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Fabrizio-Stover EM, Oliver DL, Burghard AL. Tinnitus mechanisms and the need for an objective electrophysiological tinnitus test. Hear Res 2024; 449:109046. [PMID: 38810373 DOI: 10.1016/j.heares.2024.109046] [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: 02/29/2024] [Revised: 05/16/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
Tinnitus, the perception of sound with no external auditory stimulus, is a complex, multifaceted, and potentially devastating disorder. Despite recent advances in our understanding of tinnitus, there are limited options for effective treatment. Tinnitus treatments are made more complicated by the lack of a test for tinnitus based on objectively measured physiological characteristics. Such an objective test would enable a greater understanding of tinnitus mechanisms and may lead to faster treatment development in both animal and human research. This review makes the argument that an objective tinnitus test, such as a non-invasive electrophysiological measure, is desperately needed. We review the current tinnitus assessment methods, the underlying neural correlates of tinnitus, the multiple tinnitus generation theories, and the previously investigated electrophysiological measurements of tinnitus. Finally, we propose an alternate objective test for tinnitus that may be valid in both animal and human subjects.
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Affiliation(s)
- Emily M Fabrizio-Stover
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA; Department of Otolaryngology-Head and Neck Surgery, Medical University South Carolina, Charleston, SC, USA
| | - Douglas L Oliver
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alice L Burghard
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA.
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Sendesen E, Turkyilmaz D. Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss. Brain Behav 2024; 14:e3520. [PMID: 38715412 PMCID: PMC11077254 DOI: 10.1002/brb3.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/25/2024] [Accepted: 04/20/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE In previous animal studies, sound enhancement reduced tinnitus perception in cases associated with hearing loss. The aim of this study was to investigate the efficacy of sound enrichment therapy in tinnitus treatment by developing a protocol that includes criteria for psychoacoustic characteristics of tinnitus to determine whether the etiology is related to hearing loss. METHODS A total of 96 patients with chronic tinnitus were included in the study. Fifty-two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment. RESULTS There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p < .01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p < .01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p < .05) and at all months for VAS-1 (tinnitus severity) (p < .05) and VAS-2 (tinnitus discomfort) (p < .05). CONCLUSION In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55 dB HL in a relatively short period of 1 month.
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Affiliation(s)
- Eser Sendesen
- Department of AudiologyHacettepe UniversityAnkaraTurkey
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Vielsmeier V, van der Loo J, Marcrum SC. [Somatosensory tinnitus]. HNO 2023; 71:731-738. [PMID: 37782343 DOI: 10.1007/s00106-023-01372-0] [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] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Somatosensory tinnitus represents a clinically significant subgroup of chronic tinnitus. Although not completely understood, increasing evidence suggests interactivity between the somatosensory and auditory systems is responsible for both the development and maintenance of tinnitus. OBJECTIVES The aim of this study is to provide an overview of the evaluation of somatosensory tinnitus and to propose an examination protocol to support the diagnosis and treatment of this patient group. MATERIALS AND METHODS In addition to patient history, various clinical examination maneuvers are presented to establish the diagnosis of somatosensory tinnitus. RESULTS The maneuvers can be divided into examinations of the cervical spine, temporomandibular joint, and soft tissue near the jaw. The maneuvers should be performed in a quiet environment and usually in comparison between sides. CONCLUSION Accurate and efficient diagnosis of somatosensory tinnitus is essential to initiate appropriate treatment. The clinical maneuvers presented here are well suited for this purpose.
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Affiliation(s)
- Veronika Vielsmeier
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
| | - Joachim van der Loo
- Abteilung für Physio- und Ergotherapie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Steven C Marcrum
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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da Silva MT, Silva C, Silva J, Costa M, Gadotti I, Ribeiro K. Effectiveness of Physical Therapy Interventions for Temporomandibular Disorders Associated with Tinnitus: A Systematic Review. J Clin Med 2023; 12:4329. [PMID: 37445364 DOI: 10.3390/jcm12134329] [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: 03/11/2023] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 07/15/2023] Open
Abstract
Temporomandibular disorders (TMDs) refers to different clinical conditions affecting the temporomandibular joints, masticatory muscles, and adjacent structures. Although TMDs signs and symptoms (e.g., pain and limited mouth opening) are common, otological symptoms, such as tinnitus, might also be present. This study aims to summarize the evidence of the effectiveness of physical therapy interventions in individuals with TMDs associated with tinnitus. Randomized controlled trials investigating the effectiveness of physical therapy in individuals of both genders aged 18 or older with TMDs associated with tinnitus were included. The electronic search was performed in the following databases: MEDLINE, EMBASE, CINAHL, PEDro and CENTRAL. A total of four studies were included. All studies showed that physical therapy reduced the intensity of tinnitus, and two trials showed a decrease in the pain intensity caused by TMDs, an increase in the pressure pain thresholds in the masticatory muscles and an improvement of mandibular function. Two studies presented a low risk of bias. Despite a low certainty of the evidence, this review showed that physical therapy reduces the intensity or severity of tinnitus associated with TMDs. Results may support future research on the topic and evidence-based practice by recommending the best physical therapy approach for patients, clinicians, researchers, and health system managers.
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Affiliation(s)
- Marianne Trajano da Silva
- Post-Graduation Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Carlos Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Jade Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Mateus Costa
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Inae Gadotti
- Department of Physical Therapy, Florida International University, Miami, FL 33199, USA
| | - Karyna Ribeiro
- Post-Graduation Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
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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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Lee S, Jin TJ, Jin IK. Methods, Applications, and Limitations of Somatic Maneuvers for the Modulation of Tinnitus. Audiol Res 2022; 12:644-652. [PMID: 36412657 PMCID: PMC9680272 DOI: 10.3390/audiolres12060062] [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: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
The modulation of tinnitus through somatic maneuvers is a well-documented phenomenon in tinnitus patients with somatic disorders. The purpose of this study was to review the methods, applications, and limitations of somatic maneuvers. First, 35 somatic maneuvers proposed by various research groups were summarized according to four body areas (jaw, head and neck, eye, and limbs), following which their applications and limitations were assessed. Although some studies have shown that somatic maneuvers can aid in screening for somatic tinnitus and may help alleviate symptoms with repeated practice, the limited number of studies and inconsistent results among studies make it difficult to draw definitive conclusions. Therefore, follow-up studies are required to overcome these limitations and determine whether the treatment of somatic disorders can also aid in alleviating somatic tinnitus.
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Affiliation(s)
- Sumin Lee
- Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon-si 24252, Republic of Korea
| | - Tae-Jun Jin
- Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon-si 24252, Republic of Korea
| | - In-Ki Jin
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, Hallym University, Chuncheon-si 24252, Republic of Korea
- Correspondence:
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Temporomandibular Disorders and Bruxism in Patients Attending a Tinnitus Clinic. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12104970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current study investigated the coexistence of temporomandibular disorder (TMD) and/or bruxism among 51 individuals seeking treatment in a tinnitus clinic. All participants completed a Hebrew version of the Tinnitus Handicap Inventory (THI), depression and anxiety questionnaires, and the diagnostic criteria TMD (DC/TMD) questionnaire. In addition to questionnaires, the participants underwent a clinical evaluation of the oral cavity, facial muscles, and the temporomandibular joint (TMJ). Thirty-four participants (66.7%) were diagnosed with bruxism, while TMD was found in 14 (27.5%) of the cases. Patients with both tinnitus, TMD and bruxism scored the highest in the anxiety questionnaire. The severity of depression was found to be significantly associated with the tinnitus severity. These results emphasize the clinical bond between tinnitus, TMD, and bruxism.
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Chew AQA, Saigo L, Yap AU. Is there a comorbid relationship between temporomandibular disorders and otologic signs/symptoms?: An umbrella review. Cranio 2022:1-14. [PMID: 35543516 DOI: 10.1080/08869634.2022.2069639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This umbrella review (UR) explored the possible associations between temporomandibular disorders (TMDs) and otologic signs/symptoms (OSs) and established the potential impact of TMD interventions on OSs. METHODS A systematic review of systematic reviews (SRs)/meta-analyses (MAs) was conducted according to the PRISMA guidelines and Joanna Briggs Institute UR protocol. Electronic search of the PubMed, Scopus, Web of Science, and Open Grey databases was conducted and the quality of the identified studies was assessed using the AMSTAR2 criteria. RESULTS Out of 923 and 157 articles screened for the first and second focus questions respectively, a total of 8 SRs/MAs fulfilled the eligibility criteria. The prevalence of OSs in TMD patients and contrariwise varied substantially up to 85.0-95.0%. Available evidence indicates that TMDs are associated with OSs, and TMD treatment reduced OSs. CONCLUSION Findings suggest that a comorbid relationship between TMDs and OSs exists, and therapeutic TMD interventions improve OSs.
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Affiliation(s)
- Amelia Qin'An Anya Chew
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore Health Services, Singapore
| | - Leonardo Saigo
- Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, Singapore Health Services, Singapore
| | - Adrian Ujin Yap
- Medical School, Singapore Health Services, Singapore; Department of Dentistry, Ng Teng Fong General Hospital and Faculty of Dentistry, National University Health System SingaporeNational Dental Research Institute Singapore, National Dental Centre Singapore and Duke-NUS, Singapore
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Noreña AJ, Lacher-Fougère S, Fraysse MJ, Bizaguet E, Grevin P, Thai-Van H, Moati L, Le Pajolec C, Fournier P, Ohresser M. A contribution to the debate on tinnitus definition. PROGRESS IN BRAIN RESEARCH 2021; 262:469-485. [PMID: 33931192 DOI: 10.1016/bs.pbr.2021.01.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tinnitus is generally defined as an auditory perception in the absence of environmental sound stimulation. However, this definition is quite incomplete as it omits an essential aspect, the patient's point of view. This point of view constitutes, first and foremost, a global and unified lived experience, which is not only sensory (localization, loudness, pitch and tone), but also cognitive (thoughts, attentiveness, behaviors) and emotional (discomfort, suffering). This experience can be lived in a very unpleasant way and consequently have a very negative impact on quality of life. This article proposes and justifies a new definition for tinnitus elaborated by a group of French clinicians and researchers, which is more in line with its phenomenology. It also provides a minimum knowledge base, including possibilities for clinical care, hoping to eradicate all misinformation, misconceptions and inappropriate attitudes or practices toward this condition. Here is the short version of our definition: Tinnitus is an auditory sensation without an external sound stimulation or meaning, which can be lived as an unpleasant experience, possibly impacting quality of life.
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Affiliation(s)
- Arnaud J Noreña
- Laboratoire de Neurosciences Cognitives, UMR 7291, Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France.
| | | | | | | | | | - Hung Thai-Van
- Hôpital Edouard Herriot, Pavillon U, Place d'Arsonval, Lyon, France
| | | | | | - Philippe Fournier
- Laboratoire de Neurosciences Cognitives, UMR 7291, Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
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Cheng YF, Xirasagar S, Yang TH, Wu CS, Kuo NW, Lin HC. A population-based case-control study of the association between cervical spondylosis and tinnitus. Int J Audiol 2021; 60:227-231. [PMID: 32930015 DOI: 10.1080/14992027.2020.1817996] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This population-based study aimed to study the association between tinnitus and cervical spondylosis. DESIGN A case-control study. STUDY SAMPLE We retrieved data from the Taiwan Longitudinal Health Insurance Database. We identified 2465 patients with tinnitus (cases) and 7395 comparison patients by propensity score matching. Multivariable logistic regressions were conducted to estimate the odds (OR) of a diagnosis of cervical spondylosis preceding the tinnitus diagnosis relative to controls. RESULTS We found that 1596 (16.19%) of 9860 sample patients had received a diagnosis of cervical spondylosis before the index date, significantly different between the tinnitus group and control group (17.20% vs. 15.85%, p < 0.001). Logistic regression analysis showed an adjusted OR for prior cervical spondylosis of 1.235 for cases vs. controls (95% confidence interval [CI]: 1.088-1.402). Further, the adjusted ORs were 1.246 (95% CI: 1.041-1.491) and 1.356 (95% CI: 1.016-1.811), respectively, among patients aged 45 ∼ 64 and >64 groups. No difference in cervical spondylosis likelihood between cases and controls was found among patients aged 18 ∼ 44 groups. CONCLUSIONS In conclusion, the study shows a positive association between cervical spondylosis and tinnitus. The findings call for greater awareness among physicians about a possible somatosensory component of cervical spine function which may contribute to tinnitus.
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Affiliation(s)
- Yen-Fu Cheng
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing Health Sciences, Taipei, Taiwan
| | - Chuan-Song Wu
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - Nai-Wen Kuo
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Lee HY, Kim SJ, Choi JY. Somatic Modulation in Tinnitus: Clinical Characteristics and Treatment Outcomes. J Int Adv Otol 2020; 16:213-217. [PMID: 32784160 DOI: 10.5152/iao.2020.8067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the clinical significance of the somatic modulation test in patients with tinnitus and analyze the treatment outcomes. MATERIALS AND METHODS Medical records of patients who visited the tinnitus clinic at a local university hospital between October 2018 and April 2019 were retrospectively reviewed. RESULTS The data of 81 patients were analyzed for this study, of which 61.7% (n=51) showed tinnitus modulation after one or more neck or jaw maneuvers. Patients with narrow-band noise tinnitus tended to show maneuver-induced modulation more frequently than those with pure-tone tinnitus (85.7% vs. 53.3%, p=0.010). Neck maneuvers reduced tinnitus loudness in 29.6% of the patients, while 27.2% of patients (n=22) reported worsening of tinnitus loudness, and 23.5% of patients (n=19) reported tinnitus suppression after jaw maneuvers. None of the patients with noise exposure history reported tinnitus modulation. Backward regression analysis revealed that age was an independent risk factor for improvement (Exp [B]=0.703, p=0.034, 95% CI=0.508-0.974). However, somatic modulation or medical treatments targeting somatic modulation were not related to improvement. CONCLUSION Patients showing modulation after neck or jaw maneuvers have specific clinical characteristics. However, somatic modulation itself does not affect the final treatment outcome.
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Affiliation(s)
- Ho Yun Lee
- Department of Otorhinolaryngology, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Su Jin Kim
- Department of Otorhinolaryngology, Eulji University School of Medicine, Daejeon, Korea
| | - Jun Yong Choi
- Department of Otorhinolaryngology, Eulji University School of Medicine, Daejeon, Korea
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Cheng YF, Xirasagar S, Yang TH, Wu CS, Kao YW, Shia BC, Lin HC. Increased risk of tinnitus following a trigeminal neuralgia diagnosis: a one-year follow-up study. J Headache Pain 2020; 21:46. [PMID: 32375642 PMCID: PMC7203585 DOI: 10.1186/s10194-020-01121-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/28/2020] [Indexed: 02/04/2023] Open
Abstract
Background Tinnitus due to hyperactivity across neuronal ensembles along the auditory pathway is reported. We hypothesized that trigeminal neuralgia patients may subsequently suffer from tinnitus. Using nationwide, population-based data and a retrospective cohort study design, we investigated the risk of tinnitus within 1 year following trigeminal neuralgia. Methods We used the Taiwan National Health Insurance Research Dataset, a claims database, to identify all patients diagnosed with trigeminal neuralgia from January 2001 to December 2014, 12,587 patients. From the remaining patients, we identified 12,587 comparison patients without trigeminal neuralgia by propensity score matching, using sex, age, monthly income, geographic region, residential urbanization level, and tinnitus-relevant comorbidities (hyperlipidemia, diabetes, coronary heart disease, hypertension, cervical spondylosis, temporomandibular joint disorders and injury to head and neck and index year). All study patients (n = 25,174) were tracked for a one-year period to identify those with a subsequent diagnosis of tinnitus over 1-year follow-up. Results Among total 25,174 sample patients, the incidence of tinnitus was 18.21 per 100 person-years (95% CI = 17.66 ~ 18.77), the rate being 23.57 (95% CI = 22.68 ~ 24.49) among patients with trigeminal neuralgia and 13.17 (95% CI = 12.53 ~ 13.84) among comparison patients. Furthermore, the adjusted Cox proportional hazard ratio for tinnitus in the trigeminal neuralgia group was 1.68 (95% CI = 1.58 ~ 1.80) relative to the comparison cohort. Conclusions We found a significantly increased risk of tinnitus within 1 year of trigeminal neuralgia diagnosis compared to those without the diagnosis. Further studies in other countries and ethnicities are needed to explore the relationship between trigeminal neuralgia and subsequent tinnitus.
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Affiliation(s)
- Yen-Fu Cheng
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Speech, Language and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Tzong-Han Yang
- Department of Speech, Language and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - Chuan-Song Wu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - Yi-Wei Kao
- Big Data Research Center, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ben-Chang Shia
- Big Data Research Center, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- Department of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan. .,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Abstract
The search for an effective medication that will eliminate tinnitus has a long history. Currently, no drugs exist that universally cure tinnitus. Pharmacologic interventions that have been investigated can be divided into those that attempt to eliminate the perception of tinnitus, and those that are designed to treat the negative comorbidities associated with tinnitus, thereby mitigating tinnitus' negative impact on quality of life. A third category of drugs can also be considered that addresses an identified pathologic condition that has tinnitus as an associated symptom (for example, Meniere's disease, otosclerosis, migraine-associated vertigo). This third category is not addressed.
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Affiliation(s)
- Carol A Bauer
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794, USA.
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Wu D, Ham D, Rosedale R. Physiotherapy assessment and treatment of chronic subjective tinnitus using mechanical diagnosis and therapy: a case report. J Man Manip Ther 2020; 28:119-126. [PMID: 31942839 DOI: 10.1080/10669817.2020.1714160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives: Tinnitus is the perception of sound without any external auditory stimulus. Cervicogenic somatic tinnitus (CST) is a subset in which symptoms are modulated by maneuvers of the neck. The evidence for effective diagnosis and treatment of CST is limited. Mechanical Diagnosis and Therapy (MDT) is a biopsychosocial assessment and management system that uses the response to mechanical forces to classify clinical presentations accurately. The purpose of this case report is to describe the MDT assessment and management of a patient with chronic subjective tinnitus.Methods: A 67-year-old female with a 5-year history of left-sided subjective tinnitus, neck pain, and headache was referred for physiotherapy. Outcome measures included the Visual Analogue Scale (VAS), Tinnitus Handicap Inventory (THI), and Neck Disability Index (NDI). She was evaluated and treated according to MDT principles with management consisting of individualized directional preference exercises and postural correction.Results: Significant improvements in symptoms, cervical range of motion, function, and psychosocial status were observed over the long-term. At 6 months, THI scores dropped from 62/100 to 18/100 and NDI scores dropped from 18/50 to 3/50.Discussion: A comprehensive MDT assessment led to a classification of Derangement, with treatment focusing on tailored self-management. Contrary to other interventions described for CST, the patient was able to make significant and lasting changes to her symptoms without the need for any externally applied interventions. The emphasis on self-management dovetails well with the biopsychosocial model of care. This case provides preliminary evidence for the utility of screening for Derangement in conservative tinnitus assessments.Level of Evidence: 4.
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Affiliation(s)
- Di Wu
- Physio Cabrini, Montreal, QC, Canada
| | - David Ham
- Bowmanville Family Physiotherapy, Bowmanville, ON, Canada
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Shore SE, Wu C. Mechanisms of Noise-Induced Tinnitus: Insights from Cellular Studies. Neuron 2019; 103:8-20. [PMID: 31271756 DOI: 10.1016/j.neuron.2019.05.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/25/2019] [Accepted: 05/03/2019] [Indexed: 01/21/2023]
Abstract
Tinnitus, sound perception in the absence of physical stimuli, occurs in 15% of the population and is the top-reported disability for soldiers after combat. Noise overexposure is a major factor associated with tinnitus but does not always lead to tinnitus. Furthermore, people with normal audiograms can get tinnitus. In animal models, equivalent cochlear damage occurs in animals with and without behavioral evidence of tinnitus. But cochlear-nerve-recipient neurons in the brainstem demonstrate distinct, synchronized spontaneous firing patterns only in animals that develop tinnitus, driving activity in central brain regions and ultimately giving rise to phantom perception. Examining tinnitus-specific changes in single-cell populations enables us to begin to distinguish neural changes due to tinnitus from those that are due to hearing loss.
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Affiliation(s)
- Susan E Shore
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan, Ann Arbor, MI 48109, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Calvin Wu
- Kresge Hearing Research Institute, Department of Otolaryngology, University of Michigan, Ann Arbor, MI 48109, USA
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Conlon B, Hamilton C, Hughes S, Meade E, Hall DA, Vanneste S, Langguth B, Lim HH. Noninvasive Bimodal Neuromodulation for the Treatment of Tinnitus: Protocol for a Second Large-Scale Double-Blind Randomized Clinical Trial to Optimize Stimulation Parameters. JMIR Res Protoc 2019; 8:e13176. [PMID: 31573942 PMCID: PMC6789422 DOI: 10.2196/13176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 01/13/2023] Open
Abstract
Background There is increasing evidence from animal and human studies that bimodal neuromodulation combining sound and electrical somatosensory stimulation of the tongue can induce extensive brain changes and treat tinnitus. Objective The main objectives of the proposed clinical study are to confirm the efficacy, safety, and tolerability of treatment demonstrated in a previous large-scale study of bimodal auditory and trigeminal nerve (tongue) stimulation (Treatment Evaluation of Neuromodulation for Tinnitus - Stage A1); evaluate the therapeutic effects of adjusting stimulation parameters over time; and determine the contribution of different features of bimodal stimulation in improving tinnitus outcomes. Methods This study will be a prospective, randomized, double-blind, parallel-arm, comparative clinical trial of a 12-week treatment for tinnitus using a Conformité Européenne (CE)–marked device with a pre-post and 12-month follow-up design. Four treatment arms will be investigated, in which each arm consists of two different stimulation settings, with the first setting presented during the first 6 weeks and the second setting presented during the next 6 weeks of treatment. The study will enroll 192 participants, split in a ratio of 80:80:16:16 across the four arms. Participants will be randomized to one of four arms and stratified to minimize baseline variability in four categories: two separate strata for sound level tolerance (using loudness discomfort level as indicators for hyperacusis severity), high tinnitus symptom severity based on the Tinnitus Handicap Inventory (THI), and tinnitus laterality. The primary efficacy endpoints are within-arm changes in THI and Tinnitus Functional Index as well as between-arm changes in THI after 6 weeks of treatment for the full cohort and two subgroups of tinnitus participants (ie, one hyperacusis subgroup and a high tinnitus symptom severity subgroup). Additional efficacy endpoints include within-arm or between-arm changes in THI after 6 or 12 weeks of treatment and in different subgroups of tinnitus participants as well as at posttreatment assessments at 6 weeks, 6 months, and 12 months. Treatment safety, attrition rates, and compliance rates will also be assessed and reported. Results This study protocol was approved by the Tallaght University Hospital/St. James’s Hospital Joint Research Ethics Committee in Dublin, Ireland. The first participant was enrolled on March 20, 2018. The data collection and database lock are expected to be completed by February 2020, and the data analysis and manuscript submission are expected to be conducted in autumn of 2020. Conclusions The findings of this study will be disseminated to relevant research, clinical, and health services and patient communities through publications in peer-reviewed journals and presentations at scientific and clinical conferences. Trial Registration ClinicalTrials.gov NCT03530306; https://clinicaltrials.gov/ct2/show/NCT03530306 International Registered Report Identifier (IRRID) DERR1-10.2196/13176
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Affiliation(s)
- Brendan Conlon
- Department of Otolaryngology, St James Hospital Dublin and Tallaght University Hospital Dublin, Dublin, Ireland.,Neuromod Devices Limited, Dublin, Ireland.,Trinity College Dublin, Dublin, Ireland
| | | | | | - Emma Meade
- Neuromod Devices Limited, Dublin, Ireland
| | - Deborah A Hall
- Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom.,University of Nottingham Malaysia, Semenyih, Selangor Darul Ehsan, Malaysia
| | - Sven Vanneste
- Trinity College Dublin, Dublin, Ireland.,University of Texas at Dallas, Richardson, TX, United States
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Hubert H Lim
- Neuromod Devices Limited, Dublin, Ireland.,University of Minnesota, Minneapolis, MN, United States
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Omidvar S, Jafari Z. Association Between Tinnitus and Temporomandibular Disorders: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2019; 128:662-675. [PMID: 30991812 DOI: 10.1177/0003489419842577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Tinnitus is one of the most common otological symptoms in patients with temporomandibular disorders. This study aimed to investigate the possible association between tinnitus and temporomandibular disorders. METHODS The online databases of PubMed, Ovid, ScienceDirect, and Web of Science were explored for all English articles published until September 2018 using the combined keywords tinnitus and temporomandibular. Cross-sectional, cohort, or case-control studies that investigated the association between tinnitus and temporomandibular disorders (TMDs) were considered. The quality of the included papers was assessed by the Crowe Critical Appraisal Tool. RESULTS Twenty-two papers met the eligibility criteria and were included in the systematic review. Meta-analysis was performed on 8 papers to investigate the possible relationship between tinnitus and TMDs by calculating the odds ratios. Odds ratios ranged from 1.78 to 7.79 in the studies related to tinnitus frequency in temporomandibular disorders and from 1.80 to 7.79 in the papers linked to temporomandibular disorder frequency in tinnitus, indicating a significant association between tinnitus and temporomandibular disorders. CONCLUSIONS There was a strong relationship between tinnitus occurrence and TMDs. The findings implied the significance of exploring the signs of TMDs in patients with tinnitus as well as tinnitus in those who complain from temporomandibular disorders.
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Affiliation(s)
- Shaghayegh Omidvar
- 1 Department of Audiology, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.,2 Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Zahra Jafari
- 3 Department of Neuroscience, Canadian Center for Behavioral Neuroscience (CCBN), University of Lethbridge, Lethbridge, AB, Canada
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18
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Cima RFF, Mazurek B, Haider H, Kikidis D, Lapira A, Noreña A, Hoare DJ. A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment. HNO 2019; 67:10-42. [DOI: 10.1007/s00106-019-0633-7] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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19
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Subtyping patients with somatic tinnitus: Modulation of tinnitus and history for somatic dysfunction help identify tinnitus patients with temporomandibular joint disorders. PLoS One 2018; 13:e0202050. [PMID: 30102717 PMCID: PMC6089421 DOI: 10.1371/journal.pone.0202050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/26/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Determine in a cohort of patients with normal hearing and chronic tinnitus if self-reported history for temporomandibular joint (TMJ) dysfunction and a positive modulation of tinnitus in the TMJ region could be suggestive of an underlying TMJ disorder. PATIENTS AND METHODS The study included 226 patients presenting to the Head and Neck Service of our University Hospital. Following audiological and somatic tinnitus evaluation, patients were divided into two groups. The study group (n = 134) included subjects that met both the following criteria: A) a self-reported history for TMJ dysfunction and B) a positive modulation of tinnitus following somatic maneuvers in the TMJ region. The control group (n = 92) included patients with similar demographic and tinnitus characteristics that did not meet the proposed criteria for somatic tinnitus. Afterwards, patients underwent clinical TMJ evaluation in the Service of Clinical Gnathology of our University. RESULTS One hundred thirty-one patients (57.9%) received a clinical diagnosis of TMJ disorder according to DC/TMD Axis I; 79.1% in the study group and 27.2% in the control group. Ninety-five (42.1%) patients were negative for TMJ disorders; 20.9% in the study group and 72.8% in the control group. A significantly higher number of TMJ disorders was found in patients in the study group compared to the control group (p<0.0001). Most patients had joint disorders (67.2%), followed by other (29.8%) and pain disorders (29%). Logistic regression analysis in the study group showed that female gender was more prevalent in patients with TMJ disorders. CONCLUSION Our findings in patients with chronic tinnitus and normal hearing suggest that self-reported history for somatic dysfunction and modulation of tinnitus, when occurring simultaneously in the TMJ region, can be useful to preliminarily identify patients with TMJ disorders.
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Vielsmeier V, Schecklmann M, Schlee W, Kreuzer PM, Poeppl TB, Rupprecht R, Langguth B, Lehner A. A Pilot Study of Peripheral Muscle Magnetic Stimulation as Add-on Treatment to Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus. Front Neurosci 2018. [PMID: 29515350 PMCID: PMC5826218 DOI: 10.3389/fnins.2018.00068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While brain stimulation techniques have been examined as treatment options for chronic tinnitus for many years, they have recently been extended to multimodal treatment approaches. As chronic tinnitus is often accompanied by comorbid muscular tension in the neck and back, we performed a one-arm pilot study to explore the feasibility of a new multimodal treatment approach. In detail, repetitive peripheral magnetic stimulation (rPMS) of the back was performed before and after each session of repetitive transcranial magnetic stimulation (rTMS) of the brain. Data of 41 patients were analyzed, all of which were treated with ten sessions of rTMS of the left prefrontal and left temporoparietal cortex followed by rPMS of the neck and back muscles. Tinnitus severity was measured using the tinnitus questionnaire (TQ). Neck pain was assessed using the neck pain and disability scale (NPAD). The new treatment approach was feasible and well accepted by the majority of patients. However, the overall patient group did not improve significantly in either of the questionnaires. If patients were divided in different subgroups depending on whether they were suffering from neck pain or somatosensory tinnitus, explorative post-hoc tests suggested differential effects: patients with both neck pain and somatosensory tinnitus had better outcomes than patients without those conditions or with neck pain only. This was true for both the TQ and the NPAD. This effect was of transient nature though: the TQ score went back to its baseline level after a follow-up period of 12 weeks. Based on our results we recommend that in studies that investigate tinnitus treatments targeting somatosensory afferents patients should be stratified according to somatic co-morbidities and somatosensory influence on the tinnitus percept. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT02306447.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Timm B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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21
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Ralli M, Salvi RJ, Greco A, Turchetta R, De Virgilio A, Altissimi G, Attanasio G, Cianfrone G, de Vincentiis M. Characteristics of somatic tinnitus patients with and without hyperacusis. PLoS One 2017; 12:e0188255. [PMID: 29161302 PMCID: PMC5697853 DOI: 10.1371/journal.pone.0188255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/05/2017] [Indexed: 12/14/2022] Open
Abstract
Objective Determine if somatic tinnitus patients with hyperacusis have different characteristics from those without hyperacusis. Patients and methods 172 somatic tinnitus patients with (n = 82) and without (n = 90) hyperacusis referred to the Tinnitus Unit of Sapienza University of Rome between June 2012 and June 2016 were compared for demographic characteristics, tinnitus features, self-administered questionnaire scores, nature of somatic modulation and history. Results Compared to those without hyperacusis, patients with somatic tinnitus and hyperacusis: (a) were older (43.38 vs 39.12 years, p = 0.05), (b) were more likely to have bilateral tinnitus (67.08% vs 55.56%, p = 0.04), (c) had a higher prevalence of somatic modulation of tinnitus (53.65% vs 36.66%, p = 0.02) and (d) scored significantly worse on tinnitus annoyance (39.34 vs 22.81, p<0.001) and subjective hearing level (8.04 vs 1.83, p<0.001). Conclusion Our study shows significantly higher tinnitus modulation and worse self-rating of tinnitus and hearing ability in somatic tinnitus patients with hyperacusis versus somatic tinnitus patients without hyperacusis. These differences could prove useful in developing a better understanding of the pathophysiology and establishing a course of treatment for these two groups of patients.
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Affiliation(s)
- Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Richard J. Salvi
- Center for Hearing and Deafness, University at Buffalo, Buffalo, New York, United States of America
- Department of Audiology and Speech-Language Pathology, Asia University, Taichung, Taiwan
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Rosaria Turchetta
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Clinical characteristics of patients with tinnitus evaluated with the Tinnitus Sample Case History Questionnaire in Japan: A case series. PLoS One 2017; 12:e0180609. [PMID: 28841656 PMCID: PMC5571926 DOI: 10.1371/journal.pone.0180609] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
Background The Tinnitus Sample Case History Questionnaire was determined as a standardized questionnaire for obtaining patient case histories and for characterizing patients into subgroups at the Tinnitus Research Initiative in 2006. In this study, we developed a Japanese version of this questionnaire for evaluating the clinical characteristics of patients with tinnitus. The Japanese version of the questionnaire will be available for evaluating treatments for tinnitus and for comparing data on tinnitus in research centers. Aims/Objectives To evaluate the clinical characteristics of patients with tinnitus in Japan using a newly developed Japanese version of Tinnitus Sample Case History Questionnaire. Study design This was a prospective study based on patient records. Setting University hospitals, general hospitals, and clinics. Subjects and methods We collected patient data using a Japanese translated version of the Tinnitus Sample Case History Questionnaire. In total, 584 patients who visited our institutions in Japan between August 2012 and March 2014 were included (280 males and 304 females; age 13–92 years; mean age, 60.8). We examined patients after dividing them into two groups according to the presence or absence of hyperacusis. The collected results were compared with those from the Tinnitus Research Initiative database. Results Compared with the TRI database, there were significantly more elderly female patients and fewer patients with trauma-associated tinnitus. There was a statistically lower ratio of patients with hyperacusis. We found that patients with tinnitus in addition to hyperacusis had greater tinnitus severity and exhibited higher rates of various complications. Conclusion The Japanese version of the Tinnitus Sample Case History Questionnaire developed in this study can be a useful tool for evaluating patients with tinnitus in Japan. The results of this multicenter study reflect the characteristics of patients with tinnitus who require medical care in Japan. Our data provides a preliminary basis for an international comparison of tinnitus epidemiology.
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23
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Low WK, Rangabashyam MS, Cui SL, Dsouza VD, Ong CS, Teng SW, Li HH. Is Electroacupuncture Treatment More Effective in Somatic Tinnitus Than in Nonsomatic Tinnitus? Med Acupunct 2017; 29:138-144. [PMID: 28736590 DOI: 10.1089/acu.2017.1223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In recent years, evidence has been accumulating linking subjective tinnitus to the somatosensory system. Somatic tinnitus is defined as tinnitus in which forceful contractions of jaw and neck muscles modulate the psychoacoustic attributes of tinnitus, such as pitch and loudness. Being a somatosensory-based treatment modality, needling might well be more effective for treating somatic than nonsomatic tinnitus. Objective: The aim of this study was to compare the outcomes of electroacupuncture (EA) treatment between patients with somatic and nonsomatic tinnitus. Materials and Methods: A single-blinded prospective study was carried wherein 27 patients with tinnitus were divided into either a somatic or a nonsomatic group, based on whether their tinnitus could be modulated by at least one of a series of forceful jaw and neck muscular contraction maneuvers. Tinnitus responses were evaluated after a single session of EA on selected acupoints for 30 minutes. Results: Seventeen of the 27 patients (63.0%) studied were found to have somatic tinnitus. Generalized estimating equation model analysis did not find any overall statistically significant difference in EA response between patients with somatic and nonsomatic tinnitus. However, patients with somatic tinnitus who were consistent in their responses to the muscular contraction maneuvers were more likely to improve with EA than variable responders to these maneuvers (62.5% versus 22.0%). Conclusions: EA did not provide increased benefits for patients with somatic tinnitus, compared to those with nonsomatic tinnitus overall. However, within the somatic tinnitus group, a subpopulation of patients appeared to be relatively more responsive to EA treatment.
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Affiliation(s)
- Wong-Kein Low
- Department of Otolaryngology, Singapore General Hospital, Outram Road, Singapore.,Duke-NUS Graduate Medical School, College Road, Singapore.,Mount Elizabeth Novena Specialist Centre, Singapore
| | | | - Shu Li Cui
- Pain Management Centre, Singapore General Hospital, Outram Road, Singapore
| | - Vishal Deepak Dsouza
- Department of Otolaryngology, Singapore General Hospital, Outram Road, Singapore
| | - Chun Suan Ong
- Department of Otolaryngology, Singapore General Hospital, Outram Road, Singapore
| | - Siaw Wei Teng
- Department of Otolaryngology, Singapore General Hospital, Outram Road, Singapore
| | - Hui Hua Li
- Health Services Research Unit, Singapore General Hospital, Outram Road, Singapore
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Haider HF, Hoare DJ, Costa RFP, Potgieter I, Kikidis D, Lapira A, Nikitas C, Caria H, Cunha NT, Paço JC. Pathophysiology, Diagnosis and Treatment of Somatosensory Tinnitus: A Scoping Review. Front Neurosci 2017; 11:207. [PMID: 28503129 PMCID: PMC5408030 DOI: 10.3389/fnins.2017.00207] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/27/2017] [Indexed: 11/13/2022] Open
Abstract
Somatosensory tinnitus is a generally agreed subtype of tinnitus that is associated with activation of the somatosensory, somatomotor, and visual-motor systems. A key characteristic of somatosensory tinnitus is that is modulated by physical contact or movement. Although it seems common, its pathophysiology, assessment and treatment are not well defined. We present a scoping review on the pathophysiology, diagnosis, and treatment of somatosensory tinnitus, and identify priority directions for further research. Methods: Literature searches were conducted in Google Scholar, PubMed, and EMBASE databases. Additional broad hand searches were conducted with the additional terms etiology, diagnose, treatment. Results: Most evidence on the pathophysiology of somatosensory tinnitus suggests that somatic modulations are the result of altered or cross-modal synaptic activity within the dorsal cochlear nucleus or between the auditory nervous system and other sensory subsystems of central nervous system (e.g., visual or tactile). Presentations of somatosensory tinnitus are varied and evidence for the various approaches to treatment promising but limited. Discussion and Conclusions: Despite the apparent prevalence of somatosensory tinnitus its underlying neural processes are still not well understood. Necessary involvement of multidisciplinary teams in its diagnosis and treatment has led to a large heterogeneity of approaches whereby tinnitus improvement is often only a secondary effect. Hence there are no evidence-based clinical guidelines, and patient care is empirical rather than research-evidence-based. Somatic testing should receive further attention considering the breath of evidence on the ability of patients to modulate their tinnitus through manouvers. Specific questions for further research and review are indicated.
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Affiliation(s)
- Haúla F. Haider
- ENT Department, Hospital Cuf Infante Santo—Nova Medical SchoolLisbon, Portugal
| | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Division of Clinical Neuroscience, School of Medicine, University of NottinghamNottingham, UK
| | - Raquel F. P. Costa
- Centro em Rede de Investigação em Antropologia (CRIA), Network Centre for Research in Anthropology, Universidade Nova de LisboaLisbon, Portugal
| | - Iskra Potgieter
- NIHR Nottingham Biomedical Research Centre, Division of Clinical Neuroscience, School of Medicine, University of NottinghamNottingham, UK
| | - Dimitris Kikidis
- First Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General HospitalAthens, Greece
| | - Alec Lapira
- Institute of Health Care, Mater Dei HospitalMsida, Malta
| | - Christos Nikitas
- First Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General HospitalAthens, Greece
| | - Helena Caria
- Deafness Research Group, BTR Unit, BioISI, Faculty of Sciences, University of LisbonLisbon, Portugal
- ESS/IPS–Biomedical Sciences Department, School of Health, Polytechnic Institute of SetubalLisbon, Portugal
| | - Nuno T. Cunha
- ENT Department, Hospital Pedro Hispano—MatosinhosLisbon, Portugal
| | - João C. Paço
- ENT Department, Hospital Cuf Infante Santo—Nova Medical SchoolLisbon, Portugal
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26
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Klessinger S. Radiofrequency neurotomy for the treatment of somatosensory tinnitus in a patient after spine trauma. A case report. OTOLARYNGOLOGY CASE REPORTS 2016. [DOI: 10.1016/j.xocr.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Yakunina N, Kim SS, Nam EC. Optimization of Transcutaneous Vagus Nerve Stimulation Using Functional MRI. Neuromodulation 2016; 20:290-300. [PMID: 27898202 DOI: 10.1111/ner.12541] [Citation(s) in RCA: 247] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/11/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE/HYPOTHESIS Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy, depression, and a number of other disorders. Transcutaneous stimulation of the auricular branch of the vagus nerve (tVNS) has been considered as a non-invasive alternative. Several functional magnetic resonance imaging (fMRI) studies on the effects of tVNS used different stimulation parameters and locations in the ear, which makes it difficult to determine the optimal tVNS methodology. The present study used fMRI to determine the most effective location for tVNS. MATERIALS AND METHODS Four stimulation locations in the ear were compared: the inner tragus, inferoposterior wall of the ear canal, cymba conchae, and earlobe (sham). Thirty-seven healthy subjects underwent two 6-min tVNS stimulation runs per electrode location (monophasic rectangular 500 μs pulses, 25 Hz). General linear model was performed using SPM; region-of-interest analyses were performed for the brainstem areas. RESULTS Stimulation at the ear canal resulted in the weakest activation of the nucleus of solitary tract (NTS), the recipient of most afferent vagal projections, and of the locus coeruleus (LC), a brainstem nucleus that receives direct input from the NTS. Stimulation of the inner tragus and cymba conchae activated these two nuclei as compared to sham. However, ROI analysis showed that only stimulation of the cymba conchae produced a significantly stronger activation in both the NTS and LC than did the sham stimulation. CONCLUSIONS These findings suggest that tVNS at the cymba conchae properly activates the vagal pathway and results in its strongest activation, and thus may be the optimal location for tVNS therapies applied to the auricle.
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Affiliation(s)
- Natalia Yakunina
- Institute of Medical Science, School of Medicine, Kangwon National University, Kangwondaehak-gil 1, Chuncheon, Republic of Korea.,Neuroscience Research Institute, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon, Republic of Korea
| | - Sam Soo Kim
- Neuroscience Research Institute, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon, Republic of Korea.,Department of Radiology, School of Medicine, Kangwon National University, Kangwondaehak-gil 1, Chuncheon, Republic of Korea
| | - Eui-Cheol Nam
- Neuroscience Research Institute, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon, Republic of Korea.,Department of Otolaryngology, School of Medicine, Kangwon National University, Kangwondaehak-gil 1, Chuncheon, Republic of Korea
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Lina-Granade G, Truy E, Ionescu E, Garnier P, Thai Van H. [Tinnitus and temporomandibular joint: State of the art]. ACTA ACUST UNITED AC 2016; 117:458-462. [PMID: 27836443 DOI: 10.1016/j.revsto.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
Tinnitus has been described in temporomandibular joint dysfunction for a long time. Yet, other disorders, such as hearing loss, stress, anxiety and depression, play a major role in the pathophysiology of tinnitus. Temporomandibular joint dysfunctions seem to increase the risk of tinnitus in patients with other predisposing factors. Especially somatosensory tinnitus, which is characterized by sound modulations with neck or mandible movements, is frequently associated with temporomandibular joint dysfunction, but it is not pathognomonic of such a disorder. In such cases, functional therapy of the temporomandibular joint should be part of the multidisciplinary rehabilitation of patients with tinnitus.
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Affiliation(s)
- G Lina-Granade
- Service d'ORL, de chirurgie cervico-faciale et d'audiophonologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
| | - E Truy
- Université de Lyon, université Claude-Bernard Lyon I, secteur santé, 8, avenue Rockefeller, 69008 Lyon, France; Centre de recherche en neurosciences de Lyon (CRNL), équipe dynamique cérébrale et cognition, Inserm U1028, CNRS UMR5292, centre hospitalier Le Vinatier, bâtiment 452, 95, boulevard Pinel, 69675 Bron, France
| | - E Ionescu
- Service d'audiologie et explorations otoneurologiques, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| | - P Garnier
- Service d'audiologie et explorations otoneurologiques, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| | - H Thai Van
- Université de Lyon, université Claude-Bernard Lyon I, secteur santé, 8, avenue Rockefeller, 69008 Lyon, France; Centre de recherche en neurosciences de Lyon (CRNL), équipe dynamique cérébrale et cognition, Inserm U1028, CNRS UMR5292, centre hospitalier Le Vinatier, bâtiment 452, 95, boulevard Pinel, 69675 Bron, France
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Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept. ACTA ACUST UNITED AC 2016; 23:120-3. [DOI: 10.1016/j.math.2015.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 11/21/2022]
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Di Berardino F, Filipponi E, Schiappadori M, Forti S, Zanetti D, Cesarani A. The occlusal imaging and analysis system by T-scan III in tinnitus patients. Biomed J 2016; 39:139-44. [PMID: 27372169 PMCID: PMC6140139 DOI: 10.1016/j.bj.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 10/05/2015] [Indexed: 11/23/2022] Open
Abstract
Background Several studies have demonstrated that the prevalence of temporomandibular disorders (TMDs) in tinnitus patients ranges from 7% to 95%, and it is reported in literature that idiopathic tinnitus patients should be referred to a dentist to define whether or not the tinnitus is associated with TMD. However, the possible pathophysiological relation between TMDs and tinnitus is not generally investigated in clinical practice. Methods The patterns and forces of occlusal contacts have been studied by means of T-scan III in 47 tinnitus patients (23 suffering from idiopathic tinnitus and 24 affected by Ménière disease [MD]) and 13 healthy subjects. Results The center of force target was offset in the opposite direction in 15/23 idiopathic tinnitus and in 7/24 MD patients (p = 0.026). No significant variation was found in the occlusal force. Conclusions Our data suggest that a diagnostic screening method for occlusal stability in the intercuspidal position might be clinically useful in idiopathic tinnitus patients.
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Affiliation(s)
- Federica Di Berardino
- Department of Clinical Sciences and Community, Audiology Unit, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy.
| | - Eliana Filipponi
- S.I.T.R.A. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Schiappadori
- Department of Clinical Sciences and Community, Audiology Unit, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Stella Forti
- Department of Clinical Sciences and Community, Audiology Unit, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Diego Zanetti
- Department of Clinical Sciences and Community, Audiology Unit, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Antonio Cesarani
- Department of Clinical Sciences and Community, Audiology Unit, IRCCS Fondazione Policlinico, Mangiagalli e Regina Elena, University of Milan, Milan, Italy
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Cervicogenic somatosensory tinnitus: An indication for manual therapy plus education? Part 2: A pilot study. ACTA ACUST UNITED AC 2016; 23:106-13. [PMID: 26971019 DOI: 10.1016/j.math.2016.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/11/2016] [Accepted: 02/14/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of Manual Therapy Utrecht (MTU) plus education in patients with cervicogenic somatosensory tinnitus (CeT). STUDY DESIGN Pretest-posttest design. METHOD Five hundred and six patients were referred or referred themselves. A subgroup of patients was identified with CeT, and within this a subgroup with tinnitus sensitization (TS). Two CeT groups were created based on the presence or absence of TS. Both groups underwent manual therapy combined with tinnitus education. Tinnitus intensity (VAS-tin 0-100 mm) was the primary outcome measure. Number of treatments and adverse effects were the secondary outcome measures. RESULTS A total of 122 patients with CeT (24.1%) were included (average age 53.3 years [±9.8], female 38.5% and duration of tinnitus 7.3 years [±8.9]). Patients were divided into two groups: 55 patients (45.1%) with TS (CeT + TS group) and 67 patients (54.9%) without TS (CeT - TS group). Pretest to posttest differences on the VAS-tin were statistically significant within both groups (CeT - TS group: difference VAS-tin 5.9 [p = 0.01]; CeT + TS group: difference VAS-tin 18.2 [p = 0.00]), and between the groups in favor of the CeT + TS group (difference VAS-tin 12.3 [p = 0.01]). Pretest to posttest differences were clinically significant for the CeT + TS group (difference VAS-tin 18.2 [MCIC = ≥10 mm VAS-tin]) and between the groups (difference VAS-tin 12.3 in favor of the CeT + TS group). The average number of treatment sessions was 9.6 (±2.6) for the CeT - TS group and 10.3 (±2.5) for the CeT + TS group, a non-significant difference. There were no adverse effects in either group. CONCLUSIONS Despite its limitations, this study provides valuable information on both the characteristics of patients with CeT and TS in a Dutch primary care manual therapy practice and on the potential effectiveness of MTU combined with tinnitus education for the subgroup of CeT + TS patients.
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Jonsson J, Bohman A, Shekhawat G, Kobayashi K, Searchfield G. An evaluation of the Reltus ear massager for short-term tinnitus relief. Int J Audiol 2015; 55:38-44. [DOI: 10.3109/14992027.2015.1077532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Response to Letter to the Editor: "Cervical Spine Dysfunctions in Patients with Chronic Subjective Tinnitus". Otol Neurotol 2015. [PMID: 26196210 DOI: 10.1097/mao.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wu C, Stefanescu RA, Martel DT, Shore SE. Listening to another sense: somatosensory integration in the auditory system. Cell Tissue Res 2015; 361:233-50. [PMID: 25526698 PMCID: PMC4475675 DOI: 10.1007/s00441-014-2074-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/18/2014] [Indexed: 12/19/2022]
Abstract
Conventionally, sensory systems are viewed as separate entities, each with its own physiological process serving a different purpose. However, many functions require integrative inputs from multiple sensory systems and sensory intersection and convergence occur throughout the central nervous system. The neural processes for hearing perception undergo significant modulation by the two other major sensory systems, vision and somatosensation. This synthesis occurs at every level of the ascending auditory pathway: the cochlear nucleus, inferior colliculus, medial geniculate body and the auditory cortex. In this review, we explore the process of multisensory integration from (1) anatomical (inputs and connections), (2) physiological (cellular responses), (3) functional and (4) pathological aspects. We focus on the convergence between auditory and somatosensory inputs in each ascending auditory station. This review highlights the intricacy of sensory processing and offers a multisensory perspective regarding the understanding of sensory disorders.
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Affiliation(s)
- Calvin Wu
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, 48109, USA
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Gloeckner CD, Smith BT, Markovitz CD, Lim HH. A new concept for noninvasive tinnitus treatment utilizing multimodal pathways. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:3122-5. [PMID: 24110389 DOI: 10.1109/embc.2013.6610202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Current noninvasive treatments for tinnitus have shown mixed results. There have been encouraging developments in using invasive brain or vagal nerve stimulation to modulate neural populations driving the tinnitus percept. However, these invasive treatments can only be used in a small patient population with severe conditions. In this preliminary study, we present a new treatment option we call Multimodal Synchronization Therapy (MST), which attempts to achieve synchronized and localized brain activation without invasive neural stimulation. MST combines multiple sensory, motor, limbic, and cognitive inputs to elicit activation of multimodal neurons to potentially modulate specific neurons driving the tinnitus percept. We present preliminary data in a guinea pig model showing activation of somatosensory and auditory pathways to alter neural activity within the inferior colliculus, a multimodal integration region that has shown pathological changes in animals and patients with tinnitus. Electrical stimulation of different body locations induced excitatory responses in the inferior colliculus, eliciting responses in up to 41% of all recording sites for a given somatic site. Paired somatic and acoustic stimulation resulted in enhanced or suppressed acoustic-driven neural activity in the inferior colliculus that varied depending on stimulation and recording location. Similar modulation effects were observed in the auditory cortex, which may relate to changes in auditory perception. Further studies need to incorporate multiple multimodal pathways and must also confirm that MST can suppress the abnormal neural patterns that directly drive the tinnitus percept.
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Wu C, Stefanescu RA, Martel DT, Shore SE. Tinnitus: Maladaptive auditory-somatosensory plasticity. Hear Res 2015; 334:20-9. [PMID: 26074307 DOI: 10.1016/j.heares.2015.06.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/25/2015] [Accepted: 06/02/2015] [Indexed: 01/05/2023]
Abstract
Tinnitus, the phantom perception of sound, is physiologically characterized by an increase in spontaneous neural activity in the central auditory system. However, as tinnitus is often associated with hearing impairment, it is unclear how a decrease of afferent drive can result in central hyperactivity. In this review, we first assess methods for tinnitus induction and objective measures of the tinnitus percept in animal models. From animal studies, we discuss evidence that tinnitus originates in the cochlear nucleus (CN), and hypothesize mechanisms whereby hyperactivity may develop in the CN after peripheral auditory nerve damage. We elaborate how this process is likely mediated by plasticity of auditory-somatosensory integration in the CN: the circuitry in normal circumstances maintains a balance of auditory and somatosensory activities, and loss of auditory inputs alters the balance of auditory somatosensory integration in a stimulus timing dependent manner, which propels the circuit towards hyperactivity. Understanding the mechanisms underlying tinnitus generation is essential for its prevention and treatment. This article is part of a Special Issue entitled <Tinnitus>.
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Affiliation(s)
- Calvin Wu
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA
| | - Roxana A Stefanescu
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA
| | - David T Martel
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA
| | - Susan E Shore
- Department of Otolaryngology, Kresge Hearing Research Institute, University of Michigan, Ann Arbor, MI, USA.
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Ward J, Vella C, Hoare DJ, Hall DA. Subtyping Somatic Tinnitus: A Cross-Sectional UK Cohort Study of Demographic, Clinical and Audiological Characteristics. PLoS One 2015; 10:e0126254. [PMID: 25996779 PMCID: PMC4440784 DOI: 10.1371/journal.pone.0126254] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/31/2015] [Indexed: 11/23/2022] Open
Abstract
Somatic tinnitus is the ability to modulate the psychoacoustic features of tinnitus by somatic manoeuvres. The condition is still not fully understood and further identification of this subtype is essential, particularly for the purpose of establishing protocols for both its diagnosis and treatment. This study aimed to investigate the characteristics of somatic tinnitus within a large UK cohort using a largely unselected sample. We believe this to be relatively unique in comparison to current literature on the topic. This was investigated by using a total of 608 participant assessments from a set of recognised tinnitus and audiology measures. Results from a set of chi-square tests of association found that amongst the individuals with somatic tinnitus, a higher proportion had pulsatile tinnitus (different from heartbeat), were under the age of 40, reported variation in the loudness of their tinnitus and reported temporomandibular joint (TMJ) disorder. The same pattern of results was confirmed using a multivariate analysis of the data based on logistic regression. These findings have strong implications towards the profiling of somatic tinnitus as a distinct subtype of general tinnitus.
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Affiliation(s)
- Jamie Ward
- School of Psychology, University of Sussex, Brighton, BNI 9RH, United Kingdom
- * E-mail:
| | - Claire Vella
- School of Psychology, University of Sussex, Brighton, BNI 9RH, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
| | - Deborah A. Hall
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, NG1 5DU, United Kingdom
- Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
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Abstract
Tinnitus, the perception of sound in the absence of an external sound, usually results from a disorder of: (1) the auditory system (usually peripheral, rarely central); (2) the somatosensory system (head and neck); or (3) a combination of the two. Its cause can be determined through its characteristics. The history must include the tinnitus': (1) quality (including whether it can ever be pulsatile or have a clicking component); (2) location; (3) variability; (4) predominant pitch (low or high); and (5) whether the patient can do something to modulate the percept. In addition to the standard neuro-otologic examination, the exam should include inspection of the teeth for evidence of wear, listening around the ear and neck for sounds similar to the tinnitus, palpation of the craniocervical musculature for trigger points, and probing whether the tinnitus percept can be modulated with "somatic testing." All subjects should have a recent audiogram. Presently the most compelling tinnitus theory is the dorsal cochlear nucleus (DCN) hypothesis: both the auditory and somatosensory systems converge upon and interact within the DCN. If the activity of the DCN's somatosensory-interacting fusiform cells exceeds an individual's tinnitus threshold, then tinnitus results.
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Affiliation(s)
- Robert A Levine
- Department of Ear, Nose and Throat and Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Yahav Oron
- Department of Otolaryngology, Head and Neck Surgery, E. Wolfson Medical Centre, Holon, Israel
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Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, Chandrasekhar SS, Cunningham ER, Archer SM, Blakley BW, Carter JM, Granieri EC, Henry JA, Hollingsworth D, Khan FA, Mitchell S, Monfared A, Newman CW, Omole FS, Phillips CD, Robinson SK, Taw MB, Tyler RS, Waguespack R, Whamond EJ. Clinical Practice Guideline. Otolaryngol Head Neck Surg 2014; 151:S1-S40. [DOI: 10.1177/0194599814545325] [Citation(s) in RCA: 378] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient’s quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome. Purpose The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. Action Statements The development group made a strong recommendation that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus that does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurologic abnormalities or an asymmetric hearing loss. The panel made the following recommendations: Clinicians should (a) perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus; (b) obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥ 6 months), or associated with hearing difficulties; (c) distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥ 6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care; (d) educate patients with persistent, bothersome tinnitus about management strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome tinnitus associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus. The panel recommended against (a) antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome tinnitus; (b) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus; and (c) transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus. The development group provided the following options: Clinicians may (a) obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status); and (b) recommend sound therapy to patients with persistent, bothersome tinnitus. The development group provided no recommendation regarding the effect of acupuncture in patients with persistent, bothersome tinnitus.
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Affiliation(s)
- David E. Tunkel
- Otolaryngology–Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA
| | - Carol A. Bauer
- Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Gordon H. Sun
- Partnership for Health Analytic Research, LLC, Los Angeles, California, USA
| | - Richard M. Rosenfeld
- Department of Otolaryngology, State University of New York at Downstate Medical Center, Brooklyn, New York, USA
| | | | - Eugene R. Cunningham
- Department of Research and Quality Improvement, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Sanford M. Archer
- Divisions of Rhinology & Sinus Surgery and Facial Plastic & Reconstructive Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Brian W. Blakley
- Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John M. Carter
- Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA
| | - Evelyn C. Granieri
- Division of Geriatric Medicine and Aging, Columbia University, New York, New York, USA
| | - James A. Henry
- National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon, USA
| | | | | | | | - Ashkan Monfared
- Department of Otology and Neurotology, The George Washington University, Washington, DC, USA
| | - Craig W. Newman
- Department of Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | | | - C. Douglas Phillips
- Department of Head and Neck Imaging, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Shannon K. Robinson
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Malcolm B. Taw
- Department of Medicine, UCLA Center for East-West Medicine, Los Angeles, California, USA
| | - Richard S. Tyler
- Department of Otolaryngology–Head and Neck Surgery, The University of Iowa, Iowa City, Iowa, USA
| | - Richard Waguespack
- Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Elizabeth J. Whamond
- Consumers United for Evidence-Based Healthcare, Fredericton, New Brunswick, Canada
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Manganese enhanced magnetic resonance imaging (MEMRI): a powerful new imaging method to study tinnitus. Hear Res 2014; 311:49-62. [PMID: 24583078 DOI: 10.1016/j.heares.2014.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/05/2014] [Accepted: 02/10/2014] [Indexed: 12/31/2022]
Abstract
Manganese enhanced magnetic resonance imaging (MEMRI) is a method used primarily in basic science experiments to advance the understanding of information processing in central nervous system pathways. With this mechanistic approach, manganese (Mn(2+)) acts as a calcium surrogate, whereby voltage-gated calcium channels allow for activity driven entry of Mn(2+) into neurons. The detection and quantification of neuronal activity via Mn(2+) accumulation is facilitated by "hemodynamic-independent contrast" using high resolution MRI scans. This review emphasizes initial efforts to-date in the development and application of MEMRI for evaluating tinnitus (the perception of sound in the absence of overt acoustic stimulation). Perspectives from leaders in the field highlight MEMRI related studies by comparing and contrasting this technique when tinnitus is induced by high-level noise exposure and salicylate administration. Together, these studies underscore the considerable potential of MEMRI for advancing the field of auditory neuroscience in general and tinnitus research in particular. Because of the technical and functional gaps that are filled by this method and the prospect that human studies are on the near horizon, MEMRI should be of considerable interest to the auditory research community. This article is part of a Special Issue entitled <Annual Reviews 2014>.
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Won JY, Yoo S, Lee SK, Choi HK, Yakunina N, Le Q, Nam EC. Prevalence and factors associated with neck and jaw muscle modulation of tinnitus. Audiol Neurootol 2013; 18:261-73. [PMID: 23881235 DOI: 10.1159/000351685] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/24/2013] [Indexed: 11/19/2022] Open
Abstract
Forceful contractions of neck and jaw muscles have consistently been shown to modulate tinnitus and can be used to screen patients who are responsive to somatic stimulation and, therefore, optimal candidates for somatosensory-based treatment. To identify the factors associated with somatic modulation of tinnitus, 163 patients underwent 19 neck and jaw maneuvers after an extensive physiological and audiological profile was compiled. Overall, tinnitus was modulated in 57.1% of ears tested. Unilateral tinnitus showed greater prevalence of modulation. Neck maneuvers generally decreased tinnitus loudness, whereas jaw maneuvers increased loudness. Female gender and buzzing tinnitus were associated with a high prevalence of modulation and a decrease in tinnitus loudness. Loud tinnitus and low-pitched tonal tinnitus were associated with exacerbation of the condition as a result of somatic testing. Use of these characteristics to select optimal candidates for somatosensory-based tinnitus therapies may be essential for the development of an effective approach for tinnitus treatment.
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Affiliation(s)
- Jun Yeon Won
- Department of Otolaryngology, Kangwon National University School of Medicine, Chuncheon, Vietnam
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Abstract
Tinnitus is a phantom sound percept that can be severely disabling. Its pathophysiology is poorly understood, partly due to the inability to objectively measure neural correlates of tinnitus. Gaze-evoked tinnitus (GET) is a rare form of tinnitus that may arise after vestibular schwannoma removal. Subjects typically describe tinnitus in the deaf ear on the side of the surgery that can be modulated by peripheral eye gaze. This phenomenon offers a unique opportunity to study the relation between tinnitus and brain activity. We used functional magnetic resonance imaging in humans to show that in normal-hearing control subjects, peripheral gaze results in inhibition of the auditory cortex, but no detectable response in the medial geniculate body (MGB) and inferior colliculus (IC). In patients with GET, peripheral gaze (1) reduced the cortical inhibition, (2) inhibited the MGB, and (3) activated the IC. Furthermore, increased tinnitus loudness is represented by increased activity in the cochlear nucleus (CN) and IC and reduced inhibition in the auditory cortex (AC). The increase of CN and IC activity with peripheral gaze is consistent with models of plastic reorganization in the brainstem following vestibular schwannoma removal. The activity decrease in the MGB and the reduced inhibition of the AC support a model that attributes tinnitus to a dysrhythmia of the thalamocortical loop, leading to hypometabolic theta activity in the MGB. Our data offer the first support of this loop hypothesis of tinnitus, independent of the initial experiments that led to its formulation.
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Vielsmeier V, Strutz J, Kleinjung T, Schecklmann M, Kreuzer PM, Landgrebe M, Langguth B. Temporomandibular joint disorder complaints in tinnitus: further hints for a putative tinnitus subtype. PLoS One 2012; 7:e38887. [PMID: 22723902 PMCID: PMC3378537 DOI: 10.1371/journal.pone.0038887] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 05/15/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Tinnitus is considered to be highly heterogeneous with respect to its etiology, its comorbidities and the response to specific interventions. Subtyping is recommended, but it remains to be determined which criteria are useful, since it has not yet been clearly demonstrated whether and to which extent etiologic factors, comorbid states and interventional response are related to each other and are thus applicable for subtyping tinnitus. Analyzing the Tinnitus Research Initiative Database we differentiated patients according to presence or absence of comorbid temporomandibular joint (TMJ) disorder complaints and compared the two groups with respect to etiologic factors. METHODS 1204 Tinnitus patients from the Tinnitus Research Initiative (TRI) Database with and without subjective TMJ complaints were compared with respect to demographic, tinnitus and audiological characteristics, questionnaires, and numeric ratings. Data were analysed according to a predefined statistical analysis plan. RESULTS Tinnitus patients with TMJ complaints (22% of the whole group) were significantly younger, had a lower age at tinnitus onset, and were more frequently female. They could modulate or mask their tinnitus more frequently by somatic maneuvers and by music or sound stimulation. Groups did not significantly differ for tinnitus duration, type of onset (gradual/abrupt), onset related events (whiplash etc.), character (pulsatile or not), hyperacusis, hearing impairment, tinnitus distress, depression, quality of life and subjective ratings (loudness etc.). CONCLUSION Replicating previous work in tinnitus patients with TMJ complaints, classical risk factors for tinnitus like older age and male gender are less relevant in tinnitus patients with TMJ complaints. By demonstrating group differences for modulation of tinnitus by movements and sounds our data further support the notion that tinnitus with TMJ complaints represents a subgroup of tinnitus with clinical features that are highly relevant for specific therapeutic management.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany.
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Noise overexposure alters long-term somatosensory-auditory processing in the dorsal cochlear nucleus--possible basis for tinnitus-related hyperactivity? J Neurosci 2012; 32:1660-71. [PMID: 22302808 DOI: 10.1523/jneurosci.4608-11.2012] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The dorsal cochlear nucleus (DCN) is the first neural site of bimodal auditory-somatosensory integration. Previous studies have shown that stimulation of somatosensory pathways results in immediate suppression or enhancement of subsequent acoustically evoked discharges. In the unimpaired auditory system suppression predominates. However, damage to the auditory input pathway leads to enhancement of excitatory somatosensory inputs to the cochlear nucleus, changing their effects on DCN neurons (Shore et al., 2008; Zeng et al., 2009). Given the well described connection between the somatosensory system and tinnitus in patients we sought to determine whether plastic changes in long-lasting bimodal somatosensory-auditory processing accompany tinnitus. Here we demonstrate for the first time in vivo long-term effects of somatosensory inputs on acoustically evoked discharges of DCN neurons in guinea pigs. The effects of trigeminal nucleus stimulation are compared between normal-hearing animals and animals overexposed with narrow band noise and behaviorally tested for tinnitus. The noise exposure resulted in a temporary threshold shift in auditory brainstem responses but a persistent increase in spontaneous and sound-evoked DCN unit firing rates and increased steepness of rate-level functions. Rate increases were especially prominent in buildup units. The long-term somatosensory enhancement of sound-evoked responses was strengthened while suppressive effects diminished in noise-exposed animals, especially those that developed tinnitus. Damage to the auditory nerve is postulated to trigger compensatory long-term synaptic plasticity of somatosensory inputs that might be an important underlying mechanism for tinnitus generation.
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Job A, Pons Y, Lamalle L, Jaillard A, Buck K, Segebarth C, Delon‐Martin C. Abnormal cortical sensorimotor activity during "Target" sound detection in subjects with acute acoustic trauma sequelae: an fMRI study. Brain Behav 2012; 2:187-99. [PMID: 22574285 PMCID: PMC3345361 DOI: 10.1002/brb3.21] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/18/2011] [Accepted: 08/31/2011] [Indexed: 11/26/2022] Open
Abstract
The most common consequences of acute acoustic trauma (AAT) are hearing loss at frequencies above 3 kHz and tinnitus. In this study, we have used functional Magnetic Resonance Imaging (fMRI) to visualize neuronal activation patterns in military adults with AAT and various tinnitus sequelae during an auditory "oddball" attention task. AAT subjects displayed overactivities principally during reflex of target sound detection, in sensorimotor areas and in emotion-related areas such as the insula, anterior cingulate and prefrontal cortex, in premotor area, in cross-modal sensory associative areas, and, interestingly, in a region of the Rolandic operculum that has recently been shown to be involved in tympanic movements due to air pressure. We propose further investigations of this brain area and fine middle ear investigations, because our results might suggest a model in which AAT tinnitus may arise as a proprioceptive illusion caused by abnormal excitability of middle-ear muscle spindles possibly link with the acoustic reflex and associated with emotional and sensorimotor disturbances.
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Affiliation(s)
- Agnès Job
- Institut de Recherche Biomédicale des Armées, antenne CRSSA, La Tronche, France
| | - Yoann Pons
- Hôpital d’instruction des Armées du Val‐de‐Grâce, 75 bld de Port‐Royal, Paris, France
| | | | | | - Karl Buck
- Institut franco‐allemand de recherche de Saint‐Louis, Saint Louis, France
| | - Christoph Segebarth
- INSERM U836, Grenoble Institut des Neurosciences, Grenoble, France
- Université Joseph Fourier, 38702 La Tronche, France
| | - Chantal Delon‐Martin
- INSERM U836, Grenoble Institut des Neurosciences, Grenoble, France
- Université Joseph Fourier, 38702 La Tronche, France
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Vielsmeier V, Kleinjung T, Strutz J, Bürgers R, Kreuzer PM, Langguth B. Tinnitus with temporomandibular joint disorders: a specific entity of tinnitus patients? Otolaryngol Head Neck Surg 2011; 145:748-52. [PMID: 21705788 DOI: 10.1177/0194599811413376] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Tinnitus is frequently associated with temporomandibular joint (TMJ) dysfunction. However, the nature of the relationship is not fully understood. Here the authors compared 30 patients with a confirmed diagnosis of temporomandibular joint dysfunction and tinnitus to a group of 61 patients with tinnitus but without any subjective complaints of TMJ dysfunction with respect to clinical and demographic characteristics. STUDY DESIGN Case-control study. SETTING Tertiary referral center. SUBJECTS Tinnitus patients with and without TMJ dysfunction presenting at the Department of Prosthetic Dentistry and th: Tinnitus Clinic at the University of Regensburg. RESULTS Tinnitus patients with TMJ disorder had better hearing function (P < .0005), lower age (P = .001), and lower age at tinnitus onset (P = .002) and were more frequently female (P = .003). Their subjectively perceived tinnitus loudness was lower (P = .01), and more of them could modulate their tinnitus by jaw or neck movements (P = .001). CONCLUSION Classical risk factors for tinnitus (age, male gender, hearing loss) are less relevant in tinnitus patients with TMJ disorder, suggesting a causal role of TMJ pathology in the generation and maintenance of tinnitus. Based on this finding, treatment of TMJ disorder may represent a causally oriented treatment strategy for tinnitus.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany.
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Kapoula Z, Yang Q, Lê TT, Vernet M, Berbey N, Orssaud C, Londero A, Bonfils P. Medio-lateral postural instability in subjects with tinnitus. Front Neurol 2011; 2:35. [PMID: 21647364 PMCID: PMC3103995 DOI: 10.3389/fneur.2011.00035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 05/11/2011] [Indexed: 11/13/2022] Open
Abstract
Background: Many patients show modulation of tinnitus by gaze, jaw or neck movements, reflecting abnormal sensorimotor integration, and interaction between various inputs. Postural control is based on multi-sensory integration (visual, vestibular, somatosensory, and oculomotor) and indeed there is now evidence that posture can also be influenced by sound. Perhaps tinnitus influences posture similarly to external sound. This study examines the quality of postural performance in quiet stance in patients with modulated tinnitus. Methods: Twenty-three patients with highly modulated tinnitus were selected in the ENT service. Twelve reported exclusively or predominately left tinnitus, eight right, and three bilateral. Eighteen control subjects were also tested. Subjects were asked to fixate a target at 40 cm for 51 s; posturography was performed with the platform (Technoconcept, 40 Hz) for both the eyes open and eyes closed conditions. Results: For both conditions, tinnitus subjects showed abnormally high lateral body sway (SDx). This was corroborated by fast Fourrier Transformation (FFTx) and wavelet analysis. For patients with left tinnitus only, medio-lateral sway increased significantly when looking away from the center. Conclusion: Similarly to external sound stimulation, tinnitus could influence lateral sway by activating attention shift, and perhaps vestibular responses. Poor integration of sensorimotor signals is another possibility. Such abnormalities would be accentuated in left tinnitus because of the importance of the right cerebral cortex in processing both auditory–tinnitus eye position and attention.
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Affiliation(s)
- Zoi Kapoula
- IRIS Group, UMR 8194, CNRS, Service d'Ophtalmologie, Assistance Publique Hôpitaux de Paris Paris, France
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Noreña AJ. An integrative model of tinnitus based on a central gain controlling neural sensitivity. Neurosci Biobehav Rev 2011; 35:1089-109. [PMID: 21094182 DOI: 10.1016/j.neubiorev.2010.11.003] [Citation(s) in RCA: 285] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/20/2010] [Accepted: 11/12/2010] [Indexed: 02/03/2023]
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Fioretti A, Eibenstein A, Fusetti M. New trends in tinnitus management. Open Neurol J 2011; 5:12-7. [PMID: 21541237 PMCID: PMC3085173 DOI: 10.2174/1874205x01105010012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/11/2010] [Accepted: 12/02/2010] [Indexed: 11/22/2022] Open
Abstract
Tinnitus is a perception of sound in absence of sound stimulation. Tinnitus in many cases cannot be eliminated by conventional medical treatment with drugs or surgery. Some people who begin to notice tinnitus, whether spontaneous or induced by noise, trauma or other insult, will experience spontaneous resolution, but many patients will have persistent tinnitus. For some of them, tinnitus sensation will be joined by tinnitus suffering, with many adverse effects like anxiety, depression and sleep disorders. For these tinnitus sufferers the psychological and acoustic approach proposed by the Tinnitus Retraining Therapy and Acoustic Desensitization Protocol may be helpful. Periodically new treatments are suggested like low-frequency repetitive transcranial magnetic stimulation and sequential phase shift sound cancellation treatment based on the frequency and loudness matching of the tinnitus. The aim of this work is to review modern considerations for the treatment of tinnitus.
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Aural symptoms in patients with temporomandibular joint disorders: multiple frequency tympanometry provides objective evidence of changes in middle ear impedance. Otol Neurotol 2011; 31:1359-64. [PMID: 20679956 DOI: 10.1097/mao.0b013e3181edb703] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The association of temporomandibular joint (TMJ) disorders with aural symptoms, such as tinnitus, otic fullness, and subjective decrease of hearing acuity, is a well-established clinical observation. Although several hypotheses have been made about the otic-conductive origin of these complaints, conventional 226-Hz tympanometry has failed to demonstrate any middle ear abnormalities. The aim of this study was to evaluate patients with TMJ disorders with multiple frequency tympanometry (MFT). STUDY DESIGN Prospective clinical study. SETTING Outpatient clinic. PATIENTS The population of this study consisted of 40 patients with unilateral TMJ disorders diagnosed for longer than 1 month. INTERVENTIONS After verifying that there were no abnormal otoscopic findings, 226-Hz tympanometry, conventional pure-tone audiometry, brainstem auditory evoked potentials, and MFT were performed. MAIN OUTCOME MEASURE Resonant frequency (RF) values. RESULTS With the exception of MFT, no abnormal audiologic findings were revealed. The ear ipsilateral to the lesion demonstrated significantly higher (p = 0.002) RF values in comparison to the contralateral ear. The difference in RF values was more obvious in patients aged 45 years or younger. CONCLUSION The results of this study imply an increase in the stiffness of the middle ear, which has not been detected by conventional tympanometry. This represents the first concrete documentation of minor alterations in the conductive properties of the middle ear and seems to support the various hypotheses on the middle-ear origin of aural complaints in patients with TMJ disorders. Further studies are needed before a clear insight on the presumably multifactorial pathophysiology of these complaints can finally be reached.
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