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Vijayakumar S, DiGuiseppi JA, Dabestani PJ, Ryan WG, Quevedo RV, Li Y, Diers J, Tu S, Fleegel J, Nguyen C, Rhoda LM, Imami AS, Hamoud ARA, Lovas S, McCullumsmith RE, Zallocchi M, Zuo J. In silico transcriptome screens identify epidermal growth factor receptor inhibitors as therapeutics for noise-induced hearing loss. SCIENCE ADVANCES 2024; 10:eadk2299. [PMID: 38896614 PMCID: PMC11186505 DOI: 10.1126/sciadv.adk2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 05/14/2024] [Indexed: 06/21/2024]
Abstract
Noise-induced hearing loss (NIHL) is a common sensorineural hearing impairment that lacks U.S. Food and Drug Administration-approved drugs. To fill the gap in effective screening models, we used an in silico transcriptome-based drug screening approach, identifying 22 biological pathways and 64 potential small molecule treatments for NIHL. Two of these, afatinib and zorifertinib [epidermal growth factor receptor (EGFR) inhibitors], showed efficacy in zebrafish and mouse models. Further tests with EGFR knockout mice and EGF-morpholino zebrafish confirmed their protective role against NIHL. Molecular studies in mice highlighted EGFR's crucial involvement in NIHL and the protective effect of zorifertinib. When given orally, zorifertinib was found in the perilymph with favorable pharmacokinetics. In addition, zorifertinib combined with AZD5438 (a cyclin-dependent kinase 2 inhibitor) synergistically prevented NIHL in zebrafish. Our results underscore the potential for in silico transcriptome-based drug screening in diseases lacking efficient models and suggest EGFR inhibitors as potential treatments for NIHL, meriting clinical trials.
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Affiliation(s)
- Sarath Vijayakumar
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Joseph A. DiGuiseppi
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Parinaz Jila Dabestani
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - William G. Ryan
- Department of Neurosciences, University of Toledo, Toledo, OH 43614, USA.
| | - Rene Vielman Quevedo
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Yuju Li
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Jack Diers
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Shu Tu
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Jonathan Fleegel
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Cassidy Nguyen
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Lauren M. Rhoda
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Ali Sajid Imami
- Department of Neurosciences, University of Toledo, Toledo, OH 43614, USA.
| | | | - Sándor Lovas
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Robert E. McCullumsmith
- Department of Neurosciences, University of Toledo, Toledo, OH 43614, USA.
- Neurosciences Institute, ProMedica, Toledo, OH 43606, USA
| | - Marisa Zallocchi
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Jian Zuo
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA
- Ting Therapeutics, University of California San Diego, 9310 Athena Circle, San Diego, CA 92037, USA
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Aoki S, Nozawa E. Pilot Study on Classification of Sensory Symptoms in PTSD. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:283-293. [PMID: 38938954 PMCID: PMC11199429 DOI: 10.1007/s40653-023-00602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 06/29/2024]
Abstract
PTSD treatment that focused on a sensory symptoms is increasing. The study aimed to explore symptoms and abnormalities in the five senses exhibited by persons with PTSD and to examine whether there are any differences depending on type of traumatic experience. Questionnaire was followed by interviews to clinical psychologists involved in the treatment of PTSD. 249 PTSD symptoms exhibited in the sensory organs were collected. Sensory symptoms were classified into three categories according to the type of symptoms and the type of traumatic events. Cluster 1 is a group formed by child abuse and violence together with audition, tactile, and hyperarousal. Cluster 2 is made up of natural disaster, accident, and sexual assault together with vision, olfaction and intrusion. Cluster 3 is made up of multiple traumas together with gustation and dissociation. It is speculated that the survivors of Child abuse and violence are hypersensitive to sounds, the presence of others, and physical contact because they try to quickly sense when a perpetrator is approaching. Natural disasters, accidents, and sexual assault are events with strong smell and severe visual impact, it is possible that they may easily cause reliving of the event in the form of shocking visual images and smells in flashbacks. Dissociation symptoms were related with complex trauma and taste. The mouth is the site of first contact between mother and child, and it is possible that gustatory dissociation may occur mainly in cases of severe and repeated trauma since early childhood.
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Affiliation(s)
- Sanae Aoki
- Faculty of Psychology, Department of Clinical Psychology, Rissho University, 4-2-16 Osaki, Shinagawa, Tokyo, 141-8602 Japan
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Coco L, Hooker ER, Gilbert TA, Prewitt AL, Reavis KM, O'Neil ME, Clark KD, Henry JA, Zaugg T, Carlson KF. Associations Between Traumatic Brain Injury and Severity of Tinnitus-Related Functional Impairment Among US Military Veterans: A National, Population-Based Study. J Head Trauma Rehabil 2024; 39:218-230. [PMID: 38709830 DOI: 10.1097/htr.0000000000000896] [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: 05/08/2024]
Abstract
OBJECTIVE To describe associations between a history of traumatic brain injury (TBI) and the severity of tinnitus-related functional impairment among a national, stratified random sample of veterans diagnosed with tinnitus by the Department of Veterans Affairs (VA) healthcare system. SETTING A multimodal (mailed and internet) survey administered in 2018. Participants: VA healthcare-using veterans diagnosed with tinnitus; veterans with comorbid TBI diagnosis were oversampled. DESIGN A population-based survey. MAIN MEASURES TBI history was assessed using International Classification of Diseases (ICD) diagnosis codes in veterans' VA electronic health records. The severity of participants' overall tinnitus-related functional impairment was measured using the Tinnitus Functional Index. Population prevalence and 95% confidence intervals (CIs) were estimated using inverse probability weights accounting for sample stratification and survey nonresponse. Veterans' relative risk ratios of very severe or moderate/severe tinnitus-related functional impairment, versus none/mild impairment, were estimated by TBI history using bivariable and multivariable multinomial logistic regression. RESULTS The population prevalence of TBI was 5.6% (95% CI: 4.8-6.4) among veterans diagnosed with tinnitus. Veterans with a TBI diagnosis, compared with those without a TBI diagnosis, had 3.6 times greater likelihood of rating their tinnitus-related impairment as very severe (95% CI: 2.1-6.3), and 1.5 times greater likelihood of rating their impairment as moderate/severe (95% CI: 1.0-2.4), versus none/mild. CONCLUSIONS These findings suggest an important role of TBI in the severity of tinnitus-related functional impairment among veterans. This knowledge can help inform the integration of tinnitus management services into the care received by veterans with TBI.
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Affiliation(s)
- Laura Coco
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California (Dr Coco); VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon (Drs Coco, O'Neil, and Carlson, Ms Hooker and Gilbert, and Mr Prewitt); Oregon Health & Science University-Portland State University School of Public Health, Portland (Ms Hooker, Mr Prewitt, and Drs Reavis, Clark, Zaugg, and Carlson); VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon (Drs Reavis, Henry, and Carlson); and Departments of Medical Informatics and Clinical Epidemiology (Drs O'Neil and Clark); and Otolaryngology-Head and Neck Surgery (Dr Henry), Oregon Health & Science University, Portland
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Sachdeva T, Ganpule SG. Twenty Years of Blast-Induced Neurotrauma: Current State of Knowledge. Neurotrauma Rep 2024; 5:243-253. [PMID: 38515548 PMCID: PMC10956535 DOI: 10.1089/neur.2024.0001] [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] [Indexed: 03/23/2024] Open
Abstract
Blast-induced neurotrauma (BINT) is an important injury paradigm of neurotrauma research. This short communication summarizes the current knowledge of BINT. We divide the BINT research into several broad categories-blast wave generation in laboratory, biomechanics, pathology, behavioral outcomes, repetitive blast in animal models, and clinical and neuroimaging investigations in humans. Publications from 2000 to 2023 in each subdomain were considered. The analysis of the literature has brought out salient aspects. Primary blast waves can be simulated reasonably in a laboratory using carefully designed shock tubes. Various biomechanics-based theories of BINT have been proposed; each of these theories may contribute to BINT by generating a unique biomechanical signature. The injury thresholds for BINT are in the nascent stages. Thresholds for rodents are reasonably established, but such thresholds (guided by primary blast data) are unavailable in humans. Single blast exposure animal studies suggest dose-dependent neuronal pathologies predominantly initiated by blood-brain barrier permeability and oxidative stress. The pathologies were typically reversible, with dose-dependent recovery times. Behavioral changes in animals include anxiety, auditory and recognition memory deficits, and fear conditioning. The repetitive blast exposure manifests similar pathologies in animals, however, at lower blast overpressures. White matter irregularities and cortical volume and thickness alterations have been observed in neuroimaging investigations of military personnel exposed to blast. Behavioral changes in human cohorts include sleep disorders, poor motor skills, cognitive dysfunction, depression, and anxiety. Overall, this article provides a concise synopsis of current understanding, consensus, controversies, and potential future directions.
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Affiliation(s)
- Tarun Sachdeva
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Shailesh G. Ganpule
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology Roorkee, Roorkee, India
- Department of Design, Indian Institute of Technology Roorkee, Roorkee, India
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Clark KD, Zaugg T, DeFrancesco S, Kaelin C, Henry JA, Carlson KF. Rehabilitation Service Needs and Preferences among Veterans with Tinnitus: A Qualitative Study. Semin Hear 2024; 45:29-39. [PMID: 38370519 PMCID: PMC10872667 DOI: 10.1055/s-0043-1770138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Tinnitus is prevalent among military Veterans, yet there is a gap between the demand and the provision of services for tinnitus rehabilitation services within the Veterans Health Administration (VHA). We sought to understand tinnitus rehabilitation service needs and preferences among Veterans with bothersome tinnitus who use Veterans Affairs (VA) services. We conducted semistructured telephone interviews in 2019 with Veterans diagnosed with tinnitus, who reported it as bothersome. Veterans were purposively sampled to represent national VA users, with and without comorbid traumatic brain injury (TBI), and who were or were not interested in tinnitus rehabilitation services. Qualitative data were analyzed using a modified grounded theory approach. Among 40 Veterans interviewed (32 men, 8 women; 50% with TBI), 72.5% endorsed being somewhat/very likely to be interested in tinnitus rehabilitation services while 27.5% were very/somewhat unlikely. Themes related to Veterans' interest in tinnitus rehabilitation services included barriers and facilitators to participation and preferences for receiving tinnitus services (e.g., individual vs. group-based; in-person vs. remote access). Our findings highlight factors that influence Veterans' reported need and preferences for, and readiness to engage in, rehabilitation services for tinnitus. Personalized or otherwise adaptable approaches to program delivery may help ensure maximal uptake among Veterans.
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Affiliation(s)
- Khaya D. Clark
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Oregon Health and Science University, Portland, Oregon
- Department of Defense, Hearing Center of Excellence, San Antonio, Texas
| | - Tara Zaugg
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
| | - Susan DeFrancesco
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon
- Oregon Health and Science University – Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Christine Kaelin
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
| | - James A. Henry
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kathleen F. Carlson
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon
- Oregon Health and Science University – Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon
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Davis H, Tang LA, M Picou E, Bastarache L, Tharpe AM. The Use of Electronic Health Records for Behavioral Phenotyping of School-Age Children With Unilateral Hearing Loss: A Methodological Approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:254-268. [PMID: 38056484 DOI: 10.1044/2023_jslhr-22-00610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE This methodological study describes a technique for extracting information from de-identified electronic health records (EHRs) to identify occurrences of permanent unilateral hearing loss (UHL) and associated educational comorbidities. METHOD This was an exploratory methodological study utilizing approximately 3.3 million de-identified medical records. Structured and unstructured data were extracted using both automated and manual methods. When both methods were available, positive and negative predictive values were calculated to evaluate the utility of using automated methods. RESULTS We defined a cohort of 471 records that met our criteria of school-age children with permanent UHL and no additional significant disabilities/diagnoses. Fifty-one percent of the children reflected in this cohort had indicators of adverse educational progress, defined as documentation of receiving educational services, speech-language therapy, and/or parental/teacher concern, with 12% of records reflecting overlapping services/concerns. Negative predictive values were generally high and positive predictive values were generally low, suggesting automated searches are useful for excluding factors of interest, but not finding them. CONCLUSIONS This study demonstrates the feasibility of using EHRs in examining UHL in school-age children. By restricting our cohort to individuals who were seen in audiology clinic, we were able to capture variables such as educational difficulty that are not routinely ascertained in medical contexts. The proportion of children in this cohort demonstrating a marker of adverse educational progress is consistent with numerous prior observational studies, thus providing validity to this ascertainment approach. We describe challenges encountered in creating this cohort and detail our hybrid approach to ascertaining key variables accurately.
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Affiliation(s)
- Hilary Davis
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Leigh Anne Tang
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Anne Marie Tharpe
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Shao N, Skotak M, Pendyala N, Rodriguez J, Ravula AR, Pang K, Perumal V, Rao KVR, Chandra N. Temporal Changes in Functional and Structural Neuronal Activities in Auditory System in Non-Severe Blast-Induced Tinnitus. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1683. [PMID: 37763802 PMCID: PMC10535376 DOI: 10.3390/medicina59091683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Epidemiological data indicate that blast exposure is the most common morbidity responsible for mild TBI among Service Members (SMs) during recent military operations. Blast-induced tinnitus is a comorbidity frequently reported by veterans, and despite its wide prevalence, it is also one of the least understood. Tinnitus arising from blast exposure is usually associated with direct structural damage that results in a conductive and sensorineural impairment in the auditory system. Tinnitus is also believed to be initiated by abnormal neuronal activities and temporal changes in neuroplasticity. Clinically, it is observed that tinnitus is frequently accompanied by sleep disruption as well as increased anxiety. In this study, we elucidated some of the mechanistic aspects of sensorineural injury caused by exposure to both shock waves and impulsive noise. The isolated conductive auditory damage hypothesis was minimized by employing an animal model wherein both ears were protected. Materials and Methods: After the exposure, the animals' hearing circuitry status was evaluated via acoustic startle response (ASR) to distinguish between hearing loss and tinnitus. We also compared the blast-induced tinnitus against the well-established sodium salicylate-induced tinnitus model as the positive control. The state of the sensorineural auditory system was evaluated by auditory brainstem response (ABR), and this test helped examine the neuronal circuits between the cochlea and inferior colliculus. We then further evaluated the role of the excitatory and inhibitory neurotransmitter receptors and neuronal synapses in the auditory cortex (AC) injury after blast exposure. Results: We observed sustained elevated ABR thresholds in animals exposed to blast shock waves, while only transient ABR threshold shifts were observed in the impulsive noise group solely at the acute time point. These changes were in concert with the increased expression of ribbon synapses, which is suggestive of neuroinflammation and cellular energy metabolic disorder. It was also found that the onset of tinnitus was accompanied by anxiety, depression-like symptoms, and altered sleep patterns. By comparing the effects of shock wave exposure and impulsive noise exposure, we unveiled that the shock wave exerted more significant effects on tinnitus induction and sensorineural impairments when compared to impulsive noise. Conclusions: In this study, we systematically studied the auditory system structural and functional changes after blast injury, providing more significant insights into the pathophysiology of blast-induced tinnitus.
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Affiliation(s)
- Ningning Shao
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 111 Lock Street, Newark, NJ 07102, USA
| | - Maciej Skotak
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 111 Lock Street, Newark, NJ 07102, USA
| | - Navya Pendyala
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 111 Lock Street, Newark, NJ 07102, USA
| | - Jose Rodriguez
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 111 Lock Street, Newark, NJ 07102, USA
| | - Arun Reddy Ravula
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 111 Lock Street, Newark, NJ 07102, USA
| | - Kevin Pang
- NeuroBehavioral Research Laboratory, VA New Jersey Health Care System, Research and Development (Mailstop 15), 385 Tremont Ave, East Orange, NJ 07018, USA
- Department of Pharmacology, Physiology and Neuroscience, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA
| | - Venkatesan Perumal
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 111 Lock Street, Newark, NJ 07102, USA
| | - Kakulavarapu V. Rama Rao
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 111 Lock Street, Newark, NJ 07102, USA
| | - Namas Chandra
- Center for Injury Biomechanics, Materials and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, 111 Lock Street, Newark, NJ 07102, USA
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Vijayakumar S, DiGuiseppi JA, Dabestani J, Ryan WG, Vielman Quevedo R, Li Y, Diers J, Tu S, Fleegel J, Nguyen C, Rhoda LM, Imami AS, Hamoud AAR, Lovas S, McCullumsmith R, Zallocchi M, Zuo J. In Silico Transcriptome-based Screens Identify Epidermal Growth Factor Receptor Inhibitors as Therapeutics for Noise-induced Hearing Loss. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.07.544128. [PMID: 37333346 PMCID: PMC10274759 DOI: 10.1101/2023.06.07.544128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Noise-Induced Hearing Loss (NIHL) represents a widespread disease for which no therapeutics have been approved by the Food and Drug Administration (FDA). Addressing the conspicuous void of efficacious in vitro or animal models for high throughput pharmacological screening, we utilized an in silico transcriptome-oriented drug screening strategy, unveiling 22 biological pathways and 64 promising small molecule candidates for NIHL protection. Afatinib and zorifertinib, both inhibitors of the Epidermal Growth Factor Receptor (EGFR), were validated for their protective efficacy against NIHL in experimental zebrafish and murine models. This protective effect was further confirmed with EGFR conditional knockout mice and EGF knockdown zebrafish, both demonstrating protection against NIHL. Molecular analysis using Western blot and kinome signaling arrays on adult mouse cochlear lysates unveiled the intricate involvement of several signaling pathways, with particular emphasis on EGFR and its downstream pathways being modulated by noise exposure and Zorifertinib treatment. Administered orally, Zorifertinib was successfully detected in the perilymph fluid of the inner ear in mice with favorable pharmacokinetic attributes. Zorifertinib, in conjunction with AZD5438 - a potent inhibitor of cyclin dependent kinase 2 - produced synergistic protection against NIHL in the zebrafish model. Collectively, our findings underscore the potential application of in silico transcriptome-based drug screening for diseases bereft of efficient screening models and posit EGFR inhibitors as promising therapeutic agents warranting clinical exploration for combatting NIHL. Highlights In silico transcriptome-based drug screens identify pathways and drugs against NIHL.EGFR signaling is activated by noise but reduced by zorifertinib in mouse cochleae.Afatinib, zorifertinib and EGFR knockout protect against NIHL in mice and zebrafish.Orally delivered zorifertinib has inner ear PK and synergizes with a CDK2 inhibitor.
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Myers EE, Joseph AR, Dougherty AL, Clouser MC, MacGregor AJ. Relationship Between Tinnitus and Hearing Outcomes Among US Military Personnel After Blast Injury. Ear Hear 2023; 44:300-305. [PMID: 36253906 DOI: 10.1097/aud.0000000000001285] [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: 11/05/2022]
Abstract
OBJECTIVES To examine the association between tinnitus and hearing outcomes among US military personnel after blast injury, including any hearing loss, low-frequency hearing loss, high-frequency hearing loss, early warning shift, and significant threshold shift. DESIGN In this retrospective study, the Blast-Related Auditory Injury Database was queried for male military service members who had audiometric data 2 years before and after blast injury between 2004 and 2012 with no history of hearing loss or tinnitus before injury (n = 1693). Tinnitus was defined by diagnostic codes in electronic health records. Multivariable logistic regression examined the association between tinnitus and hearing outcomes, while adjusting for covariates. RESULTS Overall, 14.2% (n = 241) of the study sample was diagnosed with tinnitus within 2 years after blast injury. The proportions of all examined hearing outcomes were higher among service members with tinnitus than those without ( p < 0.001). In multivariable analysis, service members with tinnitus had higher adjusted odds of any hearing loss (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.20-2.47), low-frequency hearing loss (OR = 2.77, 95% CI = 1.80-4.26), high-frequency hearing loss (OR = 2.15, 95% CI = 1.47-3.16), early warning shift (OR = 1.83, 95% CI = 1.36-2.45), and significant threshold shift (OR = 2.15, 95% CI = 1.60-2.89) compared with service members without tinnitus. CONCLUSIONS The findings of this study demonstrate that tinnitus diagnosed within 2 years after blast injury is associated with the examined hearing outcomes in US military personnel. Service members with blast injury who subsequently experience tinnitus should receive routine audiometric hearing conservation testing and be carefully examined for poor hearing outcomes by an audiologist.
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Affiliation(s)
- Emily E Myers
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Antony R Joseph
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
- Hearing Loss Prevention Laboratory, Communication Sciences and Disorders Department, Illinois State University, Normal, Illinois, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Mary C Clouser
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
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Le Prell CG, Clavier OH, Bao J. Noise-induced hearing disorders: Clinical and investigational tools. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:711. [PMID: 36732240 PMCID: PMC9889121 DOI: 10.1121/10.0017002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
A series of articles discussing advanced diagnostics that can be used to assess noise injury and associated noise-induced hearing disorders (NIHD) was developed under the umbrella of the United States Department of Defense Hearing Center of Excellence Pharmaceutical Interventions for Hearing Loss working group. The overarching goals of the current series were to provide insight into (1) well-established and more recently developed metrics that are sensitive for detection of cochlear pathology or diagnosis of NIHD, and (2) the tools that are available for characterizing individual noise hazard as personal exposure will vary based on distance to the sound source and placement of hearing protection devices. In addition to discussing the utility of advanced diagnostics in patient care settings, the current articles discuss the selection of outcomes and end points that can be considered for use in clinical trials investigating hearing loss prevention and hearing rehabilitation.
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Affiliation(s)
- Colleen G Le Prell
- Department of Speech, Language, and Hearing Science, University of Texas at Dallas, Richardson, Texas 75080, USA
| | | | - Jianxin Bao
- Gateway Biotechnology Inc., St. Louis, Missouri 63132, USA
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11
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Hwang PH, Nelson LD, Sharon JD, McCrea MA, Dikmen SS, Markowitz AJ, Manley GT, Temkin NR. Association Between TBI-Related Hearing Impairment and Cognition: A TRACK-TBI Study. J Head Trauma Rehabil 2022; 37:E327-E335. [PMID: 34698685 PMCID: PMC9035476 DOI: 10.1097/htr.0000000000000735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between hearing impairment and cognitive function after traumatic brain injury (TBI). SETTING A total of 18 level I trauma centers throughout the United States in the T ransforming R esearch a nd C linical K nowledge in TBI (TRACK-TBI) study. PARTICIPANTS From February 2014 to June 2018, a total of 2697 participants with TBI were enrolled in TRACK-TBI. Key eligibility criteria included external force trauma to the head, presentation to a participating level I trauma center, and receipt of a clinically indicated head computed tomographic (CT) scan within 24 hours of injury. A total of 1267 participants were evaluated in the study, with 216 participants with hearing impairment and 1051 participants without hearing impairment. Those with missing or unknown hearing status or cognitive assessment were excluded from analysis. DESIGN Prospective, observational cohort study. MAIN MEASURES Hearing impairment at 2 weeks post-TBI was based on self-report. Participants who indicated worse hearing in one or both ears were defined as having hearing impairment, whereas those who denied worse hearing in either ear were defined as not having hearing impairment and served as the reference group. Cognitive outcomes at 6 months post-TBI included executive functioning and processing speed, as measured by the Trail Making Test (TMT) B/A and the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index subscale (WAIS-IV PSI), respectively. RESULTS TBI-related hearing impairment had a small but significantly greater TMT B/A ratio than without TBI-related hearing impairment: mean difference ( B ) = 0.25; 95% CI, 0.07 to 0.43; P = .005. No significant mean differences on WAIS-IV PSI scores were found between participants with and without TBI-related hearing impairment: B = 0.36; 95% CI, -2.07 to 2.60; P = .825. CONCLUSION We conclude that TBI-related hearing impairment at 6 months postinjury was significantly associated with worse executive functioning but not cognitive processing speed.
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Affiliation(s)
- Phillip H Hwang
- Department of Anatomy & Neurobiology, Boston University, Boston, Massachusetts (Dr Hwang); Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee (Drs Nelson and McCrea); Departments of Otolaryngology (Dr Sharon) and Neurological Surgery (Dr Manley), University of California San Francisco; Departments of Rehabilitation Medicine (Dr Dikmen), Neurological Surgery (Dr Temkin), and Biostatistics (Dr Temkin), University of Washington, Seattle; and Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California (Ms Markowitz)
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Swan AA, Akin FW, Amuan ME, Riska KM, Hall CD, Kalvesmaki A, Padilla S, Crowsey E, Pugh MJ. Disruptive Dizziness Among Post-9/11 Veterans With Deployment-Related Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:199-212. [PMID: 34320551 DOI: 10.1097/htr.0000000000000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify disruption due to dizziness symptoms following deployment-related traumatic brain injury (TBI) and factors associated with receiving diagnoses for these symptoms. SETTING Administrative medical record data from the Department of Veterans Affairs (VA). PARTICIPANTS Post-9/11 veterans with at least 3 years of VA care who reported at least occasional disruption due to dizziness symptoms on the comprehensive TBI evaluation. DESIGN A cross-sectional, retrospective, observational study. MAIN MEASURES International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes of dizziness, vestibular dysfunction, and other postconcussive conditions; neurobehavioral Symptom Inventory. RESULTS Increased access to or utilization of specialty care at the VA was significant predictors of dizziness and/or vestibular dysfunction diagnoses in the fully adjusted model. Veterans who identified as Black non-Hispanic and those with substance use disorder diagnoses or care were substantially less likely to receive dizziness and vestibular dysfunction diagnoses. CONCLUSIONS Access to specialty care was the single best predictor of dizziness and vestibular dysfunction diagnoses, underscoring the importance of facilitating referrals to and utilization of specialized, comprehensive clinical facilities or experts for veterans who report disruptive dizziness following deployment-related TBI. There is a clear need for an evidence-based pathway to address disruptive symptoms of dizziness, given the substantial variation in audiovestibular tests utilized by US providers by region and clinical specialty. Further, the dearth of diagnoses among Black veterans and those in more rural areas underscores the potential for enhanced cultural competency among providers, telemedicine, and patient education to bridge existing gaps in the care of dizziness.
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Affiliation(s)
- Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio, San Antonio (Dr Swan and Ms Crowsey); South Texas Veterans Health Care System, San Antonio (Dr Swan); James H Quillen VA Medical Center, Mountain Home, Tennessee (Drs Akin and Hall); Departments of Audiology and Speech Language Pathology (Dr Akin) and Rehabilitative Sciences (Dr Hall), East Tennessee State University, Johnson City; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah (Mss Amuan and Padilla and Drs Kalvesmaki and Pugh); Department of Internal Medicine, University of Utah, Salt Lake City (Mss Amuan and Padilla and Drs Kalvesmaki and Pugh); Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina (Dr Riska); and Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina (Dr Riska)
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Le Prell CG. Prevention of Noise-Induced Hearing Loss Using Investigational Medicines for the Inner Ear: Previous Trial Outcomes Should Inform Future Trial Design. Antioxid Redox Signal 2022; 36:1171-1202. [PMID: 34346254 PMCID: PMC9221155 DOI: 10.1089/ars.2021.0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/13/2022]
Abstract
Significance: Noise-induced hearing loss (NIHL) is an important public health issue resulting in decreased quality of life for affected individuals, and significant costs to employers and governmental agencies. Recent Advances: Advances in the mechanistic understanding of NIHL have prompted a growing number of proposed, in-progress, and completed clinical trials for possible protections against NIHL via antioxidants and other drug agents. Thirty-one clinical trials evaluating prevention of either temporary or permanent NIHL were identified and are reviewed. Critical Issues: This review revealed little consistency in the noise-exposed populations in which drugs are evaluated or the primary outcomes used to measure NIHL prevention. Changes in pure-tone thresholds were the most common primary outcomes; specific threshold metrics included both average hearing loss and incidence of significant hearing loss. Changes in otoacoustic emission (OAE) amplitude were relatively common secondary outcomes. Extended high-frequency (EHF) hearing and speech-in-noise perception are commonly adversely affected by noise exposure but are not consistently included in clinical trials assessing prevention of NIHL. Future Directions: Multiple criteria are available for monitoring NIHL, but the specific criterion to be used to define clinically significant otoprotection remains a topic of discussion. Audiogram-based primary outcome measures can be combined with secondary outcomes, including OAE amplitude, EHF hearing, speech-in-noise testing, tinnitus surveys, and patient-reported outcomes. Standardization of test protocols for the above primary and secondary outcomes, and associated reporting criterion for each, would facilitate clinical trial design and comparison of results across investigational drug agents. Antioxid. Redox Signal. 36, 1171-1202.
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Affiliation(s)
- Colleen G. Le Prell
- Department of Speech, Language, and Hearing Science, University of Texas at Dallas, Richardson, Texas, USA
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Cifu DX. Clinical research findings from the long-term impact of military-relevant brain injury consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) 2013-2021. Brain Inj 2022; 36:587-597. [PMID: 35080997 DOI: 10.1080/02699052.2022.2033843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This is a summary of the published research from the 14 observational, longitudinal and big-data, epidemiological studies supported by the LIMBIC-CENC program from 2013-2021 examining the long-term effects of combat-related traumatic brain injury (TBI). Findings from these 43 primary and secondary analyses include: 1) unique fluid, advanced neuroimaging and electrophysiologic biomarkers associated with mild traumatic brain injury (mTBI), number of mTBIs and related dysfunction, 2) increases in a range of chronic difficulties, including neurosensory, sleep, pain, cognitive deficits, behavioral disorders, overall symptom burden, healthcare costs and service-connected disability, associated with mTBI, all-severity traumatic brain injury (TBI), blast exposure, and number of mTBIs, and 3) increases in the risk for suicide and neurodegeneration, including dementia and Parkinson's disease, associated with mTBI and all-severity TBI. Ongoing LIMBIC-CENC longitudinal and epidemiologic research will clarify, confirm and expand upon these findings.
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Affiliation(s)
- David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Veterans Affairs, Washington, DC, USA
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A Retrospective Study of the Effects of Traumatic Brain Injury on Auditory Function: From a Clinical Perspective. NEUROSCI 2022. [DOI: 10.3390/neurosci3010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: The main purpose of this retrospective study was to identify auditory dysfunctions related to traumatic brain injury (TBI) in individuals evaluated in an Audiology clinic. Method: Peripheral and central auditory evaluations were performed from March 2014 to June 2018 in 26 patients (14 males) with TBI. The age of the participants ranged from 9 to 59 years old (34.24 ± 15.21). Six participants had blast-related TBI and 20 had blunt force TBI. Sixteen experienced a single TBI event whereas ten experienced several. Correlation analyses were performed to verify the relationship, if any, between the number of auditory tests failed and the number, type, and severity of TBIs. Result: All participants failed at least one auditory test. Nearly 60% had abnormal results on degraded speech tests (compressed and echoed, filtered or in background noise) and 25% had a high frequency hearing loss. There was no statistically significant correlation between the number of auditory tests failed and the number, type, and severity of TBIs. Conclusion: Results indicated negative and heterogenous effects of TBI on peripheral and central auditory function and highlighted the need for a more extensive auditory assessment in individuals with TBI.
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Moore BCJ, Lowe DA, Cox G. Guidelines for Diagnosing and Quantifying Noise-Induced Hearing Loss. Trends Hear 2022; 26:23312165221093156. [PMID: 35469496 PMCID: PMC9052822 DOI: 10.1177/23312165221093156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper makes recommendations for the diagnosis and quantification of noise-induced hearing loss (NIHL) in a medico-legal context. A distinction is made between NIHL produced by: steady broadband noise, as occurs in some factories; more impulsive factory sounds, such as hammering; noise exposure during military service, which can involve very high peak sound levels; and exposure to very intense tones. It is argued that existing diagnostic methods, which were primarily developed to deal with NIHL produced by steady broadband noise, are not adequate for the diagnosis of NIHL produced by different types of exposures. Furthermore, some existing diagnostic methods are based on now-obsolete standards, and make unrealistic assumptions. Diagnostic methods are proposed for each of the types of noise exposure considered. It is recommended that quantification of NIHL for all types of exposures is based on comparison of the measured hearing threshold levels with the age-associated hearing levels (AAHLs) for a non-noise exposed population, as specified in ISO 7029 (2017), usually using the 50th percentile, but using another percentile if there are good reasons for doing so. When audiograms are available both soon after the end of military service and some time afterwards, the most recent audiogram should be used for diagnosis and quantification, since this reflects any effect of the noise exposure on the subsequent progression of hearing loss. It is recommended that the overall NIHL for each ear be quantified as the average NIHL across the frequencies 1, 2, and 4 kHz.
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Affiliation(s)
- Brian C J Moore
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, UK
| | - David A Lowe
- ENT Department, 156705James Cook University Hospital, Cleveland, UK
| | - Graham Cox
- ENT Department (retired), 6397Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Self-reported auditory problems are associated with adverse mental health outcomes and alcohol misuse in the UK Armed Forces. Soc Psychiatry Psychiatr Epidemiol 2022; 57:563-573. [PMID: 34480596 PMCID: PMC8934320 DOI: 10.1007/s00127-021-02169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/26/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Auditory problems, such as hearing loss and tinnitus, have been associated with mental health problems and alcohol misuse in the UK general population and in the US Armed Forces; however, few studies have examined these associations within the UK Armed Forces. The present study examined the association between auditory problems and probable common mental disorders, post-traumatic stress disorder and alcohol misuse. METHODS 5474 serving and ex-service personnel from the UK Armed Forces were examined, selected from those who responded to phase two (data collection 2007-09) and phase three (2014-16) of a military cohort study. Multivariable logistic regression was used to examine the association between auditory problems at phase two and mental health problems at phase three. RESULTS 9.7% of participants reported ever experiencing hearing problems alone, 7.9% reported tinnitus within the last month alone, and 7.8% reported hearing problems with tinnitus. After adjustment, hearing problems with tinnitus at phase two was associated with increased odds of probable common mental disorders (AOR = 1.50, 95% CI 1.09-2.08), post-traumatic stress disorder (AOR = 2.30, 95% CI 1.41-3.76), and alcohol misuse (AOR = 1.94, 95% CI 1.28-2.96) at phase three. Tinnitus alone was associated with probable post-traumatic stress disorder (AOR = 1.80, 95% CI 1.03-3.15); however, hearing problems alone were not associated with any outcomes of interest. CONCLUSIONS The association between auditory problems and mental health problems emphasises the importance of the prevention of auditory problems in the Armed Forces: through enhanced audiometric screening, improved hearing protection equipment, and greater levels of utilisation of such equipment.
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Giuliani NP. Factors Associated With Hearing Aid Wear Time in a Subset of U.S. Military Veterans: Tinnitus, the Presence of One or More Neurologic Conditions, and Unaided Speech Intelligibility Index. Am J Audiol 2021; 30:1114-1119. [PMID: 34546769 DOI: 10.1044/2021_aja-21-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE A retrospective analysis was conducted to explore how tinnitus, one or more neurologic conditions, unaided speech intelligibility index, and other comorbidities impact the average number of hours hearing aids are worn each day by U.S. Military Veterans. METHOD Medical records and a hearing aid database were queried to obtain information regarding active medical problems and average daily hearing aid wear time. Multiple linear regression was used to explore these relationships for 215 male Veterans whose records were available from 2009 to 2020. To be analyzed, Veterans must have possessed their hearing aid(s) for at least 3 consecutive months. RESULTS An active problem of subjective tinnitus was associated with increased hearing aid wear time (positive association) and one or more active neurologic conditions were associated with decreased hearing aid wear time (negative association). A high unaided speech intelligibility index (greater access to speech sounds without hearing aids) was also associated with decreased hearing aid wear time (negative association). CONCLUSIONS There are many complex audiologic and medical concerns that may affect hearing aid wear time in U.S. Military Veterans. Therefore, the information from this study should be expanded on prospectively by further exploring these associations, and their severity, on hearing aid wear time. The information from this and future studies may lead to clinical recommendations with the goal of increasing daily hearing aid use in this and other populations.
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Affiliation(s)
- Nicholas P. Giuliani
- Audiology and Speech Language Pathology, James H. Quillen VA Medical Center, Mountain Home, TN
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Gratias P, Nasr J, Affortit C, Ceccato JC, François F, Casas F, Pujol R, Pucheu S, Puel JL, Wang J. Impulse Noise Induced Hidden Hearing Loss, Hair Cell Ciliary Changes and Oxidative Stress in Mice. Antioxidants (Basel) 2021; 10:antiox10121880. [PMID: 34942983 PMCID: PMC8698479 DOI: 10.3390/antiox10121880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022] Open
Abstract
Recent studies demonstrated that reversible continuous noise exposure may induce a temporary threshold shift (TTS) with a permanent degeneration of auditory nerve fibers, although hair cells remain intact. To probe the impact of TTS-inducing impulse noise exposure on hearing, CBA/J Mice were exposed to noise impulses with peak pressures of 145 dB SPL. We found that 30 min after exposure, the noise caused a mean elevation of ABR thresholds of ~30 dB and a reduction in DPOAE amplitude. Four weeks later, ABR thresholds and DPOAE amplitude were back to normal in the higher frequency region (8–32 kHz). At lower frequencies, a small degree of PTS remained. Morphological evaluations revealed a disturbance of the stereociliary bundle of outer hair cells, mainly located in the apical regions. On the other hand, the reduced suprathreshold ABR amplitudes remained until 4 weeks later. A loss of synapse numbers was observed 24 h after exposure, with full recovery two weeks later. Transmission electron microscopy revealed morphological changes at the ribbon synapses by two weeks post exposure. In addition, increased levels of oxidative stress were observed immediately after exposure, and maintained for a further 2 weeks. These results clarify the pathology underlying impulse noise-induced sensory dysfunction, and suggest possible links between impulse-noise injury, cochlear cell morphology, metabolic changes, and hidden hearing loss.
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Affiliation(s)
- Paul Gratias
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, 34091 Montpellier, France; (P.G.); (J.N.); (C.A.); (J.-C.C.); (F.F.); (R.P.); (J.-L.P.)
| | - Jamal Nasr
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, 34091 Montpellier, France; (P.G.); (J.N.); (C.A.); (J.-C.C.); (F.F.); (R.P.); (J.-L.P.)
| | - Corentin Affortit
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, 34091 Montpellier, France; (P.G.); (J.N.); (C.A.); (J.-C.C.); (F.F.); (R.P.); (J.-L.P.)
| | - Jean-Charles Ceccato
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, 34091 Montpellier, France; (P.G.); (J.N.); (C.A.); (J.-C.C.); (F.F.); (R.P.); (J.-L.P.)
| | - Florence François
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, 34091 Montpellier, France; (P.G.); (J.N.); (C.A.); (J.-C.C.); (F.F.); (R.P.); (J.-L.P.)
| | - François Casas
- Unité Dynamique Du Muscle et Métabolisme (DMEM), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), University Montpellier, 34060 Montpellier, France;
| | - Rémy Pujol
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, 34091 Montpellier, France; (P.G.); (J.N.); (C.A.); (J.-C.C.); (F.F.); (R.P.); (J.-L.P.)
| | - Sylvie Pucheu
- Cilcare, 371 Rue du Professeur J. Blayac, 34080 Montpellier, France;
| | - Jean-Luc Puel
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, 34091 Montpellier, France; (P.G.); (J.N.); (C.A.); (J.-C.C.); (F.F.); (R.P.); (J.-L.P.)
| | - Jing Wang
- Institute for Neurosciences of Montpellier (INM), University Montpellier, INSERM, 34091 Montpellier, France; (P.G.); (J.N.); (C.A.); (J.-C.C.); (F.F.); (R.P.); (J.-L.P.)
- ENT Department, Hospital and University of Montpellier, 34091 Montpellier, France
- Correspondence: ; Tel.: +33-499-636-048; Fax: +33-499-636-020
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Swan AA, Nelson JT, Pogoda TK, Akin FW, Riska KM, Hall CD, Amuan ME, Yaffe K, Pugh MJ. Association of Traumatic Brain Injury With Vestibular Dysfunction and Dizziness in Post-9/11 Veterans. J Head Trauma Rehabil 2021; 35:E253-E265. [PMID: 31569144 DOI: 10.1097/htr.0000000000000513] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the prevalence and impact of vestibular dysfunction and nonspecific dizziness diagnoses and explore their associations with traumatic brain injury (TBI) severity, mechanism, and postconcussive comorbidities among post-9/11 veterans. SETTING Administrative medical record data from the US Departments of Defense and Veterans Affairs (VA). PARTICIPANTS Post-9/11 veterans with at least 3 years of VA care. DESIGN Cross-sectional, retrospective, observational study. MAIN MEASURES International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for TBI, vestibular dysfunction, dizziness, and other commonly associated postconcussive conditions; Neurobehavioral Symptom Inventory. RESULTS Of the 570 248 post-9/11 veterans in this sample, 0.45% had a diagnosis of vestibular dysfunction and 2.57% had nonspecific dizziness. Those with either condition were more likely to have evidence of TBI (57.11% vs 28.51%) and reported more disruption from neurobehavioral symptoms. Blast and nonblast injuries were associated with greater symptom disruption, particularly in combination. CONCLUSIONS There was a consistent, significant association between TBI and vestibular dysfunction or nonspecific dizziness, after controlling for sociodemographic factors, injury mechanism, and comorbid conditions. Given that most deployed post-9/11 veterans report blast and/or nonblast injuries, the need for prompt identification and management of these conditions and symptoms is clear.
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Affiliation(s)
- Alicia A Swan
- University of Texas at San Antonio (Dr Swan); Department of Defense Hearing Center of Excellence, Defense Health Agency, San Antonio, Texas (Dr Nelson); Ho-Chunk, Inc, Alexandria, Virginia (Dr Nelson); Department of Radiology and Imaging Sciences, School of Medicine, Indiana University, Indianapolis (Dr Nelson); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts (Dr Pogoda); Boston University School of Public Health, Boston, Massachusetts (Dr Pogoda); James H. Quillen VA Medical Center, Mountain Home, Tennessee (Drs Akin and Hall); Departments of Audiology and Speech Language Pathology (Dr Akin) and Physical Therapy (Dr Hall), East Tennessee State University, Johnson City; Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina (Dr Riska); Center for Health Care Organization and Implementation Research, Edith Nourse Rogers VA Medical Center, Bedford, Massachusetts (Ms Amuan); Departments of Psychiatry, Neurology and Epidemiology, School of Medicine, University of California San Francisco (Dr Yaffe); Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah (Dr Pugh); and Department of Internal Medicine, The University of Utah, Salt Lake City (Dr Pugh)
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Electronic Health Records As a Platform for Audiological Research: Data Validity, Patient Characteristics, and Hearing-Aid Use Persistence Among 731,213 U.S. Veterans. Ear Hear 2021; 42:927-940. [PMID: 33974367 PMCID: PMC8221720 DOI: 10.1097/aud.0000000000000980] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This article presents a summary of audiological, general health, and hearing aid (HA) outcome data in a large sample of U.S. Veterans receiving HAs. The current article also provides the foundation for a series of papers that will explore relationships between a wide range of factors and HA outcomes. DESIGN The patient sample is all (n = 731,213) patients for whom HAs were ordered between April 2012 and October 2014 through the U.S. Veterans Health Administration Remote Order Entry System. For these patients, Veterans Affairs electronic health records (EHRs) stored in various databases provided data on demographics, received diagnostic and procedure codes (2007 to 2017), audiometry, self-reported outcomes up to 6 months postfitting, and HA battery orders (to 2017). Data cleaning and preparation was carried out and is discussed with reference to insights that provide potential value to other researchers pursuing similar studies. HA battery order data over time was used to derive a measure of long-term HA use persistence. Descriptive statistics were used to characterize the sample, comparative analyses against other data supported basic validity assessment, and bivariate analyses probed novel associations between patient characteristics and HA use persistence at 2 years postfitting. RESULTS Following extensive cleaning and data preparation, the data show plausible characteristics on diverse metrics and exhibit adequate validity based on comparisons with other published data. Further, rates of HA use persistence are favorable when compared against therapy persistence data for other major chronic conditions. The data also show that the presence of certain comorbid conditions (Parkinson's disease, diabetes, arthritis, and visual impairment) are associated with significantly lower HA use persistence, as are prior inpatient admissions (especially among new HA recipients), and that increasing levels of multimorbidity, in general, are associated with decreasing HA use persistence. This is all despite the fact that deriving relevant audiological care-process variables from the available records was not straightforward, especially concerning the definition of the date of HA fitting, and the use of battery ordering data to determine long-term HA use persistence. CONCLUSIONS We have shown that utilizing EHRs in audiology has the potential to provide novel insights into clinical practice patterns, audiologic outcomes, and relations between factors pertaining to hearing and to other health conditions in clinical populations, despite the potential pitfalls regarding the lack of control over the variables available and limitations on how the data are entered. We thus conclude that research using EHRs has the potential to be an integral supplement to population-based and epidemiologic research in the field of audiology.
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Noise Outcomes in Servicemembers Epidemiology (NOISE) Study: Design, Methods, and Baseline Results. Ear Hear 2021; 42:870-885. [PMID: 33974792 DOI: 10.1097/aud.0000000000000974] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Military Service members and Veterans commonly report hearing loss and tinnitus, both of which can result in significant disability. During military service, Service members are exposed to many different types of loud noise, which is strongly associated with hearing loss and tinnitus. Other military-related exposures, such as chemicals and traumatic brain injury (TBI), are also linked with auditory problems. The purpose of the "Noise Outcomes in Servicemembers Epidemiology" (NOISE) study is to gather information from Active-Duty Service members and recently separated Veterans about their military and nonmilitary noise exposures, other relevant military and nonmilitary exposures, and potential outcomes of these exposures including tinnitus, hearing loss, and other hearing-related health concerns. DESIGN The NOISE study assesses lifetime noise exposures, chemical and blast exposures, TBI, physical and psychiatric comorbidities, and other military and nonmilitary exposures and outcomes that can affect auditory function. Participants undergo comprehensive in-person audiologic examinations; those who experience tinnitus undergo a complete tinnitus assessment. Exposures and select outcomes are reassessed annually by mail, and the comprehensive in-person assessment is completed every 5 years. This report presents descriptive, baseline data obtained from the first 690 participants enrolled between 2014 and 2018. RESULTS Some notable findings from this analysis include: (1) the prevalence of hearing loss in the sample was 8% for low frequencies (0.25 to 2 kHz), 20% for high frequencies (3 to 8 kHz), and 39% for extended high frequencies (9 to 16 kHz); (2) the prevalence of tinnitus was 53%; (3) the prevalence of both hearing loss and tinnitus was higher among those with higher age, more years of military service, greater degree of noise exposure, and exposures to blasts and/or TBI in the military; and (4) tinnitus was most prevalent among participants who serve/served in the Army relative to the other military branches. CONCLUSIONS The NOISE study is acquiring comprehensive data on military-related auditory dysfunction. It is the first of its kind to enroll active Service members and recently separated Veterans into a longitudinal study to examine the etiology and outcomes of tinnitus and hearing loss in this population. Although these data do not necessarily represent the entire military and Veteran populations, ongoing enrollment is focused on increasing generalizability and will also provide the statistical power to conduct multivariable analyses. This will allow us to examine longitudinal associations of interest while controlling for potential confounders and other possible sources of error. These data will provide critical knowledge to refine future military hearing conservation efforts and inform efforts to develop future treatments.
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Lowe DA, Moore BCJ. Audiometric assessment of hearing loss sustained during military service. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:1030. [PMID: 34470327 DOI: 10.1121/10.0005846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
An analysis is presented of the audiograms, obtained using Telephonics TDH39 headphones (Huntington, NY), of 80 men claiming compensation for noise-induced hearing loss (NIHL) sustained during military service. A comparison with an independent database of audiograms collected using other headphones suggested that no adjustment was needed to the hearing threshold levels (HTLs) at 6 kHz to allow for the use of TDH39 headphones. The method of Moore [(2020). J. Acoust. Soc. Am. 148, 884-894] for diagnosing military noise-induced hearing loss (M-NIHL) gave a positive diagnosis for 92.5% of right ears and 97.5% of left ears. The mean HTLs were maximal and similar at 4, 6, and 8 kHz but with considerable individual variability. A comparison with age-expected HTLs showed that M-NIHL was typically greatest at 3, 4, 6, or 8 kHz but with considerable individual variability. M-NIHL values were positive from 0.5 to 8 kHz. The HTLs were significantly higher for the left than for the right ears, but the asymmetry varied across individuals and could usually be ascribed to specific features of the noise exposure. The asymmetry existed over the range from 0.5 to 8 kHz, supporting the idea that M-NIHL occurs over a wide frequency range. Tinnitus was reported by 76 of the 80 men.
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Affiliation(s)
- David A Lowe
- ENT Department. James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, United Kingdom
| | - Brian C J Moore
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, United Kingdom
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Biswas R, Lugo A, Genitsaridi E, Trpchevska N, Akeroyd MA, Cederroth CR, Liu X, Schlee W, Garavello W, Gallus S, Hall DA. Modifiable lifestyle-related risk factors for tinnitus in the general population: An overview of smoking, alcohol, body mass index and caffeine intake. PROGRESS IN BRAIN RESEARCH 2021; 263:1-24. [PMID: 34243884 DOI: 10.1016/bs.pbr.2021.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Tinnitus is a symptom and not a disease in its own right. A number of medical conditions are known to increase the risk of developing tinnitus. Most known risk factors are otological or neurological, but general health and lifestyle can also precipitate the condition. Understanding these modifiable risk factors can help to identify vulnerable groups and can inform preventive actions to reduce likelihood of developing tinnitus. Smoking, alcohol consumption, body mass index (BMI) and caffeine intake are all lifestyle risk factors hypothesized to be related to tinnitus. Nonetheless, research findings in support of those relationships are somewhat mixed. METHODS A systematic review was conducted to identify all relevant studies on the specific risk factors. Findings were summarized using a narrative synthesis and meta-analysis, where possible. RESULTS Overall 384 studies were included, mostly using cross-sectional designs. Findings indicated significantly increased risk of tinnitus among current (based on 26 studies) and ever smokers (based on 16 studies) and among obese people (based on seven studies), but no effect of alcohol consumption (based on 11 studies). With respect to caffeine intake or coffee drinking, only three studies examined this risk factor and so we were unable to draw conclusions. CONCLUSION Our results contribute to quantifying the relationship between tinnitus and specific lifestyle-related risk factors, and we highlight some of the gaps and inconsistencies across published studies.
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Affiliation(s)
- Roshni Biswas
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Eleni Genitsaridi
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Natalia Trpchevska
- Experimental Audiology, Department of Physiology and Pharmacology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Michael A Akeroyd
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Christopher R Cederroth
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom; Experimental Audiology, Department of Physiology and Pharmacology, Biomedicum, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoqiu Liu
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Werner Garavello
- Department of Otorhinolaryngology, School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Deborah A Hall
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, United Kingdom; Heriot-Watt University Malaysia, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
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25
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Castle CL, Engward H, Kersey T. Arts activity and well-being for visually impaired military veterans: a narrative discussion of current knowledge. Public Health 2021; 194:232-237. [PMID: 33962101 DOI: 10.1016/j.puhe.2021.03.010] [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: 09/30/2020] [Revised: 02/10/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objective of this study was to offer an overview of literature relating to the topic of arts as activity within the context of military and veteran health and to consider the implications of current knowledge on future research with visually impaired veterans. STUDY DESIGN A search for literature addressing the topic of visual art activities with visually impaired veterans was undertaken. No research addressing this topic was identified. A review of literature on the related topics of mental health and well-being in military veterans, visual impairment and mental health and well-being, and art therapy for veteran populations was carried out to offer an overview of current knowledge. RESULTS While there is growing evidence of the benefits of arts engagement among both general and military populations, the role of the visual arts in the everyday lives of broader veteran samples, and the impact of these activities on holistic well-being, remains underexplored. The current article highlights the need for art as activity to be differentiated from art as therapy and argues that the former might offer a tool to positively impact the holistic well-being of visually impaired veterans. CONCLUSIONS Future research relating to the use of visual art activities in the context of veteran health and well-being should endeavour to explore the potential impacts of engagement on holistic well-being. Research is needed to build on anecdotal evidence of the positive impact of arts engagement on visually impaired veterans by systematically exploring if, and how, holistic well-being in this population may be impacted by engagement with visual art activities.
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Affiliation(s)
- C L Castle
- Research and Innovation Department, Blind Veterans UK, 12-14 Harcourt Street, W1H 4HD, London, UK; BRAVO VICTOR, Research, 12-14 Harcourt Street, W1H 4HD, London, UK.
| | - H Engward
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Chelmsford, Essex, UK
| | - T Kersey
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Chelmsford, Essex, UK
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Prewitt A, Harker G, Gilbert TA, Hooker E, O'Neil ME, Reavis KM, Henry JA, Carlson KF. Mental Health Symptoms Among Veteran VA Users by Tinnitus Severity:A Population-based Survey. Mil Med 2021; 186:167-175. [PMID: 33499436 DOI: 10.1093/milmed/usaa288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Tinnitus is prevalent among Service members and Veterans and is often comorbid with mental health disorders. Associations between the severity of individuals' tinnitus and mental health symptoms are not well described. MATERIALS AND METHODS We conducted a population-based survey of a stratified random sample of 1,800 Veterans diagnosed with tinnitus. We used the Tinnitus Functional Index to measure tinnitus severity and the Primary Care-Posttraumatic Stress Disorder (PTSD) screen and the Hospital Anxiety and Depression Scale to assess PTSD, depression, and anxiety. Descriptive statistics and bivariable and multivariable regression models were used to estimate associations between Veterans' tinnitus severity and mental health symptoms. Inverse probability weights were used to account for sample stratification and survey non-response. Multivariable odds ratios (ORs) and 95% confidence intervals (CIs) controlled for Veterans' demographics, military history, and health diagnoses. RESULTS A total of 891 Veterans completed surveys (adjusted response rate = 53%). Large proportions rated their tinnitus as severe (29.4%; 95% CI: 27.2-31.6) or very severe (18.7%; 95% CI: 16.8-20.5). In multivariable regression models, and compared with Veterans with none/mild tinnitus, the likelihood of screening positive for PTSD was increased for those who reported moderate (OR = 4.0; 95% CI: 1.6-10.3), severe (OR = 7.5; 95% CI: 3.1-18.5), or very severe (OR = 17.5; 95% CI: 4.4-70.0) tinnitus. Similarly, Veterans' likelihood of positive depression screens were elevated for those with moderate (OR = 2.6; 95% CI: 1.1-5.9), severe (OR = 3.0; 95% CI: 1.4-6.5), or very severe (OR = 15.5; 95% CI: 4.3-55.5) tinnitus, as was the likelihood of positive anxiety screens for those with severe (OR = 2.6; 95% CI: 1.1-6.3) or very severe (OR = 13.4; 95% CI: 4.0-44.3) tinnitus. CONCLUSIONS Mental health symptoms are strongly associated with Veterans' tinnitus severity. A better understanding of the interplay between these conditions may help improve the provision of interdisciplinary (Audiology and Mental Health) care for Service members and Veterans.
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Affiliation(s)
- Austin Prewitt
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR 97239, USA.,Oregon Health and Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Road (GH230), Oregon Health and Science University, Portland, OR 97239, USA
| | - Graham Harker
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR 97239, USA.,Oregon Health and Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Road (GH230), Oregon Health and Science University, Portland, OR 97239, USA
| | - Tess A Gilbert
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR 97239, USA
| | - Elizabeth Hooker
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR 97239, USA
| | - Maya E O'Neil
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR 97239, USA.,VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR),Portland, OR 97239, USA.,Department of Psychiatry, School of Medicine, 3181 SW Sam Jackson Park Road (GH230), Oregon Health and Science University, Portland, OR 97239, USA.,Department of Medical Informatics and Clinical Epidemiology, School of Medicine, 3181 SW Sam Jackson Park Road (BICC), Oregon Health & Science University, Portland, OR 97239, USA
| | - Kelly M Reavis
- Oregon Health and Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Road (GH230), Oregon Health and Science University, Portland, OR 97239, USA.,VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR),Portland, OR 97239, USA
| | - James A Henry
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR),Portland, OR 97239, USA.,Department of Otolaryngology - Head & Neck Surgery, School of Medicine, 3181 SW Sam Jackson Park Road (PV01), Oregon Health & Science University, Portland, OR 97239, USA
| | - Kathleen F Carlson
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, OR 97239, USA.,Oregon Health and Science University - Portland State University School of Public Health, 3181 SW Sam Jackson Park Road (GH230), Oregon Health and Science University, Portland, OR 97239, USA.,VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR),Portland, OR 97239, USA
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Pienkowski M. Loud Music and Leisure Noise Is a Common Cause of Chronic Hearing Loss, Tinnitus and Hyperacusis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4236. [PMID: 33923580 PMCID: PMC8073416 DOI: 10.3390/ijerph18084236] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/20/2022]
Abstract
High sound levels capable of permanently damaging the ear are experienced not only in factories and war zones but in concert halls, nightclubs, sports stadiums, and many other leisure environments. This review summarizes evidence that loud music and other forms of "leisure noise" are common causes of noise-induced hearing loss, tinnitus, and hyperacusis, even if audiometric thresholds initially remain within clinically normal limits. Given the huge global burden of preventable noise-induced hearing loss, noise limits should be adopted in a much broader range of settings, and education to promote hearing conservation should be a higher public health priority.
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Affiliation(s)
- Martin Pienkowski
- Osborne College of Audiology, Salus University, Elkins Park, PA 19027, USA
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28
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Lewis RM, Jahn KN, Parthasarathy A, Goedicke WB, Polley DB. Audiometric Predictors of Bothersome Tinnitus in a Large Clinical Cohort of Adults With Sensorineural Hearing Loss. Otol Neurotol 2021; 41:e414-e421. [PMID: 32176119 DOI: 10.1097/mao.0000000000002568] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify demographic and audiometric predictors of bothersome tinnitus within a large clinical cohort. STUDY DESIGN Retrospective chart review. SETTING Tertiary care hospital. PATIENTS 51,989 English-speaking patients between 18 and 80 years of age that received initial audiometric evaluations at the Massachusetts Eye and Ear Infirmary between the years 2000 and 2016. MAIN OUTCOME MEASURES Patients were categorized according to whether or not tinnitus was the primary reason for their visit. The likelihood of tinnitus as a primary complaint (TPC) was evaluated as a function of age, sex, and audiometric configuration. Patient-reported tinnitus percepts were qualitatively assessed in relation to audiometric configuration. RESULTS Approximately 20% of adults who presented for an initial hearing evaluation reported TPC. The prevalence of TPC increased with advancing age until approximately 50 to 54 years, and then declined thereafter. In general, men were significantly more likely to report TPC than women. TPC was statistically associated with specific audiogram configurations. In particular, TPC was most prevalent for notched and steeply sloping hearing losses, but was relatively uncommon in adults with flat losses. Patients with frequency-restricted threshold shifts often reported tonal tinnitus percepts, while patients with asymmetric configurations tended to report broadband percepts. CONCLUSIONS The probability of seeking audiological evaluation for bothersome tinnitus is highest for males, middle-aged patients, and those with notched or high-frequency hearing losses. These findings support the theory that tinnitus arises from sharp discontinuities in peripheral afferent innervation and cochlear amplification, which may induce topographically restricted changes in the central auditory pathway.
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Affiliation(s)
- Rebecca M Lewis
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Kelly N Jahn
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Aravindakshan Parthasarathy
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | | | - Daniel B Polley
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
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29
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Luha A, Kaart T, Merisalu E, Indermitte E, Orru H. Hearing Problems Among the Members of the Defence Forces in Relation to Personal and Occupational Risk Factors. Mil Med 2021; 185:e2115-e2123. [PMID: 32879984 DOI: 10.1093/milmed/usaa224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The Defence Forces' members are exposed to high-level noise that increases their risk of hearing loss (HL). Besides military noise, the other risk factors include age and gender, ototoxic chemicals, vibration, and chronic stress. The current study was designed to study the effects of personal, work conditions-related risk factors, and other health-related traits on the presence of hearing problems. MATERIALS AND METHODS A cross-sectional study among active military service members was carried out. Altogether, 807 respondents completed a questionnaire about their health and personal and work-related risk factors in indoor and outdoor environments. The statistical analysis was performed using statistical package of social sciences (descriptive statistics) and R (correlation and regression analysis) software. RESULTS Almost half of the active service members reported HL during their service period. The most important risk factors predicting HL in the military appeared to be age, gender, and service duration. Also, working in a noisy environment with exposure to technological, vehicle, and impulse noise shows a statistically significant effect on hearing health. Moreover, we could identify the effect of stress on tinnitus and HL during the service period. Most importantly, active service members not using hearing protectors, tend to have more tinnitus than those who use it. CONCLUSIONS The members of the Defence Forces experience noise from various sources, most of it resulting from outdoor activities. Personal and work conditions-related risk factors as well as stress increase the risk of hearing problems.
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Affiliation(s)
- Assar Luha
- Institute of Technology, Estonian University of Life Sciences, Kreutzwaldi 56/1, Tartu 51006, Estonia
| | - Tanel Kaart
- Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Kreutzwaldi 62, Tartu 51006, Estonia
| | - Eda Merisalu
- Institute of Technology, Estonian University of Life Sciences, Kreutzwaldi 56/1, Tartu 51006, Estonia
| | - Ene Indermitte
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia
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Sajja V, Long JB, Tenn CC. Editorial: Neurosensory Alterations From Blast Exposure and Blunt Impact. Front Neurol 2021; 12:674626. [PMID: 33897614 PMCID: PMC8060435 DOI: 10.3389/fneur.2021.674626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Venkatasivasaisujith Sajja
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States.,The Geneva Foundation, Tacoma, WA, United States
| | - Joseph B Long
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Catherine C Tenn
- Casualty Management Section, Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, AB, Canada
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MacGregor AJ, Joseph AR, Markwald RR, Dougherty AL. The Relationship Between Blast-related Hearing Threshold Shift and Insomnia in U.S. Military Personnel. Mil Med 2021; 186:844-849. [PMID: 33580669 DOI: 10.1093/milmed/usaa567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Hearing loss and insomnia emerged as preeminent sources of morbidity among military service members and veterans who served in the recent Iraq and Afghanistan conflicts. Significant threshold shift (STS), an early indicator of hearing loss, has not been studied in relation to insomnia. This study's objective was to examine the co-occurrence of STS and insomnia among U.S. military personnel with blast-related injury. MATERIALS AND METHODS A total of 652 service members who were blast-injured during military operations in Iraq or Afghanistan between 2004 and 2012 were identified from the Blast-Related Auditory Injury Database. Pre- and post-injury audiometric data were used to ascertain new-onset STS, defined as 30 dB or greater increase for the sum of thresholds at 2,000, 3,000, and 4,000 Hz for either ear. Insomnia diagnosed within 2 years post-injury was abstracted from electronic medical records. Multivariable logistic regression analysis examined the relationship between STS and insomnia, while adjusting for age, year of injury, occupation, injury severity, tinnitus and concussion diagnosed in-theater, and PTSD. RESULTS A majority of the study sample was aged 18-25 years (79.9%) and sustained mild-to-moderate injuries (92.2%). STS was present in 21.1% of service members. Cumulative incidence of diagnosed insomnia was 22.3% and 11.1% for those with and without STS, respectively. After adjusting for covariates, those with STS had nearly 2-times higher odds of insomnia (odds ratio (OR) = 1.91, 95% CI = 1.12-3.24) compared with those without STS. In multivariable modeling, the strongest association was between PTSD and insomnia (OR = 5.57, 95% CI = 3.35-9.26). A secondary finding of note was that military personnel with STS had a significantly higher frequency of PTSD compared with those without STS (28.1% vs. 15.2%). CONCLUSIONS Hearing threshold shift was associated with insomnia in military personnel with blast-related injury and could be used to identify service members at risk. Multidisciplinary care is needed to manage the co-occurrence of both conditions during the post-deployment rehabilitation phase. Future research should evaluate the specific mechanisms involved in this relationship and further explore the association between hearing threshold shift and PTSD.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Antony R Joseph
- Hearing Loss Prevention Laboratory, Communication Sciences and Disorders Department, Illinois State University, Normal, IL 61790, USA.,Leidos, Inc, San Diego, CA 92106, USA
| | - Rachel R Markwald
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA 92106, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106, USA.,Leidos, Inc, San Diego, CA 92106, USA
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Nakashima A, Vartanian O, Rhind SG, King K, Tenn C, Jetly CR. Repeated Occupational Exposure to Low-level Blast in the Canadian Armed Forces: Effects on Hearing, Balance, and Ataxia. Mil Med 2021; 187:e201-e208. [PMID: 33492379 DOI: 10.1093/milmed/usaa439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/03/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Recently, there has been increasing concern about the adverse health effects of long-term occupational exposure to low-level blast in military personnel. Occupational blast exposure occurs routinely in garrison through use of armaments and controlled blast detonations. In the current study, we focused on a population of breaching instructors and range staff. Breaching is a tactical technique that is used to gain entry into closed spaces, often through the use of explosives. MATERIALS AND METHODS Initial measurements of blast overpressure collected during breaching courses found that up to 10% of the blasts for range staff and up to 32% of the blasts for instructors exceeded the recommended 3 psi exposure limit. Using a cross-sectional design, we used tests of balance, ataxia, and hearing to compare a sample of breachers (n = 19) to age-and sex-matched military controls (n = 19). RESULTS There were no significant differences between the two groups on the balance and ataxia tests, although the average scores of both groups were lower than would be expected in a normative population. The prevalence of hearing loss was low in the breacher group (4 of 19), and hearing thresholds were not significantly different from the controls. However, the prevalence of self-reported tinnitus was significantly higher in the breacher group (12 of 19) compared with the controls (4 of 19), and all breachers who were identified as having hearing loss also reported tinnitus. CONCLUSIONS Our results suggest that basic tests of balance, ataxia, and hearing on their own were not sensitive to the effects of long-term occupational exposure to low-level blast. Some of the blast exposure levels exceeded limits, and there was a significant association of exposure with tinnitus. Future studies should supplement with additional information including exposure history and functional hearing assessments. These findings should be considered in the design of future acute and longitudinal studies of low-level blast exposure.
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Affiliation(s)
- Ann Nakashima
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada
| | - Oshin Vartanian
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada
| | - Kristen King
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, M3K 2C9, Canada
| | - Catherine Tenn
- Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, AB, T1A 8K5, Canada
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Orru H, Luha A, Pindus M, Jõgeva R, Vahisalu M, Lekk U, Indermitte E, Merisalu E. Hearing loss among military personnel in relation to occupational and leisure noise exposure and usage of personal protective equipment. Noise Health 2021; 22:90-98. [PMID: 33402609 PMCID: PMC8000139 DOI: 10.4103/nah.nah_12_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context: Hearing loss (HL) is a major health concern among military personnel due to noise from shooting, blasts, military vehicles, and noisy training environments. Nevertheless, one’s exposure can be partially reduced by using personal protective equipment (PPE). The aim of this study is to estimate the prevalence of HL among military personnel, to analyse associations between HL and self-reported occupational and leisure noise exposure, and use of PPEs. Materials and Methods: A cross-sectional study was conducted among 150 military personnel during their routine medical examinations. First, all participants filled in a questionnaire about their exposure to noise and later the respondents went through an audiometric test. The diagnostic criteria for slight, moderate, and severe HL was HL of 25–40, 41–60, and >60 dB at 4 and 6 kHz, respectively. The associations between noise exposure and HL were studied with multinomial logistic regression analysis. Results: The prevalence of slight to severe HL in high frequencies (4 and 6 kHz) among study participants was 62.7%. Nevertheless, the majority of it was slight, as the prevalence of severe HL was 9.3%. The prevalence of any kind of HL was highest in the Navy and the prevalence of severe HL was highest in the Central Command Units. The relative risk ratios (RRRs) for HL were higher among those who had been working for a long time in a noisy environment, working with noise-producing equipment, driving in a PASI or a Bandvagn or had been shooting with blanks at least once per week. It also appeared that military personnel who had HL, reported tinnitus more often. Respondents’ previous health problems, music-listening habits, and amount of exposure to loud noise in non-military environments were not independently associated with HL, but in several cases it increased the RRRs together with military exposure. We also found significantly more frequent HL among those never using PPEs. Conclusion: HL loss was more prevalent among personnel who are more often exposed to military noise, especially among those who never use PPEs. The effect was enhanced by leisure time noise, but it was not independently associated to HL.
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Affiliation(s)
- Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Assar Luha
- Institute of Technology, Estonian University of Life Sciences, Tartu, Estonia
| | - Mihkel Pindus
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | | | - Urve Lekk
- The North Medical Centre, Tallinn, Estonia
| | - Ene Indermitte
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Eda Merisalu
- Institute of Technology, n University of Life Sciences, Tartu, Estonia
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Yan L, Wang W, Wu X, Fang Q, Yang J. Clinical characteristics of subjective idiopathic tinnitus and preliminarily analyses for the effect of tinnitus multielement integration sound therapy. Eur Arch Otorhinolaryngol 2021; 278:4199-4207. [PMID: 33388978 DOI: 10.1007/s00405-020-06501-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the psychoacoustic and audiological characteristics of patients with chronic subjective tinnitus and provide basis for the personalized diagnosis and treatment of tinnitus through a single tinnitus multielement integration sound therapy (T-MIST) and analysis of efficacy preliminarily. METHODS 145 patients with tinnitus were assessed by systematic medical history collection, professional examination of otolaryngology, audiology examination, full precision test (FPT), residual inhibition test (RIT), tinnitus handicap inventory (THI) and visual analog scale (VAS) annoyance. The correlation among factors was performed. RESULTS The frequency of tinnitus was correlated with the frequency of maximum hearing loss (P < 0.05). The loudness of tinnitus was correlated with the loudness of maximum hearing loss (P < 0.05). In this study, T-MIST was used to treat tinnitus. After treatment, tinnitus alleviated VAS annoyance (P < 0.05). The results of RIT were correlated with the effect of T-MIST (P < 0.05). CONCLUSION There was a correlation between tinnitus and hearing loss. The RIT may indicate the effectiveness of acoustic therapy in patients. The FPT can find the hidden hearing loss without display on routine pure tone audiometry, so as to provide a clinical reference for the detection of early hearing loss in tinnitus patients.
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Affiliation(s)
- Lin Yan
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230000, China
| | - Weiqing Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230000, China
| | - Xiaoman Wu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230000, China
| | - Qi Fang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230000, China
| | - Jianming Yang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230000, China.
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Han BI, Lee HW, Ryu S, Kim JS. Tinnitus Update. J Clin Neurol 2021; 17:1-10. [PMID: 33480192 PMCID: PMC7840320 DOI: 10.3988/jcn.2021.17.1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022] Open
Abstract
This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss, somatosensory system dysfunction, or auditory cortex dysfunction, with hearing loss being the most common cause and serious underlying pathologies being rare. Hearing loss does not always lead to tinnitus, and patients with tinnitus do not always suffer from hearing loss. The first scenario is explained by a so-called inhibitory gating mechanism, whereas the second assumes that all tinnitus sufferers have some degree of hearing impairment, which might not be detected in standard audiological examinations. The treatments should aim at symptomatic relief and management of associated distress. Current treatment options include pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy.
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Affiliation(s)
| | - Ho Won Lee
- Department of Neurology, Kyungpook National University, Daegu, Korea
| | - Sanghyo Ryu
- Department of Neurology, Haedong Hospital, Busan, Korea.
| | - Ji Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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Chen KH, Su SB, Chen KT. An overview of occupational noise-induced hearing loss among workers: epidemiology, pathogenesis, and preventive measures. Environ Health Prev Med 2020; 25:65. [PMID: 33129267 PMCID: PMC7603754 DOI: 10.1186/s12199-020-00906-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/25/2020] [Indexed: 12/20/2022] Open
Abstract
Occupational noise-induced hearing loss (ONIHL) is the most prevalent occupational disease in the world. The goal of this study was to review the epidemiology, pathogenesis, and preventive measures of ONIHL among workers and provide evidence for the implementation of control measures. Literature studies were identified from the MEDLINE, PubMed, Embase, Web of Science, and Google Scholar using the search terms “noise-induced hearing loss” “prevalence”, “pathogenesis”, and “preventive measures”. The articles reviewed in this report were limited from 2000 to 2020. Articles that were not published in the English language, manuscripts without an abstract, and opinion articles were excluded. After a preliminary screening, all of the articles were reviewed and synthesized to provide an overview of the current status of ONIHL among workers. The mechanism of ONIHL among workers is a complex interaction between environmental and host factors (both genetic and acquired factors). The outcomes of noise exposure are different among individual subjects. Clinical trials are currently underway to evaluate the treatment effect of antioxidants on ONIHL. Noise exposure may contribute to temporary or permanent threshold shifts; however, even temporary threshold shifts may predispose an individual to eventual permanent hearing loss. Noise prevention programs are an important preventive measure in reducing the morbidity of ONIHL among workers.
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Affiliation(s)
- Kou-Huang Chen
- School of Mechanical and Electronic Engineering, Sanming University, Sanming, 365, Fujian Province, China
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, 710, Taiwan
| | - Kow-Tong Chen
- Department of Occupational Medicine, Tainan Municipal Hospital (managed by Show Chwan Medical Care Corporation), No. 670, Chongde Road, East District, Tainan, 701, Taiwan. .,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan.
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MacGregor AJ, Joseph AR, Dougherty AL. Prevalence of Tinnitus and Association with Self-Rated Health among Military Personnel Injured on Combat Deployment. Mil Med 2020; 185:e1608-e1614. [PMID: 32592390 DOI: 10.1093/milmed/usaa103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/28/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Tinnitus is an auditory problem frequently reported by military personnel and is currently responsible for 1 billion dollars annually in disability compensation. Recent military conflicts in Iraq and Afghanistan saw high levels of combat exposure coupled with a surge in blast weaponry, both of which can adversely affect hearing. The present study explored the prevalence of tinnitus and the association with self-rated health among military personnel injured during combat deployment. MATERIALS AND METHODS A total of 1,026 U.S. military personnel who sustained an injury during operations (592 battle blast, 73 battle nonblast, 361 nonbattle) in Iraq were identified from clinical records. Post-Deployment Health Assessments administered at two separate points in time were used to identify self-reported tinnitus symptoms and self-rated health within 1 year of injury. RESULTS Those with a battle blast injury had the highest prevalence of tinnitus with 19.1% and 31.3% on the first and second health assessments, respectively. In a multivariate model adjusting for combat exposure, concussion, posttraumatic stress disorder, and other covariates, tinnitus was associated with lower self-rated health for both the first (odds ratio [OR] = 3.31, 95% confidence interval [CI] = 2.07-5.30, P < 0.001) and second assessments (OR = 2.52, 95% CI = 1.76-3.61, P < 0.001). CONCLUSIONS Tinnitus is a common source of impairment among military personnel injured during combat deployment and is associated with poorer self-rated health. Future research should determine whether timing of assessment is linked to symptom recognition or reporting, and what interventions are best suited for ameliorating the negative impact of tinnitus.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106
| | - Antony R Joseph
- Hearing Loss Prevention Laboratory, Communication Sciences and Disorders Department, Illinois State University, Normal, IL 61761.,Leidos, Inc., San Diego, CA 92106
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA 92106.,Leidos, Inc., San Diego, CA 92106
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Aravind A, Ravula AR, Chandra N, Pfister BJ. Behavioral Deficits in Animal Models of Blast Traumatic Brain Injury. Front Neurol 2020; 11:990. [PMID: 33013653 PMCID: PMC7500138 DOI: 10.3389/fneur.2020.00990] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/29/2020] [Indexed: 01/30/2023] Open
Abstract
Blast exposure has been identified to be the most common cause for traumatic brain injury (TBI) in soldiers. Over the years, rodent models to mimic blast exposures and the behavioral outcomes observed in veterans have been developed extensively. However, blast tube design and varying experimental parameters lead to inconsistencies in the behavioral outcomes reported across research laboratories. This review aims to curate the behavioral outcomes reported in rodent models of blast TBI using shockwave tubes or open field detonations between the years 2008–2019 and highlight the important experimental parameters that affect behavioral outcome. Further, we discuss the role of various design parameters of the blast tube that can affect the nature of blast exposure experienced by the rodents. Finally, we assess the most common behavioral tests done to measure cognitive, motor, anxiety, auditory, and fear conditioning deficits in blast TBI (bTBI) and discuss the advantages and disadvantages of these tests.
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Affiliation(s)
- Aswati Aravind
- Department of Biomedical Engineering, Center for Injury Biomechanics, Materials and Medicine, New Jersey Institute of Technology, Newark, NJ, United States
| | - Arun Reddy Ravula
- Department of Biomedical Engineering, Center for Injury Biomechanics, Materials and Medicine, New Jersey Institute of Technology, Newark, NJ, United States
| | - Namas Chandra
- Department of Biomedical Engineering, Center for Injury Biomechanics, Materials and Medicine, New Jersey Institute of Technology, Newark, NJ, United States
| | - Bryan J Pfister
- Department of Biomedical Engineering, Center for Injury Biomechanics, Materials and Medicine, New Jersey Institute of Technology, Newark, NJ, United States
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Norman RS, Swan AA, Jenkins A, Ballard M, Amuan M, Pugh MJ. Updating and Refining Prevalence Rates of Traumatic Brain Injury–Related Communication Disorders Among Post-9/11 Veterans: A Chronic Effects of Neurotrauma Consortium Study. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-20-00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
To describe the prevalence of communication disorders in a cohort of 84,377 deployed post-9/11 veterans stratified by blast traumatic brain injury (TBI) exposure. Secondary aim was to evaluate the association between postconcussion symptoms, such as posttraumatic stress disorder, depression, anxiety, insomnia, pain, headache, substance use disorder, and auditory problems, among veterans with and without a communication disorder diagnosis.
Method
This is a retrospective study of the prevalence of aphasia, apraxia of speech and dysarthria, cognitive-communication disorder, fluency, and voice disorders among veterans, stratified by TBI severity and blast status. Data were obtained from the national Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn roster file provided by the Department of Veterans Affairs Office of Public Health and the Veterans Affairs' TBI screening and subsequent comprehensive TBI evaluation.
Results
Cognitive-communication disorder was the most prevalent diagnosis, comprising 57.1% of all communication disorder diagnoses, followed by voice disorder (19%) and aphasia (16%). Increased age was significantly associated with higher rates of aphasia, apraxia of speech/dysarthria, and voice disorder.
Conclusions
The current study shows that, while the overall total number of communication disorder diagnoses was higher in the blast groups than in the nonblast groups, TBI severity was a more significant risk factor for a diagnosis, with veterans in the more severe groups at a higher risk of being diagnosed with a communication disorder when compared to those with mild TBI and no blast exposure. In order to better inform rehabilitation and clinical management of communication conditions, it is critical to examine the influence of blast and postconcussive symptoms in post-9/11 veterans.
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Affiliation(s)
- Rocío S. Norman
- Department of Communication Sciences and Disorders, School of Health Professions, University of Texas Health Science Center at San Antonio
| | - Alicia A. Swan
- Department of Psychology, University of Texas at San Antonio
| | - Angela Jenkins
- Department of Communication Sciences and Disorders, School of Health Professions, University of Texas Health Science Center at San Antonio
| | - Matthew Ballard
- Department of Communication Sciences and Disorders, School of Health Professions, University of Texas Health Science Center at San Antonio
| | - Megan Amuan
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement, and Analytic Sciences Center, UT
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement, and Analytic Sciences Center, UT
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City
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MacGregor AJ, Joseph AR, Walker GJ, Dougherty AL. Co-occurrence of hearing loss and posttraumatic stress disorder among injured military personnel: a retrospective study. BMC Public Health 2020; 20:1076. [PMID: 32641028 PMCID: PMC7341578 DOI: 10.1186/s12889-020-08999-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/27/2020] [Indexed: 01/03/2023] Open
Abstract
Background Posttraumatic stress disorder (PTSD) and hearing loss are hallmark public health issues related to military service in Iraq and Afghanistan. Although both are significant individual contributors to disability among veterans, their co-occurrence has not been specifically explored. Methods A total of 1179 male U.S. military personnel who sustained an injury between 2004 and 2012 during operations in Iraq or Afghanistan were identified from clinical records. Pre- and postinjury audiometric data were used to define new-onset hearing loss, which was categorized as unilateral or bilateral. Diagnosed PTSD was abstracted from electronic medical records. Logistic regression analysis examined the relationship between hearing loss and PTSD, while adjusting for age, year of injury, occupation, injury severity, injury mechanism, and presence of concussion. Results The majority of the study sample were aged 18–25 years (79.9%) and sustained mild-moderate injuries (94.6%). New-onset hearing loss was present in 14.4% of casualties (10.3% unilateral, 4.1% bilateral). Rates of diagnosed PTSD were 9.1, 13.9, and 29.2% for those with no hearing loss, unilateral hearing loss, and bilateral hearing loss, respectively. After adjusting for covariates, those with bilateral hearing loss had nearly three-times higher odds of PTSD (odds ratio = 2.92; 95% CI, 1.47–5.81) compared to those with no hearing loss. Unilateral hearing loss was not associated with PTSD. Conclusions Both PTSD and hearing loss are frequent consequences of modern warfare that adversely affect the overall health of the military. Bilateral, but not unilateral, hearing loss was associated with a greater burden of PTSD. This has implications for warfighter rehabilitation and should encourage collaboration between audiology and mental health professionals.
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Affiliation(s)
- Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA.
| | - Antony R Joseph
- Hearing Loss Prevention Laboratory, Communication Sciences and Disorders Department, Illinois State University, Normal, IL, USA.,Leidos, Inc., San Diego, CA, USA
| | - G Jay Walker
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, USA.,Leidos, Inc., San Diego, CA, USA
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41
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Azadian E, Majlesi M, Jafarnezhadgero AA, Granacher U. The impact of hearing loss on three-dimensional lower limb joint torques during walking in prepubertal boys. J Bodyw Mov Ther 2020; 24:123-129. [PMID: 32507137 DOI: 10.1016/j.jbmt.2019.10.013] [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: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In children, the impact of hearing loss on biomechanical gait parameters is not well understood. Thus, the objectives of this study were to examine three-dimensional lower limb joint torques in deaf compared to age-matched healthy (hearing) children while walking at preferred gait speed. METHODS Thirty prepubertal boys aged 8-14 were enrolled in this study and divided into a group with hearing loss (deaf group) and an age-matched healthy control. Three-dimensional joint torques were analyzed during barefoot walking at preferred speed using Kistler force plates and a Vicon motion capture system. RESULTS Findings revealed that boys with hearing loss showed lower joint torques in ankle evertors, knee flexors, abductors and internal rotators as well as in hip internal rotators in both, the dominant and non-dominant lower limbs (all p < 0.05; d = 1.23-7.00; 14-79%). Further, in the dominant limb, larger peak ankle dorsiflexor (p < 0.001; d = 1.83; 129%), knee adductor (p < 0.001; d = 3.20; 800%), and hip adductor torques (p < 0.001; d = 2.62; 350%) were found in deaf participants compared with controls. CONCLUSION The observed altered lower limb torques during walking are indicative of unstable gait in children with hearing loss. More research is needed to elucidate whether physical training (e.g., balance and/or gait training) has the potential to improve walking performance in this patient group.
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Affiliation(s)
- Elaheh Azadian
- Department of Motor Behavior, Faculty of Humanities, Islamic Azad University, Hamedan Branch, Hamedan, Iran.
| | - Mahdi Majlesi
- Department of Sport Biomechanics, Faculty of Humanities, Islamic Azad University, Hamedan Branch, Hamedan, Iran.
| | - Amir Ali Jafarnezhadgero
- Department of Physical Education and Sport Sciences, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany.
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Bramhall NF, Niemczak CE, Kampel SD, Billings CJ, McMillan GP. Evoked Potentials Reveal Noise Exposure-Related Central Auditory Changes Despite Normal Audiograms. Am J Audiol 2020; 29:152-164. [PMID: 32182128 DOI: 10.1044/2019_aja-19-00060] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Complaints of auditory perceptual deficits, such as tinnitus and difficulty understanding speech in background noise, among individuals with clinically normal audiograms present a perplexing problem for audiologists. One potential explanation for these "hidden" auditory deficits is loss of the synaptic connections between the inner hair cells and their afferent auditory nerve fiber targets, a condition that has been termed cochlear synaptopathy. In animal models, cochlear synaptopathy can occur due to aging or exposure to noise or ototoxic drugs and is associated with reduced auditory brainstem response (ABR) wave I amplitudes. Decreased ABR wave I amplitudes have been demonstrated among young military Veterans and non-Veterans with a history of firearm use, suggesting that humans may also experience noise-induced synaptopathy. However, the downstream consequences of synaptopathy are unclear. Method To investigate how noise-induced reductions in wave I amplitude impact the central auditory system, the ABR, the middle latency response (MLR), and the late latency response (LLR) were measured in 65 young Veterans and non-Veterans with normal audiograms. Results In response to a click stimulus, the MLR was weaker for Veterans compared to non-Veterans, but the LLR was not reduced. In addition, low ABR wave I amplitudes were associated with a reduced MLR, but with an increased LLR. Notably, Veterans reporting tinnitus showed the largest mean LLRs. Conclusions These findings indicate that decreased peripheral auditory input leads to compensatory gain in the central auditory system, even among individuals with normal audiograms, and may impact auditory perception. This pattern of reduced MLR, but not LLR, was observed among Veterans even after statistical adjustment for sex and distortion product otoacoustic emission differences, suggesting that synaptic loss plays a role in the observed central gain. Supplemental Material https://doi.org/10.23641/asha.11977854.
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Affiliation(s)
- Naomi F. Bramhall
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland
| | | | - Sean D. Kampel
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR
| | - Curtis J. Billings
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Garnett P. McMillan
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, OR
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
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Lugo A, Edvall NK, Lazar A, Mehraei G, Lopez-Escamez JA, Bulla J, Uhlen I, Canlon B, Gallus S, Cederroth CR. Relationship between headaches and tinnitus in a Swedish study. Sci Rep 2020; 10:8494. [PMID: 32444677 PMCID: PMC7244494 DOI: 10.1038/s41598-020-65395-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022] Open
Abstract
The heterogeneity of tinnitus is likely accounting for the lack of effective treatment approaches. Headaches have been related to tinnitus, yet little is known on how headaches impact tinnitus. We use cross-sectional data from the Swedish Tinnitus Outreach Project to i) evaluate the association between headaches and tinnitus (n = 1,984 cases and 1,661 controls) and ii) investigate the phenotypic characteristics of tinnitus subjects with tinnitus (n = 660) or without (n = 1,879) headaches. In a multivariable logistic regression model, headache was significantly associated with any tinnitus (odds ratio, OR = 2.61) and more so with tinnitus as a big problem (as measured by the tinnitus functional index, TFI ≥ 48; OR = 5.63) or severe tinnitus (using the tinnitus handicap inventory, THI ≥ 58; OR = 4.99). When focusing on subjects with tinnitus, the prevalence of headaches was 26% and reached 40% in subjects with severe tinnitus. A large number of socioeconomic, phenotypic and psychological characteristics differed between headache and non-headache subjects with any tinnitus. With increasing tinnitus severity, fewer differences were found, the major ones being vertigo, neck pain and other pain syndromes, as well as stress and anxiety. Our study suggests that headaches could contribute to tinnitus distress and potentially its severity.
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Affiliation(s)
- Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Niklas K Edvall
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Andra Lazar
- Hörsel och balansmottagningen, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | | | - Jose-Antonio Lopez-Escamez
- Otology & Neurotology Group, Department of Genomic Medicine, Pfizer - Universidad de Granada - Junta de Andalucía Centro de Genómica e Investigación Oncológica (GENYO), PTS, Avenida de la Ilustración 114, 18016, Granada, Spain
- Department of Otolaryngology, Hospital Universitario Virgen de las Nieves, Instituto de Investigacion Biosanitaria ibs.GRANADA, Granada, Spain
| | - Jan Bulla
- University of Bergen, Bergen, Norway
- University of Regensburg, Regensburg, Germany
| | - Inger Uhlen
- Hörsel och balansmottagningen, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Barbara Canlon
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Christopher R Cederroth
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Stockholm, Sweden.
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Neurosensory Deficits Associated with Concussion (Auditory, Vestibular, and Visual Dysfunction). Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Moore BA, Moring JC, Hale WJ, Peterson AL. Incidence Rates of Tinnitus in Active Duty Military Service Members Between 2001 and 2015. Am J Audiol 2019; 28:866-876. [PMID: 31618059 DOI: 10.1044/2019_aja-19-0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Due to hazards in the contemporary operating environment, U.S. military service members are at increased risk for tinnitus. Previous research has characterized tinnitus prevalence in military veterans, but no population-based study of tinnitus has been conducted in active duty military service members. This study evaluated the incidence of tinnitus diagnoses in military electronic health records based on International Classification of Diseases, 9th Revision (ICD-9) codes for active duty service members between 2001 and 2015. Method Data on 85,438 active duty military service members who served between 2001 and 2015 were drawn from the Defense Medical Epidemiological Database and stratified by race, age, sex, marital status, service branch, and military pay grade. Results The incidence rate of tinnitus in U.S. military service members (per 1,000) rose consistently from 1.84 in 2001 to 6.33 in 2015. Service members most often diagnosed with tinnitus were White (72%), married (72%), males (88%), in the enlisted pay grade of E-5 to E-9 (55%), in the Army (37%), and were 35 years of age or older (50%). Statistically significant differences (p < .001) were found between observed and expected counts across all 6 demographic variables. Conclusions This is the first study to assess the incidence rates of tinnitus in active duty service members. Although there are many risk factors for auditory damage in the contemporary military operating environment, the extant literature on tinnitus in active duty military service members is limited. Future studies should consider the relationship between tinnitus-related psychological comorbidity and objective health-related quality of life, as it impacts operational readiness in active duty military service members.
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Affiliation(s)
- Brian A. Moore
- Department of Psychology, The University of Texas at San Antonio
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
| | - John C. Moring
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
- Office of Research and Development, South Texas Veterans Health Care System, San Antonio
| | - Willie J. Hale
- Department of Psychology, The University of Texas at San Antonio
| | - Alan L. Peterson
- Department of Psychology, The University of Texas at San Antonio
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio
- Office of Research and Development, South Texas Veterans Health Care System, San Antonio
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Le Prell CG, Hammill TL, Murphy WJ. Noise-induced hearing loss and its prevention: Integration of data from animal models and human clinical trials. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:4051. [PMID: 31795668 PMCID: PMC7195863 DOI: 10.1121/1.5132951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Animal models have been used to gain insight into the risk of noise-induced hearing loss (NIHL) and its potential prevention using investigational new drug agents. A number of compounds have yielded benefit in pre-clinical (animal) models. However, the acute traumatic injury models commonly used in pre-clinical testing are fundamentally different from the chronic and repeated exposures experienced by many human populations. Diverse populations that are potentially at risk and could be considered for enrollment in clinical studies include service members, workers exposed to occupational noise, musicians and other performing artists, and children and young adults exposed to non-occupational (including recreational) noise. Both animal models and clinical populations were discussed in this special issue, followed by discussion of individual variation in vulnerability to NIHL. In this final contribution, study design considerations for NIHL otoprotection in pre-clinical and clinical testing are integrated and broadly discussed with evidence-based guidance offered where possible, drawing on the contributions to this special issue as well as other existing literature. The overarching goals of this final paper are to (1) review and summarize key information across contributions and (2) synthesize information to facilitate successful translation of otoprotective drugs from animal models into human application.
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Affiliation(s)
- Colleen G Le Prell
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas 75080, USA
| | - Tanisha L Hammill
- Department of Defense, Defense Health Agency, Falls Church, Virginia 22042, USA
| | - William J Murphy
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinanati, Ohio 45226-1998, USA
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Le Prell CG, Hammill TL, Murphy WJ. Noise-induced hearing loss: Translating risk from animal models to real-world environments. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:3646. [PMID: 31795692 PMCID: PMC7341677 DOI: 10.1121/1.5133385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Noise-induced hearing loss (NIHL) is a common injury for service members and civilians. Effective prevention of NIHL with drug agents would reduce the prevalence of NIHL. There are a host of challenges in translation of investigational new drug agents from animals into human clinical testing, however. Initial articles in this special issue describe common pre-clinical (animal) testing paradigms used to assess potential otoprotective drug agents and design-related factors that impact translation of promising agents into human clinical trials. Additional articles describe populations in which NIHL has a high incidence and factors that affect individual vulnerability. While otoprotective drugs will ultimately be developed for use by specific noise-exposed populations, there has been little effort to develop pre-clinical (animal) models that accurately model exposure hazards across diverse human populations. To facilitate advances in the translational framework for NIHL otoprotection in pre-clinical and clinical testing, the overarching goals of the current series are to (1) review the animal models that have been used, highlighting the relevance to the human populations of interest, (2) provide insight into the populations for whom pharmaceutical interventions might, or might not, be appropriate, and (3) highlight the factors that drive the significant individual variability observed in humans.
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Affiliation(s)
- Colleen G Le Prell
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas 75080, USA
| | - Tanisha L Hammill
- Department of Defense, Defense Health Agency, Falls Church, Virginia 22042, USA
| | - William J Murphy
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Cincinnati, Ohio 45226, USA
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Clifford RE, Hertzano R, Ohlemiller KK. Untangling the genomics of noise-induced hearing loss and tinnitus: Contributions of Mus musculus and Homo sapiens. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:4007. [PMID: 31795683 PMCID: PMC7273513 DOI: 10.1121/1.5132552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 05/23/2023]
Abstract
Acoustic trauma is a feature of the industrial age, in general, and mechanized warfare, in particular. Noise-induced hearing loss (NIHL) and tinnitus have been the number 1 and number 2 disabilities at U.S. Veterans hospitals since 2006. In a reversal of original protocols to identify candidate genes associated with monogenic deafness disorders, unbiased genome-wide association studies now direct animal experiments in order to explore genetic variants common in Homo sapiens. However, even these approaches must utilize animal studies for validation of function and understanding of mechanisms. Animal research currently focuses on genetic expression profiles since the majority of variants occur in non-coding regions, implying regulatory divergences. Moving forward, it will be important in both human and animal research to define the phenotypes of hearing loss and tinnitus, as well as exposure parameters, in order to extricate genes related to acoustic trauma versus those related to aging. It has become clear that common disorders like acoustic trauma are influenced by large numbers of genes, each with small effects, which cumulatively lead to susceptibility to a disorder. A polygenic risk score, which aggregates these small effect sizes of multiple genes, may offer a more accurate description of risk for NIHL and/or tinnitus.
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Affiliation(s)
- Royce E Clifford
- Division of Otolaryngology-Head and Neck Surgery, University of California School of Medicine, 9500 Gilman Drive, La Jolla, California 92093, USA
| | - Ronna Hertzano
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, James T. Frenkil Building, 16 South Eutaw Street, Suite 500, Baltimore, Maryland 21201, USA
| | - Kevin K Ohlemiller
- Washington University School of Medicine, Department of Otolaryngology, Central Institute for the Deaf at Washington University School of Medicine, Fay and Carl Simons Center for Hearing and Deafness, 660 South Euclid Avenue, Saint Louis, Missouri 63110, USA
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Marceaux JC, Soble JR, O'Rourke JJF, Swan AA, Wells M, Amuan M, Sagiraju HKR, Eapen BC, Pugh MJ. Validity of early-onset dementia diagnoses in VA electronic medical record administrative data. Clin Neuropsychol 2019; 34:1175-1189. [PMID: 31645200 DOI: 10.1080/13854046.2019.1679889] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the validity of diagnoses indicative of early-onset dementia (EOD) obtained from an algorithm using administrative data, we examined Veterans Health Administration (VHA) electronic medical records (EMRs). METHOD A previously used method of identifying cases of dementia using administrative data was applied to a random sample of 176 cases of Post-9/11 deployed veterans under 65 years of age. Retrospective, cross-sectional examination of EMRs was conducted, using a combination of administrative data, chart abstraction, and review/consensus by board-certified neuropsychologists. RESULTS Approximately 73% of EOD diagnoses identified using existing algorithms were identified as false positives in the overall sample. This increased to approximately 76% among those with mental health conditions and approximately 85% among those with mild traumatic brain injury (TBI; i.e. concussion). Factors related to improved diagnostic accuracy included more severe TBI, diagnosing clinician type, presence of neuroimaging data, absence of a comorbid mental health condition diagnosis, and older age at time of diagnosis. CONCLUSIONS A previously used algorithm for detecting dementia using VHA administrative data was not supported for use in the younger adult samples and resulted in an unacceptably high number of false positives. Based on these findings, there is concern for possible misclassification in population studies using similar algorithms to identify rates of EOD among veterans. Further, we provide suggestions to develop an enhanced algorithm for more accurate dementia surveillance among younger populations.
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Affiliation(s)
- Janice C Marceaux
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA.,Department of Neurology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jason R Soble
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA.,Psychiatry & Neurology, Neuropsychiatric Institute, University of Illinois College of Medicine, Chicago, IL, USA
| | - Justin J F O'Rourke
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA
| | - Alicia A Swan
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Margaret Wells
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Megan Amuan
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA
| | - Hari Krishna Raju Sagiraju
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Blessen C Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Cone JE, Stein CR, Lee DJ, Flamme GA, Brite J. Persistent Hearing Loss among World Trade Center Health Registry Residents, Passersby and Area Workers, 2006-2007. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203864. [PMID: 31614778 PMCID: PMC6848920 DOI: 10.3390/ijerph16203864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 01/01/2023]
Abstract
Background: Prior studies have found that rescue and recovery workers exposed to the 9/11 World Trade Center (WTC) disaster have evidence of increased persistent hearing and other ear-related problems. The potential association between WTC disaster exposures and post-9/11 persistent self-reported hearing problems or loss among non-rescue and recovery survivors has not been well studied. Methods: We used responses to the World Trade Center Health Registry (Registry) enrollment survey (2003–2004) and first follow-up survey (2006–2007) to model the association between exposure to the dust cloud and persistent hearing loss (n = 22,741). Results: The prevalence of post-9/11 persistent hearing loss among survivors was 2.2%. The adjusted odds ratio (aOR) of hearing loss for those who were in the dust cloud and unable to hear was 3.0 (95% CI: 2.2, 4.0). Survivors with persistent sinus problems, headaches, PTSD and chronic disease histories had an increased prevalence of reported hearing problems compared to those without symptoms or chronic problems. Conclusions: In a longitudinal study, we observed an association between WTC-related exposures and post-9/11 self-reported hearing loss among disaster survivors.
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Affiliation(s)
- James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
- School of Medicine, New York University, New York, NY 10016, USA.
| | - Cheryl R Stein
- School of Medicine, New York University, New York, NY 10016, USA.
| | - David J Lee
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, FL 33199, USA.
| | - Gregory A Flamme
- Stephenson & Stephenson Research and Consulting, Loveland, OH 45140, USA.
| | - Jennifer Brite
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, New York City, NY 10013, USA.
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