OBJECTIVE: Etiological diagnosis and treatment of tinnitus still remain challenging in clinical practice. The aim of this study was to determine the potential contribution of a defective cochlear efferent innervation to the onset of tinnitus in patients with normal hearing. STUDY DESIGN: Prospective randomized controlled study. SETTING:Otorhinolaryngology department of a general hospital. PATIENTS: The patient group consisted of 18 normal-hearing adults (7 men, 11 women) with acute tinnitus (bilateral in 3 patients). INTERVENTIONS:Tympanogram, stapedial muscle reflex, pure tone audiometry, tinnitus pitch matching, spontaneous otoacoustic emissions, and distortion product otoacoustic emissions (DPOAEs) in the absence and presence of contralateral suppression by white noise. MAIN OUTCOME MEASURE: DPOAEs suppression amplitudes recorded from tinnitus and nontinnitus ears of the patients' group were compared with each other and with a control group. RESULTS: The contralateral application of white noise induced the enhancement of DPOAE amplitudes in some patients. The suppression of DPOAE amplitudes by contralateral white noise did not reach statistically significant levels in either ear (with or without tinnitus). On the contrary, under the same conditions, our control group demonstrated statistically significant reduction of DPOAE amplitudes at all frequencies. CONCLUSION:Patients with normal hearing acuity who have acute tinnitus seem to have a less effective functioning of the cochlear efferent system because the application of contralateral noise enhanced the DPOAEs or suppressed them less intensely than it did in a control group. Further studies may establish the clinical applications for the diagnosis of changes in efferent function, in the subjective evaluation, patient etiological grouping, treatment, or prognosis of tinnitus.
RCT Entities:
OBJECTIVE: Etiological diagnosis and treatment of tinnitus still remain challenging in clinical practice. The aim of this study was to determine the potential contribution of a defective cochlear efferent innervation to the onset of tinnitus in patients with normal hearing. STUDY DESIGN: Prospective randomized controlled study. SETTING: Otorhinolaryngology department of a general hospital. PATIENTS: The patient group consisted of 18 normal-hearing adults (7 men, 11 women) with acute tinnitus (bilateral in 3 patients). INTERVENTIONS: Tympanogram, stapedial muscle reflex, pure tone audiometry, tinnitus pitch matching, spontaneous otoacoustic emissions, and distortion product otoacoustic emissions (DPOAEs) in the absence and presence of contralateral suppression by white noise. MAIN OUTCOME MEASURE: DPOAEs suppression amplitudes recorded from tinnitus and nontinnitus ears of the patients' group were compared with each other and with a control group. RESULTS: The contralateral application of white noise induced the enhancement of DPOAE amplitudes in some patients. The suppression of DPOAE amplitudes by contralateral white noise did not reach statistically significant levels in either ear (with or without tinnitus). On the contrary, under the same conditions, our control group demonstrated statistically significant reduction of DPOAE amplitudes at all frequencies. CONCLUSION:Patients with normal hearing acuity who have acute tinnitus seem to have a less effective functioning of the cochlear efferent system because the application of contralateral noise enhanced the DPOAEs or suppressed them less intensely than it did in a control group. Further studies may establish the clinical applications for the diagnosis of changes in efferent function, in the subjective evaluation, patient etiological grouping, treatment, or prognosis of tinnitus.