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11.08.2014

Tinnitus clinical trials 2015, ringing in ears how to cure - For Begninners

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Newman, Sandridge, and Jacobson1 estimated 50 million people in the United States experience tinnitus. Clearly, the majority of hearing care professionals (HCPs, audiologists, otolaryngologists, and hearing aid dispensers) manage patients with tinnitus every day. It almost goes without saying that step one is a differential diagnosis for the patient perceiving tinnitus, and step two is treatment. Zagolski and Strek7 report tinnitus pitch and minimum masking level (MML) depend on the etiology of the tinnitus. Henry5 reports the primary tinnitus management tool (based on peer-reviewed literature) is cognitive behavioral therapy (CBT), and he reports acoustic therapies (ie, sound-based) have the next largest evidence base (after CBT). Further, Fagelson reports hearing aid amplification provides a method through which sound can be delivered therapeutically, because hearing aids amplify environmental sounds (which reduces the contrast between the perceived tinnitus and the acoustic environment), potentially allowing the patient to feel more secure and to relax. Folmer et al6 explored the peer-reviewed literature from the last 70 years related to tinnitus and determined there are effective noninvasive tinnitus treatments that are useful and often help manage the problem. CBT management of tinnitus has been occasionally criticized due to the need for focused attention on the tinnitus, and focused attention may indeed prevent habituation. Progressive Tinnitus Management (PTM) is an evidence-based and clinically tested approach developed by Department of Veterans Affairs research audiologists. Patients generally enter PTM at the triage level and progress through each stage as necessary and appropriate for their unique needs. The goal of these individualized appointments is to learn skills and techniques that empower patients to self-manage their tinnitus across multiple environments.
Tinnitus Retraining Therapy (TRT) is based on a neurophysiological model of tinnitus first introduced by Jastreboff.21 This model is guided by the hypothesis that bothersome tinnitus has origins within the limbic (emotional) and autonomic (involuntary) nervous system. Counseling sessions incorporate demystifying tinnitus, educating patients about the underlying causes of tinnitus and its effects, and introducing methods that can lead to tinnitus habituation. As we assess, manage, and treat tinnitus patients, we should keep in mind the vast majority of tinnitus patients have almost certainly searched dozens of websites looking for a cure. Fortunately, 95% to 97% of all people who perceive tinnitus are not disabled by their tinnitus.2 That is, for 95% to 97% of the people who perceive tinnitus, they may notice it now and then, but their tinnitus does not cause stress, anxiety, or depression, or cause them to lose sleep. For them, tinnitus is a major problem that may significantly attenuate quality of life and may significantly facilitate and exacerbate behavioral and physiological problems.
Therefore, the goal of this article is to review contemporary thoughts and findings, as well as the status quo, with regard to managing the patient with subjective tinnitus.


Subjective tinnitus is a phantom sound or noise perceived in the ear(s) most often described as buzzing, ringing, crickets, whistling, humming, static, hissing, or a tone (most often high-pitched) which occurs in the absence of a known external stimulus. That is, objective tinnitus occurs secondary to a physical anomaly such as a foreign object in the ear canal, a perforated tympanic membrane, a patent eustachian tube and more.
Objective tinnitus can often be managed medically or surgically, and therefore a differential diagnosis is extremely important.
Moller reasoned curing cancer, tinnitus, or pain (with a single solution) remains a noble cause and honorable goal, but is not likely to happen. MML was defined as the level at which tinnitus was rendered inaudible and defined in dB SL. Cima et al10 report cognitive behavioral therapy is the most evidence-based treatment option with regard to managing the tinnitus patient. CBT often fosters an improved patient response to their tinnitus in tandem with their perception of tinnitus becoming less handicapping and more manageable. However, the evidence base does show attending to tinnitus via CBT allows the individual to reconstruct their perception of it.19 The meta-analysis by Hesser et al17 indicates long-term benefits. Of course, for some audiologists in certain clinical settings, it may not be logistically feasible to include mental health professionals on the clinical team assessing and treating patients with tinnitus. By reclassifying tinnitus into a neutral signal, adverse reactions to the presence of tinnitus are reduced or eliminated.
According to TRT, the ideal loudness setting for a sound generator is when the perception of tinnitus and external sounds begin to blend together and the tinnitus is still audible.
Indeed, when counseling is combined with sound (or acoustic) therapies, we provide the most successful and reasonable approach to managing the tinnitus patient.
Instead, they relegate tinnitus to the background, and they habituate to it without very much effort and without discomfort.
Subjective tinnitus can only be perceived by the patient, and this type of tinnitus represents 95% to 98% of all tinnitus presentations. Therefore, we recommend all tinnitus patients be evaluated and diagnosed by a physician or a hearing care professional who has intimate knowledge of the topic area. Nonetheless, we can often successfully manage these problems, and therefore the successful management of the tinnitus patient is our goal.
Henry5 reports the tinnitus patient searching the web may fall prey to the millions of websites that promise to silence, quiet, or cure tinnitus.


Specifically, acoustic therapy may be delivered via hearing aid amplification and other products that make background sounds louder, thus reducing the loudness difference between the background noise and the perceived tinnitus. With regard to the cost-effectiveness of CBT, Maes et al11 report the cost-effectiveness (ie, economic evaluation) of multidisciplinary tinnitus treatment based on cognitive behavioral therapy is more cost-effective than usual care. Cima and colleagues10 note that improvements in tinnitus management via CBT have been reported to last up to 15 years. Using information provided to them, they provide the appropriate referral for further clinical services to assess and potentially treat the disorder. Nonetheless, many factors are important as we develop a solution for the individual tinnitus patient.
Cost-effectiveness of specialized treatment based on Cognitive Behavioral Therapy versus usual care for tinnitus. Standardized tinnitus-specific individual cognitive-behavioral therapy: a controlled outcome study with 286 tinnitus patients.
A randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus.
Just over half the participants reported bilateral tinnitus for a total of 625 ears with tinnitus. They identified specific counseling techniques shown to help the patient better manage their tinnitus, including cognitive behavioral therapy, psychological counseling and hypnosis, biofeedback, and relaxation training. They say researchers and clinicians more or less agree the larger part of tinnitus suffering is associated with negative psychological reactions to tinnitus, and these negative psychological reactions need to be addressed properly to effectively manage tinnitus. For example, someone afraid of being in noise because it will make their tinnitus worse may find the idea of attending a large social gathering impossible.
For approximately half the group, tinnitus was sudden onset, and for the other half, a gradual onset was reported.
The authors categorized their patients into groups according to probable tinnitus etiology.



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