According to the Jastreboff's neurophysiological model of tinnitus, if negative associations are attached to the tinnitus signal, tinnitus is perceived to be a threat or a danger and it activates the autonomic nervous and limbic systems. Consequently patient's awareness of tinnitus is heightened and so patient perceives it to be louder and more persistent. Jastreboff and Hazell started tinnitus retraining therapy (TRT) based on the neurophysiological model of tinnitus. The purpose of TRT is blocking tinnitus from activating the sympathetic nervous and limbic systems (habituation of reaction) and from reaching the cerebral cortex (habituation of perception). TRT is composed of two components directive counseling that tries to reclassify tinnitus into the meaningless stimuli and sound therapy that decreases the relative strength of the tinnitus signal. Physicians try to put patient's tinnitus into the territory of meaningless stimuli through retraining the brain (habituation of reaction). Because the brain habituates all unimportant stimuli, if habituation of reaction is fully achieved, habituation of perception will follow automatically. In most clinical results, clinical success rates of TRT approach or exceed 80% improvement. Early improvement can be achieved during the first few months, followed by additional progressive improvement. It should be recommended that the patient continue treatment at least 18 months.
Brain ; Cerebral Cortex ; Directive Counseling ; Humans ; Limbic System ; Tinnitus*

OBJECTIVES: The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling. METHODS: The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening. RESULTS: Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months. CONCLUSION: The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.
Alprazolam ; Benzodiazepines ; Counseling* ; Directive Counseling ; Follow-Up Studies ; Ginkgo biloba ; Hearing ; Hearing Loss ; Humans ; Otolaryngology ; Tinnitus*

BACKGROUND AND OBJECTIVES: Tinnitus retraining therapy (TRT) was introduced as a new method for tinnitus management, and it is currently an efficacious therapy in use. In this article, we would like to show the effectiveness of directive counseling in TRT on tinnitus management. MATERIALS AND METHOD: A total of 1, 100 patients who visited tinnitus clinic at the Severance Hospital from 1999 to 2002 were included in this study. Their characteristics and negative associations of tinnitus were investigated. Forty-six patients who were managed with directive counseling were evaluated with questionnaires about the psychoacoustic characteristics of tinnitus and the subjective changes in tinnitus. RESULTS: Tinnitus was developed after stress (35.6%), fatigue (32.0%) and exposure to noise (21.4%), and it was negatively associated with hearing loss (51.8%), continuation of tinnitus (51.6%) and sleep disorder (17.5%). Factors such as awareness, loudness, annoyance, the effect on life tinnitus had were decreased after directive counseling. And the tinnitus handicap inventory (THI) score was also significantly decreased. CONCLUSION: Directive counseling in TRT which includes explanation of neurophysiology of tinnitus should be tried preferentially before habituation occurs.
Directive Counseling* ; Fatigue ; Hearing Loss ; Humans ; Neurophysiology ; Noise ; Psychoacoustics ; Surveys and Questionnaires ; Tinnitus*

BACKGROUND: This study assessed the therapeutic effect of adjunctive bifrontal transcranial direct current stimulation (tDCS) in patients with tinnitus. METHODS: Forty-four patients who visited our university hospital with a complaint of non-pulsatile subjective tinnitus in January through December 2016 were enrolled. All patients received directive counseling and sound therapy, such as a sound generator or hearing aids, and/or oral clonazepam. Patients who agreed to undergo additional bifrontal tDCS were classified as the study group (n = 26). For tDCS, 1.5 mA of direct current was applied to the prefrontal cortex with a 10–20 EEG system for 20 minutes per session. RESULTS: The Tinnitus Handicap Inventory (THI), Beck Depression Inventory, and Visual Analog Scale (VAS) scores decreased significantly after treatment (P < 0.001). Patients who had a moderate or catastrophic handicap were significantly more likely to respond favorably to bifrontal tDCS (P = 0.026). There was no correlation of number of tDCS sessions with change in the THI or VAS score (P > 0.05). Logistic regression analysis revealed that the initial THI score was independently associated with improvement in the THI. However, tDCS was not a significant determinant of recovery. CONCLUSION: tDCS can be used as an adjunctive treatment in patients with severe tinnitus. Although tDCS did not decrease the loudness of tinnitus, it could alleviate the distress associated with the condition in some patients with a moderate or catastrophic handicap.
Clonazepam ; Depression ; Directive Counseling ; Electroencephalography ; Hearing Aids ; Humans ; Logistic Models ; Prefrontal Cortex ; Tinnitus* ; Transcranial Direct Current Stimulation* ; Visual Analog Scale

Objective tinnitus which may be caused by contraction of the tensor tympani and stapedial muscles is extremely rare. We present a case of middle ear myoclonus with voluntary palatal myoclonus in a musician. Otologic examination demonstrated rhythmic involuntary movement of the tympanic membrane after the exposure of loud sound or blowing of the musical instrument. Impedance audiometry confirmed the motion of tympanic membrane and those movements correlated with a tinnitus perceived by the patient. Palatal myoclonic motion, voluntarily evoked by the patient, was observed by oral examination and heard by Toynbee tube objectively. Medical treatment and directive counseling were effective for voluntary palatal myoclonus. However, the main symptom of tinnitus caused by middle ear myoclonus was not changed. The patient's tinnitus was cured by tympanotomy with sectioning of the tensor tympani and stapedial tendons.
Acoustic Impedance Tests ; Diagnosis, Oral ; Directive Counseling ; Dyskinesias ; Ear, Middle* ; Humans ; Muscles ; Music ; Myoclonus* ; Tendons ; Tensor Tympani ; Tinnitus* ; Tympanic Membrane

OBJECTIVETo analyze the influence of knowledge about hypertension and clinical competence among physicians in district and community hospitals on management of hypertensives.

METHODSQuestionnaire investigation was used in 9 district and community hospitals in Chaoyang and Haidian district, including 181 physicians and 204 patients with hypertension.

RESULTS(1) The hospitals involved were divided into two groups according to our evaluation on the knowledge of hypertension and clinical competence of physicians. Four hospitals were graded as high-score group and 5 hospitals as low-score group. (2) There was no significant difference on physicians' evaluation between district and community hospitals. There was higher proportion of hypertensives with instructed physical exercises, reducing salt ingestion, psychological balance and weight reduction in district hospitals than those in community ones. (3) The proportion of hypertensives who were examined with funduscopy, ambulatory pressure and instructed with physical exercises, reducing salt ingestion and weight reduction in high-score group was obviously higher than that in low-score group. The control rates of blood pressure, on the days of examination during lastest check-up or the past three months, were significantly higher in high-score group than in low-score group (P < 0.05).

CONCLUSIONKnowledge of hypertension and clinical management competence among physicians in district and community hospitals did influence the management of hypertension and education of physicians and thus should be increased.

Clinical Competence ; standards ; Delivery of Health Care ; standards ; Directive Counseling ; standards ; Education, Medical ; standards ; Hospitals, Community ; classification ; standards ; Humans ; Hypertension ; diagnosis ; therapy ; Patient Care ; standards ; Physicians ; standards

This randomized controlled trial study aimed to investigate the effects of a lifestyle intervention on metabolic syndrome (MetS) among middle-aged Koreans. A total of 243 middle-aged Koreans with MetS were randomly assigned to either of 2 types of lifestyle intervention for MetS and followed for 12 months. Health examinations and interventions were implemented at 16 regional branch facilities of a Korean medical institution from 2010, following the NCEP-ATP III criteria and recommendations. Lifestyle intervention (LI) group (n = 137) participated in a 12-week multi-component intervention including individual counseling, group sessions, and self-help materials. Basic usual intervention (BI) group (n = 106) was provided with one-page health information sheet on MetS and MetS management at baseline. Prevalence of MetS and each of MetS components, except for low HDL-cholesterol, in both groups were significantly reduced and maintained after the intervention. Notably, prevalence of hypertension and abdominal obesity continued to improve during the follow-up period. Between-group differences in results were not found. Both interventions were effective when they were accompanied with repeated check-ups and notification of MetS status. It is recommended to design clear guidelines for the notification of MetS after MetS screening and to encourage checking MetS status periodically for effective MetS management (KCT 0000446).
Adult ; Combined Modality Therapy ; Directive Counseling/*methods ; Female ; Humans ; Male ; Mass Screening/*methods ; Metabolic Syndrome X/*diagnosis/epidemiology/*therapy ; Middle Aged ; Patient Education as Topic/methods ; *Risk Reduction Behavior ; *Self-Help Groups ; Treatment Outcome

Colorectal Neoplasms ; diagnosis ; Directive Counseling ; Early Detection of Cancer ; methods ; statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Occult Blood ; Patient Acceptance of Health Care ; statistics & numerical data ; Patient Education as Topic