Release: Embargoed until September 24, 2000Contact: Kenneth Satterfield202-371-4517 (9/23-27)703-519-1563[email protected]
SEVERE TINNITUS ASSOCIATED WITH MENIERE'S DISEASE
A new research effort assesses which ear disorders are prone to severe and mild tinnitus
Washington, DC -- Tinnitus affects thousands, and its cause is usually attributed to an ear disorder. A new study examined patients with tinnitus and measured the prevalence of the condition with selected ear disorders.
The authors of the study, "Tinnitus in Six Otologic Diseases," are Erna Kentala, MD, from the Helsinki University Hospital, Helsinki, Finland, and Ilmari Pyykko, MD, from the Karolinska Hospital, Stockholm, Sweden. Their findings will be presented at the Annual Meeting/Oto Expo of the American Academy of Otolaryngology--Head and Neck Surgery Foundation, being held September 24-27, 2000, at the Washington, DC Convention Center.
Methodology: The researchers retrieved the medical records of 558 patients. Of that group, 243 had Meniere's disease; 59 were diagnosed with benign paroxysmal positional vertigo; 122 patients had vestibular schwannoma; 60 with vestibular neuritis; 21 patients had sudden deafness; and 53 complained of traumatic vertigo.
All patients filled in a questionnaire concerning their symptoms, earlier diseases, accidents, use of tobacco and alcohol. The occurrence of tinnitus was requested; the intensity of tinnitus graded as mild, moderate or strong, depending on the disturbance caused by the tinnitus. This information then was combined with results of audiometric, neurotologic, and imaging studies. This information was stored in the database of a neurotologic expert system.
All data were statistically analyzed. The mean and standard deviation was calculated for most factors. The association between different symptoms was determined in correlation analysis, where significance was pronounced at the 0.05 level. A logistic regression analysis was used to create a model to characterize patients with tinnitus.
Results: The prevalence of tinnitus was 100 percent in Meniere's disease, 32 percent in BPPV, 83 percent in vestibular schwannoma, 12 percent in vestibular neuritis, 86 percent in sudden deafness, and 67 percent in traumatic vertigo. The intense tinnitus was seen in Meniere's disease, while the intensity was mostly mild in other ear diseases. Tinnitus was in the affected ear in Meniere's disease, vestibular schwannoma, and sudden deafness; bilateral tinnitus was more common in BPPV, vestibular neuritis and traumatic vertigo.
The decrease in the ability to hear elevated with increased tinnitus severity. The patients with the more intense tinnitus had more sudden falls, anxiety, and central nervous system symptoms such as visual blurring, dysarthria, and subjective facial sensitivity disturbances. The age at onset of symptoms, earlier ear or concurrent other diseases and use of alcohol or tobacco were not related to occurrence of tinnitus. With logistic regression analysis, the three most important factors predicting tenets were presence of hearing loss, lightheadedness and headache.
Meniere's disease
Tinnitus was the initial symptom of 12 patients (five percent). All patients with Meniere's disease had tinnitus. It was bilateral in 54 (32 percent) of patients. The intensity of tinnitus was mild in 90 (38 percent) patients, moderate in 76 (32 percent) patients and strong in 72 (30 percent) patients. Bilateral tinnitus was experienced more frequently than unilateral. Patients whose disease started at an early age seemed to have more intense tinnitus. Intense tinnitus was linked specifically to hearing loss at 500 Hz.
Tinnitus was not affected by the frequency and duration of vertigo attacks. However, patients with intense tinnitus had vertigo more often provoked by head positioning, physical activity, or pressure changes. Unsteadiness and movement difficulties outside the vertigo attack were more common when the tinnitus was intense .
Benign paroxysmal positional vertigo
Tinnitus was present in 19 (32 percent) of the BPPV patients. None of them had subjective complaints for hearing loss. The tinnitus was bilateral in seven of these patients; intensity was mild in 14 patients. With BPPV the occurrence of tinnitus as well as the intensity of tinnitus correlated to the presence of movement difficulties outside the vertiginous spells.
Vestibular schwannoma
Tinnitus was the initial symptom of nine (seven percent) vestibular schwannoma patients. At diagnosis, tinnitus was experienced by 101 (83 percent) of vestibular schwannoma patients, four of them had a bilateral condition. The intensity of tinnitus was generally from mild (58 percent) to moderate (34 percent). Intensity did not increase over time and was not associated with the degree of hearing loss.
Vestibular neuritis
Seven (12 percent) of the vestibular neuritis patients had tinnitus; three had a bilateral condition. The disorder was mild in six patients. Four of the seven had tinnitus prior to the onset of vertigo. None of the patients with tinnitus had hearing loss; however, migraine headaches were more prevalent.
Sudden deafness
There were only 21 patients with sudden deafness. Eighteen (86 percent) of them had tinnitus, 13 of that group in the affected ear. The onset of tinnitus was related to the onset of hearing loss. Bilateral tinnitus was experienced by four patients.
Traumatic vertigo
Tinnitus was present in 35 (67 percent) traumatic vertigo patients. The intensity of tinnitus was mild in 16 patients and moderate in 12 patients. Twelve patients had bilateral tinnitus. Patients with tinnitus incurred a decline in hearing ability. Tinnitus was more common in patients with lightheadedness and with those who had headache.
Conclusion: Mild tinnitus is so common that it cannot be used to exclude a diagnosis of BPPV or vestibular neuritis. The study found that the most intense tinnitus was reported by patients with Meniere's disease.
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