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Sereda M, Xia J, El Refaie A, Hall DA, Hoare DJ. Sound therapy (using amplification devices and/or sound generators) for tinnitus. Cochrane Database Syst Rev 2018; 12:CD013094. [PMID: 30589445 PMCID: PMC6517157 DOI: 10.1002/14651858.cd013094.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Tinnitus affects 10% to 15% of the adult population, with about 20% of these experiencing symptoms that negatively affect quality of life. In England alone there are an estimated ¾ million general practice consultations every year where the primary complaint is tinnitus, equating to a major burden on healthcare services. Clinical management strategies include education and advice, relaxation therapy, tinnitus retraining therapy (TRT), cognitive behavioural therapy (CBT), sound enrichment using ear-level sound generators or hearing aids, and drug therapies to manage co-morbid symptoms such as insomnia, anxiety or depression. Hearing aids, sound generators and combination devices (amplification and sound generation within one device) are a component of many tinnitus management programmes and together with information and advice are a first line of management in audiology departments for someone who has tinnitus. OBJECTIVES To assess the effects of sound therapy (using amplification devices and/or sound generators) for tinnitus in adults. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL, via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 July 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) recruiting adults with acute or chronic subjective idiopathic tinnitus. We included studies where the intervention involved hearing aids, sound generators or combination hearing aids and compared them to waiting list control, placebo or education/information only with no device. We also included studies comparing hearing aids to sound generators, combination hearing aids to hearing aids, and combination hearing aids to sound generators. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were tinnitus symptom severity as measured as a global score on multi-item tinnitus questionnaire and significant adverse effects as indicated by an increase in self-reported tinnitus loudness. Our secondary outcomes were depressive symptoms, symptoms of generalised anxiety, health-related quality of life and adverse effects associated with wearing the device such as pain, discomfort, tenderness or skin irritation, or ear infections. We used GRADE to assess the quality of evidence for each outcome; this is indicated in italics. MAIN RESULTS This review included eight studies (with a total of 590 participants). Seven studies investigated the effects of hearing aids, four combination hearing aids and three sound generators. Seven studies were parallel-group RCTs and one had a cross-over design. In general, risk of bias was unclear due to lack of detail about sequence generation and allocation concealment. There was also little or no use of blinding.No data for our outcomes were available for any of our three main comparisons (comparing hearing aids, sound generators and combination devices with a waiting list control group, placebo or education/information only). Data for our additional comparisons (comparing these devices with each other) were also few, with limited potential for data pooling.Hearing aid only versus sound generator device onlyOne study compared patients fitted with sound generators versus those fitted with hearing aids and found no difference between them in their effects on our primary outcome, tinnitus symptom severity measured with the Tinnitus Handicap Inventory (THI) at 3, 6 or 12 months (low-quality evidence). The use of both types of device was associated with a clinically significant reduction in tinnitus symptom severity.Combination hearing aid versus hearing aid onlyThree studies compared combination hearing aids with hearing aids and measured tinnitus symptom severity using the THI or Tinnitus Functional Index. When we pooled the data we found no difference between them (standardised mean difference -0.15, 95% confidence interval -0.52 to 0.22; three studies; 114 participants) (low-quality evidence). The use of both types of device was again associated with a clinically significant reduction in tinnitus symptom severity.Adverse effects were not assessed in any of the included studies.None of the studies measured the secondary outcomes of depressive symptoms or depression, anxiety symptoms or generalised anxiety, or health-related quality of life as measured by a validated instrument, nor the newly developed core outcomes tinnitus intrusiveness, ability to ignore, concentration, quality of sleep and sense of control. AUTHORS' CONCLUSIONS There is no evidence to support the superiority of sound therapy for tinnitus over waiting list control, placebo or education/information with no device. There is insufficient evidence to support the superiority or inferiority of any of the sound therapy options (hearing aid, sound generator or combination hearing aid) over each other. The quality of evidence for the reported outcomes, assessed using GRADE, was low. Using a combination device, hearing aid or sound generator might result in little or no difference in tinnitus symptom severity.Future research into the effectiveness of sound therapy in patients with tinnitus should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the use of validated, patient-centred outcome measures for research in the field of tinnitus.
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Affiliation(s)
- Magdalena Sereda
- Division of Clinical Neuroscience, School of Medicine, University of NottinghamNIHR Nottingham Biomedical Research CentreRopewalk House, 113 The RopewalkNottinghamUKNG1 5DU
| | - Jun Xia
- The University of NottinghamCochrane Schizophrenia GroupTriumph RoadNottinghamUKNG7 2TU
| | - Amr El Refaie
- University College CorkDepartment of Speech and Hearing SciencesCorkIreland
| | - Deborah A Hall
- Division of Clinical Neuroscience, School of Medicine, University of NottinghamNIHR Nottingham Biomedical Research CentreRopewalk House, 113 The RopewalkNottinghamUKNG1 5DU
| | - Derek J Hoare
- Division of Clinical Neuroscience, School of Medicine, University of NottinghamNIHR Nottingham Biomedical Research CentreRopewalk House, 113 The RopewalkNottinghamUKNG1 5DU
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Haider HF, Bojić T, Ribeiro SF, Paço J, Hall DA, Szczepek AJ. Pathophysiology of Subjective Tinnitus: Triggers and Maintenance. Front Neurosci 2018; 12:866. [PMID: 30538616 PMCID: PMC6277522 DOI: 10.3389/fnins.2018.00866] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/06/2018] [Indexed: 01/07/2023] Open
Abstract
Tinnitus is the conscious perception of a sound without a corresponding external acoustic stimulus, usually described as a phantom perception. One of the major challenges for tinnitus research is to understand the pathophysiological mechanisms triggering and maintaining the symptoms, especially for subjective chronic tinnitus. Our objective was to synthesize the published literature in order to provide a comprehensive update on theoretical and experimental advances and to identify further research and clinical directions. We performed literature searches in three electronic databases, complemented by scanning reference lists from relevant reviews in our included records, citation searching of the included articles using Web of Science, and manual searching of the last 6 months of principal otology journals. One-hundred and thirty-two records were included in the review and the information related to peripheral and central mechanisms of tinnitus pathophysiology was collected in order to update on theories and models. A narrative synthesis examined the main themes arising from this information. Tinnitus pathophysiology is complex and multifactorial, involving the auditory and non-auditory systems. Recent theories assume the necessary involvement of extra-auditory brain regions for tinnitus to reach consciousness. Tinnitus engages multiple active dynamic and overlapping networks. We conclude that advancing knowledge concerning the origin and maintenance of specific tinnitus subtypes origin and maintenance mechanisms is of paramount importance for identifying adequate treatment.
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Affiliation(s)
- Haúla Faruk Haider
- ENT Department, Hospital Cuf Infante Santo - NOVA Medical School, Lisbon, Portugal
| | - Tijana Bojić
- Laboratory of Radiobiology and Molecular Genetics, Vinča Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Sara F Ribeiro
- ENT Department, Hospital Cuf Infante Santo - NOVA Medical School, Lisbon, Portugal
| | - João Paço
- ENT Department, Hospital Cuf Infante Santo - NOVA Medical School, Lisbon, Portugal
| | - Deborah A Hall
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.,University of Nottingham Malaysia, Semeniyh, Malaysia
| | - Agnieszka J Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Zimmerman BJ, Abraham I, Schmidt SA, Baryshnikov Y, Husain FT. Dissociating tinnitus patients from healthy controls using resting-state cyclicity analysis and clustering. Netw Neurosci 2018; 3:67-89. [PMID: 30793074 PMCID: PMC6326732 DOI: 10.1162/netn_a_00053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/19/2018] [Indexed: 12/24/2022] Open
Abstract
Chronic tinnitus is a common and sometimes debilitating condition that lacks scientific consensus on physiological models of how the condition arises as well as any known cure. In this study, we applied a novel cyclicity analysis, which studies patterns of leader-follower relationships between two signals, to resting-state functional magnetic resonance imaging (rs-fMRI) data of brain regions acquired from subjects with and without tinnitus. Using the output from the cyclicity analysis, we were able to differentiate between these two groups with 58–67% accuracy by using a partial least squares discriminant analysis. Stability testing yielded a 70% classification accuracy for identifying individual subjects’ data across sessions 1 week apart. Additional analysis revealed that the pairs of brain regions that contributed most to the dissociation between tinnitus and controls were those connected to the amygdala. In the controls, there were consistent temporal patterns across frontal, parietal, and limbic regions and amygdalar activity, whereas in tinnitus subjects, this pattern was much more variable. Our findings demonstrate a proof-of-principle for the use of cyclicity analysis of rs-fMRI data to better understand functional brain connectivity and to use it as a tool for the differentiation of patients and controls who may differ on specific traits. Chronic tinnitus is a common, yet poorly understood, condition without a known cure. Understanding differences in the functioning of brains of tinnitus patients and controls may lead to better knowledge regarding the physiology of the condition and to subsequent treatments. There are many ways to characterize relationships between neural activity in different parts of the brain. Here, we apply a novel method, called cyclicity analysis, to functional MRI data obtained from tinnitus patients and controls over a period of wakeful rest. Cyclicity analysis lends itself to interpretation as analysis of temporal orderings between elements of time-series data; it is distinct from methods like periodicity analysis or time correlation analysis in that its theoretical underpinnings are invariant to changes in time scales of the generative process. In this proof-of-concept study, we use the feature generated from the cyclicity analysis of the fMRI data to investigate group level differences between tinnitus patients and controls. Our findings indicate that temporal ordering of regional brain activation is much more consistent in the control population than in tinnitus population. We also apply methods of classification from machine learning to differentiate between the two populations with moderate amount of success.
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Affiliation(s)
- Benjamin J Zimmerman
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, IL, USA
| | - Ivan Abraham
- Department of Electrical & Computer Engineering, University of Illinois at Urbana-Champaign, IL, USA
| | - Sara A Schmidt
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, IL, USA
| | - Yuliy Baryshnikov
- Department of Electrical & Computer Engineering, University of Illinois at Urbana-Champaign, IL, USA
| | - Fatima T Husain
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, IL, USA
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Hofmeier B, Wolpert S, Aldamer ES, Walter M, Thiericke J, Braun C, Zelle D, Rüttiger L, Klose U, Knipper M. Reduced sound-evoked and resting-state BOLD fMRI connectivity in tinnitus. NEUROIMAGE-CLINICAL 2018; 20:637-649. [PMID: 30202725 PMCID: PMC6128096 DOI: 10.1016/j.nicl.2018.08.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 01/02/2023]
Abstract
The exact neurophysiological basis of chronic tinnitus, which affects 10-15% of the population, remains unknown and is controversial at many levels. It is an open question whether phantom sound perception results from increased central neural gain or not, a crucial question for any future therapeutic intervention strategies for tinnitus. We performed a comprehensive study of mild hearing-impaired participants with and without tinnitus, excluding participants with co-occurrences of hyperacusis. A right-hemisphere correlation between tinnitus loudness and auditory perceptual difficulty was observed in the tinnitus group, independent of differences in hearing thresholds. This correlation was linked to reduced and delayed sound-induced suprathreshold auditory brain responses (ABR wave V) in the tinnitus group, suggesting subsided rather than exaggerated central neural responsiveness. When anatomically predefined auditory regions of interest were analysed for altered sound-evoked BOLD fMRI activity, it became evident that subcortical and cortical auditory regions and regions involved in sound detection (posterior insula, hippocampus), responded with reduced BOLD activity in the tinnitus group, emphasizing reduced, rather than increased, central neural gain. Regarding previous findings of evoked BOLD activity being linked to positive connectivities at rest, we additionally analysed r-fcMRI responses in anatomically predefined auditory regions and regions associated with sound detection. A profound reduction in positive interhemispheric connections of homologous auditory brain regions and a decline in the positive connectivities between lower auditory brainstem regions and regions involved in sound detection (hippocampus, posterior insula) were observed in the tinnitus group. The finding went hand-in-hand with the emotional (amygdala, anterior insula) and temporofrontal/stress-regulating regions (prefrontal cortex, inferior frontal gyrus) that were no longer positively connected with auditory cortex regions in the tinnitus group but were instead positively connected to lower-level auditory brainstem regions. Delayed sound processing, reduced sound-evoked BOLD fMRI activity and altered r-fcMRI in the auditory midbrain correlated in the tinnitus group and showed right hemisphere dominance as did tinnitus loudness and perceptual difficulty. The findings suggest that reduced central neural gain in the auditory stream may lead to phantom perception through a failure to energize attentional/stress-regulating networks for contextualization of auditory-specific information. Reduced auditory-specific information flow in tinnitus has until now escaped detection in humans, as low-level auditory brain regions were previously omitted from neuroimaging studies. TRIAL REGISTRATION German Clinical Trials Register DRKS0006332.
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Key Words
- ABR wave
- ABR, auditory brainstem response
- BA, Brodmann area
- BA13A, anterior insula
- BA13P, posterior insula
- BA28, entorhinal cortex
- BB-chirp, broadband chirp
- BERA, brainstem-evoked response audiometry
- CN, cochlear nucleus
- CSF, cerebrospinal fluid
- Cortisol
- DL, dorsolateral
- EFR, envelope-followed responses
- ENT, ear, nose and throat
- FA, flip angle
- FDR, false discovery rate
- FOV, field of view
- FWHM, full width at half maximum
- G-H-S, Goebel-Hiller-Score
- HF-chirp, high-frequency chirp
- HPA, hypothalamic-pituitary-adrenal
- High-SR AF, high-spontaneous firing rates auditory fibers
- IC, inferior colliculus
- L, left
- LF-chirp, low-frequency chirp
- Low-SR AF, low-spontaneous firing rates auditory fibers
- M, medial
- MGB, medial geniculate body
- MNI, Montreal Neurological Institute
- PFC, prefrontal cortex
- PTA, pure tone audiogram
- R, right
- ROI, region of interest
- SD, standard deviation
- SOC, superior olivary complex
- SPL, sound pressure level
- SPM, Statistical Parametric Mapping
- TA, acquisition time
- TE, echo time
- TR, repetition time
- Tinnitus
- VBM, voxel-based morphometry
- fMRI
- r-fcMRI
- rCBF, resting-state cerebral blood flow
- rCBV, resting-state cerebral blood volume
- zFC, z-values functional connectivity
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Affiliation(s)
- Benedikt Hofmeier
- Department of Otolaryngology, Head and Neck Surgery, Hearing Research Center Tübingen, Molecular Physiology of Hearing, University of Tübingen, Elfriede-Aulhorn-Str. 5, D-72076 Tübingen, Germany
| | - Stephan Wolpert
- Department of Otolaryngology, Head and Neck Surgery, Hearing Research Center Tübingen, Molecular Physiology of Hearing, University of Tübingen, Elfriede-Aulhorn-Str. 5, D-72076 Tübingen, Germany
| | - Ebrahim Saad Aldamer
- Department of Otolaryngology, Head and Neck Surgery, Hearing Research Center Tübingen, Molecular Physiology of Hearing, University of Tübingen, Elfriede-Aulhorn-Str. 5, D-72076 Tübingen, Germany
| | - Moritz Walter
- Department of Otolaryngology, Head and Neck Surgery, Hearing Research Center Tübingen, Molecular Physiology of Hearing, University of Tübingen, Elfriede-Aulhorn-Str. 5, D-72076 Tübingen, Germany
| | - John Thiericke
- Department of Otolaryngology, Head and Neck Surgery, Hearing Research Center Tübingen, Molecular Physiology of Hearing, University of Tübingen, Elfriede-Aulhorn-Str. 5, D-72076 Tübingen, Germany/HNO Ärzte Praxis Part GmbB, Aschaffenburg, Germany
| | - Christoph Braun
- MEG Center, University Hospital Tübingen, Otfried-Müller-Str. 47, D-72076 Tübingen, Germany
| | - Dennis Zelle
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, D-72076 Tübingen, Germany
| | - Lukas Rüttiger
- Department of Otolaryngology, Head and Neck Surgery, Hearing Research Center Tübingen, Molecular Physiology of Hearing, University of Tübingen, Elfriede-Aulhorn-Str. 5, D-72076 Tübingen, Germany
| | - Uwe Klose
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, D-73076 Tübingen, Germany.
| | - Marlies Knipper
- Department of Otolaryngology, Head and Neck Surgery, Hearing Research Center Tübingen, Molecular Physiology of Hearing, University of Tübingen, Elfriede-Aulhorn-Str. 5, D-72076 Tübingen, Germany.
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Han Q, Zhang Y, Liu D, Wang Y, Feng Y, Yin X, Wang J. Disrupted local neural activity and functional connectivity in subjective tinnitus patients: evidence from resting-state fMRI study. Neuroradiology 2018; 60:1193-1201. [PMID: 30159629 DOI: 10.1007/s00234-018-2087-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/21/2018] [Indexed: 01/10/2023]
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Affiliation(s)
- Deborah A Hall
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham; NIHR Nottingham Biomedical Research Centre; Ropewalk House, 113 The Ropewalk Nottingham UK NG1 5DU
| | - Inge Wegner
- University Medical Center Utrecht; Department of Otorhinolaryngology & Head and Neck Surgery; Utrecht Netherlands
| | - Adriana Leni Smit
- University Medical Center Utrecht; Department of Otorhinolaryngology & Head and Neck Surgery; Utrecht Netherlands
| | - Don McFerran
- Essex County Hospital, Colchester Hospital University NHS Foundation Trust; ENT Department; Lexden Road Colchester UK
| | - Inge Stegeman
- University Medical Center Utrecht; Department of Otorhinolaryngology & Head and Neck Surgery; Utrecht Netherlands
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A systematic review and meta-analysis of psychological functioning in chronic tinnitus. Clin Psychol Rev 2018; 60:62-86. [DOI: 10.1016/j.cpr.2017.12.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 10/31/2017] [Accepted: 12/28/2017] [Indexed: 11/19/2022]
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Güntensperger D, Thüring C, Meyer M, Neff P, Kleinjung T. Neurofeedback for Tinnitus Treatment - Review and Current Concepts. Front Aging Neurosci 2017; 9:386. [PMID: 29249959 PMCID: PMC5717031 DOI: 10.3389/fnagi.2017.00386] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/09/2017] [Indexed: 12/18/2022] Open
Abstract
An effective treatment to completely alleviate chronic tinnitus symptoms has not yet been discovered. However, recent developments suggest that neurofeedback (NFB), a method already popular in the treatment of other psychological and neurological disorders, may provide a suitable alternative. NFB is a non-invasive method generally based on electrophysiological recordings and visualizing of certain aspects of brain activity as positive or negative feedback that enables patients to voluntarily control their brain activity and thus triggers them to unlearn typical neural activity patterns related to tinnitus. The purpose of this review is to summarize and discuss previous findings of neurofeedback treatment studies in the field of chronic tinnitus. In doing so, also an overview about the underlying theories of tinnitus emergence is presented and results of resting-state EEG and MEG studies summarized and critically discussed. To date, neurofeedback as well as electrophysiological tinnitus studies lack general guidelines that are crucial to produce more comparable and consistent results. Even though neurofeedback has already shown promising results for chronic tinnitus treatment, further research is needed in order to develop more sophisticated protocols that are able to tackle the individual needs of tinnitus patients more specifically.
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Affiliation(s)
- Dominik Güntensperger
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland
| | - Christian Thüring
- Department of Otorhinolaryngology, University Hospital of Zurich, Zurich, Switzerland
| | - Martin Meyer
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland
| | - Patrick Neff
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich, Zurich, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital of Zurich, Zurich, Switzerland
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James GA, Thostenson JD, Brown G, Carter G, Hayes H, Tripathi SP, Dobry DJ, Govindan RB, Dornhoffer JL, Williams DK, Kilts CD, Mennemeier MS. Neural activity during attentional conflict predicts reduction in tinnitus perception following rTMS. Brain Stimul 2017. [PMID: 28629874 DOI: 10.1016/j.brs.2017.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Subjective idiopathic tinnitus is an intrusive, distracting, and potentially disabling disorder characterized by phantom perception of sounds. Although tinnitus has no approved pharmacologic treatment, recent evidence supports the use of repetitive transcranial magnetic stimulation (rTMS) to alleviate tinnitus symptoms. OBJECTIVE/HYPOTHESIS Repetitive TMS delivered over the middle superior temporal gyrus (STG) may alter ratings of tinnitus awareness and annoyance more than loudness due to change in attentional processing. STG has reciprocal connections to regions of the prefrontal cortex that mediate attention. To probe the hypothesized influence of STG stimulation on attention, a subset of patients with tinnitus enrolled in an rTMS clinical trial [n = 12, 9 male, mean (sd) age = 49 (15) years] underwent an attentional conflict task before and after rTMS treatment in a repeated-measures functional magnetic resonance imaging (fMRI) study. METHODS The Multi-Source Interference Task (MSIT), a Stroop-based visual attentional conflict fMRI task, was used to map participants' neural processing of attentional conflict prior to rTMS intervention (Baseline) and after three rTMS intervention arms: Sham, 1 Hz, and 10 Hz (four sessions per arm, 1800 pulses per session, delivered @110% of the motor threshold over the posterior superior temporal gyrus). RESULTS All measures of tinnitus severity (awareness, loudness, and annoyance) improved with 1 Hz rTMS intervention; however, the greatest and most robust changes were observed for ratings of tinnitus awareness (mean 16% reduction in severity from Baseline, p < 0.01). The MSIT elicited a similar pattern of neural activation among tinnitus participants at Baseline compared to an independent sample of 43 healthy comparison adults (r = 0.801, p = 0.001). Linear regression with bootstrap resampling showed that greater recruitment of bilateral prefrontal and bilateral parietal regions by MSIT at Baseline corresponded with poorer treatment response. Individual regions' activities explained 37-67% variance in participant treatment response, with left dorsolateral prefrontal cortex's MSIT activity at Baseline explaining the greatest reduction in tinnitus awareness following 1 Hz stimulation. Although left dorsolateral prefrontal cortex activity at Baseline also predicted reduction in tinnitus loudness and annoyance (∼50% variance explained), these symptoms were more strongly predicted by right middle occipital cortex (∼70% variance explained) - suggesting that the neural predictors of symptom-specific treatment outcomes may be dissociable. CONCLUSION These candidate neural reactivity markers of treatment response have potential clinical value in identifying tinnitus sufferers who would or would not therapeutically benefit from rTMS intervention.
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Affiliation(s)
- G A James
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States.
| | - J D Thostenson
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - G Brown
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - G Carter
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - H Hayes
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - S P Tripathi
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - D J Dobry
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - R B Govindan
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - J L Dornhoffer
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - D K Williams
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - C D Kilts
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - M S Mennemeier
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
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Neff P, Michels J, Meyer M, Schecklmann M, Langguth B, Schlee W. 10 Hz Amplitude Modulated Sounds Induce Short-Term Tinnitus Suppression. Front Aging Neurosci 2017; 9:130. [PMID: 28579955 PMCID: PMC5437109 DOI: 10.3389/fnagi.2017.00130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/19/2017] [Indexed: 01/24/2023] Open
Abstract
Objectives: Acoustic stimulation or sound therapy is proposed as a main treatment option for chronic subjective tinnitus. To further probe the field of acoustic stimulations for tinnitus therapy, this exploratory study compared 10 Hz amplitude modulated (AM) sounds (two pure tones, noise, music, and frequency modulated (FM) sounds) and unmodulated sounds (pure tone, noise) regarding their temporary suppression of tinnitus loudness. First, it was hypothesized that modulated sounds elicit larger temporary loudness suppression (residual inhibition) than unmodulated sounds. Second, with manipulation of stimulus loudness and duration of the modulated sounds weaker or stronger effects of loudness suppression were expected, respectively. Methods: We recruited 29 participants with chronic tonal tinnitus from the multidisciplinary Tinnitus Clinic of the University of Regensburg. Participants underwent audiometric, psychometric and tinnitus pitch matching assessments followed by an acoustic stimulation experiment with a tinnitus loudness growth paradigm. In a first block participants were stimulated with all of the sounds for 3 min each and rated their subjective tinnitus loudness to the pre-stimulus loudness every 30 s after stimulus offset. The same procedure was deployed in the second block with the pure tone AM stimuli matched to the tinnitus frequency, manipulated in length (6 min), and loudness (reduced by 30 dB and linear fade out). Repeated measures mixed model analyses of variance (ANOVA) were calculated to assess differences in loudness growth between the stimuli for each block separately. Results: First, we found that all sounds elicit a short-term suppression of tinnitus loudness (seconds to minutes) with strongest suppression right after stimulus offset [F(6, 1331) = 3.74, p < 0.01]. Second, similar to previous findings we found that AM sounds near the tinnitus frequency produce significantly stronger tinnitus loudness suppression than noise [vs. Pink noise: t(27) = -4.22, p < 0.0001]. Finally, variants of the AM sound matched to the tinnitus frequency reduced in sound level resulted in less suppression while there was no significant difference observed for a longer stimulation duration. Moreover, feasibility of the overall procedure could be confirmed as scores of both tinnitus loudness and questionnaires were lower after the experiment [tinnitus loudness: t(27) = 2.77, p < 0.01; Tinnitus Questionnaire: t(27) = 2.06, p < 0.05; Tinnitus Handicap Inventory: t(27) = 1.92, p = 0.065]. Conclusion: Taken together, these results imply that AM sounds, especially in or around the tinnitus frequency, may induce larger suppression than unmodulated sounds. Future studies should thus evaluate this approach in longitudinal studies and real life settings. Furthermore, the putative neural relation of these sound stimuli with a modulation rate in the EEG α band to the observed tinnitus suppression should be probed with respective neurophysiological methods.
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Affiliation(s)
- Patrick Neff
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of ZurichZurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of ZurichZurich, Switzerland
| | - Jakob Michels
- Department of Medicine, University of RegensburgRegensburg, Germany
| | - Martin Meyer
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of ZurichZurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of ZurichZurich, Switzerland.,Cognitive Psychology Unit, University of KlagenfurtKlagenfurt, Austria
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of RegensburgRegensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of RegensburgRegensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of RegensburgRegensburg, Germany
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61
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EEG oscillatory power dissociates between distress- and depression-related psychopathology in subjective tinnitus. Brain Res 2017; 1663:194-204. [DOI: 10.1016/j.brainres.2017.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 02/20/2017] [Accepted: 03/04/2017] [Indexed: 12/12/2022]
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Davies JE, Gander PE, Hall DA. Does Chronic Tinnitus Alter the Emotional Response Function of the Amygdala?: A Sound-Evoked fMRI Study. Front Aging Neurosci 2017; 9:31. [PMID: 28270764 PMCID: PMC5318420 DOI: 10.3389/fnagi.2017.00031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/06/2017] [Indexed: 12/24/2022] Open
Abstract
Tinnitus is often associated with strong negative thoughts and emotions which can contribute to a distressing and chronic long-term condition. The amygdala, the "feeling and reacting" part of the brain, may play a key role in this process. Although implicated in several theoretical models of tinnitus, quantification of activity in the human amygdala has only been made possible more recently through neuroimaging methods such as functional magnetic resonance imaging (fMRI) but benefits from modified scanning parameters using a double-echo acquisition for improved BOLD sensitivity. This study thus examined the role of the amygdala in emotional sound processing in people with tinnitus using a novel double-echo imaging sequence for optimal detectability of subcortical activity. Our hypotheses were: (1) emotionally evocative sound clips rated as pleasant or unpleasant would elicit stronger amygdalar activation than sound clips rated as neutral, (2) people with tinnitus have greater amygdalar activation in response to emotionally evocative sounds (relative to neutral sounds) compared to controls. Methods: Twelve participants all with chronic, constant tinnitus took part. We also recruited 11 age and hearing-matched controls. Participants listened to a range of emotionally evocative sound clips; rated as pleasant, unpleasant or neutral. A region-of-interest analysis was chosen to test our a priori hypotheses. Results: Both groups displayed a robust and similar overall response to sounds vs. silence in the following ascending auditory pathways; inferior colliculus, medial geniculate body and the primary auditory cortex. In support of our first hypothesis, the amygdala's response to pleasant and unpleasant sound clips was significantly greater than neutral sounds. Opposing our second hypothesis, we found that the amygdala's overall response to pleasant and unpleasant sounds (compared to neutral sounds) was actually lower in the tinnitus group as compared to the controls. Conclusions: The "muted" amygdala activation observed in the tinnitus group could reflect an internal modification of emotional response perhaps as a result of successful habituation to emotionally negative sound. This interpretation would predict a heightened amygdala emotional response in individuals with a more clinically bothersome tinnitus.
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Affiliation(s)
- Jeff E Davies
- Division of Audiology, Faculty of Health and Life Sciences, School of Allied Health Sciences, De Montfort UniversityLeicester, UK; National Institute for Health Research, Nottingham Hearing Biomedical Research UnitNottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of NottinghamNottingham, UK
| | - Phillip E Gander
- National Institute for Health Research, Nottingham Hearing Biomedical Research UnitNottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of NottinghamNottingham, UK
| | - Deborah A Hall
- National Institute for Health Research, Nottingham Hearing Biomedical Research UnitNottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of NottinghamNottingham, UK
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63
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Maldonado Fernández M, Shin J, Scherer RW, Murdin L. Interventions for tinnitus in adults: an overview of systematic reviews. Hippokratia 2017. [DOI: 10.1002/14651858.cd011795.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Jennifer Shin
- Brigham and Women's Hospital, Massachusetts General Hospital; Department of Surgery - Otolaryngology; 75 Francis Street Boston MA USA 02115
| | - Roberta W Scherer
- Johns Hopkins Bloomberg School of Public Health; Department of Epidemiology; Room W6138 615 N. Wolfe St. Baltimore Maryland USA 21205
| | - Louisa Murdin
- Faculty of Brain Sciences, University College London; Ear Institute; London UK
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64
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Sekiya K, Takahashi M, Murakami S, Kakigi R, Okamoto H. Broadened population-level frequency tuning in the auditory cortex of tinnitus patients. J Neurophysiol 2017; 117:1379-1384. [PMID: 28053240 PMCID: PMC5350267 DOI: 10.1152/jn.00385.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/29/2016] [Accepted: 12/31/2016] [Indexed: 11/22/2022] Open
Abstract
Although subjective tinnitus is one of the most common public health concerns that impair the quality of life of many individuals, no standard treatment or objective diagnostic method currently exists. We herein revealed that population-level frequency tuning was significantly broader in the tinnitus ear than in the nontinnitus ear. The results of the present study provide an insight into the development of an objective diagnostic method for subjective tinnitus. Tinnitus is a phantom auditory perception without an external sound source and is one of the most common public health concerns that impair the quality of life of many individuals. However, its neural mechanisms remain unclear. We herein examined population-level frequency tuning in the auditory cortex of unilateral tinnitus patients with similar hearing levels in both ears using magnetoencephalography. We compared auditory-evoked neural activities elicited by a stimulation to the tinnitus and nontinnitus ears. Objective magnetoencephalographic data suggested that population-level frequency tuning corresponding to the tinnitus ear was significantly broader than that corresponding to the nontinnitus ear in the human auditory cortex. The results obtained support the hypothesis that pathological alterations in inhibitory neural networks play an important role in the perception of subjective tinnitus. NEW & NOTEWORTHY Although subjective tinnitus is one of the most common public health concerns that impair the quality of life of many individuals, no standard treatment or objective diagnostic method currently exists. We herein revealed that population-level frequency tuning was significantly broader in the tinnitus ear than in the nontinnitus ear. The results of the present study provide an insight into the development of an objective diagnostic method for subjective tinnitus.
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Affiliation(s)
- Kenichi Sekiya
- Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan.,Department of Otolaryngology, Head, and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan; and
| | - Mariko Takahashi
- Department of Otolaryngology, Head, and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan; and
| | - Shingo Murakami
- Department of Otolaryngology, Head, and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan; and
| | - Ryusuke Kakigi
- Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan.,The Graduate University for Advanced Studies (SOKENDAI), Hayama, Japan
| | - Hidehiko Okamoto
- Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan; .,The Graduate University for Advanced Studies (SOKENDAI), Hayama, Japan
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65
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Zenner HP, Delb W, Kröner-Herwig B, Jäger B, Peroz I, Hesse G, Mazurek B, Goebel G, Gerloff C, Trollmann R, Biesinger E, Seidler H, Langguth B. A multidisciplinary systematic review of the treatment for chronic idiopathic tinnitus. Eur Arch Otorhinolaryngol 2016; 274:2079-2091. [DOI: 10.1007/s00405-016-4401-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/19/2016] [Indexed: 01/17/2023]
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66
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Differential tinnitus-related neuroplastic alterations of cortical thickness and surface area. Hear Res 2016; 342:1-12. [DOI: 10.1016/j.heares.2016.08.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 12/27/2022]
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Berger JI, Coomber B, Wallace MN, Palmer AR. Reductions in cortical alpha activity, enhancements in neural responses and impaired gap detection caused by sodium salicylate in awake guinea pigs. Eur J Neurosci 2016; 45:398-409. [PMID: 27862478 PMCID: PMC5763375 DOI: 10.1111/ejn.13474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/07/2016] [Indexed: 11/30/2022]
Abstract
Tinnitus chronically affects between 10-15% of the population but, despite its prevalence, the underlying mechanisms are still not properly understood. One experimental model involves administration of high doses of sodium salicylate, as this is known to reliably induce tinnitus in both humans and animals. Guinea pigs were implanted with chronic electrocorticography (ECoG) electrode arrays, with silver-ball electrodes placed on the dura over left and right auditory cortex. Two more electrodes were positioned over the cerebellum to monitor auditory brainstem responses (ABRs). We recorded resting-state and auditory evoked neural activity from awake animals before and 2 h following salicylate administration (350 mg/kg; i.p.). Large increases in click-evoked responses (> 100%) were evident across the whole auditory cortex, despite significant reductions in wave I ABR amplitudes (in response to 20 kHz tones), which are indicative of auditory nerve activity. In the same animals, significant decreases in 6-10 Hz spontaneous oscillations (alpha waves) were evident over dorsocaudal auditory cortex. We were also able to demonstrate for the first time that cortical evoked potentials can be inhibited by a preceding gap in background noise [gap-induced pre-pulse inhibition (PPI)], in a similar fashion to the gap-induced inhibition of the acoustic startle reflex that is used as a behavioural test for tinnitus. Furthermore, 2 h following salicylate administration, we observed significant deficits in PPI of cortical responses that were closely aligned with significant deficits in behavioural responses to the same stimuli. Together, these data are suggestive of neural correlates of tinnitus and oversensitivity to sound (hyperacusis).
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Affiliation(s)
- Joel I Berger
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Ben Coomber
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark N Wallace
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Alan R Palmer
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK.,School of Medicine, University of Nottingham, Nottingham, UK
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68
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Abstract
BACKGROUND Tinnitus is the perception of sound without external acoustic stimuli. Patients with severe tinnitus may have physical and psychological complaints and their tinnitus can cause deterioration in their quality of life. At present no specific therapy for tinnitus has been found to be satisfactory in all patients. In recent decades, a number of reports have suggested that oral zinc supplementation may be effective in the management of tinnitus. Since zinc has a role in cochlear physiology and in the synapses of the auditory system, there is a plausible mechanism of action for this treatment. OBJECTIVES To evaluate the effectiveness and safety of oral zinc supplementation in the management of patients with tinnitus. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 6); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 July 2016. SELECTION CRITERIA Randomised controlled trials comparing zinc supplementation versus placebo in adults (18 years and over) with tinnitus. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures recommended by Cochrane. Our primary outcome measures were improvement in tinnitus severity and disability, measured by a validated tinnitus-specific questionnaire, and adverse effects. Secondary outcomes were quality of life, change in socioeconomic impact associated with work, change in anxiety and depression disorders, change in psychoacoustic parameters, change in tinnitus loudness, change in overall severity of tinnitus and change in thresholds on pure tone audiometry. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS We included three trials involving a total of 209 participants. The studies were at moderate to high risk of bias. All included studies had differences in participant selection criteria, length of follow-up and outcome measurement, precluding a meta-analysis. The participants were all adults over 18 years with subjective tinnitus, but one study conducted in 2013 (n = 109) included only elderly patients. Improvement in tinnitus severity and disabilityOnly the study in elderly patients used a validated instrument (Tinnitus Handicap Questionnaire) for this primary outcome. The authors of this cross-over study did not report the results of the two phases separately and found no significant differences in the proportion of patients reporting tinnitus improvement at four months of follow-up: 5% (5/93) versus 2% (2/94) in the zinc and placebo groups, respectively (risk ratio (RR) 2.53, 95% confidence interval (CI) 0.50 to 12.70; very low-quality evidence).None of the included studies reported any significant adverse effects. Secondary outcomesFor the secondary outcome change in tinnitus loudness, one study reported no significant difference between the zinc and placebo groups after eight weeks: mean difference in tinnitus loudness -9.71 dB (95% CI -25.53 to 6.11; very low-quality evidence). Another study also measured tinnitus loudness but used a 0- to 100-point scale. The authors of this second study reported no significant difference between the zinc and placebo groups after four months: mean difference in tinnitus loudness rating scores 0.50 (95% CI -5.08 to 6.08; very low-quality evidence).Two studies used unvalidated instruments to assess tinnitus severity. One (with 50 participants) reported the severity of tinnitus using a non-validated scale (0 to 7 points) and found no significant difference in subjective tinnitus scores between the zinc and placebo groups at the end of eight weeks of follow-up (mean difference (MD) -1.41, 95% CI -2.97 to 0.15; very low-quality evidence). A third trial (n = 50) also evaluated the improvement of tinnitus using a non-validated instrument (a 0 to 10 scale: 10 = severe and unbearable tinnitus). In this study, after eight weeks there was no difference in the proportion of patients with improvement in their tinnitus, 8.7% (2/23) treated with zinc versus 8% (2/25) of those who received a placebo (RR 1.09, 95% CI 0.17 to 7.10, very low-quality evidence).None of the included studies reported any of our other secondary outcomes (quality of life, change in socioeconomic impact associated with work, change in anxiety and depression disorders, change in psychoacoustic parameters or change in thresholds on pure tone audiometry). AUTHORS' CONCLUSIONS We found no evidence that the use of oral zinc supplementation improves symptoms in adults with tinnitus.
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Affiliation(s)
- Osmar C Person
- Universidade Federal de São PauloMedicina, Medical SchoolRua Pedro de Toledo, 598São PauloSão PauloBrazil04039‐001
| | - Maria ES Puga
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeBrazilian Cochrane CentreRua Borges Lagoa, 564 cj 63São PauloSão PauloBrazil04038‐000
| | - Edina MK da Silva
- Universidade Federal de São PauloEmergency Medicine and Evidence Based MedicineRua Borges Lagoa 564 cj 64Vl. ClementinoSão PauloSão PauloBrazil04038‐000
| | - Maria R Torloni
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeBrazilian Cochrane CentreRua Borges Lagoa, 564 cj 63São PauloSão PauloBrazil04038‐000
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Imsuwansri T, Hoare DJ, Phaisaltuntiwongs W, Srisubat A, Snidvongs K. Glutamate receptor antagonists for tinnitus. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thanarath Imsuwansri
- Ministry of Public Health; Institute of Medical Research and Technology Assessment, Dept of Medical Services; Tiwanon Nonthaburi Thailand 11000
| | - Derek J Hoare
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham; NIHR Nottingham Hearing Biomedical Research Unit; Ropewalk House, 113 The Ropewalk Nottingham UK NG1 5DU
| | - Wanasri Phaisaltuntiwongs
- Sirindhorn Hospital, Medical Service Department; Otorhinolaryngology Section; Bangkok Metropolitan Administration Onnut Road, Prawet District Bangkok Thailand 10250
| | - Attasit Srisubat
- Ministry of Public Health; Institute of Medical Research and Technology Assessment, Dept of Medical Services; Tiwanon Nonthaburi Thailand 11000
| | - Kornkiat Snidvongs
- Chulalongkorn University; Department of Otolaryngology, Faculty of Medicine; Bangkok Thailand
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70
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Allan TW, Besle J, Langers DRM, Davies J, Hall DA, Palmer AR, Adjamian P. Neuroanatomical Alterations in Tinnitus Assessed with Magnetic Resonance Imaging. Front Aging Neurosci 2016; 8:221. [PMID: 27708577 PMCID: PMC5030287 DOI: 10.3389/fnagi.2016.00221] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/06/2016] [Indexed: 01/08/2023] Open
Abstract
Previous studies of anatomical changes associated with tinnitus have provided inconsistent results, with some showing significant cortical and subcortical changes, while others have found effects due to hearing loss, but not tinnitus. In this study, we examined changes in brain anatomy associated with tinnitus using anatomical scans from 128 participants with tinnitus and hearing loss, tinnitus with clinically normal hearing, and non-tinnitus controls with clinically normal hearing. The groups were matched for hearing loss, age and gender. We employed voxel- and surface-based morphometry (SBM) to investigate gray and white matter volume and thickness within regions-of-interest (ROI) that were based on the results of previous studies. The largest overall effects were found for age, gender, and hearing loss. With regard to tinnitus, analysis of ROI revealed numerous small increases and decreases in gray matter and thickness between tinnitus and non-tinnitus controls, in both cortical and subcortical structures. For whole brain analysis, the main tinnitus-related significant clusters were found outside sensory auditory structures. These include a decrease in cortical thickness for the tinnitus group compared to controls in the left superior frontal gyrus (SFG), and a decrease in cortical volume with hearing loss in left Heschl’s gyrus (HG). For masked analysis, we found a decrease in gray matter volume in the right Heschle’s gyrus for the tinnitus group compared to the controls. We found no changes in the subcallosal region as reported in some previous studies. Overall, while some of the morphological differences observed in this study are similar to previously published findings, others are entirely different or even contradict previous results. We highlight other discrepancies among previous results and the increasing need for a more precise subtyping of the condition.
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Affiliation(s)
- Thomas W Allan
- Medical Research Council Institute of Hearing Research, The University of Nottingham Nottingham, UK
| | - Julien Besle
- Medical Research Council Institute of Hearing Research, The University of Nottingham Nottingham, UK
| | - Dave R M Langers
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR)Nottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, The University of NottinghamNottingham, UK
| | - Jeff Davies
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR)Nottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, The University of NottinghamNottingham, UK
| | - Deborah A Hall
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR)Nottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, The University of NottinghamNottingham, UK
| | - Alan R Palmer
- Medical Research Council Institute of Hearing Research, The University of Nottingham Nottingham, UK
| | - Peyman Adjamian
- Medical Research Council Institute of Hearing Research, The University of Nottingham Nottingham, UK
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71
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Ghodratitoostani I, Zana Y, Delbem ACB, Sani SS, Ekhtiari H, Sanchez TG. Theoretical Tinnitus Framework: A Neurofunctional Model. Front Neurosci 2016; 10:370. [PMID: 27594822 PMCID: PMC4990547 DOI: 10.3389/fnins.2016.00370] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/29/2016] [Indexed: 01/01/2023] Open
Abstract
Subjective tinnitus is the conscious (attended) awareness perception of sound in the absence of an external source and can be classified as an auditory phantom perception. Earlier literature establishes three distinct states of conscious perception as unattended, attended, and attended awareness conscious perception. The current tinnitus development models depend on the role of external events congruently paired with the causal physical events that precipitate the phantom perception. We propose a novel Neurofunctional Tinnitus Model to indicate that the conscious (attended) awareness perception of phantom sound is essential in activating the cognitive-emotional value. The cognitive-emotional value plays a crucial role in governing attention allocation as well as developing annoyance within tinnitus clinical distress. Structurally, the Neurofunctional Tinnitus Model includes the peripheral auditory system, the thalamus, the limbic system, brainstem, basal ganglia, striatum, and the auditory along with prefrontal cortices. Functionally, we assume the model includes presence of continuous or intermittent abnormal signals at the peripheral auditory system or midbrain auditory paths. Depending on the availability of attentional resources, the signals may or may not be perceived. The cognitive valuation process strengthens the lateral-inhibition and noise canceling mechanisms in the mid-brain, which leads to the cessation of sound perception and renders the signal evaluation irrelevant. However, the “sourceless” sound is eventually perceived and can be cognitively interpreted as suspicious or an indication of a disease in which the cortical top-down processes weaken the noise canceling effects. This results in an increase in cognitive and emotional negative reactions such as depression and anxiety. The negative or positive cognitive-emotional feedbacks within the top-down approach may have no relation to the previous experience of the patients. They can also be associated with aversive stimuli similar to abnormal neural activity in generating the phantom sound. Cognitive and emotional reactions depend on general personality biases toward evaluative conditioning combined with a cognitive-emotional negative appraisal of stimuli such as the case of people with present hypochondria. We acknowledge that the projected Neurofunctional Tinnitus Model does not cover all tinnitus variations and patients. To support our model, we present evidence from several studies using neuroimaging, electrophysiology, brain lesion, and behavioral techniques.
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Affiliation(s)
- Iman Ghodratitoostani
- Neurocognitive Engineering Laboratory, Institute of Mathematics and Computer Sciences, University of São Paulo São Carlos, Brazil
| | - Yossi Zana
- Center of Mathematics, Computation and Cognition, Federal University of ABC São Bernardo do Campo, Brazil
| | - Alexandre C B Delbem
- Neurocognitive Engineering Laboratory, Institute of Mathematics and Computer Sciences, University of São PauloSão Carlos, Brazil; Institute of Mathematics and Computer Sciences, University of São PauloSão Carlos, Brazil
| | - Siamak S Sani
- WHO Research- World Hearing Organization San Jose, CA, USA
| | - Hamed Ekhtiari
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences Tehran, Iran
| | - Tanit G Sanchez
- ENT Department, Faculty of Medicine, University of São PauloSão Carlos, Brazil; Instituto Ganz SanchezSão Paulo, Brazil
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72
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Chen YC, Feng Y, Xu JJ, Mao CN, Xia W, Ren J, Yin X. Disrupted Brain Functional Network Architecture in Chronic Tinnitus Patients. Front Aging Neurosci 2016; 8:174. [PMID: 27458377 PMCID: PMC4937025 DOI: 10.3389/fnagi.2016.00174] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/28/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose: Resting-state functional magnetic resonance imaging (fMRI) studies have demonstrated the disruptions of multiple brain networks in tinnitus patients. Nonetheless, several studies found no differences in network processing between tinnitus patients and healthy controls (HCs). Its neural bases are poorly understood. To identify aberrant brain network architecture involved in chronic tinnitus, we compared the resting-state fMRI (rs-fMRI) patterns of tinnitus patients and HCs. Materials and Methods: Chronic tinnitus patients (n = 24) with normal hearing thresholds and age-, sex-, education- and hearing threshold-matched HCs (n = 22) participated in the current study and underwent the rs-fMRI scanning. We used degree centrality (DC) to investigate functional connectivity (FC) strength of the whole-brain network and Granger causality to analyze effective connectivity in order to explore directional aspects involved in tinnitus. Results: Compared to HCs, we found significantly increased network centrality in bilateral superior frontal gyrus (SFG). Unidirectionally, the left SFG revealed increased effective connectivity to the left middle orbitofrontal cortex (OFC), left posterior lobe of cerebellum (PLC), left postcentral gyrus, and right middle occipital gyrus (MOG) while the right SFG exhibited enhanced effective connectivity to the right supplementary motor area (SMA). In addition, the effective connectivity from the bilateral SFG to the OFC and SMA showed positive correlations with tinnitus distress. Conclusions: Rs-fMRI provides a new and novel method for identifying aberrant brain network architecture. Chronic tinnitus patients have disrupted FC strength and causal connectivity mostly in non-auditory regions, especially the prefrontal cortex (PFC). The current findings will provide a new perspective for understanding the neuropathophysiological mechanisms in chronic tinnitus.
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Affiliation(s)
- Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Yuan Feng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Cun-Nan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Wenqing Xia
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Jun Ren
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
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73
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Vanneste S, Faber M, Langguth B, De Ridder D. The neural correlates of cognitive dysfunction in phantom sounds. Brain Res 2016; 1642:170-179. [PMID: 27016059 DOI: 10.1016/j.brainres.2016.03.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 03/15/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
Tinnitus is an auditory phantom percept with a tone, hissing or buzzing sound in the absence of an objective physical sound source. It has been shown that tinnitus can lead to emotional and cognitive impairment and people with tinnitus perform worse than a control group on different cognitive tasks. The hippocampus is known to play an important role in cognitive performance, and also in the pathophysiology of tinnitus. Hippocampal deficits have been described in animal models of tinnitus and in tinnitus patients a decrease in grey matter in the hippocampus has been demonstrated. Nineteen patients with tinnitus and fifteen healthy controls performed different cognitive processing tasks and underwent an EEG with source analysis to investigate the relationship between tinnitus loudness, tinnitus distress and tinnitus duration, cognitive impairment and neurophysiological changes in the hippocampus. Results show that both tinnitus loudness, tinnitus distress and tinnitus duration correlated positively with different cognitive measures (trail making test, Montreal cognitive assessment, mini mental state examination). It was also shown that these cognitive measures correlate with beta activity in the hippocampus, the pregenual and subgenual anterior cingulate cortex extending into the right insula. A region of interest analysis further confirms that beta activity in the left and right hippocampal area correlated with the trail making performance. In conclusion, these results support for the first time the notion that cognitive changes in tinnitus patients are associated with changes in hippocampal activity as well as the anterior cingulate and insula.
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Affiliation(s)
- Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA.
| | - Margriet Faber
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Belgium
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Germany
| | - Dirk De Ridder
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
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74
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Human Auditory and Adjacent Nonauditory Cerebral Cortices Are Hypermetabolic in Tinnitus as Measured by Functional Near-Infrared Spectroscopy (fNIRS). Neural Plast 2016; 2016:7453149. [PMID: 27042360 PMCID: PMC4793139 DOI: 10.1155/2016/7453149] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/26/2016] [Accepted: 02/07/2016] [Indexed: 12/29/2022] Open
Abstract
Tinnitus is the phantom perception of sound in the absence of an acoustic stimulus. To date, the purported neural correlates of tinnitus from animal models have not been adequately characterized with translational technology in the human brain. The aim of the present study was to measure changes in oxy-hemoglobin concentration from regions of interest (ROI; auditory cortex) and non-ROI (adjacent nonauditory cortices) during auditory stimulation and silence in participants with subjective tinnitus appreciated equally in both ears and in nontinnitus controls using functional near-infrared spectroscopy (fNIRS). Control and tinnitus participants with normal/near-normal hearing were tested during a passive auditory task. Hemodynamic activity was monitored over ROI and non-ROI under episodic periods of auditory stimulation with 750 or 8000 Hz tones, broadband noise, and silence. During periods of silence, tinnitus participants maintained increased hemodynamic responses in ROI, while a significant deactivation was seen in controls. Interestingly, non-ROI activity was also increased in the tinnitus group as compared to controls during silence. The present results demonstrate that both auditory and select nonauditory cortices have elevated hemodynamic activity in participants with tinnitus in the absence of an external auditory stimulus, a finding that may reflect basic science neural correlates of tinnitus that ultimately contribute to phantom sound perception.
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75
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Lehner A, Schecklmann M, Greenlee MW, Rupprecht R, Langguth B. Triple-site rTMS for the treatment of chronic tinnitus: a randomized controlled trial. Sci Rep 2016; 6:22302. [PMID: 26927363 PMCID: PMC4772792 DOI: 10.1038/srep22302] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/11/2016] [Indexed: 11/27/2022] Open
Abstract
Recent research indicates that tinnitus is related to alterations of neural networks including temporal, parietal, and prefrontal brain regions. The current study examines a rTMS protocol which targets three central nodes of these networks in a two-arm randomized parallel group trial. Overall, 49 patients with chronic tinnitus were randomized to receive either triple-site stimulation (left dorsolateral prefrontal stimulation, 1000 pulses, 20 Hz plus left and right temporoparietal stimulation, 1000 pulses each, 1 Hz) or single-site stimulation (left temporoparietal stimulation, 3000 pulses, 1 Hz). Both groups were treated in ten sessions. Tinnitus severity as measured by the tinnitus questionnaire was assessed before rTMS (day1), after rTMS (day12) and at two follow-up visits (day 90 and day 180). The triple-site protocol was well tolerated. There was a significant reduction in tinnitus severity for both treatment groups. The triple-site group tended to show a more pronounced treatment effect at day 90. However, the measurement time point x group interaction effect was not significant. The current results confirm former studies that indicated a significant reduction of tinnitus severity after rTMS treatment. No significant superiority of the multisite protocol was observed. Future approaches for the enhancement of treatment effects are discussed.
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Affiliation(s)
- Astrid Lehner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Mark W. Greenlee
- Institute for Psychology, University of Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany.
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
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76
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Zobay O, Adjamian P. Source-Space Cross-Frequency Amplitude-Amplitude Coupling in Tinnitus. BIOMED RESEARCH INTERNATIONAL 2015; 2015:489619. [PMID: 26665004 PMCID: PMC4668294 DOI: 10.1155/2015/489619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/19/2015] [Accepted: 10/26/2015] [Indexed: 12/18/2022]
Abstract
The thalamocortical dysrhythmia (TCD) model has been influential in the development of theoretical explanations for the neurological mechanisms of tinnitus. It asserts that thalamocortical oscillations lock a region in the auditory cortex into an ectopic slow-wave theta rhythm (4-8 Hz). The cortical area surrounding this region is hypothesized to generate abnormal gamma (>30 Hz) oscillations ("edge effect") giving rise to the tinnitus percept. Consequently, the model predicts enhanced cross-frequency coherence in a broad range between theta and gamma. In this magnetoencephalography study involving tinnitus and control cohorts, we investigated this prediction. Using beamforming, cross-frequency amplitude-amplitude coupling (AAC) was computed within the auditory cortices for frequencies (f1, f2) between 2 and 80 Hz. We find the AAC signal to decompose into two distinct components at low (f1, f2 < 30 Hz) and high (f1, f2 > 30 Hz) frequencies, respectively. Studying the correlation of AAC with several key covariates (age, hearing level (HL), tinnitus handicap and duration, and HL at tinnitus frequency), we observe a statistically significant association between age and low-frequency AAC. Contrary to the TCD predictions, however, we do not find any indication of statistical differences in AAC between tinnitus and controls and thus no evidence for the predicted enhancement of cross-frequency coupling in tinnitus.
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Affiliation(s)
- Oliver Zobay
- MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, UK
| | - Peyman Adjamian
- MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, UK
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77
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Schecklmann M, Lehner A, Gollmitzer J, Schmidt E, Schlee W, Langguth B. Repetitive transcranial magnetic stimulation induces oscillatory power changes in chronic tinnitus. Front Cell Neurosci 2015; 9:421. [PMID: 26557055 PMCID: PMC4617176 DOI: 10.3389/fncel.2015.00421] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/04/2015] [Indexed: 11/13/2022] Open
Abstract
Chronic tinnitus is associated with neuroplastic changes in auditory and non-auditory cortical areas. About 10 years ago, repetitive transcranial magnetic stimulation (rTMS) of auditory and prefrontal cortex was introduced as potential treatment for tinnitus. The resulting changes in tinnitus loudness are interpreted in the context of rTMS induced activity changes (neuroplasticity). Here, we investigate the effect of single rTMS sessions on oscillatory power to probe the capacity of rTMS to interfere with tinnitus-specific cortical plasticity. We measured 20 patients with bilateral chronic tinnitus and 20 healthy controls comparable for age, sex, handedness, and hearing level with a 63-channel electroencephalography (EEG) system. Educational level, intelligence, depressivity and hyperacusis were controlled for by analysis of covariance. Different rTMS protocols were tested: Left and right temporal and left and right prefrontal cortices were each stimulated with 200 pulses at 1 Hz and with an intensity of 60% stimulator output. Stimulation of central parietal cortex with 6-fold reduced intensity (inverted passive-cooled coil) served as sham condition. Before and after each rTMS protocol 5 min of resting state EEG were recorded. The order of rTMS protocols was randomized over two sessions with 1 week interval in between. Analyses on electrode level showed that people with and without tinnitus differed in their response to left temporal and right frontal stimulation. In tinnitus patients left temporal rTMS decreased frontal theta and delta and increased beta2 power, whereas right frontal rTMS decreased right temporal beta3 and gamma power. No changes or increases were observed in the control group. Only non-systematic changes in tinnitus loudness were induced by single sessions of rTMS. This is the first study to show tinnitus-related alterations of neuroplasticity that were specific to stimulation site and oscillatory frequency. The observed effects can be interpreted within the thalamocortical dysrhythmia model assuming that slow waves represent processes of deafferentiation and that high frequencies might be indicators for tinnitus loudness. Moreover our findings confirm the role of the left temporal and the right frontal areas as relevant hubs in tinnitus related neuronal network. Our results underscore the value of combined TMS-EEG measurements for investigating disease related changes in neuroplasticity.
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Affiliation(s)
- Martin Schecklmann
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Judith Gollmitzer
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Eldrid Schmidt
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Clinic, University of Regensburg Regensburg, Germany
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78
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Zhang D, Ma Y. Repetitive transcranial magnetic stimulation improves both hearing function and tinnitus perception in sudden sensorineural hearing loss patients. Sci Rep 2015; 5:14796. [PMID: 26463446 PMCID: PMC4604476 DOI: 10.1038/srep14796] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 09/09/2015] [Indexed: 11/17/2022] Open
Abstract
The occurrence of sudden sensorineural hearing loss (SSHL) affects not only cochlear activity but also neural activity in the central auditory system. Repetitive transcranial magnetic stimulation (rTMS) above the auditory cortex has been reported to improve auditory processing and to reduce the perception of tinnitus, which results from network dysfunction involving both auditory and non-auditory brain regions. SSHL patients who were refractory to standard corticosteroid therapy (SCT) and hyperbaric oxygen (HBO) therapy received 20 sessions of 1 Hz rTMS to the temporoparietal junction ipsilateral to the symptomatic ear (rTMS group). RTMS therapy administered in addition to SCT and HBO therapy resulted in significantly greater recovery of hearing function and improvement of tinnitus perception compared SCT and HBO therapy without rTMS therapy. Additionally, the single photon emission computed tomography (SPECT) measurements obtained in a subgroup of patients suggested that the rTMS therapy could have alleviated the decrease in regional cerebral brain flow (rCBF) in SSHL patients. RTMS appears to be an effective, practical, and safe treatment strategy for SSHL.
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Affiliation(s)
- Dai Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yuewen Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
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79
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Elgoyhen AB, Langguth B, De Ridder D, Vanneste S. Tinnitus: perspectives from human neuroimaging. Nat Rev Neurosci 2015; 16:632-42. [DOI: 10.1038/nrn4003] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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80
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Mwilambwe-Tshilobo L, Davis AJO, Aizenberg M, Geffen MN. Selective Impairment in Frequency Discrimination in a Mouse Model of Tinnitus. PLoS One 2015; 10:e0137749. [PMID: 26352864 PMCID: PMC4564173 DOI: 10.1371/journal.pone.0137749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 08/20/2015] [Indexed: 01/26/2023] Open
Abstract
Tinnitus is an auditory disorder, which affects millions of Americans, including active duty service members and veterans. It is manifested by a phantom sound that is commonly restricted to a specific frequency range. Because tinnitus is associated with hearing deficits, understanding how tinnitus affects hearing perception is important for guiding therapies to improve the quality of life in this vast group of patients. In a rodent model of tinnitus, prolonged exposure to a tone leads to a selective decrease in gap detection in specific frequency bands. However, whether and how hearing acuity is affected for sounds within and outside those frequency bands is not well understood. We induced tinnitus in mice by prolonged exposure to a loud mid-range tone, and behaviorally assayed whether mice exhibited a change in frequency discrimination acuity for tones embedded within the mid-frequency range and high-frequency range at 1, 4, and 8 weeks post-exposure. A subset of tone-exposed mice exhibited tinnitus-like symptoms, as demonstrated by selective deficits in gap detection, which were restricted to the high frequency range. These mice exhibited impaired frequency discrimination both for tones in the mid-frequency range and high-frequency range. The remaining tone exposed mice, which did not demonstrate behavioral evidence of tinnitus, showed temporary deficits in frequency discrimination for tones in the mid-frequency range, while control mice remained unimpaired. Our findings reveal that the high frequency-specific deficits in gap detection, indicative of tinnitus, are associated with impairments in frequency discrimination at the frequency of the presumed tinnitus.
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Affiliation(s)
- Laetitia Mwilambwe-Tshilobo
- Department of Otorhinolaryngology HNS, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Andrew J. O. Davis
- Department of Otorhinolaryngology HNS, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Mark Aizenberg
- Department of Otorhinolaryngology HNS, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Maria N. Geffen
- Department of Otorhinolaryngology HNS, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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81
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Alterations of Regional Cerebral Blood Flow in Tinnitus Patients as Assessed Using Single-Photon Emission Computed Tomography. PLoS One 2015; 10:e0137291. [PMID: 26332128 PMCID: PMC4557829 DOI: 10.1371/journal.pone.0137291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/14/2015] [Indexed: 12/12/2022] Open
Abstract
Tinnitus is the perception of phantom sound without an external auditory stimulus. Using neuroimaging techniques, such as positron emission tomography, electroencephalography, magnetoencephalography, and functional magnetic resonance imaging (fMRI), many studies have demonstrated that abnormal functions of the central nervous system are closely associated with tinnitus. In our previous research, we reported using resting-state fMRI that several brain regions, including the rectus gyrus, cingulate gyrus, thalamus, hippocampus, caudate, inferior temporal gyrus, cerebellar hemisphere, and medial superior frontal gyrus, were associated with tinnitus distress and loudness. To reconfirm these results and probe target regions for repetitive transcranial magnetic stimulation (rTMS), we investigated the regional cerebral blood flow (rCBF) between younger tinnitus patients (<60 years old) and the age-matched controls using single-photon emission computed tomography and easy Z-score imaging system. Compared with that of controls, the rCBF of tinnitus patients was significantly lower in the bilateral medial superior frontal gyri, left middle occipital gyrus and significantly higher in the bilateral cerebellar hemispheres and vermis, bilateral middle temporal gyri, right fusiform gyrus. No clear differences were observed between tinnitus patients with normal and impaired hearing. Regardless of the assessment modality, similar brain regions were identified as characteristic in tinnitus patients. These regions are potentially involved in the pathophysiology of chronic subjective tinnitus.
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82
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Alterations to the attention system in adults with tinnitus are modality specific. Brain Res 2015; 1620:81-97. [DOI: 10.1016/j.brainres.2015.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/17/2015] [Accepted: 05/08/2015] [Indexed: 11/23/2022]
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83
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Maldonado Fernández M, Shin J, Scherer RW, Murdin L. Interventions for tinnitus in adults: an overview of systematic reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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84
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Eggermont JJ, Roberts LE. Tinnitus: animal models and findings in humans. Cell Tissue Res 2015; 361:311-36. [PMID: 25266340 PMCID: PMC4487353 DOI: 10.1007/s00441-014-1992-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/14/2014] [Indexed: 12/19/2022]
Abstract
Chronic tinnitus (ringing of the ears) is a medically untreatable condition that reduces quality of life for millions of individuals worldwide. Most cases are associated with hearing loss that may be detected by the audiogram or by more sensitive measures. Converging evidence from animal models and studies of human tinnitus sufferers indicates that, while cochlear damage is a trigger, most cases of tinnitus are not generated by irritative processes persisting in the cochlea but by changes that take place in central auditory pathways when auditory neurons lose their input from the ear. Forms of neural plasticity underlie these neural changes, which include increased spontaneous activity and neural gain in deafferented central auditory structures, increased synchronous activity in these structures, alterations in the tonotopic organization of auditory cortex, and changes in network behavior in nonauditory brain regions detected by functional imaging of individuals with tinnitus and corroborated by animal investigations. Research on the molecular mechanisms that underlie neural changes in tinnitus is in its infancy and represents a frontier for investigation.
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Affiliation(s)
- Jos J Eggermont
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, and Department of Psychology, University of Calgary, 2500 University Drive N.W, Calgary, AB, Canada,
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85
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Hoare DJ, Whitham D, Henry JA, Shorter GW. Neuromodulation (desynchronisation) for tinnitus in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Derek J Hoare
- University of Nottingham; National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit; Ropewalk House, 113 The Ropewalk Nottingham UK NG1 5DU
| | - Diane Whitham
- Queen's Medical Centre; Nottingham Clinical Trials Unit; Room 2201 Clinical Trials Unit C Floor, South Block Nottingham UK NG7 2UH
| | - James A Henry
- VA Medical Center - NCRAR; National Center for Rehabilitative Auditory Research; 3710 SW US Veterans Hospital Road Portland USA OR 97239
- Oregon Hearing Research Center; Department of Otolaryngology; Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland USA OR 97239-3098
| | - Gillian W Shorter
- University of Ulster; Bamford Centre for Mental Health and Wellbeing; Room MI020, Magee Campus Londonderry UK BT48 7JL
- University of Ulster; MRC All Ireland Hub for Trials Methodology Research; Northland Road Londonderry UK BT48 7JL
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86
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Maslin MRD, Lloyd SK, Rutherford S, Freeman S, King A, Moore DR, Munro KJ. Rapid Increase in Neural Conduction Time in the Adult Human Auditory Brainstem Following Sudden Unilateral Deafness. J Assoc Res Otolaryngol 2015; 16:631-40. [PMID: 26055149 DOI: 10.1007/s10162-015-0526-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 05/20/2015] [Indexed: 12/25/2022] Open
Abstract
Individuals with sudden unilateral deafness offer a unique opportunity to study plasticity of the binaural auditory system in adult humans. Stimulation of the intact ear results in increased activity in the auditory cortex. However, there are no reports of changes at sub-cortical levels in humans. Therefore, the aim of the present study was to investigate changes in sub-cortical activity immediately before and after the onset of surgically induced unilateral deafness in adult humans. Click-evoked auditory brainstem responses (ABRs) to stimulation of the healthy ear were recorded from ten adults during the course of translabyrinthine surgery for the removal of a unilateral acoustic neuroma. This surgical technique always results in abrupt deafferentation of the affected ear. The results revealed a rapid (within minutes) reduction in latency of wave V (mean pre = 6.55 ms; mean post = 6.15 ms; p < 0.001). A latency reduction was also observed for wave III (mean pre = 4.40 ms; mean post = 4.13 ms; p < 0.001). These reductions in response latency are consistent with functional changes including disinhibition or/and more rapid intra-cellular signalling affecting binaurally sensitive neurons in the central auditory system. The results are highly relevant for improved understanding of putative physiological mechanisms underlying perceptual disorders such as tinnitus and hyperacusis.
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Affiliation(s)
- M R D Maslin
- School of Psychological Sciences, University of Manchester, A3.11 Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - S K Lloyd
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - S Freeman
- Salford Royal NHS Foundation Trust, Salford, UK
| | - A King
- Salford Royal NHS Foundation Trust, Salford, UK
| | - D R Moore
- School of Psychological Sciences, University of Manchester, A3.11 Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - K J Munro
- School of Psychological Sciences, University of Manchester, A3.11 Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK. .,Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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87
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Ward J, Vella C, Hoare DJ, Hall DA. Subtyping Somatic Tinnitus: A Cross-Sectional UK Cohort Study of Demographic, Clinical and Audiological Characteristics. PLoS One 2015; 10:e0126254. [PMID: 25996779 PMCID: PMC4440784 DOI: 10.1371/journal.pone.0126254] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/31/2015] [Indexed: 11/23/2022] Open
Abstract
Somatic tinnitus is the ability to modulate the psychoacoustic features of tinnitus by somatic manoeuvres. The condition is still not fully understood and further identification of this subtype is essential, particularly for the purpose of establishing protocols for both its diagnosis and treatment. This study aimed to investigate the characteristics of somatic tinnitus within a large UK cohort using a largely unselected sample. We believe this to be relatively unique in comparison to current literature on the topic. This was investigated by using a total of 608 participant assessments from a set of recognised tinnitus and audiology measures. Results from a set of chi-square tests of association found that amongst the individuals with somatic tinnitus, a higher proportion had pulsatile tinnitus (different from heartbeat), were under the age of 40, reported variation in the loudness of their tinnitus and reported temporomandibular joint (TMJ) disorder. The same pattern of results was confirmed using a multivariate analysis of the data based on logistic regression. These findings have strong implications towards the profiling of somatic tinnitus as a distinct subtype of general tinnitus.
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Affiliation(s)
- Jamie Ward
- School of Psychology, University of Sussex, Brighton, BNI 9RH, United Kingdom
- * E-mail:
| | - Claire Vella
- School of Psychology, University of Sussex, Brighton, BNI 9RH, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
| | - Deborah A. Hall
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
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88
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Krings JG, Wineland A, Kallogjeri D, Rodebaugh TL, Nicklaus J, Lenze EJ, Piccirillo JF. A novel treatment for tinnitus and tinnitus-related cognitive difficulties using computer-based cognitive training and D-cycloserine. JAMA Otolaryngol Head Neck Surg 2015; 141:18-26. [PMID: 25356570 DOI: 10.1001/jamaoto.2014.2669] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Tinnitus affects more than 40 million people in the Unites States, and cognitive difficulties are among the most commonly associated symptoms. OBJECTIVE To test the feasibility and preliminarily the effectiveness of using a putative neuroplasticity-enhancing drug, D-cycloserine, to facilitate a computer-assisted CT program for improving tinnitus bother and related cognitive difficulties. DESIGN, SETTING, AND PARTICIPANTS Double-blind, randomized clinical trial at an outpatient academic medical center of 34 participants aged 35 to 65 years with subjective, unilateral or bilateral, nonpulsatile tinnitus of at least 6 months' duration. INTERVENTIONS Five weeks of twice-weekly computer-based CT with either 250 mg D-cycloserine or placebo orally prior to computer CT sessions. MAIN OUTCOMES AND MEASURES Difference in the change in Tinnitus Functional Index (TFI) score between the 2 groups. RESULTS After excluding 1 participant lost to follow-up, 1 who withdrew, 1 who did not complete 90% of sessions, and 1 outlier, 30 participants were included in the analysis. The D-cycloserine plus CT group showed a significant improvement in median TFI score (-5.8 [95% CI, -9.4 to -1.1]) and self-reported cognitive deficits (-4.5 [95% CI, -11.5 to -1.0]), but the placebo group did not (-1.0 [95% CI, -11.7 to 4.9] and -2.0 [95% CI, -5.1 to 2.0], respectively). After controlling for age and duration of tinnitus, there was no significant difference in TFI score change between the 2 groups (P = .41). After confounders were controlled for, the D-cycloserine group demonstrated a significantly greater improvement in self-reported cognitive deficits as compared with the placebo group (P = .03). No serious adverse events were reported. CONCLUSIONS AND RELEVANCE Use of a computer-based CT program with a putative neuroplasticity-sensitizing drug, D-cycloserine, was feasible and well tolerated. With the limited sample size, the adjuvant use of D-cycloserine was no more effective than placebo at improving tinnitus bother. The finding that D-cycloserine use was more effective than placebo at improving self-reported cognitive difficulties could be important given the high rate of concern for cognitive deficits in patients with tinnitus. D-cycloserine and other putative neuroplasticity-facilitating agents could be investigated in the future as a strategy to enhance neuroplasticity-based tinnitus treatments. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01550796.
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Affiliation(s)
- James G Krings
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri2Doris Duke Clinical Research Fellowship, Washington University School of Medicine, St Louis, Missouri3Stanford Medical Scholars Fellowship, St
| | - Andre Wineland
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Thomas L Rodebaugh
- Department of Psychology, Washington University in St Louis, St Louis, Missouri
| | - Joyce Nicklaus
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
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89
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Zobay O, Palmer AR, Hall DA, Sereda M, Adjamian P. Source space estimation of oscillatory power and brain connectivity in tinnitus. PLoS One 2015; 10:e0120123. [PMID: 25799178 PMCID: PMC4370720 DOI: 10.1371/journal.pone.0120123] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/04/2015] [Indexed: 01/15/2023] Open
Abstract
Tinnitus is the perception of an internally generated sound that is postulated to emerge as a result of structural and functional changes in the brain. However, the precise pathophysiology of tinnitus remains unknown. Llinas’ thalamocortical dysrhythmia model suggests that neural deafferentation due to hearing loss causes a dysregulation of coherent activity between thalamus and auditory cortex. This leads to a pathological coupling of theta and gamma oscillatory activity in the resting state, localised to the auditory cortex where normally alpha oscillations should occur. Numerous studies also suggest that tinnitus perception relies on the interplay between auditory and non-auditory brain areas. According to the Global Brain Model, a network of global fronto—parietal—cingulate areas is important in the generation and maintenance of the conscious perception of tinnitus. Thus, the distress experienced by many individuals with tinnitus is related to the top—down influence of this global network on auditory areas. In this magnetoencephalographic study, we compare resting-state oscillatory activity of tinnitus participants and normal-hearing controls to examine effects on spectral power as well as functional and effective connectivity. The analysis is based on beamformer source projection and an atlas-based region-of-interest approach. We find increased functional connectivity within the auditory cortices in the alpha band. A significant increase is also found for the effective connectivity from a global brain network to the auditory cortices in the alpha and beta bands. We do not find evidence of effects on spectral power. Overall, our results provide only limited support for the thalamocortical dysrhythmia and Global Brain models of tinnitus.
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Affiliation(s)
- Oliver Zobay
- MRC Institute of Hearing Research, University Park, Nottingham, United Kingdom
| | - Alan R. Palmer
- MRC Institute of Hearing Research, University Park, Nottingham, United Kingdom
| | - Deborah A. Hall
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, 113 The Ropewalk Nottingham, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Magdalena Sereda
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, 113 The Ropewalk Nottingham, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Peyman Adjamian
- MRC Institute of Hearing Research, University Park, Nottingham, United Kingdom
- * E-mail:
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90
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Vanneste S, Van De Heyning P, De Ridder D. Tinnitus: a large VBM-EEG correlational study. PLoS One 2015; 10:e0115122. [PMID: 25781934 PMCID: PMC4364116 DOI: 10.1371/journal.pone.0115122] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/18/2014] [Indexed: 11/29/2022] Open
Abstract
A surprising fact in voxel-based morphometry (VBM) studies performed in tinnitus is that not one single region is replicated in studies of different centers. The question then rises whether this is related to the low sample size of these studies, the selection of non-representative patient subgroups, or the absence of stratification according to clinical characteristics. Another possibility is that VBM is not a good tool to study functional pathologies such as tinnitus, in contrast to pathologies like Alzheimer's disease where it is known the pathology is related to cell loss. In a large sample of 154 tinnitus patients VBM and QEEG (Quantitative Electroencephalography) was performed and evaluated by a regression analysis. Correlation analyses are performed between VBM and QEEG data. Uncorrected data demonstrated structural differences in grey matter in hippocampal and cerebellar areas related to tinnitus related distress and tinnitus duration. After control for multiple comparisons, only cerebellar VBM changes remain significantly altered. Electrophysiological differences are related to distress, tinnitus intensity, and tinnitus duration in the subgenual anterior cingulate cortex, dorsal anterior cingulate cortex, hippocampus, and parahippocampus, which confirms previous results. The absence of QEEG-VBM correlations suggest functional changes are not reflected by co-occurring structural changes in tinnitus, and the absence of VBM changes (except for the cerebellum) that survive correct statistical analysis in a large study population suggests that VBM might not be very sensitive for studying tinnitus.
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Affiliation(s)
- Sven Vanneste
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
- School for Behavioral & Brain Sciences, University of Texas at Dallas, Dallas, Texas, United States of America
| | - Paul Van De Heyning
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
- ENT Department, University Hospital Antwerp, Antwerp, Belgium
| | - Dirk De Ridder
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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91
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The effectiveness of neuro-music therapy according to the Heidelberg model compared to a single session of educational counseling as treatment for tinnitus: a controlled trial. J Psychosom Res 2015; 78:285-92. [PMID: 25224125 DOI: 10.1016/j.jpsychores.2014.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Tinnitus is a very common symptom, yet the quest for an effective treatment is challenging. Results from several clinical trials support the notion that neuro-music therapy is an effective means to reduce tinnitus distress with short duration and long lasting effect. However, until now, the effectiveness has not been tested in a controlled trial against an active comparator. METHODS The trial was designed as two-center, parallel intervention group controlled study with two intervention groups: Counseling (50minute individualized personal instruction) or neuro-music therapy (counseling plus eight 50-minute sessions of individualized music therapy). Data of n=290 patients suffering from chronic tinnitus were analyzed. Outcome measure was the change in Tinnitus Questionnaire Total Scores (TQ) from baseline (admission) to end of treatment. RESULTS Both treatment groups achieved a statistically relevant reduction in TQ scores, though 66% of patients in the music therapy group attained a clinically meaningful improvement compared to 33% in the counseling group. A binary logistic regression revealed two variables significantly influencing therapy outcome: initial tinnitus score and type of therapy with an OR for the music therapy compared to the counseling of 4.34 (CI 2.33-8.09). CONCLUSIONS Counseling is an appropriate treatment option with well above chance of improvement. The neuro-music therapy outperformed the counseling. This treatment targets the tinnitus sound itself, is short in duration, intrinsically motivating and easy to operate and thus presents a possible complement to the therapeutic spectrum in chronic tinnitus. The trial was registered at the ClinicalTrials.gov registry (ID: NCT01845155).
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92
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Krick CM, Grapp M, Daneshvar-Talebi J, Reith W, Plinkert PK, Bolay HV. Cortical reorganization in recent-onset tinnitus patients by the Heidelberg Model of Music Therapy. Front Neurosci 2015; 9:49. [PMID: 25745385 PMCID: PMC4333796 DOI: 10.3389/fnins.2015.00049] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/04/2015] [Indexed: 12/19/2022] Open
Abstract
Pathophysiology and treatment of tinnitus still are fields of intensive research. The neuroscientifically motivated Heidelberg Model of Music Therapy, previously developed by the German Center for Music Therapy Research, Heidelberg, Germany, was applied to explore its effects on individual distress and on brain structures. This therapy is a compact and fast application of nine consecutive 50-min sessions of individualized therapy implemented over 1 week. Clinical improvement and long-term effects over several years have previously been published. However, the underlying neural basis of the therapy's success has not yet been explored. In the current study, the therapy was applied to acute tinnitus patients (TG) and healthy active controls (AC). Non-treated patients were also included as passive controls (PTC). As predicted, the therapeutic intervention led to a significant decrease of tinnitus-related distress in TG compared to PTC. Before and after the study week, high-resolution MRT scans were obtained for each subject. Assessment by repeated measures design for several groups (Two-Way ANOVA) revealed structural gray matter (GM) increase in TG compared to PTC, comprising clusters in precuneus, medial superior frontal areas, and in the auditory cortex. This pattern was further applied as mask for general GM changes as induced by the therapy week. The therapy-like procedure in AC also elicited similar GM increases in precuneus and frontal regions. Comparison between structural effects in TG vs. AC was calculated within the mask for general GM changes to obtain specific effects in tinnitus patients, yielding GM increase in right Heschl's gyrus, right Rolandic operculum, and medial superior frontal regions. In line with recent findings on the crucial role of the auditory cortex in maintaining tinnitus-related distress, a causative relation between the therapy-related GM alterations in auditory areas and the long-lasting therapy effects can be assumed.
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Affiliation(s)
- Christoph M Krick
- Department for Neuroradiology, Saarland University Hospital Homburg, Germany
| | - Miriam Grapp
- German Center for Music Therapy Research (Victor Dulger Institute) DZM Heidelberg, Germany
| | | | - Wolfgang Reith
- Department for Neuroradiology, Saarland University Hospital Homburg, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital for Ear, Nose, and Throat, University of Heidelberg Heidelberg, Germany
| | - Hans Volker Bolay
- Music Therapy Tinnitus Outpatient Department, German Center for Music Therapy Research (Victor Dulger Institute) DZM Heidelberg, Germany
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93
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Altered intra- and interregional synchronization in resting-state cerebral networks associated with chronic tinnitus. Neural Plast 2015; 2015:475382. [PMID: 25734018 PMCID: PMC4334979 DOI: 10.1155/2015/475382] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/20/2014] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Subjective tinnitus is hypothesized to arise from aberrant neural activity; however, its neural bases are poorly understood. To identify aberrant neural networks involved in chronic tinnitus, we compared the resting-state functional magnetic resonance imaging (fMRI) patterns of tinnitus patients and healthy controls. MATERIALS AND METHODS Resting-state fMRI measurements were obtained from a group of chronic tinnitus patients (n = 29) with normal hearing and well-matched healthy controls (n = 30). Regional homogeneity (ReHo) analysis and functional connectivity analysis were used to identify abnormal brain activity; these abnormalities were compared to tinnitus distress. RESULTS Relative to healthy controls, tinnitus patients had significant greater ReHo values in several brain regions including the bilateral anterior insula (AI), left inferior frontal gyrus, and right supramarginal gyrus. Furthermore, the left AI showed enhanced functional connectivity with the left middle frontal gyrus (MFG), while the right AI had enhanced functional connectivity with the right MFG; these measures were positively correlated with Tinnitus Handicap Questionnaires (r = 0.459, P = 0.012 and r = 0.479, P = 0.009, resp.). CONCLUSIONS Chronic tinnitus patients showed abnormal intra- and interregional synchronization in several resting-state cerebral networks; these abnormalities were correlated with clinical tinnitus distress. These results suggest that tinnitus distress is exacerbated by attention networks that focus on internally generated phantom sounds.
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94
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Lau C, Zhang JW, McPherson B, Pienkowski M, Wu EX. Long-term, passive exposure to non-traumatic acoustic noise induces neural adaptation in the adult rat medial geniculate body and auditory cortex. Neuroimage 2015; 107:1-9. [DOI: 10.1016/j.neuroimage.2014.11.048] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/12/2014] [Accepted: 11/22/2014] [Indexed: 02/02/2023] Open
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95
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Ajayi OV, Phillips JS, Laopaiboon M, McFerran D. Melatonin for tinnitus. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Olakunle V Ajayi
- Essex County Hospital, Colchester Hospital University NHS Foundation Trust; ENT Department; Turner Road Colchester Essex UK CO4 5JL
| | - John S Phillips
- Norfolk and Norwich University Hospital NHS Trust; Department of Otolaryngology; Colney Lane Norwich UK NR4 7UY
| | - Malinee Laopaiboon
- Khon Kaen University; Department of Biostatistics and Demography, Faculty of Public Health; 123 Mitraparb Road Amphur Muang Khon Kaen Thailand 40002
| | - Don McFerran
- Essex County Hospital, Colchester Hospital University NHS Foundation Trust; ENT Department; Turner Road Colchester Essex UK CO4 5JL
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96
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Schecklmann M, Giani A, Tupak S, Langguth B, Raab V, Polak T, Várallyay C, Harnisch W, Herrmann MJ, Fallgatter AJ. Functional near-infrared spectroscopy to probe state- and trait-like conditions in chronic tinnitus: a proof-of-principle study. Neural Plast 2014; 2014:894203. [PMID: 25478237 PMCID: PMC4248328 DOI: 10.1155/2014/894203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Several neuroscience tools showed the involvement of auditory cortex in chronic tinnitus. In this proof-of-principle study we probed the capability of functional near-infrared spectroscopy (fNIRS) for the measurement of brain oxygenation in auditory cortex in dependence from chronic tinnitus and from intervention with transcranial magnetic stimulation. METHODS Twenty-three patients received continuous theta burst stimulation over the left primary auditory cortex in a randomized sham-controlled neuronavigated trial (verum = 12; placebo = 11). Before and after treatment, sound-evoked brain oxygenation in temporal areas was measured with fNIRS. Brain oxygenation was measured once in healthy controls (n = 12). RESULTS Sound-evoked activity in right temporal areas was increased in the patients in contrast to healthy controls. Left-sided temporal activity under the stimulated area changed over the course of the trial; high baseline oxygenation was reduced and vice versa. CONCLUSIONS By demonstrating that rTMS interacts with auditory evoked brain activity, our results confirm earlier electrophysiological findings and indicate the sensitivity of fNIRS for detecting rTMS induced changes in brain activity. Moreover, our findings of trait- and state-related oxygenation changes indicate the potential of fNIRS for the investigation of tinnitus pathophysiology and treatment response.
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Affiliation(s)
- Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Anette Giani
- Max Planck Institute for Biological Cybernetics, 72076 Tübingen, Germany
| | - Sara Tupak
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, 48149 Münster, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstraße 84, 93053 Regensburg, Germany
| | - Vincent Raab
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, 97080 Würzburg, Germany
| | - Thomas Polak
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, 97080 Würzburg, Germany
| | - Csanád Várallyay
- Department of Neurosurgery, University of Würzburg, 97080 Würzburg, Germany
| | - Wilma Harnisch
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, 97080 Würzburg, Germany
| | - Martin J. Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, 97080 Würzburg, Germany
| | - Andreas J. Fallgatter
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076 Tübingen, Germany
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97
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Adjamian P. The application of electro- and magneto-encephalography in tinnitus research - methods and interpretations. Front Neurol 2014; 5:228. [PMID: 25431567 PMCID: PMC4230045 DOI: 10.3389/fneur.2014.00228] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/22/2014] [Indexed: 12/11/2022] Open
Abstract
In recent years, there has been a significant increase in the use of electroencephalography (EEG) and magnetoencephalography (MEG) to investigate changes in oscillatory brain activity associated with tinnitus with many conflicting results. Current view of the underlying mechanism of tinnitus is that it results from changes in brain activity in various structures of the brain as a consequence of sensory deprivation. This in turn gives rise to increased spontaneous activity and/or synchrony in the auditory centers but also involves modulation from non-auditory processes from structures of the limbic and paralimbic system. Some of the neural changes associated with tinnitus may be assessed non-invasively in human beings with MEG and EEG (M/EEG) in ways, which are superior to animal studies and other non-invasive imaging techniques. However, both MEG and EEG have their limitations and research results can be misinterpreted without appropriate consideration of these limitations. In this article, I intend to provide a brief review of these techniques, describe what the recorded signals reflect in terms of the underlying neural activity, and their strengths and limitations. I also discuss some pertinent methodological issues involved in tinnitus-related studies and conclude with suggestions to minimize possible discrepancies between results. The overall message is that while MEG and EEG are extremely useful techniques, the interpretation of results from tinnitus studies requires much caution given the individual variability in oscillatory activity and the limits of these techniques.
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98
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Lanting CP, de Kleine E, Langers DRM, van Dijk P. Unilateral tinnitus: changes in connectivity and response lateralization measured with FMRI. PLoS One 2014; 9:e110704. [PMID: 25329557 PMCID: PMC4203817 DOI: 10.1371/journal.pone.0110704] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 09/25/2014] [Indexed: 12/26/2022] Open
Abstract
Tinnitus is a percept of sound that is not related to an acoustic source outside the body. For many forms of tinnitus, mechanisms in the central nervous system are believed to play a role in the pathology. In this work we specifically assessed possible neural correlates of unilateral tinnitus. Functional magnetic resonance imaging (fMRI) was used to investigate differences in sound-evoked neural activity between controls, subjects with left-sided tinnitus, and subjects with right-sided tinnitus. We assessed connectivity patterns between auditory nuclei and the lateralization of the sound-evoked responses. Interestingly, these response characteristics did not relate to the laterality of tinnitus. The lateralization for left- or right ear stimuli, as expressed in a lateralization index, was considerably smaller in subjects with tinnitus compared to that in controls, reaching significance in the right primary auditory cortex (PAC) and the right inferior colliculus (IC). Reduced functional connectivity between the brainstem and the cortex was observed in subjects with tinnitus. These differences are consistent with two existing models that relate tinnitus to i) changes in the corticothalamic feedback loops or ii) reduced inhibitory effectiveness between the limbic system and the thalamus. The vermis of the cerebellum also responded to monaural sound in subjects with unilateral tinnitus. In contrast, no cerebellar response was observed in control subjects. This suggests the involvement of the vermis of the cerebellum in unilateral tinnitus.
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Affiliation(s)
- Cornelis P. Lanting
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
- * E-mail:
| | - Emile de Kleine
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
| | - Dave R. M. Langers
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, School of Clinical Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
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99
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Aberrant spontaneous brain activity in chronic tinnitus patients revealed by resting-state functional MRI. NEUROIMAGE-CLINICAL 2014; 6:222-8. [PMID: 25379434 PMCID: PMC4215464 DOI: 10.1016/j.nicl.2014.09.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/12/2014] [Accepted: 09/13/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The neural mechanisms that give rise to the phantom sound of tinnitus are poorly understood. This study aims to investigate whether aberrant spontaneous brain activity exists in chronic tinnitus patients using resting-state functional magnetic resonance imaging (fMRI) technique. MATERIALS AND METHODS A total of 31 patients with chronic tinnitus patients and 32 healthy age-, sex-, and education-matched healthy controls were prospectively examined. Both groups had normal hearing thresholds. We calculated the amplitude of low-frequency fluctuations (ALFFs) of fMRI signals to measure spontaneous neuronal activity and detect the relationship between fMRI information and clinical data of tinnitus. RESULTS Compared with healthy controls, we observed significant increased ALFF within several selected regions including the right middle temporal gyrus (MTG), right superior frontal gyrus (SFG), and right angular gyrus; decreased ALFF was detected in the left cuneus, right middle occipital gyrus and bilateral thalamus. Moreover, tinnitus distress correlated positively with increased ALFF in right MTG and right SFG; tinnitus duration correlated positively with higher ALFF values in right SFG. CONCLUSIONS The present study confirms that chronic tinnitus patients have aberrant ALFF in many brain regions, which is associated with specific clinical tinnitus characteristics. ALFF disturbance in specific brain regions might be used to identify the neuro-pathophysiological mechanisms in chronic tinnitus patients.
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100
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Hoare DJ, Van Labeke N, McCormack A, Sereda M, Smith S, Taher HA, Kowalkowski VL, Sharples M, Hall DA. Gameplay as a source of intrinsic motivation in a randomized controlled trial of auditory training for tinnitus. PLoS One 2014; 9:e107430. [PMID: 25215617 PMCID: PMC4162598 DOI: 10.1371/journal.pone.0107430] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/19/2014] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies of frequency discrimination training (FDT) for tinnitus used repetitive task-based training programmes relying on extrinsic factors to motivate participation. Studies reported limited improvement in tinnitus symptoms. Purpose To evaluate FDT exploiting intrinsic motivations by integrating training with computer-gameplay. Methods Sixty participants were randomly assigned to train on either a conventional task-based training, or one of two interactive game-based training platforms over six weeks. Outcomes included assessment of motivation, tinnitus handicap, and performance on tests of attention. Results Participants reported greater intrinsic motivation to train on the interactive game-based platforms, yet compliance of all three groups was similar (∼70%) and changes in self-reported tinnitus severity were not significant. There was no difference between groups in terms of change in tinnitus severity or performance on measures of attention. Conclusion FDT can be integrated within an intrinsically motivating game. Whilst this may improve participant experience, in this instance it did not translate to additional compliance or therapeutic benefit. Trial Registration ClinicalTrials.gov NCT02095262
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Affiliation(s)
- Derek J. Hoare
- National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Nicolas Van Labeke
- Institute of Educational Technology, The Open University, Milton Keynes, United Kingdom
| | - Abby McCormack
- National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Magdalena Sereda
- National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sandra Smith
- National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Hala Al Taher
- National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom
| | | | - Mike Sharples
- Institute of Educational Technology, The Open University, Milton Keynes, United Kingdom
| | - Deborah A. Hall
- National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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