Joseph Attias

Tinnitus with Normal Hearing Sensitivity: Extended High-Frequency Audiometry and Auditory-Nerve Brain-Stem-Evoked Responses

Extended high-frequency (HF) audiometry and auditory-nerve brain-stem-evoked responses (ABR) were carried out on two groups of subjects with normal hearing sensitivity. The experimental group comprised 17 subjects with tinnitus, while the control group consisted of age- and sex-matched subjects, not suffering from tinnitus. The aim of the study was to determine whether extended HF audiometry or ABR might reveal significant differences between these two groups of subjects with normal hearing sensitivity. In addition, the characteristics of tinnitus in subjects with normal audiograms were discussed. The results of extended HF audiometry showed no significant differences between the subjects with and without tinnitus. The ABR parameters considered were also within normal limits bilaterally. Based on the methods employed in this study, tinnitus in normal listeners does not appear to reflect appreciable damage in the cochlea or in the brain-stem auditory pathways. The authors present some suggestions for future research.

Event-related potentials in post-traumatic stress disorder of combat origin

Visual event-related potentials (ERPs) of primary interest in this study of post-traumatic stress disorder (PTSD) were N1, N2, P2, and P3. Forty Israeli combat veterans consisting of 20 PTSD sufferers and 20 normal controls were evaluated. ERPs were recorded in response to three sets of computer-generated visual stimuli, presented in the form of a modified oddball paradigm. These stimuli included: domestic animal pictures (targets), emotionally neutral pictures of furnishings (nontargets), and combat-related pictures (nontarget probes). Subjects were required to discriminate between target and nontarget stimuli by pressing a button in response to target stimuli only. Subjects were instructed to ignore all nontarget stimuli. As expected, target stimuli evoked accentuated P3 amplitudes in both controls and PTSD patients. The nontarget combat-related pictures elicited enhanced P3 and N1 amplitudes in the PTSD patients only. N2 amplitudes were accentuated in PTSD patients for both targets and combat-related pictures. P3 latencies and reaction times to target stimuli were prolonged in PTSD patients. The same tendency was observed for N1 latencies. These results may indicate that an altered state of early and late cognitive selective attention processing exists in PTSD patients in addition to a vulnerability to traumatic reminiscences.

Sleep disturbance associated with chronic tinnitus.

Sleep disturbance is a common and frequent complaint reported by tinnitus sufferers. Recent studies have shown that when insomnia and depression are associated with tinnitus there is decreased tolerance and increased discomfort with the tinnitus. The purpose of this study was to assess the reported prevalence and severity of sleep disturbance in chronic tinnitus patients. Patients (n = 80) were military personnel without major psychiatric disturbance and their tinnitus was associated with noise-induced permanent hearing loss (NIHL). Mini Sleep Questionnaire (MSQ) scores for sleep disturbance were found to be higher than those of normal controls in 77% of the patients. Highest MSQ scores in tinnitus patients with a sleep complaint were for delayed sleep, morning awakenings, mid-sleep awakenings, morning fatigue, and chronic fatigue. In contrast, a complaint of excessive daytime sleep (EDS) was not common. The self-rated severity of the tinnitus was greater in subjects with higher sleep disturbance scores. Self-rated depressive symptomatology was also highly correlated with sleep disturbance. Retrospective examination of sleep records and polysomnographic data for 10 patients with a complaint of chronic tinnitus revealed a combined effect for the tinnitus condition when associated with another conventional sleep disorder. In spite of the common complaint of sleep disturbance in tinnitus, only a minority seek a sleep examination.

Psychological Profile of Help-seeking and Non-help-seeking Tinnitus Patients

The psychological profile of tinnitus patients who sought treatment (Help-Seeking, HS) was compared with that of patients who did not seek help (non-help-seeking, NHS) and with normal control subjects. Psychological evaluations as well as hearing, tinnitus loudness, and tinnitus pitch were measured. Overall, the psychiatric symptomatology of HS (n = 50) was more severe with poorer effective coping abilities and externalization of locus of control than NHS (n - 50). However, the psychiatric symptomatology of the NHS was remarkably more severe than that in the normals (n = 73) and more like that in the HS even though they did not turn to treatment. Tinnitus loudness was significantly lower in HS than in NHS subjects. The lower the tinnitus loudness, the higher the psychiatric symptomatology. The trend towards subclinical abnormalities in NHS indicates their vulnerability to pathology and this requires the attention of the therapist in order to increase the patients self-awareness and to suggest preventive coping strategies or relaxation techniques.

Evaluating noise induced hearing loss with distortion product otoacoustic emissions

This study assessed the clinical efficacy of screening for noise induced hearing loss (NIHL) with distortion product otoacoustic emissions (DPOAE). DPOAEs were recorded from 76 military personnel (137 ears) aged between 17 and 41 years in response to equilevel 70 dB SPL primary stimulating tones. The 2f1-f2 DPOAE levels were correlated with audiometric thresholds at frequencies close to f2. Ears with normal audiograms, but with a history of military noise exposure, had DPOAEs that were significantly decreased in amplitude as compared to the ears of normal hearing non-exposed to noise subjects. These ears also had an increased absence of DPOAEs as compared with the ears of the normal hearing non-exposed to noise subjects. Although, in general, the DPOAE amplitudes and spectral frequency ranges reflected the audiometric NIHL configurations, in a number of cases DPOAEs were present for hearing losses up to 75 dB HL. As a consequence, DPOAEs correlated moderately and negatively with the audiometric thresholds. Applying test criteria designed to logically reflect NIHL, DPOAE sensitivity and specificity levels ranged between 0.51-0.90 and 0.63-0.25, respectively. These findings indicate that DPOAEs, recorded and analysed as described, are not sufficiently sensitive to serve as a single test to identify NIHL.

Comparison between Self-Hypnosis, Masking and Attentiveness for Alleviation of Chronic Tinnitus

The efficacy of self-hypnosis (SH), masking (MA) and attentiveness to the patients complaints (AT) in the alleviation of tinnitus was evaluated. Forty-five male patients close in age with chronic tinnitus related to acoustic trauma were assigned to three matched subgroups: SH, AT or MA. The therapeutic stimuli in the SH and MA sessions, recorded on audio cassettes, were given to the patients for use when needed. SH significantly reduced the tinnitus severity; AT partially relieved the tinnitus; MA did not have any significant effect.

Effects of hypothermia on auditory brain-stem and somatosensory evoked responses. A model of a synaptic and axonal lesion.

Auditory nerve brain-stem (ABR) and somatosensory evoked responses (SER) were recorded in cats as body temperature was uniformly lowered from 37 to 27 degrees C. Analysis of the results showed that the alterations in the evoked responses were due to disturbances induced both in axonal propagation and synaptic transmission by the hypothermia. By studying the first wave of the SER, which is solely an axonal event, and by assuming reasonable values for the total synaptic delay and axonal propagation times along the ABR pathway, it was concluded that this lesion model induced an effect on synaptic transmission 1.3-1.7 times greater than that on axonal propagation. There was a strong inverse correlation between wave latency and body temperature, with slightly steeper slopes for the longer latency waves. Wave amplitudes were not correlated with temperature. Furthermore, the wave latencies and amplitudes were generally not dependent on stimulus rate.

Efficacy of self-hypnosis for tinnitus relief.

The efficacy of self-hypnosis (SH) on tinnitus relief was compared with two control procedures: 1) presentation of a brief auditory stimulus (BAS) to the ear with tinnitus; 2) waiting list (WL), i.e. patients receiving no formal treatment. The results have shown that 73% of SH subjects reported disappearance of tinnitus during treatment sessions, as compared with only 24% in the BAS group. Moreover, the short-term (1 week) and long-term (2 months) symptom profiles of only SH subjects revealed a significant improvement. Thus, SH may well be a beneficial method for the relief of tinnitus.

Characteristics of click-evoked otoacoustic emissions in ears with normal hearing and with noise-induced hearing loss.

The clinical application of click-evoked otoacoustic emissions (EOAE) in the assessment of noise-induced hearing loss (NIHL) was examined in a group of 72 ears with NIHL and 61 ears with normal hearing (NH). The characteristics of the EOAE in ears with NIHL significantly differed from the NH, according to all EOAE parameters tested in the present study. The mean overall EOAE level was lower and the mean EOAE nonlinearity threshold was worse in the NIHL group. In 95% of the NH ears the EOAE spectrum range was wide, while in 91.5% of the NIHL ears the range was narrow. Moreover, in 94% of the ears with NIHL, the frequency at which the hearing loss began (BHL) was at or above the frequency of the last peak in the EOAE spectrum (FLP). Furthermore, combination of EOAE spectral measures correctly discriminate on average 93.5% of ears with NH from NIHL (sensitivity) and 92% of ears with NIHL from NH (specificity). In contrast, the nonlinearity threshold and the overall level of EOAE yielded lower specificity of less than 33%. It was therefore concluded that EOAE spectrum may serve as a useful and objective tool in screening adults with suspected noise-induced high frequency hearing loss.

Vocal attrition related to idiosyncratic dysphonia: Re-analysis of survey data

In a recent survey study it was found that female army instructors were significantly more likely to suffer from symptoms of vocal attrition than new female recruits, supporting the clinical impression that those who are engaged in a vocally taxing vocation are at higher risk for vocal attrition than those who are not. In the present study we found that instructors who reported having rapid, excessive or loud speech, or a combination of these, were significantly more likely to report symptoms of vocal attrition than instructors who reported not having these speech habits. Difference in prevalence of vocal attrition symptoms among recruits with and without these speech habits was statistically non-significant. The present findings confirm the clinical impression that idiosyncratic dysphonia can increase the risk of vocal attrition, especially in people who are engaged in a vocally demanding profession or vocation.