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Pienkowski M. Rationale and Efficacy of Sound Therapies for Tinnitus and Hyperacusis. Neuroscience 2019; 407:120-134. [DOI: 10.1016/j.neuroscience.2018.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/20/2022]
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Tzounopoulos T, Balaban C, Zitelli L, Palmer C. Towards a Mechanistic-Driven Precision Medicine Approach for Tinnitus. J Assoc Res Otolaryngol 2019; 20:115-131. [PMID: 30825037 PMCID: PMC6453992 DOI: 10.1007/s10162-018-00709-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022] Open
Abstract
In this position review, we propose to establish a path for replacing the empirical classification of tinnitus with a taxonomy from precision medicine. The goal of a classification system is to understand the inherent heterogeneity of individuals experiencing and suffering from tinnitus and to identify what differentiates potential subgroups. Identification of different patient subgroups with distinct audiological, psychophysical, and neurophysiological characteristics will facilitate the management of patients with tinnitus as well as the design and execution of drug development and clinical trials, which, for the most part, have not yielded conclusive results. An alternative outcome of a precision medicine approach in tinnitus would be that additional mechanistic phenotyping might not lead to the identification of distinct drivers in each individual, but instead, it might reveal that each individual may display a quantitative blend of causal factors. Therefore, a precision medicine approach towards identifying these causal factors might not lead to subtyping these patients but may instead highlight causal pathways that can be manipulated for therapeutic gain. These two outcomes are not mutually exclusive, and no matter what the final outcome is, a mechanistic-driven precision medicine approach is a win-win approach for advancing tinnitus research and treatment. Although there are several controversies and inconsistencies in the tinnitus field, which will not be discussed here, we will give a few examples, as to how the field can move forward by exploring the major neurophysiological tinnitus models, mostly by taking advantage of the common features supported by all of the models. Our position stems from the central concept that, as a field, we can and must do more to bring studies of mechanisms into the realm of neuroscience.
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Affiliation(s)
- Thanos Tzounopoulos
- Pittsburgh Hearing Research Center and Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
| | - Carey Balaban
- Pittsburgh Hearing Research Center and Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Lori Zitelli
- Pittsburgh Hearing Research Center and Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Catherine Palmer
- Pittsburgh Hearing Research Center and Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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53
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Ponticorvo S, Manara R, Pfeuffer J, Cappiello A, Cuoco S, Pellecchia MT, Saponiero R, Troisi D, Cassandro C, John M, Scarpa A, Cassandro E, Di Salle F, Esposito F. Cortical pattern of reduced perfusion in hearing loss revealed by ASL-MRI. Hum Brain Mapp 2019; 40:2475-2487. [PMID: 30715769 DOI: 10.1002/hbm.24538] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/21/2019] [Accepted: 01/25/2019] [Indexed: 02/05/2023] Open
Abstract
Age-related hearing loss (HL) can be related to brain dysfunction or structural damage and may result in cerebral metabolic/perfusion abnormalities. Arterial spin labeling (ASL) magnetic resonance imaging (MRI) allows investigating noninvasively brain perfusion changes. Pseudocontinuous ASL and T1-weighted MRI (at 3 T) and neuropsychological testing (Montreal Cognitive Assessment) were performed in 31 HL (age range = 47-77 years, mean age ± SD = 63.4 ± 8.4 years, pure-tone average [PTA] HL > 50 dB) and 28 normal hearing (NH; age range = 48-78 years, mean age ± SD = 59.7 ± 7.4 years) subjects. Cerebral blood flow (CBF) and gray matter volume (GMV) were analyzed in the cortical volume to assess perfusion and structural group differences. Two HL subjects showing cognitive impairment were excluded from group comparisons. No significant differences in either global or local atrophy were detected between groups but the HL group exhibited significant regional effects of reduced perfusion within the bilateral primary auditory cortex, with maximal CBF difference (-17.2%) in the right lateral Heschl's gyrus. For the whole sample of HL and NH subjects (n = 59 = 31 HL + 28 NH), the regional CBF was correlated positively to the regional GMV (p = 0.020). In HL subjects (n = 31), the regional CBF was correlated negatively to the audiogram steepness (frequency range: 2-4 kHz, right ear: p = 0.022, left ear: p = 0.015). The observed cortical pattern of perfusion reduction suggests that neuronal metabolism can be related to HL before the recognition of brain structural damage. This also illustrates the potential of ASL-MRI to contribute early functional markers of reduced central processing associated with HL.
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Affiliation(s)
- Sara Ponticorvo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Renzo Manara
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Josef Pfeuffer
- MR Application Development, Siemens Healthcare GmbH, Erlangen, Germany
| | - Arianna Cappiello
- Department of Neurosciences and Craniofacial Disorders, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Sofia Cuoco
- Department of Neurosciences and Craniofacial Disorders, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.,Department of Neurosciences and Craniofacial Disorders, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Renato Saponiero
- Department of Diagnostic Imaging, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Donato Troisi
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.,Department of Neurosciences and Craniofacial Disorders, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Claudia Cassandro
- Department of Neurosciences and Craniofacial Disorders, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Marta John
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Alfonso Scarpa
- Department of Neurosciences and Craniofacial Disorders, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Ettore Cassandro
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.,Department of Neurosciences and Craniofacial Disorders, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Francesco Di Salle
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.,Department of Diagnostic Imaging, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.,Department of Diagnostic Imaging, Scuola Medica Salernitana, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
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Tang D, Li H, Chen L. Advances in Understanding, Diagnosis, and Treatment of Tinnitus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1130:109-128. [DOI: 10.1007/978-981-13-6123-4_7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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55
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Möhrle D, Hofmeier B, Amend M, Wolpert S, Ni K, Bing D, Klose U, Pichler B, Knipper M, Rüttiger L. Enhanced Central Neural Gain Compensates Acoustic Trauma-induced Cochlear Impairment, but Unlikely Correlates with Tinnitus and Hyperacusis. Neuroscience 2018; 407:146-169. [PMID: 30599268 DOI: 10.1016/j.neuroscience.2018.12.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 01/09/2023]
Abstract
For successful future therapeutic strategies for tinnitus and hyperacusis, a subcategorization of both conditions on the basis of differentiated neural correlates would be of invaluable advantage. In the present study, we used our refined operant conditioning animal model to divide equally noise-exposed rats into groups with either tinnitus or hyperacusis, with neither condition, or with both conditions co-occurring simultaneously. Using click stimulus and noise burst-evoked Auditory Brainstem Responses (ABR) and Distortion Product Otoacoustic Emissions, no hearing threshold difference was observed between any of the groups. However, animals with neither tinnitus nor hyperacusis responded to noise trauma with shortened ABR wave I and IV latencies and elevated central neuronal gain (increased ABR wave IV/I amplitude ratio), which was previously assumed in most of the literature to be a neural correlate for tinnitus. In contrast, animals with tinnitus had reduced neural response gain and delayed ABR wave I and IV latencies, while animals with hyperacusis showed none of these changes. Preliminary studies, aimed at establishing comparable non-invasive objective tools for identifying tinnitus in humans and animals, confirmed reduced central gain and delayed response latency in human and animals. Moreover, the first ever resting state functional Magnetic Resonance Imaging (rs-fMRI) analyses comparing humans and rats with and without tinnitus showed reduced rs-fMRI activities in the auditory cortex in both patients and animals with tinnitus. These findings encourage further efforts to establish non-invasive diagnostic tools that can be used in humans and animals alike and give hope for differentiated classification of tinnitus and hyperacusis.
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Affiliation(s)
- Dorit Möhrle
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Benedikt Hofmeier
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Mario Amend
- University of Tübingen, Department of Preclinical Imaging and Radiopharmacy, University Hospital Tübingen, Röntgenweg 13, 72076 Tübingen, Germany.
| | - Stephan Wolpert
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Kun Ni
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany; Shanghai Jiao Tong University, Department of Otolaryngology, Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Luding Road, NO. 355. Putuo District, 200062 Shanghai, China.
| | - Dan Bing
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Uwe Klose
- University Hospital Tübingen, Department of Diagnostic and Interventional Neuroradiology, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
| | - Bernd Pichler
- University of Tübingen, Department of Preclinical Imaging and Radiopharmacy, University Hospital Tübingen, Röntgenweg 13, 72076 Tübingen, Germany.
| | - Marlies Knipper
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Lukas Rüttiger
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
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56
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Shaheen LA, Liberman MC. Cochlear Synaptopathy Changes Sound-Evoked Activity Without Changing Spontaneous Discharge in the Mouse Inferior Colliculus. Front Syst Neurosci 2018; 12:59. [PMID: 30559652 PMCID: PMC6286982 DOI: 10.3389/fnsys.2018.00059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/26/2018] [Indexed: 12/12/2022] Open
Abstract
Tinnitus and hyperacusis are life-disrupting perceptual abnormalities that are often preceded by acoustic overexposure. Animal models of overexposure have suggested a link between these phenomena and neural hyperactivity, i.e., elevated spontaneous rates (SRs) and sound-evoked responses. Prior work has focused on changes in central auditory responses, with less attention paid to the exact nature of the associated cochlear damage. The demonstration that acoustic overexposure can cause cochlear neuropathy without permanent threshold elevation suggests cochlear neuropathy per se may be a key elicitor of neural hyperactivity. We addressed this hypothesis by recording responses in the mouse inferior colliculus (IC) following a bilateral, neuropathic noise exposure. One to three weeks post-exposure, mean SRs were unchanged in mice recorded while awake, or under anesthesia. SRs were also unaffected by more intense, or unilateral exposures. These results suggest that neither neuropathy nor hair cell loss are sufficient to raise SRs in the IC, at least in 7-week-old mice, 1-3 weeks post exposure. However, it is not clear whether our mice had tinnitus. Tone-evoked rate-level functions at the CF were steeper following exposure, specifically in the region of maximal neuropathy. Furthermore, suppression driven by off-CF tones and by ipsilateral noise were reduced. Both changes were especially pronounced in neurons of awake mice. This neural hypersensitivity may manifest as behavioral hypersensitivity to sound - prior work reports that this same exposure causes elevated acoustic startle. Together, these results indicate that neuropathy may initiate a compensatory response in the central auditory system leading to the genesis of hyperacusis.
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Affiliation(s)
- Luke A. Shaheen
- Oregon Hearing Research Center, Oregon Health and Science University, Portland, OR, United States
| | - M. Charles Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
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57
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Jagoda L, Giroud N, Neff P, Kegel A, Kleinjung T, Meyer M. Speech perception in tinnitus is related to individual distress level - A neurophysiological study. Hear Res 2018; 367:48-58. [DOI: 10.1016/j.heares.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
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58
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Kleinjung T, Thüring C, Güntensperger D, Neff P, Meyer M. [Neurofeedback for the treatment of chronic tinnitus : Review and future perspectives]. HNO 2017; 66:198-204. [PMID: 29143096 DOI: 10.1007/s00106-017-0432-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurofeedback is a noninvasive neuromodulation technique employing real-time display of brain activity in terms of electroencephalography (EEG) signals to teach self-regulation of distinct patterns of brain activity or influence brain activity in a targeted manner. The benefit of this approach for control of symptoms in attention deficit disorders, hyperactivity, depression, and migraine has been proven. Studies in recent years have also repeatedly shown this treatment to improve tinnitus symptoms, although it has not become established as routine therapy. The primary focus of this review is the rational of EEG neurofeedback for tinnitus treatment and the currently available data from published studies. Furthermore, alternative neurofeedback protocols using real-time functional magnetic resonance imaging (fMRI) measurements for tinnitus control are considered. Finally, this article highlights how modern EEG analysis (source localization, connectivity) and the improving understanding of tinnitus pathology can contribute to development of more focused neurofeedback protocols for more sustainable control of tinnitus.
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Affiliation(s)
- T Kleinjung
- Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, UniversitätsSpital Zürich, Frauenklinikstraße 24, 8091, Zürich, Schweiz.
| | - C Thüring
- Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, UniversitätsSpital Zürich, Frauenklinikstraße 24, 8091, Zürich, Schweiz
| | - D Güntensperger
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
| | - P Neff
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
| | - M Meyer
- Psychologisches Institut, Universität Zürich, Zürich, Schweiz
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59
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Cai Y, Zhou Q, Yang H, Jiang J, Zhao F, Huang X, Mo H, Chen X, Xiong H, Chen S, Zhang X, Zheng Y. Logistic regression analysis of factors influencing the effectiveness of intensive sound masking therapy in patients with tinnitus. BMJ Open 2017; 7:e018050. [PMID: 29146645 PMCID: PMC5695311 DOI: 10.1136/bmjopen-2017-018050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To investigate factors influencing the effectiveness of intensive sound masking therapy on tinnitus using logistic regression analysis. DESIGN The study used a retrospective cross-section analysis. PARTICIPANTS 102 patients with tinnitus were recruited at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, China. INTERVENTION Intensive sound masking therapy was used as an intervention approach for patients with tinnitus. PRIMARY AND SECONDARY OUTCOME MEASURES Participants underwent audiological investigations and tinnitus pitch and loudness matching measurements, followed by intensive sound masking therapy. The Tinnitus Handicap Inventory (THI) was used as the outcome measure pre and post treatment. Multivariate logistic regression was performed to investigate the association of demographic and audiological factors with effective therapy. RESULTS According to the THI score changes pre and post sound masking intervention, 51 participants were categorised into an effective group, the remaining 51 participants were placed in a non-effective group. Those in the effective group were significantly younger than those in the non-effective group (P=0.012). Significantly more participants had flat audiogram configurations in the effective group (P=0.04). Multivariable logistic regression analysis showed that age (OR=0.96, 95% CI 0.93 to 0.99, P=0.007), audiometric configuration (P=0.027) and THI score pre treatment (OR=1.04, 95% CI 1.02 to 1.07, P<0.001) were significantly associated with therapeutic effectiveness. Further analysis showed that patients with flat audiometric configurations were 5.45 times more likely to respond to intervention than those with high-frequency steeply sloping audiograms (OR=5.45, 95% CI 1.67 to 17.86, P=0.005). CONCLUSION Audiometric configuration, age and THI scores appear to be predictive of the effectiveness of sound masking treatment. Gender, tinnitus characteristics and hearing threshold measures do not seem to be related to treatment effectiveness. A further randomised control study is needed to provide evidence of the effectiveness of prognostic factors in tinnitus interventions.
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Affiliation(s)
- Yuexin Cai
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Qian Zhou
- Clinical Research Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haidi Yang
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Jiajia Jiang
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Fei Zhao
- Department of Speech Language Therapy and Hearing Science, Cardiff Metropolitan University, Cardiff, Wales, UK
- Department of Hearing and Speech Science, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Xiayin Huang
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Hanjie Mo
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Xiaoting Chen
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Hao Xiong
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Suijun Chen
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xueyuan Zhang
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
| | - Yiqing Zheng
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou, China
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60
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[Good practices with tinnitus in adult]. Presse Med 2017; 46:1064-1070. [PMID: 29097035 DOI: 10.1016/j.lpm.2017.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 11/22/2022] Open
Abstract
The interrogation is essential to trace the genesis of the tinnitus and to appreciate its repercussion. Clinical examination should look for a local, vascular or cervical cause. The ENT consultation with audiogram and tinnitus evaluation is essential to know the characteristics of the tinnitus and to consider the treatment. If tinnitus is accompanied by a decrease in hearing, then wearing hearing aids can correct deafness and decrease the tinnitus. The psychological impact of tinnitus must always be taken into account and the use of a multidisciplinary team is an interesting solution. Medical treatments are not very effective; on the other hand psychotherapies (CBT, TRT and sophrology) bring a real improvement. The doctor's speech must always be supportive and provide therapeutic hope.
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Noroozian M, Jafari Z, Shahmiri E, Omidvar S, Zendehbad A, Amini N, Radmehr M, Bagherian M, Yoonessi A. Effect of Age, Gender and Hearing Loss on the Degree of Discomfort Due to Tinnitus. Basic Clin Neurosci 2017; 8:435-442. [PMID: 29942427 PMCID: PMC6010657 DOI: 10.29252/nirp.bcn.8.6.435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Tinnitus is one of the complex symptoms of hearing described as a phantom auditory sensation without any external stimulation. Due to the subjective nature of tinnitus, perception and discomfort of tinnitus vary among the patients. The main aim of this study is to investigate the effects of gender, age and the degree of hearing loss on discomfort due to tinnitus. Methods: Eighteen patients with tinnitus, aged 21–72 years, (9 males and 9 females) were recruited. Tinnitus discomfort was investigated by Tinnitus Handicap Inventory (THI) questionnaire. Psychoacoustic assessments of tinnitus and auditory threshold assessments were evaluated using a 2-channel clinical audiometer. Results: The results showed no significant correlation between THI scores with loudness matching (P=0.187), mean of auditory threshold (P=0.304), gender (P=0.93) and age (P=0.200). Also, no significant correlation was found between maximal level of hearing loss and pitch matching (P=0.208). Conclusion: The study findings suggests that tinnitus is not correlated with age, gender and hearing loss. Overall, tinnitus is a complicated clinical condition which its real impact and degree of discomfort are unclear. More investigation is needed to clarify the factors involving in tinnitus annoyance.
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Affiliation(s)
- Maryam Noroozian
- Department of Memory and Behavioral Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Jafari
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Elaheh Shahmiri
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Omidvar
- Department of Audiology, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Zendehbad
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Amini
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Radmehr
- Department of Audiology, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Bagherian
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Yoonessi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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62
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No auditory experience, no tinnitus: Lessons from subjects with congenital- and acquired single-sided deafness. Hear Res 2017; 354:9-15. [DOI: 10.1016/j.heares.2017.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/10/2017] [Accepted: 08/09/2017] [Indexed: 11/18/2022]
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63
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The relationship between tinnitus pitch and parameters of audiometry and distortion product otoacoustic emissions. The Journal of Laryngology & Otology 2017; 131:1017-1025. [DOI: 10.1017/s0022215117001803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AbstractObjectives:Chronic tinnitus is associated with reduced auditory input, which results in changes in the central auditory system. This study aimed to examine the relationship between tinnitus pitch and parameters of audiometry and distortion product otoacoustic emissions. For audiometry, the parameters represented the edge frequency of hearing loss, the frequency of maximum hearing loss and the frequency range of hearing loss. For distortion product otoacoustic emissions, the parameters were the frequency of lowest distortion product otoacoustic emission amplitudes and the frequency range of reduced distortion product otoacoustic emissions.Method:Sixty-seven patients (45 males, 22 females) with subjective chronic tinnitus, aged 18 to 73 years, were included.Results:No correlation was found between tinnitus pitch and parameters of audiometry and distortion product otoacoustic emissions. However, tinnitus pitch fell mostly within the frequency range of hearing loss.Conclusion:The current study seems to confirm the relationship between tinnitus pitch and the frequency range of hearing loss, thus supporting the homeostatic plasticity model.
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Work-Related Noise Exposure in a Cohort of Patients with Chronic Tinnitus: Analysis of Demographic and Audiological Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091035. [PMID: 28885581 PMCID: PMC5615572 DOI: 10.3390/ijerph14091035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 02/08/2023]
Abstract
Work-related noise exposure is one of the major factors contributing to the development of adult-onset hearing loss and tinnitus. The aim of this study was to analyze, in patients with chronic tinnitus and long-term occupational noise exposure, (A) characteristics of hearing loss, tinnitus, comorbidities, demographic characteristics and a history of work-related noise exposure and (B) differences among individuals employed in occupations with high and low risk of developing work-related noise-induced hearing loss (NIHL). One hundred thirty six patients with chronic tinnitus and at least a 10 year-long working history were divided into two groups based on the risk of their profession to induce NIHL. Individuals employed in jobs at high risk for NIHL were mostly males and exhibited a poorer hearing threshold, more evident in the left ear. Tinnitus was mostly bilateral; the next largest presentation was left-sided; patients described their tinnitus as buzzing or high-pitched. Correlation between age, length of tinnitus and worse hearing was found. Patients with a higher degree of hearing impairment were mostly males and were more likely to have a family history of hearing loss and at least one cardiovascular comorbidity. Our study shows some differences in individuals with tinnitus and a history of a profession associated with increased exposure to NIHL compared to those without such a history.
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Langguth B, Hund V, Landgrebe M, Schecklmann M. Tinnitus Patients with Comorbid Headaches: The Influence of Headache Type and Laterality on Tinnitus Characteristics. Front Neurol 2017; 8:440. [PMID: 28894434 PMCID: PMC5581323 DOI: 10.3389/fneur.2017.00440] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/10/2017] [Indexed: 12/13/2022] Open
Abstract
Background Both clinical experience and clinical studies suggest a relationship between tinnitus and headache. Here, we aimed to investigate the influence of comorbid headache type and headache laterality on tinnitus characteristics. Method The Tinnitus Research Initiative database was screened for patients of the Tinnitus Center of the University Regensburg who reported comorbid headaches. These patients were contacted to complete additional validated questionnaires. Based on these data, patients were categorized according to headache type and headache laterality, and their clinical characteristics were compared with tinnitus patients, who did not report comorbid headaches. Results Data from 193 patients with tinnitus and comorbid headaches were compared with those from 765 tinnitus patients without comorbid headaches. Tinnitus patients with comorbid headache have higher scores in tinnitus questionnaires, a lower quality of life and more frequently comorbidities such as painful sensation to loud sounds, vertigo, pain (neck, temporomandibular, and general), and depressive symptoms when compared with tinnitus patients without headaches. Both headache laterality and headache type interact with the degree of comorbidity with higher impairment in patients with left-sided and bilateral headaches as well as in patients with migraine or cluster headache. Conclusion The observed increased impairment in tinnitus patients with comorbid headache can be explained as an additive effect of both disorders on health-related quality of life. The more frequent occurrence of further comorbidities suggests a generally increased amplification of sensory signals in a subset of tinnitus patients with comorbid headaches.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Verena Hund
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Hausham, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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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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Zhang Y, Liu B, Wang R, Jia R, Gu X. Characteristics of the Cochlear Symptoms and Functions in Meniere's Disease. Chin Med J (Engl) 2017; 129:2445-2450. [PMID: 27748337 PMCID: PMC5072257 DOI: 10.4103/0366-6999.191767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Meniere's disease is a unique, progressive disease of the inner ear. The complex manifestation presents diagnostic challenges. The cochlear symptoms often present before vertigo and tend to be ignored. This study aimed to analyze the characteristics of cochlear symptoms and functions associated with Meniere's disease to investigate the regularity of the development of this disorder. METHODS One-hundred fifteen patients who were diagnosed with definite unilateral Meniere's disease at the Hearing and Vestibular Clinic of the Department of Otorhinolaryngology of Beijing Tongren Hospital from August 2013 to November 2015 were recruited in this retrospective study. Initial symptoms, duration from initial symptoms to the diagnosis, hearing thresholds, audiogram patterns, and caloric test results were collected and analyzed for each patient. Data were analyzed using SPSS 13.0 statistical software by Spearman's correlation, Kruskal-Wallis H test, Chi-square test, and Fisher's exact test. RESULTS The average hearing threshold of these patients was 45.24 ± 18.40 dB HL. A majority of the patients (55.65%) were in Stage 3. The initial presentation of the disorder in 58 cases (50.43%) comprised only cochlear symptoms without vertigo. A weak, positive correlation was found between the degree of hearing loss and duration of the disease from initial symptoms to the diagnosis (rs = 0.288, P = 0.002). Upward-sloping, inverted "V," downward-sloping, and flat pattern were the main audiometric patterns observed with a distinctive distribution between stages (P < 0.001). Based on the configurations of audiograms, the audiometric patterns had a weak correlation to the duration (rs = 0.269, P = 0.004), and there was a tendency of duration to rising from upward-sloping, inverted "V", downward-sloping to flat pattern. (H = 10.024, P = 0.018). Frequencies of tinnitus in 56 patients (64.4%) were at the lowest points of the audiograms, i.e., the frequencies of the poorest hearing threshold. The patients at an advanced stage (Stage 3 [56] and Stage 4 [73]) exhibited a significantly higher abnormality of canal paresis than those at the earlier stages (Stage 1 [23] and Stage 2 [42]) (χ2 = 5.973, P = 0.015). CONCLUSIONS Patients with definite Meniere's disease always have a moderate to severe sensorineural hearing loss before diagnosis. Cochlear symptoms are the most common initial presentation. With the progression of the duration, the hearing impairment becomes more severe and the distribution of the audiometric pattern is distinctive between stages.
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Affiliation(s)
- Yi Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China
| | - Bo Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China
| | - Rui Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China
| | - Ruo Jia
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China
| | - Xin Gu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730; Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China
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Langguth B, Landgrebe M, Schlee W, Schecklmann M, Vielsmeier V, Steffens T, Staudinger S, Frick H, Frick U. Different Patterns of Hearing Loss among Tinnitus Patients: A Latent Class Analysis of a Large Sample. Front Neurol 2017; 8:46. [PMID: 28265258 PMCID: PMC5316929 DOI: 10.3389/fneur.2017.00046] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/31/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The heterogeneity of tinnitus is a major challenge for tinnitus research. Even if a complex interaction of many factors is involved in the etiology of tinnitus, hearing loss (HL) has been identified as the most relevant etiologic factor. Here, we used a data-driven approach to identify patterns of hearing function in a large sample of tinnitus patients presenting in a tinnitus clinic. METHODS Data from 2,838 patients presenting at the Tinnitus Center of the University Regensburg between 2007 and 2014 have been analyzed. Standard audiometric data were frequency-wise categorized in four categories [a: normal hearing (0-20 dB HL); b: moderate HL (25-50 dB HL; representing outer hair cell loss); c: severe HL (>50 dB HL; representing outer and inner hair cell loss); d: no data available] and entered in a latent class analysis, a statistical method to find subtypes of cases in multivariate categorical data. To validate the clinical relevance of the identified latent classes, they were compared with respect to clinical and demographic characteristics of their members. RESULTS The classification algorithm identified eight distinct latent classes with an excellent separation. Patient classes differed with respect to demographic (e.g., age, gender) and clinical characteristics (e.g., tinnitus location, tinnitus severity, gradual, or abrupt onset, etc.). DISCUSSION Our results demonstrate that data-driven categorization of hearing function seems to be a promising approach for profiling tinnitus patients, as it revealed distinct subtypes that reflect prototypic forms of HL and that differ in several relevant clinical characteristics.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; kbo Lech-Mangfall-Klinik Agatharied, Hausham, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany
| | - Veronika Vielsmeier
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany; Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Thomas Steffens
- Interdisciplinary Tinnitus Center of the University of Regensburg, Regensburg, Germany; Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Susanne Staudinger
- Interdisciplinary Tinnitus Center of the University of Regensburg , Regensburg , Germany
| | - Hannah Frick
- Department of Statistical Science, University College London , London , UK
| | - Ulrich Frick
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; HSD University of Applied Sciences, Cologne, Germany
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High-Resolution fMRI of Auditory Cortical Map Changes in Unilateral Hearing Loss and Tinnitus. Brain Topogr 2017; 30:685-697. [DOI: 10.1007/s10548-017-0547-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/18/2017] [Indexed: 12/19/2022]
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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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Wrzosek M, Szymiec E, Klemens W, Kotyło P, Schlee W, Modrzyńska M, Lang-Małecka A, Preis A, Bulla J. Polish Translation and Validation of the Tinnitus Handicap Inventory and the Tinnitus Functional Index. Front Psychol 2016; 7:1871. [PMID: 27965609 PMCID: PMC5126044 DOI: 10.3389/fpsyg.2016.01871] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/14/2016] [Indexed: 01/05/2023] Open
Abstract
Objective: The need for validated measures enabling clinicians to classify tinnitus patients according to the severity of tinnitus and screen the progress of therapies in our country led us to translate into Polish and to validate two tinnitus questionnaires, namely the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI). Design: The original English versions of the questionnaires were translated into Polish and translated back to English by three independent translators. These versions were then finalized by the authors into a Polish THI (THI-Pl) and a Polish TFI (TFI-Pl). Participants from three laryngological centers in Poland anonymously answered the THI-Pl (N = 98) and the TFI-Pl (N = 108) in addition to the Polish versions of the Center for Epidemiologic Studies Depression Scale as a measure of self-perceived level of depression, and the Satisfaction With Life Scale to assess self-perceived quality of life. Both were used to determine discriminant validity. Two Visual Analog Scales were used to measure tinnitus annoyance and tinnitus loudness in order to determine convergent validity. Results: Similar to the original version of the THI, the THI-Pl showed a high internal consistency (Cronbach's α = 0.93). The exploratory factor analysis revealed that the questionnaire has a three-factorial structure that does not correspond to the original division for functional, catastrophic, and emotional subscales. Convergent and discriminant validities were confirmed. The TFI-Pl showed high internal consistency (Cronbach's α = 0.96) with the reliability ranging from 0.82 to 0.95 for its different subscales. Factor analysis confirmed an eight-factorial structure with factors assigning all items to appropriate subscales reported in the original version of the questionnaire. Discriminant and convergent validities were also confirmed for the TFI-Pl. Conclusion: We translated and validated the Polish versions of the THI and the TFI to make them suitable for clinical use in Poland.
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Affiliation(s)
- Małgorzata Wrzosek
- Department of Logic and Cognitive Science, Adam Mickiewicz University Poznań, Poland
| | | | | | - Piotr Kotyło
- Audiology and Phoniatrics Clinic, Nofer Institute of Occupational Medicine in Łódź Łódź, Poland
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
| | | | | | - Anna Preis
- Institute of Acoustics, Adam Mickiewicz University Poznań, Poland
| | - Jan Bulla
- Department of Mathematics, University of Bergen Bergen, Norway
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Kim TS, Yoo MH, Lee HS, Yang CJ, Ahn JH, Chung JW, Park HJ. Short-term changes in tinnitus pitch related to audiometric shape in sudden sensorineural hearing loss. Auris Nasus Larynx 2016; 43:281-6. [DOI: 10.1016/j.anl.2015.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/02/2015] [Accepted: 10/16/2015] [Indexed: 11/16/2022]
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Manche SK, Madhavi J, Meganadh KR, Jyothy A. Association of tinnitus and hearing loss in otological disorders: a decade-long epidemiological study in a South Indian population. Braz J Otorhinolaryngol 2016; 82:643-649. [PMID: 26923827 PMCID: PMC9444790 DOI: 10.1016/j.bjorl.2015.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/14/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Tinnitus is a common disorder that occurs frequently across all strata of population and has an important health concern. Tinnitus is often associated with different forms of hearing loss of varying severity. OBJECTIVE The present study aimed to identify the association of tinnitus with hearing loss in various otological disorders of a South Indian population. METHODS A total of 3255 subjects referred to the MAA ENT Hospital, Hyderabad, from 2004 to 2014, affected with various otological diseases have been included in the present cross-sectional study. Diagnosis of the diseases was confirmed by an ear, nose, and throat (ENT) specialist using detailed medical and clinical examination. Statistical analysis was performed using the χ2 test and binary logistic regression. RESULTS Tinnitus was observed in 29.3% (956) of the total study subjects that showed an increased prevalence in greater than 40 years of age. There was a significant increase in risk of tinnitus with middle (OR=1.79, 95% CI=1.02-3.16) and inner (OR=3.00, 95% CI=1.65-5.45) inner ear diseases. It was noted that 96.9% (n=927) of the tinnitus subjects was associated with hearing loss. Otitis media (60.9%), presbycusis (16.6%) and otosclerosis (14.3%) are the very common otological disorders leading to tinnitus. Tinnitus was significantly associated with higher degree of hearing loss in chronic suppurative otitis media (CSOM) subjects. CONCLUSION The present study could identify the most prevalent otological risk factors leading to development of tinnitus with hearing loss in a South Indian population.
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Affiliation(s)
- Santoshi Kumari Manche
- MAA ENT Hospitals, Speech and Hearing Center, Somajiguda, Hyderabad, Telangana State, India; Osmania University, Institute of Genetics and Hospital for Genetic Diseases, Hyderabad, Telangana State, India
| | - Jangala Madhavi
- MAA ENT Hospitals, Speech and Hearing Center, Somajiguda, Hyderabad, Telangana State, India; Osmania University, Institute of Genetics and Hospital for Genetic Diseases, Hyderabad, Telangana State, India
| | - Koralla Raja Meganadh
- MAA ENT Hospitals, Speech and Hearing Center, Somajiguda, Hyderabad, Telangana State, India
| | - Akka Jyothy
- Osmania University, Institute of Genetics and Hospital for Genetic Diseases, Hyderabad, Telangana State, India.
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Seimetz BM, Teixeira AR, Rosito LPS, Flores LS, Pappen CH, Dall'igna C. Pitch and Loudness Tinnitus in Individuals with Presbycusis. Int Arch Otorhinolaryngol 2016; 20:321-326. [PMID: 27746834 PMCID: PMC5063743 DOI: 10.1055/s-0035-1570311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/04/2015] [Indexed: 10/25/2022] Open
Abstract
Introduction Tinnitus is a symptom that is often associated with presbycusis. Objective This study aims to analyze the existence of association among hearing thresholds, pitch, and loudness of tinnitus in individuals with presbycusis, considering the gender variable. Methods Cross-sectional, descriptive, and prospective study, whose sample consisted of individuals with tinnitus and diagnosis of presbycusis. For the evaluation, we performed anamnesis along with otoscopy, pure tone audiometry, and acuphenometry to analyze the psychoacoustic characteristics of tinnitus individuals. Results The sample consisted of 49 subjects, with a mean age of 69.57 ± 6.53 years, who presented unilateral and bilateral tinnitus, therefore, a sample of 80 ears. In analyzing the results, as for acuphenometry, the loudness of tinnitus was more present at 0dB and the pitch was 6HKz and 8HKz. Regarding the analysis of the association between the frequency of greater hearing threshold and tinnitus pitch, no statistical significance (p = 0.862) was found. As for the association between the intensity of greater hearing threshold and tinnitus loudness, no statistical significance (p = 0.115) was found. Conclusion There is no significant association between the hearing loss of patients with presbycusis and the pitch and loudness of tinnitus.
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Affiliation(s)
- Bruna Macangnin Seimetz
- Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Adriane Ribeiro Teixeira
- Department of Developmental Psychology and Personality, Universidade Federal do Rio Grande do Sul, Instituto de Psicologia da UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leticia Petersen Schmidt Rosito
- Department of Otolaryngology - Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Carlos Henrique Pappen
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Celso Dall'igna
- Department of Otolaryngology - Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Vanneste S, De Ridder D. Deafferentation-based pathophysiological differences in phantom sound: Tinnitus with and without hearing loss. Neuroimage 2015; 129:80-94. [PMID: 26708013 DOI: 10.1016/j.neuroimage.2015.12.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 12/23/2022] Open
Abstract
Tinnitus has been considered an auditory phantom percept. Recently a theoretical multiphase compensation mechanism at a cortical level has been hypothesized linking auditory deafferentation to tinnitus. This Bayesian brain model predicts that two very different kinds of tinnitus should exist, depending on the amount of hearing loss: an auditory cortex related form of tinnitus not associated with hearing loss, and a (para)hippocampal form associated with hearing loss, in which the auditory cortex might be of little relevance. In order to verify this model, resting state source analyzed EEG recordings were made in 129 tinnitus patients, and correlated to the mean hearing loss, the range of the hearing loss and the hearing loss at the tinnitus frequency. Results demonstrate that tinnitus can be linked to 2 very different mechanisms. In patients with little or no hearing loss, the tinnitus seems to be more related to auditory cortex activity, but not to (para)hippocampal memory related activity, whereas in tinnitus patients with more severe hearing loss, tinnitus seems to be related to (para)hippocampal mechanisms. Furthermore hearing loss seems to drive the communication between the auditory cortex and the parahippocampus, as measured by functional and effective connectivity.
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Affiliation(s)
- Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA.
| | - Dirk De Ridder
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand
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The Relevance of the High Frequency Audiometry in Tinnitus Patients with Normal Hearing in Conventional Pure-Tone Audiometry. BIOMED RESEARCH INTERNATIONAL 2015; 2015:302515. [PMID: 26583098 PMCID: PMC4637018 DOI: 10.1155/2015/302515] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/08/2015] [Indexed: 02/04/2023]
Abstract
Objective. The majority of tinnitus patients suffer from hearing loss. But a subgroup of tinnitus patients show normal hearing thresholds in the conventional pure-tone audiometry (125 Hz–8 kHz). Here we explored whether the results of the high frequency audiometry (>8 kHz) provide relevant additional information in tinnitus patients with normal conventional audiometry by comparing those with normal and pathological high frequency audiometry with respect to their demographic and clinical characteristics. Subjects and Methods. From the database of the Tinnitus Clinic at Regensburg we identified 75 patients with normal hearing thresholds in the conventional pure-tone audiometry. We contrasted these patients with normal and pathological high-frequency audiogram and compared them with respect to gender, age, tinnitus severity, pitch, laterality and duration, comorbid symptoms and triggers for tinnitus onset. Results. Patients with pathological high frequency audiometry were significantly older and had higher scores on the tinnitus questionnaires in comparison to patients with normal high frequency audiometry. Furthermore, there was an association of high frequency audiometry with the laterality of tinnitus. Conclusion. In tinnitus patients with normal pure-tone audiometry the high frequency audiometry provides useful additional information. The association between tinnitus laterality and asymmetry of the high frequency audiometry suggests a potential causal role for the high frequency hearing loss in tinnitus etiopathogenesis.
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Flores LS, Teixeira AR, Rosito LPS, Seimetz BM, Dall'Igna C. Pitch and Loudness from Tinnitus in Individuals with Noise-induced Hearing Loss. Int Arch Otorhinolaryngol 2015; 20:248-53. [PMID: 27413408 PMCID: PMC4942292 DOI: 10.1055/s-0035-1562935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/28/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction
Tinnitus is one of the symptoms that affects individuals suffering from noise induced hearing loss. This condition can be disabling, leading the affected individual to turn away from work. Objective
This literature review aims to analyze the possible association between gender and tinnitus pitch and loudness, the degree of hearing loss and the frequencies affected in subjects with noise-induced hearing loss. Methods
This contemporary cohort study was conducted through a cross-sectional analysis. The study sample consisted of adults with unilateral or bilateral tinnitus, who had been diagnosed with noise-induced hearing loss. The patients under analysis underwent an otorhinolaryngological evaluation, pure tone audiometry, and acuphenometry. Results
The study included 33 subjects with noise-induced hearing loss diagnoses, of which 22 (66.7%) were men. Authors observed no statistical difference between gender and loudness/pitch tinnitus and loudness/pitch in subjects with bilateral tinnitus. Authors found an inverse relation between tinnitus loudness with intensity greater hearing threshold and the average of the thresholds and the grade of hearing loss. The tinnitus pitch showed no association with higher frequency of hearing threshold. Conclusion
Data analysis shows that, among the individuals evaluated, the greater the hearing loss, the lower the loudness of tinnitus. We did not observe an association between hearing loss and tinnitus pitch.
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Affiliation(s)
- Leticia Sousa Flores
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Adriane Ribeiro Teixeira
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leticia Petersen Schmidt Rosito
- Department of Otolaryngology - Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Macagnin Seimetz
- Post-Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Celso Dall'Igna
- Department of Ophthalmology and Otorhinolaryngology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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da Cruz Fernandes L, Momensohn-Santos TM, Carvalho JSM, Carvalho FLDQ. Tinnitus and normal hearing: a study on contralateral acoustic reflex. Am J Audiol 2015; 22:291-6. [PMID: 23824442 DOI: 10.1044/1059-0889(2013/13-0005)] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the difference of the contralateral acoustic reflex (AR) threshold between adult subjects with hearing within clinically normal limits, with and without tinnitus. METHOD The study sample in this exploratory, descriptive, and comparative study comprised 40 female subjects who were evaluated: 20 had tinnitus and 20 formed the control group. The contralateral AR threshold was evaluated at the frequencies of 500, 1000, and 2000 Hz. RESULTS Elevated or absent AR thresholds were found only in subjects with complaints of tinnitus. At all frequencies and in either ear, the median AR threshold was higher in the group that complained of tinnitus (100.0 dB; range = 95.0–100.0 dB) compared with the control group (90.0 dB; range = 86.3–95.0 dB; p < .01). There was a statistically significant difference ( p < .05) in the group with tinnitus, in each of the frequencies studied and in both the right and left ear. CONCLUSION The results suggest that evaluation of the efferent system, through AR, could be an important tool for the differential diagnosis of tinnitus in patients whose hearing was within clinically normal limits.
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Wu C, Stefanescu RA, Martel DT, Shore SE. Tinnitus: Maladaptive auditory-somatosensory plasticity. Hear Res 2015; 334:20-9. [PMID: 26074307 DOI: 10.1016/j.heares.2015.06.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/25/2015] [Accepted: 06/02/2015] [Indexed: 01/05/2023]
Abstract
Tinnitus, the phantom perception of sound, is physiologically characterized by an increase in spontaneous neural activity in the central auditory system. However, as tinnitus is often associated with hearing impairment, it is unclear how a decrease of afferent drive can result in central hyperactivity. In this review, we first assess methods for tinnitus induction and objective measures of the tinnitus percept in animal models. From animal studies, we discuss evidence that tinnitus originates in the cochlear nucleus (CN), and hypothesize mechanisms whereby hyperactivity may develop in the CN after peripheral auditory nerve damage. We elaborate how this process is likely mediated by plasticity of auditory-somatosensory integration in the CN: the circuitry in normal circumstances maintains a balance of auditory and somatosensory activities, and loss of auditory inputs alters the balance of auditory somatosensory integration in a stimulus timing dependent manner, which propels the circuit towards hyperactivity. Understanding the mechanisms underlying tinnitus generation is essential for its prevention and treatment. This article is part of a Special Issue entitled <Tinnitus>.
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Affiliation(s)
- Calvin Wu
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA
| | - Roxana A Stefanescu
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA
| | - David T Martel
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA
| | - Susan E Shore
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA.
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Sereda M, Edmondson-Jones M, Hall DA. Relationship between tinnitus pitch and edge of hearing loss in individuals with a narrow tinnitus bandwidth. Int J Audiol 2015; 54:249-56. [PMID: 25470623 PMCID: PMC4438350 DOI: 10.3109/14992027.2014.979373] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/18/2014] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Psychoacoustic measures of tinnitus, in particular dominant tinnitus pitch and its relationship to the shape of the audiogram, are important in determining and verifying pathophysiological mechanisms of the condition. Our previous study postulated that this relationship might vary between different groups of people with tinnitus. For a small subset of participants with narrow tinnitus bandwidth, pitch was associated with the audiometric edge, consistent with the tonotopic reorganization theory. The current study objective was to establish this relationship in an independent sample. DESIGN This was a retrospective design using data from five studies conducted between 2008 and 2013. STUDY SAMPLE From a cohort of 380 participants, a subgroup group of 129 with narrow tinnitus bandwidth were selected. RESULTS Tinnitus pitch generally fell within the area of hearing loss. There was a statistically significant correlation between dominant tinnitus pitch and edge frequency; higher edge frequency being associated with higher dominant tinnitus pitch. However, similar to our previous study, for the majority of participants pitch was more than an octave above the edge frequency. CONCLUSIONS The findings did not support our prediction and are therefore not consistent with the reorganization theory postulating tinnitus pitch to correspond to the audiometric edge.
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Affiliation(s)
- Magdalena Sereda
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, UK
- Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark Edmondson-Jones
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, UK
- Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Deborah A. Hall
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, UK
- Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
Hearing plays a vital role in the performance of a soldier and is important for speech processing. Noise-induced hearing loss is a significant impairment in the military and can affect combat performance. Military personnel are constantly exposed to high levels of noise and it is not surprising that noise induced hearing loss and tinnitus remain the second most prevalent service-connected disabilities. Much of the noise experienced by military personnel exceeds that of maximum protection achievable with double hearing protection. Unfortunately, unlike civilian personnel, military personnel have little option but to remain in noisy environments in order to complete specific tasks and missions. Use of hearing protection devices and follow-up audiological tests have become the mainstay of prevention of noise-induced hearing loss. This review focuses on sources of noise within the military, pathophysiology and management of patients with noise induced hearing loss.
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Affiliation(s)
- Jenica Su-Ern Yong
- Department of Otolaryngology-Head and Neck Surgery, National University Health System, National University of Singapore, Singapore, Singapore
| | - De-Yun Wang
- Department of Otolaryngology-Head and Neck Surgery, National University Health System, National University of Singapore, Singapore, Singapore
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Hayes SH, Radziwon KE, Stolzberg DJ, Salvi RJ. Behavioral models of tinnitus and hyperacusis in animals. Front Neurol 2014; 5:179. [PMID: 25278931 PMCID: PMC4166233 DOI: 10.3389/fneur.2014.00179] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/02/2014] [Indexed: 12/31/2022] Open
Abstract
The phantom perception of tinnitus and reduced sound-level tolerance associated with hyperacusis have a high comorbidity and can be debilitating conditions for which there are no widely accepted treatments. One factor limiting the development of treatments for tinnitus and hyperacusis is the lack of reliable animal behavioral models of these disorders. Therefore, the purpose of this review is to highlight the current animal models of tinnitus and hyperacusis, and to detail the advantages and disadvantages of each paradigm. To date, this is the first review to include models of both tinnitus and hyperacusis.
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Affiliation(s)
- Sarah H Hayes
- Center for Hearing and Deafness, Department of Communicative Disorders and Sciences, University at Buffalo, The State University of New York , Buffalo, NY , USA
| | - Kelly E Radziwon
- Center for Hearing and Deafness, Department of Communicative Disorders and Sciences, University at Buffalo, The State University of New York , Buffalo, NY , USA
| | - Daniel J Stolzberg
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario , London, ON , Canada
| | - Richard J Salvi
- Center for Hearing and Deafness, Department of Communicative Disorders and Sciences, University at Buffalo, The State University of New York , Buffalo, NY , USA
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Can an auditory illusion trick the brain into turning down tinnitus? Med Hypotheses 2014; 83:119-21. [PMID: 24767808 DOI: 10.1016/j.mehy.2014.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 03/24/2014] [Indexed: 11/23/2022]
Abstract
Tinnitus, the phantom perception of sound with no external source, affects an estimated 10-15% of the adult population. Current treatments for this oftentimes distressing condition are of limited effectiveness. The "central gain" model proposes that tinnitus arises from an increase in the responsiveness, or gain, of neurons in central auditory pathways, triggered by damage to the auditory periphery. It has been suggested that tinnitus might be treated by compensating for the peripheral damage, thereby restoring normal levels of input to the central pathways, and hence reducing central gain. Unfortunately, when tinnitus originates with permanent damage to the auditory periphery, it may be impossible to compensate for this damage directly. However, we hypothesize that tinnitus may be treated by tricking the brain into believing that it temporarily receives normal levels of input at frequencies where peripheral damage has occurred. We identify an auditory illusion that seems capable, in principle, of achieving this objective. If effective, this approach would offer a safe, accessible, and non-invasive treatment for tinnitus.
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Abstract
Tinnitus is one of the major audiological diseases, affecting a significant portion of the ageing society. Despite its huge personal and presumed economic impact there are only limited therapeutic options available. The reason for this deficiency lies in the very nature of the disease as it is deeply connected to elementary plasticity of auditory processing in the central nervous system. Understanding these mechanisms is essential for developing a therapy that reverses the plastic changes underlying the pathogenesis of tinnitus. This requires experiments that address individual neurons and small networks, something usually not feasible in human patients. However, in animals such invasive experiments on the level of single neurons with high spatial and temporal resolution are possible. Therefore, animal models are a very critical element in the combined efforts for engineering new therapies. This review provides an overview over the most important features of animal models of tinnitus: which laboratory species are suitable, how to induce tinnitus, and how to characterize the perceived tinnitus by behavioral means. In particular, these aspects of tinnitus animal models are discussed in the light of transferability to the human patients.
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86
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Zhao F, Stephens SDG, Ishak WS, Meyer-Bisch C. The characteristics of Audioscan and DPOAE measures in tinnitus patients with normal hearing thresholds. Int J Audiol 2014; 53:309-17. [DOI: 10.3109/14992027.2013.868047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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87
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Abstract
Background Many people with tinnitus also suffer from hyperacusis. Both clinical and basic scientific data indicate an overlap in pathophysiologic mechanisms. In order to further elucidate the interplay between tinnitus and hyperacusis we compared clinical and demographic characteristics of tinnitus patients with and without hyperacusis by analyzing a large sample from an international tinnitus patient database. Materials The default dataset import [November 1st, 2012] from the Tinnitus Research Initiative [TRI] Database was used for analyses. Hyperacusis was defined by the question “Do sounds cause you pain or physical discomfort?” of the Tinnitus Sample Case History Questionnaire. Patients who answered this question with “yes” were contrasted with “no”-responders with respect to 41 variables. Results 935 [55%] out of 1713 patients were characterized as hyperacusis patients. Hyperacusis in tinnitus was associated with younger age, higher tinnitus-related, mental and general distress; and higher rates of pain disorders and vertigo. In relation to objective audiological assessment patients with hyperacusis rated their subjective hearing function worse than those without hyperacusis. Similarly the tinnitus pitch was rated higher by hyperacusis patients in relation to the audiometrically determined tinnitus pitch. Among patients with tinnitus and hyperacusis the tinnitus was more frequently modulated by external noise and somatic maneuvers, i.e., exposure to environmental sounds and head and neck movements change the tinnitus percept. Conclusions Our findings suggest that the comorbidity of hyperacusis is a useful criterion for defining a sub-type of tinnitus which is characterized by greater need of treatment. The higher sensitivity to auditory, somatosensory and vestibular input confirms the notion of an overactivation of an unspecific hypervigilance network in tinnitus patients with hyperacusis.
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Basile CÉ, Fournier P, Hutchins S, Hébert S. Psychoacoustic assessment to improve tinnitus diagnosis. PLoS One 2013; 8:e82995. [PMID: 24349414 PMCID: PMC3861445 DOI: 10.1371/journal.pone.0082995] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 11/07/2013] [Indexed: 11/24/2022] Open
Abstract
The diagnosis of tinnitus relies on self-report. Psychoacoustic measurements of tinnitus pitch and loudness are essential for assessing claims and discriminating true from false ones. For this reason, the quantification of tinnitus remains a challenging research goal. We aimed to: (1) assess the precision of a new tinnitus likeness rating procedure with a continuous-pitch presentation method, controlling for music training, and (2) test whether tinnitus psychoacoustic measurements have the sensitivity and specificity required to detect people faking tinnitus. Musicians and non-musicians with tinnitus, as well as simulated malingerers without tinnitus, were tested. Most were retested several weeks later. Tinnitus pitch matching was first assessed using the likeness rating method: pure tones from 0.25 to 16 kHz were presented randomly to participants, who had to rate the likeness of each tone to their tinnitus, and to adjust its level from 0 to 100 dB SPL. Tinnitus pitch matching was then assessed with a continuous-pitch method: participants had to match the pitch of their tinnitus to an external tone by moving their finger across a touch-sensitive strip, which generated a continuous pure tone from 0.5 to 20 kHz in 1-Hz steps. The predominant tinnitus pitch was consistent across both methods for both musicians and non-musicians, although musicians displayed better external tone pitch matching abilities. Simulated malingerers rated loudness much higher than did the other groups with a high degree of specificity (94.4%) and were unreliable in loudness (not pitch) matching from one session to the other. Retest data showed similar pitch matching responses for both methods for all participants. In conclusion, tinnitus pitch and loudness reliably correspond to the tinnitus percept, and psychoacoustic loudness matches are sensitive and specific to the presence of tinnitus.
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Affiliation(s)
- Charles-Édouard Basile
- School of Speech Pathology and Audiology, Université de Montréal, Montréal, Québec, Canada
- International Laboratory for Research on Brain, Music, and Sound (BRAMS), Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - Philippe Fournier
- School of Speech Pathology and Audiology, Université de Montréal, Montréal, Québec, Canada
- International Laboratory for Research on Brain, Music, and Sound (BRAMS), Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
| | - Sean Hutchins
- International Laboratory for Research on Brain, Music, and Sound (BRAMS), Université de Montréal, Montréal, Québec, Canada
| | - Sylvie Hébert
- School of Speech Pathology and Audiology, Université de Montréal, Montréal, Québec, Canada
- International Laboratory for Research on Brain, Music, and Sound (BRAMS), Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, Québec, Canada
- * E-mail:
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Buzo BC, Carvallo RMM. Psychoacoustic analyses of cochlear mechanisms in tinnitus patients with normal auditory thresholds. Int J Audiol 2013; 53:40-7. [PMID: 24168288 DOI: 10.3109/14992027.2013.840931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Tinnitus is often related to auditory dysfunction. We hypothesised that, among individuals with normal auditory thresholds, the mechanism of frequency selectivity might differ between subjects with and without tinnitus. Our objective was to identify any differences between normal-hearing individuals with tinnitus and those without in terms of psychophysical tuning curves (PTCs) and threshold-equalising noise (TEN) test results. DESIGN We determined PTCs and performed the TEN test. STUDY SAMPLE We evaluated 57 individuals, 16 with bilateral tinnitus (tinnitus-group) and 41 without tinnitus (control-group). RESULTS We found significant differences between tinnitus and control groups regarding the following: 2 kHz PTCs obtained in noise at 6 and 8 kHz; 4 kHz PTCs obtained in noise at 2 and 8 kHz; and 6 and 8 kHz PTCs obtained in noise at 2 and 3 kHz. The TEN test revealed differences between groups in terms of auditory thresholds, which were significantly higher in the tinnitus group. In addition, none of the individuals in the tinnitus group were found to have dead regions in the cochlea. CONCLUSIONS Despite having normal auditory thresholds, individuals with tinnitus have auditory patterns that differ significantly from those seen in individuals without tinnitus, such differences being suggestive of cochlear impairment.
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Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol 2013; 12:920-930. [PMID: 23948178 DOI: 10.1016/s1474-4422(13)70160-1] [Citation(s) in RCA: 431] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lang A, Vernet M, Yang Q, Orssaud C, Londero A, Kapoula Z. Differential auditory-oculomotor interactions in patients with right vs. left sided subjective tinnitus: a saccade study. Front Hum Neurosci 2013; 7:47. [PMID: 23550269 PMCID: PMC3581810 DOI: 10.3389/fnhum.2013.00047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 02/05/2013] [Indexed: 12/31/2022] Open
Abstract
Subjective tinnitus (ST) is a frequent but poorly understood medical condition. Recent studies demonstrated abnormalities in several types of eye movements (smooth pursuit, optokinetic nystagmus, fixation, and vergence) in ST patients. The present study investigates horizontal and vertical saccades in patients with tinnitus lateralized predominantly to the left or to the right side. Compared to left sided ST, tinnitus perceived on the right side impaired almost all the parameters of saccades (latency, amplitude, velocity, etc.) and noticeably the upward saccades. Relative to controls, saccades from both groups were more dysmetric and were characterized by increased saccade disconjugacy (i.e., poor binocular coordination). Although the precise mechanisms linking ST and saccadic control remain unexplained, these data suggest that ST can lead to detrimental auditory, visuomotor, and perhaps vestibular interactions.
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Affiliation(s)
- Alexandre Lang
- CNRS CESEM - UMR 8194, Université Paris Descartes Paris, France
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The reduced cochlear output and the failure to adapt the central auditory response causes tinnitus in noise exposed rats. PLoS One 2013; 8:e57247. [PMID: 23516401 PMCID: PMC3596376 DOI: 10.1371/journal.pone.0057247] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/18/2013] [Indexed: 01/15/2023] Open
Abstract
Tinnitus is proposed to be caused by decreased central input from the cochlea, followed by increased spontaneous and evoked subcortical activity that is interpreted as compensation for increased responsiveness of central auditory circuits. We compared equally noise exposed rats separated into groups with and without tinnitus for differences in brain responsiveness relative to the degree of deafferentation in the periphery. We analyzed (1) the number of CtBP2/RIBEYE-positive particles in ribbon synapses of the inner hair cell (IHC) as a measure for deafferentation; (2) the fine structure of the amplitudes of auditory brainstem responses (ABR) reflecting differences in sound responses following decreased auditory nerve activity and (3) the expression of the activity-regulated gene Arc in the auditory cortex (AC) to identify long-lasting central activity following sensory deprivation. Following moderate trauma, 30% of animals exhibited tinnitus, similar to the tinnitus prevalence among hearing impaired humans. Although both tinnitus and no-tinnitus animals exhibited a reduced ABR wave I amplitude (generated by primary auditory nerve fibers), IHCs ribbon loss and high-frequency hearing impairment was more severe in tinnitus animals, associated with significantly reduced amplitudes of the more centrally generated wave IV and V and less intense staining of Arc mRNA and protein in the AC. The observed severe IHCs ribbon loss, the minimal restoration of ABR wave size, and reduced cortical Arc expression suggest that tinnitus is linked to a failure to adapt central circuits to reduced cochlear input.
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Abstract
PURPOSE This study was designed to investigate methods to help patients suffering from unilateral tinnitus synthesizing an auditory replica of their tinnitus. MATERIALS AND METHODS Two semi-automatic methods (A and B) derived from the auditory threshold of the patient and a method (C) combining a pure tone and a narrow band-pass noise centred on an adjustable frequency were devised and rated on their likeness over two test sessions. A third test evaluated the stability over time of the synthesized tinnitus replica built with method C, and its proneness to merge with the patient's tinnitus. Patients were then asked to try and control the lateralisation of this single percept through the adjustment of the tinnitus replica level. RESULTS The first two tests showed that seven out of ten patients chose the tinnitus replica built with method C as their preferred one. The third test, performed on twelve patients, revealed pitch tuning was rather stable over a week interval. It showed that eight patients were able to consistently match the central frequency of the synthesized tinnitus (presented to the contralateral ear) to their own tinnitus, which leaded to a unique tinnitus percept. The lateralisation displacement was consistent across patients and revealed an average range of 29dB to obtain a full lateral shift from the ipsilateral to the contralateral side. CONCLUSIONS Although spectrally simpler than the semi-automatic methods, method C could replicate patients' tinnitus, to some extent. When a unique percept between synthesized tinnitus and patients' tinnitus arose, lateralisation of this percept was achieved.
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94
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The relationship between tinnitus pitch and hearing sensitivity. Eur Arch Otorhinolaryngol 2013; 271:41-8. [DOI: 10.1007/s00405-013-2375-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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95
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Noise-Induced Inner Hair Cell Ribbon Loss Disturbs Central Arc Mobilization: A Novel Molecular Paradigm for Understanding Tinnitus. Mol Neurobiol 2012; 47:261-79. [DOI: 10.1007/s12035-012-8372-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/29/2012] [Indexed: 11/27/2022]
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