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Subjective tinnitus (hereafter tinnitus) is often considered and studied as a perceptual phenomenon. Accordingly, various abnormalities in the area of cognitive processing have been reported in patients with tinnitus. At the same time, the disorder is characterized by considerable emotional distress, which is associated with a high comorbidity of affective disorders. Here, we aim to outline the close link between cognition and emotion, and how current research from the field of cognitive neuroscience examines the processing and acquisition of emotional stimuli. The emotional valence of stimuli can be acquired after brief exposure to learning, leading from neutral to appetitive or aversive evaluation. In contrast to neutral stimuli, emotional stimuli attract attention very early (about 100 ms) during processing, leading to deeper processing and corresponding memory effects. The involved subcortical and cortical network encompasses limbic and sensory areas. In particular, prefrontal regions are involved in the acquisition and evaluation of emotional stimuli as also shown in studies of patients with affect disorders. The interplay of cognitive and emotional processes seems to be central to the development, maintenance, and treatment of tinnitus., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Patient orientation in the decision-making process for the best treatment, but patient participation in research projects, are more required., Methods: In a multi-center prospective cross-sectional study, ENT patients completed a layman-friendly questionnaire with questions on patient orientation, evidence-based medicine, need for research, and health literacy. The survey was performed during an ENT awareness week in June 2021 in 27 ENT practices, 18 ENT clinics and 14 university ENT departments., Results: 2023 patient responses (46% female; 49% 46-75 years old; 40% in ENT practice) were evaluated. The most commonly reported ENT diseases were sensory disorders (16.8%), or tumors (12.7%), Shared decision-making was the favored process for treatment decisions (43.5%). Sufficient time to talk was cited as the most important element of the relationship (15.8%). Most participants felt well informed about treatment steps (42.4%). For electronic searches, general search engines were primarily used (50.3%). Three-quarters of participants (73.7%) had never participated in a study before. About two-thirds (62.8%) could not imagine doing so in the future. Factors such as gender, age, schooling, or location of the survey were associated with different response behaviors., Discussion: The desire for patient orientation is also high among ENT patients and frequently implemented by ENT doctors in practice and clinic. Especially, patients with lower education level should be more involved in the planning of studies in order to provide opportunities for participation in accordance with the recommendations of the funding institutions., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The term of subjective tinnitus is used to describe a perceived noise without an external sound source. Therefore, it seems to be obvious that tinnitus can be understood as purely auditory, sensory problem. From a clinical point of view, however, this is a very inadequate description, as there are significant comorbidities associated with chronic tinnitus. Neurophysiological investigations with different imaging techniques give a very similar picture, because not only the auditory system is affected in chronic tinnitus patients, but also a widely ramified subcortical and cortical network. In addition to auditory processing systems, networks consisting of frontal and parietal regions are particularly disturbed. For this reason, some authors conceptualize tinnitus as a network disorder rather than a disorder of a circumscribed system. These findings and this concept suggest that tinnitus must be diagnosed and treated in a multidisciplinary and multimodal manner., Competing Interests: Die Autorinnen geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Numerous studies show that impairments in chronic tinnitus are closely connected with psychosomatic and other concomitant symptoms. This overview summarizes some of these studies. Beyond hearing loss, individual interactions of medical and psychosocial stress factors as well as resources are of central importance. Tinnitus related distress reflects a large number of intercorrelated, psychosomatic influences - such as personality traits, stress reactivity and depression or anxiety - which can be accompanied by cognitive difficulties and should be conceptualized and assessed within a vulnerability-stress-reaction model. Superordinate factors such as age, gender or education level can increase vulnerability to stress. Therefore, diagnosis and therapy of chronic tinnitus be individualised, multidimensional and interdisciplinary. Multimodal psychosomatic therapy approaches aim to address individually constellated medical, audiological and psychological influences in order to sustainably increase the quality of life of those affected. Counselling in the first contact is also indispensable for diagnosis and therapy., Competing Interests: Die Autorinnen geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Tinnitus is a highly prevalent symptom and a common reason for seeing an otolaryngologist. Since tinnitus can go hand in hand with hearing loss, the step-by-step clarification of hearing loss is one of the essential ENT examinations for tinnitus sufferers. The anamnesis and medical history are relevant, since a multidimensional interaction with the tinnitus can be important for the treatment, especially in the case of a psychological comorbidity. In the vast majority of patients, no causal factor can be found. In the absence of external stimuli, phantom perceptions of tones or noises are held responsible for subjective tinnitus, which probably arises from pathological changes of the auditory pathway, but also in non-auditory cortical structures. In the case of acute tinnitus, a comprehensive audiological assessment is needed, and if the hearing threshold is normal, counseling is the priority. The patient must be informed about the nature of these benign symptoms. So far, there is no acute therapy that has been proven to increase the probability of healing, i.e. the disappearance of the acute tinnitus. Only if the hearing threshold descended, for instance in case of sudden idiopathic hearing loss, therapy of the underlying disease can also lead to improvement or healing of the acute tinnitus. Counseling for chronic tinnitus with high burden is also about reducing exaggerated expectations of healing that cannot be fulfilled. The training of habituation strategies is important. The standard of therapy for chronic tinnitus with psychological strain represents cognitive behavioral therapy for dealing with the tinnitus in a beneficial way. Tinnitus is a symptom of a very heterogeneous group of patients. In the future, it is to be hoped that digital applications and interventions in particular will be evaluated in quality-controlled clinical studies in order to be able to further personalize patient therapy., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen O. Guntinas-Lichius: Dt. HNO-Gesellschaft; J. Prengel und C. Dobel geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background:  The treatment of chronic tinnitus poses still a challenge for clinicians and researchers alike. Since a couple of years, the tailor-made notched music training (TMNMT) has been proposed as a new method in which the frequency of tonal tinnitus is been filtered from the spectrum of individually chosen music. Today, some smartphone-based apps are available for the patients, i. e. Tinnitracks., Methods:  During spring 2018, in total 457 ENT-physicians have been consulted by e-mail in respect of effectiveness and compatibility by using Tinnitracks. The data were collected centrally, were arcsin transformed and analysed by single factor ANOVA, t-tests were used for further analyses of effects., Results:  In total, 117 (25.6 %) of all consulted ENT-physicians participated in the survey. On average, TMNMT has been used for 1.26 years in the offices. With respect to loudness, frequency, and comfort of the tinnitus significant effects were found, which came forth by less reporting of negative in comparison of equal or better effects. Significant differences between "equal" and "better" as a positive effect of the therapy were not found., Discussion:  The effectiveness of Tinnitracks has not been investigated. Our survey demonstrated that Tinnitracks did not influence negatively the loudness or discomfort of the tinnitus, its frequency was not influenced significantly. Negative effects were statistically not significant. Thus, a therapy with Tinnitracks could not be recommended yet., Competing Interests: Die Autoren versichern, dass die Arbeit ohne eine Unterstützung durch die Tinnitracks anbietende Firma Sonormed, Hamburg, erfolgte. Die Forschung von Autor #2 zu Tinnitus wird durch die Deutsche Forschungsgemeinschaft unterstützt (Do 711/7–1). Die Forschung von Autor #1 wird vom Deutschen Berufsverband der HNO-Ärzte e. V. unterstützt., (© Georg Thieme Verlag KG Stuttgart · New York.)

Facial palsy is not only a movement disorder but leads also to an emotional and communicative disorder in chronic stage but also in some patients already during the acute phase of the disease. The present review describes the current knowledge of the neurobiological and psychological fundamentals on the relation of facial movement and its emotional context. So far there is not much knowledge on the impact of a facial palsy on the interaction between facial movement, emotional processing and communicative skills of the patient. The emotional contagion seems to be reduced in patients with facial palsy. The ability to express emotions seems also to be reduced. Moreover, the patients feel to be perceived negatively. In fact, most of the expressions of patients with facial palsy are allocated with a negative affect even when the patients are smiling. Patients with facial palsy react with negative stress, anxiety and depression. The patients avoid social contacts. In turn, this reinforces the communicative disorder. The otorhinolaryngologist can use the Facial Disability Index as a simple questionnaire to detect such dysfunctions. Diagnostics that are necessary to develop a therapy program are presented in this review. Standardized therapy concepts that are not only treat the movement disorder but also the emotional context is missing so far. Finally, the review will give an outlook on potential therapy strategies., (© Georg Thieme Verlag KG Stuttgart · New York.)