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Vanneste S, Byczynski G, Verplancke T, Ost J, Song JJ, De Ridder D. Switching tinnitus on or off: An initial investigation into the role of the pregenual and rostral to dorsal anterior cingulate cortices. Neuroimage 2024; 297:120713. [PMID: 38944171 DOI: 10.1016/j.neuroimage.2024.120713] [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: 12/14/2023] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024] Open
Abstract
Research indicates that hearing loss significantly contributes to tinnitus, but it alone does not fully explain its occurrence, as many people with hearing loss do not experience tinnitus. To identify a secondary factor for tinnitus generation, we examined a unique dataset of individuals with intermittent chronic tinnitus, who experience fluctuating periods of tinnitus. EEGs of healthy controls were compared to EEGs of participants who reported perceiving tinnitus on certain days, but no tinnitus on other days.. The EEG data revealed that tinnitus onset is associated with increased theta activity in the pregenual anterior cingulate cortex and decreased theta functional connectivity between the pregenual anterior cingulate cortex and the auditory cortex. Additionally, there is increased alpha effective connectivity from the dorsal anterior cingulate cortex to the pregenual anterior cingulate cortex. When tinnitus is not perceived, differences from healthy controls include increased alpha activity in the pregenual anterior cingulate cortex and heightened alpha connectivity between the pregenual anterior cingulate cortex and auditory cortex. This suggests that tinnitus is triggered by a switch involving increased theta activity in the pregenual anterior cingulate cortex and decreased theta connectivity between the pregenual anterior cingulate cortex and auditory cortex, leading to increased theta-gamma cross-frequency coupling, which correlates with tinnitus loudness. Increased alpha activity in the dorsal anterior cingulate cortex correlates with distress. Conversely, increased alpha activity in the pregenual anterior cingulate cortex can transiently suppress the phantom sound by enhancing theta connectivity to the auditory cortex. This mechanism parallels chronic neuropathic pain and suggests potential treatments for tinnitus by promoting alpha activity in the pregenual anterior cingulate cortex and reducing alpha activity in the dorsal anterior cingulate cortex through pharmacological or neuromodulatory approaches.
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Affiliation(s)
- Sven Vanneste
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, College Green 2, Dublin, Ireland; Global Brain Health Institute & Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; Brai3n, Ghent, Belgium.
| | - Gabriel Byczynski
- Lab for Clinical & Integrative Neuroscience, School of Psychology, Trinity College Dublin, College Green 2, Dublin, Ireland; Global Brain Health Institute & Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | | | | | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, the Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, the Republic of Korea
| | - Dirk De Ridder
- Brai3n, Ghent, Belgium; Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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2
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De Ridder D, Siddiqi MA, Dauwels J, Serdijn WA, Strydis C. NeuroDots: From Single-Target to Brain-Network Modulation: Why and What Is Needed? Neuromodulation 2024; 27:711-729. [PMID: 38639704 DOI: 10.1016/j.neurom.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/05/2023] [Accepted: 01/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Current techniques in brain stimulation are still largely based on a phrenologic approach that a single brain target can treat a brain disorder. Nevertheless, meta-analyses of brain implants indicate an overall success rate of 50% improvement in 50% of patients, irrespective of the brain-related disorder. Thus, there is still a large margin for improvement. The goal of this manuscript is to 1) develop a general theoretical framework of brain functioning that is amenable to surgical neuromodulation, and 2) describe the engineering requirements of the next generation of implantable brain stimulators that follow from this theoretic model. MATERIALS AND METHODS A neuroscience and engineering literature review was performed to develop a universal theoretical model of brain functioning and dysfunctioning amenable to surgical neuromodulation. RESULTS Even though a single target can modulate an entire network, research in network science reveals that many brain disorders are the consequence of maladaptive interactions among multiple networks rather than a single network. Consequently, targeting the main connector hubs of those multiple interacting networks involved in a brain disorder is theoretically more beneficial. We, thus, envision next-generation network implants that will rely on distributed, multisite neuromodulation targeting correlated and anticorrelated interacting brain networks, juxtaposing alternative implant configurations, and finally providing solid recommendations for the realization of such implants. In doing so, this study pinpoints the potential shortcomings of other similar efforts in the field, which somehow fall short of the requirements. CONCLUSION The concept of network stimulation holds great promise as a universal approach for treating neurologic and psychiatric disorders.
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Affiliation(s)
- Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Muhammad Ali Siddiqi
- Department of Electrical Engineering, Lahore University of Management Sciences, Lahore, Pakistan; Neuroscience Department, Erasmus Medical Center, Rotterdam, The Netherlands; Quantum and Computer Engineering Department, Delft University of Technology, Delft, The Netherlands
| | - Justin Dauwels
- Microelectronics Department, Delft University of Technology, Delft, The Netherlands
| | - Wouter A Serdijn
- Neuroscience Department, Erasmus Medical Center, Rotterdam, The Netherlands; Section Bioelectronics, Delft University of Technology, Delft, The Netherlands
| | - Christos Strydis
- Neuroscience Department, Erasmus Medical Center, Rotterdam, The Netherlands; Quantum and Computer Engineering Department, Delft University of Technology, Delft, The Netherlands
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Devolder P, Keppler H, Keshishzadeh S, Taghon B, Dhooge I, Verhulst S. The role of hidden hearing loss in tinnitus: Insights from early markers of peripheral hearing damage. Hear Res 2024; 450:109050. [PMID: 38852534 DOI: 10.1016/j.heares.2024.109050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
Since the presence of tinnitus is not always associated with audiometric hearing loss, it has been hypothesized that hidden hearing loss may act as a potential trigger for increased central gain along the neural pathway leading to tinnitus perception. In recent years, the study of hidden hearing loss has improved with the discovery of cochlear synaptopathy and several objective diagnostic markers. This study investigated three potential markers of peripheral hidden hearing loss in subjects with tinnitus: extended high-frequency audiometric thresholds, the auditory brainstem response, and the envelope following response. In addition, speech intelligibility was measured as a functional outcome measurement of hidden hearing loss. To account for age-related hidden hearing loss, participants were grouped according to age, presence of tinnitus, and audiometric thresholds. Group comparisons were conducted to differentiate between age- and tinnitus-related effects of hidden hearing loss. All three markers revealed age-related differences, whereas no differences were observed between the tinnitus and non-tinnitus groups. However, the older tinnitus group showed improved performance on low-pass filtered speech in noise tests compared to the older non-tinnitus group. These low-pass speech in noise scores were significantly correlated with tinnitus distress, as indicated using questionnaires, and could be related to the presence of hyperacusis. Based on our observations, cochlear synaptopathy does not appear to be the underlying cause of tinnitus. The improvement in low-pass speech-in-noise could be explained by enhanced temporal fine structure encoding or hyperacusis. Therefore, we recommend that future tinnitus research takes into account age-related factors, explores low-frequency encoding, and thoroughly assesses hyperacusis.
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Affiliation(s)
- Pauline Devolder
- Hearing Technology @ WAVES, Department of Information Technology, Ghent University, Zwijnaarde, Belgium; Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Hannah Keppler
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Ear, Nose and Throat, Ghent University Hospital, Ghent, Belgium
| | - Sarineh Keshishzadeh
- Hearing Technology @ WAVES, Department of Information Technology, Ghent University, Zwijnaarde, Belgium
| | - Baziel Taghon
- Hearing Technology @ WAVES, Department of Information Technology, Ghent University, Zwijnaarde, Belgium
| | - Ingeborg Dhooge
- Department of Ear, Nose and Throat, Ghent University Hospital, Ghent, Belgium; Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Sarah Verhulst
- Hearing Technology @ WAVES, Department of Information Technology, Ghent University, Zwijnaarde, Belgium
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Langguth B, de Ridder D, Schlee W, Kleinjung T. Tinnitus: Clinical Insights in Its Pathophysiology-A Perspective. J Assoc Res Otolaryngol 2024; 25:249-258. [PMID: 38532055 PMCID: PMC11150221 DOI: 10.1007/s10162-024-00939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Tinnitus, the perception of sound without a corresponding external sound source, and tinnitus disorder, which is tinnitus with associated suffering, present a multifaceted clinical challenge due to its heterogeneity and its incompletely understood pathophysiology and especially due to the limited therapeutic options. In this narrative review, we give an overview on various clinical aspects of tinnitus including its heterogeneity, contributing factors, comorbidities and therapeutic pathways with a specific emphasis on the implications for its pathophysiology and future research directions. Tinnitus exhibits high perceptual variability between affected individuals (heterogeneity) and within affected individuals (temporal variability). Hearing loss emerges as predominant risk factor and the perceived pitch corresponds to areas of hearing loss, supporting the compensatory response theory. Whereas most people who have tinnitus can live a normal life, in 10-20% tinnitus interferes severely with quality of life. These patients suffer frequently from comorbidities such as anxiety, depression or insomnia, acting as both risk factors and consequences. Accordingly, neuroimaging studies demonstrate shared brain networks between tinnitus and stress-related disorders shedding light on the intricate interplay of mental health and tinnitus. The challenge lies in deciphering causative relationships and shared pathophysiological mechanisms. Stress, external sounds, time of day, head movements, distraction, and sleep quality can impact tinnitus perception. Understanding these factors provides insights into the interplay with autonomic, sensory, motor, and cognitive processes. Counselling and cognitive-behavioural therapy demonstrate efficacy in reducing suffering, supporting the involvement of stress and anxiety-related networks. Hearing improvement, especially through cochlear implants, reduces tinnitus and thus indirectly validates the compensatory nature of tinnitus. Brain stimulation techniques can modulate the suffering of tinnitus, presumably by alteration of stress-related brain networks. Continued research is crucial for unravelling the complexities of tinnitus. Progress in management hinges on decoding diverse manifestations, identifying treatment-responsive subtypes, and advancing targeted therapeutic approaches.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany.
| | - Dirk de Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
- Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Safazadeh S, Thioux M, Renken RJ, van Dijk P. Sound-Evoked Neural Activity in Normal-Hearing Tinnitus: Effects of Frequency and Stimulated Ear Side. Brain Sci 2024; 14:544. [PMID: 38928544 PMCID: PMC11201825 DOI: 10.3390/brainsci14060544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Tinnitus is a common phantom auditory percept believed to be related to plastic changes in the brain due to hearing loss. However, tinnitus can also occur in the absence of any clinical hearing loss. In this case, since there is no hearing loss, the mechanisms that drive plastic changes remain largely enigmatic. Previous studies showed subtle differences in sound-evoked brain activity associated with tinnitus in subjects with tinnitus and otherwise normal hearing, but the results are not consistent across studies. Here, we aimed to investigate these differences using monaural rather than binaural stimuli. Sound-evoked responses were measured using functional magnetic resonance imaging (MRI) in participants with and without tinnitus. All participants had clinically normal audiograms. The stimuli were pure tones with frequencies between 353 and 8000 Hz, presented monaurally. A Principal Component Analysis (PCA) of the response in the auditory cortex revealed no difference in tonotopic organization, which confirmed earlier studies. A GLM analysis showed hyperactivity in the lateral areas of the bilateral auditory cortex. Consistent with the tonotopic map, this hyperactivity mainly occurred in response to low stimulus frequencies. This may be related to hyperacusis. Furthermore, there was an interaction between stimulation side and tinnitus in the parahippocampus. This may reflect an interference between tinnitus and spatial orientation.
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Affiliation(s)
- Shahin Safazadeh
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (M.T.); (P.v.D.)
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, 9713 AV Groningen, The Netherlands;
- Cognitive Neuroscience Center, Biomedical Sciences of Cells and Systems, University of Groningen, 9713 AW Groningen, The Netherlands
| | - Marc Thioux
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (M.T.); (P.v.D.)
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, 9713 AV Groningen, The Netherlands;
- Cognitive Neuroscience Center, Biomedical Sciences of Cells and Systems, University of Groningen, 9713 AW Groningen, The Netherlands
| | - Remco J. Renken
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, 9713 AV Groningen, The Netherlands;
- Cognitive Neuroscience Center, Biomedical Sciences of Cells and Systems, University of Groningen, 9713 AW Groningen, The Netherlands
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (M.T.); (P.v.D.)
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, 9713 AV Groningen, The Netherlands;
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Hockley A, Malmierca MS. Auditory processing control by the medial prefrontal cortex: A review of the rodent functional organisation. Hear Res 2024; 443:108954. [PMID: 38271895 DOI: 10.1016/j.heares.2024.108954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
Afferent inputs from the cochlea transmit auditory information to the central nervous system, where information is processed and passed up the hierarchy, ending in the auditory cortex. Through these brain pathways, spectral and temporal features of sounds are processed and sent to the cortex for perception. There are also many mechanisms in place for modulation of these inputs, with a major source of modulation being based in the medial prefrontal cortex (mPFC). Neurons of the rodent mPFC receive input from the auditory cortex and other regions such as thalamus, hippocampus and basal forebrain, allowing them to encode high-order information about sounds such as context, predictability and valence. The mPFC then exerts control over auditory perception via top-down modulation of the central auditory pathway, altering perception of and responses to sounds. The result is a higher-order control of auditory processing that produces such characteristics as deviance detection, attention, avoidance and fear conditioning. This review summarises connections between mPFC and the primary auditory pathway, responses of mPFC neurons to auditory stimuli, how mPFC outputs shape the perception of sounds, and how changes to these systems during hearing loss and tinnitus may contribute to these conditions.
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Affiliation(s)
- A Hockley
- Cognitive and Auditory Neuroscience Laboratory, Institute of Neuroscience of Castilla y León, University of Salamanca, Salamanca, Spain; Department of Cell Biology and Pathology, University of Salamanca, Salamanca, Spain; Institute for Biomedical Research of Salamanca, Salamanca, Spain.
| | - M S Malmierca
- Cognitive and Auditory Neuroscience Laboratory, Institute of Neuroscience of Castilla y León, University of Salamanca, Salamanca, Spain; Department of Cell Biology and Pathology, University of Salamanca, Salamanca, Spain; Institute for Biomedical Research of Salamanca, Salamanca, Spain
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Wagenaar O, Gilles A, Van Rompaey V, Blom H. Goal Attainment Scale in tinnitus (GAS-T): treatment goal priorities by chronic tinnitus patients in a real-world setting. Eur Arch Otorhinolaryngol 2024; 281:693-700. [PMID: 37488402 DOI: 10.1007/s00405-023-08134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/13/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Standard treatment for tinnitus is cognitive behavioral therapy, although level of evidence of effectiveness is low. There is need for a Goal Attainment Scale to evaluate treatment effects based on patient satisfaction. Preliminary work in a clinical sample has identified six common personal treatment goals. The purpose of this study is to determine whether the preliminary identified goals are confirmed by a heterogeneous sample of people with bothersome tinnitus and to identify any other common personal goals with the intention to construct a closed-end Goal Attainment Scale for tinnitus for use in research of effectiveness of (new) tinnitus treatments. METHODS Two consecutive polls were plotted in an online peer support group form a heterogeneous sample. First, members were asked to vote for preliminary identified goals and asked to formulate additional personal goals. Corresponding goals were grouped together. Goals that were acknowledged by at least 10% of respondents were used in the second poll in which respondents could vote for statements that they recognized themselves in. RESULTS The first poll (N = 180) resulted in 15 personal treatment goals. Comparison resulted in five common goals, which were confirmed in the second poll (N = 238): to gain control, to improve well-being and sleep, to reduce effects on hearing and to understand tinnitus. CONCLUSIONS We expect that if a patient achieves personal goals, he will be likely to reduce healthcare consumption. Based on common personal goals, validity of treatment evaluations is increased. We present a closed-end Goal Attainment Scale in tinnitus.
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Affiliation(s)
- Olav Wagenaar
- Department of Neurology, Rijndam Rehabilitation Center, Rotterdam, The Netherlands.
| | - Annick Gilles
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Henk Blom
- Otorhinolaryngology, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
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Zhu M, Gong Q. EEG spectral and microstate analysis originating residual inhibition of tinnitus induced by tailor-made notched music training. Front Neurosci 2023; 17:1254423. [PMID: 38148944 PMCID: PMC10750374 DOI: 10.3389/fnins.2023.1254423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023] Open
Abstract
Tailor-made notched music training (TMNMT) is a promising therapy for tinnitus. Residual inhibition (RI) is one of the few interventions that can temporarily inhibit tinnitus, which is a useful technique that can be applied to tinnitus research and explore tinnitus mechanisms. In this study, RI effect of TMNMT in tinnitus was investigated mainly using behavioral tests, EEG spectral and microstate analysis. To our knowledge, this study is the first to investigate RI effect of TMNMT. A total of 44 participants with tinnitus were divided into TMNMT group (22 participants; ECnm, NMnm, RInm represent that EEG recordings with eyes closed stimuli-pre, stimuli-ing, stimuli-post by TMNMT music, respectively) and Placebo control group (22 participants; ECpb, PBpb, RIpb represent that EEG recordings with eyes closed stimuli-pre, stimuli-ing, stimuli-post by Placebo music, respectively) in a single-blind manner. Behavioral tests, EEG spectral analysis (covering delta, theta, alpha, beta, gamma frequency bands) and microstate analysis (involving four microstate classes, A to D) were employed to evaluate RI effect of TMNMT. The results of the study showed that TMNMT had a stronger inhibition ability and longer inhibition time according to the behavioral tests compared to Placebo. Spectral analysis showed that RI effect of TMNMT increased significantly the power spectral density (PSD) of delta, theta bands and decreased significantly the PSD of alpha2 band, and microstate analysis showed that RI effect of TMNMT had shorter duration (microstate B, microstate C), higher Occurrence (microstate A, microstate C, microstate D), Coverage (microstate A) and transition probabilities (microstate A to microstate B, microstate A to microstate D and microstate D to microstate A). Meanwhile, RI effect of Placebo decreased significantly the PSD of alpha2 band, and microstate analysis showed that RI effect of Placebo had shorter duration (microstate C, microstate D), higher occurrence (microstate B, microstate C), lower coverage (microstate C, microstate D), higher transition probabilities (microstate A to microstate B, microstate B to microstate A). It was also found that the intensity of tinnitus symptoms was significant positively correlated with the duration of microstate B in five subgroups (ECnm, NMnm, RInm, ECpb, PBpb). Our study provided valuable experimental evidence and practical applications for the effectiveness of TMNMT as a novel music therapy for tinnitus. The observed stronger residual inhibition (RI) ability of TMNMT supported its potential applications in tinnitus treatment. Furthermore, the temporal dynamics of EEG microstates serve as novel functional and trait markers of synchronous brain activity that contribute to a deep understanding of the neural mechanism underlying TMNMT treatment for tinnitus.
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Affiliation(s)
- Min Zhu
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Qin Gong
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
- School of Medicine, Shanghai University, Shanghai, China
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Wójcik J, Kochański B, Cieśla K, Lewandowska M, Karpiesz L, Niedziałek I, Raj-Koziak D, Skarżyński PH, Wolak T. An MR spectroscopy study of temporal areas excluding primary auditory cortex and frontal regions in subjective bilateral and unilateral tinnitus. Sci Rep 2023; 13:18417. [PMID: 37891242 PMCID: PMC10611771 DOI: 10.1038/s41598-023-45024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Previous studies indicate changes in neurotransmission along the auditory pathway in subjective tinnitus. Most authors, however, investigated brain regions including the primary auditory cortex, whose physiology can be affected by concurrent hearing deficits. In the present MR spectroscopy study we assumed increased levels of glutamate and glutamine (Glx), and other Central Nervous System metabolites in the temporal lobe outside the primary auditory cortex, in a region involved in conscious auditory perception and memory. We studied 52 participants with unilateral (n = 24) and bilateral (n = 28) tinnitus, and a control group without tinnitus (n = 25), all with no severe hearing losses and a similar hearing profile. None of the metabolite levels in the temporal regions of interest were found related to tinnitus status or laterality. Unexpectedly, we found a tendency of increased concentration of Glx in the control left medial frontal region in bilateral vs unilateral tinnitus. Slightly elevated depressive and anxiety symptoms were also shown in participants with tinnitus, as compared to healthy individuals, with the bilateral tinnitus group marginally more affected. We discuss no apparent effect in the temporal lobes, as well as the role of frontal brain areas, with respect to hearing loss, attention and psychological well-being in chronic tinnitus. We furthermore elaborate on the design-related and technical obstacles of MR spectroscopy.
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Affiliation(s)
- Joanna Wójcik
- Bioimaging Research Center, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Kajetany, 05-830, Nadarzyn, Poland
| | - Bartosz Kochański
- Bioimaging Research Center, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Kajetany, 05-830, Nadarzyn, Poland
| | - Katarzyna Cieśla
- Bioimaging Research Center, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Kajetany, 05-830, Nadarzyn, Poland.
| | - Monika Lewandowska
- Faculty of Philosophy and Social Sciences, Institute of Psychology, Nicolaus Copernicus University, Fosa Staromiejska 1a Street, 87-100, Toruń, Poland
| | - Lucyna Karpiesz
- Tinnitus Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Kajetany, 05-830, Nadarzyn, Poland
| | - Iwona Niedziałek
- Tinnitus Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Kajetany, 05-830, Nadarzyn, Poland
| | - Danuta Raj-Koziak
- Tinnitus Department, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Kajetany, 05-830, Nadarzyn, Poland
| | - Piotr Henryk Skarżyński
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Kajetany, 05-830, Nadarzyn, Poland
- Institute of Sensory Organs, Mokra 1 Street, Kajetany, 05-830, Nadarzyn, Poland
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Kondratowicza 8 Street, 03-242, Warsaw, Poland
| | - Tomasz Wolak
- Bioimaging Research Center, World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, Kajetany, 05-830, Nadarzyn, Poland
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Mohsen S, Sadeghijam M, Talebian S, Pourbakht A. Use of Some Relevant Parameters for Primary Prediction of Brain Activity in Idiopathic Tinnitus Based on a Machine Learning Application. Audiol Neurootol 2023; 28:446-457. [PMID: 37331332 DOI: 10.1159/000530811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION Tinnitus is one of the most common complaints, distressing about 15-24% of the adult population. Because of its pathophysiology heterogeneity, no curable treatment has been attained yet. Even though a neuromodulation management technique based on the tinnitus network model is currently being developed, it has not yet worked because the most involved brain areas still remain unpredictable from the patient's individual clinical and functional profile. A remarkable correlation between tinnitus network activity and the subjective measures of tinnitus like perceived loudness and annoyance and functional handicap is well established. Therefore, this study aimed to develop software for predicting the involved brain areas in the tinnitus network based on the subjective characteristics and clinical profile of patients using a supervised machine-learning method. METHODS The involved brain areas of 30 tinnitus patients ranging from 6 to 80 months in duration were recognized by using QEEG and sLORETA software. There was a correlation between subjective information and those areas of activities in all rhythms by which we wrote our software. RESULTS For verification and validation of the software, we compared and analyzed the results with SPSS data and the receiver operating characteristic (ROC) curves. CONCLUSIONS The findings of this study confirmed the effectiveness of the software in predicting the brain activity in tinnitus subjects; however, some other important parameters can be added to the model to strengthen its reliability and feasibility in clinical use.
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Affiliation(s)
- Samer Mohsen
- Department of Otolaryngology, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
- Department of Audiology, Faculty of Health Sciences, Damascus University, Damascus, Syrian Arab Republic
| | - Maryam Sadeghijam
- Rehabilitation Research Center, Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Talebian
- Motor Control Laboratory, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourbakht
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Singh A, Smith PF, Zheng Y. Targeting the Limbic System: Insights into Its Involvement in Tinnitus. Int J Mol Sci 2023; 24:9889. [PMID: 37373034 DOI: 10.3390/ijms24129889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Tinnitus is originally derived from the Latin verb tinnire, which means "to ring". Tinnitus, a complex disorder, is a result of sentient cognizance of a sound in the absence of an external auditory stimulus. It is reported in children, adults, and older populations. Patients suffering from tinnitus often present with hearing loss, anxiety, depression, and sleep disruption in addition to a hissing and ringing in the ear. Surgical interventions and many other forms of treatment have been only partially effective due to heterogeneity in tinnitus patients and a lack of understanding of the mechanisms of tinnitus. Although researchers across the globe have made significant progress in understanding the underlying mechanisms of tinnitus over the past few decades, tinnitus is still deemed to be a scientific enigma. This review summarises the role of the limbic system in tinnitus development and provides insight into the development of potential target-specific tinnitus therapies.
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Affiliation(s)
- Anurag Singh
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
- The Eisdell Moore Centre for Research in Hearing and Balance Disorders, University of Auckland, Auckland 1023, New Zealand
| | - Paul F Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
- The Eisdell Moore Centre for Research in Hearing and Balance Disorders, University of Auckland, Auckland 1023, New Zealand
| | - Yiwen Zheng
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
- The Eisdell Moore Centre for Research in Hearing and Balance Disorders, University of Auckland, Auckland 1023, New Zealand
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12
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Chhaya V, Patel D, Shethia F, Manchaiah V, Khambholja K. Current Therapeutic Trends for Tinnitus Cure and Control: A Scoping Review. Indian J Otolaryngol Head Neck Surg 2023:1-9. [PMID: 37362110 PMCID: PMC10237063 DOI: 10.1007/s12070-023-03910-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
The present scoping review assessed knowledge updates in tinnitus management. We included randomized trials, non-randomized studies, systematic reviews, meta-analyses, and observational studies in last 5 years on patients with tinnitus using Population, Concept, and Context mnemonic. We excluded studies on tinnitus epidemiology, technique-specific comparative studies for tinnitus assessment, review articles, or case reports. We used an artificial intelligence-powered tool MaiA for overall workflow management. Data charting elements included study identifiers, study design, population, interventions used, their outcomes on tinnitus scales, and treatment recommendations if any. Charted data from selected sources of evidence was presented using tables and a concept map. We also identified five evidence-based clinical practice guidelines (CPGs) [from the United States, Europe, and Japan regions] in our review of total 506 results, 205 underwent screening based on eligibility criteria and 38 were included for the final charting. We found three major categories of interventions in our review: Medical technology therapies; Behavioural/habituation therapies; and Pharmacological, herbal/complementary, and alternative medicine therapies. Although evidence-based guidelines on tinnitus therapy did not recommend stimulation therapies, majority of the tinnitus research to date is focused on stimulation. It is highly recommended that clinicians consider CPGs when making treatment recommendations and make the distinction between established management approaches with good evidence and emerging treatment approaches for tinnitus management. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03910-2.
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Affiliation(s)
| | - Divya Patel
- Genpro Research Pvt Ltd, Baroda, Gujarat India
| | | | - Vinaya Manchaiah
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Hospital, Aurora, CO USA
| | - Kapil Khambholja
- Genpro Research Pvt Ltd, Baroda, Gujarat India
- Genpro Research Inc, Boston, USA
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13
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Mazurek B, Böcking B, Dobel C, Rose M, Brüggemann P. Tinnitus and Influencing Comorbidities. Laryngorhinootologie 2023; 102:S50-S58. [PMID: 37130530 PMCID: PMC10184670 DOI: 10.1055/a-1950-6149] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Numerous studies show that impairments in chronic tinnitus are closely connected with psychosomatic and other concomitant symptoms. This overview summarizes some of these studies. Beyond hearing loss, individual interactions of medical and psychosocial stress factors as well as resources are of central importance. Tinnitus related distress reflects a large number of intercorrelated, psychosomatic influences - such as personality traits, stress reactivity and depression or anxiety - which can be accompanied by cognitive difficulties and should be conceptualized and assessed within a vulnerability-stress-reaction model. Superordinate factors such as age, gender or education level can increase vulnerability to stress. Therefore, diagnosis and therapy of chronic tinnitus be individualised, multidimensional and interdisciplinary. Multimodal psychosomatic therapy approaches aim to address individually constellated medical, audiological and psychological influences in order to sustainably increase the quality of life of those affected. Counselling in the first contact is also indispensable for diagnosis and therapy.
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Affiliation(s)
- Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Berlin
| | | | - Christian Dobel
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Jena, Jena
| | - Matthias Rose
- Medizinische Klinik m. S. Psychosomatik, Charité - Universitätsmedizin Berlin, Berlin
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14
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De Ridder D, Friston K, Sedley W, Vanneste S. A parahippocampal-sensory Bayesian vicious circle generates pain or tinnitus: a source-localized EEG study. Brain Commun 2023; 5:fcad132. [PMID: 37223127 PMCID: PMC10202557 DOI: 10.1093/braincomms/fcad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/14/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Pain and tinnitus share common pathophysiological mechanisms, clinical features, and treatment approaches. A source-localized resting-state EEG study was conducted in 150 participants: 50 healthy controls, 50 pain, and 50 tinnitus patients. Resting-state activity as well as functional and effective connectivity was computed in source space. Pain and tinnitus were characterized by increased theta activity in the pregenual anterior cingulate cortex, extending to the lateral prefrontal cortex and medial anterior temporal lobe. Gamma-band activity was increased in both auditory and somatosensory cortex, irrespective of the pathology, and extended to the dorsal anterior cingulate cortex and parahippocampus. Functional and effective connectivity were largely similar in pain and tinnitus, except for a parahippocampal-sensory loop that distinguished pain from tinnitus. In tinnitus, the effective connectivity between parahippocampus and auditory cortex is bidirectional, whereas the effective connectivity between parahippocampus and somatosensory cortex is unidirectional. In pain, the parahippocampal-somatosensory cortex is bidirectional, but parahippocampal auditory cortex unidirectional. These modality-specific loops exhibited theta-gamma nesting. Applying a Bayesian brain model of brain functioning, these findings suggest that the phenomenological difference between auditory and somatosensory phantom percepts result from a vicious circle of belief updating in the context of missing sensory information. This finding may further our understanding of multisensory integration and speaks to a universal treatment for pain and tinnitus-by selectively disrupting parahippocampal-somatosensory and parahippocampal-auditory theta-gamma activity and connectivity.
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Affiliation(s)
- Dirk De Ridder
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, University College London, London WC1N 3AR, UK
| | - William Sedley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Sven Vanneste
- Correspondence to: Sven Vanneste Lab for Clinical & Integrative Neuroscience Global Brain Health Institute and Institute of Neuroscience Trinity College Dublin, College Green 2, Dublin D02 PN40, Ireland E-mail:
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15
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Zhang C, Wang X, Ding Z, Zhou H, Liu P, Xue X, Wang L, Jiang Y, Chen J, Shen W, Yang S, Wang F. Study on tinnitus-related electroencephalogram microstates in patients with vestibular schwannomas. Front Neurosci 2023; 17:1159019. [PMID: 37090804 PMCID: PMC10118047 DOI: 10.3389/fnins.2023.1159019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
Tinnitus is closely associated with cognition functioning. In order to clarify the central reorganization of tinnitus in patients with vestibular schwannoma (VS), this study explored the aberrant dynamics of electroencephalogram (EEG) microstates and their correlations with tinnitus features in VS patients. Clinical and EEG data were collected from 98 VS patients, including 76 with tinnitus and 22 without tinnitus. Microstates were clustered into four categories. Our EEG microstate analysis revealed that VS patients with tinnitus exhibited an increased frequency of microstate C compared to those without tinnitus. Furthermore, correlation analysis demonstrated that the Tinnitus Handicap Inventory (THI) score was negatively associated with the duration of microstate A and positively associated with the frequency of microstate C. These findings suggest that the time series and syntax characteristics of EEG microstates differ significantly between VS patients with and without tinnitus, potentially reflecting abnormal allocation of neural resources and transition of functional brain activity. Our results provide a foundation for developing diverse treatments for tinnitus in VS patients.
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Affiliation(s)
- Chi Zhang
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Zhan Tan Temple Outpatient Department, Central Medical Branch of PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiaoguang Wang
- Zhan Tan Temple Outpatient Department, Central Medical Branch of PLA General Hospital, Beijing, China
| | - Zhiwei Ding
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Hanwen Zhou
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Peng Liu
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Xinmiao Xue
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Li Wang
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yuke Jiang
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Jiyue Chen
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Weidong Shen
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shiming Yang
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fangyuan Wang
- The First Medical Center, Chinese PLA General Hospital, Beijing, China
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China
- The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Fangyuan Wang,
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16
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Watson N, Schaper FLWVJ, Jabbour S, Sadler S, Bain PA, Fox MD, Naples JG. Is There an Optimal Repetitive Transcranial Magnetic Stimulation Target to Treat Chronic Tinnitus? Otolaryngol Head Neck Surg 2023; 168:300-306. [PMID: 35671136 DOI: 10.1177/01945998221102082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/04/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Chronic tinnitus is a clinical symptom that affects 10% to 15% of the adult population. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment, but significant heterogeneity exists in the treatment outcomes and stimulation parameters. In this study, we perform a qualitative systematic review to determine if there is an optimal rTMS site to treat tinnitus. DATA SOURCES A literature search was performed by searching the MEDLINE, Embase, Web of Science, and Cochrane databases. REVIEW METHODS Sham-controlled studies in adults were included that contained >10 patients with tinnitus for >3 months and utilized 10 to 20 electroencephalography coordinates. Study outcomes were considered positive if the treatment arm reported a significant reduction in the primary tinnitus score relative to sham. RESULTS There were 1211 studies screened. Nineteen studies met the inclusion criteria, and 8 unique stimulation sites were reported. Studies had 53.7 ± 46.0 patients (mean ± SD). The mean duration of follow-up was 10.3 ± 9.6 weeks. Positive outcomes regarding tinnitus suppression were reported in 5 of 5 (100%) studies stimulating the temporoparietal junction midway between T3 and P3 or between T4 and P4. Tinnitus suppression at all other sites was less frequent with a combined success rate of only 8 of 14 (57.1%). CONCLUSION Significant heterogeneity exists in the literature in regard to the optimal transcranial magnetic stimulation target. These preliminary findings suggest that the temporoparietal junction midway between T3 and P3 or T4 and P4 is a promising nonauditory rTMS target in the setting of chronic tinnitus. Future research should elucidate the effectiveness of this site for tinnitus suppression.
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Affiliation(s)
| | | | - Sandrine Jabbour
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael D Fox
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James G Naples
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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17
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A Protocol to Investigate Deep Brain Stimulation for Refractory Tinnitus: From Rat Model to the Set-Up of a Human Pilot Study. Audiol Res 2022; 13:49-63. [PMID: 36648926 PMCID: PMC9844413 DOI: 10.3390/audiolres13010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chronic tinnitus can have an immense impact on quality of life. Despite recent treatment advances, many tinnitus patients remain refractory to them. Preclinical and clinical evidence suggests that deep brain stimulation (DBS) is a promising treatment to suppress tinnitus. In rats, it has been shown in multiple regions of the auditory pathway that DBS can have an alleviating effect on tinnitus. The thalamic medial geniculate body (MGB) takes a key position in the tinnitus network, shows pathophysiological hallmarks of tinnitus, and is readily accessible using stereotaxy. Here, a protocol is described to evaluate the safety and test the therapeutic effects of DBS in the MGB in severe tinnitus sufferers. METHODS Bilateral DBS of the MGB will be applied in a future study in six patients with severe and refractory tinnitus. A double-blinded, randomized 2 × 2 crossover design (stimulation ON and OFF) will be applied, followed by a period of six months of open-label follow-up. The primary focus is to assess safety and feasibility (acceptability). Secondary outcomes assess a potential treatment effect and include tinnitus severity measured by the Tinnitus Functional Index (TFI), tinnitus loudness and distress, hearing, cognitive and psychological functions, quality of life, and neurophysiological characteristics. DISCUSSION This protocol carefully balances risks and benefits and takes ethical considerations into account. This study will explore the safety and feasibility of DBS in severe refractory tinnitus, through extensive assessment of clinical and neurophysiological outcome measures. Additionally, important insights into the underlying mechanism of tinnitus and hearing function might be revealed. TRIAL REGISTRATION ClinicalTrials.gov NCT03976908 (6 June 2019).
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18
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Smeele SJ, Adhia DB, De Ridder D. Feasibility and Safety of High-Definition Infraslow Pink Noise Stimulation for Treating Chronic Tinnitus—A Randomized Placebo-Controlled Trial. Neuromodulation 2022:S1094-7159(22)01339-3. [DOI: 10.1016/j.neurom.2022.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022]
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19
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Lee SJ, Park J, Lee SY, Koo JW, Vanneste S, De Ridder D, Lim S, Song JJ. Triple network activation causes tinnitus in patients with sudden sensorineural hearing loss: A model-based volume-entropy analysis. Front Neurosci 2022; 16:1028776. [PMID: 36466160 PMCID: PMC9714300 DOI: 10.3389/fnins.2022.1028776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/02/2022] [Indexed: 11/04/2023] Open
Abstract
Tinnitus can be defined as the conscious perception of phantom sounds in the absence of corresponding external auditory signals. Tinnitus can develop in the setting of sudden sensorineural hearing loss (SSNHL), but the underlying mechanism is largely unknown. Using electroencephalography, we investigated differences in afferent node capacity between 15 SSNHL patients without tinnitus (NT) and 30 SSNHL patients with tinnitus (T). Where the T group showed increased afferent node capacity in regions constituting a "triple brain network" [default mode network (DMN), central executive network (CEN), and salience network (SN)], the NT group showed increased information flow in regions implicated in temporal auditory processing and noise-canceling pathways. Our results demonstrate that when all components of the triple network are activated due to sudden-onset auditory deprivation, tinnitus ensues. By contrast, auditory processing-associated and tinnitus-suppressing networks are highly activated in the NT group, to overcome the activation of the triple network and effectively suppress the generation of tinnitus.
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Affiliation(s)
- Seung Jae Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jaemin Park
- Department of Mathematical Sciences, Seoul National University, Seoul, South Korea
| | - Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Dirk De Ridder
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Seonhee Lim
- Department of Mathematical Sciences, Seoul National University, Seoul, South Korea
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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20
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Billig AJ, Lad M, Sedley W, Griffiths TD. The hearing hippocampus. Prog Neurobiol 2022; 218:102326. [PMID: 35870677 PMCID: PMC10510040 DOI: 10.1016/j.pneurobio.2022.102326] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/08/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
The hippocampus has a well-established role in spatial and episodic memory but a broader function has been proposed including aspects of perception and relational processing. Neural bases of sound analysis have been described in the pathway to auditory cortex, but wider networks supporting auditory cognition are still being established. We review what is known about the role of the hippocampus in processing auditory information, and how the hippocampus itself is shaped by sound. In examining imaging, recording, and lesion studies in species from rodents to humans, we uncover a hierarchy of hippocampal responses to sound including during passive exposure, active listening, and the learning of associations between sounds and other stimuli. We describe how the hippocampus' connectivity and computational architecture allow it to track and manipulate auditory information - whether in the form of speech, music, or environmental, emotional, or phantom sounds. Functional and structural correlates of auditory experience are also identified. The extent of auditory-hippocampal interactions is consistent with the view that the hippocampus makes broad contributions to perception and cognition, beyond spatial and episodic memory. More deeply understanding these interactions may unlock applications including entraining hippocampal rhythms to support cognition, and intervening in links between hearing loss and dementia.
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Affiliation(s)
| | - Meher Lad
- Translational and Clinical Research Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - William Sedley
- Translational and Clinical Research Institute, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Timothy D Griffiths
- Biosciences Institute, Newcastle University Medical School, Newcastle upon Tyne, UK; Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London, UK; Human Brain Research Laboratory, Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, USA
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21
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Mazurek B, Hesse G, Sattel H, Kratzsch V, Lahmann C, Dobel C. S3 Guideline: Chronic Tinnitus : German Society for Otorhinolaryngology, Head and Neck Surgery e. V. (DGHNO-KHC). HNO 2022; 70:795-827. [PMID: 36227338 PMCID: PMC9581878 DOI: 10.1007/s00106-022-01207-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Gerhard Hesse
- Tinnitus-Klinik, KH Bad Arolsen, Große Allee 50, 34454, Bad Arolsen, Germany.
- Universität Witten/Herdecke, Witten, Germany.
| | - Heribert Sattel
- Klinikum rechts der Isar, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technical University of Munich, Langerstr. 3, 81675, Munich, Germany
| | - Volker Kratzsch
- Abt. Hörbehinderung, Tinnitus und Schwindelerkrankungen, VAMED Rehaklinik Bad Grönenbach, Sebastian-Kneipp-Allee 3-5, 87730, Bad Grönenbach, Germany
| | - Claas Lahmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 8, 79104, Freiburg, Germany
| | - Christian Dobel
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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22
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Fuksa J, Profant O, Tintěra J, Svobodová V, Tóthová D, Škoch A, Syka J. Functional changes in the auditory cortex and associated regions caused by different acoustic stimuli in patients with presbycusis and tinnitus. Front Neurosci 2022; 16:921873. [PMID: 36340777 PMCID: PMC9626994 DOI: 10.3389/fnins.2022.921873] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/31/2022] [Indexed: 09/30/2023] Open
Abstract
Presbycusis and tinnitus are the two most common hearing related pathologies. Although both of these conditions presumably originate in the inner ear, there are several reports concerning their central components. Interestingly, the onset of presbycusis coincides with the highest occurrence of tinnitus. The aim of this study was to identify age, hearing loss, and tinnitus related functional changes, within the auditory system and its associated structures. Seventy-eight participants were selected for the study based on their age, hearing, and tinnitus, and they were divided into six groups: young controls (Y-NH-NT), subjects with mild presbycusis (O-NH-NT) or expressed presbycusis (O-HL-NT), young subjects with tinnitus (Y-NH-T), subjects with mild presbycusis and tinnitus (O-NH-T), and subjects with expressed presbycusis and tinnitus (O-HL-T). An MRI functional study was performed with a 3T MRI system, using an event related design (different types of acoustic and visual stimulations and their combinations). The amount of activation of the auditory cortices (ACs) was dependent on the complexity of the stimuli; higher complexity resulted in a larger area of the activated cortex. Auditory stimulation produced a slightly greater activation in the elderly, with a negative effect of hearing loss (lower activation). The congruent audiovisual stimulation led to an increased activity within the default mode network, whereas incongruent stimulation led to increased activation of the visual cortex. The presence of tinnitus increased activation of the AC, specifically in the aged population, with a slight prevalence in the left AC. The occurrence of tinnitus was accompanied by increased activity within the insula and hippocampus bilaterally. Overall, we can conclude that expressed presbycusis leads to a lower activation of the AC, compared to the elderly with normal hearing; aging itself leads to increased activity in the right AC. The complexity of acoustic stimuli plays a major role in the activation of the AC, its support by visual stimulation leads to minimal changes within the AC. Tinnitus causes changes in the activity of the limbic system, as well as in the auditory AC, where it is bound to the left hemisphere.
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Affiliation(s)
- Jakub Fuksa
- Department of Otorhinolaryngology, 3rd Faculty of Medicine, Faculty Hospital Královské Vinohrady, Charles University, Prague, Czechia
- Department of Auditory Neuroscience, Institute of Experimental Medicine, The Czech Academy of Sciences, Prague, Czechia
| | - Oliver Profant
- Department of Otorhinolaryngology, 3rd Faculty of Medicine, Faculty Hospital Královské Vinohrady, Charles University, Prague, Czechia
- Department of Auditory Neuroscience, Institute of Experimental Medicine, The Czech Academy of Sciences, Prague, Czechia
| | - Jaroslav Tintěra
- MR Unit, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Veronika Svobodová
- Department of Auditory Neuroscience, Institute of Experimental Medicine, The Czech Academy of Sciences, Prague, Czechia
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czechia
| | - Diana Tóthová
- Department of Auditory Neuroscience, Institute of Experimental Medicine, The Czech Academy of Sciences, Prague, Czechia
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czechia
| | - Antonin Škoch
- MR Unit, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Josef Syka
- Department of Auditory Neuroscience, Institute of Experimental Medicine, The Czech Academy of Sciences, Prague, Czechia
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Self-Directed Neurofeedback Treatment for Subjective Tinnitus Patients Evaluated by Multimodal Functional Imaging. Neural Plast 2022; 2022:5114721. [PMID: 36304208 PMCID: PMC9596274 DOI: 10.1155/2022/5114721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/13/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
Neurofeedback (NFB) is a relatively novel approach to the treatment of tinnitus, and prior studies have demonstrated that the increases in alpha activity rather than reduced delta power seem to drive these NFB-related improvements in tinnitus symptoms. The present study was therefore designed to explore whether the implementation of an alpha training protocol with a portable neurofeedback apparatus would achieve improvements in tinnitus patient symptoms. In this study, 38 tinnitus patients underwent NFB training while 18 were enrolled in a control group. The study was single-blinded such that only participants were not aware of their group assignments. Those in the NFB group underwent 15 NFB training sessions over 5 weeks, in addition to pre- and posttraining tests including the Tinnitus Handicap Inventory (THI), Tinnitus Handicap Questionnaire (THQ), visual analog scales (VAS), electroencephalography (EEG), and functional magnetic resonance imaging (fMRI). Our result find that when the THI, THQ, and VAS scores of patients in the two groups were assessed after a 5-week training period, these scores were unchanged in control patients whereas they had significantly improved in the NFB group patients. EEG analyses revealed that the alpha band was increased in the occipital lobe following NFB treatment, while fMRI indicated an increase in regional homogeneity (ReHo) in the right frontal lobe of patients in the NFB group after treatment that was negatively correlated with THI and VAS scores. The results of this analysis indicate that alpha NFB training can be effectively used to reduce tinnitus-related distress and sound perception in patients.
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Hearing Aid Use Time Is Causally Influenced by Psychological Parameters in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss. J Clin Med 2022; 11:jcm11195869. [PMID: 36233736 PMCID: PMC9573609 DOI: 10.3390/jcm11195869] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Hearing aids (HAs) can improve tinnitus-related distress (TRD) and speech-comprehension (SC) in silence or at 55 dB level of noise-interference (SC_55 dB) in patients with chronic tinnitus and mild-to-moderate hearing loss. However, the role of HA use time in relation to psychological, audiological, or self-reported tinnitus characteristics is an under-investigated area. Methods: We examine 177 gender-stratified patients before (t1) and after an intervention comprising binaural DSLchild algorithm-based HA fitting and auditory training (t2) and at a 70-day follow up [t3]. HA use time was retrospectively retrieved (at t2) for the pre-post- and (at t3) post-follow up periods. General linear models investigated HA use time in relation to (1) general audiological, (2) tinnitus-related audiological, (3) tinnitus-related self-report, and (4) distress-related self-report indices before and after treatment, where applicable. Receiver operator characteristic analyses identified optimal HA use time for hereby-mediated treatment changes. Results: At t1 and t2, psychological, but not audiological indices causally influenced prospective HA use time—except for SC_55 dB at t1, which, however, correlated with patients’ anxiety, depressivity, and psychological distress levels. Correlations did not differ between patient subgroups defined by categorical tinnitus-related audiological or self-report indices. HA use time partly mediated treatment-related improvement in TRD, but not SC. Optimal use amounted to 9.5–10.5 h/day. Conclusions: An awareness of psychological influences may help clinicians facilitate HA use and, thereby, TRD improvement with hearing amplification.
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Li W, Ma X, Wang Q, He X, Qu X, Zhang L, Chen L, Liu Z. Intrinsic Network Changes in Bilateral Tinnitus Patients with Cognitive Impairment: A Resting-State Functional MRI Study. Brain Sci 2022; 12:brainsci12081049. [PMID: 36009112 PMCID: PMC9405767 DOI: 10.3390/brainsci12081049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Previous studies have found a link between tinnitus and cognitive impairment, even leading to dementia. However, the mechanisms underlying this association are not clear. The purpose of this study was to explore intrinsic network changes in tinnitus and hearing loss patients with cognitive disorders. We included 17 individuals with bilateral idiopathic tinnitus, hearing loss, and cognitive impairment (PA) and 21 healthy controls. We identified resting-state networks (RSNs) and measured intra-network functional connectivity (FC) values via independent component analysis (ICA). We also evaluated correlations between RSNs and clinical characteristics. Compared with the healthy controls, the PA group showed decreased connectivity within the ventral attention network, dorsal attention network (DAN), visual network, left frontoparietal network, right frontoparietal network, sensorimotor network, and increased connectivity within the executive control network. MoCA (Montreal Cognitive Assessment) scores were negatively correlated with the FC values for left calcarine within the DAN. We identified abnormal intrinsic connectivity in several brain networks, mainly involving cognitive control, vision, sensorimotor function, and the cerebellum, in tinnitus patients with cognitive impairment. It may be possible to use the FC strength of the left calcarine within the DAN as an imaging marker to predict cognitive impairment in tinnitus patients.
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Affiliation(s)
- Wei Li
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100730, China
| | - Xiaobo Ma
- Department of Otolaryngology Head and Neck Surgery, Capital Medical University, Beijing Tongren Hospital, Beijing 100730, China
| | - Qian Wang
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100730, China
| | - Xueying He
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100730, China
- Department of Radiology, Medical School of Nanjing University, Afliated Drum Tower Hospital, Nanjing 210008, China
| | - Xiaoxia Qu
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100730, China
| | - Lirong Zhang
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100730, China
| | - Lanyue Chen
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100730, China
| | - Zhaohui Liu
- Department of Radiology, Capital Medical University, Beijing Tongren Hospital, Beijing 100730, China
- Correspondence: ; Tel.: +86-10-582-680-34
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Zhou GP, Li WW, Chen YC, Wei HL, Yu YS, Guo X, Yin X, Tao YJ, Zhang H. Disrupted intra- and inter-network connectivity in unilateral acute tinnitus with hearing loss. Front Aging Neurosci 2022; 14:833437. [PMID: 35978951 PMCID: PMC9376359 DOI: 10.3389/fnagi.2022.833437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Currently, the underlying neurophysiological mechanism of acute tinnitus is still poorly understood. This study aimed to explore differences in brain functional connectivity (FC) within and between resting-state networks (RSNs) in acute tinnitus patients with hearing loss (ATHL). Furthermore, it also evaluated the correlations between FC alterations and clinical characteristics. Methods Two matched groups of 40 patients and 40 healthy controls (HCs) were included. Independent component analysis (ICA) was employed to obtain RSNs and FC differences were calculated within RSNs. In addition, the relationships between networks were conducted using functional network connectivity (FNC) analysis. Finally, an analysis of correlation was used to evaluate the relationship between FNC abnormalities and clinical data. Results Results of this study found that seven major RSNs including the auditory network (AN), cerebellum network (CN), default mode network (DMN), executive control network (ECN), sensorimotor network (SMN), ventral attention network (VAN), and visual network (VN) were extracted using the group ICA in both groups. Furthermore, it was noted that the ATHL group showed aberrant FC within the CN, ECN, and VN as compared with HCs. Moreover, different patterns of network interactions were observed between groups, including the SMN-ECN, SMN-CN, ECN-AN, DMN-VAN, and DMN-CN connections. The correlations between functional disconnection and clinical characteristics in ATHL were also found in this study. Conclusion In conclusion, this study indicated widespread alterations of intra- and inter-network connectivity in ATHL, suggesting that multiple large-scale network dysfunctions and interactions are involved in the early stage. Furthermore, our findings may provide new perspectives to understand the neuropathophysiological mechanism of acute tinnitus.
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Affiliation(s)
- Gang-Ping Zhou
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Wang-Wei Li
- Department of E.N.T., The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Heng-Le Wei
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xi Guo
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yue-Jin Tao
- Department of E.N.T., The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Yue-Jin Tao,
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
- Hong Zhang,
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A clinical trial of a patient-customized virtual reality intervention for tinnitus. Sci Rep 2022; 12:12441. [PMID: 35859044 PMCID: PMC9300604 DOI: 10.1038/s41598-022-16764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
Virtual reality (VR) has recently been used as a clinical treatment because it can efficiently simulate situations that are difficult to control in real-world settings. In our study, we assessed the potential of VR in patients with chronic subjective tinnitus. An evaluation of its clinical benefits was performed based on analyses of patient electroencephalograms (EEGs) and by questionnaire responses after 6–8 weeks of patient involvement in our VR-based alleviation program. Clinical trials were performed at a tertiary academic hospital. Nineteen patients (aged 33–64 years) who visited our hospital with chronic subjective tinnitus over 3 months were enrolled in the study. The intervention consisted of trashing the tinnitus avatar in VR. We expected that the patients would have the subjective feeling of controlling tinnitus through our intervention. The VR environment comprised four different sessions in four different settings: a bedroom, a living room, a restaurant, and a city street. We analyzed changes in the source activities of the prefrontal regions related to tinnitus in these patients using standardized low-resolution brain electromagnetic tomography. The Tinnitus Handicap Inventory (THI), the total score (from 50.11 to 44.21, P = 0.046) and the grade (from 3.16 to 2.79, P = 0.035) were significantly improved after the VR-based tinnitus treatment program (P < 0.05). The Pittsburgh Sleep Quality Index also showed improved outcomes (P = 0.025). On the other hand, a Tinnitus Handicap Questionnaire, Quality of Life Assessment (WHO-QOL), Hospital Anxiety and Depression Scale, Profile of Mood States revealed no significant change after the intervention. The baseline EEG data showed that brain activity in the orbitofrontal cortex significantly increased in the alpha and theta frequency bands. Furthermore, patients who showed a THI score improvement after the intervention showed specific increases in brain activity for the theta and high beta bands in the orbitofrontal cortex. Our findings suggest that the virtual reality-based program, as in parts of cognitive behavioral treatment, may help to alleviate tinnitus-related distress in patients with chronic subjective tinnitus.
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De Ridder D, Vanneste S, Song JJ, Adhia D. Tinnitus and the triple network model: a perspective. Clin Exp Otorhinolaryngol 2022; 15:205-212. [PMID: 35835548 PMCID: PMC9441510 DOI: 10.21053/ceo.2022.00815] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Tinnitus is defined as the conscious awareness of a sound without an identifiable external sound source, and tinnitus disorder as tinnitus with associated suffering. Chronic tinnitus has been anatomically and phenomenologically separated into three pathways: a lateral “sound” pathway, a medial “suffering” pathway, and a descending noise-canceling pathway. Here, the triple network model is proposed as a unifying framework common to neuropsychiatric disorders. It proposes that abnormal interactions among three cardinal networks—the self-representational default mode network, the behavioral relevance-encoding salience network and the goal-oriented central executive network—underlie brain disorders. Tinnitus commonly leads to negative cognitive, emotional, and autonomic responses, phenomenologically expressed as tinnitus-related suffering, processed by the medial pathway. This anatomically overlaps with the salience network, encoding the behavioral relevance of the sound stimulus. Chronic tinnitus can also become associated with the self-representing default mode network and becomes an intrinsic part of the self-percept. This is likely an energy-saving evolutionary adaptation, by detaching tinnitus from sympathetic energy-consuming activity. Eventually, this can lead to functional disability by interfering with the central executive network. In conclusion, these three pathways can be extended to a triple network model explaining all tinnitus-associated comorbidities. This model paves the way for the development of individualized treatment modalities.
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Affiliation(s)
- Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (Aotearoa)
| | - Sven Vanneste
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Jae-Jin Song
- Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Divya Adhia
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand (Aotearoa)
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Clustering approach based on psychometrics and auditory event-related potentials to evaluate acoustic therapy effects. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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30
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Cortical auditory evoked potentials, brain signal variability and cognition as biomarkers to detect the presence of chronic tinnitus. Hear Res 2022; 420:108489. [DOI: 10.1016/j.heares.2022.108489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/03/2022] [Accepted: 03/19/2022] [Indexed: 12/31/2022]
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Riha C, Güntensperger D, Kleinjung T, Meyer M. Recovering Hidden Responder Groups in Individuals Receiving Neurofeedback for Tinnitus. Front Neurosci 2022; 16:867704. [PMID: 35812211 PMCID: PMC9261875 DOI: 10.3389/fnins.2022.867704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
The widespread understanding that chronic tinnitus is a heterogeneous phenomenon with various neural oscillatory profiles has spurred investigations into individualized approaches in its treatment. Neurofeedback, as a non-invasive tool for altering neural activity, has become increasingly popular in the personalized treatment of a wide range of neuropsychological disorders. Despite the success of neurofeedback on the group level, the variability in the treatment efficacy on the individual level is high, and evidence from recent studies shows that only a small number of people can effectively modulate the desired aspects of neural activity. To reveal who may be more suitable, and hence benefit most from neurofeedback treatment, we classified individuals into unobserved subgroups with similar oscillatory trajectories during the treatment and investigated how subgroup membership was predicted by a series of characteristics. Growth mixture modeling was used to identify distinct latent subgroups with similar oscillatory trajectories among 50 individuals suffering from chronic subjective tinnitus (38 male, 12 female, mean age = 47.1 ± 12.84) across 15 neurofeedback training sessions. Further, the impact of characteristics and how they predicted the affiliation in the identified subgroups was evaluated by including measures of demographics, tinnitus-specific (Tinnitus Handicap Inventory) and depression variables, as well as subjective quality of life subscales (World Health Organization—Quality of Life Questionnaire), and health-related quality of life subscales (Short Form-36) in a logistic regression analysis. A latent class model could be fitted to the longitudinal data with a high probability of correctly classifying distinct oscillatory patterns into 3 different groups: non-responder (80%), responder (16%), and decliner (4%). Further, our results show that the health-related wellbeing subscale of the Short Form-36 questionnaire was differentially associated with the groups. However, due to the small sample size in the Responder group, we are not able to provide sufficient evidence for a distinct responder profile. Nevertheless, the identification of oscillatory change-rate differences across distinct groups of individuals provides the groundwork from which to tease apart the complex and heterogeneous oscillatory processes underlying tinnitus and the attempts to modify these through neurofeedback. While more research is needed, our results and the analytical approach presented may bring clarity to contradictory past findings in the field of tinnitus research, and eventually influence clinical practice.
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Affiliation(s)
- Constanze Riha
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Research Priority Program “ESIT—European School of Interdisciplinary Tinnitus Research,” Zurich, Switzerland
- *Correspondence: Constanze Riha, , orcid.org/0000-0002-6006-7018
| | | | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland
- Neuroscience Center Zurich (ZNZ), ETH Zürich, Zurich, Switzerland
| | - Martin Meyer
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich (ZNZ), ETH Zürich, Zurich, Switzerland
- University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Zurich, Switzerland
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Lan L, Liu Y, Xu JJ, Ma D, Yin X, Wu Y, Chen YC, Cai Y. Aberrant Modulations of Neurocognitive Network Dynamics in Migraine Comorbid With Tinnitus. Front Aging Neurosci 2022; 14:913191. [PMID: 35813956 PMCID: PMC9257523 DOI: 10.3389/fnagi.2022.913191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe possible relationship between migraine and tinnitus still remains elusive although migraine is often accompanied by chronic tinnitus. Several neuroimaging studies have reinforced the cognitive network abnormality in migraine and probably as well as tinnitus. The present work aims to investigate the dynamic neurocognitive network alterations of migraine comorbid with tinnitus.Materials and MethodsParticipants included migraine patients (n = 32), tinnitus patients (n = 20), migraine with tinnitus (n = 27), and healthy controls (n = 47), matched for age and gender. Resting-state functional magnetic resonance imaging (rs-fMRI) with independent component analysis (ICA), sliding window cross-correlation, and clustering state analysis was used to detect the dynamic functional network connectivity (dFNC) of each group. Correlation analyses illustrated the association between clinical symptoms and abnormal dFNC in migraine as well as tinnitus.ResultsCompared with healthy controls, migraine patients exhibited decreased cerebellar network and visual network (CN-VN) connectivity in State 2; migraine with tinnitus patients showed not only decreased CN-VN connectivity in State 2 but also decreased cerebellar network and executive control network (CN-ECN) connectivity in State 2 and increased cerebellar network and somatomotor network (SMN-VN) connectivity in State 1. The abnormal cerebellum dFNC with the executive control network (CN-ECN) was negatively correlated with headache frequency of migraine (rho = −0.776, p = 0.005).ConclusionBrain network characteristics of migraine with tinnitus patients may indicate different mechanisms for migraine and tinnitus. Our results demonstrated a transient pathologic state with atypical cerebellar-cortical connectivity in migraine with tinnitus patients, which might be used to identify the neuro-pathophysiological mechanisms in migraine accompanied by tinnitus.
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Affiliation(s)
- Liping Lan
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yin Liu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Di Ma
- College of Information Science and Technology, Nanjing Forestry University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuanqing Wu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Yu-Chen Chen,
| | - Yuexin Cai
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Yuexin Cai,
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Random Forest Classification to Predict Response to High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief: A Preliminary Feasibility Study. Ear Hear 2022; 43:1816-1823. [PMID: 35666538 PMCID: PMC9592176 DOI: 10.1097/aud.0000000000001246] [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: 02/04/2023]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex has been hypothesized to reduce tinnitus severity by modifying cortical activity in brain regions associated with the perception of tinnitus. However, individual response to tDCS has proven to be variable. We investigated the feasibility of using random forest classification to predict the response to high-definition (HD) tDCS for tinnitus relief. DESIGN A retrospective analysis was performed on a dataset consisting of 99 patients with subjective tinnitus receiving six consecutive sessions of HD-tDCS at the Antwerp University Hospital. A baseline assessment consisted of pure-tone audiometry and a set of questionnaires including the Tinnitus Functional Index (TFI), Hospital Anxiety and Depression Scale, and Edinburgh Handedness Inventory. Random forest classification was applied to predict, based on baseline questionnaire scores and hearing levels, whether each individual responded positively to the treatment (defined as a decrease of at least 13 points on the TFI). Further testing of the model was performed on an independent cohort of 32 patients obtained from the tinnitus center at the University of Regensburg. RESULTS Twenty-four participants responded positively to the HD-tDCS treatment. The random forest classifier predicted treatment response with an accuracy of 85.71% (100% sensitivity, 81.48% specificity), significantly outperforming a more traditional logistic regression approach. Performance of the classifier on an independent cohort was slightly but not significantly above chance level (71.88% accuracy, 66.67% sensitivity, 73.08% specificity). Feature importance analyses revealed that baseline tinnitus severity, co-occurrence of depressive symptoms and handedness were the most important predictors of treatment response. Baseline TFI scores were significantly higher in responders than in nonresponders. CONCLUSIONS The proposed random forest classifier predicted treatment response with a high accuracy, significantly outperforming a more traditional statistical approach. Machine learning methods to predict treatment response might ultimately be used in a clinical setting to guide targeted treatment recommendations for individual tinnitus patients.
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Becker L, Keck A, Rohleder N, Müller-Voggel N. Higher Peripheral Inflammation Is Associated With Lower Orbitofrontal Gamma Power in Chronic Tinnitus. Front Behav Neurosci 2022; 16:883926. [PMID: 35493955 PMCID: PMC9039358 DOI: 10.3389/fnbeh.2022.883926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic tinnitus, the continuous perception of a phantom sound, is a highly prevalent audiological symptom, for which the underlying pathology has not yet been fully understood. It is associated with neurophysiological alterations in the central nervous system and chronic stress, which can be related with a disinhibition of the inflammatory system. We here investigated the association between resting-state oscillatory activity assessed with Magnetoencephalography (MEG), and peripheral inflammation assessed by C-reactive protein (CRP) in a group of patients with chronic tinnitus (N = 21, nine males, mean age: 40.6 ± 14.6 years). Additionally, CRP was assessed in an age- and sex-matched healthy control group (N = 21, nine males, mean age: 40.9 ± 15.2 years). No MEG data was available for the control group. We found a significant negative correlation between CRP and gamma power in the orbitofrontal cortex in tinnitus patients (p < 0.001), pointing to a deactivation of the orbitofrontal cortex when CRP was high. No significant clusters were found for other frequency bands. Moreover, CRP levels were significantly higher in the tinnitus group than in the healthy controls (p = 0.045). Our results can be interpreted based on findings from previous studies having disclosed the orbitofrontal cortex as part of the tinnitus distress network. We suggest that higher CRP levels and the associated deactivation of the orbitofrontal cortex in chronic tinnitus patients is maintaining the tinnitus percept through disinhibition of the auditory cortex and attentional or emotional top-down processes. Although the direction of the association (i.e., causation) between CRP levels and orbitofrontal gamma power in chronic tinnitus is not yet known, inflammation reducing interventions are promising candidates when developing treatments for tinnitus patients. Overall, our study highlights the importance of considering immune-brain communication in tinnitus research.
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Affiliation(s)
- Linda Becker
- Department of Psychology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Linda Becker
| | - Antonia Keck
- Department of Neurosurgery, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nicolas Rohleder
- Department of Psychology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadia Müller-Voggel
- Department of Neurosurgery, Universitätsklinikum Erlangen, Erlangen, Germany
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Can GABAkines Quiet the Noise? The GABAA Receptor Neurobiology and Pharmacology of Tinnitus. Biochem Pharmacol 2022; 201:115067. [DOI: 10.1016/j.bcp.2022.115067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
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36
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Elgoyhen AB. The α9α10 nicotinic acetylcholine receptor: a compelling drug target for hearing loss? Expert Opin Ther Targets 2022; 26:291-302. [PMID: 35225139 PMCID: PMC9007918 DOI: 10.1080/14728222.2022.2047931] [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: 11/04/2022]
Abstract
INTRODUCTION Hearing loss is a major health problem, impacting education, communication, interpersonal relationships, and mental health. Drugs that prevent or restore hearing are lacking and hence novel drug targets are sought. There is the possibility of targeting the α9α10 nicotinic acetylcholine receptor (nAChR) in the prevention of noise-induced, hidden hearing loss and presbycusis. This receptor mediates synaptic transmission between medial olivocochlear efferent fibers and cochlear outer hair cells. This target is key since enhanced olivocochlear activity prevents noise-induced hearing loss and delays presbycusis. AREAS COVERED The work examines the α9α10 nicotinic acetylcholine receptor (nAChR), its role in noise-induced, hidden hearing loss and presbycusis and the possibility of targeting. Data has been searched in Pubmed, the World Report on Hearing from the World Health Organization and the Global Burden of Disease Study 2019. EXPERT OPINION The design of positive allosteric modulators of α9α10 nAChRs is proposed because of the advantage of reinforcing the medial olivocochlear (MOC)-hair cell endogenous neurotransmission without directly stimulating the target receptors, therefore avoiding receptor desensitization and reduced efficacy. The time is right for the discovery and development of α9α10 nAChRs targeting agents and high throughput screening assays will support this.
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Affiliation(s)
- Ana Belén Elgoyhen
- Laboratorio de Fisiología y Genética de la Audición, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres" (INGEBI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Lan L, Liu Y, Wu Y, Xu ZG, Xu JJ, Song JJ, Salvi R, Yin X, Chen YC, Cai Y. Specific brain network predictors of interventions with different mechanisms for tinnitus patients. EBioMedicine 2022; 76:103862. [PMID: 35104784 PMCID: PMC8814370 DOI: 10.1016/j.ebiom.2022.103862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aberrant brain network that gives rise to the phantom sound of tinnitus is believed to determine the effectiveness of tinnitus therapies involving neuromodulation with repetitive transcranial magnetic stimulation (rTMS) and sound therapy utilizing tailor-made notch music training (TMNMT). To test this hypothesis, we determined how effective rTMS or TMNMT were in ameliorating tinnitus in patients with different functional brain networks. METHODS Resting-state functional MRI was used to construct brain functional networks in patients with tinnitus (41 males/45 females, mean age 49.53±11.19 years) and gender-matched healthy controls (22 males/35 females, mean age 46.23±10.23 years) with independent component analysis (ICA). A 2 × 2 analysis of variance with treatment outcomes (Effective group, EG/Ineffective group, IG) and treatment types (rTMS/TMNMT) was used to test the interaction between outcomes and treatment types associated with functional network connections (FNCs). FINDINGS The optimal neuroimaging indicator for responding to rTMS (AUC 0.804, sensitivity 0.700, specificity 0.913) was FNCs in the salience network-right frontoparietal network (SN-RFPN) while for responding to TMNMT (AUC 0.764, sensitivity 0.864, specificity 0.667) was the combination of FNCs in the auditory network- salience network (AUN-SN) and auditory network-cerebellar network (AUN-CN). INTERPRETATION Tinnitus patients with higher FNCs in the SN-RFPN is associated with a recommendation for rTMS whereas patients with lower FNCs in the AUN-SN and AUN-CN would suggest TMNMT as the better choice. These results indicate that brain network-based measures aid in the selection of the optimal form of treatment for a patient contributing to advances in precision medicine. FUNDING Yuexin Cai is supported by Key R&D Program of Guangdong Province, China (Grant No. 2018B030339001), National Natural Science Foundation of China (82071062), Natural Science Foundation of Guangdong province (2021A1515012038), the Fundamental Research Funds for the Central Universities (20ykpy91), and Sun Yat-Sen Clinical Research Cultivating Program (SYS-Q-201903). Yu-Chen Chen is supported by Medical Science and Technology Development Foundation of Nanjing Department of Health (No. ZKX20037), and Natural Science Foundation of Jiangsu Province (No. BK20211008).
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Affiliation(s)
- Liping Lan
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, Guangdong 510120, China
| | - Yin Liu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing 210006, China
| | - Yuanqing Wu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen-Gui Xu
- Department of Otolaryngology, Nanjing Pukou Central Hospital, Pukou Branch Hospital of Jiangsu Province Hospital, Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Richard Salvi
- Center for Hearing and Deafness, University at Buffalo, The State University of New York, Buffalo, United States
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing 210006, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing 210006, China.
| | - Yuexin Cai
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, Guangdong 510120, China; Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China.
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38
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Li X, Xu N, Dai C, Meng X, Qiu X, Ding H, Zeng R, Lv H, Zhao P, Yang Z, Gong S, Wang Z. Altered Neurovascular Coupling in Unilateral Pulsatile Tinnitus. Front Neurosci 2022; 15:791436. [PMID: 35126039 PMCID: PMC8815060 DOI: 10.3389/fnins.2021.791436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/09/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Altered cerebral blood flow (CBF) and regional homogeneity (ReHo) have been reported in pulsatile tinnitus (PT) patients. We aimed to explore regional neurovascular coupling changes in PT patients. Materials and Methods Twenty-four right PT patients and 25 sex- and age-matched normal controls were included in this study. All subjects received arterial spin labeling imaging to measure CBF and functional MRI to compute ReHo. CBF/ReHo ratio was used to assess regional neurovascular coupling between the two groups. We also analyzed the correlation between CBF/ReHo ratio and clinical data from the PT patients. Results PT patients exhibited increased CBF/ReHo ratio in left middle temporal gyrus and right angular gyrus than normal controls, and no decreased CBF/ReHo ratio was found. CBF/ReHo ratio in the left middle temporal gyrus of PT patients was positively correlated with Tinnitus Handicap Inventory score (r = 0.433, p = 0.035). Conclusion These findings indicated that patients with PT exhibit abnormal neurovascular coupling, which provides new information for understanding the neuropathological mechanisms underlying PT.
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Affiliation(s)
- Xiaoshuai Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ning Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chihang Dai
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuxu Meng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Qiu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Rong Zeng
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- *Correspondence: Han Lv,
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Pengfei Zhao,
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Zhenchang Wang,
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Symptom dimensions to address heterogeneity in tinnitus. Neurosci Biobehav Rev 2022; 134:104542. [PMID: 35051524 DOI: 10.1016/j.neubiorev.2022.104542] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 01/10/2023]
Abstract
Tinnitus, the auditory phantom percept, is a well-known heterogenous disorder with multiple subtypes. Researchers and clinicians have tried to classify these subtypes according to clinical profiles, aetiologies, and response to treatment with little success. The occurrence of overlapping tinnitus subtypes suggests that the disorder exists along a continuum of severity, with no clear distinct boundaries. In this perspective, we propose a neuro-mechanical framework, viewing tinnitus as a dimensional disorder which is a complex interplay of its behavioural, biological and neurophysiological phenotypes. Moreover, we explore the potential of these dimensions as interacting networks without a common existing cause, giving rise to tinnitus. Considering tinnitus as partially overlapping, dynamically changing, interacting networks, each representing a different aspect of the unified tinnitus percept, suggests that the interaction of these networks determines the phenomenology of the tinnitus, ultimately leading to a dimensional spectrum, rather than a categorical subtyping. A combination of a robust theoretical framework and strong empirical evidence can advance our understanding of the functional mechanisms underlying tinnitus and ultimately, improve treatment strategies.
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40
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Lee SY, Chang M, Kwon B, Choi BY, Koo JW, Moon T, De Ridder D, Vanneste S, Song JJ. Is the posterior cingulate cortex an on-off switch for tinnitus?: A comparison between hearing loss subjects with and without tinnitus. Hear Res 2021; 411:108356. [PMID: 34600166 DOI: 10.1016/j.heares.2021.108356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 08/14/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
As the human brain works in a Bayesian manner to minimize uncertainty toward external stimuli, the deafferented brain may generate tinnitus in an attempt to fill in missing auditory information, e.g. due to hearing loss. However, not everybody with hearing loss develops tinnitus. Understanding the differences between people with hearing loss who develop tinnitus versus those who do not offers a unique opportunity to unravel critical brain areas involved in the generation of a phantom sound. In this study, we compared resting-state quantitative electroencephalography between hearing loss patients with (HL-T) and without tinnitus (HL-NT) to identify cortical oscillatory signatures that may reveal prerequisites for the selective development of tinnitus in subjects with hearing loss. We enrolled 65 subjects with HL-NT and 65 subjects with HL-T whose tinnitus handicap inventory scores were <16 (grade 1) to minimize the bias induced by distress-induced cortical activity changes. Subjects in the HL-T and HL-NT groups were matched in terms of the bilateral hearing threshold (0.25-8 kHz) using nearest neighbor method. Compared to the HL-NT group, the HL-T group showed significantly higher activity in the right parahippocampus for the beta 1 frequency band, in the left inferior parietal lobule (IPL) for the beta 2 frequency band, and in the right IPL for the beta 3- and gamma frequency bands. Functional connectivity analyses revealed that the HL-T group had significantly higher connectivity than the HL-NT group between both parahippocampal gyri and the right IPL for the delta frequency band, and between the left posterior cingulate cortex (PCC) and right IPL for the beta 2 frequency band. These results suggest that tinnitus may be perceived only if auditory memory stored in the parahippocampus is actively linked to the IPL-based "circuit breaker" system and the circuit breaker signal is connected to the PCC-based default mode network (DMN). Thus, when the circuit breaker system regards tinnitus secondary to peripheral deafferentation as a salient event and then the DMN regards tinnitus as a norm, subjects with hearing loss may consciously perceive tinnitus. The results of this study further refine the recently proposed Bayesian model and decipher the neurobiological mechanism of the selective development of tinnitus in subjects with hearing loss.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Korea
| | - Munyoung Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | | | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Korea
| | - Ja-Won Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Korea
| | - Taesup Moon
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Dirk De Ridder
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sven Vanneste
- Lab for Clinical & Integrative Neuroscience, Trinity College of Neuroscience, Trinity College Dublin, Ireland
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, 13620, Korea..
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Hu S, Hall DA, Zubler F, Sznitman R, Anschuetz L, Caversaccio M, Wimmer W. Bayesian brain in tinnitus: Computational modeling of three perceptual phenomena using a modified Hierarchical Gaussian Filter. Hear Res 2021; 410:108338. [PMID: 34469780 DOI: 10.1016/j.heares.2021.108338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/27/2021] [Accepted: 08/17/2021] [Indexed: 01/01/2023]
Abstract
Recently, Bayesian brain-based models emerged as a possible composite of existing theories, providing an universal explanation of tinnitus phenomena. Yet, the involvement of multiple synergistic mechanisms complicates the identification of behavioral and physiological evidence. To overcome this, an empirically tested computational model could support the evaluation of theoretical hypotheses by intrinsically encompassing different mechanisms. The aim of this work was to develop a generative computational tinnitus perception model based on the Bayesian brain concept. The behavioral responses of 46 tinnitus subjects who underwent ten consecutive residual inhibition assessments were used for model fitting. Our model was able to replicate the behavioral responses during residual inhibition in our cohort (median linear correlation coefficient of 0.79). Using the same model, we simulated two additional tinnitus phenomena: residual excitation and occurrence of tinnitus in non-tinnitus subjects after sensory deprivation. In the simulations, the trajectories of the model were consistent with previously obtained behavioral and physiological observations. Our work introduces generative computational modeling to the research field of tinnitus. It has the potential to quantitatively link experimental observations to theoretical hypotheses and to support the search for neural signatures of tinnitus by finding correlates between the latent variables of the model and measured physiological data.
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Affiliation(s)
- Suyi Hu
- Department for Otolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Switzerland; Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Deborah A Hall
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Department of Psychology, School of Social Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
| | - Frédéric Zubler
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Raphael Sznitman
- Artificial Intelligence in Medical Imaging, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Lukas Anschuetz
- Department for Otolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Marco Caversaccio
- Department for Otolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Switzerland; Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Wilhelm Wimmer
- Department for Otolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Switzerland; Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
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Lv H, Chen Q, Wei X, Liu C, Zhao P, Wang Z, Yang Z, Gong S, You H, Wang Z. Sound therapy can modulate the functional connectivity of the auditory network. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110323. [PMID: 33838149 DOI: 10.1016/j.pnpbp.2021.110323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 04/03/2021] [Accepted: 04/04/2021] [Indexed: 02/07/2023]
Abstract
The functional connectivity of the auditory network is considered to be important in the development of tinnitus. We hypothesized that sound therapy, as a commonly used effective treatment for tinnitus, can modulate the functional connectivity of the auditory network. In this prospective observational study, we recruited 27 tinnitus patients who had undergone 12 weeks of sound therapy and 27 matched healthy controls. For the two groups of subjects, resting-state functional magnetic resonance imaging was acquired both at baseline and at the 12th week. We utilized independent component analysis and seed-based functional connectivity analysis to characterize the connectivity features of the auditory network. Interaction effects between the two groups and the two scans within the auditory network were observed, which were driven by increased functional connectivity in the left primary auditory cortex (PAC) and decreased values in the secondary auditory cortex (SAC) in tinnitus patients after treatment. Increased connections between the auditory network and limbic network, as well as decreased values with the bilateral thalami, were identified. The effects were mainly driven by the functional connectivity alterations of the SAC rather than that of the PAC. Significant positive correlations between the percent improvement in the Tinnitus Handicap Inventory (THI) score and the percentage change rates of functional connectivity between the SAC and bilateral thalami were observed. Our study contributes to the understanding of the mechanism of tinnitus and effective sound therapy, providing evidence to support the theory of a gain adaptation mechanism that quantifies the recovered gating function of the thalamus in tinnitus patients.
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Affiliation(s)
- Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Chunli Liu
- Department of Otolaryngology, The Affiliated Hospital of Chengde Medical College, Hebei 067000, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhaodi Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hong You
- Liver Research Center, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Santacruz JL, Arnold R, Tuinstra J, Stewart RE, van Dijk P. Validation of a Dutch version of the Tinnitus Functional Index in a tertiary referral tinnitus clinic. Heliyon 2021; 7:e07733. [PMID: 34430732 PMCID: PMC8371215 DOI: 10.1016/j.heliyon.2021.e07733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/21/2021] [Accepted: 08/04/2021] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Tinnitus is a condition with a subjective nature that requires self-report questionnaires for its assessment. Aspects such as quality of life, sleep or intrusiveness have been addressed by multiple tinnitus questionnaires, but the high responsiveness to treatment effects of the Tinnitus Functional Index (TFI) makes this questionnaire part of the standard practice in tinnitus screening. To date, the TFI has been translated to more than 20 languages and used in more than 22 countries. In this study, the TFI was translated to Dutch and validated through a clinical population in the Netherlands. METHODS After a back-translation procedure, the Dutch TFI was filled-out by 377 patients in the tinnitus outpatient clinic at the Ear, Nose and Throat (ENT) department of the University Medical Center Groningen, in the Netherlands. Reliability and construct validity of the questionnaire were assessed by correlations with one other tinnitus questionnaire (Tinnitus Handicap Inventory, THI) and with three psychological functioning questionnaires (Rand-36, Cantril's ladder and the Hospital Anxiety and Depression Scale (HADS)). The eight-factor structure of the Dutch TFI was tested by means of exploratory factor analysis using three different models (ICM-CFA, ESEM and ESEM-CFA). RESULTS The Dutch TFI showed a high internal consistency (α = 0.95), and construct validity was proven by moderate-to high-convergent correlations with the THI (r = 0.47-0.79) and by moderate convergent (r = 0.55-0.67) and good-to moderate-divergent (r = 0.12-0.47) correlations with the psychological functioning questionnaires. The eight-factor structure of the TFI was confirmed for the Dutch version by the three models. CONCLUSION The Dutch version of the TFI is a reliable instrument for screening tinnitus impact in a clinical population, and its psychometric properties are comparable to the original TFI and other validated tinnitus questionnaires.
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Affiliation(s)
- Jose L. Santacruz
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, the Netherlands
| | - Rosemarie Arnold
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jolanda Tuinstra
- University of Groningen, University Medical Center Groningen, Dept. of Health Sciences, the Netherlands
- University of Applied Sciences NHL Stenden, Dept. Health and Social Studies, Leeuwarden, the Netherlands
| | - Roy E. Stewart
- University of Groningen, University Medical Center Groningen, Dept. of Health Sciences, the Netherlands
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, the Netherlands
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Zimdahl JW, Thomas H, Bolland SJ, Leggett K, Barry KM, Rodger J, Mulders WHAM. Excitatory Repetitive Transcranial Magnetic Stimulation Over Prefrontal Cortex in a Guinea Pig Model Ameliorates Tinnitus. Front Neurosci 2021; 15:693935. [PMID: 34366777 PMCID: PMC8339289 DOI: 10.3389/fnins.2021.693935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
Tinnitus, a phantom auditory perception that can seriously affect quality of life, is generally triggered by cochlear trauma and associated with aberrant activity throughout the auditory pathways, often referred to as hyperactivity. Studies suggest that non-auditory structures, such as prefrontal cortex (PFC), may be involved in tinnitus generation, by affecting sensory gating in auditory thalamus, allowing hyperactivity to reach the cortex and lead to perception. Indeed, human studies have shown that repetitive transcranial magnetic stimulation (rTMS) of PFC can alleviate tinnitus. The current study investigated whether this therapeutic effect is achieved through inhibition of thalamic hyperactivity, comparing effects of two common clinical rTMS protocols with sham treatment, in a guinea pig tinnitus model. Animals underwent acoustic trauma and once tinnitus developed were treated with either intermittent theta burst stimulation (iTBS), 20 Hz rTMS, or sham rTMS (10 days, 10 min/day; weekdays only). Tinnitus was reassessed and extracellular recordings of spontaneous tonic and burst firing rates in auditory thalamus made. To verify effects in PFC, densities of neurons positive for calcium-binding proteins, calbindin and parvalbumin, were investigated using immunohistochemistry. Both rTMS protocols significantly reduced tinnitus compared to sham. However, spontaneous tonic firing decreased following 20 Hz stimulation and increased following iTBS in auditory thalamus. Burst rate was significantly different between 20 Hz and iTBS stimulation, and burst duration was increased only after 20 Hz treatment. Density of calbindin, but not parvalbumin positive neurons, was significantly increased in the most dorsal region of PFC indicating that rTMS directly affected PFC. Our results support the involvement of PFC in tinnitus modulation, and the therapeutic benefit of rTMS on PFC in treating tinnitus, but indicate this is not achieved solely by suppression of thalamic hyperactivity.
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Affiliation(s)
- Jack W Zimdahl
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Harrison Thomas
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Samuel J Bolland
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia.,Perron Institute for Neurological and Translational Research, Crawley, WA, Australia
| | - Kerry Leggett
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Kristin M Barry
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Jennifer Rodger
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia.,Perron Institute for Neurological and Translational Research, Crawley, WA, Australia
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Koops EA, Eggermont JJ. The thalamus and tinnitus: Bridging the gap between animal data and findings in humans. Hear Res 2021; 407:108280. [PMID: 34175683 DOI: 10.1016/j.heares.2021.108280] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/26/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022]
Abstract
The neuronal mechanisms underlying tinnitus are yet to be revealed. Tinnitus, an auditory phantom sensation, used to be approached as a purely auditory domain symptom. More recently, the modulatory impact of non-auditory brain regions on the percept and burden of tinnitus are explored. The thalamus is uniquely situated to facilitate the communication between auditory and non-auditory subcortical and cortical structures. Traditionally, animal models of tinnitus have focussed on subcortical auditory structures, and research with human participants has been concerned with cortical activity in auditory and non-auditory areas. Recently, both research fields have investigated the connectivity between subcortical and cortical regions and between auditory and non-auditory areas. We show that even though the different fields employ different methods to investigate the activity and connectivity of brain areas, there is consistency in the results on tinnitus between these different approaches. This consistency between human and animals research is observed for tinnitus with peripherally instigated hearing damage, and for results obtained with salicylate and noise-induced tinnitus. The thalamus integrates input from limbic and prefrontal areas and modulates auditory activity via its connections to both subcortical and cortical auditory areas. Reported altered activity and connectivity of the auditory, prefrontal, and limbic regions suggest a more systemic approach is necessary to understand the origins and impact of tinnitus.
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Affiliation(s)
- Elouise A Koops
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Jos J Eggermont
- Departments of Physiology and Pharmacology, and Psychology, University of Calgary, Calgary, Alberta, Canada
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Yakunina N, Nam EC. Direct and Transcutaneous Vagus Nerve Stimulation for Treatment of Tinnitus: A Scoping Review. Front Neurosci 2021; 15:680590. [PMID: 34122002 PMCID: PMC8193498 DOI: 10.3389/fnins.2021.680590] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/05/2021] [Indexed: 12/27/2022] Open
Abstract
Recent animal research has shown that vagus nerve stimulation (VNS) paired with sound stimuli can induce neural plasticity in the auditory cortex in a controlled manner. VNS paired with tones excluding the tinnitus frequency eliminated physiological and behavioral characteristics of tinnitus in noise-exposed rats. Several clinical trials followed and explored the effectiveness of VNS paired with sound stimuli for alleviating tinnitus in human subjects. Transcutaneous VNS (tVNS) has received increasing attention as a non-invasive alternative approach to tinnitus treatment. Several studies have also explored tVNS alone (not paired with sound stimuli) as a potential therapy for tinnitus. In this review, we discuss existing knowledge about direct and tVNS in terms of applicability, safety, and effectiveness in diminishing tinnitus symptoms in human subjects. This review includes all existing clinical and neuroimaging studies of tVNS alone or paired with acoustic stimulation in tinnitus patients and outlines the present limitations that must be overcome to maximize the potential of (t)VNS as a therapy for tinnitus.
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Affiliation(s)
- Natalia Yakunina
- Institute of Medical Science, School of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Eui-Cheol Nam
- Department of Otolaryngology, School of Medicine, Kangwon National University, Chuncheon, South Korea
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Poeppl TB, Schecklmann M, Sakreida K, Landgrebe M, Langguth B, Eickhoff SB. Prediction of response to repetitive transcranial magnetic stimulation in phantom sounds based on individual brain anatomy. Brain Commun 2021; 3:fcab115. [PMID: 34396100 PMCID: PMC8361389 DOI: 10.1093/braincomms/fcab115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
Non-invasive brain stimulation can reduce the severity of tinnitus phantom sounds beyond the time of stimulation by inducing regional neuroplastic changes. However, there are no good clinical predictors for treatment outcome. We used machine learning to investigate whether brain anatomy can predict therapeutic outcome. Sixty-one chronic tinnitus patients received repetitive transcranial magnetic stimulation of left dorsolateral prefrontal and temporal cortex. Before repetitive transcranial magnetic stimulation, a structural magnetic resonance image was obtained from all patients. To predict individual treatment response in new subjects, we employed a support vector machine ensemble for individual out-of-sample prediction. In the cross-validation, the support vector machine ensemble based on stratified sub-sampling and feature selection yielded an area under the curve of 0.87 for prediction of therapy success in new, previously unseen subjects. This corresponded to a balanced accuracy of 83.5%, sensitivity of 77.2% and specificity of 87.2%. Investigating the most selected features showed the involvement of the auditory cortex but also revealed a network of non-auditory brain areas. These findings suggest that idiosyncratic brain patterns accurately predict individual responses to repetitive transcranial magnetic stimulation treatment for tinnitus. Our findings may hence pave the way for future investigations into the precision treatment of tinnitus, involving automatic identification of the appropriate treatment method for the individual patient.
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Affiliation(s)
- Timm B Poeppl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,Department of Psychiatry and Psychotherapy, Universität Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, Universität Regensburg, Regensburg, Germany
| | - Katrin Sakreida
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Michael Landgrebe
- Department of Psychiatry, Psychotherapy and Psychosomatics, kbo-Lech-Mangfall-Klinik Agatharied, Hausham, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, Universität Regensburg, Regensburg, Germany
| | - Simon B Eickhoff
- Institute for Systems Neuroscience, Heinrich Heine University, Düsseldorf, Germany.,Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
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48
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Partyka M, Neff P, Bacri T, Michels J, Weisz N, Schlee W. Gender differentiates effects of acoustic stimulation in patients with tinnitus. PROGRESS IN BRAIN RESEARCH 2021; 263:25-57. [PMID: 34243890 DOI: 10.1016/bs.pbr.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gender constitutes a major factor to consider when tailoring subtype-based therapies for tinnitus. Previous reports showed important differences between men and women concerning basic perceptual tinnitus characteristics (i.e., laterality, frequency, tinnitus loudness) as well as psychological reactions linked to this condition. Therapeutic approaches based on acoustic stimulation involve processes beyond a pure masking effect and consist of sound presentation temporarily altering or alleviating tinnitus perception via residual and/or lateral inhibition mechanisms. Presented stimuli may include pure tones, noise, and music adjusted to or modulated to filter out tinnitus pitch and therefore trigger reparative functional and structural changes in the auditory system. Furthermore, recent findings suggest that in tonal tinnitus, the presentation of pitch-adjusted sounds which were altered by a 10Hz modulation of amplitude was more efficient than unmodulated stimulation. In this paper, we investigate sex differences in the outcome of different variants of acoustic stimulation, looking for factors revealing predictive value in the efficiency of tinnitus relief.
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Affiliation(s)
- Marta Partyka
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Patrick Neff
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria; University of Zurich, Zurich, Switzerland
| | - Timothée Bacri
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Jakob Michels
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Nathan Weisz
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Winfried Schlee
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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49
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Riha C, Güntensperger D, Oschwald J, Kleinjung T, Meyer M. Application of Latent Growth Curve modeling to predict individual trajectories during neurofeedback treatment for tinnitus. PROGRESS IN BRAIN RESEARCH 2021; 263:109-136. [PMID: 34243885 DOI: 10.1016/bs.pbr.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tinnitus is a heterogeneous phenomenon indexed by various EEG oscillatory profiles. Applying neurofeedback (NFB) with the aim of changing these oscillatory patterns not only provides help for those who suffer from the phantom percept, but a promising foundation from which to probe influential factors. The reliable attribution of influential factors that potentially predict oscillatory changes during the course of NFB training may lead to the identification of subgroups of individuals that are more or less responsive to NFB training. The present study investigated oscillatory trajectories of delta (3-4Hz) and individual alpha (8.5-12Hz) during 15 NFB training sessions, based on a Latent Growth Curve framework. First, we found the desired enhancement of alpha, while delta was stable throughout the NFB training. Individual differences in tinnitus-specific variables and general-, as well as health-related quality of life predictors were largely unrelated to oscillatory change prior to and across the training. Only the predictors age and sex at baseline were clearly related to slow-wave delta, particularly so for older female individuals who showed higher delta power values from the start. Second, we confirmed a hierarchical cross-frequency association between the two frequency bands; however, in opposing directions to those anticipated in tinnitus. The establishment of individually tailored NFB protocols would boost this therapy's effectiveness in the treatment of tinnitus. In our analysis, we propose a conceptual groundwork toward this goal of developing more targeted treatment.
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Affiliation(s)
- Constanze Riha
- Chair of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Research Priority Program "ESIT-European School of Interdisciplinary Tinnitus Research", Zurich, Switzerland
| | - Dominik Güntensperger
- Chair of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jessica Oschwald
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland
| | - Martin Meyer
- Chair of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
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50
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Brewster KK, Golub JS, Rutherford BR. Neural circuits and behavioral pathways linking hearing loss to affective dysregulation in older adults. NATURE AGING 2021; 1:422-429. [PMID: 37118018 PMCID: PMC10154034 DOI: 10.1038/s43587-021-00065-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/12/2021] [Indexed: 04/30/2023]
Abstract
Substantial evidence now links age-related hearing loss to incident major depressive disorder in older adults. However, research examining the neural circuits and behavioral mechanisms by which age-related hearing loss leads to depression is at an early phase. It is known that hearing loss has adverse structural and functional brain consequences, is associated with reduced social engagement and loneliness, and often results in tinnitus, which can independently affect cognitive control and emotion processing circuits. While pathways leading from these sequelae of hearing loss to affective dysregulation and depression are intuitive to hypothesize, few studies have yet been designed to provide conclusive evidence for specific pathophysiological mechanisms. Here we review the neurobiological and behavioral consequences of age-related hearing loss, present a model linking them to increased risk for major depressive disorder and suggest how future studies may facilitate the development of rationally designed therapeutic interventions for older adults with impaired hearing to reduce risk for depression and/or ameliorate depressive symptoms.
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Affiliation(s)
- Katharine K Brewster
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- New York State Psychiatric Institute, New York, NY, USA.
| | - Justin S Golub
- Department of Otolaryngology-Head and Neck Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Bret R Rutherford
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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