Psychoacoustic classification of persistent tinnitus

Braz J Otorhinolaryngol. 2018;84(5):583---590 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE Psychoacoustic classification of persistent tinnitus夽 Flavia Alencar de Barros Suzuki ∗ , Fabio Akira Suzuki, Ektor Tsuneo Onishi, Norma Oliveira Penido Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM), Departamento de Otorrinolaringologia e Cirurgia Cabeça e Pescoço, São Paulo, SP, Brazil Received 18 January 2017; accepted 9 July 2017 Available online 1 August 2017 KEYWORDS Tinnitus/classification; Audiometry; Psychoacoustic/ characteristics Abstract Introduction: Tinnitus is a difficult to treat symptom, with different responses in patients. It is classified in different ways, according to its origin and associated diseases. Objective: to propose a single and measurable classification of persistent tinnitus, through its perception as sounds of nature or of daily life and its comparison with pure tone or noise, of high or low pitch, presented to the patient by audiometer sound. Methods: A total of 110 adult patients, of both genders, treated at the Tinnitus Outpatient Clinic, were enrolled according to the inclusion and exclusion criteria. Otorhinolaryngologic and Audiological, Pitch Matching and Loudness, Visual Analog Scale, Tinnitus Handicap Inventory and Minimum Masking Level assessments were performed. Results: In these 110 patients, 181 tinnitus complaints were identified accordingly to type and ear, with 93 (51%) Pure Tone, and 88 (49%) Noise type; 19 at low and 162 at high frequency; with a mean in the Pure Tone of 5.47 in the Visual Analog Scale and 12.31 decibel in the Loudness and a mean in the Noise of 6.66 and 10.51 decibel. For Tinnitus Handicap Inventory and Minimum Masking Level, the 110 patients were separated into three groups with tinnitus, Pure Tone, Noise and multiple. Tinnitus Handicap Inventory higher in the group with multiple tinnitus, of 61.38. Masking noises such as White Noise and Narrow Band were used for the Minimum Masking Level at the frequencies of 500 and 6000 Hz. There was a similarity between the Pure Tone and Multiple groups. In the Noise group, different responses were found when Narrow Band was used at low frequency. 夽 Please cite this article as: Suzuki FA, Suzuki FA, Onishi ET, Penido NO. Psychoacoustic classification of persistent tinnitus. Braz J Otorhinolaryngol. 2018;84:583---90. ∗ Corresponding author. E-mail: flavia (F.A. Suzuki). Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. https://doi.org/10.1016/j.bjorl.2017.07.005 1808-8694/© 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). 584 Suzuki FA et al. Conclusion: Classifying persistent tinnitus as pure tone or noise, present in high or low frequency and establishing its different characteristics allow us to know its peculiarities and the effects of this symptom in patients’ lives. © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). PALAVRAS-CHAVE Zumbido/classificação; Audiometria; Psicoacústicas/ características Classificação psicoacústica do zumbido persistente Resumo Introdução: O zumbido é um sintoma de difícil tratamento, com respostas diferentes nos pacientes. É classificado de formas diversas, de acordo com a origem ou doenças associadas. Objetivo: Propor uma classificação única e mensurável do zumbido persistente, por meio da sua percepção como sons da natureza ou da vida cotidiana e da sua comparação com o tom puro ou o ruído, de pitch alto ou baixo, apresentados ao paciente pelos sons do audiômetro. Método: Participaram 110 pacientes adultos, de ambos os sexos, atendidos no Ambulatório de Zumbido, tendo sido observados os critérios de inclusão e exclusão. Realizada avaliação otorrinolaringológica, audiológica, Pitch Matching e Loudness, Visual Analog Scale, Tinnitus Handicap Inventory e Minimum Masking Level. Resultados: Nesses 110 pacientes foram identificadas 181 queixas de zumbido separadas por tipo e orelha, sendo 93 (51%) tipo tom puro e 88 (49%) tipo ruído; 19 de baixa frequência e 162 de alta frequência; com média do Visual Analog Scale no tom puro de 5,47 e ruído de 6,66; média do Loudness do tom puro de 12,31 dBNS e ruído de 10,51 dBNS. Para o Tinnitus Handicap Inventory e o Minimum Masking Level os 110 pacientes foram separados em três grupos com zumbido, tom puro, ruído e múltiplo, com a média do Tinnitus Handicap Inventory maior no grupo com zumbido múltiplo com 61,38. Para o Minimum Masking Level foram usados os ruídos mascaradores tipo White Noise e Narrow Band nas frequências de 500 Hz e 6000 Hz. Houve semelhança entre os grupos com tom puro e múltiplo. No grupo de ruído foram encontradas respostas diferentes quando usado o Narrow Band em frequência baixa. Conclusão: Classificar o zumbido persistente em tom puro ou ruído, presentes em frequência alta ou baixa e estabelecer suas diferentes características nos permitem conhecer suas particularidades e a repercussão desse sintoma na vida dos pacientes. © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Este é um artigo Open Access sob uma licença CC BY (http:// creativecommons.org/licenses/by/4.0/). Introduction The increase in the worldwide population and life expectancy challenges our existence and may cause a crisis in the public and private health systems in both, poor and rich countries. Researchers around the world are looking for solutions to improve the population’s accessibility to the health system, using standardized, simplified and easyto-use classifications and treatments. Regarding tinnitus, the first step in this investigation is to find a cause and effect relationship, seeking the etiological treatment of the underlying disease to be able to suppress or inhibit tinnitus. When it persists, the patient often returns home without any assistance or is referred to some psychological treatment to learn how to live with this sensation. Although the current approach to tinnitus is based on symptomatic approaches, its classification continues to be established by its origin or etiology.1---3 In the Clinical Practice Guideline Tinnitus --- CPGT, Tunkel et al. (2014)4 addressed the importance of classification to direct the treatment, considering individuals amenable to treatment those with persistent and uncomfortable tinnitus for more than 6 months. However, they have not shown scientific evidence of how to manage patients with sequel or idiopathic tinnitus. In these cases, the treatment guidance would have to be based only on the symptom, defined by the patients as the perc (...truncated)