The present study was carried out in order to analyze the clinical characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss. The study considered 520 consecutive tinnitus sufferers. The following parameters were considered: age, sex, subjective disturbance caused by tinnitus, subjective judgment of tinnitus intensity, tinnitus laterality, tinnitus duration, tinnitus measurements, normal hearing or associated hearing loss. Among the patients considered, 223 have normal hearing while 297 have a hearing deficit. The hearing impairment was found to be in most cases of sensorineural type. The subjective discomfort is higher in presence of hearing loss. Subjects with hearing loss needed significantly higher masking levels. No evident differences in the residual inhibition (RI) result between the two groups were found. The present study confirms that tinnitus is most frequently associated with hearing loss. The characteristics of tinnitus in normal hearing subjects, except for the subjective judgment of tinnitus intensity, the pitch and the RI, are significantly different for those observed in subjects with hearing loss. The association of tinnitus and hearing deficit seems to increase the perceived severity of the symptom.

Despite its incidence, there are still few reports in literature relating to tinnitus in children. Almost all data were collected by means of questionnaires or in a limited population of children. In order to collect data in a homogeneous way and directly from the patients, the protocol of study proposed by Savastano has been applied to 1,100 children. The results showed tinnitus as present in 374 children but only 6.5% of the cases complained spontaneously about it. In all, 76.4% of the children demonstrated normal hearing, whereas 64.5% reported being bothered by their tinnitus. Tinnitus measurements were obtained and are reproducible in all patients older than 8 years of age. The loudness level was <10 dB in 48.6% of cases, which was higher than 10 dB in 51.4%. As for the frequency distribution, in most cases it appears to be between 0 and 1,000 Hz. There is a correspondence between the loudness level and masking level. A total inhibition of <60 s for most children with lower loudness was obtained. The present study demonstrates that the application in the infancy of a specific protocol of study allows the presence of tinnitus to be discovered, giving specific and detailed information about it so as to minimize its damage to be obtained. Moreover, for the first time, data regarding the measurement of tinnitus in childhood has been gathered.

To assess whether pathogenic endothelial dysfunction is involved in acute idiopathic tinnitus we enrolled 44 patients and 25 healthy volunteers. In blood from the internal jugular vein and brachial vein we determined malonaldehyde, 4-hydroxynonenal, myeloperoxidase, glutathione peroxidase, nitric oxide, L-arginine and L-ornitine, thrombomodulin (TM) and von Willebrand factor (vWF) activity during tinnitus and asymptomatic period. Higher plasma concentrations of oxidative markers and L-arginine, and lower nitric oxide and L-ornitine levels were observed in jugular blood of patients with tinnitus, there being a significant difference between brachial and jugular veins. TM and vWF activity were significantly higher in patients' jugular blood than in brachial blood. Our results suggest oxidant, TM, vWF activity production are increased and nitric oxide production reduced in brain circulation reflux blood of patients with acute tinnitus. These conditions are able to cause a general cerebro-vascular endothelial dysfunction, which in turn induce a dysfunction of microcirculation in the inner ear.

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