A new therapeutic approach for somatosensory tinnitus

当知觉特征(如音调和响度)改变时，可怀疑有躯体感觉耳鸣 紧接着头部和颈部动作，肌肉剧烈收缩，或眼睛或下巴运动。 据估计，60%至80%的耳鸣患者能够通过以下方式调整耳鸣 操纵颌骨、头部和颈部的躯体区域(Ralli等人，2017)，提示躯体感觉耳鸣 然而，退伍军人中这种类型的耳鸣的流行率尚不清楚。事实上，体细胞 手法可以直接影响许多患者的耳鸣感觉(Shore，2011)提供了 拟议研究采用非传统治疗方法的科学前提(即，不寻常 对于患有这种耳鸣的退伍军人来说，这涉及到物理治疗。这项研究是 实现我们开发能够诊断、评估和治疗退伍军人的临床框架的长期目标 伴有体感耳鸣。 这项拟议的研究是基于克利夫兰临床模型，该模型将所有耳鸣患者评估为 确定他们的耳鸣是否可以进行躯体调节。当检测到躯体感觉耳鸣时， 规定了个性化的理疗方案。治疗体感耳鸣的新方法 为我们的初步研究提供了结构。这项研究的结果将：i)提供数据估计和描述 体感耳鸣在患有耳鸣的退伍军人中的患病率和II)为使用 克利夫兰诊所个性化理疗方法的改编版本，用于治疗退伍军人 体感耳鸣。 第一年的重点将是调整神经筛查检查和物理治疗程序，用于 克利夫兰诊所的耳鸣管理诊所，供退伍军人使用。将进行电话筛查，以 确定疑似患有体感耳鸣的退伍军人。根据电话筛选结果，10 怀疑患有体感耳鸣的退伍军人和10名退伍军人的耳鸣疑似 受躯体动作的影响，将被邀请参加面对面的访问，以确定 电话筛查用于识别患有躯体感觉耳鸣的退伍军人(目标1)。此外，另一个样本 在10名能够从身体上调整耳鸣的退伍军人中(通过亲自访问1确认)，将被邀请 参加本研究的理疗部分，参加3次个体化理疗 会议(目标2)。将通过问卷调查来评估体感的效果和影响。 耳鸣对生活质量的影响。 拟议工作的结果将对患者和卫生保健提供者产生临床影响。这项研究 正在采取必要的步骤，为指导临床决策提供循证方法 患有耳鸣的退伍军人。所学知识将传播给多个学科的医疗保健提供者 (例如，听力学、理疗、初级保健等)破除“无能为力”的观念，提高 对如何最好地评估和治疗患有耳鸣的退伍军人的认识。

Somatosensory tinnitus is suspected when perceptual characteristics (e.g., pitch and loudness) change immediately following head and neck maneuvers, forceful muscle contractions, or eye or jaw movements. Prevalence estimates range from 60 to 80% of tinnitus patients being able to modulate their tinnitus by manipulating somatic regions of the jaw, head, and neck (Ralli et al, 2017), suggesting somatosensory tinnitus to be common, yet the prevalence of this type of tinnitus in Veterans is unknown. The fact that somatic manipulations can directly influence the tinnitus perception for many patients (Shore, 2011) provides the scientific premise for the proposed research to adapt a non-traditional therapeutic approach (i.e., not usual care) for Veterans with this type of tinnitus, which involves physiotherapy. This research is the first step in achieving our long-term goal to develop a clinical framework that can diagnose, assess, and treat Veterans with somatosensory tinnitus. The proposed research is based on the Cleveland Clinic model which evaluates all tinnitus patients to determine if their tinnitus can be somatically modulated. When somatosensory tinnitus is detected, an individualized physiotherapy program is prescribed. This novel approach to somatosensory tinnitus treatment provides the structure for our pilot study. Results of this study will: i) provide data estimating and describing the prevalence of somatosensory tinnitus in Veterans with tinnitus and ii) generate feasibility data for using an adapted version of Cleveland Clinic's individualized physiotherapy approach to treat Veterans with somatosensory tinnitus. The focus of Year 1 will be adapting the neurological screening exam and physiotherapy procedures used at Cleveland Clinic's Tinnitus Management Clinic for use in Veterans. A phone screening will be conducted to identify Veterans suspected of having somatosensory tinnitus. Based on the phone screening results, 10 Veterans suspected of having somatosensory tinnitus and 10 Veterans whose tinnitus is not suspected to be influenced by somatic maneuvers, will be invited to attend an in-person visit to determine how accurate the phone screening was in identifying Veterans with somatosensory tinnitus (Aim 1). Additionally, another sample of 10 Veterans who can somatically modulate their tinnitus (confirmed by in-person Visit 1) will be invited to participate in the physical therapy portion of this study and attend 3 individualized physiotherapy treatment sessions (Aim 2). Questionnaires will be administered to evaluate the effects and impact of somatosensory tinnitus on quality of life. Outcomes of the proposed work will have clinical impact for patients and health care providers. This research is taking the necessary steps to provide an evidence-based approach to direct clinical decision-making for Veterans with tinnitus. Knowledge learned will be disseminated to healthcare providers in multiple disciplines (e.g., audiology, physical therapy, primary care, etc.) to dispel the belief that “nothing can be done” and raise awareness regarding how best to assess and treat Veterans with tinnitus.