***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: We examined 26 consecutive patients with subjective tinnitus .  All subjects were treated with the tricyclic antidepressant trimipramine in a double-blind study , each subject acting as his own control . All subjects were evaluated with pure tone audiometry , site of lesion testing , and auditory brain stem evoked response . The tinnitus assessment consisted of frequency and intensity matching , the determination of masking levels , and a subjective evaluation of severity . Plasma levels of trimipramine were monitored at regular intervals , and the Zung and Millon inventories were administered at the beginning and end of each study period . Nineteen subjects completed the study . Within the trimipramine group , one reported complete disappearance of his tinnitus , eight reported improvement , three no change , and seven that tinnitus was worse . Within the placebo group , eight reported improvement , seven no change , and four that tinnitus was worse . The natural history of tinnitus is such that what has been observed may reflect the evolution of the disease itself , rather than the effect of treatment . We feel that while tricyclics may not have been shown to be effective , the placebo effect played a significant role in the results obtained Although there is increasing awareness that depression can add significantly to the disability associated with chronic medical illness , it is not clear whether all of the impact of psychosocial factors upon medical disability are mediated by or moderated by depression . It has not been determined whether treating depression alone is an adequate strategy for addressing psychosocial magnification of medical disability . We analyzed data collected at initiation of a treatment trial from 92 subjects with chronic severe tinnitus to assess the role of coping , and 49 subject-spouse pairs to assess the role of marital interaction  in  tinnitus-related role dysfunction . Three multiple regression models were developed . After accounting for gender , tinnitus loudness , and depressive severity among the 92 subjects , greater role dysfunction was associated appraisal of tinnitus as salient , and less role dysfunction with coping through avoidance or seeking social support . Marital interaction was assessed from patient and spouse perspectives . In the patient-rated set , less marital cohesion was associated with greater tinnitus-related role dysfunction . In the spouse-rated set , more punishing responses to subject illness behavior were associated with greater tinnitus-related role dysfunction . In each case the disabling effect was greater in the face of high levels of subject depression . This study provides evidence for the oft-stated analogy between chronic tinnitus and chronic pain , and provides justification for a similar multimodal treatment strategy . Reducing depression is an important means to reduce medical disability but should be supplemented by clinical attention to appraisal of the illness , modes of coping with the illness , and spousal response to the illness OBJECTIVE The purpose of this study was to test the hypothesis that decreases in severity of depressive symptoms in patients with chronic tinnitus would correlate with reductions in measures of functional disability . METHOD This study describes the correlations between several measures of functional disability and Hamilton depression scores in two groups of patients with major depression and depressive symptoms ( D-NOS ) who were patients enrolled in a 12-week placebo-controlled , double-blind trial of nortriptyline . These patients had chronic severe tinnitus which was associated in most patients with high frequency hearing loss . The effect of whether affective symptoms improved and the patient 's initial depression status ( major depression versus depressive symptoms ) are examined in order to increase underst and ing about the correlations between depressive symptoms and functional disability . RESULTS Most measures of functional disability decreased synchronously with Hamilton Depression Scale scores in both patients with major depression and those with sub clinical depressive symptoms . Patients whose depression improved had a significantly greater change in each disability measure than patients whose depression did not improve . This significant decrease in functional disability was seen in 11 of 13 scales in the improved D-NOS group , versus only 3 of the 13 scales in the unimproved D-NOS group ; 9 of 13 scales of functional disability significantly decreased in the improved major depression group , versus 3 of 13 scales in the unimproved major depression group . CONCLUSIONS The results suggest that there was a significant correlation between improvement in both major depression and depression-NOS symptoms , and decreases in measures of functional disability in an aging population with a chronic medical illness Validity of the neurophysiological model of tinnitus ( Jastreboff , 1990 ) , outlined in this paper , was tested on data from multicenter trial of tinnitus masking ( Hazell et al. , 1985 ) . Minimal masking level , intensity match of tinnitus , and the threshold of hearing have been evaluated on a total of 382 patients before and after 6 months of treatment with maskers , hearing aids , or combination devices .  The data has been divided into categories depending on treatment outcome and type of approach used . Results of analysis revealed that : i ) the psychoacoustical description of tinnitus does not possess a predictive value for the outcome of the treatment ; ii ) minimal masking level changed significantly depending on the treatment outcome , decreasing on average by 5.3 dB in patients reporting improvement , and increasing by 4.9 dB in those whose tinnitus remained the same or worsened ; iii ) 73.9 % of patients reporting improvement had their minimal masking level decreased as compared with 50.5 % for patients not showing improvement , which is at the level of r and om change ; iv ) the type of device used has no significant impact on the treatment outcome and minimal masking level change ; v ) intensity match and threshold of hearing did not exhibit any significant changes which can be related to treatment outcome . These results are fully consistent with the neurophysiological interpretation of mechanisms involved in the phenomenon of tinnitus and its alleviation The efficiency of two treatment modalities for subjective/idiopathic tinnitus ( SIT ) :  biofeedback ( BF ) and amitriptyline hydrochloride ( AT ) was investigated in 225 r and omly selected subjects . Findings show that after 10 weeks of treatment in the BF group , 43.5 % of the patients reported an improvement of tinnitus during activity . In the AT group , 27.5 % of patients reported subjective improvement of tinnitus at rest although only 15.8 % of the AT patients reported improvement during activity . Biofeedback during rest had a significantly better effect on tinnitus disturbance than AT . No objective diminishment of tinnitus loudness was found as a result of any of the treatment modalities . We believe that BF can help tinnitus patients especially during periods of rest and we also suggest trying tricyclic antidepressant drugs such as AT for treatment of tinnitus patients , in small doses , however , to minimize the side effects of this drug . Subjective tinnitus ( ST ) is one of the most common and yet most unclear of otologic symptoms.(1 - 4 ) ST can accompany any type of hearing loss including both sensorineural as well as conductive hearing loss , and may originate from any part of the auditory pathway.(1,5 ) Treatment of ST must be primarily directed to the basic illness diagnosed after a thorough general ear-nose-throat and neurologic evaluation.(6 ) Severity of ST is evaluated both objective ly , by determining the pitch and intensity of the tinnitus,(7 ) and subjectively as described by the patient . Because of the relatively high incidence of ST and in some patients , the severe personal reaction to it , many different treatments have been suggested , but generally only small to moderate success has been achieved in reducing tinnitus and its consequences , if any at all.(8 ) In this study we examined the effect of two treatment modalities : amitriptyline hydro-chloride and biofeedback Patients disabled by tinnitus show a high prevalence of major depression . Furthermore , tinnitus produces patterns of disability similar to those produced by major depression . To explore further this link between tinnitus and depression , and to investigate the efficacy of treating depression in the treatment of tinnitus , a single-blind , placebo-washout , nonr and omized pilot study of the tricyclic antidepressant nortriptyline ( hydrochloride ) was undertaken in disabled tinnitus patients who also met diagnostic criteria for major depression . Nineteen patients began the study , two responded to placebo  , and two dropped out prior to completion . Fourteen considered their tinnitus improved , and 12 chose to continue taking nortriptyline after the study . Depression severity decreased , on the average , by 65 % ( p<.0001 ) . Tinnitus loudness measured by audiometric matching decreased by a mean of 10 dB or 50 % ( p<.02 ) . Self-reports of tinnitus loudness and severity , somatic and psychologic symptoms , and psychosocial dysfunction all showed significant improvement with treatment . These results suggest that what initially appears to be an irreversible otologic disability in these patients may be in large part a reversible psychiatric disability OBJECTIVES The aim of the study is to confirm the effectiveness of sulpiride and hydroxyzine in tinnitus patients . The administration of sulpiride , a D2 antagonist of dopamine receptors , together with hydroxyzine , a subcortical sedative , covers the areas of tinnitus perception . METHODS A prospect i ve , r and omized , single blinded , placebo-control study was done in general otorhinolaryngology consultations for 2002 - 2004 in Seville and Zaragoza ( Spain ) . One hundred and fifty patients consulted for subjective tinnitus . They were included r and omly in three groups of 50 . A group took sulpiride ( 50 mg/8 h ) alone , other the same dose of sulpiride plus hydroxyzine ( 25 mg/12 h ) , and the third placebo ( lactose ) , for 1 month . One hundred and twenty-two patients completed the study .  Clinical history , tonal audiometry , tympanometry , and tinnitometry were done in the beginning and end of the study . Subjective Grading of Tinnitus Perception and visual analogical scale ( 0 - 10 ) were done for result evaluation . RESULTS Based on the Subjective Grading of Tinnitus Perception , tinnitus perception diminished by 56 % in patients treated with sulpiride and by 81 % in patients treated with sulpiride plus hydroxyzine . Based on the visual analogical scale , tinnitus perception diminished from 7.8 to 6.3 in the patients treated with sulpiride , and from 7.8 to 5.1 in those treated with sulpiride plus hydroxyzine . CONCLUSIONS Sulpiride plus hydroxyzine decreases tinnitus perception . Tinnitus auditolimbic dopaminergic pathway opens wide therapeutical implication OBJECTIVE To determine whether the antidepressant , nortriptyline , is effective for treatment of depression , tinnitus-related disability , and tinnitus symptoms in patients with severe chronic tinnitus . DESIGN A 12-week , double-blind , r and omized controlled trial . SETTING A university otolaryngology clinic . PATIENTS Ninety-two subjects with severe chronic tinnitus : 38 with current major depression and 54 with depressive symptoms and significant tinnitus-related disability . INTERVENTION Nortriptyline ( maintained at 50 to 150 mg/mL for 6 weeks ) or placebo . MAIN OUTCOME MEASURES Hamilton Depression Rating Scale , Tinnitus Disability Measures , and Audiometric Measures . RESULTS Nortriptyline was superior to placebo by multivariate analysis of covariance for depression ( 10.6 vs 14.3 final Hamilton Depression score ) , for tinnitus-related disability ( 1.8 vs 2.4 final MPI Tinnitus Interference ) , and tinnitus loudness ( 13.6 vs 20.0 dB final loudness match [ in worst ear at tinnitus frequency ] ) . When major depression and depressive symptoms groups were considered separately , nortriptyline was superior to placebo on these same measures but differences did not achieve statistical significance . CONCLUSIONS The antidepressant nortriptyline decreases depression , functional disability , and tinnitus loudness associated with severe chronic tinnitus . What appears to be irreversible disability of otologic origin may , in part , be reversible disability of psychiatric origin Objective : The relationship between tinnitus and anxiety and depressive disorders has been frequently alluded to , but there are few studies on antidepressants in the treatment of tinnitus , and the efficacy of sertraline on severe refractory tinnitus has not been reported . Method : Consecutive tinnitus patients ( n = 76 ) considered to be at high risk for severe and disabling tinnitus according to a recently developed screening procedure were r and omly assigned to 16 weeks of double-blind treatment with placebo ( n = 38 ) or sertraline ( n = 38 ) at a fixed dose ( 25 mg/d on the first week and 50 mg/d on the following 15 weeks ) . Between-group comparisons of Tinnitus Severity Question naire scores over 16 weeks were made as the primary outcome measure . Secondary outcomes of tinnitus loudness and tinnitus annoyance were also measured using a visual analogue scale . Severity of depressive and anxiety symptoms was evaluated using the Hamilton rating scales ( Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale , interview-based ratings ) and the Comprehensive Psychopathological Rating Scale ( self-ratings ) . Results : The intention-to-treat analysis showed sertraline to be more effective than placebo ( P = 0.024 ) in decreasing reported tinnitus severity according to the Tinnitus Severity Question naire at 16 weeks ' follow-up . There was also more improvement ( P = 0.014 ) in perceived tinnitus loudness . There were significant correlations between reduction of tinnitus according to 
    Output:
    
All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to method ological bias .
The trial that investigated the SSRI drug found no overall improvement in any of the vali date d outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug .
Reports of side effects including sedation , sexual dysfunction and dry mouth were common .
There is insufficient evidence to say that antidepressant drug therapy improves tinnitus