The Tinnitus Clinical Practice Guidelines were first published in Japan in May 2019. The guideline provides guidance based on evidence, and recommends cognitive behavioral therapy (CBT) for which strong evidence has been accumulated. However, in Japan, while CBT is used for the treatment of conditions such as depression, it is rarely used yet for tinnitus.

　　One of the reasons why CBT for tinnitus has not yet been implemented in Japan may be due to differences among therapists of tinnitus. In other countries, psychiatrists treat tinnitus. Furthermore However, there are still only a few doctors in the field of psychiatry in Japan who can use CBT, and CBT recognized by insurance only includes indications such as depression, anxiety disorder, panic disorder, post-traumatic stress disorder, etc. At present, CBT is gaining more attention, and we hope that CBT for tinnitus will be implemented in the near future in Japan.

　　Much of the difficulty associated with chronic tinnitus is due to the inability of the patients to distract the mind away from the tinnitus. If tinnitus causes anxiety, it shall inevitably draw attention. When the stress responses resulting from anxiety become associated with tinnitus through classical conditioning, tinnitus itself would pose a threat. However, diverting attention away from tinnitus would remove the stress responses. The effectiveness of Cognitive Behavioral Therapy (CBT) has been shown for patients with tinnitus. In recent years, mindfulness-based CBT has gained momentum in clinical practice.“Mindfulness” is a state wherein the person pays attention exclusively to events that are taking place “here and now.” Tinnitus patients are instructed to direct their attention to their own natural breathing, and if they are distracted by the tinnitus or other thoughts, to return their attention to the breathing as soon as possible. If done successfully, they will learn to perceive the tinnitus, but without the suffering, and obtain the insight that they can manage tinnitus with attention control. Once it is understood that tinnitus can be managed by the patients themselves in combination with sound therapy, often, no further visits to the clinic are required.

　　This survey was conducted to clarify the prevalence of frailty and the characteristics of frailty in elderly hearing-impaired patients, using a questionnaire (KCL: Kihon Check List). A total of 117 patients over the age of 60 years who visited our ENT department seeking hearing aids were included.

　　The prevalence of frailty among the subjects, excluding those who had been certified as requiring long-term care, was 26.5%. The total percentage of patients who were classified under the categories of pre-frailty, frailty, and long-term care was about 60%, and less than about 40% of patients were classified in the category of robust status. In the examination by the hearing level, a significant correlation was observed between the average total score on the KCL and the degree of hearing loss, although this correlation was no longer seen after the results were adjusted for age. The proportion of patients with KCL≧8 points, including those classified as requiring long-term care, increased as the hearing loss progressed. No significant correlation was observed between the percentage of patients classified as having cognitive function decline and the degree of hearing loss. On the other hand, the proportion of patients classified as having physical function decline and housebound increased significantly as the degree of hearing loss increased.

　　About a half of the elderly patients seeking hearing aids were classified under the categories of frailty and pre-frailty, suggesting that this group is a target group for efforts to prevent long-term care.

　　We surveyed the teachers in early interventions and preschools for hearing-impaired infants (2-5 years old) at Special Needs Education Schools for the Deaf, to determine the status of language development and education of hearing-impaired infants and the current situation and issues related to the parents' involvement. Based on the responses obtained from 258 teachers from 64 of the 99 schools surveyed (response rate 64.6%), the data of 984 hearing-impaired infants were examined.

　　The results revealed an incidence of mild-to-moderate hearing loss of 28.1%, and of severe-to-profound hearing loss of 71.9%. Of the children with profound hearing loss, 69.4% had cochlear implants. Among the hearing-impaired children, 24.1% had other developmental disabilities. In all, 75.2% of the Special Needs Education Schools for the Deaf used both auditory oral and sign language method simultaneously.

　　In regard to the language development status of the hearing-impaired infants, 69.4% of 2-year-old children showed a language development age of under 1 to 1 year; 44.9% of 3- to 5-year-old children and only 65.5% of 5-year-old children showed a language development age of 4 to 5 years. In regard to the instructions provided to the parents to facilitate transition of their children to the next language development age, the teachers set 2- to 3-year tasks (imitation induction and utterance correction) for 55.3% of children with a language development age of under 1 to 1 year, and 4- to 5-year tasks (expansion of vocabulary, explanation of word meaning) for 84.3% of children with a language development age of 4 to 5 years.

　　 Factors related to the language development level of the hearing-impaired infants were the preschool age, years of teaching experience of the teachers, and appropriate goal setting for parents. Therefore, this study suggests the importance of improving expertise and accumulating practices for individualized instruction development, and the importance of the parents' involvement.

　　In this study, we examined the effect of age at the start of intervention in children using hearing aids (HAs), and also the effect of age at the start of intervention and the effect of age at cochlear implantation in children using cochlear implants (CIs). All these children had profound hearing loss of 90dB or over and had received the same educational program using the auditory-verbal/oral method. We assessed their language ability using the WPPSI Intelligence Test at 6 years of age. Statistical analysis showed that the Verbal IQ (VIQ) scores of children using HAs who started the intervention at 11 months of age (average) were significantly higher than those of the children using HAs who started the intervention at 2 years of age. The VIQ scores of children who started the intervention at 11 months of age and received CIs at 2 years of age were significantly higher than the VIQ scores of children who started the intervention at 2 years of age and received CIs at 3 years of age. These results demonstrated a significant effect of early intervention and early cochlear implantation in children with profound hearing loss of 90dB or over.

　　Medical treatment for tinnitus in contemporary Japan has evolved based on TRT (Tinnitus Retraining Therapy). We think there are two main challenges to TRT:

　　1) In many cases, acoustic therapy for silence avoidance at night cannot reduce the distress unless concrete proposals.

　　2) While hearing aids are highly effective for tinnitus patients with hearing impairment, they are not easy to use.

　　Our treatment for tinnitus is focused on gradual counseling for proper implementation of acoustic therapy (mainly night silence avoidance and hearing aids), as well as concrete methods for acoustic therapy.

　　We considered the effects of our treatment for tinnitus, and the problems associated with the treatment. We examined the effects of our therapy using the THI (Tinnitus Handicap Inventory) score in 66 patients with tinnitus.

　　The mean score on the THI decreased significantly from the first ENT consultation to the first visit to the tinnitus outpatient department, from the first visit to the tinnitus outpatient department to one month later, and from one month to three months after the first visit. The proportion of patients with “severe handicap” (58-100 scores) decreased from 48.5% at the first consultation to 4.5% after 6 months of treatment.

　　The THI scores improved in 50 (75.8%) of the 66 patients studied, especially in 26 (81.3%) of the 32 patients with severe handicap. We think that mainly the acoustic therapy for silence avoidance at night and the hearing aids were effective.

　　 I feel that cooperation between doctor and speech therapist is the key to successful treatment of tinnitus.