Titus's tinnitus

Current and Emerging Therapies for Chronic Subjective Tinnitus

IMPORTANCE

Chronic subjective tinnitus, the perception of sound without an external source for longer than six months, may be a greatly debilitating condition for some people, and is associated with psychiatric comorbidities and high healthcare costs. Current treatments are not beneficial for all patients and there is a large need for new therapies for tinnitus.

OBSERVATIONS

Unlike rarer cases of objective tinnitus, chronic subjective tinnitus often has no obvious etiology and a diverse pathophysiology. In the absence of objective testing, diagnosis is heavily based on clinical assessment. Management strategies include hearing aids, sound masking, tinnitus retraining therapy, cognitive behavioral therapy, and emerging therapies including transcranial magnetic stimulation and electrical stimulation.

CONCLUSIONS AND RELEVANCE

Although current treatments are limited, emerging diagnostics and treatments provide promising avenues for the management of tinnitus symptoms.

Advancing tinnitus research and researcher training: A case study review and future perspectives

Tinnitus affects one in 10 people and for many significantly impairs quality of life. Whilst there has been a notable increase in tinnitus research funding and tinnitus-related scientific publications in recent years, this is not keeping pace with other disciplines such as hearing loss. Tinnitus research is less attractive to industry funders, in particular because the field lacks consensus on many topics, objective measures, and treatment success stories. There is a clear need for even more funding, better quality studies, increased capacity, and more interdisciplinary working in the field. One important effort in this direction was the European School for Interdisciplinary Tinnitus research (ESIT) project. This EU-funded doctoral training program brought together a consortium of clinicians, academics, commercial partners, patient organizations, and public health experts. The program supported fundamental science and clinical research projects in order to advance treatments, develop innovative research methods, perform genetic and epidemiological studies, and establish a pan-European data resource. Underpinning the program was a comprehensive training curriculum designed to address the skills and researcher competencies defined by the Vitae Researcher Development Framework. This approach, reviewed in detail here, allowed for systematic identification of strengths and development needs, action planning, and review of achievements. We conclude the general need for increased capacity in the field, and coordinated efforts to both improve research quality and address fundamental issues that will attract and retain funding and researchers. ESIT provides an evidenced format for training in the field of tinnitus research.

Animal Models of Tinnitus: A Review

Animal models have significantly contributed to understanding the pathophysiology of chronic subjective tinnitus. They are useful because they control etiology, which in humans is heterogeneous; employ random group assignment; and often use methods not permissible in human studies. Animal models can be broadly categorized as either operant or reflexive, based on methodology. Operant methods use variants of established psychophysical procedures to reveal what an animal hears. Reflexive methods do the same using elicited behavior, for example, the acoustic startle reflex. All methods contrast the absence of sound and presence of sound, because tinnitus cannot by definition be perceived as silence.

Bothersome tinnitus : Cognitive behavioral perspectives

Tinnitus is not traceable to a single disease or pathology, but merely a symptom, which is distressing to some but not all individuals able to perceive it. The experience of tinnitus does not equate to tinnitus distress. Tinnitus suffering might be understood as a function of tinnitus-related distress in that bothersome tinnitus is an illness rather than a disease. In bothersome (distressing) tinnitus, the perception of the characteristic sound is a very disturbing and bothersome experience because of maladaptive psychological responses. Several cognitive and behavioral theoretical frameworks attempting to explain the nature and cause of tinnitus suffering have been introduced in and will be summarized here. Current treatment approaches are generally based on models that aim to: alleviate the perceptional experience by focusing on the tinnitus perception for habituation or even soothing purposes; decrease awareness of the sound by attentional training and cognitive interventions; decrease the maladaptive responses and the resulting distress by behavioral methods (i. e., exposure). The cognitive behavioral fear-avoidance model may offer an integrative cognitive behavioral approach that can lead to a new set of paradigms for studying the underlying mechanisms explaining chronic tinnitus suffering as well for developing innovative strategies to treat bothersome tinnitus.

Brain Waves Evaluation of Sound Therapy in Chronic Subjective Tinnitus Cases Using Wavelet Decomposition

Management and treatment of subjective tinnitus is an ongoing focus of research activities. One of the most viable assessments of such treatment is the evaluation of brain activity in addition to patient response and clinical assessment. This study focuses on sound therapy and evaluation of patients’ electroencephalogram (EEG) in order to verify the potency of this approach. Broadband sound therapy was applied to nineteen participants aging from 25 to 64 and suffering from chronic subjective tinnitus to study the difference of brain activity, a) before fake treatment, b) after fake treatment and c) after the main treatment, using EEG and Visual Analog Scale (VAS) for evaluating Residual Inhibition (RI). Four features were extracted using 4-level wavelet decomposition with Symlet 8 as its mother wavelet. For the “After the main treatment” stage, the mean value of wavelet coefficients for the last wavelet level, which corresponded to delta band of EEG, was lower in the FC3 channel based on Two-Sample T-Test with significance level of 0.01, as compared to the same channel of the “before the treatment” stage, for cases in which decreased tinnitus loudness were reported.

A brain centred view of psychiatric comorbidity in tinnitus: from otology to hodology

Introduction. Comorbid psychiatric disorders are frequent among patients affected by tinnitus. There are mutual clinical influences between tinnitus and psychiatric disorders, as well as neurobiological relations based on partially overlapping hodological and neuroplastic phenomena. The aim of the present paper is to review the evidence of alterations in brain networks underlying tinnitus physiopathology and to discuss them in light of the current knowledge of the neurobiology of psychiatric disorders. Methods. Relevant literature was identified through a search on Medline and PubMed; search terms included tinnitus, brain, plasticity, cortex, network, and pathways. Results. Tinnitus phenomenon results from systemic-neurootological triggers followed by neuronal remapping within several auditory and nonauditory pathways. Plastic reorganization and white matter alterations within limbic system, arcuate fasciculus, insula, salience network, dorsolateral prefrontal cortex, auditory pathways, ffrontocortical, and thalamocortical networks are discussed. Discussion. Several overlapping brain network alterations do exist between tinnitus and psychiatric disorders. Tinnitus, initially related to a clinicoanatomical approach based on a cortical localizationism, could be better explained by an holistic or associationist approach considering psychic functions and tinnitus as emergent properties of partially overlapping large-scale neural networks.

The first case of drug-dependent memory: the biblical Lot in Talmudic and Midrashic exegesis

The literature on alcohol and alcoholism has long noted how the effects of alcohol are reported in early sources, including religious texts such as the Bible and Talmud. In that vein, we suggest that the Bible, as elucidated according to long-established rabbinic interpretation, contains the earliest recorded case of drug-dependent memory, in the account of Lot's alcohol-facilitated incestuous relationships with his daughters (Genesis 19:29-38). We posit that the Talmudic, Midrashic, and traditional rabbinic commentaries that support our reading of the Lot narrative convey keen understanding of the effects of alcohol on recall. These Jewish sources, written centuries ago, demonstrate insight into the nature of alcohol-influenced cognitive function, which was thought to have been unknown prior to contemporary times.

Chapter 4: neurology in the Bible and the Talmud

The Bible, a major pillar of Western Civilization consists of Hebrew Scriptures, assembled over a millennium and accepted as of divine origin. The Talmud is a compendium of Jewish laws, covering every possible aspect of life, analyzed in depth from 200 BCE to 600 CE, becoming the foundation of Jewish existence. The all-encompassing character of the books provides numerous medical problems and observations that appear in various connotations. When in need to clarify various legal dilemmas, the Talmudic sages displayed astoundingly accurate anatomical knowledge and were pioneers in clinical-pathological correlations. The descriptions of "neurological" events in the Bible are very precise but show no evidence of neurological knowledge. Those reported in the various tractates of the Talmud are evidence of a substantial medical knowledge, marked by Hellenistic influence. Subjects such as head and spinal injuries, epilepsy, handedness neuralgias aphasia tinnitus and tremor were discussed in depth. This chapter is an updated collection of the studies, extracting observations and discussions of neurological manifestations from the ancient texts.