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Seasonal trends in tinnitus symptomatology: evidence from Internet search engine query data
Abstract
The primary aim of this study was to test the hypothesis that the symptom of tinnitus demonstrates a seasonal pattern with worsening in the winter relative to the summer using Internet search engine query data. Normalized search volume for the term 'tinnitus' from January 2004 through December 2013 was retrieved from Google Trends. Seasonal effects were evaluated using cosinor regression models. Primary countries of interest were the United States and Australia. Secondary exploratory analyses were also performed using data from Germany, the United Kingdom, Canada, Sweden, and Switzerland. Significant seasonal effects for 'tinnitus' search queries were found in the United States and Australia (p < 0.00001 for both countries), with peaks in the winter and troughs in the summer. Secondary analyses demonstrated similarly significant seasonal effects for Germany (p < 0.00001), Canada (p < 0.00001), and Sweden (p = 0.0008), again with increased search volume in the winter relative to the summer. Our findings indicate that there are significant seasonal trends for Internet search queries for tinnitus, with a zenith in winter months. Further research is indicated to determine the biological mechanisms underlying these findings, as they may provide insights into the pathophysiology of this common and debilitating medical symptom.
... Interestingly, related research has only been presented on data that was gathered without any mHealth context. For example, a study on seasonal changes in tinnitus symptomatology concluded that searches for tinnitus aspects are higher in winter than in summer, as well as when comparing countries [7]. Another work suggests an association with depression, which constitutes a common comorbidity of tinnitus, and season [8]. ...
... If the data are not grouped by country, momentary tinnitus is most likely to occur in the summer. This is in contrast to the results of [7], where Tinnitus was most likely in summer. When we group our data by country, an ambiguous picture emerges between countries as to the most likely season for tinnitus. ...
... This question cannot be answered unambiguously and conclusively. Related work on tinnitus and seasonality does suggest winter as the worst season [7,9,10]. However, 41.8% of all individuals (n = 100) report perceiving summer as the second-worst season, which argues against the theory of seasonal affective disorders [47]. ...
Tinnitus is an auditory phantom perception without external sound stimuli. This chronic perception can severely affect quality of life. Because tinnitus symptoms are highly heterogeneous, multimodal data analyses are increasingly used to gain new insights. MHealth data sources, with their particular focus on country- and season-specific differences, can provide a promising avenue for new insights. Therefore, we examined data from the TrackYourTinnitus (TYT) mHealth platform to create symptom profiles of TYT users. We used gradient boosting engines to classify momentary tinnitus and regress tinnitus loudness, using country of origin and season as features. At the daily assessment level, tinnitus loudness can be regressed with a mean absolute error rate of 7.9% points. In turn, momentary tinnitus can be classified with an F1 score of 93.79%. Both results indicate differences in the tinnitus of TYT users with respect to season and country of origin. The significance of the features was evaluated using statistical and explainable machine learning methods. It was further shown that tinnitus varies with temperature in certain countries. The results presented show that season and country of origin appear to be valuable features when combined with longitudinal mHealth data at the level of daily assessment.
... The Google searches data could be reached and downloaded from the year 2004 [15]. Several examinations used Google Trends data to examine the seasonal variation in varying health problems, such as depression [16], major mental illnesses [17], restless leg syndrome [18,19], sleep disordered breathing [20], multiple sclerosis [21], leg cramps [19,22], brain aneurysms and subarachnoid hemorrhage [23], tinnitus [24], foot and ankle pain [25], ankle swelling [26], vitamin D [27], systemic lupus erythematous [28], gout [29], rhinitis [30], tanning using [31], and cellulitis [32]. ...
... The observational, ecological research was performed according to the Helsinki declaration, and the policy of Google [33]. As indicated in earlier researches, an ethics approval was not necessary [18,20,[23][24][25]31], because our study consisted of data that available to the public with no person-identifiable info. We adhered the recommendation of a current overview on Google Trends in health care research [13]. ...
... We selected the USA, the UK, Canada, and Australia because these countries reflect native English-speaking countries in both hemispheres. With an inclusion of countries of both hemispheres, we can assess the seasonal pattern, which is expected as reversed by about 6 months among the hemispheres, similarly emphasized in previous studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. New Zealand and Ireland could not be included because Google Trends did not provide any data for our study's primary search query (teeth grinding + teeth clenching); probably, the data were too sparse to generate trend (Supplementary file 2). ...
Objective
Seasonality of bruxism and its symptoms has not been tested and reflects a major niche in our understanding and the epidemiology of bruxism. Our aim is to use the Google Trends data to examine whether there was a seasonal pattern in the Google search volumes of bruxism and its symptoms on a population basis.
Methods
In the observational, ecological research, we interrogated Google Trends for the following query terms: [bruxism] and [teeth grinding + teeth clenching] to obtain the internet search query volume. These queries were searched within the USA, the UK, Canada, and Australia from January 2004 to December 2017.
Results
The cosinor analysis showed statistically significant seasonal patterns in [bruxism] in the USA (amplitude {A} = 1.91, p = 0.003), Canada (A = 1.91, p < 0.001), and Australia (A = 2.25, p < 0.001), and a trend towards a seasonal variation in the UK (A = 1.11, p = 0.032), with a peak in the winter months and trough in the summer months. Similarly, a statistically significant seasonal variation was found in [teeth grinding + teeth clenching] in the USA (A = 5.54, p < 0.001), the UK (A = 4.36, p < 0.001), and Australia (A = 3.11, p < 0.001), and a trend towards a seasonal variation in Canada (A = 1.53, p = 0.034). The peaks in winter and troughs in summer were reversed by 6 months in countries of northern hemisphere compared to Australia. Time series plots emphasized the consistency of seasonal trend that was ascertained in the cosinor analysis, by repeating in nearly all years.
Conclusion
The preliminary evidence showed a seasonal variation in bruxism and its symptoms, with a peak in the winter months. This novel finding in bruxism epidemiology requires to be verified with clinical studies, and further researches are necessary to elucidate the potential mechanism behind seasonal variation in bruxism.
... It represents an unbiased sample of Google engine data, which can be sampled from as far back as 2004 [16]. An increasing number of studies have investigated Google Trends data to test the seasonality of a variety of health conditions, including depression [17], major mental illnesses [18], restless leg syndrome [19,20], sleep-disordered breathing [21], multiple sclerosis [22], leg cramps [20,23], brain aneurysms and subarachnoid hemorrhage [24], tinnitus [25], foot and ankle pain [26], ankle swelling [27], vitamin D [28], systemic lupus erythematous [29], rhinitis [30], tanning using [31], and cellulitis [32]. ...
... This observational, ecological study was conducted in accordance with the Declaration of Helsinki, as well as the Google's terms of service and privacy policy [37]. As highlighted in the previous studies, formal ethics approval was not required [19,21,[24][25][26][27]31], since this work comprised publicly available anonymous data, and contained no personally identifiable information. In this study, the documentation use followed the recommendations of a recent review addressing Google Trends in healthcare studies [14]. ...
... The USA, the UK, Canada, Ireland, Australia, and New Zealand were chosen as majority native English-speaking countries in the northern and southern hemispheres. Including countries from both hemispheres allows for assessing seasonal variations that are expected to be out of phase by about 6 months between these hemispheres, as indicated in earlier investigations [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. ...
Introduction/objective
While few studies with various types of outcomes and methodology have investigated the seasonality of gout, no internet data has been used in any study. This novel methodology may complement and extend the previous traditional data sources and has increasingly been used in investigating the seasonality of health conditions. Therefore, the objective of this study was to utilize the Google Trends data to test whether there is a seasonal variation in the internet searches for gout on a population basis.
Methods
In this observational ecological study, the Google Trends was searched for the [gout] within the USA, the UK, Canada, Ireland, Australia, and New Zealand from January 01, 2004, to December 31, 2017, utilizing the “health” category.
Results
The cosinor analyses revealed a statistically significant seasonal variation in relative search volume of the [gout] in the USA, the UK (p < 0.001), Canada (p < 0.001), Ireland (p < 0.001), Australia (p < 0.001), and New Zealand (p < 0.001), with a peak in the late spring/early summer months and trough in the late fall/early winter months. The peaks in late spring/early summer and troughs in late fall/early winter were out of phase by 6 months in the northern compared to the southern hemisphere countries.
Conclusion
Another line of evidence from internet search query data showed a seasonal variation in gout, with a peak in the late spring/early summer months. Further studies aimed at elucidating the possible mechanisms behind seasonality in gout are needed.
... [2] Notably, several studies have already used GT to analyze web user searches for different otolaryngological symptoms, conditions, and diseases. [3][4][5][6] Furthermore, conditions in other medical disciplines have been assessed, including in cardiology [7,8], urology [9], and orthopedic surgery [10]. In general, the internet has become an appealing source of health care information, particularly for younger people, who are more amenable to new and innovative approaches for gaining novel information in an online environment [11]. ...
... As noted, GT has often been used to analyze user-associated online behavior in regard to different otorhinolaryngologic conditions [3][4][5][6]16]. Furthermore, public online interest for certain oral, maxillofacial, and dentistry problems has been analyzed by several authors [31][32][33]. ...
Background
The data retrieved with the online search engine, Google Trends, can summarize internet inquiries into specified search terms. This engine may be used for analyzing inquiry peaks for different medical conditions and symptoms.
Objective
The aim of this study was to analyze World Wide Web interest peaks for “ear pain,” “ear infection,” and “ear drops.”
Methods
We used Google Trends to assess the public online interest for search terms “ear pain,” “ear infection,” and “ear drops” in 5 English and non–English-speaking countries from both hemispheres based on time series data. We performed our analysis for the time frame between January 1, 2004, and December 31, 2019. First, we assessed whether our search terms were most relevant to the topics of ear pain, ear infection, and ear drops. We then tested the reliability of Google Trends time series data using the intraclass correlation coefficient. In a second step, we computed univariate time series plots to depict peaks in web-based interest. In the last step, we used the cosinor analysis to test the statistical significance of seasonal interest peaks.
ResultsIn the first part of the study, it was revealed that “ear infection,” “ear pain,” and “ear drops” were the most relevant search terms in the noted time frame. Next, the intraclass correlation analysis showed a moderate to excellent reliability for all 5 countries’ 3 primary search terms. The subsequent analysis revealed winter interest peaks for “ear infection” and “ear pain”. On the other hand, the World Wide Web search for “ear drops” peaked annually during the summer months. All peaks were statistically significant as revealed by the cosinor model (all P values
... It involves the analysis of online search patterns to gain more insight on human behavior to inform medical professionals [9]. Indeed, several medical reports assessed the seasonality of different symptoms and diseases, such as tinnitus, epistaxis, laryngitis or dengue fever using GT [9][10][11][12][13][14][15]. However, up to now, literature has been sparse on web-based inquiries regarding acute pharyngitis or its most common symptoms. ...
... In recent years, GT was often used for infodemiological assessment of different medical phenomena [9][10][11][12][13][14][15]. As shown by Kang et al. [34], GT has been proven to be a good complementary source for surveillance of annual influenza outbreaks and noted that GT could be used for detecting early signals of major outbreaks. ...
Objective
To assess whether web-based public inquiries into pharyngitis-related search terms follow annual incidence peaks of acute pharyngitis in various countries from both hemispheres.
Methods
Google Trends (GT) was utilized for systematic acquisition of pharyngitis-related search terms (sore throat, cough, fever, cold). Six countries from both hemispheres including four English (United Kingdom, United States, Canada, and Australia) and two non-English speaking countries (Austria and Germany) were selected for further analysis. Time series data on relative search interest for pharyngitis-related search terms, covering a timeframe between 2004 and 2019 were extracted. Following reliability analysis using the intra-class correlation coefficient, the cosinor time series analysis was utilized to determine annual peaks in public-inquiries.
Results
The extracted datasets of GT proved to be highly reliable with correlation coefficients ranging from 0.83 to 1.0. Graphical visualization showed annual seasonal peaks for pharyngitis-related search terms in all included countries. The cosinor time series analysis revealed these peaks to be statistically significant during winter months (all p < 0.001).
Conclusion
Our study revealed seasonal variations for pharyngitis-related terms which corresponded to winter incidence peaks of acute pharyngitis. These results highlight the need for easily accessible information on diagnosis, therapy, and red-flag symptoms for this common disease. Accurately informed patients might contribute to a reduction of unnecessary clinic visits and potentially cutback the futile antibiotic overuse.
... A popular tool for big data mining is represented by Google Trends (GT), which allows users to explore oscillations in public interest, by selecting filters on geographical location and time [14]. Owing to these circumstances, it is not surprising that many health-related issues have already been associated with internet-search peaks in recent years to complement traditional data sources [15][16][17][18][19][20][21][22]. Noteworthy, previous studies on nose bleeding and GT suffered from two major methodological shortcomings: First, no systematical approach was chosen for evaluating epistaxis-related search terms that are representative for the general population. ...
... Furthermore, the "health" category was selected to evaluate health specific interest. In accordance to previously published studies, winter months were defined as December, January, February and March for the northern hemisphere, whereas June, July, August and September were assigned to the southern hemisphere [15][16][17]28]. The present study followed the checklist for use of GT in health care research by Nuti et al. [21]. ...
PurposeEpistaxis represents the most frequent ear, nose, throat-related emergency symptom. Seasonal variation in epistaxis incidence, with peaks during winter months, is widely accepted, although the literature itself remains inconclusive. The objective of this study was to evaluate public inquiry into nose bleeding, by considering Google-based search query frequency on “Epistaxis”-related search terms and to assess possible seasonal variations globally.Methods
Epistaxis-related search terms were systematically collected and compared using Google Trends (GT). Relative search volumes for the most relevant epistaxis-related terms, covering a timeframe from 2004 to 2019 were analysed using cosinor time series analysis for the United States of America, Germany, the United Kingdom, Italy, Canada, Australia, and New Zealand.ResultsGraphical representation revealed seasonal variations with peaks during winter months in the majority of countries included. Subsequent cosinor analysis revealed these variations to be significant (all p < 0.001).Conclusion
Public interest in seeking epistaxis-related information through the Internet displayed seasonal patterns in countries from both hemispheres, with the highest interest during winter months. Further studies exploring causality with environmental factors are warranted.
... The Google Trends has been presenting these search query data that can be pulled from as early as 2004 [19]. Up to this point, several studies have used Google Trends data in examining the public interest in a wide spectrum of acute health issues, including aneurysmal subarachnoid hemorrhage [28], foot and ankle pain [49], ankle swelling [30], tanning practices [50], and cellulitis [55]; and also a wide range of chronic health issues such as depression [53], mental health problems [3], restless legs [24,38], snoring and sleep apnea [23], bruxism [27], multiple sclerosis [34], nocturnal leg cramp [17,38], tinnitus [42], vitamin D [35], lupus [45], gout [26], and rhinitis [8]. These studies have also demonstrated the Google Trends data as useful in testing the seasonal trends of seeking out online health information [3, 8, 17, 23, 24, 26-28, 30, 32, 34, 35, 38, 42, 45, 49, 50, 53, 55]. ...
... Similar to the previously published investigations assessing the seasonal pattern in the internet searches for healthrelated topics by leveraging Google Trends data [23,24,35,42,50], the cosinor analyses were employed to assess the seasonal patterns. Cosinor analyses and the application by which the cosinor analysis is executed has been explained somewhere else [5,6]. ...
Some researches with different designs investigated the seasonal pattern of psoriasis; however, the seasonal variation in public interest in psoriasis has not yet been examined. The monitoring of internet search activity has increasingly been used to gain insights into public interest in health-related topics. The aim of the investigation is to employ the Google Trends datasets to evaluate whether a seasonal trend exists in the internet searches of psoriasis by the general public. In the observational investigation, the Google Trends was queried for the [psoriasis] in the United States, the United Kingdom, Canada, Ireland, Australia, and New Zealand between January 2004 and December 2018. The cosinor analysis demonstrated a statistically significant seasonal pattern of searches for [psoriasis] in the United Kingdom (p < 0.001), Canada (p = 0.002), Ireland (p < 0.001), Australia (p < 0.001), and New Zealand (p < 0.001), and a trend towards a seasonal variation in searches in the United States (p = 0.079), with the zenith in late winter/early spring and through in late summer/early fall. A zenith in late winter/early spring and valley in late summer/early fall presented an approximately 6-month difference between hemispheres. Public interest in seeking psoriasis information through internet searches displayed a seasonal pattern, with the highest interest in the late winter/early spring. If a more comprehensive study validated the association of psoriasis flares with patterns in online searches, beyond investigating only seasonality in public interest, the internet data could be used to guide public health interventions and to manage the care of patients with psoriasis.
... Currently, the scientific literature lacks any leads to how relative humidity could affect tinnitus directly. An infodemiological study reported a winter peak in web-based inquiries for tinnitus [37]. Relative humidity is generally higher in winter as colder air has a decreased capability of holding water vapor and saturates at lower levels than hot air. ...
Purpose
Extreme weather events are rising due to the accelerating pace of climate change. These events impact human health and increase emergency room visits (EV) for many morbidities. Tinnitus is a common cause of EVs within otolaryngology in Germany and Austria. The effect of extreme weather conditions on tinnitus-related EVs is unknown.
Methods
A total of 526 tinnitus-related EVs at a tertiary care hospital in Vienna were identified. A distributed lag non-linear model with a maximum lag period of 14 days was fitted to investigate the immediate and delayed effect of single-day and prolonged (three-day) extreme atmospheric pressure, relative humidity, mean temperature, precipitation and mean wind speed on EV rates. Extreme conditions were defined as the 1st, 5th, 95th, and 99th percentile of the meteorological variables. Relative risk (RR) is defined as risk for tinnitus-related EVs at an extreme condition compared to the risk at the median weather condition. Cumulative RR (cRR) is the total cumulated EV risk for a given time period.
Results
High relative humidity increased same-day RR for tinnitus-related EVs to 1.75. Both low and high atmospheric pressure raised cRR as early as three days after an event to a maximum of 3.24. Low temperatures mitigated cRR within 4 days, while high temperatures tended to increase risk. Prolonged precipitation reduced cRR within one day.
Conclusion
Extreme meteorological conditions are associated with tinnitus-related EV rates. Further investigation into potential causative links and underlying pathophysiological mechanisms is warranted.
... Google Trends studies can be characterized into three main areas [36]: identifying seasonality, examining correlations between surveillance data and Google Trends, and forecasting. Seasonality has most commonly been investigated through visual observation [37][38][39][40][41][42], Kruskal-Wallis test [43][44][45], and Cosinor analysis [42,[46][47][48][49]. The Pearson correlation coefficient is the principal statistical measure used to compare surveillance data to Google Trends [24,27,[50][51][52][53][54][55][56][57][58][59][60][61][62][63][64]. ...
The COVID-19 pandemic has disrupted the seasonal patterns of several infectious diseases. Understanding when and where an outbreak may occur is vital for public health planning and response. We usually rely on well-functioning surveillance systems to monitor epidemic outbreaks. However, not all countries have a well-functioning surveillance system in place, or at least not for the pathogen in question. We utilized Google Trends search results for RSV-related keywords to identify outbreaks. We evaluated the strength of the Pearson correlation coefficient between clinical surveillance data and online search data and applied the Moving Epidemic Method (MEM) to identify country-specific epidemic thresholds. Additionally, we established pseudo-RSV surveillance systems, enabling internal stakeholders to obtain insights on the speed and risk of any emerging RSV outbreaks in countries with imprecise disease surveillance systems but with Google Trends data. Strong correlations between RSV clinical surveillance data and Google Trends search results from several countries were observed. In monitoring an upcoming RSV outbreak with MEM, data collected from both systems yielded similar estimates of country-specific epidemic thresholds, starting time, and duration. We demonstrate in this study the potential of monitoring disease outbreaks in real time and complement classical disease surveillance systems by leveraging online search data.
... Mountain View, CA, US), using the term tinnitus as "medical topic" (thus overcoming possible linguistic differences), setting the geographical area to "worldwide", within a search period comprising the past 5 years (i.e., from August 2017 to August 2022). The weekly Google Trends score for the term tinnitus, which was found to reliably reflect the impact of this condition in the general population [3], was primarily separated in two periods, i.e., "pre-COVID-19" (between August 2017 and February 2020) and "COVID-19" (between March 2020 and August 2022), for demarcating the initiation of the COVID-19 pandemic, but was then also clustered within specific period of prevalence of different SARS-CoV-2 variants (i.e., ancestral: March 2020-January 2021; Alpha: February 2021-June 2021; Delta: July 2021-December 2021; Omicron: January 2022-August 2022), as described elsewhere [4]. The median number (and interquartile range; IQR) of weekly Google searches for "tinnitus" was then compared with Mann-Whitney test (Analyse-it Software Ltd, Leeds, UK). ...
Background: This infodemiological analysis is aimed to define whether the worldwide burden of tinnitus may have increased during the coronavirus disease 2019 (COVID-19) pandemic. Methods. We performed an electronic search in Google Trends with the term tinnitus as “medical topic”, setting the geographical area to “worldwide”, within a search period comprising the past 5 years (i.e., from August 2017 to August 2022). Results: A significant increase has been observed in the median worldwide burden of Google searches for tinnitus by comparing the volume after (median, 64; IQR, 60-69) versus before (58; IQR 52-61; p<0.001; +10.3%) the initiation of the COVID-19 pandemic. Although such trend was consistent over time irrespective of the virus variants, with values of Google searches always higher than the pre-COVID period (all p<0.001), higher weekly Google Trends searches were noted during prevalence of Delta and Omicron lineages. Conclusion: Specific interventions shall be planned to support the larger number of patients that may seek healthcare consultation and/or may need to live with tinnitus after the COVID-19 pandemic.
... Tinnitus has been reported to have a seasonal pattern, where it is worse in the winter than in the summer. 73 Thus, the hours of sunlight per day or certain temperatures might be associated with the onset or severity of tinnitus. Countries with their main city at an intermediate latitude (40°-51°) had the lowest prevalence and the lowest severity of tinnitus. ...
Importance:
To date, no systematic review has taken a meta-analytic approach to estimating the prevalence and incidence of tinnitus in the general population.
Objective:
To provide frequency estimates of tinnitus worldwide.
Data sources:
An umbrella review followed by a traditional systematic review was performed by searching PubMed-MEDLINE and Embase from inception through November 19, 2021.
Study selection:
Research data from the general population were selected, and studies based on patients or on subgroups of the population with selected lifestyle habits were excluded. No restrictions were applied according to date, age, sex, and country.
Data extraction and synthesis:
Relevant extracted information included type of study, time and location, end point, population characteristics, and tinnitus definition. The study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.
Main outcomes and measures:
Pooled prevalence estimates of any tinnitus, severe tinnitus, chronic tinnitus, and diagnosed tinnitus as well as incidence of tinnitus were obtained using random-effects meta-analytic models; heterogeneity between studies was controlled using the χ2 test, and inconsistency was measured using the I2 statistic.
Results:
Among 767 publications, 113 eligible articles published between 1972 and 2021 were identified, and prevalence estimates from 83 articles and incidence estimates from 12 articles were extracted. The pooled prevalence of any tinnitus among adults was 14.4% (95% CI, 12.6%-16.5%) and ranged from 4.1% (95% CI, 3.7%-4.4%) to 37.2% (95% CI, 34.6%-39.9%). Prevalence estimates did not significantly differ by sex (14.1% [95% CI, 11.6%-17.0%] among male individuals; 13.1% [95% CI, 10.5%-16.2%] among female individuals), but increased prevalence was associated with age (9.7% [95% CI, 7.4%-12.5%] among adults aged 18-44 years; 13.7% [95% CI, 11.0%-17.0%] among those aged 45-64 years; and 23.6% [95% CI, 19.4%-28.5%] among those aged ≥65 years; P < .001 among age groups). The pooled prevalence of severe tinnitus was 2.3% (95% CI, 1.7%-3.1%), ranging from 0.5% (95% CI, 0.3%-0.7%) to 12.6% (95% CI, 11.1%-14.1%). The pooled prevalence of chronic tinnitus was 9.8% (95% CI, 4.7%-19.3%) and the pooled prevalence of diagnosed tinnitus was 3.4% (95% CI, 2.1%-5.5%). The pooled incidence rate of any tinnitus was 1164 per 100 000 person-years (95% CI, 479-2828 per 100 000 person-years).
Conclusions and relevance:
Despite the substantial heterogeneity among studies, this comprehensive systematic review on the prevalence and incidence of tinnitus suggests that tinnitus affects more than 740 million adults globally and is perceived as a major problem by more than 120 million people, mostly aged 65 years or older. Health policy makers should consider the global burden of tinnitus, and greater effort should be devoted to boost research on tinnitus.
... This newly defined research area mainly uses Google Trends (GT), a tool that provides information on the extent of the relative search interest for specific search terms categorized by geographical location and timeframe. To date, web-based interest has been associated with seasonal trends for various diseases and disorders, amongst them the flu [7,[17][18][19][20]. ...
Background: Corona Virus Disease 2019 (COVID-19) emerged in December 2019 and rapidly spread globally. Since there is still no specific treatment available, prevention of disease spread is crucial to manage the pandemic. Adequate public information is very important. To assess the optimal timing, the aim of this study was to investigate the association between web-based interest and new cases and deaths due to COVID-19.
Methods: Web-based interest for queries related to ‘coronavirus’ was assessed between 1 January and 19 June 2020, using Google Trends in Australia, Brazil, Canada, Germany, Italy, South Africa, South Korea, Spain, United Kingdom, and the United States of America. Reliability analysis of the used search terms was performed using the intraclass
correlation coefficient. To investigate the association between web-based interest and new COVID-19 cases or deaths, the relative search volume was analysed for correlation with new cases and deaths.
Results: Reliability analysis revealed excellent reliability for COVID-19 search terms in all countries. Web-based interest peaked between 23 February and 5 April 2020, which was prior to the peak of new infections and deaths in most included countries. There was a moderate to strong correlation between COVID-19 related queries and new cases or new deaths.
Conclusion: Web-based interest in COVID-19 peaked prior to the peak of new infections and deaths in most countries included. Thus, monitoring public interest via Google Trends might be useful to select the optimal-timing of web-based disease-specific information and preventive measures.
... Time series seasonal decomposition analysis was applied to represent the trend and seasonality in a time series. All time series data were decomposed into a trend Similar to existing studies analyzing the seasonal trends of health status utilizing network data (19,20,21), the cosinor analysis was applied to validate the hypothesis that the RSV of cancer recurrence displays significant seasonality during the period of . CC-BY 4.0 International license perpetuity. ...
Background
While few clinical and epidemiological studies have assessed how seasonality affects cancer recurrence, it has not been studied with the utility of the internet data. In this study, we aim to test whether cancer recurrence presents seasonality on a population level, utilizing internet search query data.
Methods
This infodemiological study used Google Trends to find query data for the term “cancer recurrence” from January 01, 2004, to December 31, 2018 in the USA, the UK, Canada, and Australia. Time series seasonal decomposition and the cosinor analysis were used to analyze and describe the seasonal trends for cancer recurrence.
Results
A general upward trend in UK and northern hemisphere were observed. Statistically significant seasonal trends on “cancer recurrence” in the USA ( p =1.33×10 ⁻⁵ ), the UK ( p =0.012), and northern hemisphere ( p =5.67×10 ⁻⁷ ) were revealed by cosinor analysis, with a peak in early summer and nadir in early winter. Besides, a seasonal variation was also found in Australia ( p =2.3×10 ⁻⁴ ), with a peak in late summer and nadir in late winter.
Conclusions
The evidence from internet search query data showed a seasonal variation in cancer recurrence, with a peak in early summer(northern hemisphere)/late summer(southern hemisphere). Besides, the relative search volume of “cancer recurrence” appeared a general upward trend in UK and northern hemisphere in recent years.
... The most popular way to explore seasonality is to use visual evidence and examine and discuss peaks, as shown in Table 2. Furthermore, several studies have used cosinor analysis [8,69,134,138,142], which is a time series analysis method for seasonal data using least squares. ...
Background: In the era of information overload, are big data analytics the answer to access and better manage available knowledge? Over the last decade, the use of Web-based data in public health issues, that is, infodemiology, has been proven useful in assessing various aspects of human behavior. Google Trends is the most popular tool to gather such information, and it has been used in several topics up to this point, with health and medicine being the most focused subject. Web-based behavior is monitored and analyzed in order to examine actual human behavior so as to predict, better assess, and even prevent health-related issues that constantly arise in everyday life.
Objective: This systematic review aimed at reporting and further presenting and analyzing the methods, tools, and statistical approaches for Google Trends (infodemiology) studies in health-related topics from 2006 to 2016 to provide an overview of the usefulness of said tool and be a point of reference for future research on the subject.
Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for selecting studies, we searched for the term “Google Trends” in the Scopus and PubMed databases from 2006 to 2016, applying specific criteria for types of publications and topics. A total of 109 published papers were extracted, excluding duplicates and those that did not fall inside the topics of health and medicine or the selected article types. We then further categorized the published papers according to their methodological approach, namely, visualization, seasonality, correlations, forecasting, and modeling.
Results: All the examined papers comprised, by definition, time series analysis, and all but two included data visualization. A total of 23.1% (24/104) studies used Google Trends data for examining seasonality, while 39.4% (41/104) and 32.7% (34/104) of the studies used correlations and modeling, respectively. Only 8.7% (9/104) of the studies used Google Trends data for predictions and forecasting in health-related topics; therefore, it is evident that a gap exists in forecasting using Google Trends data.
Conclusions: The monitoring of online queries can provide insight into human behavior, as this field is significantly and continuously growing and will be proven more than valuable in the future for assessing behavioral changes and providing ground for research using data that could not have been accessed otherwise.
... We also focus on work that estimates biologically-rooted metrics. For example, we exclude metrics based on seasonality [11,130], pollen counts [58,165], over-the-counter drug sales volume [82,98], and emergency department visits [52]. ...
Effective disease monitoring provides a foundation for effective public health systems. This has historically been accomplished with patient contact and bureaucratic aggregation, which tends to be slow and expensive. Recent internet-based approaches promise to be real-time and cheap, with few parameters. However, the question of when and how these approaches work remains open. We addressed this question using Wikipedia access logs and category links. Our experiments, replicable and extensible using our open source code and data, test the effect of semantic article filtering, amount of training data, forecast horizon, and model staleness by comparing across 6 diseases and 4 countries using thousands of individual models. We found that our minimal-configuration, language-agnostic article selection process based on semantic relatedness is effective for improving predictions, and that our approach is relatively insensitive to the amount and age of training data. We also found, in contrast to prior work, very little forecasting value, and we argue that this is consistent with theoretical considerations about the nature of forecasting. These mixed results lead us to propose that the currently observational field of internet-based disease surveillance must pivot to include theoretical models of information flow as well as controlled experiments based on simulations of disease.
Tinnitus, affecting 10–15% of adults, is a multifactorial disorder with a challenging etiology. It is often associated with sex, age, obesity, smoking, and alcohol consumption. Current literature suggests that tinnitus could be associated with seasonal variability, exhibiting seasonal patterns. Although tinnitus is suggested to follow a seasonal trend conclusive evidence associating its onset to seasonality is lacking. This study aims to evaluate the impact of seasonal variability on the prevalence of tinnitus. Data was collected from MDClone platform regarding patients admitted to ‘Clalit medical services' in Israel's southern district due to the first emergence of tinnitus symptoms between the years 2005–2020. The comparison was relaying on difference in gender, age, known risk factors for tinnitus, and date of onset of tinnitus. A total of 56,315 patients were included in this cohort study. Winter is the most common season for first admissions due to tinnitus symptoms including 16,094 patients (29%). Summer (Beta = –3.037, p = 0.012) and autumn (Beta = –3.764, p < 0.001) show a negative effect on minimal mean temperature which suggest lower tinnitus incidence in a higher temperature. Humidity and maximal mean temperature did not show any statistical significance. Except for age (mean 51.73 ± 17.49), no statistical significance was found in the prevalence of risk factors related to tinnitus. In conclusion Our findings shows that tinnitus is associated with seasonality and its trends. The incidence of tinnitus is declining over the past two decades following a peak in the winter, with age being the only significant risk factor.
We conducted an umbrella review of the scientific literature followed by a systematic review to comprehensively collect existing evidence on global prevalence from national or regional representative samples of tinnitus. The present chapter shows selected results from a comprehensive recently published systematic review and meta-analysis (Jarach et al., 2022; JAMA Neurol. 2022;79(9):888–900).
Out of 767 publications retrieved in November 2021, we identified 113 eligible publications and extracted prevalence estimates from 89 articles included in the meta-analyses. We present here results from 81 articles with available information on any or severe tinnitus. Overall, prevalence of any tinnitus was 14.4% in adults and 13.6% in children; prevalence of severe tinnitus was 2.3% in adults and 2.7% in children.
Prevalence estimates did not significantly differ by sex, while tinnitus prevalence increased with increasing age: any tinnitus was reported by 9.7% of young adults, 13.7% of middle-aged adults, and 23.6% of older adults. Corresponding estimates for severe tinnitus were 0.4% in young adults, 2.7% in middle aged, and 6.9% among older adults, respectively.
Our results indicate that globally tinnitus affects more than 740 million people and is felt as a major problem by more than 120 million subjects, mostly aged 65 years or more.
Objective:
Approximately 50 million US adults experience chronic tinnitus, yet search behaviors and topics of concern to these patients have not been investigated on a national level.
Study design:
Observational.
Setting:
Online database and tertiary otology clinic.
Patients:
Nationwide and institutional samples.
Interventions:
None.
Main outcome measure:
A search engine optimization tool was utilized to extract metadata on "People Also Ask" (PAA) questions pertaining to tinnitus. Website quality was assessed using JAMA benchmark criteria. Search volume trends were investigated along with institutional-level data on tinnitus incidence.
Results:
Of the 500 PAA questions assessed, the majority (54.0%) contained value-type content. The most popular question categories pertained to tinnitus treatment (29.3%), alternative treatment approaches (21.5%), technical details (16.9%), and timeline of symptoms (13.4%). Patients were most interested in treatment with wearable masking devices and most commonly searched for tinnitus as being attributable to a neurologic etiology. Online searches pertaining to unilateral tinnitus symptoms have increased >3-fold since the onset of the COVID-19 pandemic. Likewise, review of patient encounters at our tertiary otology clinic revealed a nearly 2-fold increase in tinnitus consultations since 2020.
Conclusions:
Topics of interest and concern identified herein may inform the development of patient education materials and help guide clinical practice. Online search data suggest an increase in tinnitus searches since the onset of COVID-19, which did correlate clinically with an increase in tinnitus consultations at our institution.
Background: This infodemiological analysis is aimed to define whether the worldwide burden of tinnitus may have increased during the coronavirus disease 2019 (COVID-19) pandemic.
Methods. We performed an electronic search in Google Trends with the term tinnitus as “medical topic”, setting the geographical area to “worldwide”, within a search period comprising the past 5 years (i.e., from August 2017 to August 2022).
Results: A significant increase has been observed in the median worldwide burden of Google searches for tinnitus by comparing the volume after (median, 64; IQR, 60-69) versus before (58; IQR 52-61; p<0.001; +10.3%) the initiation of the COVID-19 pandemic. Although such trend was consistent over time irrespective of the virus variants, with values of Google searches always higher than the pre-COVID period (all p<0.001), higher weekly Google Trends searches were noted during prevalence of Delta and Omicron lineages.
Conclusion: Specific interventions shall be planned to support the larger number of patients that may seek healthcare consultation and/or may need to live with tinnitus after the COVID-19 pandemic.
Objective:
To investigate the circannual rhythm (seasonal incidence) of idiopathic sudden sensorineural hearing loss (ISSNHL).
Methods:
Data were retrieved from the medical files of an original cohort of all consecutive patients with ISSNHL in a tertiary medical center between 2012 and 2020. A systematic literature search of "MEDLINE" via "PubMed," "Embase," and "Web of Science" on comparable published cases was performed. A Google Trends analysis of the term [sudden hearing loss] and related terms between 2014 and 2020 was also performed.
Results:
Most of the published series (9/12) reported the highest ISSNHL incidence in the spring and the lowest in the winter (8/12). In our local series, the incidence during the winter was significantly lower than that for the other seasons by a factor of 0.69 (95% confidence interval, 0.65-0.77; p = 0.041; r = 0.36). Google Trends data showed no significant correlation between the calendric month and the incidence of ISSNHL in any of the analyzed countries (p = 0.873, r2 = 0.029).
Conclusion:
The ISSNHL incidence was lowest during the winter season in our cohort and reported for other cohorts worldwide. Google Trends-based model analysis did not determine any circannual rhythm.
Objectives:
Prevalence of tinnitus has been reported to vary according to the target population and definition of tinnitus. To improve the understanding of tinnitus, authors used the nation-wide health claim data to study the tinnitus in the entire population of South Korea.
Study design:
Retrospective big data review.
Setting:
Analysis of big data from the National Health Information Database.
Patients:
Patients diagnosed with tinnitus according to International Classification of Diseases code 10th edition (ICD-10) and requested to receive National Health Insurance claim at least once from January 2006 to December 2015.
Intervention:
None.
Main outcome measure:
Epidemiologic data, association of tinnitus with the otologic and systemic diseases.
Results:
The number of patients who received medical care because of tinnitus was 1.44% (0.78 million per 51 million) in 2015. There was a higher prevalence of tinnitus in women, and the overall prevalence increased with increasing age of patients and peaked at patients in their 70s (4.43%). The prevalence of tinnitus among patients aged 10 to 30 years, showed a tendency to increase during study period. In the regional analysis, highest prevalence was observed in Gwangju (2.02%). In comparison with the control group, the patients with tinnitus showed a higher frequency in otologic and systemic disease. Especially, noise induced hearing loss (adjusted odds ratio [AOR] = 82.1, 95% confidence interval [95% CI] = 74.8-90.2) and sudden sensorineueal hearing loss (AOR = 49.7, 95% CI = 48.4-51.0) showed high frequency in tinnitus patient group.
Conclusions:
The prevalence and incidence of tinnitus in this study for entire nation were lower than previously reported studies. These results have limitation because the study only covered patient using the medical service for tinnitus and missed tinnitus sufferers not seeking medical service. However, this study is meaningful in that it was targeting entire nation, reflected the characteristics of clinically significant tinnitus patient enough to visit medical service.
Introduction: Antibiotic-resistant bacteria are an increasing threat to the effectiveness of antibiotics. The majority of antibiotics are prescribed in primary care settings for upper respiratory tract infections. The purpose of this study was to describe seasonal trends in outpatient antibiotic prescriptions in the United States over a 5-year period.Methods: This study was a retrospective, cross-sectional observation of systemic antibiotic prescriptions in the outpatient setting from 2006 to 2010. Winter months were defined as the first and fourth quarters of the calendar year. Antibiotic prescribing rates were calculated (prescriptions/1000 population) using annual U.S. Census Bureau population data.Results: Over 1.34 billion antibiotic prescriptions were dispensed over the 5-year period. The antibiotic prescription (Rx) rate decreased from 892 Rx/1000 population in 2006 to 867 Rx/1000 population in 2010. Penicillins and macrolides were the primary antibiotic classes prescribed, but penicillin prescribing decreased while macrolide prescribing increased over the study period. Overall, antibiotic prescriptions were 24.5% higher in winter months compared to the summer with the largest difference (28.8%) in 2008 and the smallest (20.4%) in 2010. This seasonality was consistently drug class-dependent, driven by a 75% and 100% increase in penicillin and macrolide prescriptions, respectively, in the winter months.Conclusions: The mean outpatient antibiotic prescription rate decreased in the United States from 2006 to 2010. More antibiotic prescribing in the outpatient setting was observed in the winter months, predominately driven by the macrolide and penicillin classes. Understanding annual variability in antibiotic use can assist with designing interventions to improve the judicious use of antibiotics.
There are few studies about the association between tinnitus and sleep disorders in the general population worldwide. This study assessed this association in a Japanese community.
A total of 14,027 participants 45 to 79 years of age who were in the Takayama Study responded to a self-administered questionnaire about tinnitus and sleep disorders.
Of this population, 13.3% of men and 10.6% of women had current tinnitus. The percentages of insomnia, respectively, among individuals with and without tinnitus were 28.1% in men and 36.1% in women and 18.8% in men and 21.5% in women. There were 1.7-fold (95% confidence interval [CI], 1.4 to 2.1) and 1.8-fold (95% CI, 1.5 to 2.2) increases in the odds ratios (ORs) of insomnia for those with tinnitus compared with those without tinnitus in men and women, respectively. Loud or very loud tinnitus was associated with 2.8-fold (95% CI, 1.8 to 4.3) and 3.3-fold (95% CI, 1.9 to 5.6) increases in the OR of insomnia in men and women, respectively. Even low (ie, quiet) or moderate tinnitus was significantly associated with insomnia. Difficulty initiating sleep, difficulty maintaining sleep, and a poor perceived quality of sleep were also significantly associated with tinnitus.
Insomnia and other sleep disorders were significantly associated with tinnitus in Japanese adults.
Despite the fact that urinary tract infection (UTI) is a very frequent disease, little is known about its seasonality in the community.
To estimate seasonality of UTI using multiple time series constructed with available proxies of UTI. Eight time series based on two databases were used: sales of urinary antibacterial medications reported by a panel of pharmacy stores in France between 2000 and 2012, and search trends on the Google search engine for UTI-related terms between 2004 and 2012 in France, Germany, Italy, the USA, China, Australia and Brazil. Differences between summers and winters were statistically assessed with the Mann-Whitney test. We evaluated seasonality by applying the Harmonics Product Spectrum on Fast Fourier Transform. Seven time series out of eight displayed a significant increase in medication sales or web searches in the summer compared to the winter, ranging from 8% to 20%. The eight time series displayed a periodicity of one year. Annual increases were seen in the summer for UTI drug sales in France and Google searches in France, the USA, Germany, Italy, and China. Increases occurred in the austral summer for Google searches in Brazil and Australia.
An annual seasonality of UTIs was evidenced in seven different countries, with peaks during the summer.
Cortisol is critical for maintenance of health and homeostasis and factors affecting cortisol levels are of clinical importance. There is conflicting information about the effects of season on morning cortisol and little information on the effects of sunlight on population cortisol assessment. The aim of this study was to assess whether changes in median serum cortisol occurred in a population in conjunction with changing seasons, daylight saving time (DST) or time of sunrise. We analysed serum cortisol results (n = 27 569) from a single large laboratory over a 13-year period. Subjects with confounding medications or medical conditions were excluded and data analysed in 15-minute intervals. We assessed the influence of traditional seasons, seasons determined by equinox/solstice, DST and time of sunrise on median cortisol. The median time of cortisol collection did not vary significantly between seasons. Using traditional seasons, median cortisol was lowest in summer (386 nmol/L) and spring (384 nmol/L) with higher cortisol in autumn (406 nmol/L) and winter (414 nmol/L). Median cortisol was lowest in the summer solstice quarter with significant comparative increases in the spring equinox quarter (3.1%), the autumn equinox quarter (4.5%) and the winter solstice quarter (8.6%). When cortisol was modelled against time, with adjustment for actual sunrise time on day of collection, for each hour delay in sunrise there was a 4.8% increase in median cortisol (95% CI: 3.9-5.7%). In modelling to explain the variation in cortisol over the morning, sunrise time was better than season in explaining seasonal effects. A subtle cyclic pattern in median cortisol also occurred throughout the months of the year. A 3-year trial of DST allowed comparison of cortisol in DST and non DST periods, when clock time differed by one hour. There was modest evidence of a difference in acrophase between DST and non DST cortisol (p = 0.038), with DST peak cortisol estimated to occur 58 minutes later than non-DST peak. In summary, we found that time of sunrise and time of cortisol collection were the most important factors influencing median cortisol. For each hour later that the sun rose there was an almost 5% increase in median cortisol. There was significant seasonal variability with lowest cortisol noted in summer coinciding with the earliest sunrise time. This is an important finding which is consistent with the understanding that light is the major zeitgeber in entrainment of the human circadian cortisol rhythm. Our data suggest this rhythm is resistant to the arbitrary changes in clock time with daylight saving.
The prevalence of hearing problems in the Western world has, due to aging of the population, doubled over the past 30 years. Thereby, noise-induced hearing loss is an important factor that worsens over time in addition to age-related hearing loss. Hearing loss is usually measured as an elevation of a person's hearing thresholds, expressed in decibel (dB). However, recent animal studies have unraveled a type of permanent cochlear damage, without an elevation of hearing thresholds. This subtle damage is linked to a permanent and progressive degeneration of auditory fibers that occurs in association with damage of the inner hair cell synapse. Afferent neuronal degeneration has been suggested to be involved in hyperacusis (over sensitivity to sound) and tinnitus (a phantom sound percept). Hyperacusis and tinnitus are potentially devastating conditions that are still incurable. The main risk factors to develop tinnitus or hyperacusis are hearing loss, social stress and age. Both tinnitus and hyperacusis have been discussed in the context of a pathological increased response gain in subcortical brain regions as a reaction to deprivation of sensory input. Novel studies confirm the involvement of peripheral deafferentation for tinnitus and hyperacusis, but suggest that the disorder results from different brain responses to different degrees of deafferentation: while tinnitus may arise as a failure of the brain to adapt to deprived peripheral input, hyperacusis may result from an 'over-adaptive' increase in response gain. Moreover, moderate and high stress levels at the time of acoustic trauma have been suggested to play a pivotal role in the vulnerability of the cochlea to acoustic damage and therefore for the development of tinnitus and hyperacusis.
Background:
Acute otitis media (AOM) occurs as a complication of viral upper respiratory tract infections in young children. AOM and respiratory viruses both display seasonal variation. Our objective was to examine the temporal association between circulating respiratory viruses and the occurrence of pediatric ambulatory care visits for AOM.
Methods:
This retrospective study included 9 seasons of respiratory viral activity (2002 to 2010) in Utah. We used Intermountain Healthcare electronic medical records to assess community respiratory viral activity via laboratory-based active surveillance and to identify children <18 years with outpatient visits and International Classification of Diseases, Ninth Revision codes for AOM. We assessed the strength of the association between AOM and individual respiratory viruses using interrupted time series analyses.
Results:
During the study period, 96,418 respiratory viral tests were performed; 46,460 (48%) were positive. The most commonly identified viruses were respiratory syncytial virus (22%), rhinovirus (8%), influenza (8%), parainfluenza (4%), human metapneumovirus (3%) and adenovirus (3%). AOM was diagnosed during 271,268 ambulatory visits. There were significant associations between peak activity of respiratory syncytial virus, human metapneumovirus, influenza A and office visits for AOM. Adenovirus, parainfluenza and rhinovirus were not associated with visits for AOM.
Conclusions:
Seasonal respiratory syncytial virus, human metapneumovirus and influenza activity were temporally associated with increased diagnoses of AOM among children. These findings support the role of individual respiratory viruses in the development AOM. These data also underscore the potential for respiratory viral vaccines to reduce the burden of AOM.
There is a need for effective interventions and policies that target the leading preventable causes of death in the U.S. (e.g., smoking, overweight/obesity, physical inactivity). Such efforts could be aided by the use of publicly available, real-time search query data that illustrate times and locations of high and low public interest in behaviors related to preventable causes of death.
This study explored patterns of search query activity for the terms 'weight', 'diet', 'fitness', and 'smoking' using Google Insights for Search.
Search activity for 'weight', 'diet', 'fitness', and 'smoking' conducted within the United States via Google between January 4(th), 2004 (first date data was available) and November 28(th), 2011 (date of data download and analysis) were analyzed. Using a generalized linear model, we explored the effects of time (month) on mean relative search volume for all four terms.
Models suggest a significant effect of month on mean search volume for all four terms. Search activity for all four terms was highest in January with observable declines throughout the remainder of the year.
These findings demonstrate discernable temporal patterns of search activity for four areas of behavior change. These findings could be used to inform the timing, location and messaging of interventions, campaigns and policies targeting these behaviors.
Tinnitus is a frequent, debilitating hearing disorder associated with severe emotional and psychological suffering. Although a link between stress and tinnitus has been widely recognized, the empirical evidence is scant. Our aims were to test for dysregulation of the stress-related hypothalamus-pituitary adrenal (HPA) axis in tinnitus and to examine ear sensitivity variations with cortisol manipulation.
Twenty-one tinnitus participants and 21 controls comparable in age, education, and overall health status but without tinnitus underwent basal cortisol assessments on three non-consecutive days and took 0.5 mg of dexamethasone (DEX) at 23:00 on the first day. Cortisol levels were measured hourly the next morning. Detection and discomfort hearing thresholds were measured before and after dexamethasone suppression test.
Both groups displayed similar basal cortisol levels, but tinnitus participants showed stronger and longer-lasting cortisol suppression after DEX administration. Suppression was unrelated to hearing loss. Discomfort threshold was lower after cortisol suppression in tinnitus ears.
Our findings suggest heightened glucocorticoid sensitivity in tinnitus in terms of an abnormally strong glucocorticoid receptor (GR)-mediated HPA-axis feedback (despite a normal mineralocorticoid receptor (MR)-mediated tone) and lower tolerance for sound loudness with suppressed cortisol levels. Long-term stress exposure and its deleterious effects therefore constitute an important predisposing factor for, or a significant pathological consequence of, this debilitating hearing disorder.
In rhesus monkeys, the magnitude of the cochlear response to auditory stimuli (click-evoked otoacoustic emissions, [CEOAEs]) is correlated with seasonal changes in circulating testosterone levels. The present study investigated the association between circulating testosterone and CEOAE production in men. CEOAEs were measured in 67 men and 37 women, and saliva was analyzed to quantify bioavailable testosterone. A sex difference in CEOAE response amplitude was found, confirming previous reports. In agreement with the monkey work, seasonal variation in the CEOAE response amplitude also was identified. CEOAEs were greater in summer and fall, the seasons that showed the lowest levels of circulating testosterone. On an individual basis, men who had higher levels of testosterone at the time of assessment exhibited smaller CEOAE response amplitudes. These findings support previous data from rhesus macaques and are consistent with the prospect of an activational effect of testosterone in the human cochlea.
Hearing difficulties are a large public health problem. Knowledge is scarce regarding risk of disability pension among people who have been sickness absent due to these difficulties.
A cohort including all 4,687,756 individuals living in Sweden in 2005, aged 20-64, and not on disability or old-age pension, was followed through 2009. Incidence rate ratios (RR) of disability pension with 95% confidence intervals (CI) were estimated using Cox proportional hazard models.
In multivariable models, individuals who had a sick-leave spell due to otoaudiological diagnoses in 2005 had a 1.52-fold (95% CI: 1.43-1.62) increased risk of being granted a disability pension compared to individuals on sick leave due to other diagnoses. Hearing and tinnitus sick-leave diagnoses were associated with risk of disability pension: RR 3.38, 95% CI: 3.04-3.75, and 3.30, 95% CI: 2.95-3.68, respectively. No association was observed between sick leave due to vertigo diagnoses and disability pension whereas otological diagnoses and no sick leave were inversely associated with risk of disability pension compared to non-otoaudiological sick-leave diagnoses. Sick leave due to otoaudiological diagnoses was positively associated with risk of disability pension due to otoaudiological diagnoses and sick leave due to a tinnitus diagnosis was also associated with risk of disability pension due to mental diagnoses. The risk of disability pension among individuals with hearing or tinnitus sick-leave diagnoses was highest in the age group 35-44. Moreover, men had a slightly higher risk.
This large cohort study suggests an increased risk of disability pension among those with sickness absence due to otoaudiological diagnoses, particularly hearing and tinnitus diagnoses, compared to those with sickness absence due to non-otoaudiological diagnoses.
Data on more than a decade of outpatient macrolide, lincosamide and streptogramin (MLS) use in Europe were collected from 33 countries within the European Surveillance of Antimicrobial Consumption (ESAC) project, funded by the European Centre for Disease Prevention and Control (ECDC), using the WHO Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology.
For the period 1997-2009, data on outpatient use of systemic MLS aggregated at the level of the active substance were collected and expressed in DDD (WHO, version 2011) per 1000 inhabitants per day (DID). Using a classification based on mean plasma elimination half-life, macrolide use was analysed for trends over time, seasonal variation and composition.
Total outpatient MLS use in 2009 varied by a factor of 18 between the countries with highest (11.5 DID in Greece) and lowest (0.6 DID in Sweden) use. MLS use showed high seasonal variation. Short-, intermediate- and long-acting macrolides were the most commonly used agents in 2, 25 and 5 countries, respectively (mainly erythromycin, clarithromycin and azithromycin, respectively). In Sweden, mainly lincosamides (clindamycin) were used. Lincosamide use was observed in all countries, while substantial use of a streptogramin was only seen in France (pristinamycin). For Europe, a significant increase in outpatient MLS use was found, as well as a significant seasonal variation, which increased over time from 1997 to 2009. Relative use of long-acting macrolides and lincosamides significantly increased over time with respect to intermediate-acting macrolides, and relative use of the latter increased with respect to short-acting macrolides.
The observed differences between European countries in the levels of MLS use and the extreme seasonal variations in their use suggest that this subgroup of antibiotics is still prescribed inappropriately in many countries.
Smokers can use the web to continue or quit their habit. Online vendors sell reduced or tax-free cigarettes lowering smoking costs, while health advocates use the web to promote cessation. We examined how smokers' tax avoidance and smoking cessation Internet search queries were motivated by the United States' (US) 2009 State Children's Health Insurance Program (SCHIP) federal cigarette excise tax increase and two other state specific tax increases. Google keyword searches among residents in a taxed geography (US or US state) were compared to an untaxed geography (Canada) for two years around each tax increase. Search data were normalized to a relative search volume (RSV) scale, where the highest search proportion was labeled 100 with lesser proportions scaled by how they relatively compared to the highest proportion. Changes in RSV were estimated by comparing means during and after the tax increase to means before the tax increase, across taxed and untaxed geographies. The SCHIP tax was associated with an 11.8% (95% confidence interval [95%CI], 5.7 to 17.9; p
Seasonal depression has generated considerable clinical interest in recent years. Despite a common belief that people in higher latitudes are more vulnerable to low mood during the winter, it has never been demonstrated that human's moods are subject to seasonal change on a global scale. The aim of this study was to investigate large-scale seasonal patterns of depression using Internet search query data as a signature and proxy of human affect.
Our study was based on a publicly available search engine database, Google Insights for Search, which provides time series data of weekly search trends from January 1, 2004 to June 30, 2009. We applied an empirical mode decomposition method to isolate seasonal components of health-related search trends of depression in 54 geographic areas worldwide. We identified a seasonal trend of depression that was opposite between the northern and southern hemispheres; this trend was significantly correlated with seasonal oscillations of temperature (USA: r = -0.872, p<0.001; Australia: r = -0.656, p<0.001). Based on analyses of search trends over 54 geological locations worldwide, we found that the degree of correlation between searching for depression and temperature was latitude-dependent (northern hemisphere: r = -0.686; p<0.001; southern hemisphere: r = 0.871; p<0.0001).
Our findings indicate that Internet searches for depression from people in higher latitudes are more vulnerable to seasonal change, whereas this phenomenon is obscured in tropical areas. This phenomenon exists universally across countries, regardless of language. This study provides novel, Internet-based evidence for the epidemiology of seasonal depression.
To evaluate the effects of cold exposure on the musculoskeletal system, two surveys on the subjective musculoskeletal symptoms among male electricians working in the buildings under construction were performed in winter (N=74) and summer seasons (N=83). A self-administered questionnaire was used to collect information on age, occupational career, working habit, present illness, and subjective musculoskeletal symptoms. Mean age, occupational career and daily smoking of the supervisors were significantly higher than those of the other subjects. In general, prevalence rates of stiffness, numbness, pain and Raynaud's phenomenon in the fingers, finger cold sensation, dull movement of the fingers, pain in the wrist, knee joint pain, pain and numbness in the foot and foot cold sensation in winter were significantly higher than those in summer. These results were marked especially in the workers except supervisors. In winter, there were no significant differences in the prevalence rates of subjective musculoskeletal complaints between the supervisors and the other workers. On the other hand, in summer, prevalence of stiffness and pain in the shoulder, stiffness and pain in the neck, dullness and pain in the arm, finger cold sensation, low back dullness and low back pain in the supervisors were significantly higher than those in the other workers. These results suggest that effects of cold on the musculoskeletal symptoms markedly appeared in the workers except supervisors.
To help making comfortable workplaces and to prevent health disorders induced by the exposure to moderate cold in two different groups of out-door workers, we conducted a survey to compare subjective symptoms and cold prevention measures in winter between traffic control workers and construction workers. The subjects of this study were 98 male traffic control workers and 149 male workers engaged in building construction. Work loads of traffic control workers and construction workers were estimated at RMR1-2 and RMR2-4, respectively. All subjects were asked to complete a self-administered questionnaire covering age, occupational career, working figure, present illness, past history of diseases, individual preventive measures to the cold, subjective symptoms in the winter (43 items) and subjective symptoms occurred during daytime working in the winter (6 items). In two parts of the construction workplaces (the place where a morning assembly was held and on the 7th floor of the construction site) dry bulb, wet bulb and globe temperatures were measured in January. Windchill Index (kcal/cm,(2) x h) was calculated by the measured dry bulb temperature and wind velocity. Mean values of dry bulb temperature between 9:00 and 16:30 in the place where a morning assembly was held for three days were between 4.8 +/- 1.2 degrees C at 9:00 am and 9.3 +/- 1.1 degrees C at noon. Mean values of Windchill Index in the place where a morning assembly was held were between 490.8+/-23.9 kcal/cm(2) x h at 9:30 am and 608.2+/-47.3 kcal/cm(2) x h at 2:30 pm. Occupational career, monthly working days, daily working hours, one way commuting hours, and daily smoking numbers of the traffic control workers were significantly shorter than the construction workers (p<0.01). There were no significant differences in the prevalence of chillness in the arms and legs between the traffic control workers (5.1%) and the construction workers (0.7%). Prevalence of wearing a warm underwear, body warmer, warm trousers, underpants, warm socks, shoe warmer and muffler in the traffic control workers were significantly higher than the construction workers. The subjective symptoms in winter complained most frequently were shoulder stiffness (51.0%), finger cold sensation (50.0%) and neck stiffness (48.0%) in the traffic control workers, and were easy to get fatigued (49.0%), lumbago (48.3%) and finger cold sensation (47.7%) in the construction workers. On the basis of the results obtained, it is clearly shown that the two groups are at the risk of disorders due to their working environment. Therefore, these workers are needed to undergo occupational health programs for prevention of cold exposure disorders. Applications of preventive countermeasures for both groups are discussed.
Seasonal influenza epidemics are a major public health concern, causing tens of millions of respiratory illnesses and 250,000 to 500,000 deaths worldwide each year. In addition to seasonal influenza, a new strain of influenza virus against which no previous immunity exists and that demonstrates human-to-human transmission could result in a pandemic with millions of fatalities. Early detection of disease activity, when followed by a rapid response, can reduce the impact of both seasonal and pandemic influenza. One way to improve early detection is to monitor health-seeking behaviour in the form of queries to online search engines, which are submitted by millions of users around the world each day. Here we present a method of analysing large numbers of Google search queries to track influenza-like illness in a population. Because the relative frequency of certain queries is highly correlated with the percentage of physician visits in which a patient presents with influenza-like symptoms, we can accurately estimate the current level of weekly influenza activity in each region of the United States, with a reporting lag of about one day. This approach may make it possible to use search queries to detect influenza epidemics in areas with a large population of web search users.
Lesion and neuroimaging studies suggest the amygdala is important in the perception and production of negative emotion; however, the effects of emotion regulation on the amygdalar response to negative stimuli remain unknown. Using event-related fMRI, we tested the hypothesis that voluntary modulation of negative emotion is associated with changes in neural activity within the amygdala. Negative and neutral pictures were presented with instructions to either “maintain” the emotional response or “passively view” the picture without regulating the emotion. Each picture presentation was followed by a delay, after which subjects indicated how they currently felt via a response keypad. Consistent with previous reports, greater signal change was observed in the amygdala during the presentation of negative compared to neutral pictures. No significant effect of instruction was found during the picture presentation component of the trial. However, a prolonged increase in signal change was observed in the amygdala when subjects maintained the negative emotional response during the delay following negative picture offset. This increase in amygdalar signal due to the active maintenance of negative emotion was significantly correlated with subjects' self-reported dispositional levels of negative affect. These results suggest that consciously evoked cognitive mechanisms that alter the emotional response of the subject operate, at least in part, by altering the degree of neural activity within the amygdala.
Among younger adults, the ability to willfully regulate negative affect, enabling effective responses to stressful experiences, engages regions of prefrontal cortex (PFC) and the amygdala. Because regions of PFC and the amygdala are known to influence the hypothalamic-pituitary-adrenal axis, here we test whether PFC and amygdala responses during emotion regulation predict the diurnal pattern of salivary cortisol secretion. We also test whether PFC and amygdala regions are engaged during emotion regulation in older (62- to 64-year-old) rather than younger individuals. We measured brain activity using functional magnetic resonance imaging as participants regulated (increased or decreased) their affective responses or attended to negative picture stimuli. We also collected saliva samples for 1 week at home for cortisol assay. Consistent with previous work in younger samples, increasing negative affect resulted in ventral lateral, dorsolateral, and dorsomedial regions of PFC and amygdala activation. In contrast to previous work, decreasing negative affect did not produce the predicted robust pattern of higher PFC and lower amygdala activation. Individuals demonstrating the predicted effect (decrease < attend in the amygdala), however, exhibited higher signal in ventromedial prefrontal cortex (VMPFC) for the same contrast. Furthermore, participants displaying higher VMPFC and lower amygdala signal when decreasing compared with the attention control condition evidenced steeper, more normative declines in cortisol over the course of the day. Individual differences yielded the predicted link between brain function while reducing negative affect in the laboratory and diurnal regulation of endocrine activity in the home environment.
Background: Acute otitis media (AOM) occurs as a complication of viral upper respiratory tract infections in young children. AOM and respiratory viruses both display seasonal variation. Our objective was to examine the temporal association between circulating respiratory viruses and the occurrence of pediatric ambulatory care visits for AOM. Methods: This retrospective study included 9 seasons of respiratory viral activity (2002 to 2010) in Utah. We used Intermountain Healthcare electronic medical records to assess community respiratory viral activity via laboratory-based active surveillance and to identify children <18 years with outpatient visits and International Classification of Diseases, Ninth Revision codes for AOM. We assessed the strength of the association between AOM and individual respiratory viruses using interrupted time series analyses. Results: During the study period, 96,418 respiratory viral tests were performed; 46,460 (48%) were positive. The most commonly identified viruses were respiratory syncytial virus (22%), rhinovirus (8%), influenza (8%), parainfluenza (4%), human metapneumovirus (3%) and adenovirus (3%). AOM was diagnosed during 271,268 ambulatory visits. There were significant associations between peak activity of respiratory syncytial virus, human metapneumovirus, influenza A and office visits for AOM. Adenovirus, parainfluenza and rhinovirus were not associated with visits for AOM. Conclusions: Seasonal respiratory syncytial virus, human metapneumovirus and influenza activity were temporally associated with increased diagnoses of AOM among children. These findings support the role of individual respiratory viruses in the development AOM. These data also underscore the potential for respiratory viral vaccines to reduce the burden of AOM.
Many common diseases, such as the flu and cardiovascular disease, increase markedly in winter and dip in summer. These seasonal patterns have been part of life for millennia and were first noted in ancient Greece by both Hippocrates and Herodotus. Recent interest has focused on climate change, and the concern that seasons will become more extreme with harsher winter and summer weather. We describe a set of R functions designed to model seasonal patterns in disease. We illustrate some simple descriptive and graphical methods, a more complex method that is able to model non-stationary patterns, and the case-crossover to control for seasonal confounding.
In the sound therapy for tinnitus, mainly environmental sound, a sound generator and a hearing aid are used and have been shown to be effective. We sometimes encounter cases in which a remarkable effect is not achieved, or in which a hearing aid cannot be introduced easily. In this research, we used a hearing-aid with a music and sound generator function for the sound therapy of tinnitus in 24 patients. It was found that patients with severe tinnitus and hearing loss mainly chose preferred this hearing aid. It was suggested that this hearing aid might become a device of first choice for the sound therapy of tinnitus and that the music function is useful for patients with tinnitus.
The primary aim of the current study was to test the hypothesis that there is a seasonal component to snoring and obstructive sleep apnea (OSA) through the use of Google search engine query data.
Internet search engine query data were retrieved from Google Trends from January 2006 to December 2012. Monthly normalized search volume was obtained over that 7-year period in the USA and Australia for the following search terms: "snoring" and "sleep apnea". Seasonal effects were investigated by fitting cosinor regression models. In addition, the search terms "snoring children" and "sleep apnea children" were evaluated to examine seasonal effects in pediatric populations.
Statistically significant seasonal effects were found using cosinor analysis in both USA and Australia for "snoring" (p < 0.00001 for both countries). Similarly, seasonal patterns were observed for "sleep apnea" in the USA (p = 0.001); however, cosinor analysis was not significant for this search term in Australia (p = 0.13). Seasonal patterns for "snoring children" and "sleep apnea children" were observed in the USA (p = 0.002 and p < 0.00001, respectively), with insufficient search volume to examine these search terms in Australia. All searches peaked in the winter or early spring in both countries, with the magnitude of seasonal effect ranging from 5 to 50 %.
Our findings indicate that there are significant seasonal trends for both snoring and sleep apnea internet search engine queries, with a peak in the winter and early spring. Further research is indicated to determine the mechanisms underlying these findings, whether they have clinical impact, and if they are associated with other comorbid medical conditions that have similar patterns of seasonal exacerbation.
Respiratory viruses are important pediatric pathogens with pronounced seasonal patterns of circulation. Various hypotheses have been put forth to explain the seasonality of these infections, many involving environmental factors. This review summarizes the effect of temperature on the epidemicity of respiratory viruses, with an emphasis on epidemiological findings from large-scale metanalyses, laboratory-derived data using animal models, and possible mechanisms to account for viral seasonality.
Patients with Willis-Ekbom disease (restless legs syndrome [RLS]) frequently report seasonal worsening of their symptoms; however, seasonal patterns in this disorder have not been systematically evaluated. The purpose of our investigation was to utilize Internet search query data to test the hypothesis that restless legs symptoms vary by season, with worsening in the summer months.
Internet search query data were obtained from Google Trends. Monthly normalized search volume was determined for the term restless legs between January 2004 and December 2012. Using cosinor analysis, seasonal effects were tested for data from the United States, Australia, Germany, the United Kingdom, and Canada.
Cosinor analysis revealed statistically significant seasonal effects on search queries in the United States (P=.005), Australia (P=.00007), Germany (P=.00009), and the United Kingdom (P=.003), though a trend was present in the search data from Canada (P=.098). Search queries peaked in summer months in both northern (June and July) and southern (January) hemispheres. Search query volume increased by 24-40% during summer relative to winter months across all evaluated countries.
Evidence from Internet search queries across a wide range of dates and geographic areas suggested a seasonality of restless legs symptomatology with a peak in summer months. Our novel finding in RLS epidemiology needs to be confirmed in additional samples, and underlying mechanisms must be elucidated.
We aim to evaluate the incidence and clinical manifestations of sensorineural hearing loss (SNHL) in adult patients with acute otitis media (AOM). Seventy-five patients (age > 18 years; 83 ears) diagnosed with AOM between January 2008 and March 2011 at our clinic were enroled and retrospectively reviewed. We detected audiometrically confirmed SNHL during the course of AOM in eight patients. The clinical course, treatment, and audiometric final outcome of each case were reviewed. SNHL was associated with AOM in 8 out of 83 ears (9.3 %). The mean age of patients was 57.5 years, and the mean follow-up period was 21.1 months (range 0.6-46.3 months). The most common symptom was tinnitus. Mean bone conduction hearing threshold was 39.5 dB in pure tone audiometry. All patients showed high-frequency HL, and three showed pan-frequency HL. All patients were treated with oral antibiotics at the initial visit. Seven ears were treated with a combination of oral steroids. Myringotomy was also performed. Seven of eight patients showed improvement; however, 8 kHz thresholds were not improved. This suggested that the inflammation spread through the round window. The mean duration of recovery was 18.6 days. SNHL associated with AOM in adult patients occurs during the early phases of the disease course. High-frequency hearing was commonly affected and was well treated with oral antibiotics, myringotomy, and steroid therapy. Audiometry can be helpful for treating adult patients with AOM. Active treatment, including myringotomy, should be performed during the early phase, if SNHL is suspected.
Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus. With prevalence ranging from 10% to 15%, tinnitus is a common disorder. Many people habituate to the phantom sound, but tinnitus severely impairs quality of life of about 1-2% of all people. Tinnitus has traditionally been regarded as an otological disorder, but advances in neuroimaging methods and development of animal models have increasingly shifted the perspective towards its neuronal correlates. Increased neuronal firing rate, enhanced neuronal synchrony, and changes in the tonotopic organisation are recorded in central auditory pathways in reaction to deprived auditory input and represent-together with changes in non-auditory brain areas-the neuronal correlate of tinnitus. Assessment of patients includes a detailed case history, measurement of hearing function, quantification of tinnitus severity, and identification of causal factors, associated symptoms, and comorbidities. Most widely used treatments for tinnitus involve counselling, and best evidence is available for cognitive behavioural therapy. New pathophysiological insights have prompted the development of innovative brain-based treatment approaches to directly target the neuronal correlates of tinnitus.
Approximately 20% of Americans suffer from hypersensitivity diseases. The head and neck are the most commonly affected target organs of the allergic reaction, and the effect of allergic reactions in producing nasal symptoms was first reported by Dr. French K. Hansel. 22 The ear also has been suspected of being a target organ for an allergic reaction. The first case reports suggesting an allergic basis for labyrinthine symptoms were in 1893, although Duke published the first clinical report of a suspected allergic etiology for Meniere's disease in 1923. 17,37 Likewise, anecdotal information concerning an allergic basis for otitis media with effusion has been reported for generations. This chapter reviews the immune and allergic activity of the ear as we currently understand it, and suggests mechanisms by which a classic allergic or autoimmune response may result in the production of otologic symptoms. Various treatment modalities, including specific allergic testing and treatment techniques, are described.
Tinnitus is a common medical symptom that can be debilitating. Risk factors include hearing loss, ototoxic medication, head injury, and depression. At presentation, the possibilities of otological disease, anxiety, and depression should be considered. No effective drug treatments are available, although much research is underway into mechanisms and possible treatments. Surgical intervention for any otological pathology associated with tinnitus might be effective for that condition, but the tinnitus can persist. Available treatments include hearing aids when hearing loss is identified (even mild or unilateral), wide-band sound therapy, and counselling. Cognitive behavioural therapy (CBT) is indicated for some patients, but availability of tinnitus-specific CBT in the UK is poor. The evidence base is strongest for a combination of sound therapy and CBT-based counselling, although clinical trials are constrained by the heterogeneity of patients with tinnitus.
Google Trends is a valuable new additional tool for medical research, mainly for epidemiological and economical issues, which is fast and inexpensive to use and may be especially helpful when analyzing patient collectives who go to general practitioners or specialists in private practice rather than public or university clinics, where data for statistics are most often collected from.
Background:
Population mental health surveillance is an important challenge limited by resource constraints, long time lags in data collection, and stigma. One promising approach to bridge similar gaps elsewhere has been the use of passively generated digital data.
Purpose:
This article assesses the viability of aggregate Internet search queries for real-time monitoring of several mental health problems, specifically in regard to seasonal patterns of seeking out mental health information.
Methods:
All Google mental health queries were monitored in the U.S. and Australia from 2006 to 2010. Additionally, queries were subdivided among those including the terms ADHD (attention deficit-hyperactivity disorder); anxiety; bipolar; depression; anorexia or bulimia (eating disorders); OCD (obsessive-compulsive disorder); schizophrenia; and suicide. A wavelet phase analysis was used to isolate seasonal components in the trends, and based on this model, the mean search volume in winter was compared with that in summer, as performed in 2012.
Results:
All mental health queries followed seasonal patterns with winter peaks and summer troughs amounting to a 14% (95% CI=11%, 16%) difference in volume for the U.S. and 11% (95% CI=7%, 15%) for Australia. These patterns also were evident for all specific subcategories of illness or problem. For instance, seasonal differences ranged from 7% (95% CI=5%, 10%) for anxiety (followed by OCD, bipolar, depression, suicide, ADHD, schizophrenia) to 37% (95% CI=31%, 44%) for eating disorder queries in the U.S. Several nonclinical motivators for query seasonality (such as media trends or academic interest) were explored and rejected.
Conclusions:
Information seeking on Google across all major mental illnesses and/or problems followed seasonal patterns similar to those found for seasonal affective disorder. These are the first data published on patterns of seasonality in information seeking encompassing all the major mental illnesses, notable also because they likely would have gone undetected using traditional surveillance.
HYPOTHESIS: Glucocorticoids (GCs) are widely used as a therapeutic modality for the inner ear disorders including Ménière's disease (MD). The concentration of GCs in the target cells is known to be regulated by 11β-hydroxysteroid dehydrogenase (11β-HSD), an enzyme complex responsible for the conversion of hormonally active cortisol into inactive cortisone. There is no morphologic indication of glucocorticoid receptors (GRs) and 11β-HSD isoforms (11β-HSD1 and 2) in human inner ear. OBJECTIVES: The objectives of this study are to determine whether GRs and the isoforms of 11β-HSD are present in human inner ear tissues and to reveal their precise distribution. STUDY DESIGN: This study investigated the expression of GRs and 11β-HSD isoforms (11β-HSD1 and 2) in the human inner ear. METHODS: In humans, immunostaining of GRs, 11β-HSD1, and 11β-HSD2 was performed in the stria vascularis (SV) and the vestibular tissues, whereas in the cochlear tissues except for the SV, only GRs were investigated. RESULTS: Immunoreactivity of GRs was detected in the SV, outer hair cells, inner hair cell, spiral ligament, Reissner's membrane, vestibular hair cells, vestibular nerve, transitional cells, and dark cells of the crista ampullaris. 11β-HSD1 was observed in the SV, the apical area of the vestibular hair cells, the transitional cells, and the dark cells. However, no immunoreactivity of 11β-HSD2 was observed. CONCLUSION: Those data indicate that different local steroid regulation by GRs and the isoforms of 11β-HSD is present in various parts of the human inner ear tissues and that the tissues are a direct therapeutic target of glucocorticoids in the inner ear diseases.
Chronic tinnitus affects approximately 5% of the population. Severe distress due to the phantom noise is experienced by 20% of the tinnitus patients. This distress cannot be predicted by psychoacoustic features of the tinnitus. It is commonly assumed that negative cognitive emotional evaluation of the tinnitus and its expected consequences is a major factor that determines the impact of tinnitus-related distress. Models of tinnitus distress and recently conducted research propose differences in limbic, frontal and parietal processing between highly and low distressed tinnitus patients. An experimental paradigm using verbal material to stimulate cognitive emotional processing of tinnitus-related information was conducted. Age and sex matched highly (n = 16) and low (n = 16) distressed tinnitus patients and healthy controls (n = 16) underwent functional magnetic resonance imaging (fMRI) while sentences with neutral, negative or tinnitus-related content were presented. A random effects group analysis was performed on the basis of the general linear model. Tinnitus patients showed stronger activations to tinnitus-related sentences in comparison to neutral sentences than healthy controls in various limbic/emotion processing areas, such as the anterior cingulate cortex, midcingulate cortex, posterior cingulate cortex, retrosplenial cortex and insula and also in frontal areas. Highly and low distressed tinnitus patients differed in terms of activation of the left middle frontal gyrus. A connectivity analysis and correlational analysis between the predictors of the general linear model of relevant contrasts and tinnitus-related distress further supported the idea of a fronto-parietal-cingulate network, which seems to be more active in highly distressed tinnitus patients. This network may present an aspecific distress network. Based on the findings the left middle frontal gyrus and the right medial frontal gyrus are suggested as target regions for neuromodulatory approaches in the treatment of tinnitus. For future studies we recommend the use of idiosyncratic stimulus material.
Climate, in particular sunshine, influences mood and energy levels, creating a positive upswing of mood on bright, sunny days and negative downswing in cold, dark winter seasons. Higher serotonin transporter availability in healthy human subjects in times of lesser light exposure and lower serotonin levels have been shown in winter.
We examined the light-dependent variations in serotonin-1A receptor binding in limbic regions in 36 drug-naive healthy human subjects. Receptor binding was quantified using positron emission tomography and the radioligand [carbonyl-¹¹C]WAY-100635. Binding potential values were related to the amount of individual exposure to sunlight (daily duration of sunshine) and global radiation (total light intensity).
We found a 20-30% lower serotonin-1A receptor binding in the group exposed to a lower amount of global light radiation. Partial correlation analysis revealed significant positive correlations between the regional postsynaptic serotonin-1A receptor binding and global radiation accumulated over a period of 5 days.
Seasonal factors, such as daily amount of sunshine and global radiation, influence serotonin-1A receptor binding in limbic brain regions of healthy human subjects. Combined with recently demonstrated seasonal fluctuations in the serotonin transporter availability, our results underline the importance of seasonal factors in the regulation of the serotonergic transmission.
Humans' endogenous testosterone concentrations vary over a number of temporal scales, with little known about variation longer than monthly cycles. Past studies of seasonal or circannual variation have principally used male participants and have produced inconsistent results. Thus, little is known about how testosterone concentrations fluctuate throughout the year, whether such variation differs between men and women, and whether there are influences of hormonal contraceptive use. The present study collected saliva samples from a large sample (N=718) of men and women, each collected at one time point within a relatively uniform distribution over a full calendar year. Both men and normally-cycling women displayed seasonal variation in salivary testosterone concentrations, such that testosterone concentrations are maximal in the fall and minimal in the summer. Notably, normally-cycling women had testosterone concentrations that were over 100% greater at their maximum in fall compared to their minimum in summer. Women using hormonal contraceptives not only had consistently lower endogenous testosterone concentrations, but also showed a flatter seasonal testosterone profile. The implications for studies of psychology and human behavioral endocrinology are discussed.
Allergy may affect the outer, the middle, or the inner ear. Although the otologic manifestations of allergy are not by themselves diagnostic, the history, including family history and associated symptoms in other target organs, will often help lead to the correct diagnosis and institution of therapy. Patients with significant and chronic symptoms, including those with labyrinthine symptoms of allergy, will respond well to specific immunotherapy and/or dietary elimination.
To assess the prevalence of tinnitus along with factors potentially associated with having tinnitus.
Data were from the Beaver Dam Offspring Study, an epidemiological cohort study of aging.
After a personal interview and audiometric examination, participants (n = 3267, ages 21-84 years) were classified as having tinnitus if in the past year they reported having tinnitus of at least moderate severity or that caused difficulty in falling asleep. Results: The prevalence of tinnitus was 10.6%. In a multivariable logistic regression model adjusting for age and sex, the following factors were associated with having tinnitus: hearing impairment (Odds Ratio (OR) = 3.20), currently having a loud job (OR = 1.90), history of head injury (OR = 1.84), depressive symptoms (OR = 1.82), history of ear infection (men, OR = 1.75), history of target shooting (OR = 1.56), arthritis (OR = 1.46), and use of NSAID medications (OR = 1.33). For women, ever drinking alcohol in the past year was associated with a decreased risk of having tinnitus (OR = 0.56).
These results suggest that tinnitus is a common symptom in this cohort and may be associated with some modifiable risk factors.
Seasonal patterns have been found in a remarkable range of health conditions, including birth defects, respiratory infections and cardiovascular disease. Accurately estimating the size and timing of seasonal peaks in disease incidence is an aid to understanding the causes and possibly to developing interventions. With global warming increasing the intensity of seasonal weather patterns around the world, a review of the methods for estimating seasonal effects on health is timely.
This is the first book on statistical methods for seasonal data written for a health audience. It describes methods for a range of outcomes (including continuous, count and binomial data) and demonstrates appropriate techniques for summarising and modelling these data. It has a practical focus and uses interesting examples to motivate and illustrate the methods. The statistical procedures and example data sets are available in an R package called ‘season’.
Adrian Barnett is a senior research fellow at Queensland University of Technology, Australia. Annette Dobson is a Professor of Biostatistics at The University of Queensland, Australia. Both are experienced medical statisticians with a commitment to statistical education and have previously collaborated in research in the methodological developments and applications of biostatistics, especially to time series data. Among other projects, they worked together on revising the well-known textbook "An Introduction to Generalized Linear Models," third edition, Chapman Hall/CRC, 2008. In their new book they share their knowledge of statistical methods for examining seasonal patterns in health.
Tinnitus is an auditory phantom percept with a tone, hissing, or buzzing sound in the absence of any objective physical sound source. About 6% to 25% of the affected people report interference with their lives as tinnitus causes a considerable amount of distress. However, the underlying neurophysiological mechanism for the development of tinnitus-related distress remains not well understood. Hence we focus on the cortical and subcortical source differences in resting-state EEG between tinnitus patients with different grades of distress using continuous scalp EEG recordings and Low Resolution Electromagnetic Tomography (LORETA). Results show more synchronized alpha activity in the tinnitus patients with a serious amount of distress with peaks localized to various emotion-related areas. These areas include subcallosal anterior cingulate cortex, the insula, parahippocampal area and amygdala. In addition, less alpha synchronized activity was found in the posterior cingulate cortex, precuneus and DLPFC. A comparison between the tinnitus group with distress and the Nova Tech EEG (NTE) normative database demonstrated increased synchronized alpha and beta activity and less synchronized delta and theta activity in the dorsal anterior cingulate cortex in tinnitus patients with distress. It is interesting that the areas found show some overlap with the emotional component of the pain matrix and the distress related areas in asthmatic dyspnea. Unpleasantness of pain activates the anterior cingulate and prefrontal cortices, amygdala, and insula. As such, it might be that distress is related to alpha and beta activity in the dorsal anterior cingulate cortex, the amount of distress perceived to an alpha network consisting of the amygdala-anterior cingulate cortex-insula-parahippocampal area.
BEFORE attacking the subject with which this paper is concerned, noises in the ears, it may be wise to discuss for a moment head noises in general, in order to avoid confusion.The term "tinnitus," meaning a ringing, should—strictly speaking— be reserved for the symptom of ringing in the ears (tinnitus aurium). Using the word in the more general sense, however, as it commonly is used, to comprise all varieties of head noises, one may divide the causes of this symptom into two main classes—extrinsic and intrinsic.Extrinsic or false tinnitus results from disturbances which arise outside the auditory tract, and includes not only extraneous sounds but also the large group of psychogenic disturbances. Intrinsic or true tinnitus is the result of some disturbance within the auditory tract itself.1 The two classes can usually be readily distinguished by certain clinical features: the character of the noise—for instance, the throbbing of
We used a representative older population-based cohort to establish the predictors and impacts of tinnitus.
A total of 1,214 participants of the Blue Mountains Hearing Study were followed for 5 years (1997-1999 to 2002-2004). The presence of tinnitus was assessed by an audiologist-administered questionnaire. Hearing impairment was defined as the pure tone average (PTA)(0.5-4KHz)>25 dB HL, in the better ear. Quality of life was measured by use of the Short Form 36-item Health Survey (SF-36). Depression was assessed using either the SF-36 (Mental Health Index, subscale) and the Center for Epidemiologic Studies Depression Scale.
Symptomatic dizziness and hearing loss were significant risk factors for incident tinnitus, multivariable-adjusted odds ratio, 2.41 (95% confidence interval, 1.62-3.58) and odds ratio 2.31 (95% confidence interval, 1.46-3.66), respectively. Incident tinnitus cases demonstrated significantly lower mean SF-36 scores compared with subjects without tinnitus and were more likely to be depressed as assessed by both the Mental Health Index and Center for Epidemiologic Studies Depression Scale.
Incident tinnitus was predicted by two otological risk factors, dizziness and hearing loss. Temporal data documented diminished quality of life and psychological well-being in those subjects experiencing tinnitus. This finding highlights the importance of effective intervention strategies to prevent potentially debilitating morbidity associated with tinnitus.
This study was conducted to determine whether the incidence of idiopathic sudden sensorineural hearing loss (ISSHL) varies throughout the year.
This study is a retrospective case review.
This study was conducted at a tertiary referral center within a teaching hospital.
Inclusion criteria were a diagnosis of ISSHL confirmed by audiometric data. Exclusion criteria were intracranial neoplasms, a history of Ménière's disease, previous ear procedures, chemotherapy, or radiation therapy to the head or neck. There was no exclusion criterion based on age. Ninety-seven patients met these criteria. The median age was 52 years (range, 26-85 yr), and there were 53 (54.6%) women and 44 (45.4%) men.
Monthly incidence counts were compiled across a 3-year period. Counts were analyzed for uneven incidence distributions and seasonal variation via standard statistical tests.
Overall, no evidence was found for an uneven distribution or for a peak either by chi2 (p > 0.1), which assesses for any uneven distribution, or by the circular mean (p > 0.1), which assesses for a pattern of seasonal variation. In the subset of patients (24 of 97; 24.7%) who reported experiencing an upper respiratory infection before or concurrent with the onset of ISSHL, no evidence was found for an uneven distribution of hearing loss onset throughout the year either by chi2 (p > 0.1) or by the circular mean (p > 0.1).
The results of this study suggest that ISSHL incidence does not display uneven distribution throughout the year.
Emotional stress is often associated with auditory phenomena such as hyperacusis, tinnitus, Ménière's disease and vertigo. Stress develops as a result of a person's attempts to come to terms with the increased or unexpected demands of his or her environment. Stress serves to protect one from physical danger and to temporarily increase one's performance in order to increase the probability of survival. Sleep and appetite are particularly reduced, while anxiety increases. The mental changes induced by stress may contribute to the onset or exacerbation of tinnitus. The following links exist between the auditory and stress systems: the limbic system, which regulates instinctive behavior and emotions, is linked to the auditory system via the medial geniculate body (amygdala). The hypothalamus, which is the integrative center of the endocrine and autonomic systems, is linked to the auditory system via the inferior colliculus. The reticular system, which is focused on the behavior pattern of attention and excitement, projects serotonergic fibers to all pathways of the auditory system, ranging from the cochlea to the auditory cortex.
This article details clinical reports and studies of ototoxicity associated with the administration of erythromycin and its analogues. Suspected mechanisms of ototoxicity also are discussed. Ototoxicity due to erythromycin appears to be clearly dose related.
While health information is often said to be the most sought after information on the web, empirical data on the actual frequency of health-related searches on the web are missing. In the present study we aimed to determine the prevalence of health-related searches on the web by analyzing search terms entered by people into popular search engines. We also made some preliminary attempts in qualitatively describing and classifying these searches. Occasional difficulties in determining what constitutes a "health-related" search led us to propose and validate a simple method to automatically classify a search string as "health-related". This method is based on determining the proportion of pages on the web containing the search string and the word "health", as a proportion of the total number of pages with the search string alone. Using human codings as gold standard we plotted a ROC curve and determined empirically that if this "co-occurance rate" is larger than 35%, the search string can be said to be health-related (sensitivity: 85.2%, specificity 80.4%). The results of our "human" codings of search queries determined that about 4.5% of all searches are "health-related". We estimate that globally a minimum of 6.75 Million health-related searches are being conducted on the web every day, which is roughly the same number of searches that have been conducted on the NLM Medlars system in 1996 in a full year.
Tinnitus is the perception of sound in the absence of an apparent acoustic stimulus. More than 35 million Americans experience tinnitus, with 2–3 million severely debilitated by this distressing symptom. The prevalence increases with age and there is a high incidence associated with both noise-induced and age-related hearing loss. Although there are several theories regarding the pathophysiology of tinnitus, the precise mechanism remains to be elucidated. The most compelling of these is the hypothesis that tinnitus occurs as a result of spontaneous and aberrant neural activity at any level along the auditory axis, even after cochlear nerve transection or labyrinthine ablation.
There are numerous aetiologies associated with tinnitus. Tinnitus, in clinical practice, is characterised as either objective or subjective. The distinction is relevant in terms of both aetiology and treatment. Despite a large number of therapeutic interventions and studies claiming success in treating tinnitus, a cure remains elusive. However, there are several potential treatment options that offer patients varying degrees of symptomatic improvement and enhanced quality of life.
It is imperative to formulate a rational and systematic approach in evaluating an older adult with tinnitus. An individualised treatment regimen and the creation of a strong therapeutic relationship are the hallmarks of successful management of the patient with tinnitus.
The inner ear of humans and experimental animals demonstrate an abundance of glucocorticoid receptors (GR). Glucocorticoids (GC) are widely used to treat different hearing disorders; yet the mechanisms of GC action on the inner ear are unknown. We demonstrate how GR can directly modulate hearing sensitivity in response to a moderate acoustic trauma that results in a hearing loss (10-30 dB). The GC agonist (dexamethasone) and the drugs (metyrapone + RU 486) showed opposing effects on hearing threshold shifts. GC agonist (dexamethasone) decreased the hearing threshold whereas pre-treatment with a GC synthesis inhibitor (metyrapone) in combination with a GR antagonist (RU 486) exacerbated auditory threshold shifts (25-60 dB) after acoustic trauma with statistically significant increase in GR mRNA and GR protein compared with the vehicle and acoustic trauma group. Acoustic trauma caused a significant increase in the nuclear transport of NF-kappaB, whereas pre-treatment with the drugs (metyrapone and RU 486) blocked NF-kappaB nuclear transport into spiral ganglion nuclei. An NF-kappaB inhibitor, pyrrolidine dithiocarbamate ammonium blocked the trauma-induced translocation of NF-kappaB and resulted in a hearing loss (45-60) dB. These results indicate that several factors define the responsiveness of the inner ear to GC, including the availability of ligand or receptor, and the nuclear translocation of GR and NF-kappaB. These findings will further our understanding of individual GC responsiveness to steroid treatment, and will help improve the development of pharmaceuticals to selectively target GR in the inner ear for individuals with increased sensitivity to acoustic trauma.
Our objective in this study was to evaluate a causal relationship between vestibular pathological findings and climatic variations during the year (summer, autumn, winter, and spring). The study was conducted in a Brazilian clinic located in a tropical climate and having well-defined warm and cold weather. For this retrospective study, our outpatients were the subjects, and the diagnosis was made on the basis of clinical (ear, nose, and throat) and electronystagmographic evaluation. Data were collected, matched with the year's seasons, and analyzed for significance statistics. We found no significant differences among the illnesses in relation to the climatic seasons. We concluded that a correlation did not exist between annual seasons and vestibular disorders in our environment.
We investigated potential markers of susceptibility to tinnitus in a group of normal hearing young pilots aged 25-35 years and with 8 +/- 5 years of aircraft noise exposure. 316 pilots were interviewed about their tinnitus status and were tested for hearing thresholds (audiograms) and distortion products otoacoustic emissions (DPOAE-grams). There was no subject with permanent tinnitus. 23% reported having occasionally perceived tinnitus after flight missions and 77% reported never having experienced tinnitus after flight missions. General discomfort in the ears to noise was higher in the occasional tinnitus group (15 vs. 6%). The major finding was that difference of susceptibility to tinnitus in normal hearing subjects exposed to noise on a daily basis seemed to be clearly related to lower DPOAEs, bilaterally, in the 1500- to 2800-kHz range. However, no difference could be observed between groups on audiograms at the 2-kHz frequency range. This study provided evidence of outer hair cell dysfunctions in normal hearing subjects exposed to noise and susceptible to tinnitus. Hypersensitivity to noise and decreased DPOAEs in a non-noise-specific frequency range support the idea of another alteration mechanism than noise itself. This point was discussed in the light of recent publications.
To identify potential and modifiable risk factors for tinnitus in a population of older adults.
Cross-sectional study. Detailed questionnaires were interviewer-administered in a representative sample of 2015 persons aged 55+ yr, living in an area west of Sydney, Australia. Air- and bone-conduction audiometric thresholds were measured from 250 to 8000 Hz and from 500 to 4000 Hz, respectively. TEOAE and SOAE were measured for both ears.
After adjusting for multiple variables in a Cox proportional hazards model, factors that significantly increased the risk of tinnitus were poorer hearing and cochlear function, self-reported work-related noise exposure, and history of middle ear or sinus infections, severe neck injury or migraine.
Interventions aimed at reducing age-related hearing loss, particularly by reducing excessive work-related noise exposure, and the effective, timely treatment of ear-related infections, may all decrease the risk of tinnitus.