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Leaver AM, Chen YJ, Parrish TB. Focal tDCS of auditory cortex in chronic tinnitus: A randomized controlled mechanistic trial. Clin Neurophysiol 2024; 158:79-91. [PMID: 38198874 PMCID: PMC10896454 DOI: 10.1016/j.clinph.2023.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The goal of this pilot study was to understand how focal transcranial direct current stimulation (tDCS) targeting auditory cortex changes brain function in chronic tinnitus using magnetic resonance imaging (MRI). METHODS People with chronic tinnitus were randomized to active or sham tDCS on five consecutive days in this mechanistic trial (n = 10/group). Focal 4x1 tDCS (central anode, surround cathodes) targeted left auditory cortex, with single-blind 2 mA current during twenty-minute sessions. Arterial spin-labeled and blood oxygenation level dependent MRI occurred immediately before and after the first tDCS session, and tinnitus symptoms were measured starting one week before the first tDCS session and through four weeks after the final session. RESULTS Acute increases in cerebral blood flow and functional connectivity were noted in auditory cortex after the first active tDCS session. Reduced tinnitus loudness ratings after the final tDCS session correlated with acute change in functional connectivity between an auditory network and mediodorsal thalamus and prefrontal cortex. Reduced tinnitus intrusiveness also correlated with acute change in connectivity between precuneus and an auditory network. CONCLUSIONS Focal auditory-cortex tDCS can influence function in thalamus, auditory, and prefrontal cortex, which may associate with improved tinnitus. SIGNIFICANCE With future refinement, tDCS targeting auditory cortex could become a viable intervention for tinnitus.
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Affiliation(s)
- Amber M Leaver
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA.
| | - Yufen J Chen
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
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2
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Chen Q, Lv H, Wang Z, Li X, Wang X, Huang Y, Zhao P, Yang Z, Gong S, Wang Z. Multimodal quantitative magnetic resonance imaging of the thalamus in tinnitus patients with different outcomes after sound therapy. CNS Neurosci Ther 2023; 29:4070-4081. [PMID: 37392024 PMCID: PMC10651975 DOI: 10.1111/cns.14330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/08/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
AIMS This study systematically investigated structural and functional alterations in the thalamus and its subregions using multimodal magnetic resonance imaging (MRI) and examined its clinical relevance in tinnitus patients with different outcomes after sound therapy (narrowband noise). METHODS In total, 60 patients with persistent tinnitus and 57 healthy controls (HCs) were recruited. Based on treatment efficacy, 28 patients were categorized into the effective group and 32 into the ineffective group. Five MRI measurements of the thalamus and its seven subregions, including gray matter volume, fractional anisotropy, fractional amplitude of low-frequency fluctuation, and functional connectivity (FC), were obtained for each participant and compared between the groups. RESULTS Patients in both the groups exhibited widespread functional and diffusion abnormalities in the whole thalamus and several subregions, with more obvious changes observed in the effective group. All tinnitus patients had abnormal FC compared with the HCs; FC differences between the two patient groups were only observed in the striatal network, auditory-related cortex, and the core area of the limbic system. We combined the multimodal quantitative thalamic alterations and used it as an imaging indicator to evaluate prognosis before sound therapy and achieved a sensitivity of 71.9% and a specificity of 85.7%. CONCLUSION Similar patterns of thalamic alterations were identified in tinnitus patients with different outcomes, with more obvious changes observed in the effective group. Our findings support the tinnitus generation hypothesis of frontostriatal gating system dysfunction. A combination of multimodal quantitative thalamic properties may be used as indicators to predict tinnitus prognosis before sound therapy.
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Affiliation(s)
- Qian Chen
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Han Lv
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Zhaodi Wang
- Department of OtolaryngologyBeijing Jingmei Group General HospitalBeijingChina
| | - Xiaoshuai Li
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xinghao Wang
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | | | - Pengfei Zhao
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Zhenghan Yang
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck SurgeryBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Zhenchang Wang
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
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Hinkley LBN, Haas SS, Cheung SW, Nagarajan SS, Subramaniam K. Reduced neural connectivity in the caudate anterior head predicts hallucination severity in schizophrenia. Schizophr Res 2023; 261:1-5. [PMID: 37678144 PMCID: PMC10878029 DOI: 10.1016/j.schres.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/13/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Caudate functional abnormalities have been identified as one critical neural substrate underlying sensory gating impairments that lead to auditory phantom hallucinations in both patients with schizophrenia (SZ) and tinnitus, characterized by the perception of internally generated sounds in the absence of external environmental auditory stimuli. In this study, we tested the hypothesis as to whether functional connectivity abnormalities in distinct caudate subdivisions implicated in sensory gating and auditory phantom percepts in tinnitus, which are currently being localized for neuromodulation targeting using deep brain stimulation techniques, would be associated with auditory phantom hallucination severity in SZ. METHODS Twenty five SZ and twenty eight demographically-matched healthy control (HC) participants, completed this fMRI resting-state study and clinical assessments. RESULTS Between-group seed-to-voxel analyses revealed only one region, the caudate anterior head, which showed reduced functional connectivity with the thalamus that survived whole-brain multiple comparison corrections. Importantly, connectivity between the caudate anterior head with thalamus negatively correlated with hallucination severity. CONCLUSIONS In the present study, we deliver the first evidence of caudate subdivision specificity for the neural pathophysiology underlying hallucinations in schizophrenia within a sensory gating framework that has been developed for auditory phantoms in patients with tinnitus. Our findings provide transdiagnostic convergent evidence for the role of the caudate in the gating of auditory phantom hallucinations, observed across patients with SZ and tinnitus by specifying the anterior caudate division is key to mediation of hallucinations, and creating a path towards personalized treatment approaches to arrest auditory phantom hallucinations from reaching perceptual awareness.
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Affiliation(s)
- Leighton B N Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA 94143, USA; Surgical Services, San Francisco Veterans Health Care System, San Francisco, CA 94121, USA
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Karuna Subramaniam
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA.
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Leaver AM, Chen YJ, Parrish TB. Focal transcranial direct current stimulation of auditory cortex in chronic tinnitus: A randomized controlled mechanistic trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.12.23292557. [PMID: 37502874 PMCID: PMC10370232 DOI: 10.1101/2023.07.12.23292557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Objective The goal of this pilot MRI study was to understand how focal transcranial direct current stimulation (tDCS) targeting auditory cortex changes brain function in chronic tinnitus. Methods People with chronic tinnitus were randomized to active or sham tDCS on five consecutive days in this pilot mechanistic trial (n=10/group). Focal 4×1 tDCS (central anode, surround cathodes) targeted left auditory cortex, with single-blind 2mA current during twenty-minute sessions. Arterial spin-labeled and blood oxygenation level dependent MRI occurred immediately before and after the first tDCS session, and tinnitus symptoms were measured starting one week before the first tDCS session and through four weeks after the final session. Results Acute increases in cerebral blood flow and functional connectivity were noted in auditory cortex after the first active tDCS session. Reduced tinnitus loudness ratings after the final tDCS session correlated with acute change in functional connectivity between an auditory network and mediodorsal thalamus and prefrontal cortex. Reduced tinnitus intrusiveness also correlated with acute change in connectivity between precuneus and an auditory network. Conclusions Focal auditory-cortex tDCS can influence function in thalamus, auditory, and prefrontal cortex, which may associate with improved tinnitus. Significance With future refinement, noninvasive brain stimulation targeting auditory cortex could become a viable intervention for tinnitus.
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Affiliation(s)
- Amber M. Leaver
- Department of Radiology, Northwestern University, Chicago, IL, 60611
| | - Yufen J. Chen
- Department of Radiology, Northwestern University, Chicago, IL, 60611
| | - Todd B. Parrish
- Department of Radiology, Northwestern University, Chicago, IL, 60611
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任 柯, 刘 晖, 王 宇, 张 文, 杨 婷, 许 丽. [Progress in neural network mechanism of tinnitus using functional magnetic resonance imaging]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:582-587. [PMID: 37549953 PMCID: PMC10570109 DOI: 10.13201/j.issn.2096-7993.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 08/09/2023]
Abstract
Tinnitus refers to the perception of abnormal sound in the absence of external sound stimulation. It can have an impact on a person's mood, memory, attention, and mental state, although the mechanism of tinnitus is still unclear. In recent years, the research on the central neural mechanism of tinnitus has attracted the attention of scholars.Functional magnetic resonance imaging (fMRI),as an effective imaging technology, has been actively employed in this field. This paper provides a systematic summary of studies on the central neural mechanism of tinnitus by fMRI in recent years,revealed the changes of functional connections among tinnitus-related neural networks,such as auditory network,limbic system,default mode network and salience network. The central neural mechanism of tinnitus involves multiple networks that interact with each other. By understanding this mechanism, we hope to develop more targeted prevention and treatment strategies to help patients alleviate long-term tinnitus.
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Affiliation(s)
- 柯蕙 任
- 西安医学院(西安,710000)X'ian Medical College, Xi'an, 710000, China
| | - 晖 刘
- 陕西省人民医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital
| | - 宇娟 王
- 陕西省人民医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital
| | - 文 张
- 陕西省人民医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital
| | - 婷 杨
- 西安医学院(西安,710000)X'ian Medical College, Xi'an, 710000, China
| | - 丽丽 许
- 西安医学院(西安,710000)X'ian Medical College, Xi'an, 710000, China
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Wu Q, Wang J, Han D, Hu H, Gao H. Efficacy and safety of acupuncture and moxibustion for primary tinnitus: A systematic review and meta-analysis. Am J Otolaryngol 2023; 44:103821. [PMID: 36905913 DOI: 10.1016/j.amjoto.2023.103821] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Tinnitus is a common otological symptom that can seriously affect a patient's quality of life, and effective therapies are still lacking. A large number of studies have found that compared with traditional therapy, acupuncture and moxibustion treatment are beneficial for the treatment of primary tinnitus, although current evidence remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of acupuncture and moxibustion for primary tinnitus. METHODS We conducted a comprehensive literature review in multiple databases from inception through December 2021, including PubMed, Medline, Ovid, Embase, Science Direct, Chinese National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Biomedical Literature (CBM) and VIP Database. The database search was supplemented by subsequent periodic scrutiny of unpublished and ongoing RCTs from the Cochrane Central Register of Controlled Trials (CENTRAL) and the WHO International Clinical Trials Registry (ICTRP). We included RCTs that compared acupuncture and moxibustion with pharmacological therapies, oxygen or physical therapies, or no treatment, for treating primary tinnitus. The main outcome measures were Tinnitus Handicap Inventory (THI) and efficacy rate; the secondary outcome measures were Tinnitus Evaluation Questionnaire (TEQ), Pure Tone Average (PTA), Visual Analogue Scale (VAS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and adverse events. Data accumulation and synthesis included meta-analysis, subgroup analysis, publication bias, risk-of-bias assessment, sensitivity analysis, and adverse events. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to grade the evidence quality. RESULTS We included 34 RCTs involving 3086 patients. Results indicated that compared with the controls, acupuncture and moxibustion resulted in significantly lower scores on the THI, achieved a significantly higher efficacy rate, reduced scores on TEQ, PTA, VAS, HAMA and HAMD. The meta-analysis revealed that acupuncture and moxibustion have a good safety profile in the treatment of primary tinnitus. CONCLUSION The results showed that acupuncture and moxibustion for primary tinnitus yielded the greatest decrease in tinnitus severity and improvement in quality of life. Due to the low quality of GRADE evidence grade, the considerable heterogeneity among trials for several data syntheses, more high-quality studies with large sample sizes and longer follow-up periods are urgently needed.
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Affiliation(s)
- Qiqi Wu
- Department of Acupuncture, Moxibustion and Massage, Wenzhou Central Hospital, Wenzhou, China
| | - Jiawei Wang
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dexiong Han
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hantong Hu
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
| | - Hong Gao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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Lin CT, Ghosh S, Hinkley LB, Dale CL, Souza ACS, Sabes JH, Hess CP, Adams ME, Cheung SW, Nagarajan SS. Multi-tasking deep network for tinnitus classification and severity prediction from multimodal structural MR images. J Neural Eng 2023; 20. [PMID: 36595270 DOI: 10.1088/1741-2552/acab33] [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: 07/13/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022]
Abstract
Objective:Subjective tinnitus is an auditory phantom perceptual disorder without an objective biomarker. Fast and efficient diagnostic tools will advance clinical practice by detecting or confirming the condition, tracking change in severity, and monitoring treatment response. Motivated by evidence of subtle anatomical, morphological, or functional information in magnetic resonance images of the brain, we examine data-driven machine learning methods for joint tinnitus classification (tinnitus or no tinnitus) and tinnitus severity prediction.Approach:We propose a deep multi-task multimodal framework for tinnitus classification and severity prediction using structural MRI (sMRI) data. To leverage complementary information multimodal neuroimaging data, we integrate two modalities of three-dimensional sMRI-T1 weighted (T1w) and T2 weighted (T2w) images. To explore the key components in the MR images that drove task performance, we segment both T1w and T2w images into three different components-cerebrospinal fluid, grey matter and white matter, and evaluate performance of each segmented image.Main results:Results demonstrate that our multimodal framework capitalizes on the information across both modalities (T1w and T2w) for the joint task of tinnitus classification and severity prediction.Significance:Our model outperforms existing learning-based and conventional methods in terms of accuracy, sensitivity, specificity, and negative predictive value.
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Affiliation(s)
- Chieh-Te Lin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Sanjay Ghosh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Leighton B Hinkley
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Corby L Dale
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Ana C S Souza
- Department of Telecommunication and Mechatronics Engineering, Federal University of Sao Joao del-Rei, Praca Frei Orlando, 170, Sao Joao del Rei 36307, MG, Brazil
| | - Jennifer H Sabes
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter St., San Francisco, CA 94115, United States of America
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Meredith E Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Phillips Wangensteen Building, 516 Delaware St., Minneapolis, MN 55455, United States of America
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter St., San Francisco, CA 94115, United States of America.,Surgical Services, Veterans Affairs, 4150 Clement St., San Francisco, CA 94121, United States of America
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter St., San Francisco, CA 94115, United States of America.,Surgical Services, Veterans Affairs, 4150 Clement St., San Francisco, CA 94121, United States of America
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Rosemann S, Rauschecker JP. Neuroanatomical alterations in middle frontal gyrus and the precuneus related to tinnitus and tinnitus distress. Hear Res 2022; 424:108595. [DOI: 10.1016/j.heares.2022.108595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/04/2022]
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