This report is a clinical statistical observation of tinnitus gathered from the 9 main otolaryngological departments in Japan. A total of 34, 717 patients visiting these 9 departments were analyzed. The incidence of tinnitus was 7.3%. Bilateral tinnitus cases were seen 2. 4 times as much as unilateral tinnitus cases. In Iwate Medical University 5, 271 patients were analyzed and the results are as follows. The incidence of tinnitus was 10. 1 % and cases with bilateral tinnitus were seen 3 times as much as unilateral tinnitus cases. The chief complaint in 39.7% of the 532 cases was tinnitus. The others were all complaints concerned with other otological symptoms. In the case with hearing disturbances, tinnitus was usually accompanied with sensorineural hearing loss and was found to a high degree in cases of sudden deafness, Meniere's disease and cochlear neuronitis. A lot of the cases complained of hearing a sound they called kee-n, therefore we thought the foundamental sound of tinnitus was this sound.

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Pitch match test was performed to forty-three patients with various kind of tinnitus. Thirty-three cases out of 43 determined to have pure tone like tinnitus. From the results of pitch match test on these cases, some pathogenesis of tinnitus were discussed on the cases having hair cell damage.

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By refering to literatures the author pointed out that some patients who had hearing loss caused by retrocochlear lesions and had no cochlear impairment complain of tinnitus. This is often called central tinnitus. According to the knowledge obtained from the literatures the auditory characteristic features of central tinnitus are speculated as follows. 1) Though some central tinnitus can be easily masked by sound in the contralateral ear, some cannot be masked even by loud sound in the ipsilateral ear. 2) Some central tinnitus cannot be abolished by lignocain which filled up the tympanic cavity and permeated into the cochlea by aids of an iontophoresis technique. 3) Some central tinnitus cannot be suppressed by electrical stimulation of the ear with the round window electrode. However, these speculations have not been confirmed on the cases with hearing loss caused by retrocochlear lesions.

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Statistical observation was performed for the subjects complaining of tinnitus who consulted the department of otolaryngology of Kanazawa Medical University during the past three years. Problems in evaluation of tinnitus are also discussed. The results are as follows; 1) Tinnitus was a complaint in 8.18% of the patients who consulted the department of otolaryngology. With respect to the ages, these percentages were 0.36% for the patients younger than ten years, 5.60% for the teens, 6.17% for the 20s, 8.88% for the 30s, 12.07% for the 40s, 17.70 96 for the 50s, 18.04 96 for the 60s and 17.23% for those over the 70s. 2) The incidence of tinnitus was 27.6% of the patients with hearing loss. Among the patients with sensorineural hearing loss, the incidence was relatively high in sudden deafness (90%), Meniere's disease (90%), CP angle tumor (86 96), acute low-fre-quency sensorineural hearing loss (71%) and acoustic trauma (56.6%), and relatively low in presbyacusis (25.8%). Conductive hearing loss due to otosclerosis (50%), traumatic eardrum perforation (34%) and impacted cerumen (34%) were acompanied by tinnitus relatively frequently. 3) It is important to examine the subjective expression, pitch match, loudness balance, masking and residual inhibition in the clinical evaluation of tinnitus. The results of these examinations are in other papers.

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We investigated 478 ears with tinnitus and sensorineural deafness and tinnitus without hearing loss. The relationship of type of deafness with tone, intensity, and frequency of tinnitus were studied. 1) In many cases, tinnitus was found in either the low-frequency range or the high-frequency range. 2) Patients were asked to describe their tinnitus using vowel sounds. In most cases, the low frequency range was described with the vowels (u) or (o), the middle frequency with (a), and the high frequency with (i). 3) Many patients described their tinnitus as a pure tone. 4) The intensity of tinnitus was usually within 10 dB H. L. 5) Patients with sensorineural deafness expressed their high frequency tinnitus as an (i) sound. The frequency of the tinnitus corresponded well with the frequency of their maximum hearing loss. 6) Patients with sudden deafness had hearing loss in the middle frequency range, and the tinnitus was described as an (a) sound. The frequency of the tinnitus and the frequency of the maximum hearing loss did not match well. 7) In many cases, patients with tinnitus but without hearing loss described their tinnitus as either high or low frequency. Various vowels were chosen to describe their tinnitus.

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Tinnitus, an abnormality of auditory sensation, is a frequently encountered complaint in daily clinical work. The patients of tinnitus in Japan are usually trying to complain it by expressing with using onomatopoeia. Onomatopoeia are characteristic to Japanese language and are not observed in the other languages. We present the preliminary experiments which were performed as a model in order to examine the background of these onomatopoeia. Normal subjects can explain pure tones and narrow band noises linguistically using onomatopoeia in the model-experiments. In results, typical onomatopoeia expressed boo-n, poo-n are equivalent to low ranged pure tones, pee-n, kee-n, shee-n are to high range of pure tones as well. In the same manner, go-n, za- for low tone range of narrow band noises and shu-, shee-n are similar to high tone of narrow band noises. The characteristics of explanations on onomatopoeia were very different in those of vowels in the onomatopoeia.

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The patients of tinnitus in Japan are usually trying to complain it by expressing with using onomatopoeia. Onomatopoeia are characteristic to Japanese language and are not observed in the other language. Clinical observation of onomatopoeia was carried out. Factors representing the background of onomatopoeia were clinically analyzed. An audiogram for comparison of the sounds with frequencies similar to those of tinnitus was used for reference. 58 kinds of onomatopoeia were observed in 1000 patients of tinnitus, 21% of patients were trying complain it by expressing with using ki-n. 19% were using jee-. 6% were using za-. In analyzed onomatopoeia expressed by patients of tinnitus, as based on an audiogram, were different high frequency deafness and low frequency deafness. The patients of high pitch tinnitus were trying to complain by expressing using ki-n, ki-, pi-n, pi-, shee-n, in low pitch tinnitus, patients were using boo-n, boo.

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The purpose of the present study was the objective evaluation of the subjective tinnitus by the use of onomatopoeia were attempted. For these purposes, 30 representative onomatopoeia selected by the main factor method was clinically used. As a result the patients can choose an adequate onomatopoeia from among the 30 representative ones. When it was done, a correct and objective assessment of the tinnitus complained of by the patients should be clinically feasible.

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Experiments were made of how normal persons express pure tone, band noise (B. N.), and white noise (W. N.), by vowel sounds and the results were compared with those obtained from patients with tinnitus. Low tone was often expressed by the vowels of u and o, and middle and high tones were by the vowel of i in healthy persons. No great difference was made by using selected words. B. N. was expressed in a quite different way from that in pure tone. Patients with sensori-neural hearing loss gave different expression from that given by normal persons. However, their vowel expression tended to be similar to that of the others. The results, the way of expression by normal persons were used for anamnesis of tinnitus patients. Conductive tinnitus occurred particularly around the sounds, u, go, and 136, and the pitch was all less than 500 Hz. In mixed tinnitus, there was considerable variation, probably depending upon how conductive and sensorineural elements participate in. Sensori-neural tinnitus was found in a whole pitch range, and mostly expressed as the sounds of i series. The patients rarely complained of tinnitus of B. N.-like sound. There was found no specificity to pitch nor to disease in tinnitus.

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A new approach named PAST (Psychoacoustic Scale of Tinnitus) method has been developed for psychoacoustic evaluation of tinnitus using a microcomputer based device. Pairs of stimulus sounds, the acoustic variable of which correlates dominantly with the directing psychoacoustic characteristic, are successively presented to a patient to let him select the sound resembling the tinnitus more closely. From his responses, a psychoacoustic scale, that is the PAST value, is constructed to represent the dissimilarity of each sound to the tinnitus in reference to the directing characteristic. And then the acoustic and corresponding psychoacoustic characteristics of the tinnitus are estimated from the sound with the minimum dissimilarity on the PAST value. Based on the results of a patient, the capability of the method to direct the pitch, loudness and timbre of the tinnitus was indicated. The varidity of the principle and the usefulness in the clinical application were also verified.

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Fory-three patients with subjective tinnitus were evaluated by pitch match method. The pitch match method was performed by using pure tone audiometer (fixed frequency) and sweep audiometer (continuous frequency). As the test tone, pure tone, narrow band noise and white noise were used. Out of 43 patients, seven were tinnitus sufferer without hearing impairment and the other 36 were the cases with various type of sensoryneural hearing impairment. The pitch sensation for 33 patients, most of whose hearing impairment were sensory type, were identified as pure tone. The pitch sensation for some cases of presbycusis and the patients without hearing problem revealed to be band noise or white noise in character.

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Pitch match test is commonly used as a clinical measurement for tinnitus. It is, however, unknown how precisely the patients' estimated pitch by this technique represent their actual pitch of tinnitus. In order to examine the precision of this technique, we made an experiment using tinnitus simulation. The subjects were 14 normal hearing adults without tinnitus, each of whom was presented by continuous simulated tinnitus sound (STS) to one ear and pitch match test was performed under 13 experimental conditions. The results were as follows; 1) The mean error was less than one octave except in one condition where STS of narrow band noise was matched by pure tone. 2) When the tone of STS differed from the test sound, the errors of measurement increased. 3) There was no significant difference between the results of ipsilateral and contralateral matching tests. 4) The differences of loudness and pitch of STS did not affect the results of pitch match test. 5) No significant difference was found between the results when using discrete test sounds presented by a conventional pure tone audiometer and using continuous test sounds by an automatic audiometer.

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The analogous pitch and tone of tinnitus was identified in 56 ears complaining of tinnitus. 4 types of test sounds were used which were generated by TDH 49 ear phone and 4 kinds of electric signals; sine, triangle, rectangle and saw-tooth waves. Test sounds were given to each contralateral ear and frequency and intensity of tinnitus were determined by use of pitch matching and loudness balance method. Tinnitus of 27 ears were similar to sounds which were generated by rectangular, 7 ears were triangular, 9 ears were saw-tooth waves and 9 other ears were shown to be sine wave but 4 ears were undeterminable under these test conditions. Relationships between pitch of tinnitus and impaired frequency of the audiogram is very high (r=0.80). The pitch of tinnitus is initiated by the impaired auditory peripheral center as spacial information from which abnormal discharges were generated.

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In order to establish the testing procedure of the loudness of tinnitus, loudness estimates of tinnitus using balance method in different test conditions were compared each other, and loudness of the external continuous sounds simulating tinnitus were measured by the same procedure as the measurement of tinnitus. In cases having sensorineural hearing loss at the tinnitus frequency, the loudness recruitment is the largest factor that modifies the result. This difficulty can be avoided by using other frequencies as a test tone at which bone conduction hearing is normal. Even in non-recruiting ears, test-retest variability in the successive balance test was minimal (0.5 dB), while this variability becomes larger (3.5 dB) when the second measurements were performed after a certain period for the patients who reported no change of the loudness of their tinnitus. Loudness estimates of the simulating sounds were significantly larger by using delayed balance method than by using simultanuous balance method. This result suggests the possibility that the measurement of tinnitus by balance test gives us lower estimate than real loudness. Subjective assessment of the change of the tinnitus loudness correlated better with the before-to-after ratio of the sensation level of tinnitus in dB than in sone scale which is the countable measure.

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The relationship between masking curve of tinnitus and audiometric configuration, and the mechanism and clinical significance of the masking of tinnitus were reviewed with reference to the literature. The method of measuring residual inhibition (RI) and the clinical results obtained with it were also described. In addition, the report also included the results on the method of measuring tinnitus reported by the members of the research group of the tinnitus measurement.

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Test sounds which can be produced easily and regarded as effective for the measurement of tinnitus were prepared with a synthesizer, and it was applied clinically. Test sounds included pure tone, and frequency modulated tones of the clipped sine wave, square wave, triangle wave and pulsed wave. Fifty-nine patients with tinnitus on one side were examined with this equipment. Those in whom the tinnitus tone was pure tone, made up for 46%, while in other patients, the square wave and pulsed wave were 16.9%, respectively, and the triangle wave constituted 8.5%. The majority of patients had tinnitus over 8000 Hz, and in many of them various test sounds of 8000 Hz were frequency modulated, and there were no frequency modulated cases below that frequency.

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1) The reproducibility and reliability of test findings obtained with the tinnitus balance method using an ordinary audiometer were examined. 2) It was considered from the test findings of tinnitus not showing subjective changes at the intervals of three hours and 3.8 months in the mean that the changes of 1 octave in frequency, and those by 10 dB in loudness could not be regarded as significant. 3) The number of cases in which test results showed similarly clear changes was small among the cases in which subjective changes of tinnitus were noted. 4) The changes of tinnitus in Ménièr's disease, and those of tinnitus found with the glycerol-loaded tinnitus balance method, were similar. It was found that there was a tendency of low-tone tinnitus at the onset of Menier's disease, and of high-tone tinnitus at the remission of the disease. When glycerol was loaded, the pre-load low-tone tinnitus disappeared, or changed into high-tone. These changes were observed even in the cases where auditory acuity was not observed. Provided that these findings were made the glycerol-loaded tinnitus balance test positive, the rate of positiveness of the glycerol test was twice that when the auditory acuity findings alone was made the index. 5) It was found necessary when considering the tinnitus measurement results whether the method was the balance method or the adjustment method, and whether the sound was presented to the tinnitus side or to the non-tinnitus side, since the results might vary.

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The frequency-modulated signals of which the carrier is a pure tone and of which the envelope is a low pass filtered noise were developed as the test tone to compare with tinnitus. The character of the pure tone like tinnitus was discussed.

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Intravenous administration of local anesthetics such as xylocaine has been widely used to determine the indication to use anticonvulsant for tinnitus or simply to relief tinnitus. Main drawback of this prescription is its side effects, such as cardiovascular depression. Since the effectiveness of the local anesthetic to tinnitus is attributed to its anticonvulsive effect, we thought intravenous administration of anticonvulsant itself might be effective for tinnitus and prepare more direct information about it. With the patient in sitting position, 250 mg of Phenytoin (also known as diphenylhydantoin, Aleviatine®) in 100 ml of saline was intravenously administrated in about 10 min. If the tinnitus disappeared, the administration was discontinued at that point. Fourty patients with tinnitus were submitted to the Aleviatine test. Thirty (75%) had a positive result, i. e. 60% or more reduction in the intensity of tinnitus. Within this group, 22 (55%) experienced complete relief (disappearance) of tinnitus for a while. Seven (17.5%) had a negative result, i. e. less than 40% improvement, and in 1 (2.5%) the tinnitus was worse following the Aleviatine injection. Major side effects, such as blackout sensation of eyes, flushing of face and numbness of extremities were observed in 3 (7.5%). The concentration of Aleveatine in serum drawn three minutes after the completion of injection was measured by homogenous enzyme immunoassay. The concentration ranged from 3.5 to 22 μg/ml. The positive relationship between serum concentration and administrated doses per body weight was observed. There was, however, no significant relationship between effectiveness and serum concentration of drug. In order to determine the site and mode of action of Aleviatine we have given it intravenously while recording the auditory brainstem response (ABR). None of patient showed any significant changes of ABR. In guinea pig, however, given more than 20 mg/Kg body weight of Aleviatine, a significant change of ABR was observed. Latency and amplitude of Pi as well as those of other peak was dosedependently prolonged. From these results site and mode of action was briefly discussed, especially in terms of biochemical neuropharmacology.(This research was supported by the Grant-in-Aid for Co-operative Research, No 56370028 from the Ministry of Education, Science and Culture of Japan.)

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Many different treatments for the tinnitus have been reported, however, tinnitus is still a vexing problem to both patients and physicians. A rational system of treatment for the tinnitus must be made, in which psychological aspects are taken into account. In this paper we reported the psychological analysis of tinnitus patients and also referred to the possibility of psychotherapy for the tinnitus.

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The effect of treatment on the subjective tinnitus is evaluated subjectively by questioning. We planed a diary of tinnitus and kept patients with it. And the changes (loudness, tone, feeling of numbness in the ear) of tinnitus before and after treatments was kept a diary of tinnitus. Based on these results, we thinked that a diary of tinnitus are objective evaluation of the treatments of tinnitus.

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