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De Ridder D, Adhia D, Vanneste S. The brain's duck test in phantom percepts: Multisensory congruence in neuropathic pain and tinnitus. Brain Res 2024; 1844:149137. [PMID: 39103069 DOI: 10.1016/j.brainres.2024.149137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/26/2024] [Accepted: 08/01/2024] [Indexed: 08/07/2024]
Abstract
Chronic neuropathic pain and chronic tinnitus have been likened to phantom percepts, in which a complete or partial sensory deafferentation results in a filling in of the missing information derived from memory. 150 participants, 50 with tinnitus, 50 with chronic pain and 50 healthy controls underwent a resting state EEG. Source localized current density is recorded from all the sensory cortices (olfactory, gustatory, somatosensory, auditory, vestibular, visual) as well as the parahippocampal area. Functional connectivity by means of lagged phase synchronization is also computed between these regions of interest. Pain and tinnitus are associated with gamma band activity, reflecting prediction errors, in all sensory cortices except the olfactory and gustatory cortex. Functional connectivity identifies theta frequency connectivity between each of the sensory cortices except the chemical senses to the parahippocampus, but not between the individual sensory cortices. When one sensory domain is deprived, the other senses may provide the parahippocampal 'contextual' area with the most likely sound or somatosensory sensation to fill in the gap, applying an abductive 'duck test' approach, i.e., based on stored multisensory congruence. This novel concept paves the way to develop novel treatments for pain and tinnitus, using multisensory (i.e. visual, vestibular, somatosensory, auditory) modulation with or without associated parahippocampal targeting.
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Affiliation(s)
- Dirk De Ridder
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Divya Adhia
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sven Vanneste
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute & Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland. https://www.lab-clint.org
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Hu W, Xu D, Xing Q. Probe into the treatment of tinnitus by acupuncture combined with medicine under the mechanism of pathophysiology: A review. Medicine (Baltimore) 2024; 103:e39832. [PMID: 39331935 PMCID: PMC11441956 DOI: 10.1097/md.0000000000039832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024] Open
Abstract
Tinnitus is a common medical disorder. The risk factors include hearing loss, ototoxic medications, head injuries, and depression. Therefore, ear disorders, anxiety, and depression should be considered in the treatment of tinnitus. Although considerable research has been conducted on the pathogenesis and treatment of tinnitus, there is currently no effective treatment. Traditional Chinese medicine (TCM) has a certain effect on tinnitus and a large number of clinical trials have been conducted. Its treatment methods vary and include TCM, acupuncture, and music therapy. TCM treatment of tinnitus usually takes the method of comprehensive treatment, not only relying on drugs but also safety. Therefore, this review explores the treatment of tinnitus using acupuncture combined with medicine, based on the new pathophysiological mechanism of tinnitus.
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Affiliation(s)
- Wenhui Hu
- The Eighth Medical Center of Chinese PLA General Hospital & Medical School, Beijing, China
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Boedts M, Buechner A, Khoo SG, Gjaltema W, Moreels F, Lesinski-Schiedat A, Becker P, MacMahon H, Vixseboxse L, Taghavi R, Lim HH, Lenarz T. Combining sound with tongue stimulation for the treatment of tinnitus: a multi-site single-arm controlled pivotal trial. Nat Commun 2024; 15:6806. [PMID: 39160146 PMCID: PMC11333749 DOI: 10.1038/s41467-024-50473-z] [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: 08/24/2023] [Accepted: 07/08/2024] [Indexed: 08/21/2024] Open
Abstract
Bimodal neuromodulation is emerging as a nonsurgical treatment for tinnitus. Bimodal treatment combining sound therapy with electrical tongue stimulation using the Lenire device is evaluated in a controlled pivotal trial (TENT-A3, NCT05227365) consisting of 6-weeks of sound-only stimulation (Stage 1) followed by 6-weeks of bimodal treatment (Stage 2) with 112 participants serving as their own control. The primary endpoint compares the responder rate observed in Stage 2 versus Stage 1, where a responder exceeds 7 points in the Tinnitus Handicap Inventory. In participants with moderate or more severe tinnitus, there is a clinically superior performance of bimodal treatment (58.6%; 95% CI: 43.5%, 73.6%; p = 0.022) compared to sound therapy alone (43.2%; 95% CI: 29.7%, 57.8%), which is not observed in the full cohort across all severity groups. Consistent results are observed for the secondary endpoint based on the Tinnitus Functional Index (bimodal treatment: 45.5%; 95% CI: 31.7%, 59.9%; sound-only stimulation: 29.6%; 95% CI: 18.2%, 44.2%; p = 0.010), where a responder exceeds 13 points. There are no device related serious adverse events. These positive outcomes led to FDA De Novo approval of the Lenire device for tinnitus treatment.
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Affiliation(s)
- Michael Boedts
- BRAI3N Clinic, Gent, Belgium
- Maria Middelares General Hospital, Gent, Belgium
| | - Andreas Buechner
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover Medical School, Hannover, Germany
| | - S Guan Khoo
- St. James's Hospital, Dublin, Ireland
- St. Vincent's Hospital, Dublin, Ireland
| | | | | | - Anke Lesinski-Schiedat
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover Medical School, Hannover, Germany
| | - Philipp Becker
- German Hearing Center (DHZ), Hannover Medical School, Hannover, Germany
| | | | | | | | - Hubert H Lim
- Neuromod Devices Limited, Dublin, Ireland.
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, MN, USA.
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
- German Hearing Center (DHZ), Hannover Medical School, Hannover, Germany
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Wang L, Xu H, Song Z, Wang H, Hu W, Gao Y, Zhang Z, Jiang J. fMRI signals in white matter rewire gray matter community organization. Neuroimage 2024; 297:120763. [PMID: 39084280 DOI: 10.1016/j.neuroimage.2024.120763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/17/2024] [Accepted: 07/29/2024] [Indexed: 08/02/2024] Open
Abstract
Human brain gray matter (GM) has usually been clustered into multiple functional networks. The white matter (WM) fiber bundles are known to interconnect these networks simultaneously, engaging in numerous cognitive functions. However, the exact interconnections between GM and WM are still unclear, whether functional signals in WM rewires GM community organization remains to be explored. In this study, we divided brain functional connections into three types by using edge-centric method, including intra-GM, intra-WM and GM-WM connections, and calculated the edge community evaluation indexes for quantifying GM community engagement. The results showed that the involvement of WM significantly enhanced community entropy in the heteromodal system, while the sensory-attention system remained barely changed. In addition, delta community entropy showed a significant correlation with clinical cognitive scale. Our results suggested that WM rewired GM community organization, enhancing the community engagement of brain regions in the heteromodal system. This involvement was observed to be disrupted in disease groups. Our study revealed that considering the functional signals of GM and WM simultaneously could better understand the brain's functional organization.
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Affiliation(s)
- Luyao Wang
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai 200444, China
| | - Huanyu Xu
- School of Communication and Information Engineering, Shanghai University, Shanghai 200444, China
| | - Ziyan Song
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai 200444, China
| | - Huanxin Wang
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai 200444, China
| | - Wenjing Hu
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai 200444, China
| | - Yiwen Gao
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai 200444, China
| | - Zhilin Zhang
- Research Center for Medical Artificial Intelligence, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Jiehui Jiang
- Institute of Biomedical Engineering, School of Life Sciences, Shanghai University, Shanghai 200444, China.
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Yasoda-Mohan A, Chen F, Ó Sé C, Allard R, Ost J, Vanneste S. Phantom perception as a Bayesian inference problem: a pilot study. J Neurophysiol 2024; 131:1311-1327. [PMID: 38718414 DOI: 10.1152/jn.00349.2023] [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: 09/20/2023] [Revised: 04/18/2024] [Accepted: 05/01/2024] [Indexed: 06/19/2024] Open
Abstract
Tinnitus is the perception of a continuous sound in the absence of an external source. Although the role of the auditory system is well investigated, there is a gap in how multisensory signals are integrated to produce a single percept in tinnitus. Here, we train participants to learn a new sensory environment by associating a cue with a target signal that varies in perceptual threshold. In the test phase, we present only the cue to see whether the person perceives an illusion of the target signal. We perform two separate experiments to observe the behavioral and electrophysiological responses to the learning and test phases in 1) healthy young adults and 2) people with continuous subjective tinnitus and matched control subjects. We observed that in both parts of the study the percentage of false alarms was negatively correlated with the 75% detection threshold. Additionally, the perception of an illusion goes together with increased evoked response potential in frontal regions of the brain. Furthermore, in patients with tinnitus, we observe no significant difference in behavioral or evoked response in the auditory paradigm, whereas patients with tinnitus were more likely to report false alarms along with increased evoked activity during the learning and test phases in the visual paradigm. This emphasizes the importance of integrity of sensory pathways in multisensory integration and how this process may be disrupted in people with tinnitus. Furthermore, the present study also presents preliminary data supporting evidence that tinnitus patients may be building stronger perceptual models, which needs future studies with a larger population to provide concrete evidence on.NEW & NOTEWORTHY Tinnitus is the continuous phantom perception of a ringing in the ears. Recently, it has been suggested that tinnitus may be a maladaptive inference of the brain to auditory anomalies, whether they are detected or undetected by an audiogram. The present study presents empirical evidence for this hypothesis by inducing an illusion in a sensory domain that is damaged (auditory) and one that is intact (visual). It also presents novel information about how people with tinnitus process multisensory stimuli in the audio-visual domain.
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Affiliation(s)
- Anusha Yasoda-Mohan
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Feifan Chen
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Colum Ó Sé
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Remy Allard
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Jan Ost
- Brain Research Center for Advanced, International, Innovative and Interdisciplinary Neuromodulation, Ghent, Belgium
| | - Sven Vanneste
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Brain Research Center for Advanced, International, Innovative and Interdisciplinary Neuromodulation, Ghent, Belgium
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De Ridder D, Friston K, Sedley W, Vanneste S. A parahippocampal-sensory Bayesian vicious circle generates pain or tinnitus: a source-localized EEG study. Brain Commun 2023; 5:fcad132. [PMID: 37223127 PMCID: PMC10202557 DOI: 10.1093/braincomms/fcad132] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/14/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Pain and tinnitus share common pathophysiological mechanisms, clinical features, and treatment approaches. A source-localized resting-state EEG study was conducted in 150 participants: 50 healthy controls, 50 pain, and 50 tinnitus patients. Resting-state activity as well as functional and effective connectivity was computed in source space. Pain and tinnitus were characterized by increased theta activity in the pregenual anterior cingulate cortex, extending to the lateral prefrontal cortex and medial anterior temporal lobe. Gamma-band activity was increased in both auditory and somatosensory cortex, irrespective of the pathology, and extended to the dorsal anterior cingulate cortex and parahippocampus. Functional and effective connectivity were largely similar in pain and tinnitus, except for a parahippocampal-sensory loop that distinguished pain from tinnitus. In tinnitus, the effective connectivity between parahippocampus and auditory cortex is bidirectional, whereas the effective connectivity between parahippocampus and somatosensory cortex is unidirectional. In pain, the parahippocampal-somatosensory cortex is bidirectional, but parahippocampal auditory cortex unidirectional. These modality-specific loops exhibited theta-gamma nesting. Applying a Bayesian brain model of brain functioning, these findings suggest that the phenomenological difference between auditory and somatosensory phantom percepts result from a vicious circle of belief updating in the context of missing sensory information. This finding may further our understanding of multisensory integration and speaks to a universal treatment for pain and tinnitus-by selectively disrupting parahippocampal-somatosensory and parahippocampal-auditory theta-gamma activity and connectivity.
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Affiliation(s)
- Dirk De Ridder
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, University College London, London WC1N 3AR, UK
| | - William Sedley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Sven Vanneste
- Correspondence to: Sven Vanneste Lab for Clinical & Integrative Neuroscience Global Brain Health Institute and Institute of Neuroscience Trinity College Dublin, College Green 2, Dublin D02 PN40, Ireland E-mail:
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Surgent O, Riaz A, Ausderau KK, Adluru N, Kirk GR, Guerrero-Gonzalez J, Skaletski EC, Kecskemeti SR, Dean III DC, Weismer SE, Alexander AL, Travers BG. Brainstem white matter microstructure is associated with hyporesponsiveness and overall sensory features in autistic children. Mol Autism 2022; 13:48. [PMID: 36536467 PMCID: PMC9762648 DOI: 10.1186/s13229-022-00524-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Elevated or reduced responses to sensory stimuli, known as sensory features, are common in autistic individuals and often impact quality of life. Little is known about the neurobiological basis of sensory features in autistic children. However, the brainstem may offer critical insights as it has been associated with both basic sensory processing and core features of autism. METHODS Diffusion-weighted imaging (DWI) and parent-report of sensory features were acquired from 133 children (61 autistic children with and 72 non-autistic children, 6-11 years-old). Leveraging novel DWI processing techniques, we investigated the relationship between sensory features and white matter microstructure properties (free-water-elimination-corrected fractional anisotropy [FA] and mean diffusivity [MD]) in precisely delineated brainstem white matter tracts. Follow-up analyses assessed relationships between microstructure and sensory response patterns/modalities and analyzed whole brain white matter using voxel-based analysis. RESULTS Results revealed distinct relationships between brainstem microstructure and sensory features in autistic children compared to non-autistic children. In autistic children, more prominent sensory features were generally associated with lower MD. Further, in autistic children, sensory hyporesponsiveness and tactile responsivity were strongly associated with white matter microstructure in nearly all brainstem tracts. Follow-up voxel-based analyses confirmed that these relationships were more prominent in the brainstem/cerebellum, with additional sensory-brain findings in the autistic group in the white matter of the primary motor and somatosensory cortices, the occipital lobe, the inferior parietal lobe, and the thalamic projections. LIMITATIONS All participants communicated via spoken language and acclimated to the sensory environment of an MRI session, which should be considered when assessing the generalizability of this work to the whole of the autism spectrum. CONCLUSIONS These findings suggest unique brainstem white matter contributions to sensory features in autistic children compared to non-autistic children. The brainstem correlates of sensory features underscore the potential reflex-like nature of behavioral responses to sensory stimuli in autism and have implications for how we conceptualize and address sensory features in autistic populations.
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Affiliation(s)
- Olivia Surgent
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI USA
| | - Ali Riaz
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
| | - Karla K. Ausderau
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, Madison, WI USA
| | - Nagesh Adluru
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI USA
| | - Gregory R. Kirk
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
| | - Jose Guerrero-Gonzalez
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI USA
| | - Emily C. Skaletski
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, Madison, WI USA
| | - Steven R. Kecskemeti
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
| | - Douglas C Dean III
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI USA
| | - Susan Ellis Weismer
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI USA
- Department of Psychology, University of Wisconsin-Madison, Madison, WI USA
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI USA
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI USA
| | - Brittany G. Travers
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, Madison, WI USA
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Spencer S, Mielczarek M, Olszewski J, Sereda M, Joossen I, Vermeersch H, Gilles A, Michiels S. Effectiveness of bimodal auditory and electrical stimulation in patients with tinnitus: A feasibility study. Front Neurosci 2022; 16:971633. [PMID: 36090280 PMCID: PMC9449838 DOI: 10.3389/fnins.2022.971633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTinnitus is a common symptom, affecting about 10–15% of the adult population. When input from the somatosensory system can influence and/or elicit tinnitus, this type of subjective tinnitus is called somatosensory tinnitus. Recently, a new type of bimodal neurostimulation treatment has shown promising results for a specific subgroup within the somatosensory tinnitus population. It is, however, not clear if this bimodal stimulation is also effective in patients with other types of subjective tinnitus.AimThe aim of this study was to evaluate the feasibility and efficacy of non-invasive bimodal auditory-somatosensory stimulation in reducing tinnitus severity among a general population of people with subjective tinnitus.MethodsChronic subjective tinnitus patients were recruited from the ENT department of the Antwerp University Hospital. Somatosensory stimulation was delivered by Transcutaneous Electrical Nerve Stimulation (TENS), and it was combined with auditory stimulation via headphones. The therapy comprised six sessions of thirty minutes twice a week for a period of 3 consecutive weeks. Follow up measurements were scheduled 9–12 weeks after the last treatment session. The change of the Tinnitus Functional Index (TFI) score, a questionnaire evaluating tinnitus burden and effects on the quality of life, was the primary outcome measure.ResultsTwenty-nine patients were enrolled in the study. A linear mixed-effects model was used to analyze the efficacy of bimodal treatment. The results of this analysis showed a statistically significant decrease (by 6, 9 points) in average TFI score at the follow up visit when compared to baseline. The ability to modulate tinnitus did not have an influence on the treatment results.ConclusionOur study showed that bimodal stimulation is a feasible and safe method of tinnitus treatment. The method might be an effective treatment for some participants with tinnitus, especially those who have accompanying neck/temporomandibular problems, although, the evidence from this trial is quite weak. Additional research is needed toward establishing the optimal treatment protocol, as well as selecting the most appropriate inclusion criteria.
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Affiliation(s)
- Shikha Spencer
- Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, Lodz, Poland
| | - Marzena Mielczarek
- Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, Lodz, Poland
| | - Jurek Olszewski
- Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, Lodz, Poland
| | - Magdalena Sereda
- School of Medicine, Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Iris Joossen
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
| | - Hanne Vermeersch
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Sarah Michiels
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
- REVAL—Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- *Correspondence: Sarah Michiels,
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Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial. Sci Rep 2022; 12:10845. [PMID: 35773272 PMCID: PMC9246951 DOI: 10.1038/s41598-022-13875-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
More than 10% of the population suffers from tinnitus, which is a phantom auditory condition that is coded within the brain. A new neuromodulation approach to treat tinnitus has emerged that combines sound with electrical stimulation of somatosensory pathways, supported by multiple animal studies demonstrating that bimodal stimulation can elicit extensive neural plasticity within the auditory brain. More recently, in a large-scale clinical trial, bimodal neuromodulation combining sound and tongue stimulation drove significant reductions in tinnitus symptom severity during the first 6 weeks of treatment, followed by diminishing improvements during the second 6 weeks of treatment. The primary objective of the large-scale randomized and double-blinded study presented in this paper was to determine if background wideband noise as used in the previous clinical trial was necessary for bimodal treatment efficacy. An additional objective was to determine if adjusting the parameter settings after 6 weeks of treatment could overcome treatment habituation effects observed in the previous study. The primary endpoint at 6-weeks involved within-arm and between-arm comparisons for two treatment arms with different bimodal neuromodulation settings based on two widely used and validated outcome instruments, Tinnitus Handicap Inventory and Tinnitus Functional Index. Both treatment arms exhibited a statistically significant reduction in tinnitus symptoms during the first 6-weeks, which was further reduced significantly during the second 6-weeks by changing the parameter settings (Cohen’s d effect size for full treatment period per arm and outcome measure ranged from − 0.7 to − 1.4). There were no significant differences between arms, in which tongue stimulation combined with only pure tones and without background wideband noise was sufficient to reduce tinnitus symptoms. These therapeutic effects were sustained up to 12 months after the treatment ended. The study included two additional exploratory arms, including one arm that presented only sound stimuli during the first 6 weeks of treatment and bimodal stimulation in the second 6 weeks of treatment. This arm revealed the criticality of combining tongue stimulation with sound for treatment efficacy. Overall, there were no treatment-related serious adverse events and a high compliance rate (83.8%) with 70.3% of participants indicating benefit. The discovery that adjusting stimulation parameters overcomes previously observed treatment habituation can be used to drive greater therapeutic effects and opens up new opportunities for optimizing stimuli and enhancing clinical outcomes for tinnitus patients with bimodal neuromodulation.
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Gloeckner CD, Nocon JC, Lim HH. Topographic and widespread auditory modulation of the somatosensory cortex: potential for bimodal sound and body stimulation for pain treatment. J Neural Eng 2022; 19. [PMID: 35671702 DOI: 10.1088/1741-2552/ac7665] [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: 01/11/2022] [Accepted: 06/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE There has been growing interest in understanding multisensory integration in the cortex through activation of multiple sensory and motor pathways to treat brain disorders, such as tinnitus or essential tremors. For tinnitus, previous studies show that combined sound and body stimulation can modulate the auditory pathway and lead to significant improvements in tinnitus symptoms. Considering that tinnitus is a type of chronic auditory pain, bimodal stimulation could potentially alter activity in the somatosensory pathway relevant for treating chronic pain. As an initial step towards that goal, we mapped and characterized neuromodulation effects in the somatosensory cortex (SC) in response to sound and/or electrical stimulation of the body. APPROACH We first mapped the topographic organization of activity across the SC of ketamine-anesthetized guinea pigs through electrical stimulation of different body locations using subcutaneous needle electrodes or with broadband acoustic stimulation. We then characterized how neural activity in different parts of the SC could be facilitated or suppressed with bimodal stimulation. MAIN RESULTS The topography in the SC of guinea pigs in response to electrical stimulation of the body aligns consistently to that shown in previous rodent studies. Interestingly, auditory broadband noise stimulation primarily excited SC areas that typically respond to stimulation of lower body locations. Although there was only a small subset of SC locations that were excited by acoustic stimulation alone, all SC recording sites could be altered (facilitated or suppressed) with bimodal stimulation. Furthermore, specific regions of the SC could be modulated by stimulating an appropriate body region combined with broadband noise. SIGNIFICANCE These findings show that bimodal stimulation can excite or modulate firing across a widespread yet targeted population of SC neurons. This approach may provide a non-invasive method for altering or disrupting abnormal firing patterns within certain parts of the SC for chronic pain treatment.
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Affiliation(s)
- Cory D Gloeckner
- University of Minnesota Duluth, 1305 Ordean Court, Duluth, Minnesota, 55812, UNITED STATES
| | - Jian C Nocon
- Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, Massachusetts, 02215, UNITED STATES
| | - Hubert H Lim
- Department of Biomedical Engineering, University of Minnesota, 7-105 Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, USA, Minneapolis, Minnesota, 55455, UNITED STATES
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Ansorge J, Wu C, Shore SE, Krieger P. Audiotactile interactions in the mouse cochlear nucleus. Sci Rep 2021; 11:6887. [PMID: 33767295 PMCID: PMC7994829 DOI: 10.1038/s41598-021-86236-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/11/2021] [Indexed: 11/15/2022] Open
Abstract
Multisensory integration of auditory and tactile information occurs already at the level of the cochlear nucleus. Rodents use their whiskers for tactile perception to guide them in their exploration of the world. As nocturnal animals with relatively poor vision, audiotactile interactions are of great importance for this species. Here, the influence of whisker deflections on sound-evoked spiking in the cochlear nucleus was investigated in vivo in anesthetized mice. Multichannel, silicon-probe electrophysiological recordings were obtained from both the dorsal and ventral cochlear nucleus. Whisker deflections evoked an increased spiking activity in fusiform cells of the dorsal cochlear nucleus and t-stellate cells in ventral cochlear nucleus, whereas bushy cells in the ventral cochlear nucleus showed a more variable response. The response to broadband noise stimulation increased in fusiform cells and primary-like bushy cells when the sound stimulation was preceded (~ 20 ms) by whisker stimulation. Multi-sensory integration of auditory and whisker input can thus occur already in this early brainstem nucleus, emphasizing the importance of early integration of auditory and somatosensory information.
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Affiliation(s)
- Josephine Ansorge
- Department of Systems Neuroscience, Faculty of Medicine, Ruhr University Bochum, Universitätsstraße 150, 44780, Bochum, Germany
| | - Calvin Wu
- 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.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Patrik Krieger
- Department of Systems Neuroscience, Faculty of Medicine, Ruhr University Bochum, Universitätsstraße 150, 44780, Bochum, Germany.
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12
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Zhang J, Huang S, Nan W, Zhou H, Wang J, Wang H, Salvi R, Yin S. Switching Tinnitus-On: Maps and source localization of spontaneous EEG. Clin Neurophysiol 2020; 132:345-357. [PMID: 33450557 DOI: 10.1016/j.clinph.2020.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify the spectrotemporal changes and sources in patients that could "turn on" tinnitus with multichannel electroencephalography (EEG) system. METHODS Multichannel EEG was recorded from six patients during the Tinnitus-On and Tinnitus-Off states. The EEG power spectrum and eLORETA-based sources were measured. RESULTS There was a global increase in delta and theta during Tinnitus-On plus large changes in alpha 1 and alpha 2. During the Tinnitus-On state, many new sources in delta, theta, alpha 1 and gamma bands emerged in the opposite hemisphere in the inferior temporal gyrus (Brodmann area, BA 20), middle temporal gyrus (BA 21), lateral perirhinal cortex (BA 36), ventral entorhinal cortex (BA 28) and anterior pole of the temporal gyrus (BA 38). CONCLUSIONS The emergence of new delta, theta and gamma band sources in the inferior temporal gyrus (BA 20), middle temporal gyrus (BA 21) and lateral perirhinal cortex (BA 36) plus the appearance of new delta and theta sources in the ventral entorhinal cortex (BA28) and anterior pole of the temporal lobe (BA 38) may comprise a network capable of evoking the phantom sound of tinnitus by simultaneously engaging brain regions involved in memory, sound recognition, and distress which together contribute to tinnitus severity. SIGNIFICANCE The sudden appearance of new sources of activity in the opposite hemisphere within the inferior temporal gyrus, middle temporal gyrus and perirhinal cortex may initiate the perception of tinnitus perception.
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Affiliation(s)
- Jiajia Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
| | - Shujian Huang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
| | - Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai 200234, China
| | - Huiqun Zhou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China.
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, Canada
| | - Hui Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China.
| | - Richard Salvi
- SUNY Distinguished Professor Center for Hearing and Deafness, 137 Cary Hall, University at Buffalo, Buffalo, NY, USA
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
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13
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Manohar S, Adler HJ, Radziwon K, Salvi R. Interaction of auditory and pain pathways: Effects of stimulus intensity, hearing loss and opioid signaling. Hear Res 2020; 393:108012. [PMID: 32554129 DOI: 10.1016/j.heares.2020.108012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/24/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
Moderate intensity sounds can reduce pain sensitivity (i.e., audio-analgesia) whereas intense sounds can induce aural pain, evidence of multisensory interaction between auditory and pain pathways. To explore auditory-pain pathway interactions, we used the tail-flick (TF) test to assess thermal tail-pain sensitivity by measuring the latency of a rat to remove its tail from 52 °C water. In Experiment 1, TF latencies were measured in ambient noise and broadband noise (BBN) presented from 80 to 120 dB SPL. TF latencies gradually increased from ambient to 90 dB SPL (audio-analgesia), but then declined. At 120 dB, TF latencies were significantly shorter than normal, evidence for audio-hyperalgesia near the aural threshold for pain. In Experiment II, the opioid pain pathway was modified by treating rats with a high dose of fentanyl known to induce post-treatment hyperalgesia. TF latencies in ambient noise were normal 10-days post-fentanyl. However, TF latencies became shorter than normal from 90 to 110 dB indicating that fentanyl pre-treatment had converted audio-analgesia to audio-hyperalgesia. In Experiment III, we tested the hypothesis that hearing loss could alter pain sensitivity by unilaterally exposing rats to an intense noise that induced a significant hearing loss. TF latencies in ambient noise gradually declined from 1- to 4-weeks post-exposure indicating that noise-induced hearing loss had increased pain sensitivity. Our results suggest that auditory and pain pathways interact in ways that depend on intensity, hearing loss and opioid pain signaling, results potentially relevant to pain hyperacusis.
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Affiliation(s)
- Senthilvelan Manohar
- Center for Hearing and Deafness, 137 Cary Hall, University at Buffalo, Buffalo, NY, 14214, USA
| | - Henry J Adler
- Center for Hearing and Deafness, 137 Cary Hall, University at Buffalo, Buffalo, NY, 14214, USA
| | - Kelly Radziwon
- Center for Hearing and Deafness, 137 Cary Hall, University at Buffalo, Buffalo, NY, 14214, USA
| | - Richard Salvi
- Center for Hearing and Deafness, 137 Cary Hall, University at Buffalo, Buffalo, NY, 14214, USA.
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14
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Cimino R, Bucci R, Ambrosio A, Carrabba L, Corrado B, Simeon V, Michelotti A. Temporomandibular disorders, neck disability, and oral parafunctions in tinnitus patients: A cross-sectional epidemiological study from Southern Italy. Cranio 2020; 40:485-493. [PMID: 32559128 DOI: 10.1080/08869634.2020.1781499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the prevalence of temporomandibular disorders (TMD) in a sample of tinnitus patients and to determine the association between tinnitus, TMD, neck disability, and oral parafunctions. METHODS Seventy-nine tinnitus patients were enrolled and underwent standardized clinical examination for TMD. The tinnitus severity was measured with the Tinnitus Handicap Inventory (THI). The oral parafunctions were self-reported with the Oral Behavior Checklist (OBC). The neck disability was recorded with the Neck Disability Index (NDI). RESULTS More than half of the sample presented TMD, and the most frequent diagnosis was TMD pain. Higher THI was observed in TMD-pain individuals, compared to TMD-free (β 18.4; 95%CI 6.7, 30.1; p = 0.002). The OBC showed a significant low-to-moderate positive correlation with the THI (rho= 0.368, p = 0.001), while the NDI did not. DISCUSSION Standardized assessment of TMD and oral behaviors should be integrated into the routine diagnostic evaluations of tinnitus patients.
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Affiliation(s)
- Roberta Cimino
- Department of Neurosciences, Reproductive Sciences and Oral Science, School of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
| | - Rosaria Bucci
- Department of Neurosciences, Reproductive Sciences and Oral Science, School of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy.,Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Andrea Ambrosio
- Department of Neurosciences, Reproductive Sciences and Oral Science, School of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
| | - Laura Carrabba
- Department of Neurosciences, Reproductive Sciences and Oral Science, Audiology Unit, University of Naples Federico II, Naples, Italy
| | - Bruno Corrado
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Vittorio Simeon
- Department of Public, Clinical and Preventive Medicine, Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Science, School of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, Naples, Italy
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15
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Kuenzel T. Modulatory influences on time-coding neurons in the ventral cochlear nucleus. Hear Res 2019; 384:107824. [DOI: 10.1016/j.heares.2019.107824] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/10/2019] [Accepted: 10/14/2019] [Indexed: 02/07/2023]
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16
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Shore SE, Wu C. Mechanisms of Noise-Induced Tinnitus: Insights from Cellular Studies. Neuron 2019; 103:8-20. [PMID: 31271756 DOI: 10.1016/j.neuron.2019.05.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/25/2019] [Accepted: 05/03/2019] [Indexed: 01/21/2023]
Abstract
Tinnitus, sound perception in the absence of physical stimuli, occurs in 15% of the population and is the top-reported disability for soldiers after combat. Noise overexposure is a major factor associated with tinnitus but does not always lead to tinnitus. Furthermore, people with normal audiograms can get tinnitus. In animal models, equivalent cochlear damage occurs in animals with and without behavioral evidence of tinnitus. But cochlear-nerve-recipient neurons in the brainstem demonstrate distinct, synchronized spontaneous firing patterns only in animals that develop tinnitus, driving activity in central brain regions and ultimately giving rise to phantom perception. Examining tinnitus-specific changes in single-cell populations enables us to begin to distinguish neural changes due to tinnitus from those that are due to hearing loss.
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Affiliation(s)
- Susan E Shore
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan, Ann Arbor, MI 48109, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Calvin Wu
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan, Ann Arbor, MI 48109, USA
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17
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Conlon B, Hamilton C, Hughes S, Meade E, Hall DA, Vanneste S, Langguth B, Lim HH. Noninvasive Bimodal Neuromodulation for the Treatment of Tinnitus: Protocol for a Second Large-Scale Double-Blind Randomized Clinical Trial to Optimize Stimulation Parameters. JMIR Res Protoc 2019; 8:e13176. [PMID: 31573942 PMCID: PMC6789422 DOI: 10.2196/13176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 01/13/2023] Open
Abstract
Background There is increasing evidence from animal and human studies that bimodal neuromodulation combining sound and electrical somatosensory stimulation of the tongue can induce extensive brain changes and treat tinnitus. Objective The main objectives of the proposed clinical study are to confirm the efficacy, safety, and tolerability of treatment demonstrated in a previous large-scale study of bimodal auditory and trigeminal nerve (tongue) stimulation (Treatment Evaluation of Neuromodulation for Tinnitus - Stage A1); evaluate the therapeutic effects of adjusting stimulation parameters over time; and determine the contribution of different features of bimodal stimulation in improving tinnitus outcomes. Methods This study will be a prospective, randomized, double-blind, parallel-arm, comparative clinical trial of a 12-week treatment for tinnitus using a Conformité Européenne (CE)–marked device with a pre-post and 12-month follow-up design. Four treatment arms will be investigated, in which each arm consists of two different stimulation settings, with the first setting presented during the first 6 weeks and the second setting presented during the next 6 weeks of treatment. The study will enroll 192 participants, split in a ratio of 80:80:16:16 across the four arms. Participants will be randomized to one of four arms and stratified to minimize baseline variability in four categories: two separate strata for sound level tolerance (using loudness discomfort level as indicators for hyperacusis severity), high tinnitus symptom severity based on the Tinnitus Handicap Inventory (THI), and tinnitus laterality. The primary efficacy endpoints are within-arm changes in THI and Tinnitus Functional Index as well as between-arm changes in THI after 6 weeks of treatment for the full cohort and two subgroups of tinnitus participants (ie, one hyperacusis subgroup and a high tinnitus symptom severity subgroup). Additional efficacy endpoints include within-arm or between-arm changes in THI after 6 or 12 weeks of treatment and in different subgroups of tinnitus participants as well as at posttreatment assessments at 6 weeks, 6 months, and 12 months. Treatment safety, attrition rates, and compliance rates will also be assessed and reported. Results This study protocol was approved by the Tallaght University Hospital/St. James’s Hospital Joint Research Ethics Committee in Dublin, Ireland. The first participant was enrolled on March 20, 2018. The data collection and database lock are expected to be completed by February 2020, and the data analysis and manuscript submission are expected to be conducted in autumn of 2020. Conclusions The findings of this study will be disseminated to relevant research, clinical, and health services and patient communities through publications in peer-reviewed journals and presentations at scientific and clinical conferences. Trial Registration ClinicalTrials.gov NCT03530306; https://clinicaltrials.gov/ct2/show/NCT03530306 International Registered Report Identifier (IRRID) DERR1-10.2196/13176
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Affiliation(s)
- Brendan Conlon
- Department of Otolaryngology, St James Hospital Dublin and Tallaght University Hospital Dublin, Dublin, Ireland.,Neuromod Devices Limited, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | | | | | - Emma Meade
- Neuromod Devices Limited, Dublin, Ireland
| | - Deborah A Hall
- Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom.,University of Nottingham Malaysia, Semenyih, Selangor Darul Ehsan, Malaysia
| | - Sven Vanneste
- Trinity College Dublin, Dublin, Ireland.,University of Texas at Dallas, Richardson, TX, United States
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Hubert H Lim
- Neuromod Devices Limited, Dublin, Ireland.,University of Minnesota, Minneapolis, MN, United States
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18
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Kimura A, Imbe H. Robust Subthreshold Cross-modal Modulation of Auditory Response by Cutaneous Electrical Stimulation in First- and Higher-order Auditory Thalamic Nuclei. Neuroscience 2018; 372:161-180. [PMID: 29309880 DOI: 10.1016/j.neuroscience.2017.12.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 12/14/2022]
Abstract
Conventional extracellular recording has revealed cross-modal alterations of auditory cell activities by cutaneous electrical stimulation of the hindpaw in first- and higher-order auditory thalamic nuclei (Donishi et al., 2011). Juxta-cellular recording and labeling techniques were used in the present study to examine the cross-modal alterations in detail, focusing on possible nucleus and/or cell type-related distinctions in modulation. Recordings were obtained from 80 cells of anesthetized rats. Cutaneous electrical stimulation, which did not elicit unit discharges, i.e., subthreshold effects, modulated early (onset) and/or late auditory responses of first- (64%) and higher-order nucleus cells (77%) with regard to response magnitude, latency and/or burst spiking. Attenuation predominated in the modulation of response magnitude and burst spiking, and delay predominated in the modulation of response time. Striking alterations of burst spiking took place in higher-order nucleus cells, which had the potential to exhibit higher propensities for burst spiking as compared to first-order nucleus cells. A subpopulation of first-order nucleus cells showing modulation in early response magnitude in the caudal domain of the nucleus had larger cell bodies and higher propensities for burst spiking as compared to cells showing no modulation. These findings suggest that somatosensory influence is incorporated into parallel channels in auditory thalamic nuclei to impose distinct impacts on cortical and subcortical sensory processing. Further, cutaneous electrical stimulation given after early auditory responses modulated late responses. Somatosensory influence is likely to affect ongoing auditory processing at any time without being coincident with sound onset in a narrow temporal window.
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Affiliation(s)
- Akihisa Kimura
- Department of Physiology, Wakayama Medical University, Wakayama Kimiidera 811-1, 641-8509, Japan.
| | - Hiroki Imbe
- Department of Physiology, Wakayama Medical University, Wakayama Kimiidera 811-1, 641-8509, Japan
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19
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Takacs JD, Forrest TJ, Basura GJ. Noise exposure alters long-term neural firing rates and synchrony in primary auditory and rostral belt cortices following bimodal stimulation. Hear Res 2017; 356:1-15. [DOI: 10.1016/j.heares.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/04/2017] [Accepted: 07/10/2017] [Indexed: 11/16/2022]
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20
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Dillingham CH, Gay SM, Behrooz R, Gabriele ML. Modular-extramodular organization in developing multisensory shell regions of the mouse inferior colliculus. J Comp Neurol 2017; 525:3742-3756. [PMID: 28786102 DOI: 10.1002/cne.24300] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/07/2017] [Accepted: 07/28/2017] [Indexed: 11/07/2022]
Abstract
The complex neuroanatomical connections of the inferior colliculus (IC) and its major subdivisions offer a juxtaposition of segregated processing streams with distinct organizational features. While the tonotopically layered central nucleus is well-documented, less is known about functional compartments in the neighboring lateral cortex (LCIC). In addition to a laminar framework, LCIC afferent-efferent patterns suggest a multimodal mosaic, consisting of a patchy modular network with surrounding extramodular domains. This study utilizes several neurochemical markers that reveal an emerging LCIC modular-extramodular microarchitecture. In newborn and post-hearing C57BL/6J and CBA/CaJ mice, histochemical and immunocytochemical stains were performed for acetylcholinesterase (AChE), nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d), glutamic acid decarboxylase (GAD), cytochrome oxidase (CO), and calretinin (CR). Discontinuous layer 2 modules are positive for AChE, NADPH-d, GAD, and CO throughout the rostrocaudal LCIC. While not readily apparent at birth, discrete cell clusters emerge over the first postnatal week, yielding an identifiable modular network prior to hearing onset. Modular boundaries continue to become increasingly distinct with age, as surrounding extramodular fields remain largely negative for each marker. Alignment of modular markers in serial sections suggests each highlight the same periodic patchy network throughout the nascent LCIC. In contrast, CR patterns appear complementary, preferentially staining extramodular LCIC zones. Double-labeling experiments confirm that NADPH-d, the most consistent developmental modular marker, and CR label separate, nonoverlapping LCIC compartments. Determining how this emerging modularity may align with similar LCIC patch-matrix-like Eph/ephrin guidance patterns, and how each interface with, and potentially influence developing multimodal LCIC projection configurations is discussed.
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Affiliation(s)
| | - Sean M Gay
- Department of Biology, James Madison University, Harrisonburg, Virginia
| | - Roxana Behrooz
- Department of Biology, James Madison University, Harrisonburg, Virginia
| | - Mark L Gabriele
- Department of Biology, James Madison University, Harrisonburg, Virginia
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21
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Connectional Modularity of Top-Down and Bottom-Up Multimodal Inputs to the Lateral Cortex of the Mouse Inferior Colliculus. J Neurosci 2017; 36:11037-11050. [PMID: 27798184 DOI: 10.1523/jneurosci.4134-15.2016] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 09/04/2016] [Indexed: 12/14/2022] Open
Abstract
The lateral cortex of the inferior colliculus receives information from both auditory and somatosensory structures and is thought to play a role in multisensory integration. Previous studies in the rat have shown that this nucleus contains a series of distinct anatomical modules that stain for GAD-67 as well as other neurochemical markers. In the present study, we sought to better characterize these modules in the mouse inferior colliculus and determine whether the connectivity of other neural structures with the lateral cortex is spatially related to the distribution of these neurochemical modules. Staining for GAD-67 and other markers revealed a single modular network throughout the rostrocaudal extent of the mouse lateral cortex. Somatosensory inputs from the somatosensory cortex and dorsal column nuclei were found to terminate almost exclusively within these modular zones. However, projections from the auditory cortex and central nucleus of the inferior colliculus formed patches that interdigitate with the GAD-67-positive modules. These results suggest that the lateral cortex of the mouse inferior colliculus exhibits connectional as well as neurochemical modularity and may contain multiple segregated processing streams. This finding is discussed in the context of other brain structures in which neuroanatomical and connectional modularity have functional consequences. SIGNIFICANCE STATEMENT Many brain regions contain subnuclear microarchitectures, such as the matrix-striosome organization of the basal ganglia or the patch-interpatch organization of the visual cortex, that shed light on circuit complexities. In the present study, we demonstrate the presence of one such micro-organization in the rodent inferior colliculus. While this structure is typically viewed as an auditory integration center, its lateral cortex appears to be involved in multisensory operations and receives input from somatosensory brain regions. We show here that the lateral cortex can be further subdivided into multiple processing streams: modular regions, which are targeted by somatosensory inputs, and extramodular zones that receive auditory information.
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22
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Hebert JR, Manago MM. Reliability and Validity of the Computerized Dynamic Posturography Sensory Organization Test in People with Multiple Sclerosis. Int J MS Care 2017; 19:151-157. [PMID: 28603464 DOI: 10.7224/1537-2073.2016-027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND People with multiple sclerosis (MS) frequently have impaired postural control (balance). Psychometric properties of clinical tests of balance for individuals with MS, including the computerized dynamic posturography sensory organization test (CDP-SOT), are poorly understood. This study aimed to determine the reliability and discriminant validity of the CDP-SOT in people with MS. METHODS The CDP-SOT was performed on 30 participants with MS. A 2-week-interval, repeated-measures (sessions 1 and 2) design was implemented to investigate test-retest reliability of the CDP-SOT and the ability of the CDP-SOT to discriminate between participants with lower versus higher disability. Self-reported disability level was based on Patient-Determined Disease Steps (PDDS) scale scores: lower (PDDS scale score, 0-3; n = 17) and higher (PDDS scale score, 4-6; n = 13). RESULTS All six conditions of the CDP-SOT had good-to-excellent reliability (interclass correlation coefficients, 0.70-0.90) and excellent reliability for composite scores (0.90). Composite scores were significantly greater in the lower-disability group versus the higher-disability group at session 1 (70.89 vs. 48.60, P = .001) and session 2 (74.82 vs. 48.85, P = .002). CONCLUSIONS The CDP-SOT is a reliable measure of balance and accurately differentiates disability status in people with MS. Collectively, the results support clinical application of the CDP-SOT as a reliable and valid measure of disease-related progression of impaired balance related to sensory integration and its utility in determining changes in balance in response to treatment.
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Abstract
Tinnitus is a phantom auditory sensation that reduces quality of life for millions of people worldwide, and for which there is no medical cure. Most cases of tinnitus are associated with hearing loss caused by ageing or noise exposure. Exposure to loud recreational sound is common among the young, and this group are at increasing risk of developing tinnitus. Head or neck injuries can also trigger the development of tinnitus, as altered somatosensory input can affect auditory pathways and lead to tinnitus or modulate its intensity. Emotional and attentional state could be involved in the development and maintenance of tinnitus via top-down mechanisms. Thus, military personnel in combat are particularly at risk owing to combined risk factors (hearing loss, somatosensory system disturbances and emotional stress). Animal model studies have identified tinnitus-associated neural changes that commence at the cochlear nucleus and extend to the auditory cortex and other brain regions. Maladaptive neural plasticity seems to underlie these changes: it results in increased spontaneous firing rates and synchrony among neurons in central auditory structures, possibly generating the phantom percept. This Review highlights the links between animal and human studies, and discusses several therapeutic approaches that have been developed to target the neuroplastic changes underlying tinnitus.
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24
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Meredith MA, Allman BL. Single-unit analysis of somatosensory processing in the core auditory cortex of hearing ferrets. Eur J Neurosci 2015; 41:686-98. [PMID: 25728185 DOI: 10.1111/ejn.12828] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/07/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022]
Abstract
The recent findings in several species that the primary auditory cortex processes non-auditory information have largely overlooked the possibility of somatosensory effects. Therefore, the present investigation examined the core auditory cortices (anterior auditory field and primary auditory cortex) for tactile responsivity. Multiple single-unit recordings from anesthetised ferret cortex yielded histologically verified neurons (n = 311) tested with electronically controlled auditory, visual and tactile stimuli, and their combinations. Of the auditory neurons tested, a small proportion (17%) was influenced by visual cues, but a somewhat larger number (23%) was affected by tactile stimulation. Tactile effects rarely occurred alone and spiking responses were observed in bimodal auditory-tactile neurons. However, the broadest tactile effect that was observed, which occurred in all neuron types, was that of suppression of the response to a concurrent auditory cue. The presence of tactile effects in the core auditory cortices was supported by a substantial anatomical projection from the rostral suprasylvian sulcal somatosensory area. Collectively, these results demonstrate that crossmodal effects in the auditory cortex are not exclusively visual and that somatosensation plays a significant role in modulation of acoustic processing, and indicate that crossmodal plasticity following deafness may unmask these existing non-auditory functions.
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Affiliation(s)
- M Alex Meredith
- Department of Anatomy and Neurobiology, Virginia Commonwealth University School of Medicine, 1101 E. Marshall Street, Sanger Hall Rm-12-067, Richmond, VA, 23298-0709, USA
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Elgoyhen AB, Langguth B, De Ridder D, Vanneste S. Tinnitus: perspectives from human neuroimaging. Nat Rev Neurosci 2015; 16:632-42. [DOI: 10.1038/nrn4003] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Basura GJ, Koehler SD, Shore SE. Bimodal stimulus timing-dependent plasticity in primary auditory cortex is altered after noise exposure with and without tinnitus. J Neurophysiol 2015; 114:3064-75. [PMID: 26289461 DOI: 10.1152/jn.00319.2015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/18/2015] [Indexed: 01/08/2023] Open
Abstract
Central auditory circuits are influenced by the somatosensory system, a relationship that may underlie tinnitus generation. In the guinea pig dorsal cochlear nucleus (DCN), pairing spinal trigeminal nucleus (Sp5) stimulation with tones at specific intervals and orders facilitated or suppressed subsequent tone-evoked neural responses, reflecting spike timing-dependent plasticity (STDP). Furthermore, after noise-induced tinnitus, bimodal responses in DCN were shifted from Hebbian to anti-Hebbian timing rules with less discrete temporal windows, suggesting a role for bimodal plasticity in tinnitus. Here, we aimed to determine if multisensory STDP principles like those in DCN also exist in primary auditory cortex (A1), and whether they change following noise-induced tinnitus. Tone-evoked and spontaneous neural responses were recorded before and 15 min after bimodal stimulation in which the intervals and orders of auditory-somatosensory stimuli were randomized. Tone-evoked and spontaneous firing rates were influenced by the interval and order of the bimodal stimuli, and in sham-controls Hebbian-like timing rules predominated as was seen in DCN. In noise-exposed animals with and without tinnitus, timing rules shifted away from those found in sham-controls to more anti-Hebbian rules. Only those animals with evidence of tinnitus showed increased spontaneous firing rates, a purported neurophysiological correlate of tinnitus in A1. Together, these findings suggest that bimodal plasticity is also evident in A1 following noise damage and may have implications for tinnitus generation and therapeutic intervention across the central auditory circuit.
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Affiliation(s)
- Gregory J Basura
- Department of Otolaryngology/Head and Neck Surgery, Kresge Hearing Research Institute, The University of Michigan, Ann Arbor, Michigan;
| | - Seth D Koehler
- Department of Biomedical Engineering, The University of Michigan, Ann Arbor, Michigan; and
| | - Susan E Shore
- Department of Otolaryngology/Head and Neck Surgery, Kresge Hearing Research Institute, The University of Michigan, Ann Arbor, Michigan; Department of Biomedical Engineering, The University of Michigan, Ann Arbor, Michigan; and Molecular and Integrative Physiology, The University of Michigan, Ann Arbor, Michigan
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Wu C, Stefanescu RA, Martel DT, Shore SE. Listening to another sense: somatosensory integration in the auditory system. Cell Tissue Res 2015; 361:233-50. [PMID: 25526698 PMCID: PMC4475675 DOI: 10.1007/s00441-014-2074-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/18/2014] [Indexed: 12/19/2022]
Abstract
Conventionally, sensory systems are viewed as separate entities, each with its own physiological process serving a different purpose. However, many functions require integrative inputs from multiple sensory systems and sensory intersection and convergence occur throughout the central nervous system. The neural processes for hearing perception undergo significant modulation by the two other major sensory systems, vision and somatosensation. This synthesis occurs at every level of the ascending auditory pathway: the cochlear nucleus, inferior colliculus, medial geniculate body and the auditory cortex. In this review, we explore the process of multisensory integration from (1) anatomical (inputs and connections), (2) physiological (cellular responses), (3) functional and (4) pathological aspects. We focus on the convergence between auditory and somatosensory inputs in each ascending auditory station. This review highlights the intricacy of sensory processing and offers a multisensory perspective regarding the understanding of sensory disorders.
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Affiliation(s)
- Calvin Wu
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, 48109, USA
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Gloeckner CD, Smith BT, Markovitz CD, Lim HH. A new concept for noninvasive tinnitus treatment utilizing multimodal pathways. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:3122-5. [PMID: 24110389 DOI: 10.1109/embc.2013.6610202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Current noninvasive treatments for tinnitus have shown mixed results. There have been encouraging developments in using invasive brain or vagal nerve stimulation to modulate neural populations driving the tinnitus percept. However, these invasive treatments can only be used in a small patient population with severe conditions. In this preliminary study, we present a new treatment option we call Multimodal Synchronization Therapy (MST), which attempts to achieve synchronized and localized brain activation without invasive neural stimulation. MST combines multiple sensory, motor, limbic, and cognitive inputs to elicit activation of multimodal neurons to potentially modulate specific neurons driving the tinnitus percept. We present preliminary data in a guinea pig model showing activation of somatosensory and auditory pathways to alter neural activity within the inferior colliculus, a multimodal integration region that has shown pathological changes in animals and patients with tinnitus. Electrical stimulation of different body locations induced excitatory responses in the inferior colliculus, eliciting responses in up to 41% of all recording sites for a given somatic site. Paired somatic and acoustic stimulation resulted in enhanced or suppressed acoustic-driven neural activity in the inferior colliculus that varied depending on stimulation and recording location. Similar modulation effects were observed in the auditory cortex, which may relate to changes in auditory perception. Further studies need to incorporate multiple multimodal pathways and must also confirm that MST can suppress the abnormal neural patterns that directly drive the tinnitus percept.
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Ohyama T, Schneider-Mizell CM, Fetter RD, Aleman JV, Franconville R, Rivera-Alba M, Mensh BD, Branson KM, Simpson JH, Truman JW, Cardona A, Zlatic M. A multilevel multimodal circuit enhances action selection in Drosophila. Nature 2015; 520:633-9. [PMID: 25896325 DOI: 10.1038/nature14297] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/06/2015] [Indexed: 12/18/2022]
Abstract
Natural events present multiple types of sensory cues, each detected by a specialized sensory modality. Combining information from several modalities is essential for the selection of appropriate actions. Key to understanding multimodal computations is determining the structural patterns of multimodal convergence and how these patterns contribute to behaviour. Modalities could converge early, late or at multiple levels in the sensory processing hierarchy. Here we show that combining mechanosensory and nociceptive cues synergistically enhances the selection of the fastest mode of escape locomotion in Drosophila larvae. In an electron microscopy volume that spans the entire insect nervous system, we reconstructed the multisensory circuit supporting the synergy, spanning multiple levels of the sensory processing hierarchy. The wiring diagram revealed a complex multilevel multimodal convergence architecture. Using behavioural and physiological studies, we identified functionally connected circuit nodes that trigger the fastest locomotor mode, and others that facilitate it, and we provide evidence that multiple levels of multimodal integration contribute to escape mode selection. We propose that the multilevel multimodal convergence architecture may be a general feature of multisensory circuits enabling complex input-output functions and selective tuning to ecologically relevant combinations of cues.
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Affiliation(s)
- Tomoko Ohyama
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Casey M Schneider-Mizell
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Richard D Fetter
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Javier Valdes Aleman
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Romain Franconville
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Marta Rivera-Alba
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Brett D Mensh
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Kristin M Branson
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Julie H Simpson
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - James W Truman
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Albert Cardona
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
| | - Marta Zlatic
- Howard Hughes Medical Institute Janelia Research Campus, 19700 Helix Drive, Ashburn, Virginia 20147, USA
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Markovitz CD, Smith BT, Gloeckner CD, Lim HH. Investigating a new neuromodulation treatment for brain disorders using synchronized activation of multimodal pathways. Sci Rep 2015; 5:9462. [PMID: 25804410 PMCID: PMC4372796 DOI: 10.1038/srep09462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 03/06/2015] [Indexed: 11/21/2022] Open
Abstract
Neuromodulation is an increasingly accepted treatment for neurological and psychiatric disorders but is limited by its invasiveness or its inability to target deep brain structures using noninvasive techniques. We propose a new concept called Multimodal Synchronization Therapy (mSync) for achieving targeted activation of the brain via noninvasive and precisely timed activation of auditory, visual, somatosensory, motor, cognitive, and limbic pathways. In this initial study in guinea pigs, we investigated mSync using combined activation of just the auditory and somatosensory pathways, which induced differential and timing dependent plasticity in neural firing within deep brain and cortical regions of the auditory system. Furthermore, by varying the location of somatosensory stimulation across the body, we increased or decreased spiking activity across different neurons. These encouraging results demonstrate the feasibility of systematically modulating the brain using mSync. Considering that hearing disorders such as tinnitus and hyperacusis have been linked to abnormal and hyperactive firing patterns within the auditory system, these results open up the possibility for using mSync to decrease this pathological activity by varying stimulation parameters. Incorporating multiple types of pathways beyond just auditory and somatosensory inputs and using other activation patterns may enable treatment of various brain disorders.
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Affiliation(s)
- Craig D Markovitz
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA
| | - Benjamin T Smith
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA
| | - Cory D Gloeckner
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA
| | - Hubert H Lim
- 1] Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA [2] Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA [3] Institute for Translational Neuroscience, University of Minnesota, Minneapolis, MN USA
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Cianfrone G, Mazzei F, Salviati M, Turchetta R, Orlando MP, Testugini V, Carchiolo L, Cianfrone F, Altissimi G. Tinnitus Holistic Simplified Classification (THoSC): A New Assessment for Subjective Tinnitus, With Diagnostic and Therapeutic Implications. Ann Otol Rhinol Laryngol 2015; 124:550-60. [PMID: 25725038 DOI: 10.1177/0003489415570931] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE One of the most debated topics in tinnitus is its standard and practical classification. The most popular classification distinguishes subjective from objective tinnitus. Other classifications are based on different features. On the whole, they seem incomplete, and the diagnostic and therapeutic algorithms are often difficult for practical purposes. The aim of this work is to develop a new diagnostic and therapeutic algorithm. METHODS Our model is based on 10 years of experience. In particular, the starting point is the data retrieved from 212 consecutive patients in our Tinnitus Unit between May and December 2013: We found a clear auditory disorder in 74.5% of the population, muscolo-skeletal disorders and/or trigeminal disease in 57.1%, and psychiatric comorbidities in 43.8%. Different features coexisted in 59.9% of the population. RESULTS Following such data we propose the Tinnitus Holistic Simplified Classification, which takes into account the different tinnitogenic mechanisms and the interactions between them. It differentiates tinnitus that arises from: (1) auditory alterations (Auditory Tinnitus), (2) complex auditory-somatosensory interactions (Somatosensory Tinnitus), (3) psychopathological-auditory interactions (Psychopathology-related Tinnitus), and (4) 2 or all of the previous mechanisms (Combined Tinnitus). CONCLUSIONS In our opinion this classification provides an accurate and easy tailored path to manage tinnitus patients.
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Affiliation(s)
- Giancarlo Cianfrone
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
| | - Filippo Mazzei
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
| | - Massimo Salviati
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Rosaria Turchetta
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
| | - Maria Patrizia Orlando
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
| | - Valeria Testugini
- A.I.R.S. Italian Association for the Research on Deafness, Rome, Italy
| | - Laura Carchiolo
- A.I.R.S. Italian Association for the Research on Deafness, Rome, Italy
| | | | - Giancarlo Altissimi
- Department of Otorhinolayngology, Audiology and Ophtalmology, Unit of Audiology, Sapienza University of Rome, Rome, Italy
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Frost R, Armstrong BC, Siegelman N, Christiansen MH. Domain generality versus modality specificity: the paradox of statistical learning. Trends Cogn Sci 2015; 19:117-25. [PMID: 25631249 DOI: 10.1016/j.tics.2014.12.010] [Citation(s) in RCA: 263] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
Statistical learning (SL) is typically considered to be a domain-general mechanism by which cognitive systems discover the underlying distributional properties of the input. However, recent studies examining whether there are commonalities in the learning of distributional information across different domains or modalities consistently reveal modality and stimulus specificity. Therefore, important questions are how and why a hypothesized domain-general learning mechanism systematically produces such effects. Here, we offer a theoretical framework according to which SL is not a unitary mechanism, but a set of domain-general computational principles that operate in different modalities and, therefore, are subject to the specific constraints characteristic of their respective brain regions. This framework offers testable predictions and we discuss its computational and neurobiological plausibility.
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Affiliation(s)
- Ram Frost
- The Hebrew University of Jerusalem, Jerusalem, Israel; Haskins Laboratories, New Haven, CT, USA; Basque Center for Cognition, Brain, and Language, San Sebastian, Spain.
| | - Blair C Armstrong
- Basque Center for Cognition, Brain, and Language, San Sebastian, Spain
| | | | - Morten H Christiansen
- Haskins Laboratories, New Haven, CT, USA; Cornell University, Ithaca, NY, USA; University of Southern Denmark, Odense, Denmark
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Yang G, Baad-Hansen L, Wang K, Xie QF, Svensson P. Effect of negative emotions evoked by light, noise and taste on trigeminal thermal sensitivity. J Headache Pain 2014; 15:71. [PMID: 25380624 PMCID: PMC4238313 DOI: 10.1186/1129-2377-15-71] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/28/2014] [Indexed: 12/03/2022] Open
Abstract
Background Patients with migraine often have impaired somatosensory function and experience headache attacks triggered by exogenous stimulus, such as light, sound or taste. This study aimed to assess the influence of three controlled conditioning stimuli (visual, auditory and gustatory stimuli and combined stimuli) on affective state and thermal sensitivity in healthy human participants. Methods All participants attended four experimental sessions with visual, auditory and gustatory conditioning stimuli and combination of all stimuli, in a randomized sequence. In each session, the somatosensory sensitivity was tested in the perioral region with use of thermal stimuli with and without the conditioning stimuli. Positive and Negative Affect States (PANAS) were assessed before and after the tests. Subject based ratings of the conditioning and test stimuli in addition to skin temperature and heart rate as indicators of arousal responses were collected in real time during the tests. Results The three conditioning stimuli all induced significant increases in negative PANAS scores (paired t-test, P ≤0.016). Compared with baseline, the increases were in a near dose-dependent manner during visual and auditory conditioning stimulation. No significant effects of any single conditioning stimuli were observed on trigeminal thermal sensitivity (P ≥0.051) or arousal parameters (P ≥0.057). The effects of combined conditioning stimuli on subjective ratings (P ≤0.038) and negative affect (P = 0.011) were stronger than those of single stimuli. Conclusions All three conditioning stimuli provided a simple way to evoke a negative affective state without physical arousal or influence on trigeminal thermal sensitivity. Multisensory conditioning had stronger effects but also failed to modulate thermal sensitivity, suggesting that so-called exogenous trigger stimuli e.g. bright light, noise, unpleasant taste in patients with migraine may require a predisposed or sensitized nervous system.
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Affiliation(s)
| | | | | | - Qiu-Fei Xie
- Department of Prosthodontics and Center for Oral Functional Diagnosis, Treatment and Research, Peking University School and hospital of Stomatology, Zhongguancun Nandajie 22, 100081 Beijing, China.
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Modulation of electrocortical brain activity by attention in individuals with and without tinnitus. Neural Plast 2014; 2014:127824. [PMID: 25024849 PMCID: PMC4082949 DOI: 10.1155/2014/127824] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/15/2014] [Indexed: 02/07/2023] Open
Abstract
Age and hearing-level matched tinnitus and control groups were presented with a 40 Hz AM sound using a carrier frequency of either 5 kHz (in the tinnitus frequency region of the tinnitus subjects) or 500 Hz (below this region). On attended blocks subjects pressed a button after each sound indicating whether a single 40 Hz AM pulse of variable increased amplitude (target, probability 0.67) had or had not occurred. On passive blocks subjects rested and ignored the sounds. The amplitude of the 40 Hz auditory steady-state response (ASSR) localizing to primary auditory cortex (A1) increased with attention in control groups probed at 500 Hz and 5 kHz and in the tinnitus group probed at 500 Hz, but not in the tinnitus group probed at 5 kHz (128 channel EEG). N1 amplitude (this response localizing to nonprimary cortex, A2) increased with attention at both sound frequencies in controls but at neither frequency in tinnitus. We suggest that tinnitus-related neural activity occurring in the 5 kHz but not the 500 Hz region of tonotopic A1 disrupted attentional modulation of the 5 kHz ASSR in tinnitus subjects, while tinnitus-related activity in A1 distributing nontonotopically in A2 impaired modulation of N1 at both sound frequencies.
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Abstract
Tinnitus and cochlear damage have been associated with changes in somatosensory-auditory integration and plasticity in the dorsal cochlear nucleus (DCN). Recently, we demonstrated in vivo that DCN bimodal plasticity is stimulus timing-dependent, with Hebbian and anti-Hebbian timing rules that reflect in vitro spike timing-dependent plasticity. In this in vivo study, we assessed the stimulus timing dependence of bimodal plasticity in a tinnitus model. Guinea pigs were exposed to a narrowband noise that produced a temporary elevation of auditory brainstem response thresholds. A total of 60% of the guinea pigs developed tinnitus as indicated by gap-induced prepulse inhibition of the acoustic startle. After noise exposure and tinnitus induction, stimulus timing-dependent plasticity was measured by comparing responses to sound before and after paired somatosensory and auditory stimulation presented with varying intervals and orders. In comparison with Sham and noise-exposed animals that did not develop tinnitus, timing rules in verified tinnitus animals were more likely to be anti-Hebbian and broader for those bimodal intervals in which the neural activity showed enhancement. Furthermore, units from exposed animals with tinnitus were more weakly suppressed than either Sham animals or exposed animals without tinnitus. The broadened timing rules in the enhancement phase in animals with tinnitus, and in the suppressive phase in exposed animals without tinnitus was in contrast to narrow, Hebbian-like timing rules in Sham animals. These findings implicate alterations in DCN bimodal spike timing-dependent plasticity as underlying mechanisms in tinnitus, opening the way for a therapeutic target.
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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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Abstract
AbstractThere is a strong interaction between multisensory processing and the neuroplasticity of the human brain. On one hand, recent research demonstrates that experience and training in various domains modifies how information from the different senses is integrated; and, on the other hand multisensory training paradigms seem to be particularly effective in driving functional and structural plasticity. Multisensory training affects early sensory processing within separate sensory domains, as well as the functional and structural connectivity between uni- and multisensory brain regions. In this review, we discuss the evidence for interactions of multisensory processes and brain plasticity and give an outlook on promising clinical applications and open questions.
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