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Hoare DJ, Shorter GW, Shekhawat GS, El Refaie A, Labree B, Sereda M. Neuromodulation Treatments Targeting Pathological Synchrony for Tinnitus in Adults: A Systematic Review. Brain Sci 2024; 14:748. [PMID: 39199443 PMCID: PMC11352582 DOI: 10.3390/brainsci14080748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 09/01/2024] Open
Abstract
(1) Background: Tinnitus involves the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source. For many people, tinnitus is a disorder associated with symptoms of emotional distress, cognitive dysfunction, autonomic arousal, behavioural changes, and functional disability. Many symptoms can be addressed effectively using education or cognitive behavioural therapy. However, there is no treatment that effectively reduces or alters tinnitus-related neurophysiological activity and thus the tinnitus percept. In this systematic review, we evaluated the effectiveness of neuromodulation therapies for tinnitus that explicitly target pathological synchronous neural activity. (2) Methods: Multiple databases were searched for randomised controlled trials of neuromodulation interventions for tinnitus in adults, with 24 trials included. The risk of bias was assessed, and where appropriate, meta-analyses were performed. (3) Results: Few trials used acoustic, vagal nerve, or transcranial alternating current stimulation, or bimodal stimulation techniques, with limited evidence of neuromodulation or clinical effectiveness. Multiple trials of transcranial direct current stimulation (tDCS) were identified, and a synthesis demonstrated a significant improvement in tinnitus symptom severity in favour of tDCS versus control, although heterogeneity was high. (4) Discussion: Neuromodulation for tinnitus is an emerging but promising field. Electrical stimulation techniques are particularly interesting, given recent advances in current flow modelling that can be applied to future studies.
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Affiliation(s)
- Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK; (B.L.); (M.S.)
- Department of Speech and Hearing Sciences, University College Cork, T12 EK59 Cork, Ireland;
| | - Gillian W. Shorter
- Drug and Alcohol Research Network, School of Psychology, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Giriraj S. Shekhawat
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA 5001, Australia;
- Tinnitus Research Initiative, Universitätsstrasse 84, 93053 Regensburg, Germany
| | - Amr El Refaie
- Department of Speech and Hearing Sciences, University College Cork, T12 EK59 Cork, Ireland;
| | - Bas Labree
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK; (B.L.); (M.S.)
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK; (B.L.); (M.S.)
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2
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Wu Q, Wang J, Han D, Qian L, Hu H, Gao H. Current status of transcutaneous auricular vagus nerve stimulation for tinnitus: a narrative review of modern research. Front Neurosci 2024; 18:1405310. [PMID: 39027324 PMCID: PMC11254635 DOI: 10.3389/fnins.2024.1405310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
Tinnitus, characterized by phantom sound perception, is a highly disruptive disorder lacking definitive and effective treatments. Its intricate neural mechanisms are not fully understood. Transcutaneous auricular vagus nerve stimulation (taVNS) has demonstrated potential as a substitute or supplementary treatment by activating central vagal pathways. However, standardized therapeutic protocols and objective tests to assess efficacy are lacking. Therefore, taVNS shows promise as a therapy for tinnitus, and treatment protocols should be optimized in future clinical trials.
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Affiliation(s)
- Qiqi Wu
- Department of Acupuncture, Moxibustion and Massage, Wenzhou Central Hospital, Wenzhou, China
| | - Jiawei Wang
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dexiong Han
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lala Qian
- Department of Acupuncture, Moxibustion and Massage, Wenzhou Central Hospital, Wenzhou, China
| | - Hantong Hu
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hong Gao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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3
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Korupolu R, Miller A, Park A, Yozbatiran N. Neurorehabilitation with vagus nerve stimulation: a systematic review. Front Neurol 2024; 15:1390217. [PMID: 38872818 PMCID: PMC11169586 DOI: 10.3389/fneur.2024.1390217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
Objective To systematically review vagus nerve stimulation (VNS) studies to present data on the safety and efficacy on motor recovery following stroke, traumatic brain injury (TBI), and spinal cord injury (SCI). Methods Data sources: PubMed, EMBASE, SCOPUS, and Cochrane. Study selection Clinical trials of VNS in animal models and humans with TBI and SCI were included to evaluate the effects of pairing VNS with rehabilitation therapy on motor recovery. Data extraction Two reviewers independently assessed articles according to the evaluation criteria and extracted relevant data electronically. Data synthesis Twenty-nine studies were included; 11 were animal models of stroke, TBI, and SCI, and eight involved humans with stroke. While there was heterogeneity in methods of delivering VNS with respect to rehabilitation therapy in animal studies and human non-invasive studies, a similar methodology was used in all human-invasive VNS studies. In animal studies, pairing VNS with rehabilitation therapy consistently improved motor outcomes compared to controls. Except for one study, all human invasive and non-invasive studies with controls demonstrated a trend toward improvement in motor outcomes compared to sham controls post-intervention. However, compared to non-invasive, invasive VNS, studies reported severe adverse events such as vocal cord palsy, dysphagia, surgical site infection, and hoarseness of voice, which were found to be related to surgery. Conclusion Our review suggests that VNS (non-invasive or invasive) paired with rehabilitation can improve motor outcomes after stroke in humans. Hence, VNS human studies are needed in people with TBI and SCI. There are risks related to device implantation to deliver invasive VNS compared to non-invasive VNS. Future human comparison studies are required to study and quantify the efficacy vs. risks of paired VNS delivered via different methods with rehabilitation, which would allow patients to make an informed decision. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330653.
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Affiliation(s)
- Radha Korupolu
- University of Texas Health Science Center at Houston, Houston, TX, United States
- TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Alyssa Miller
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Andrew Park
- Craig Hospital, Englewood, CO, United States
- University of Colorado Hospital, Aurora, CO, United States
| | - Nuray Yozbatiran
- University of Texas Health Science Center at Houston, Houston, TX, United States
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Cacace AT, Berri B. Blast Overpressures as a Military and Occupational Health Concern. Am J Audiol 2023; 32:779-792. [PMID: 37713532 DOI: 10.1044/2023_aja-23-00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
PURPOSE This tutorial reviews effects of environmental stressors like blast overpressures and other well-known acoustic contaminants (continuous, intermittent, and impulsive noise) on hearing, tinnitus, vestibular, and balance-related functions. Based on the overall outcome of these effects, detailed consideration is given to the health and well-being of individuals. METHOD Because hearing loss and tinnitus are consequential in affecting quality of life, novel neuromodulation paradigms are reviewed for their positive abatement and treatment-related effects. Examples of clinical data, research strategies, and methodological approaches focus on repetitive transcranial magnetic stimulation (rTMS) and electrical stimulation of the vagus nerve paired with tones (VNSt) for their unique contributions to this area. RESULTS Acoustic toxicants transmitted through the atmosphere are noteworthy for their propensity to induce hearing loss and tinnitus. Mounting evidence also indicates that high-level rapid onset changes in atmospheric sound pressure can significantly impact vestibular and balance function. Indeed, the risk of falling secondary to loss of, or damage to, sensory receptor cells in otolith organs (utricle and saccule) is a primary reason for this concern. As part of the complexities involved in VNSt treatment strategies, vocal dysfunction may also manifest. In addition, evaluation of temporospatial gait parameters is worthy of consideration based on their ability to detect and monitor incipient neurological disease, cognitive decline, and mortality. CONCLUSION Highlighting these respective areas underscores the need to enhance information exchange among scientists, clinicians, and caregivers on the benefits and complications of these outcomes.
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Affiliation(s)
- Anthony T Cacace
- Department of Communication Sciences & Disorders, Wayne State University, Detroit, MI
| | - Batoul Berri
- Department of Communication Sciences & Disorders, Wayne State University, Detroit, MI
- Department of Otolaryngology, University of Michigan, Ann Arbor
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Cho YS, Park S, Kim GY, Jo M, Hong SH, Moon IJ. Effects of Transcutaneous Trigeminal Electrical Stimulation and Sound Therapy in Patients with Tinnitus. Yonsei Med J 2023; 64:618-624. [PMID: 37727921 PMCID: PMC10522882 DOI: 10.3349/ymj.2022.0611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Tinnitus is one of the most common health conditions worldwide. Although various methods of treatment have been used, the condition is still difficult to manage or cure. This study aimed to evaluate the therapeutic effects of transcutaneous trigeminal electrical stimulation (TTES) combined with notched sound therapy (NST) on patients with tinnitus. MATERIALS AND METHODS A clinical trial was conducted prospectively from September 2020 to September 2021 at a single center in South Korea. In total, 14 patients took part in this trial. Periodic visits and tele-monitoring were used to assess treatment compliance and collect data, including electroencephalography (EEG), photoplethysmography (PPG), tinnitus handicap inventory (THI), tinnitus magnitude index, Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and 36-item short-form survey (SF-36) results. RESULTS Changes after intervention were analyzed with paired t-test. This study showed that alpha waves in the left hemisphere measured by EEG (p=0.024), autonomic nervous system balance (p=0.007), and stress level (p=0.022) measured by PPG significantly changed after intervention. Also, THI scores especially emotional symptoms (p=0.029) and catastrophic symptoms (p=0.043) decreased after treatment. The SF-36 score, both mental component summary and physical component summary score (each p<0.001), increased significantly, whereas the PSQI score (p<0.001) and BDI score (p<0.001) decreased after TTES and NST. CONCLUSION Based on the results of our study, we could confirm that TTES combined with NST can significantly improve tinnitus, catastrophic symptoms, and the overall quality of life of patients.
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Affiliation(s)
- Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
| | - Sungwon Park
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga-Young Kim
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
| | - Mini Jo
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
| | - Sung Hwa Hong
- Department of Otorhinolaryngology, Myongji Hospital, Hanyang University Medical Center, Goyang, Korea
| | - Il Joon Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea.
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Pisani A, Paciello F, Del Vecchio V, Malesci R, De Corso E, Cantone E, Fetoni AR. The Role of BDNF as a Biomarker in Cognitive and Sensory Neurodegeneration. J Pers Med 2023; 13:jpm13040652. [PMID: 37109038 PMCID: PMC10140880 DOI: 10.3390/jpm13040652] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) has a crucial function in the central nervous system and in sensory structures including olfactory and auditory systems. Many studies have highlighted the protective effects of BDNF in the brain, showing how it can promote neuronal growth and survival and modulate synaptic plasticity. On the other hand, conflicting data about BDNF expression and functions in the cochlear and in olfactory structures have been reported. Several clinical and experimental research studies showed alterations in BDNF levels in neurodegenerative diseases affecting the central and peripheral nervous system, suggesting that BDNF can be a promising biomarker in most neurodegenerative conditions, including Alzheimer's disease, shearing loss, or olfactory impairment. Here, we summarize current research concerning BDNF functions in brain and in sensory domains (olfaction and hearing), focusing on the effects of the BDNF/TrkB signalling pathway activation in both physiological and pathological conditions. Finally, we review significant studies highlighting the possibility to target BDNF as a biomarker in early diagnosis of sensory and cognitive neurodegeneration, opening new opportunities to develop effective therapeutic strategies aimed to counteract neurodegeneration.
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Affiliation(s)
- Anna Pisani
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fabiola Paciello
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Valeria Del Vecchio
- Department of Neuroscience, Reproductive Sciences and Dentistry-Audiology Section, University of Naples Federico II, 80131 Naples, Italy
| | - Rita Malesci
- Department of Neuroscience, Reproductive Sciences and Dentistry-Audiology Section, University of Naples Federico II, 80131 Naples, Italy
| | - Eugenio De Corso
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Elena Cantone
- Department of Neuroscience, Reproductive Sciences and Dentistry-ENT Section, University of Naples Federico II, 80131 Naples, Italy
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive Sciences and Dentistry-Audiology Section, University of Naples Federico II, 80131 Naples, Italy
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Connell JT, Bassiouni A, Harrison E, Laden S, O'Brien S, Sahota R, Carney AS, Foreman A, Krishnan S, Hodge JC. Customised acoustic therapy delivered through a web-based platform-An innovative approach to tinnitus treatment. Clin Otolaryngol 2023; 48:226-234. [PMID: 36550768 DOI: 10.1111/coa.14027] [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: 11/18/2021] [Revised: 11/16/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Customised acoustic therapy aims to moderate the neural pathways implicated in the pathophysiology of tinnitus. This study aimed to assess the efficacy of customised acoustic therapy administered via a web-based treatment platform. DESIGN Clinical trial with prospective recruitment. Fifty-eight participants underwent 6 weeks of customised acoustic therapy. SETTING Treatment was delivered for 2 h each day using a smartphone, tablet or computer. Treatment was integrated into usual daily activities. PARTICIPANTS Participants with subjective tinnitus were recruited through public and private otolaryngology clinics and electronic and print media. MAIN OUTCOMES MEASURED FiveQ, a novel 5 question tinnitus questionnaire, was measured at baseline and each week of treatment. Statistical analyses, including Wilcoxon, Mann-Whitney and mixed linear regression, were used to assess treatment efficacy and identify factors associated with treatment response. RESULTS 39/58 participants (67.2%) had an improvement in symptom severity scores, 4 had no change (6.9%) and 15 had a decline from baseline (25.9%). Mean FiveQ scores improved by 22.9% from 40.8 (SD = 21.4) at baseline to 31.5 (SD = 21.3) following 6 weeks of treatment (p < 0.001). With the exception of the slight tinnitus group, all other groups (from mild to catastrophic) demonstrated a treatment response. Participants with low frequency tinnitus (<2000 Hz) had a significantly greater treatment response (p < 0.001). CONCLUSION Customised acoustic therapy administered via a web-based platform demonstrated encouraging efficacy. At least mild symptoms at baseline and low frequency tinnitus were associated with a greater treatment response. Customised acoustic therapy offers accessible and efficacious tinnitus treatment, however longer term clinical studies are required to confirm the observed initial benefit is maintained.
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Affiliation(s)
- James Thomas Connell
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ahmed Bassiouni
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ella Harrison
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Stephanie Laden
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Sinead O'Brien
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Raguwinder Sahota
- Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - A Simon Carney
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Foreman
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suren Krishnan
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John-Charles Hodge
- Department of Otolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Paciello F, Ripoli C, Fetoni AR, Grassi C. Redox Imbalance as a Common Pathogenic Factor Linking Hearing Loss and Cognitive Decline. Antioxidants (Basel) 2023; 12:antiox12020332. [PMID: 36829891 PMCID: PMC9952092 DOI: 10.3390/antiox12020332] [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: 12/05/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Experimental and clinical data suggest a tight link between hearing and cognitive functions under both physiological and pathological conditions. Indeed, hearing perception requires high-level cognitive processes, and its alterations have been considered a risk factor for cognitive decline. Thus, identifying common pathogenic determinants of hearing loss and neurodegenerative disease is challenging. Here, we focused on redox status imbalance as a possible common pathological mechanism linking hearing and cognitive dysfunctions. Oxidative stress plays a critical role in cochlear damage occurring during aging, as well as in that induced by exogenous factors, including noise. At the same time, increased oxidative stress in medio-temporal brain regions, including the hippocampus, is a hallmark of neurodegenerative disorders like Alzheimer's disease. As such, antioxidant therapy seems to be a promising approach to prevent and/or counteract both sensory and cognitive neurodegeneration. Here, we review experimental evidence suggesting that redox imbalance is a key pathogenetic factor underlying the association between sensorineural hearing loss and neurodegenerative diseases. A greater understanding of the pathophysiological mechanisms shared by these two diseased conditions will hopefully provide relevant information to develop innovative and effective therapeutic strategies.
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Affiliation(s)
- Fabiola Paciello
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Cristian Ripoli
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154966
| | - Anna Rita Fetoni
- Unit of Audiology, Department of Neuroscience, Università degli Studi di Napoli Federico II, 80138 Naples, Italy
| | - Claudio Grassi
- Department of Neuroscience, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Long Y, Wang W, Liu J, Liu K, Gong S. Effect of tinnitus on sound localization ability in patients with normal hearing. Braz J Otorhinolaryngol 2023; 89:462-468. [PMID: 36841711 PMCID: PMC10164763 DOI: 10.1016/j.bjorl.2023.01.003] [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: 08/14/2022] [Revised: 12/06/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES To determine whether tinnitus negatively impacts the accuracy of sound source localization in participants with normal hearing. METHODS Seventy-five participants with tinnitus and 74 without tinnitus were enrolled in this study. The accuracy of sound source discrimination on the horizontal plane was compared between the two participant groups. The test equipment consisted of 37 loudspeakers arranged in a 180° arc facing forward with 5° intervals between them. The stimuli were pure tones of 0.25, 0.5, 1, 2, 4, and 8kHz at 50dB SPL. The stimuli were divided into three groups: low frequency (LF: 0.25, 0.5, and 1kHz), 2kHz, and high frequency (HF: 4 and 8kHz) stimuli. RESULTS The Root Mean Square Error (RMSE) score of all the stimuli in the tinnitus group was significantly higher than that in the control group (13.45±3.34 vs. 11.44±2.56, p=4.115, t<0.001). The RMSE scores at LF, 2kHz, and HF were significantly higher in the tinnitus group than those in the control group (LF: 11.66±3.62 vs. 10.04±3.13, t=2.918, p=0.004; 2kHz: 16.63±5.45 vs. 14.43±4.52, t=2.690, p=0.008; HF: 13.42±4.74 vs. 11.14 ±3.68, t=3.292, p=0.001). Thus, the accuracy of sound source discrimination in participants with tinnitus was significantly worse than that in those without tinnitus, despite the stimuli frequency. There was no difference in the ability to localize the sound of the matched frequency and other frequencies (12.86±6.29 vs. 13.87±3.14, t=1.204, p=0.236). Additionally, there was no correlation observed between the loudness of tinnitus and RMSE scores (r=0.096, p=0.434), and the Tinnitus Handicap Inventory (THI) and RMSE scores (r=-0.056, p=0.648). CONCLUSIONS Our present data suggest that tinnitus negatively impacted sound source localization accuracy, even when participants had normal hearing. The matched pitch and loudness and the impact of tinnitus on patients' daily lives were not related to the sound source localization ability. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Yue Long
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Clinical Center for Hearing Loss, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiao Liu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ke Liu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Shusheng Gong
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China; Clinical Center for Hearing Loss, Capital Medical University, Beijing, China.
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10
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Simonetti P, Vasconcelos LG, Gândara MR, Lezirovitz K, Medeiros ÍRTD, Oiticica J. Hearing aid effectiveness on patients with chronic tinnitus and associated hearing loss. Braz J Otorhinolaryngol 2022; 88 Suppl 3:S164-S170. [PMID: 35729042 DOI: 10.1016/j.bjorl.2022.03.002] [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: 08/31/2021] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Our study aimed to measure the effectiveness of using HA in reducing the disturbance caused by tinnitus. METHODS Study was designed as a within-subjects clinical trial. Nineteen patients with chronic tinnitus and untreated sensorineural hearing loss were under counseling, HA fitting and 6 months follow-up. Tinnitus assessment was performed with Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), pitch and loudness matching, and Minimum Masking Level measurements (MML). RESULTS following 6 months of HA use, a reduction in reported tinnitus and hearing handicap scales scores was observed both statistically and clinically. The pitch and loudness matching, as well as MML at the baseline and final evaluation were compared. MML's thresholds reduced significantly after 6 months of HA use. CONCLUSION Our study has provided evidence that HA fitting is a valuable treatment strategy for chronic tinnitus relief and associated hearing loss subtype of patient. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Patricia Simonetti
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil.
| | - Laura Garcia Vasconcelos
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Mara Rocha Gândara
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Karina Lezirovitz
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Ítalo Roberto Torres de Medeiros
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Jeanne Oiticica
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
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11
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Krane NA, Loyo M, Pollock J, Hill M, Johnson CZ, Stevens AA. Exploratory Study of the Brain Response in Facial Synkinesis after Bell Palsy with Systematic Review and Meta-analysis of the Literature. AJNR Am J Neuroradiol 2022; 43:1470-1475. [PMID: 36574328 PMCID: PMC9575525 DOI: 10.3174/ajnr.a7619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Facial synkinesis, characterized by unintentional facial movements paired with intentional movements, is a debilitating sequela of Bell palsy. PURPOSE Our aim was to determine whether persistent peripheral nerve changes arising from Bell palsy result in persistent altered brain function in motor pathways in synkinesis. DATA SOURCES A literature search using terms related to facial paralysis, Bell palsy, synkinesis, and fMRI through May 2021 was conducted in MEDLINE and EMBASE. Additionally, an fMRI study examined lip and eyeblink movements in 2 groups: individuals who fully recovered following Bell palsy and individuals who developed synkinesis. STUDY SELECTION Task-based data of the whole brain that required lip movements in healthy controls were extracted from 7 publications. Three studies contributed similar whole-brain analyses in acute Bell palsy. DATA ANALYSIS The meta-analysis of fMRI in healthy control and Bell palsy groups determined common clusters of activation within each group using activation likelihood estimates. A separate fMRI study used multivariate general linear modeling to identify changes associated with synkinesis in smiling and blinking tasks. DATA SYNTHESIS A region of the precentral gyrus contralateral to the paretic side of the face was hypoactive in synkinesis during lip movements compared with controls. This region was centered in a cluster of activation identified in the meta-analysis of the healthy controls but absent from individuals with Bell palsy. LIMITATIONS The meta-analysis relied on a small set of studies. The small sample of subjects with synkinesis limited the power of the fMRI analysis. CONCLUSIONS Premotor pathways show persistent functional changes in synkinesis first identifiable in acute Bell palsy.
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Affiliation(s)
- N A Krane
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - M Loyo
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - J Pollock
- Division of Neuroradiology (J.P.), Department of Diagnostic Radiology
| | - M Hill
- Department of Otolaryngology-Head and Neck Surgery (M.H.), University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - C Z Johnson
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - A A Stevens
- Advanced Imaging Research Center (A.A.S.), Oregon Health & Science University, Portland, Oregon
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12
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Rodenkirch C, Carmel JB, Wang Q. Rapid Effects of Vagus Nerve Stimulation on Sensory Processing Through Activation of Neuromodulatory Systems. Front Neurosci 2022; 16:922424. [PMID: 35864985 PMCID: PMC9294458 DOI: 10.3389/fnins.2022.922424] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/15/2022] [Indexed: 12/13/2022] Open
Abstract
After sensory information is encoded into neural signals at the periphery, it is processed through multiple brain regions before perception occurs (i.e., sensory processing). Recent work has begun to tease apart how neuromodulatory systems influence sensory processing. Vagus nerve stimulation (VNS) is well-known as an effective and safe method of activating neuromodulatory systems. There is a growing body of studies confirming VNS has immediate effects on sensory processing across multiple sensory modalities. These immediate effects of VNS on sensory processing are distinct from the more well-documented method of inducing lasting neuroplastic changes to the sensory pathways through repeatedly delivering a brief VNS burst paired with a sensory stimulus. Immediate effects occur upon VNS onset, often disappear upon VNS offset, and the modulation is present for all sensory stimuli. Conversely, the neuroplastic effect of pairing sub-second bursts of VNS with a sensory stimulus alters sensory processing only after multiple pairing sessions, this alteration remains after cessation of pairing sessions, and the alteration selectively affects the response properties of neurons encoding the specific paired sensory stimulus. Here, we call attention to the immediate effects VNS has on sensory processing. This review discusses existing studies on this topic, provides an overview of the underlying neuromodulatory systems that likely play a role, and briefly explores the potential translational applications of using VNS to rapidly regulate sensory processing.
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Affiliation(s)
- Charles Rodenkirch
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
- Jacobs Technion-Cornell Institute, Cornell Tech, New York, NY, United States
- *Correspondence: Charles Rodenkirch,
| | - Jason B. Carmel
- Department of Neurology and Orthopedics, Columbia University Medical Center, New York, NY, United States
| | - Qi Wang
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
- Qi Wang,
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13
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Zhang SQ, Chen HB, Liu J, Dai WJ, Lu QQ, Li JC. Research status and prospects of acupuncture for prevention and treatment of chemo- and radiotherapy-induced salivary gland dysfunction in head and neck cancer. Anat Rec (Hoboken) 2021; 304:2381-2396. [PMID: 34626452 DOI: 10.1002/ar.24784] [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: 05/27/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023]
Abstract
Salivary gland dysfunction (SGD) induced by chemo- and radiotherapy for head and neck cancer (HNC) has always been a difficult problem in modern medicine. The quality of life of a large number of HNC patients is severely impaired by SGD such as xerostomia and dysphagia. In recent years, several studies have found that acupuncture can improve patients' salivary secretion, but it has not yet been approved as an alternative therapy for SGD. For this reason, we collected the clinical study reports on acupuncture in the treatment of SGD induced by chemo- and radiotherapy in HNC patients in the past 20 years, and analyzed and discussed the advantages and disadvantages of these studies with respect to tumor types, group setting, intervention modality, acupoints selection, outcome evaluation, and safety. We believed that acupuncture is beneficial for SGD, but the existing objective evidence is insufficient to support its effectiveness. Therefore, improving the Standards for Reporting Interventions in Clinical Trials of Acupuncture, selecting the optimal combination of acupoints through scientific and rigorous study design, and exploring the potential mechanism of acupuncture in the treatment of diseases combined with the meridian theory may be effective ways to promote the acceptance of acupuncture as an alternative therapy for SGD in future. The significance of this review is to provide a reference for researchers to carry out high-quality clinical trials of acupuncture in the treatment of SGD in future from the perspective of the combination of modern medicine and traditional Chinese medicine.
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Affiliation(s)
- Shan-Qiang Zhang
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Hai-Bin Chen
- Department of Histology and Embryology, Shantou University Medical College, Shantou, China
| | - Jun Liu
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Wen-Jie Dai
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Qi-Qi Lu
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
| | - Ji-Cheng Li
- Medical Research Center, Yue Bei People's Hospital, Shantou University Medical College, Shaoguan, China
- Department of Anatomy and Embryology, School of Medicine, Zhejiang University, Hangzhou, China
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14
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Paciello F, Rinaudo M, Longo V, Cocco S, Conforto G, Pisani A, Podda MV, Fetoni AR, Paludetti G, Grassi C. Auditory sensory deprivation induced by noise exposure exacerbates cognitive decline in a mouse model of Alzheimer's disease. eLife 2021; 10:70908. [PMID: 34699347 PMCID: PMC8547960 DOI: 10.7554/elife.70908] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/15/2021] [Indexed: 12/18/2022] Open
Abstract
Although association between hearing impairment and dementia has been widely documented by epidemiological studies, the role of auditory sensory deprivation in cognitive decline remains to be fully understood. To address this issue we investigated the impact of hearing loss on the onset and time-course of cognitive decline in an animal model of Alzheimer's disease (AD), that is the 3×Tg-AD mice and the underlying mechanisms. We found that hearing loss induced by noise exposure in the 3×Tg-AD mice before the phenotype is manifested caused persistent synaptic and morphological alterations in the auditory cortex. This was associated with earlier hippocampal dysfunction, increased tau phosphorylation, neuroinflammation, and redox imbalance, along with anticipated memory deficits compared to the expected time-course of the neurodegenerative phenotype. Our data suggest that a mouse model of AD is more vulnerable to central damage induced by hearing loss and shows reduced ability to counteract noise-induced detrimental effects, which accelerates the neurodegenerative disease onset.
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Affiliation(s)
- Fabiola Paciello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Rinaudo
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Longo
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Cocco
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Conforto
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Pisani
- Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Vittoria Podda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Fetoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Paludetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Otolaryngology Head and Neck Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Grassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Short-Term Effects of Vagus Nerve Stimulation on Learning and Evoked Activity in Auditory Cortex. eNeuro 2021; 8:ENEURO.0522-20.2021. [PMID: 34088737 PMCID: PMC8240839 DOI: 10.1523/eneuro.0522-20.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/21/2022] Open
Abstract
Chronic vagus nerve stimulation (VNS) has been shown to facilitate learning, but effects of acute VNS on neural coding and behavior remain less well understood. Ferrets implanted with cuff electrodes on the vagus nerve were trained by classical conditioning on an auditory tone frequency-reward association. One tone was associated with reward while another tone was not. Tone frequencies and reward associations were changed every 2 d, requiring learning of a new relationship. When tones were paired with VNS, animals consistently learned the new association within 2 d. When VNS occurred randomly between trials, learning within 2 d was unreliable. In passively listening animals, neural activity in primary auditory cortex (A1) and pupil size were recorded before and after acute VNS-tone pairing. After pairing with a neuron’s best-frequency (BF) tone, responses by a subpopulation of neurons were reduced. VNS paired with an off-BF tone or during intertrial intervals had no effect. The BF-specific reduction in neural responses after VNS remained, even after regressing out changes explained by pupil-indexed arousal. VNS induced brief dilation in the pupil, and the size of this change predicted the magnitude of persistent changes in the neural response. This interaction suggests that fluctuations in neuromodulation associated with arousal gate the long-term VNS effects on neural activity.
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16
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Yin L, Chen X, Lu X, An Y, Zhang T, Yan J. An updated meta-analysis: repetitive transcranial magnetic stimulation for treating tinnitus. J Int Med Res 2021; 49:300060521999549. [PMID: 33729855 PMCID: PMC7975580 DOI: 10.1177/0300060521999549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To undertake an updated meta-analysis to obtain more evidence from randomized
controlled trials (RCTs) to assess the effect of repetitive transcranial
magnetic stimulation (rTMS) for the treatment of tinnitus. Methods PubMed®, Embase®, Web of Science, Cochrane Database of Systematic Reviews,
CBM, CNKI and Wanfang were searched for RCTs from inception up to March
2020. Studies meeting the eligibility criteria were included in the
meta-analysis. The mean difference was calculated and the effect size was
evaluated using a Z test. Results The analysis included 12 randomized sham-controlled clinical trials with a
total of 717 participants. Active rTMS was superior to sham rTMS in terms of
the short-term and long-term effects (6 months) on the tinnitus handicap
inventory scores, but an immediate effect was not significant. There was no
significant immediate effect on the tinnitus questionnaire (TQ) and Beck
depression inventory (BDI) scores. Conclusions This meta-analysis demonstrated that rTMS improved tinnitus-related symptoms,
but the TQ and BDI scores demonstrated little immediate benefit. Future
research should be undertaken on large samples in multi-centre settings with
longer follow-up durations.
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Affiliation(s)
- Lu Yin
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao Chen
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xingang Lu
- Department of Traditional Chinese Medicine, Shanghai Key Laboratory of Clinical Geriatric Medicine, HuaDong Hospital, FuDan University, Shanghai, China
| | - Yun An
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tao Zhang
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juntao Yan
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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17
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Stegeman I, Velde HM, Robe PAJT, Stokroos RJ, Smit AL. Tinnitus treatment by vagus nerve stimulation: A systematic review. PLoS One 2021; 16:e0247221. [PMID: 33705401 PMCID: PMC7951891 DOI: 10.1371/journal.pone.0247221] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 02/04/2021] [Indexed: 01/21/2023] Open
Abstract
Background Tinnitus is a phantom sensation of sound, which can have a negative impact on quality of life of those affected. No curative treatments are currently known. Neuromodulation by vagus nerve stimulation has emerged as a new treatment option for tinnitus, though till date the effectiveness remains unclear. Therefore, we aim to review the effect of vagus nerve stimulation on tinnitus distress and tinnitus symptom severity in patients with chronic tinnitus. Methods We searched Pubmed, Embase and the Cochrane Library systematically for RCTs, observational studies and case studies on the effect of VNS treatment for tinnitus on October 29, 2019. Studies including adult patients with subjective tinnitus, comparing transcutaneous or implantable VNS to placebo or no treatment or before and after application of VNS treatment on tinnitus distress and tinnitus symptom severity measured with a validated questionnaire were eligible. The risk of bias was assessed with the appropriate tool for each type of study. Results Our search identified 9 primary studies of which 2 RCTs, 5 cohort studies and 2 case series or reports. 5 studies used transcutaneous VNS treatment and 4 used implanted VNS treatment. 6 studies combined VNS treatment with sound therapy. There was a serious risk of bias in all studies, especially on confounding. Most studies reported a small decrease in tinnitus distress or tinnitus symptom severity. Conclusion Due to methodological limitations and low reporting quality of the included studies, the effect of VNS on tinnitus remains unclear. To draw conclusions for which patient population and to what extent (t)VNS is beneficial in the treatment of tinnitus, a randomised controlled trial should be considered.
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Affiliation(s)
- I Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - H M Velde
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - P A J T Robe
- University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - R J Stokroos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - A L Smit
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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18
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Riffle TL, Martel DT, Jones GR, Shore SE. Bimodal Auditory Electrical Stimulation for the Treatment of Tinnitus: Preclinical and Clinical Studies. Curr Top Behav Neurosci 2021; 51:295-323. [PMID: 33083999 PMCID: PMC8058117 DOI: 10.1007/7854_2020_180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tinnitus, or the phantom perception of sound, arises from pathological neural activity. Neurophysiological research has shown increased spontaneous firing rates and synchronization along the auditory pathway correlate strongly with behavioral measures of tinnitus. Auditory neurons are plastic, enabling external stimuli to be utilized to elicit long-term changes to spontaneous firing and synchrony. Pathological plasticity can thus be reversed using bimodal auditory plus nonauditory stimulation to reduce tinnitus. This chapter discusses preclinical and clinical evidence for efficacy of bimodal stimulation treatments of tinnitus, with highlights on sham-controlled, double-blinded clinical trials. The results from these studies have shown some efficacy in reducing the severity of tinnitus, based on subjective and objective outcome measures including tinnitus questionnaires and psychophysical tinnitus measurements. While results of some studies have been positive, the degree of benefit and the populations that respond to treatment vary across the studies. Directions and implications of future studies are discussed.
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Affiliation(s)
- Travis L Riffle
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - David T Martel
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Gerilyn R Jones
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Susan E Shore
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
- Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.
- Kresge Hearing Research Institute, Ann Arbor, MI, USA.
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19
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Darrow MJ, Mian TM, Torres M, Haider Z, Danaphongse T, Seyedahmadi A, Rennaker RL, Hays SA, Kilgard MP. The tactile experience paired with vagus nerve stimulation determines the degree of sensory recovery after chronic nerve damage. Behav Brain Res 2021; 396:112910. [PMID: 32971197 PMCID: PMC7572822 DOI: 10.1016/j.bbr.2020.112910] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022]
Abstract
Loss of sensory function is a common consequence of neurological injury. Recent clinical and preclinical evidence indicates vagus nerve stimulation (VNS) paired with tactile rehabilitation, consisting of delivery of a variety of mechanical stimuli to the hyposensitive skin surface, yields substantial and long-lasting recovery of somatosensory function after median and ulnar nerve transection and repair. Here, we tested the hypothesis that a specific component of the tactile rehabilitation paired with VNS is necessary for recovery of somatosensory function. In a second experiment in a separate cohort, we investigated whether VNS paired with tactile rehabilitation could improve skilled forelimb motor function. Elements of the study design, including planned sample size, assessments, and statistical comparisons, were preregistered prior to beginning data collection (https://osf.io/3tm8u/). Animals received a peripheral nerve injury (PNI) causing chronic sensory loss. Eight weeks after injury, animals were given a VNS implant followed by six weeks of tactile rehabilitation sessions consisting of repeated application of one of two distinct mechanical stimuli, a filament or a paintbrush, to the previously denervated forepaw. VNS paired with either filament indentation or brushing of the paw significantly improved recovery of forelimb withdrawal thresholds after PNI compared to tactile rehabilitation without VNS. The effect size was twice as large when VNS was paired with brushing compared to VNS paired with point indentation. An independent replication in a second cohort confirmed that VNS paired with brush restored forelimb withdrawal thresholds to normal. These rats displayed significant improvements in performance on a skilled forelimb task compared to rats that did not receive VNS. These findings support the utility of pairing VNS with tactile rehabilitation to improve recovery of somatosensory and motor function after neurological injury. Additionally, this study demonstrates that the sensory characteristics of the rehabilitation paired with VNS determine the degree of recovery.
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Affiliation(s)
- Michael J Darrow
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Tabarak M Mian
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Miranda Torres
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Zainab Haider
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Tanya Danaphongse
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Armin Seyedahmadi
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Robert L Rennaker
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Seth A Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States.
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
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20
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Barbour DL. Hidden Hearing Loss: Mixed Effects of Compensatory Plasticity. Curr Biol 2020; 30:R1433-R1436. [PMID: 33290713 DOI: 10.1016/j.cub.2020.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hidden hearing loss manifests as speech perception difficulties with normal hearing thresholds. A new study shows that neural compensation induced by this disorder may actually improve speech perception under narrow conditions within an overall profile of degradation.
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Affiliation(s)
- Dennis L Barbour
- Laboratory of Sensory Neuroscience and Neuroengineering, Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA.
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21
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De Ridder D, Langguth B, Vanneste S. Vagus nerve stimulation for tinnitus: A review and perspective. PROGRESS IN BRAIN RESEARCH 2020; 262:451-467. [PMID: 33931191 DOI: 10.1016/bs.pbr.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Vagus nerve stimulation is a promising new tool in the treatment of chronic tinnitus. Current protocols involve pairing sounds, which exclude the tinnitus frequency, with simultaneous vagus nerve stimulation (VNS). This is based on extensive preclinical animal studies that demonstrate that pairing non-tinnitus sounds with VNS results in a tonotopic map plasticity. It is thought that by expanding the non-tinnitus sound representation, it is possible to overturn the expanded tonotopic map associated with the tinnitus frequency in these animal models. These findings have been translated into a clinical approach, where a clinically significant, but moderate improvement, in tinnitus distress and a modest benefit in tinnitus loudness perception has been shown. Yet, pairing tinnitus matched sound to VNS may produce tinnitus improvement by Pavlovian conditioning, in which the distressful tinnitus sound becomes associated with a relaxing "rest and digest" response from activation of the vagus nerve. If this hypothesis is correct, beneficial effects should be achieved with paired sounds that resemble the tinnitus sounds as much as possible. In conclusion, although the potential to use VNS to drive neural plasticity to reduce or eliminate the neural drivers of ongoing tinnitus is exciting, much work is needed to more completely understand the neural basis of tinnitus and to develop tailored therapies to address the suffering caused by this heterogeneous condition. Whether pairing of the vagus stimulation with non-tinnitus or tinnitus-matched sounds is essential is still to be determined.
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Affiliation(s)
- Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, United States; Global Brain Health Institute & Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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22
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Manz EJ, Sertel S, Szecsenyi J, Plinkert PK, Joos S. Acupuncture as Complementary Treatment for Acute Tinnitus: A Randomized Controlled Pilot Study. Complement Med Res 2020; 28:96-103. [PMID: 32712606 DOI: 10.1159/000508630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Up to now, tinnitus has been an almost non-treatable symptom affecting more than 18% of the population in industrialized countries. So far, there are only a few studies evaluating the effectiveness of acupuncture in tinnitus treatment, none of which include acute tinnitus (<3 months). The aim of this pilot study was to explore the feasibility of recruitment and adherence to acupuncture conducted according to the principles of traditional Chinese medicine in patients with acute idiopathic tinnitus and to assess effect sizes on subjective and objective outcomes within a randomized controlled design. PATIENTS AND METHODS After randomization patients of the control group received usual care (n = 23), and patients of the intervention group (n = 25) received 4 additional acupuncture treatments in a 4- to 6-week period. Tinnitus severity was assessed by means of a visual analogue scale as well as standardized and validated tinnitus questionnaires (Tinnitus Functional Index and 12-item Mini Tinnitus Questionnaire) at baseline and 6 weeks after. These subjective parameters were completed by tone audiometry. Comparisons of the groups were carried out using the Wilcoxon-Mann-Whitney test. RESULTS Both groups were comparable without significant differences in baseline values. All outcomes, except for the overall well-being, showed better improvements in the intervention group with clinically significant differences from baseline to end point. However, among the outcomes only the subjective change in tinnitus severity showed a significant group difference. No serious side effects were observed. CONCLUSION The design of our pilot study was feasible in terms of recruitment, although patient adherence to treatment remained challenging. However, considering the small intergroup differences, procedures regarding the numbers of acupuncture sessions and the total period of the acupuncture treatment should be reconsidered. The results of this pilot study provide a good basis for future confirmatory trials.
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Affiliation(s)
- Enikö Julia Manz
- Institute for General Practice and Interprofessional Care, University Hospital, Tübingen, Germany,
| | - Serkan Sertel
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Service Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter-Karl Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital, Tübingen, Germany
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Hong SZ, Huang S, Severin D, Kirkwood A. Pull-push neuromodulation of cortical plasticity enables rapid bi-directional shifts in ocular dominance. eLife 2020; 9:e54455. [PMID: 32432545 PMCID: PMC7239653 DOI: 10.7554/elife.54455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/01/2020] [Indexed: 02/06/2023] Open
Abstract
Neuromodulatory systems are essential for remodeling glutamatergic connectivity during experience-dependent cortical plasticity. This permissive/enabling function of neuromodulators has been associated with their capacity to facilitate the induction of Hebbian forms of long-term potentiation (LTP) and depression (LTD) by affecting cellular and network excitability. In vitro studies indicate that neuromodulators also affect the expression of Hebbian plasticity in a pull-push manner: receptors coupled to the G-protein Gs promote the expression of LTP at the expense of LTD, and Gq-coupled receptors promote LTD at the expense of LTP. Here we show that pull-push mechanisms can be recruited in vivo by pairing brief monocular stimulation with pharmacological or chemogenetical activation of Gs- or Gq-coupled receptors to respectively enhance or reduce neuronal responses in primary visual cortex. These changes were stable, inducible in adults after the termination of the critical period for ocular dominance plasticity, and can rescue deficits induced by prolonged monocular deprivation.
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Affiliation(s)
- Su Z Hong
- Mind/Brain Institute, Johns Hopkins UniversityBaltimoreUnited States
| | - Shiyong Huang
- Mind/Brain Institute, Johns Hopkins UniversityBaltimoreUnited States
| | - Daniel Severin
- Mind/Brain Institute, Johns Hopkins UniversityBaltimoreUnited States
| | - Alfredo Kirkwood
- Mind/Brain Institute, Johns Hopkins UniversityBaltimoreUnited States
- Department of Neuroscience, Johns Hopkins UniversityBaltimoreUnited States
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24
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Kochilas HL, Cacace AT, Arnold A, Seidman MD, Tarver WB. Vagus nerve stimulation paired with tones for tinnitus suppression: Effects on voice and hearing. Laryngoscope Investig Otolaryngol 2020; 5:286-296. [PMID: 32337360 PMCID: PMC7178458 DOI: 10.1002/lio2.364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/23/2020] [Accepted: 02/08/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE In individuals with chronic tinnitus, our interest was to determine whether daily low-level electrical stimulation of the vagus nerve paired with tones (paired-VNSt) for tinnitus suppression had any adverse effects on motor-speech production and physiological acoustics of sustained vowels. Similarly, we were also interested in evaluating for changes in pure-tone thresholds, word-recognition performance, and minimum-masking levels. Both voice and hearing functions were measured repeatedly over a period of 1 year. STUDY DESIGN Longitudinal with repeated-measures. METHODS Digitized samples of sustained frontal, midline, and back vowels (/e/, /o/, /ah/) were analyzed with computer software to quantify the degree of jitter, shimmer, and harmonic-to-noise ratio contained in these waveforms. Pure-tone thresholds, monosyllabic word-recognition performance, and MMLs were also evaluated for VNS alterations. Linear-regression analysis was the benchmark statistic used to document change over time in voice and hearing status from a baseline condition. RESULTS Most of the regression functions for the vocal samples and audiometric variables had slope values that were not significantly different from zero. Four of the nine vocal functions showed a significant improvement over time, whereas three of the pure tone regression functions at 2-4 kHz showed some degree of decline; all changes observed were for the left ear, all were at adjacent frequencies, and all were ipsilateral to the side of VNS. However, mean pure-tone threshold changes did not exceed 4.29 dB from baseline and therefore, would not be considered clinically significant. In some individuals, larger threshold shifts were observed. No significant regression/slope effects were observed for word-recognition or MMLs. CONCLUSION Quantitative voice analysis and assessment of audiometric variables showed minimal if any evidence of adverse effects using paired-VNSt over a treatment period of 1 year. Therefore, we conclude that paired-VNSt is a safe tool for tinnitus abatement in humans without significant side effects. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Helen L. Kochilas
- North Atlanta Ears, Nose, Throat & Allergy, AlpharettaGeorgia
- Present address:
North Atlanta Ears, Nose, Throat & AllergyAlpharettaGeorgia
| | - Anthony T. Cacace
- Department of Communication Sciences & Disorders, Wayne State University, DetroitMichigan
| | - Amy Arnold
- The Hearing Clinic, BrightonMichigan
- Present address:
The Hearing ClinicBrightonMichigan
| | - Michael D. Seidman
- Florida ENT Surgical Specialists, Florida Hospital Medical Group, Head & Neck Surgery Center of Florida, CelebrationFlorida
- Present address:
Florida Hospital Medical GroupHead & Neck Surgery Center of FloridaCelebrationFlorida
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25
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Colzato L, Beste C. A literature review on the neurophysiological underpinnings and cognitive effects of transcutaneous vagus nerve stimulation: challenges and future directions. J Neurophysiol 2020; 123:1739-1755. [PMID: 32208895 DOI: 10.1152/jn.00057.2020] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Brain stimulation approaches are important to gain causal mechanistic insights into the relevance of functional brain regions and/or neurophysiological systems for human cognitive functions. In recent years, transcutaneous vagus nerve stimulation (tVNS) has attracted considerable popularity. It is a noninvasive brain stimulation technique based on the stimulation of the vagus nerve. The stimulation of this nerve activates subcortical nuclei, such as the locus coeruleus and the nucleus of the solitary tract, and from there, the activation propagates to the cortex. Since tVNS is a novel stimulation technique, this literature review outlines a brief historical background of tVNS, before detailing underlying neurophysiological mechanisms of action, stimulation parameters, cognitive effects of tVNS on healthy humans, and, lastly, current challenges and future directions of tVNS research in cognitive functions. Although more research is needed, we conclude that tVNS, by increasing norepineprine (NE) and gamma-aminobutyric acid (GABA) levels, affects NE- and GABA-related cognitive performance. The review provides detailed background information how to use tVNS as a neuromodulatory tool in cognitive neuroscience and outlines important future leads of research on tVNS.
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Affiliation(s)
- Lorenza Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.,Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.,Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.,Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
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26
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Vagus nerve stimulation as a promising adjunctive treatment for ischemic stroke. Neurochem Int 2019; 131:104539. [DOI: 10.1016/j.neuint.2019.104539] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/03/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022]
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27
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Deklerck AN, Marechal C, Pérez Fernández AM, Keppler H, Van Roost D, Dhooge IJM. Invasive Neuromodulation as a Treatment for Tinnitus: A Systematic Review. Neuromodulation 2019; 23:451-462. [DOI: 10.1111/ner.13042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/09/2019] [Accepted: 07/31/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Ann N. Deklerck
- Faculty of Medicine and Health Sciences, Department of Head and Skin Gent University Ghent Belgium
| | - Celine Marechal
- Faculty of Medicine and Health Sciences, Department of Head and Skin Gent University Ghent Belgium
| | | | - Hannah Keppler
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences Ghent University Ghent Belgium
- Department of Otorhinolaryngology Ghent University Hospital Ghent Belgium
| | - Dirk Van Roost
- Department of Neurosurgery Ghent University Hospital Ghent Belgium
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair Ghent University Ghent Belgium
| | - Ingeborg J. M. Dhooge
- Faculty of Medicine and Health Sciences, Department of Head and Skin Gent University Ghent Belgium
- Department of Otorhinolaryngology Ghent University Hospital Ghent Belgium
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28
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Müller MLTM, Marusic U, van Emde Boas M, Weiss D, Bohnen NI. Treatment options for postural instability and gait difficulties in Parkinson's disease. Expert Rev Neurother 2019; 19:1229-1251. [PMID: 31418599 DOI: 10.1080/14737175.2019.1656067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies.Areas covered: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise, and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions.Expert opinion: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the 'silver bullet' that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy, and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide complementary benefits to manage axial motor features in PD, but selection of treatment modalities should be tailored to the individual patient's needs.
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Affiliation(s)
- Martijn L T M Müller
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre of Koper, Koper, Slovenia.,Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia
| | - Miriam van Emde Boas
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nicolaas I Bohnen
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
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29
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Borland MS, Vrana WA, Moreno NA, Fogarty EA, Buell EP, Vanneste S, Kilgard MP, Engineer CT. Pairing vagus nerve stimulation with tones drives plasticity across the auditory pathway. J Neurophysiol 2019; 122:659-671. [PMID: 31215351 DOI: 10.1152/jn.00832.2018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Previous studies have demonstrated that pairing vagus nerve stimulation (VNS) with sounds can enhance the primary auditory cortex (A1) response to the paired sound. The neural response to sounds following VNS-sound pairing in other subcortical and cortical auditory fields has not been documented. We predicted that VNS-tone pairing would increase neural responses to the paired tone frequency across the auditory pathway. In this study, we paired VNS with the presentation of a 9-kHz tone 300 times a day for 20 days. We recorded neural responses to tones from 2,950 sites in the inferior colliculus (IC), A1, anterior auditory field (AAF), and posterior auditory field (PAF) 24 h after the last pairing session in anesthetized rats. We found that VNS-tone pairing increased the percentage of IC, A1, AAF, and PAF that responds to the paired tone frequency. Across all tested auditory fields, the response strength to tones was strengthened in VNS-tone paired rats compared with control rats. VNS-tone pairing reduced spontaneous activity, frequency selectivity, and response threshold across the auditory pathway. This is the first study to document both cortical and subcortical plasticity following VNS-sound pairing. Our findings suggest that VNS paired with sound presentation is an effective method to enhance auditory processing.NEW & NOTEWORTHY Previous studies have reported primary auditory cortex plasticity following vagus nerve stimulation (VNS) paired with a sound. This study extends previous findings by documenting that fields across the auditory pathway are altered by VNS-tone pairing. VNS-tone pairing increases the percentage of each field that responds to the paired tone frequency. This is the first study to document both cortical and subcortical plasticity following VNS-sound pairing.
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Affiliation(s)
- Michael S Borland
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Will A Vrana
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Nicole A Moreno
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Elizabeth A Fogarty
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Elizabeth P Buell
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Sven Vanneste
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
| | - Crystal T Engineer
- The University of Texas at Dallas, Texas Biomedical Device Center, Richardson, Texas.,The University of Texas at Dallas, School of Behavioral and Brain Sciences, Richardson, Texas
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30
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Guercio GD, Thomas ME, Cisneros-Franco JM, Voss P, Panizzutti R, de Villers-Sidani E. Improving cognitive training for schizophrenia using neuroplasticity enhancers: Lessons from decades of basic and clinical research. Schizophr Res 2019; 207:80-92. [PMID: 29730045 DOI: 10.1016/j.schres.2018.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 01/29/2023]
Abstract
Mounting evidence indicates that schizophrenia is a disorder that stems from maladaptive plasticity within neural circuits and produces broad cognitive deficits leading to loss of autonomy. A large number of studies have identified abnormalities spanning many neurotransmitter systems in schizophrenia, and as a result, a variety of drugs have been developed to attempt to treat these abnormalities and enhance cognition. Unfortunately, positive results have been limited so far. This may be in part because the scope of abnormalities in the schizophrenic brain requires a treatment capable of engaging many different neurotransmitter systems. One approach to achieving this kind of treatment has been to use neuroplasticity-based computerized cognitive training programs to stimulate the formation of more adaptive circuits. Although the number of studies implementing this approach has increased exponentially in recent years, effect sizes for cognitive gains have been modest and adherence to treatment remains an important challenge in many studies, as patients are often required to train for 40 h or more. In the present paper, we argue that cognitive training protocols will benefit from the addition of cognitive enhancers to produce more robust and longer lasting targeted neuroplasticity. Indeed, recent data from animal studies have provided support for combining plasticity-enhancing drugs with tailored behavioral training paradigms to restore normal function within dysfunctioning neural circuits. The advantages and challenges of applying this approach to patients with schizophrenia will be discussed.
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Affiliation(s)
- G D Guercio
- Biomedical Sciences Institute, Federal University of Rio de Janeiro, RJ, Brazil; Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
| | - M E Thomas
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - J M Cisneros-Franco
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - P Voss
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - R Panizzutti
- Biomedical Sciences Institute, Federal University of Rio de Janeiro, RJ, Brazil
| | - E de Villers-Sidani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
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31
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Lee HY, Kim SJ, Chang DS, Shin SA. Tinnitus in the side with better hearing. Am J Otolaryngol 2019; 40:400-403. [PMID: 30799211 DOI: 10.1016/j.amjoto.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/18/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We aimed to confirm the characteristics of patients with tinnitus in the better-hearing side. MATERIALS AND METHODS Among the 778 patients who visited the tinnitus clinic complaining of unilateral tinnitus at a local university hospital between March 2014 and December 2017, we recruited 62 patients who showed tinnitus in the better-hearing side on pure-tone audiometry. The mean hearing threshold was calculated using the arithmetic mean of the pure tone thresholds at 1, 2, 3, and 4 kHz. In addition, patients' medical history, tinnitus questionnaires, and other audiologic test results were thoroughly analyzed together for diagnosis. RESULTS Fluctuating hearing loss without vertigo or Ménière's disease were the most common etiologies (n = 16, 25.8%), followed by high-frequency hearing loss (n = 13, 21.0%), sudden idiopathic hearing loss (n = 6, 9.7%), and presbycusis (n = 6, 9.7%). Somatosensory tinnitus was also observed in seven patients. Neck pain was associated with tinnitus in five patients (8.1%), and two other patients (3.2%) experienced temporomandibular disorder in the same side as the tinnitus. CONCLUSION Tinnitus was associated with deterioration of hearing even when it occurred in the better-hearing side. Among the possible etiologies, fluctuating hearing loss in the tinnitus side was the most common audiologic finding. Assessment of hearing level at each frequency was more effective in detecting high-frequency hearing loss rather than the use of the mean hearing level. In addition, somatosensory tinnitus should not be ignored.
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32
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Pienkowski M. Rationale and Efficacy of Sound Therapies for Tinnitus and Hyperacusis. Neuroscience 2019; 407:120-134. [DOI: 10.1016/j.neuroscience.2018.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/20/2022]
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33
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Morris R, Martini DN, Madhyastha T, Kelly VE, Grabowski TJ, Nutt J, Horak F. Overview of the cholinergic contribution to gait, balance and falls in Parkinson's disease. Parkinsonism Relat Disord 2019; 63:20-30. [PMID: 30796007 DOI: 10.1016/j.parkreldis.2019.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/02/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
Mobility deficits, including gait disturbance, balance impairments and falls, are common features of Parkinson's disease (PD) that negatively impact quality of life. Mobility deficits respond poorly to dopaminergic medications, indicating a role for additional neurotransmitters. Due to the critical role of cortical input to gait and balance, acetylcholine-an essential neurotransmitter system for attention-has become an area of interest for mobility. This review aimed to identify the role of cholinergic function on gait, balance, and falls in PD using three techniques; pharmacological, imaging, and electrophysiological. Studies supported the role of the cholinergic system for mobility in PD, with the most promising evidence indicating a role in falls. Imaging studies demonstrated involvement of anterior cholinergic (basal forebrain) systems in gait, and posterior (brainstem) systems in balance. However, this review identified a small number of studies which used varying protocols, making comparisons difficult. Further studies are warranted, measuring comprehensive gait and balance characteristics as well as gold standard falls detection to further quantify the relationship between ACh and mobility in PD.
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Affiliation(s)
- Rosie Morris
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Douglas N Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Tara Madhyastha
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Valerie E Kelly
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Thomas J Grabowski
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - John Nutt
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Fay Horak
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Portland Veterans Affairs Health Care System, Portland, OR, USA.
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34
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Yakunina N, Kim SS, Nam EC. BOLD fMRI effects of transcutaneous vagus nerve stimulation in patients with chronic tinnitus. PLoS One 2018; 13:e0207281. [PMID: 30485375 PMCID: PMC6261575 DOI: 10.1371/journal.pone.0207281] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/29/2018] [Indexed: 12/25/2022] Open
Abstract
Objective Vagus nerve stimulation (VNS) is a neuromodulation method used for treatment of epilepsy and depression. Transcutaneous VNS (tVNS) has been gaining popularity as a noninvasive alternative to VNS. Previous tVNS neuroimaging studies revealed brain (de)activation patterns that involved multiple areas implicated in tinnitus generation and perception. In this study, functional magnetic resonance imaging (fMRI) was used to explore the effects of tVNS on brain activity in patients with tinnitus. Methods Thirty-six patients with chronic tinnitus received tVNS to the inner tragus, cymba conchae, and earlobe (sham stimulation). Results The locus coeruleus and nucleus of the solitary tract in the brainstem were activated in response to stimulation of both locations compared with the sham stimulation. The cochlear nuclei were also activated, which was not observed in healthy subjects with normal hearing. Multiple auditory and limbic structures, as well as other brain areas associated with generation and perception of tinnitus, were deactivated by tVNS, particularly the parahippocampal gyrus, which was recently speculated to cause tinnitus in hearing-impaired patients. Conclusions tVNS via the inner tragus or cymba conchae suppressed neural activity in the auditory, limbic, and other tinnitus-related non-auditory areas through auditory and vagal ascending pathways in tinnitus patients. The results from this study are discussed in the context of several existing models of tinnitus. They indicate that the mechanism of action of tVNS might be involved in multiple brain areas responsible for the generation of tinnitus, tinnitus-related emotional annoyance, and their mutual reinforcement.
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Affiliation(s)
- Natalia Yakunina
- Institute of Medical Science, Kangwon National University, School of Medicine, Chuncheon, Republic of Korea
- Neuroscience Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Sam Soo Kim
- Neuroscience Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
- Department of Radiology, Kangwon National University, School of Medicine, Chuncheon, Republic of Korea
| | - Eui-Cheol Nam
- Neuroscience Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea
- Department of Otolaryngology, Kangwon National University, School of Medicine, Chuncheon, Republic of Korea
- * E-mail:
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35
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Attarha M, Bigelow J, Merzenich MM. Unintended Consequences of White Noise Therapy for Tinnitus—Otolaryngology's Cobra Effect. JAMA Otolaryngol Head Neck Surg 2018; 144:938-943. [DOI: 10.1001/jamaoto.2018.1856] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mouna Attarha
- Posit Science Corporation, San Francisco, California
| | - James Bigelow
- Coleman Memorial Laboratory, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
| | - Michael M. Merzenich
- Posit Science Corporation, San Francisco, California
- Coleman Memorial Laboratory, Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
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36
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Wichova H, Alvi SA, Shew M, Lin J, Sale K, Larsen C, Staecker H. Tinnitus perception in patients after vagal nerve stimulator implantation for epilepsy. Am J Otolaryngol 2018; 39:599-602. [PMID: 30025741 DOI: 10.1016/j.amjoto.2018.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Vagal nerve stimulation in conjunction with sound therapy has been proposed as a treatment for subjective tinnitus. The purpose of this study is to retrospectively review the effect of VNS on perception of tinnitus in epilepsy patients. We explore the incidence of tinnitus and its perceived reduction in patients requiring implantation of VNS for medically refractory seizures. MATERIALS AND METHODS A phone survey was conducted in adult patients with prior VNS implantation. A questionnaire including the visual analog scale (VAS) of tinnitus loudness was used to determine the presence and severity of tinnitus. RESULTS Out of the 56 patients who had completed the phone survey, 20 (35%) reported the presence of pre-operative tinnitus. The tinnitus positive group was significantly older (p = 0.019). Of the 20 pre-operative tinnitus positive patients, all patients continued to have tinnitus post-operatively. Four (20%) noted no changes in VAS of tinnitus loudness while 16 (80%) had at least a one-point decrease. The mean difference between pre- and post-operative VAS of loudness was 2.05, with a standard deviation of 1.84 and this was statistically significant (p < 0.001). CONCLUSIONS In this study, we evaluate the potential of vagal nerve stimulation to alter the perception of tinnitus in patients with refractory epilepsy. Eighty percent of patients noted some level of subjective tinnitus improvement after VNS implantation. Given this finding, there may be a potential additional benefit to the use of VNS in patients with epilepsy.
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Rammo R, Ali R, Pabaney A, Seidman M, Schwalb J. Surgical Neuromodulation of Tinnitus: A Review of Current Therapies and Future Applications. Neuromodulation 2018; 22:380-387. [DOI: 10.1111/ner.12793] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/16/2018] [Accepted: 04/24/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Richard Rammo
- Department of NeurosurgeryHenry Ford HospitalDetroit MI USA
| | - Rushna Ali
- Department of Neurological SurgeryVanderbilt UniversityNashville TN USA
| | - Aqueel Pabaney
- Department of Neurosurgery, Grandview Medical CenterKettering Health NetworkDayton OH USA
| | - Michael Seidman
- Department of OtolaryngologyFlorida Hospital Celebration HealthCelebration FL USA
| | - Jason Schwalb
- Department of NeurosurgeryHenry Ford HospitalDetroit MI USA
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Ruan Q, Yu Z, Zhang W, Ruan J, Liu C, Zhang R. Cholinergic Hypofunction in Presbycusis-Related Tinnitus With Cognitive Function Impairment: Emerging Hypotheses. Front Aging Neurosci 2018; 10:98. [PMID: 29681847 PMCID: PMC5897739 DOI: 10.3389/fnagi.2018.00098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 03/22/2018] [Indexed: 01/21/2023] Open
Abstract
Presbycusis (age-related hearing loss) is a potential risk factor for tinnitus and cognitive deterioration, which result in poor life quality. Presbycusis-related tinnitus with cognitive impairment is a common phenotype in the elderly population. In these individuals, the central auditory system shows similar pathophysiological alterations as those observed in Alzheimer's disease (AD), including cholinergic hypofunction, epileptiform-like network synchronization, chronic inflammation, and reduced GABAergic inhibition and neural plasticity. Observations from experimental rodent models indicate that recovery of cholinergic function can improve memory and other cognitive functions via acetylcholine-mediated GABAergic inhibition enhancement, nicotinic acetylcholine receptor (nAChR)-mediated anti-inflammation, glial activation inhibition and neurovascular protection. The loss of cholinergic innervation of various brain structures may provide a common link between tinnitus seen in presbycusis-related tinnitus and age-related cognitive impairment. We hypothesize a key component of the condition is the withdrawal of cholinergic input to a subtype of GABAergic inhibitory interneuron, neuropeptide Y (NPY) neurogliaform cells. Cholinergic denervation might not only cause the degeneration of NPY neurogliaform cells, but may also result in decreased AChR activation in GABAergic inhibitory interneurons. This, in turn, would lead to reduced GABA release and inhibitory regulation of neural networks. Reduced nAChR-mediated anti-inflammation due to the loss of nicotinic innervation might lead to the transformation of glial cells and release of inflammatory mediators, lowering the buffering of extracellular potassium and glutamate metabolism. Further research will provide evidence for the recovery of cholinergic function with the use of cholinergic input enhancement alone or in combination with other rehabilitative interventions to reestablish inhibitory regulation mechanisms of involved neural networks for presbycusis-related tinnitus with cognitive impairment.
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Affiliation(s)
- Qingwei Ruan
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuowei Yu
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weibin Zhang
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Ruan
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunhui Liu
- Department of Otolaryngology, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruxin Zhang
- Department of Otolaryngology, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Gauvin DV, Yoder J, Zimmermann ZJ, Tapp R. Ototoxicity: The Radical Drum Beat and Rhythm of Cochlear Hair Cell Life and Death. Int J Toxicol 2018; 37:195-206. [PMID: 29575954 DOI: 10.1177/1091581818761128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The function and structure of the auditory information processing system establishes a unique sensory environment for the "perfect storm." The battle between life and death pits the cascade of an apoptotic storm, programmed cell death cascades, against simple cell death (necrosis) pathways. Live or die, the free radical biology of oxygen and hydroxylation, and the destruction of transition metal migration through the mechanical gate sensory processes of the hair cell lead to direct access to the cytoplasm, cytoplasmic reticulum, and mitochondria of the inner workings of the hair cells. These lead to subsequent interactions with nuclear DNA resulting in permanent hearing loss. The yin and yang of pharmaceutical product development is to document what kills, why it kills, and how do we mitigate it. This review highlights the processes of cell death within the cochlea.
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Affiliation(s)
- David V Gauvin
- 1 Neurobehavioral Sciences Department, MPI Research, Inc., Mattawan, MI, USA
| | - Joshua Yoder
- 1 Neurobehavioral Sciences Department, MPI Research, Inc., Mattawan, MI, USA
| | | | - Rachel Tapp
- 1 Neurobehavioral Sciences Department, MPI Research, Inc., Mattawan, MI, USA
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Peter N, Kleinjung T. Neuromodulation for tinnitus treatment: an overview of invasive and non-invasive techniques. J Zhejiang Univ Sci B 2018; 20:116-130. [PMID: 29770647 DOI: 10.1631/jzus.b1700117] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Tinnitus is defined as a perception of sound without any external sound source. Chronic tinnitus is a frequent condition that can affect the quality of life. So far, no causal cure for tinnitus has been documented, and most pharmacologic and psychosomatic treatment modalities aim to diminish tinnitus' impact on the quality of life. Neuromodulation, a novel therapeutic modality, which aims at alternating nerve activity through a targeted delivery of a stimulus, has emerged as a potential option in tinnitus treatment. This review provides a brief overview of the current neuromodulation techniques as tinnitus treatment options. The main intention is to provide updated knowledge especially for medical professionals counselling tinnitus patients in this emerging field of medicine. Non-invasive methods such as repetitive transcranial magnetic stimulation, transcranial electrical stimulation, neurofeedback, and transcutaneous vagus nerve stimulation were included, as well as invasive methods such as implanted vagus nerve stimulation and invasive brain stimulation. Some of these neuromodulation techniques revealed promising results; nevertheless, further research is needed, especially regarding the pathophysiological principle as to how these neuromodulation techniques work and what neuronal change they induce. Various studies suggest that individually different brain states and networks are involved in the generation and perception of tinnitus. Therefore, in the future, individually tailored neuromodulation strategies could be a promising approach in tinnitus treatment for achieving a more substantial and longer lasting improvement of complaints.
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Affiliation(s)
- Nicole Peter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich 8091, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich 8091, Switzerland
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Peng L, Mu K, Liu A, Zhou L, Gao Y, Shenoy IT, Mei Z, Chen Q. Transauricular vagus nerve stimulation at auricular acupoints Kindey (CO10), Yidan (CO11), Liver (CO12) and Shenmen (TF4) can induce auditory and limbic cortices activation measured by fMRI. Hear Res 2018; 359:1-12. [DOI: 10.1016/j.heares.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 01/28/2023]
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Pairing sound with vagus nerve stimulation modulates cortical synchrony and phase coherence in tinnitus: An exploratory retrospective study. Sci Rep 2017; 7:17345. [PMID: 29230011 PMCID: PMC5725594 DOI: 10.1038/s41598-017-17750-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/30/2017] [Indexed: 12/24/2022] Open
Abstract
Recent research has shown that vagus nerve stimulation (VNS) paired with tones or with rehabilitative training can help patients to achieve reductions in tinnitus perception or to expedite motor rehabilitation after suffering an ischemic stroke. The rationale behind this treatment is that VNS paired with experience can drive neural plasticity in a controlled and therapeutic direction. Since previous studies observed that gamma activity in the auditory cortex is correlated with tinnitus loudness, we assessed resting-state source-localized EEG before and after one to three months of VNS-tone pairing in chronic tinnitus patients. VNS-tone pairing reduced gamma band activity in left auditory cortex. VNS-tone pairing also reduced the phase coherence between the auditory cortex and areas associated with tinnitus distress, including the cingulate cortex. These results support the hypothesis that VNS-tone pairing can direct therapeutic neural plasticity. Targeted plasticity therapy might also be adapted to treat other conditions characterized by hypersynchronous neural activity.
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The Interval Between VNS-Tone Pairings Determines the Extent of Cortical Map Plasticity. Neuroscience 2017; 369:76-86. [PMID: 29129793 DOI: 10.1016/j.neuroscience.2017.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/25/2017] [Accepted: 11/02/2017] [Indexed: 11/23/2022]
Abstract
Repeatedly pairing vagus nerve stimulation (VNS) with a tone or movement drives highly specific and long-lasting plasticity in auditory or motor cortex, respectively. Based on this robust enhancement of plasticity, VNS paired with rehabilitative training has emerged as a potential therapy to improve recovery, even when delivered long after the neurological insult. Development of VNS delivery paradigms that reduce therapy duration and maximize efficacy would facilitate clinical translation. The goal of the current study was to determine whether primary auditory cortex (A1) plasticity can be generated more quickly by shortening the interval between VNS-tone pairing events or by delivering fewer VNS-tone pairing events. While shortening the inter-stimulus interval between VNS-tone pairing events resulted in significant A1 plasticity, reducing the number of VNS-tone pairing events failed to alter A1 responses. Additionally, shortening the inter-stimulus interval between VNS-tone pairing events failed to normalize neural and behavioral responses following acoustic trauma. Extending the interval between VNS-tone pairing events yielded comparable A1 frequency map plasticity to the standard protocol, but did so without increasing neural excitability. These results indicate that the duration of the VNS-event pairing session is an important parameter that can be adjusted to optimize neural plasticity for different clinical needs.
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Tyler R, Cacace A, Stocking C, Tarver B, Engineer N, Martin J, Deshpande A, Stecker N, Pereira M, Kilgard M, Burress C, Pierce D, Rennaker R, Vanneste S. Vagus Nerve Stimulation Paired with Tones for the Treatment of Tinnitus: A Prospective Randomized Double-blind Controlled Pilot Study in Humans. Sci Rep 2017; 7:11960. [PMID: 28931943 PMCID: PMC5607328 DOI: 10.1038/s41598-017-12178-w] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 09/05/2017] [Indexed: 12/19/2022] Open
Abstract
The aim of the pilot study was to evaluate the effect of Vagus Nerve Stimulation (VNS) paired with sounds in chronic tinnitus patients. All participants were implanted and randomized to a paired VNS (n = 16) or control (n = 14) group. After 6 weeks of home therapy, all participants received paired VNS. The device was used on 96% of days with good compliance. After 6 weeks, the paired VNS group improved on the Tinnitus Handicap Inventory (THI) (p = 0.0012) compared to controls (p = 0.1561). The between-group difference was 10.3% (p = 0.3393). Fifty percent of the participants in the paired VNS group showed clinically meaningful improvements compared to 28% in controls. At one year, 50% of participants had a clinically meaningful response. The therapy had greater benefits for participants with tonal and non-blast induced tinnitus at the end of 6 (24.3% vs. 2%, p = 0.05) and 12 weeks (34% vs. 2%, p = 0.004) compared to controls with 80% and 70% responding at 6 months and 1 year, respectively. Adverse effects were mild and well-tolerated and the therapy had a similar safety profile to VNS for epilepsy. VNS paired with tones may be effective for a subgroup of tinnitus patients and provides impetus for a larger pivotal study.
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Affiliation(s)
- Richard Tyler
- University of Iowa Department of Otolaryngology-Head and Neck Surgery and Communication Sciences and Disorders, The University of Iowa, Iowa City, IA, USA.
| | - Anthony Cacace
- Department of Communication Sciences & Disorders, Wayne State University, Detroit, MI, USA
| | - Christina Stocking
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA
| | - Brent Tarver
- MicroTransponder, Inc., 2802 Flintrock Trace, Suite 226, Austin, TX, USA
| | - Navzer Engineer
- MicroTransponder, Inc., 2802 Flintrock Trace, Suite 226, Austin, TX, USA
| | - Jeffrey Martin
- Callier Center for Communication Disorders, School for Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Aniruddha Deshpande
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY, USA
| | - Nancy Stecker
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA
| | - Melissa Pereira
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, USA
| | - Michael Kilgard
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, USA
| | - Chester Burress
- MicroTransponder, Inc., 2802 Flintrock Trace, Suite 226, Austin, TX, USA
| | - David Pierce
- MicroTransponder, Inc., 2802 Flintrock Trace, Suite 226, Austin, TX, USA
| | - Robert Rennaker
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX, USA
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, School for Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA
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Caspary DM, Llano DA. Auditory thalamic circuits and GABA A receptor function: Putative mechanisms in tinnitus pathology. Hear Res 2017; 349:197-207. [PMID: 27553899 PMCID: PMC5319923 DOI: 10.1016/j.heares.2016.08.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/28/2016] [Accepted: 08/17/2016] [Indexed: 01/02/2023]
Abstract
Tinnitus is defined as a phantom sound (ringing in the ears), and can significantly reduce the quality of life for those who suffer its effects. Ten to fifteen percent of the general adult population report symptoms of tinnitus with 1-2% reporting that tinnitus negatively impacts their quality of life. Noise exposure is the most common cause of tinnitus and the military environment presents many challenging high-noise situations. Military noise levels can be so intense that standard hearing protection is not adequate. Recent studies suggest a role for inhibitory neurotransmitter dysfunction in response to noise-induced peripheral deafferentation as a key element in the pathology of tinnitus. The auditory thalamus, or medial geniculate body (MGB), is an obligate auditory brain center in a unique position to gate the percept of sound as it projects to auditory cortex and to limbic structures. Both areas are thought to be involved in those individuals most impacted by tinnitus. For MGB, opposing hypotheses have posited either a tinnitus-related pathologic decrease or pathologic increase in GABAergic inhibition. In sensory thalamus, GABA mediates fast synaptic inhibition via synaptic GABAA receptors (GABAARs) as well as a persistent tonic inhibition via high-affinity extrasynaptic GABAARs and slow synaptic inhibition via GABABRs. Down-regulation of inhibitory neurotransmission, related to partial peripheral deafferentation, is consistently presented as partially underpinning neuronal hyperactivity seen in animal models of tinnitus. This maladaptive plasticity/Gain Control Theory of tinnitus pathology (see Auerbach et al., 2014; Richardson et al., 2012) is characterized by reduced inhibition associated with increased spontaneous and abnormal neuronal activity, including bursting and increased synchrony throughout much of the central auditory pathway. A competing hypothesis suggests that maladaptive oscillations between the MGB and auditory cortex, thalamocortical dysrhythmia, predict tinnitus pathology (De Ridder et al., 2015). These unusual oscillations/rhythms reflect net increased tonic inhibition in a subset of thalamocortical projection neurons resulting in abnormal bursting. Hyperpolarizing de-inactivation of T-type Ca2+ channels switches thalamocortical projection neurons into burst mode. Thalamocortical dysrhythmia originating in sensory thalamus has been postulated to underpin neuropathies including tinnitus and chronic pain. Here we review the relationship between noise-induced tinnitus and altered inhibition in the MGB.
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Affiliation(s)
- Donald M Caspary
- Department of Pharmacology and Neuroscience, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Daniel A Llano
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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Electrical Stimulation of the Ear, Head, Cranial Nerve, or Cortex for the Treatment of Tinnitus: A Scoping Review. Neural Plast 2016; 2016:5130503. [PMID: 27403346 PMCID: PMC4925995 DOI: 10.1155/2016/5130503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/22/2016] [Accepted: 05/18/2016] [Indexed: 11/18/2022] Open
Abstract
Tinnitus is defined as the perception of sound in the absence of an external source. It is often associated with hearing loss and is thought to result from abnormal neural activity at some point or points in the auditory pathway, which is incorrectly interpreted by the brain as an actual sound. Neurostimulation therapies therefore, which interfere on some level with that abnormal activity, are a logical approach to treatment. For tinnitus, where the pathological neuronal activity might be associated with auditory and other areas of the brain, interventions using electromagnetic, electrical, or acoustic stimuli separately, or paired electrical and acoustic stimuli, have been proposed as treatments. Neurostimulation therapies should modulate neural activity to deliver a permanent reduction in tinnitus percept by driving the neuroplastic changes necessary to interrupt abnormal levels of oscillatory cortical activity and restore typical levels of activity. This change in activity should alter or interrupt the tinnitus percept (reduction or extinction) making it less bothersome. Here we review developments in therapies involving electrical stimulation of the ear, head, cranial nerve, or cortex in the treatment of tinnitus which demonstrably, or are hypothesised to, interrupt pathological neuronal activity in the cortex associated with tinnitus.
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Sensorineural Tinnitus: Its Pathology and Probable Therapies. Int J Otolaryngol 2016; 2016:2830157. [PMID: 26977153 PMCID: PMC4761664 DOI: 10.1155/2016/2830157] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/12/2016] [Indexed: 12/11/2022] Open
Abstract
Tinnitus is not a single disease but a group of different diseases with different pathologies and therefore different treatments. Regarding tinnitus as a single disease is hampering progress in understanding of the pathophysiology of tinnitus and perhaps, more importantly, it is a serious obstacle in development of effective treatments for tinnitus. Subjective tinnitus is a phantom sound that takes many different forms and has similarities with chronic neuropathic pain. The pathology may be in the cochlea, in the auditory nerve, or, most commonly, in the brain. Like chronic neuropathic pain tinnitus is not life threatening but influences many normal functions such as sleep and the ability to concentrate on work. Some forms of chronic tinnitus have two components, a (phantom) sound and a component that may best be described as suffering or distress. The pathology of these two components may be different and the treatment that is most effective may be different for these two components. The most common form of treatment of tinnitus is pharmacological agents and behavioral treatment combined with sound therapy. Less common treatments are hypnosis and acupuncture. Various forms of neuromodulation are becoming in use in an attempt to reverse maladaptive plastic changes in the brain.
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Deng A, Liang X, Sun Y, Xiang Y, Yang J, Yan J, Sun W. Scopolamine attenuates auditory cortex response. Acta Otolaryngol 2015; 135:1132-7. [PMID: 26144861 DOI: 10.3109/00016489.2015.1064996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
CONCLUSION Scopolamine, a tropane alkaloid drug that mainly acts as an antagonist of muscarinic acetylcholine receptors, was found to reduce the local field potentials (LFP) of auditory cortex (AC) evoked by tone and gap-offsets whose effects may compensate the cortical hyperexcitability related to tinnitus. OBJECTIVE To study the effects of scopolamine on the AC and the inferior colliculus (IC) of awake rats in order to understand scopolamine's effect on tinnitus and gap detection. METHOD Silent gaps (duration varied from 2-100 ms) embedded in otherwise continuous noise were used to elicit AC and IC response. Gap evoked AC and IC field potentials were recorded from awake rats before and after treatment of scopolamine (3 mg/kg, i.m.). RESULTS Acute injection of scopolamine (3 mg/kg, i.m.) induced a significant reduction of the AC response, but not the IC response, to the offset of the gaps embedded in white noise. The results suggest that scopolamine may reduce AC neural synchrony.
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Affiliation(s)
- Anchun Deng
- a 1 Department of Otolaryngology Head and Neck Surgery, Xinqiao Hospital, Third Military Medical University , Chongqing, PR China
| | - Xiaojun Liang
- a 1 Department of Otolaryngology Head and Neck Surgery, Xinqiao Hospital, Third Military Medical University , Chongqing, PR China
| | - Yuchen Sun
- b 2 Center for Hearing and Deafness, Department of Communicative Disorders and Sciences, State University of New York at Buffalo , Buffalo, NY, USA
| | - Yanghong Xiang
- a 1 Department of Otolaryngology Head and Neck Surgery, Xinqiao Hospital, Third Military Medical University , Chongqing, PR China
| | - Junjie Yang
- a 1 Department of Otolaryngology Head and Neck Surgery, Xinqiao Hospital, Third Military Medical University , Chongqing, PR China
| | - Jingjing Yan
- a 1 Department of Otolaryngology Head and Neck Surgery, Xinqiao Hospital, Third Military Medical University , Chongqing, PR China
| | - Wei Sun
- b 2 Center for Hearing and Deafness, Department of Communicative Disorders and Sciences, State University of New York at Buffalo , Buffalo, NY, USA
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Hoare DJ, Whitham D, Henry JA, Shorter GW. Neuromodulation (desynchronisation) for tinnitus in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Derek J Hoare
- University of Nottingham; National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit; Ropewalk House, 113 The Ropewalk Nottingham UK NG1 5DU
| | - Diane Whitham
- Queen's Medical Centre; Nottingham Clinical Trials Unit; Room 2201 Clinical Trials Unit C Floor, South Block Nottingham UK NG7 2UH
| | - James A Henry
- VA Medical Center - NCRAR; National Center for Rehabilitative Auditory Research; 3710 SW US Veterans Hospital Road Portland USA OR 97239
- Oregon Hearing Research Center; Department of Otolaryngology; Oregon Health & Science University 3181 SW Sam Jackson Park Road Portland USA OR 97239-3098
| | - Gillian W Shorter
- University of Ulster; Bamford Centre for Mental Health and Wellbeing; Room MI020, Magee Campus Londonderry UK BT48 7JL
- University of Ulster; MRC All Ireland Hub for Trials Methodology Research; Northland Road Londonderry UK BT48 7JL
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Simonetti P, Oiticica J. Tinnitus Neural Mechanisms and Structural Changes in the Brain: The Contribution of Neuroimaging Research. Int Arch Otorhinolaryngol 2015; 19:259-65. [PMID: 26157502 PMCID: PMC4490922 DOI: 10.1055/s-0035-1548671] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/09/2015] [Indexed: 12/26/2022] Open
Abstract
Introduction Tinnitus is an abnormal perception of sound in the absence of an external stimulus. Chronic tinnitus usually has a high impact in many aspects of patients' lives, such as emotional stress, sleep disturbance, concentration difficulties, and so on. These strong reactions are usually attributed to central nervous system involvement. Neuroimaging has revealed the implication of brain structures in the auditory system. Objective This systematic review points out neuroimaging studies that contribute to identifying the structures involved in the pathophysiological mechanism of generation and persistence of various forms of tinnitus. Data Synthesis Functional imaging research reveals that tinnitus perception is associated with the involvement of the nonauditory brain areas, including the front parietal area; the limbic system, which consists of the anterior cingulate cortex, anterior insula, and amygdala; and the hippocampal and parahippocampal area. Conclusion The neuroimaging research confirms the involvement of the mechanisms of memory and cognition in the persistence of perception, anxiety, distress, and suffering associated with tinnitus.
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Affiliation(s)
- Patricia Simonetti
- Department of Otolaryngology, School of Medicine, University of São Paulo, Brazil
| | - Jeanne Oiticica
- Department of Otolaryngology, School of Medicine, University of São Paulo, Brazil
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