitus was less than 10dB in its intensity. The acupuncture was effective in 59% to allaviate tinnitus.
Tinnitus is an otological symptom which is often encountered and is yet difficult to treat. Transtympanic anesthesia with 1ml of 4% Lidocaine was performed in 86 patients (119 ears) suffering from cochlear tinninus. The results are summarized as follows: 1) Tinnitus was completely abolished or considerably ameliorated in 37 ears (31%) 2) Tinnitus was moderately ameliorated in 52 ears (44%) 3) Tinnitus was slightly ameliorated in 30 ears (25%) Consequently, we found the therapeutic effectiveness of the transtympanic anesthesia in 75% of our cases. It is not elucidated whether the therapeutic effect of the transtympanic anesthesia was attributed to anesthetic blockade of the tympanic plexus or the inhibition of cochlear cell activity. However, it is undeniable that the transtympanic anesthesia has a remarkable therapeutic effect to tinnitus without any significant side effects. It is hoped that this therapeutic method would be used more often for the patients suffering from tinnitus.
Tinnitus is an otological symptom which is often encountered but yet difficult to treat. If tinnitus is of cochlear origin then it seems reasonable to assume that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic injections of dexamesasone were conducted in patients suffering from tinnitus. One hundred and nine patients (138ears) with tinnitus were included in this study. Dexamesasone was applied to the middle ear cavity by transtympanic injections. Our results are summarized as follows: 1) In 87 ears, tinnitus was abolished 2) In 39 ears, tinnitus was considerably ameliorated 3) In 14 ears, tinnitus was slightly ameliorated or no effect.
Tinnitus matching was performed in 24 patients with various types of etiology using a commercially available music synthesizer. Pure tone tinnitus was synthesized either by sine or pulse wave. In some cases, tinnitus was matched by band noise, but its band width varied considerably among individuals. In 17 out of 24 cases, tinnitus disappeared or decreased after masking by the synthesizer. Masking was the most effective when the tinnitus was high-pitched pure tone, and had small loudness and low masking level. In contrast, tinnitus of pulsating nature showed no effect of synthesizer masking.