A document by Mohammad Haghani Dogahe. Click on the document to view its contents.

Objectives: to determine the Epidermal growth factor receptor (EGFR) over-expression in laryngeal carcinoma primary tumor and in first echelon node in N0 neck. Design: A Cross sectional retrospective study. Setting: Otolaryngology and Pathology Departments, Suez Canal University Hospital (Ismailia, Egypt). Participants: Twenty five patients. Main outcome measures: EGFR expression is linked to early neoplastic transformation, cellular proliferation, and the metastatic process in laryngeal cancer. Twenty paraffin preserved primary laryngeal squamous cell carcinoma (LSCC) and their cervical lymph nodes stained with hematoxylin & eosin and EGFR using immunohistochemical technique with scoring system. Results: EGFR expression in occult metastasis was associated with higher T stage (p=<0.001) and higher tumor grade (p=0.001). EGFR expression in occult metastasis was correlated with primary LSCC cartilage invasion (p=0.05), lymphovascular invasion (p=0.028) & muscle invasion (p=0.05). Laryngeal expression of EGFR and cervical lymph node metastasis as evidenced by EGFR immunohistochemical staining (p=0.001). Conclusion: EGFR immunohistopathological analysis of the lymph nodes and the primary tumour is a highly valuable tool for the detection of the cervical metastatic status and the N stage. Key words: Epidermal Growth Factor Receptor (EGFR), Larynx, N0, Squamous cell Carcinoma, Metastasis

Abstract Objective: To analyse the role of surgery along with antimicrobials to improve clinical outcomes in treating refractory cases of skull base osteomyelitis (SBO). Study design and setting: A prospective comparative study in a tertiary care centre with 70 SBO patients meeting eligibility criteria. Participants: The study population comprised 35 patients refractory to systemic antimicrobials of at least four weeks duration who later underwent surgery in addition to medication (surgical group). They were compared with a medical group that responded to medications alone. Main outcome measures: The outcome variables studied were the resolution of clinical features (pain, discharge, radiology, and inflammatory markers), culture yield, and total duration of treatment. Results: According to our study, relief of pain was faster in the surgical group(1.66 against 4.57 months) with statistical significance (p< 0. 001). Relief of symptoms (p< 0.001), radiological improvement (p= 0.001), and normalizing of inflammatory markers (p<0.001) were better in the surgical group than in the medical group. The duration of treatment was an average of 9. 2 months in the surgical group compared to 11.3 months in the medical group (p= 0.019). Microbial culture from deep tissue sampling was positive in 24 surgical patients (68.57%). Conclusion: The treatment response to surgery and antimicrobials in treating refractory cases of SBO was better than the group who responded to antimicrobials alone. Surgery provided higher microbial yield resulting in culture-specific antimicrobials. The surgical group observed faster relief of symptoms, reduced hospital stay, and total treatment duration.

Xeroderma pigmentosum (XP) is a rare genodermatosis characterized by defective DNA repair, leading to hypersensitivity to ultraviolet (UV) sunlight and predisposes to various cutaneous and non-cutaneous malignancies. Platinum compounds are used against cutaneous cancers as concurrent chemoradiotherapy. But the XP gene polymorphism has a potential role in metabolism of these agents and their susceptibility. Here, we report a case of cutaneous squamous cell carcinoma in a patient with XP who had severe toxicity to chemotherapy. We also discuss other similar cases reported in literature of this entity, to highlight this potentially lethal pharmacogenomic association.

Surgical Management of Broad-basedSessileVocal Cord Polyps: Transnasal Vocal Fold Polypectomy Versus Microlaryngoscopic Surgery- Our Experience in 159 CasesRunning title: Surgical Management of Broad-based Sessile Vocal Cord Polyps

Objectives: Airway reconstruction for laryngotracheal stenosis (LTS) improves dyspnoea. There is little evidence relating to impact upon voice and swallowing. We explored voice and swallowing outcomes in adults with LTS before and after reconstructive surgery. Design: With ethical approval, twenty consecutive LTS patients undergoing airway reconstruction at a tertiary referral center were prospectively recruited. Outcome measures were collected pre-reconstructive surgery, two-weeks post-surgery and up to 4-6 months post-surgery. These included physiological values (maximum phonation time (MPT) and fundamental frequency; penetration-aspiration score, residue score), clinician-reported (GRBAS, functional oral intake score, 100ml Water Swallow Test) and patient-reported outcomes (Voice Handicap Index-10, Reflux Symptoms Index, Eating Assessment Tool, Dysphagia Handicap Index). Results: The observational study identified patient-reported and clinician-reported voice and swallow difficulties pre- and post-surgery; median and interquartile range are reported at each timepoint: Voice Handicap Index-10 23 (8-31); 20.5 (9-33.5), 24.5 (12.5-29); Dysphagia Handicap Index 9 (0-37); 13 (7-44); 15 (4-34); GRBAS grade 1(1-2); 2 (1-2.5); 2(1-2); 100ml Water Swallow Test volume score 16.7 (11.1-20); 14.3 (12.5-16.7); 16.7 (14.3-20.0); 100ml Water Swallow Test capacity score 16.3 ± 9.0; 11.0 ± 4.1; 12.5 ± 2.6. Conclusion: We present the first prospective data on voice and swallowing outcomes in adults with LTS before and after reconstructive surgery. The variability of the outcomes was higher than expected but importantly, for many the voice and swallow outcomes were not within normal limits before surgery. The clinical value of the study demonstrates the need for individual assessment and management of LTS patients’ voice and swallowing.

Objectives: We aimed to evaluate the trend of HPV infection status in oropharyngeal squamous cell carcinoma (OPSCC) according to various epidemiologic factors in the United States. Design: Retrospective cohort study. Setting: Surveillance, Epidemiology, and End Results (SEER) 2010-2016 database. Participants: A total of 13081 patients with OPSCC were enrolled. Patients were diagnosed with OPSCC primarily in the base of tongue, posterior pharyngeal wall, soft palate, and tonsil between 2010 and 2016 and were tested for HPV infection status. Main outcome measures: We analyzed how the number of OPSCC patients changed according to various demographic factors from 2010 to 2016. Additionally, we forecasted and confirmed the number of HPV (+) and (-) patients with OPSCC using the autoregressive integrated moving average (ARIMA) model. Results: The number of HPV (+) patients with OPSCC has increased over the past 7 years, but the degree of increase varied greatly according to the age, sex, and subsites. The number of HPV (-) patients increased until 2015 in all age groups for each site but did not change or decrease since then. Appropriate ARIMA models were applied to forecast HPV (+) and (-) patients, and the predicted data matched the actual data well. Conclusions: This large population-based study suggests that HPV (+) patients with OPSCC has increased and will continue to increase. However, the trends in HPV infection status in patients differed greatly according to various demographic factors. These results present a direction for establishing appropriate preventive measures to deal with HPV-related OPSCC in more detail.

Background: Intra and post-operative blood loss is a major risk in head and neck (H&N) surgery. Recently the use of tranexamic acid (TXA) has been investigated by multiple studies for reducing intra and post-operative bleeding, however reported results are variable. Objectives: To determine the safety and efficacy of tranexamic acid use in Head and Neck surgery. Methods: Systematic review of MEDLINE, EMBASE, CINAHL, Cochrane Library, PubMed, ClinicalKey and Clinicaltrials.gov according to the PRISMA guidelines. Studies were included if they reported on intraoperative bleeding, volume or duration of post-operative drain or return to theatre rate for post-operative haemorrhage in adult populations following use of TXA. Risk of bias assessment with Cochrane Risk of Bias (RoB2) tool for RCTs and NOS tool for non-randomised studies. Results: 16 studies were identified (114, 407 patients). 8 studies evaluated TXA in major H&N surgery and 8 studies in tonsillectomy. Primary outcomes were reduction in intraoperative or post-operative bleeding. Secondary outcomes included the duration of post-operative drain placement and return to theatre rate. No adverse events were reported in any patients. TXA is effective in reducing intra-operative blood loss in tonsillectomy. However, the effect on post-tonsillectomy haemorrhage was unclear. Insufficient evidence exists of benefit of TXA on intra-operative bleeding in major H&N procedures. Post-operative bleeding rates were substantially reduced in most major H&N studies. The duration of drain placement and risk of blood transfusion was unchanged in most cases. Conclusion: TXA use is safe in H&N patients. Whilst sufficient evidence exists to support the use of TXA in tonsillectomy, insufficient evidence exists to recommend use in major H&N surgery. Key words: Tranexamic acid, Head and Neck surgery, thyroidectomy, tonsillectomy

Objectives: To analyze the value of neutrophil‐to‐lymphocyte ratio (NLR) and anemia on results in patients with laryngeal squamous cell carcinomas (LSCC). Design and setting: The patients were categorized into 2 groups as low and high. The relationship between NLR and anemia overall survival (OS), disease-free survival (DFS), and local regional recurrence-free survival (LRRFS) was investigated. Participants: LSCC patients included. Results: OS and DFS were better in patients in low NLR group. In the multivariate analysis, high NLR was significant indicator of worse OS and DFS. Conclusions: NLR is  a biomarker in LSCC.

Objective: To investigate post-intubation laryngeal complications in severe COVID-19 patients. Methods: From September 2020 to April 2021, consecutive patients presenting with laryngological symptoms following severe COVID-19 infection and related intubation were included. Demographic, age, gender, comorbidities, symptoms, intubation duration, tracheostomy features, and laryngeal findings were collected. Videolaryngostroboscopy findings were analyzed by two senior laryngologists in a blind manner. Results: Forty-three patients completed the evaluations. The intubation duration was <14 days in 22 patients (group 1) and >14 days in 21 patients (group 2). The following abnormalities were found on an average post-intubation time of 51.6 days: posterior glottic stenosis (N=14), posterior commissure hypertrophy (N=19) or laryngeal diffuse edema (N=10), granuloma (N=8), laryngeal necrosis (N=2), vocal fold atrophy (N=2), subglottic stenosis (N=1) and glottic flange (N=1). Sixteen patients required surgical treatment (N=17 procedures). The number of intubation days was significantly higher in patients with posterior glottic stenosis (26.1 ± 9.4) compared with those presenting posterior commissure hypertrophy (11.5 ± 2.9) or granuloma (15.1 ± 5.8; p<0.001). Fourteen patients required surgical management. Conclusion: Prolonged intubation used in severe COVID-19 patients is associated with significant laryngeal disorders. Patients with a history of >2-week intubation have a higher risk of posterior glottic stenosis.

To perform surgery with a minimally invasive procedure is preferred during daily practices. With the endoscope development in otology, a direct view of ossicles or lesions in the tympanic cavity without disturbing the mastoid becomes possible. Accompanied by a growing number of endoscopic surgeries, the complications were more commonly seen due to certain drawbacks, like single-hand practices and loss of three-dimensional images[1]. Rarely, to our knowledge, dislocated stapes protrudes into the vestibule cavity during endoscopic surgery, which results in profound hearing loss and vertigo.

Key Points: ● The Facial Clinimetric Evaluation (FaCE) scale, consisting of six subscales, measures facial palsy-specific quality of life. ● Each subscale’s weight in the total FaCE score is based on the number of questions but may not reflect the subscale’s true contributions to ‘overall’ facial-palsy specific quality of life. ● In 80 patients, we analyzed the subscales’ correlations with a validated Visual Analogue Scale (VAS) score that quantifies overall facial palsy-related burden. ● Social function and facial comfort had stronger correlations with overall facial palsy-related quality of life than their weights in the FaCE total score suggests. ● Greater importance should be placed on social function and facial comfort when estimating the quality of life of patients with facial palsy.

Objectives: To investigate the use of tracheostoma humidification by people with total laryngectomy (PTL) in the UK and explore influencing factors. Design: National cross-sectional survey and case note review. Setting: 26 UK National Health Service (NHS) centres providing care to PTL. Participants: PTL reviewed by speech and language therapy (SLT) between March and September 2020. Methods: Secondary analysis of data collected during a national multi-centre audit of PTL completed in response to the Covid-19 pandemic. Data were collected on type of humidification used by PTL and demographic information. Type of humidification was dichotomised as ‘HME’ (closed-system heat moisture exchanger) or ‘non-HME’ (alternative stoma cover or no stoma cover). Univariable analysis was performed to determine the association with several potential explanatory variables including gender, age, living circumstances, distance from treatment centre, communication method and time elapsed since laryngectomy. A backwards selection procedure was used to determine the final model for multiple regression analysis. Results: Data were obtained from 1216 PTL from 26 centres across the UK; information on type of tracheostoma humidification used was available for 1097 PTL. Most PTL (69%) used an HME. Following multiple regression analysis, time elapsed since laryngectomy (p=<0.001), living circumstances (p=0.002) and communication method (p=<0.001) were statistically significant factors in HME use. Conclusion: In the UK, most PTL follow recommendations to use a closed-system HME, though there is marked variability across centres. HME use is influenced by time elapsed since laryngectomy, living circumstances and communication method.

•Primary nasal lymphoma is mainly non-Hodgkin lymphoma; NK/T-cell lymphoma is the most common type. •Nasal non-Hodgkin’s lymphoma mainly occurs in middle-aged and older men. •Clinical symptoms of patients with nasal NK/T-cell lymphoma are unspecific and the early symptoms are atypical. The main signs, changes in nasal microbiota, nasal mucosa, and surrounding organs, are easily misdiagnosed as sinusitis and nasal polyps, complicating patient awareness at the early stage. •Nasal NK/T-cell lymphoma is rare and clinically highly aggressive with a high recurrence rate and poor prognosis. Therefore, early detection and diagnosis are crucial. •Clinicopathological manifestations of nasal non-Hodgkin lymphoma are complex, and the final pathological classification needs to be confirmed using pathology and immunohistochemistry.

Introduction The UK Medical Licensing Assessment (UKMLA) curriculum represents a consensus on core content including ENT-related content for newly qualified doctors. However, there is no similar consensus as to how ENT content should be taught at medical school. Design A virtual consensus forum was held at the 2nd East of England ENT Conference in April 2021 to ascertain views of medical students and junior doctors on how ENT should be taught at medical school. A syllabus of ENT-related items based on the UKMLA and GMC practical procedures curricula was divided into ‘Presentations’, ‘Conditions’ and ‘Practical Procedures’. 64 participants (27 students, 11 foundation doctors, and 7 other junior doctors) voted via anonymous polling for up to three of nine teaching methods they believed were best suited to teach each syllabus item. Results For ‘Presentations’, work-based/clinical-based learning and small-group seminars were significantly more popular than other methods, a further two were of middling popularity, and the remaining five (including simulation and e-learning) were significantly less popular. ‘Conditions’ results were near-identical, with work-based/clinical-based learning and small-group seminars significantly more popular than the remaining teaching methods. For ‘Practical procedures’ the three practical teaching methods were significantly more popular than the six theoretical methods. Conclusion Students and junior doctors express clear preference for clinical-based teaching and small-group seminars when learning ENT content. E-learning is poorly favoured, despite being increasingly used by medical schools and teaching bodies. Co-design of clinical training between students and educators may ensure training better matches students’ needs and expectations.

Key PointsPrevious studies have linked recurrent or persistent BPPV to age, anxiety or/and depression and medical comorbidityFactors such as the socioeconomical status have not been assessed.In our retrospective powered cohort we showed that there is a positive correlation between recurrent or persistent BPPV and ageWe found no correlation with the presence of underlying anxiety/depression and recurrent or persistent BPPV and age.While one would have expected that the socioeconomical and educational status would have had an impact on recurrent/persistent BPPV, using the Scottish Index of Multiple Deprivation, we did not identify such link.

Objectives Current patient prioritization is based on guidance from the Federation of Surgical Specialty Associations (FSSA). This approach fails to identify and prioritize patients with the greatest need and risk of deterioration. Quality of Life (QOL) metrics and augmented intelligence (AI) can be used to achieve this. Our feasibility study aims to assess whether QOL metrics and AI could be used to prioritize an elective waiting list. Design An augmented intelligence software, Copeland Clinical Artificial Intelligence (C2-AI, Cambridge England), was used to analyze physiological data to calculate current and delayed morbidity and mortality. These patients also completed online QOL surveys. The combined scores were used to reprioritize the waiting list. The correlation was assessed between the original FSSA and enhanced waiting list. Differences in current and delayed mortality and morbidity were also compared. Results 20 patients were analyzed by C2-AI. An increase was seen in patient mortality (0.57% to 0.68%, p<0.01) and morbidity if their procedure was delayed (7.6% to 8.8%, p<0.01). The greatest increases were seen in the risk of pneumonia, wound infection, and hemorrhage. The enhanced waiting list failed to correlate with the initial FSSA waiting list prioritization. Conclusions Our study was able to demonstrate that AI and QOL metrics can be used to prioritize patients on an elective operative list. Furthermore, it might be possible to mitigate against complications in high risk patients due to operative delay. Future studies will implementation of the enhanced prioritization to asses whether it is beneficial to patients and the healthcare system.

Study objective Since, OSA affects various parts of the body, there has been little interest about the effect of OSA on voice. The objective of this study was to evaluate the risk of benign vocal fold lesions (BVFL) in OSA patients Methods This retrospective cohort study used data from the National Health Insurance Service (NHIS) database. The study group was defined as the group diagnosed with OSA between 2008 and 2011. Non-OSA groups were selected based on propensity score matching. Incidence of BVFL among participants during the follow-up was analyzed. Cox proportional hazard regression analyses were performed to evaluate the association between OSA and incident BVFL. Results The HR value of the OSA group calculated by considering eight variables indicates that the risk of developing BVFL is 79% higher than that of the control group. Further, among OSA patients, patients with a history of OP had a 35% lower risk of developing BVFL. The relationships between BVFL and seven individual variables considered were as follows: 1) For age, HR for the 40-59 years group was 1.20 (95%CI, 1.09-1.32). 2) For sex, the HR in the female group was 1.22 (95%CI, 1.10-1.35). 3) For residential areas, the HR values for “Seoul” 1.39(95%CI, 1.23-1.59). 4) In the high economic status group, the HR was 1.10 (95%CI, 1.01-1.21). Conclusions and Relevance This observational study indicated that OSA is associated with an increased incidence of BVFL. The incidence of BVFL increased with older age, female sex, and high SES.

• Background: Vertigo / dizziness is a common problem encountered in clinical practice. It is described in different ways by each patient. Hence, it becomes difficult for the clinician to interpret and manage dizziness suffered by the patients. • Objective: To study demographics, types of vertigo / dizziness, its impact on the quality of life and management in a UAE otolaryngology clinic • Method: This is a retrospective, observational, descriptive study of patients presenting with dizziness in our medical facility, between September 2019 to March 2022. • Result: In the present study, 58.61% of the patients were male. Average age of the study population was 42.69 years. Vertigo/spinning type of dizziness was the most reported symptom. Most reported associated symptom was nausea, and the trigger was ‘head movement’. 56.30% of the study population was diagnosed with benign paroxysmal positional vertigo (BPPV). Most used diagnostic tool was Dix-Hallpike maneuver, and the management method was particle repositioning maneuver. The average baseline Dizziness Handicap Inventory (DHI) score was 19.37 (± 13.46), which reduced to 9.22 (±10.94) three weeks after treatment (p value <0.0001). • Conclusion: Vertigo / dizziness related to peripheral causes accounts for a significant proportion of cases in routine otolaryngology practice. From our study we can easily conclude that vertigo / dizziness related disorders negatively affect QOL. Proper diagnosis and management would help to improve the symptoms and QOL. Simple office-based, patient-oriented detail history taking, and clinical examination is important in the diagnosis and management of the dizziness. History taking or questions should focus on the type of dizziness, associated features, duration, and triggers which would help in pinpointing differential diagnosis and the management. Red flags like focal neurological signs should be taken seriously and investigated further. Keywords: Dizziness, vertigo, Dix-Hallpike maneuver, particle repositioning maneuver, DHI

Objective: Chloral Hydrate is the most commonly used sedative for Auditory Brainstem Response (ABR) test. The aim of this study was to retrospectively analyze the safety and effectiveness of Chloral Hydrate in patients undergoing ABR tests through a single-center and large sample size cross-sectional study. Methods: Data were collected from December 2015 to March 2022, which included 7,176 ABR tests (6,106 patients). Basic information was collected, then telephone follow-up was conducted for patients with two or more consecutive tests less than 60 days, and administration method, failure performance, and adverse events were collected. Total sedation failure rate, sedation failure rates in different age groups (≤0.5 years, 0.5-3 years, 3-12 years, ≥12 years) and incidence of adverse events were calculated. Results: A total of 4,967(69.21%) ABR tests were younger than 3 years of age. The sedation failure rate was 3.11% with a Chloral Hydrate dose of 30 mg/kg of weight, which ranged from 1.44% to 4.31% in different age groups. In the sedation failure tests, insufficient sedation was found in 74.44% of the tests. The incidence of adverse events was 0.35%, with most commonly vomiting. Conclusion: The sedation failure rate and the incidence of adverse events in this study are relatively low compared with other previous studies, and Chloral Hydrate can be considered a safe and effective sedative with the permissible dose. However, there were still many patients who failed to complete the test due to insufficient sedation (mostly infants and children), which imply that alternative sedatives with easier preparation process are needed.

Objectives The aim of this study was to assess the efficacy of a new emergency department intervention for the management of epistaxis, aiming to reduce epistaxis admissions. Design Tranexamic acid (TXA) (500mg/ml) soaked NasoPore® packing was in the pathway for epistaxis which did not terminate following 10 minutes of simple first aid. The pathway was utilised for adult patients presenting with non-traumatic, anterior epistaxis. Pre- and post-implementation admission rates and re-attendance rates were recorded by retrospective audit at a large central London hospital. Results Epistaxis admissions were reduced by 51.7% (p<0.05) following the implementation of the TXA-soaked NasoPore® pathway. Conclusions The significant reduction in epistaxis admissions demonstrates that this intervention is beneficial for patient outcomes. This has the potential to be introduced in other A&E departments and also pre-hospital settings.

Objectives: To investigate the prevalence and risks factors associated with electrode migration in cochlear implant (CI) recipients. Design: Retrospective cohort study of all CIs performed between 1 January 2018-1 August 2021 in a single tertiary adult and paediatric cochlear implant centre in the UK. Main outcome measures: The primary aim is to determine the prevalence of electrode migration, based on comparing intraoperative surgeon report and results of a routine plain X-ray performed 2 weeks after surgery. Electrode migration is defined as the detection of movement of 2 or more electrodes out of the cochlea from time of surgery. Multivariate analysis was performed to investigate risk factors including preoperative factors and intraoperative factors that might predispose to migration. Results: 465 patients, having 516 distinct surgery sessions, with 628 implants were analyzed. Electrode migration occurred in 11.5% of all implants. Pre-existing cochlear abnormality was an independent associated risk factor for electrode migration (OR:3.40<1.20-9.62> p=0.021). Demographics, surgical technique, usage of a precurved electrode, CSF leak, surgeon seniority and intraoperative telemetry did not influence risk of migration. There were 5 implants which migrated later than 2 weeks, median: 263days, for which head injury was a common precipitating factor. There was some difference between different lateral wall electrodes Conclusion: Electrode migration in the early postoperative period is a common occurrence and is more likely in implant recipients with obstructed or malformed cochleae. Keywords : Cochlear implants, Electrode migration, Risk factors, Cochlear abnormalities, Postoperative X-ray

Objectives: To study the effectiveness of Sucralfate suspension oral rinse compared to normal saline alone for pain reduction and wound healing promotion in open oral surgical wounds. The primary outcome of this study was postoperative pain VAS score reduction. The secondary outcome was wound healing promotion based on wound grade and maximal wound length reduction Study Design: Randomized controlled trial Setting: Department of Otolaryngology, King Chulalongkorn Memorial Hospital Materials and Methods: A total of 30 patients with secondary healing intraoral surgical wound were enrolled in this study. Sucralfate suspension (1g/5ml) was prescribed to a randomized experimental group as an oral rinse every 6 hours for 14 days in addition to standard postoperative care. Postoperative pain VAS score, wound grade and wound length were collected and compared with baseline from initial to final visit during a 2-week period. Results: The mean change of VAS score was significantly lower from baseline in the Sucralfate group at day3 (-0.77 in control and -2.15 in Sucralfate, p<0.05) and day 7 (-2.15 in control and -3.62 in Sucralfate, p<0.05). Wound grade distribution over time was the same in both Sucralfate and control groups. The mean change of wound length was not significantly different between the two groups. No adverse reaction to Sucralfate was reported during the study participation. Conclusions: Sucralfate suspension oral rinse can be recommended as an effective topical analgesic solution in postoperative secondary healing of intraoral wound with no significant interference. Benefits to wound healing promotion have yet to be proven. Keywords: Sucralfate, oral wound, oral surgery, pain, wound healing, postoperative, analgesia

Objective: To evaluate the effectiveness of refined acoustic therapy in combination with cognitive therapy for tinnitus compared to common treatment modality. Study Design: A single-center, randomized, and controlled trial. Methods: Patients were randomised into either the treatment group (refined sound therapy combined with cognitive therapy) or the control group (post-auricular injections of lidocaine and methylprednisolone sodium succinate). Information pre- and post-treatment was collected using the Self-Rating Depression Scale (SDS), the Hamilton Anxiety Rating Scale (HAM-A), visual analogue score (VAS), Tinnitus loudness, and Tinnitus Handicap Inventory (THI) score. Results: The THI (33.54 versus 19.23), SDS (41.79 versus 35.54) and HAM-A (9.46 versus 6.19) scores of the treatment group improved significantly (p<0.05). In the control group, the THI scores improved significantly (31.7 versus 26.24, p<0.05), but the SDS (p=0.338) and HAM-A (p=0.574) scores did not. Tinnitus loudness (the treatment group 46.67 versus 41.19; the control group 43.12 versus 40.18) and VAS scores (the treatment group 5.67 versus 4.17; the control group 5.58 versus 4.73) were significantly improved in the two groups (p<0.05). There was significant difference in the reduction of THI (14.31 versus 5.45), SDS (6.25 versus 1.02), HAM-A (3.27 versus 0.45) and VAS (1.50 versus 0.85) scores between the two groups (p<0.05), and the treatment group showed a greater reduction. There was no significant difference in the reduction of tinnitus loudness (p=0.057). Conclusion: Refined sound therapy combined with cognitive therapy is more effective at treating tinnitus and improving psychological symptoms. Post-auricular injections of lidocaine and methylprednisolone sodium succinate has no effect at improving psychological symptoms.