Tinnitus Retraining Therapy is one approach for habituation of tinnitus. It is logically based on the neurophysiological model described Jastreboff (1990). Since 1999, 107 patients (Male 43, Female 64) have been seen at Department of Otolaryngology, Nagoya City University, School of Medicine and Sekiya Otolaryngology Clinic. We evaluated changes of tinnitus by questionnaire, visual analogue scale (VAS), tinnitus handicap inventory (THI), aimed at the evaluation of tinnitus on patients lives, and the level of tinnitus induced annoyance. Our data indicate significant improvement in about 90% of patients who followed for over 1 year. These results suggested that TRT was highly effective for tinnitus in Japanese patients.
A one-month-old male infant was diagnosed as Joubert syndrome. Before birth, agenesis of cerebellar vermis was found by magnetic resonance imaging. After birth, abnormal respiration and eye movement were observed. The infant was referred to our department for hearing examination, because hearing disturbance was suspected by screening automated auditory brain stem response (AABR). The behavioral observation audiometry test showed a positive response to only big sounds. Conditioned orientation response could not be performed because of systemic myopathy. ABR was performed at the age of 4-months under sedated condition. The ABR wave showed bilateral prolonged I-III inter peak latency, indicating impaired synchronization of nerve firing caused by brain stem malfunction. These results suggest that screening hearing test using AABR is not useful in a patient with brain stem malfunction.
The present study assessed the clinical application of Tinnitus Handicap Inventory (THI) translated into Japanese in order to evaluate tinnitus annoyance and difficulty in activities in daily life. Subjects were 182 tinnitus patients (male 88, female 94) who completed the THI and the standardized tinnitus test promoted by the Tinnitus Study Group in 1993. These questionnaires were completed in 34 subjects also after various therapies. The results showed that the THI score was related to sleep disturbance and 5-point subjective scales for tinnitus loudness and tinnitus annoyance, although no significant correlation was found between the THI score and tinnitus loudness level or minimal masking level (dBSL). From these results, we conclude that the THI score may be useful to estimate tinnitus annoyance quantitatively, and difficulty in activities of daily life. The THI will be available as a clinical indicator of tinnitus and useful to evaluate a therapeutic effect.
The air-bag system has reduced the number of fatal injuries during motor vehicle accidents. However, it is reported that the air-bag deployment unfortunately has induced new spectrum of injuries. The air-bag inflation may produce intense (150-170dB) pressure wave. We present a 64-year-old male with acute unilateral sensorineural hearing loss following air-bag deployment. His audiogram showed mid-frequency hearing loss in the left ear. The other audiometric tests such as ABLB test, DPOAE, ECochG and ABRs indicate cochlear deafness. After the medication including steroids, no improvement was seen in his hearing. We should know that the air-bag deployment might cause the permanent deafness.
Dipoles of SVR were compared using monotonous stimulation and the vowel sound of “a”. Twelve adult healthy volunteers were examined and the positive component found in latency 150-200msec was analyzed by Dipole Tracing Methods. Monotonous stimulation resulted in dipole to locate around the midlobe to the temporal lobe of the contra-lateral side, whereas vowel sound “a” stimulation resulted in dipole to be expressed around the left temporal lobe, regardless to the side of stimulation.
The Self-Assessment Scale for Japanese hearing impaired was administered to 239 cases with hearing aids and 155 without hearing aids, and the result was analyzed. The scores of the 3 subscales; speech perception under a favorable listening condition, speech perception under an unfavorable listening condition and environmental sound recognition, appeared to reflect the hearing level of the cases, and to indicate that hearing aids were useful for alleviating hearing disability. The scores of those 2 subscales on speech perception revealed that those cases with mild hearing loss were more susceptible to unfavorable listening conditions than those with severe hearing loss. On the other hand, the scores of the other 3 subscales; behavioral reaction, emotional reaction and communication strategy, were less correlative to the hearing level and other attributes. Further studies must be required to disclose other possible factors affecting those subscales. It was considered that aural rehabilitation programs including counseling and communication trainings would be useful to improve those problems.
Functional magnetic resonance imaging (fMRI) is a new non-invasive resource to examine the cerebral function. We studied the activation of the central auditory cortex using pure-tone and Japanese word stimuli in the right-handed normal hearing volunteers. For 1000Hz puretone, hearing threshold was examined under the presence of the background scanner noise. The intensity of the examined stimuli was 40dB above the threshold (40dBSL). The stimuli were delivered to each ear separately through the tubes with a diameter of 3mm which lead the stimuli from the transducer to the ear. Special earmuffs were attached to the tube. Activated pixels were identified using the linear cross correlation program. By optimizing the correlation coefficient threshold, the data obtained with the functional MRI technique were evaluated by observing the increase of signal intensity for each pixel in response to the task. Activation was present in the superior temporal gyrus and the transverse temporal gyrus during pure-tone. And the Japanese word task activated the superior temporal gyrus and the middle temporal gyrus.