Kajsa-Mia Holgers

Psychiatric Disorders in Tinnitus Patients without Severe Hearing Impairment: 24 Month Follow-up of Patients at an Audiological Clinic: Alteraciones psiquiátricas en pacientes con tinnitus sin hipoacusia severa: Seguimiento durante 24 meses en una clínica audiólogica

The relationship between tinnitus and psychiatric disorders has long been recognised. We have addressed this question by investigating the prevalence of psychiatric diagnosis in a consecutive series of tinnitus patients (n = 82) without severe socially disabling hearing loss referred to an audiological clinic. The psychiatric evaluation was based on a standardised diagnostic interview (SCID-P) in accordance with the Diagnostic and Statistical Manual of mental disorders (DSM-III-R) and on the Hospital Anxiety and Depression Scale (HAD Scale). An experienced psychiatrist performed the interview 24 months after the patients first visit to the clinic. Lifetime depressive and anxiety disorders were recorded in 62 per cent and 45 per cent of the cases respectively, but only 34 per cent had had contact with any healthcare institution for emotional disturbances. Only 7 per cent reported that they had tinnitus prior to their depressive and/or anxiety disorders. We conclude that it is of great importance to identify these emotional disturbances in patients suffering from tinnitus. La relación entre tinnitus y las alteraciones psiquiátricas ha sido ampliamente reconocida. Nos hemos acercado a este tema investigando la prevalencia de diagnóstico psiquiátrico en una serie consecutiva de pacientes sin hipoacusia severa (n=582) referidos a una clinica audiológica. La evaluateón psiquiátrica se basó en una entrevista diagnóstica estandarizada (SCID-P) de acuerdo con el Manual Diagnóstico y Estadístico de Desórdenes Mentales (DSM-IIIR) y con la Escala de Ansiedad y Depresión Hospitalaria (HAD scale). Un psiquiatra experimentado condujo la entrevista 24 meses después de la primera visita de cada paciente a la clínica. 62% de los pacientes presentaban alteraciones depresivas y 42%, ansiedad de larga evolutión, pero sólo el 34% había tenido contacto con alguna instituteón de salud especializada. Sólo un 7% reportaron que tenían el tinnitus antes de inicíar con los problemas de ansiedad o depresion. Concluimos que es sumamente importante identificar estas alteraciones emocionales en los pacientes con tinnitus.

Clinical, immunological and bacteriological evaluation of adverse reactions to skin-penetrating titanium implants in the head and neck region.

Between 1977 und October 1989, 445 patients have been treated with bone‐anchored skin‐penetrating titanium implants for anchorage of facial prostheses or bone‐conducting hearing aids, at the Ear. Nose and Throat Department at Sahlgrens Hospital in Gothenburg. The majority of patients had no adverse skin read ions, while a few patients were responsible for the majority of the adverse reactions. The aim of our study was to analyse differences between these groups. We started a clinical study on 9 patients with a clinical history of adverse skin reactions around the titanium implants and 9 patients without adverse skin reactions were used us controls. None of the patients had delayed hypersensitivity to titanium., Microbiological analyses showed that when there was clinical irritation, Staphylococccus aureus could be isolated.

Predictive Factors for the Severity of Tinnitus: Factores predictivos de la severidad del tinnitus

The majority of patients with tinnitus experience a lessening of their symptoms during an 18-month period after their first consultation. The exception to this rule is severe incapacitating tinnitus, the sometimes very troublesome symptoms of which show no sign of diminishing with time. The aim of the present study was to investigate risk factors for incapacitating tinnitus, as measured by absence from work related to tinnitus (AWT) of more than 1 month during an 18-month period after the first visit to the tinnitus clinic. Audiometric data and the scores from the Tinnitus Severity Questionnaire and the Nottingham Health Profile at the first visit to the clinic were correlated to AWT by a logistic regression model. By using this risk model, an individual risk score for AWT could be estimated. Depression and physical immobility were strong predictors of AWT, and hearing loss was moderate. Based on these results, we suggest that the aetiology of tinnitus severity could be described as depression-/anxiety-related, somatic, and auditory tinnitus.

Predictive factors for development of severe tinnitus suffering-further characterisation

The purpose of this study was to identify risk factors for Severe Tinnitus Suffering (STS) and to describe the results from psychiatric diagnostic interviews of STS positive and STS negative patients. Consecutive tinnitus patients (n = 127) completed the Nottingham Health Profile (NHP) and the Tinnitus Severity Questionnaire (TSQ) and answered general health questions at the first visit to the clinic and at eighteen months follow-up. Twenty-four months after the first tinnitus consultation, standardized diagnostic interviews (SCID-P), according to DSM-IIIR, were performed by an experienced psychiatrist. The calculated probability for STS was 93%, if three items from the NHP (18,32,33) were positive. STS positive patients had more anxiety disorders with more psychosocial stress and lower global assessment of function scores. Results suggest that the NHP may be a useful tool in the clinical management of tinnitus patients and emphasises the importance of identifying depressive and anxiety disorders in this population.

Ginkgo biloba Extract for the Treatment of Tinnitus

Previous studies have shown contradictory results of Ginkgo biloba extract (GBE) treatment of tinnitus. The present study was divided into two parts: first an open part, without placebo control (n = 80), followed by a double-blind placebo-controlled study (n = 20). The patients included in the open study were patients who had been referred to the Department of Audiology, Sahlgrens Hospital, Göteborg, Sweden, due to persistent severe tinnitus. Patients reporting a positive effect on tinnitus in the open study were included in the double-blind placebo-controlled study (20 out of 21 patients participated). 7 patients preferred GBE to placebo, 7 placebo to GBE and 6 patients had no preference. Statistical group analysis gives no support to the hypothesis that GBE has any effect on tinnitus, although it is possible that GBE has an effect on some patients due to several reasons, e.g. the diverse etiology of tinnitus. Since there is no objective method to measure the symptom, the search for an effective drug can only be made on an individual basis.

The suffering of tinnitus in childhood and adolescence

Objectives: Investigate the profile of young patients complaining of tinnitus and study the prevalence and the severity of tinnitus in schoolchildren. Design: Ninety-five consecutive patients (55 boys), 8–20 years old, seeking help for tinnitus at our clinic were studied using audiometry, structural interviews, Tinnitus Severity Questionnaire (TSQ) and Hospital Anxiety and Depression Scale (HAD), together with Visual Analog Scales (VAS) on tinnitus loudness and annoyance. Results: The onset of tinnitus was twice as often sudden than gradual. In 54% of the children, tinnitus had started after noise exposure, most commonly listening to music. Correlations were found between the pure-tone average (PTA) of 3, 4, and 6 kHz and TSQ scores; between TSQ and HAD subscales; and between TSQ and VAS. According to the Hospital Anxiety Depression Scale, 32% and 14.5%, respectively, were above the cut level for clinical anxiety and depressive disorders. The girls showed more signs of anxiety disorders than the boys. Conclusions: The majority of the help seekers had been exposed to noise, mostly music. Predisposing factors for tinnitus severity are high-frequency hearing loss and anxiety and depressive disorders.

Tinnitus in 7-year-old children

The prevalence of tinnitus in children with normal hearing has been reported to be between 6% and 36% and much higher in children with hearing loss. The aim of the present study was to perform an epidemiological, cross-sectional study, on the prevalence of tinnitus in 7-year-old school children (n=964) and to statistically analyse the relation of tinnitus to gender, noise exposure, intratympanic pressure and hearing parameters. Tinnitus was reported by 12% of the children and in contrast to other reports, hearing parameters, did not correlate to the prevalence of tinnitus and no gender differences were found. Noise induced tinnitus was reported in 2.5% of the children. Conclusion: persistent tinnitus in children may have similar causes to that in adults.

Noise exposure and subjective hearing symptoms among school children in Sweden

OBJECTIVE The aim of the present study was to evaluate factors of importance for the experience of temporary threshold shift (TTS), noise- induced tinnitus (NIT), spontaneous tinnitus (ST) in school children. SUBJECTS AND METHODS A total of 671 students aged 13-16 years old were asked to fill in a questionnaire containing items concerning TTS, NIT, ST, hearing loss (HL), heredity for HL, noise exposure, history of otitis media, symptoms of anxiety and depression, psychosocial factors and habits, life satisfaction, chronic medical conditions, age, gender and height. The questionnaire was filled in during school hours. RESULTS Correlations were found with exercise and eating habits, sleep disturbances, BMI, depressive and anxiety disorders, heredity for HL and noise exposure dosage. The risk for TTS was nine times higher in students who reported having a verified hearing loss than in subjects without subjective or verified complaints of hearing loss. The risk for NIT was approximately four times higher in the group who visited concerts 6-12 times per year as compared to those who never attended concerts. There was almost a threefold increase in the risk for ST in the group that sometimes experienced TTS, as compared to those without TTS, and a tenfold increase in risk for ST in those who reported having a verified hearing loss. CONCLUSION In school children, exposure to leisure noise is correlated with tinnitus and the risk increases with increasing noise exposure. Sensitivity to subjective hearing loss has similar risk factors as seen for metabolic syndrome and we suggest that this sensitivity may be another side of metabolic syndrome.

Electron microscopic observations on the soft tissue around clinical long-term percutaneous titanium implants

Percutaneous implants of titanium ad modum Brånemark have been in clinical use in the head and neck since 1977. The incidence of adverse reactions is low. In a previous study we have demonstrated the presence of inflammatory cells in the subcutaneous connective tissue surrounding the implants and this increased exposure to exogenous antigens was suggested to be compensated by a barrier of inflammatory cells in the soft tissue. To get further information on the nature of the tissue-implant contact, in the present study we have examined the structure of the tissue close to the percutaneous implant using transmission electron microscopy. We could not see evidence for an attachment of the epithelium to the implant, nor between the connective tissue and the implant. Retrieved implants were also analysed and we did not find any organized tissue remaining on the implants.

Tinnitus in the general population with a focus on noise and stress: a public health study.

Objectives: To evaluate the influence of noise and stress on the probability of tinnitus in the general population. Design: Questionnaire data were obtained from 12,166 subjects. Results: Each year of age increased the odds ratio of tinnitus by about 3%. Men generally showed a higher risk for tinnitus compared with women. Exposure to noise and stress emerged important for the probability of tinnitus. However, for the transition from mild to severe tinnitus, stress turned out to be especially important. Conclusions: Stress management strategies should be included in hearing conservation programs, especially for individuals with mild tinnitus who report a high stress load.