Diagnostic Clues in Pulsatile Tinnitus (Somatosounds)

Global research hot spot and trends in tinnitus treatment between 2000 and 2021: A bibliometric and visualized study

Background

In the 21^st century, the prevalence of tinnitus is increasing, impacting approximately one in five people. It is a very complicated condition that significantly affects quality of life. Despite the availability of hundreds of tinnitus treatment options, none are very successful. In light of this, there has been a steady increase in studies on tinnitus treatments in the recent past. To comprehend them better, this study used bibliometric approaches to analyze and summarize 21^st century scientific research accomplishments in tinnitus treatment.

Methods

The Web of Science Core Collection (WoSCC) was searched for papers that had been published and related to the treatment of tinnitus. VOSviewer, CiteSpace, R, and Tableau software programs were used to conduct bibliometric studies. To evaluate and visualize the results.

Results

2,933 publications on tinnitus treatment were found in 74 countries. Between 2000 and 2021, publications increased steadily. Otolaryngology-Head & Neck Surgery had the highest impact factor, whereas Otology & Neurotology had the most magazines and the highest h, g, and m index. Langguth B was the most prolific author in terms of productivity during the past 21 years. Numerous eminent authors and organizations from multiple nations collaborated. With 626 papers, the United States of America (USA) contributed the most to this field, making them the leading contributor. Neuroplasticity, sound therapy, and cognitive behavioral therapy (CBT) have attracted the attention of researchers, leading to the development of innovative diagnostic and treatment strategies for tinnitus.

Conclusion

This bibliometric study provides a comprehensive analysis of worldwide publications, cooperation, and research hotspots in tinnitus therapy, revealing the present status of research on this issue and guiding tinnitus treatment research in the coming years.

Association Between Tinnitus and Hypertension: A Cross-Sectional Analysis of the National Health and Nutrition Examination Survey

OBJECTIVE

Evaluating the association between arterial hypertension and tinnitus while controlling for gender, race, diabetes, hearing loss, and depression as potential confounders.

STUDY DESIGN

The present study employed a cross-sectional design.

SETTING

Health interviews were conducted in the respondents' homes.

PATIENTS

Respondents represent a nationwide sample of the noninstitutionalized civilian population of the United States. A total of 5,735 adults were identified by the NHANES 2015 to 2016 questionnaires.

INTERVENTIONS

Questionnaires were administered to each participant.

MAIN OUTCOME MEASURES

Participants' responses regarding tinnitus, hypertension, hearing loss, depression, diabetes, and demographics were used to evaluate potential associations. Multivariate logistic regression analyses were conducted on different age groups with the presence of hypertension as the response variable.

RESULTS

Participants aged 20 to 39 with tinnitus were significantly more likely to be diagnosed with hypertension (OR = 2.49; p = 0.024) after adjusting for potential confounding. No significant association between tinnitus and hypertension was found for older age groups. The diagnosis of diabetes was associated with hypertension in ages 20 to 39 (OR = 7.11; p = 0.001), 40 to 59 (OR = 3.45; p = 0.020), and 60 to 69 (OR = 3.89; p = 0.032).

CONCLUSIONS

Tinnitus is associated with hypertension in younger age groups of 20 to 39 years of age but not in age groups greater than 40 years. Diabetes is also associated with hypertension in individuals aged 20 to 69 years. This finding of tinnitus as a risk factor for hypertension in younger populations may inform better clinical practice and lead to earlier detection of hypertension in at-risk patients.

Hearing Loss and Hypertension: A Literature Review

Hypertension is a condition in which there is an abnormal blood pressure with a systolic pressure of more than 140 mmHg and a diastolic pressure of more than 90 mmHg. It has been cited that hypertension can cause hearing loss. To understand the association between hypertension and hearing loss, a systematic review has been carried out in Pubmed Central, Google Scholar, EBSCO, Web of Science, Indian Science Abstracts, J Gate, Proquest, and Shodh Ganga. This review included original articles published on or after 2016 with cross-sectional study design, retrospective study design, and longitudinal design and excluded case reports and letters to the editors. Out of the 11,977 articles, only ten articles were finalized. These 10 articles stated a possible association between hypertension and hearing loss by explaining that Cochlear microcirculation change resulted in tissue hypoxia that caused hearing loss.

Extracranial Vertebral Artery-Internal Jugular Vein-Spinal Vein Fistula in Neurofibromatosis Type I: Case Report and Literature Review

Background

A cervical arteriovenous fistula (AVF) in neurofibromatosis type I (NF-1) is uncommon, and it brings challenges and difficulty in treatment.

Case Presentation

A 39-year-old woman was diagnosed with an NF-1-associated spontaneous vertebral artery-internal jugular vein-spinal vein fistula. The fistula was placed by coil embolization. Postoperative examination showed that the fistula closure was satisfied, and the patient's abnormal clinical manifestation disappeared without any complications after 24 months of interventional embolization. As per the literature, interventional embolization is currently the main treatment method, and it has the distinguishing features of less trauma, quick recovery, and a good prognosis.

Conclusion

NF-1 associated with a spontaneous arteriovenous fistula is rare in clinical practice, which carries significant challenges in treatment, but can be effectively treated using endovascular embolism. Endovascular embolism could be the potential choice of treatment in NF-1 associated with AVF.

Effectiveness of Dry Needling in Bothersome Chronic Tinnitus in Patients with Myofascial Trigger Points

Introduction  Therapeutic dry needling (DN) is effective in reducing the discomfort of chronic somatosensory tinnitus in patients with myofascial trigger points (MTP)s.

Objective  To evaluate the efficacy of DN in chronic somatosensory tinnitus discomfort in patients with MTP.

Methods  Placebo-controlled paired trial that included 16 patients with a diagnosis of somatosensory chronic tinnitus and with the presence of at least one active or latent MTP. Treatment was performed in two phases: (1) four sessions (one session per week for four consecutive weeks) of placebo DN and (2) four sessions of therapeutic DN with a gap (washout) of 15 days between these phases.

Results  The Tinnitus Handicap Inventory (THI) variable and its emotional domain had a statistically significant reduction in therapeutic DN when compared with placebo DN ( p  = 0.024 and p = 0.011, respectively).

The tinnitus visual analogic scale (VAS) signaled a reduction in tinnitus discomfort when compared with moments before and after therapeutic DN ( p  < 0.05).

Conclusion  The therapeutic DN technique for MTP in patients with chronic tinnitus of somatosensory origin proved effective in reducing symptom discomfort, as measured by the THI (total score) and its emotional domain when compared with placebo DN.

Transtemporal Venous Decompression for Idiopathic Venous Pulsatile Tinnitus

Objective To evaluate the clinical characteristics and present surgical outcomes of transtemporal venous decompression technique in the treatment of pulsatile tinnitus (PT).

Study Design This is a prospective cohort study.

Setting This study was done at the tertiary private neurotologic skull base clinic.

Participants The primary author, between March 2012 and February 2013, evaluated 55 patients with the complaint of PT. Seven out of the 55 patients were diagnosed with severe, unrelenting idiopathic pulsatile tinnitus (IPT), and were placed into the study. These seven patients had temporal bone computed tomography, magnetic resonance imaging, arteriogram, videonystagmography, electrocochleography, and lumbar puncture based on the symptoms. All the seven patients underwent transtemporal venous decompression surgery.

Main Outcome Measure Resolution of PT was determined as the primary outcome measure.

Results Six out of seven patients had complete resolution of their PT immediately after surgery and at 3 to 4 years follow-up. One patient developed intracranial hypertension after 3 months requiring ventriculoperitoneal shunt, which resolved PT as well. No complications occurred.

Conclusion A significant subset of the PT patient population has known reversible causes. The more common includes conductive hearing loss, superior canal dehiscence, benign intracranial hypertension, jugulosigmoid venous anomalies, stapedial myoclonus, etc. There exists a subset of patients who have IPT. Transtemporal venous decompression is a surgical technique that can be employed to give patients with IPT long-term relief.

Pulsatile tinnitus: imaging and differential diagnosis

BACKGROUND

Pulsatile tinnitus, unlike idiopathic tinnitus, usually has a specific, identifiable cause. Nonetheless, uncertainty often arises in clinical practice about the findings to be sought and the strategy for work-up.

METHODS

Selective literature review and evaluation of our own series of patients.

RESULTS

Pulsatile tinnitus can have many causes. No prospective studies on this subject are available to date. Pulsatile tinnitus requires both a functional organ of hearing and a genuine, physical source of sound, which can, under certain conditions, even be objectified by an examiner. Pulsatile tinnitus can be classified by its site of generation as arterial, arteriovenous, or venous. Typical arterial causes are arteriosclerosis, dissection, and fibromuscular dysplasia. Common causes at the arteriovenous junction include arteriovenous fistulae and highly vascularized skull base tumors. Common venous causes are intracranial hypertension and, as predisposing factors, anomalies and normal variants of the basal veins and sinuses. In our own series of patients, pulsatile tinnitus was most often due to highly vascularized tumors of the temporal bone (16%), followed by venous normal variants and anomalies (14%) and vascular stenoses (9%). Dural arteriovenous fistulae, inflammatory hyperemia, and intracranial hypertension were tied for fourth place (8% each).

CONCLUSION

The clinical findings and imaging studies must always be evaluated together. Thorough history-taking and clinical examination are the basis for the efficient use of imaging studies to reveal the cause of pulsatile tinnitus.