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Deklerck AN, Swinnen F, Keppler H, Dhooge IJM. Changes in Tinnitus Characteristics and Residual Inhibition following Cochlear Implantation: A Prospective Analysis. Brain Sci 2023; 13:1484. [PMID: 37891851 PMCID: PMC10605020 DOI: 10.3390/brainsci13101484] [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: 09/24/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
This study aims to explore the effect of cochlear implantation on tinnitus perception. A prospective study was conducted on 72 adult hearing-impaired patients to evaluate tinnitus perception before and after cochlear implantation, using standardized tinnitus questionnaires (the tinnitus sample case-history questionnaire, tinnitus functional index (TFI), and tinnitus handicap inventory (THI)). A large variety of demographic and hearing- and implant-related data was collected from patient hospital records to explore possible associations with the implantation effect. The prevalence of tinnitus complaints before implantation was 58.3%. The temporary induction or aggravation of tinnitus immediately after surgery was noted in 20% and 46.7% of patients, respectively. When evaluated 3 months after implantation, 60% of tinnitus patients experienced a clinically significant reduction in their complaints; most of the improvements were experienced immediately after activation of the implant. Only the scores for TFI and THI at baseline were found to be significantly correlated with a reduction in TFI scores after implantation. In 80% of tinnitus patients, the tinnitus remained suppressed for some time after taking off the device. The large subset of patients with residual inhibition supports the involvement of central pathophysiological processes in implantation effects on tinnitus, which are explored in this paper.
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Affiliation(s)
- Ann Nancy Deklerck
- Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Freya Swinnen
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (F.S.); (H.K.)
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hannah Keppler
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (F.S.); (H.K.)
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Ingeborg Johanna Maria Dhooge
- Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
- Department of Otorhinolaryngology, Ghent University Hospital, 9000 Ghent, Belgium
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Evaluating the efficacy of hearing aids for tinnitus therapy - A Positron emission tomography study. Brain Res 2022; 1775:147728. [PMID: 34793755 DOI: 10.1016/j.brainres.2021.147728] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022]
Abstract
Brain imaging studies have revealed neural changes in chronic tinnitus patients that are not restricted to auditory brain areas; rather, the engagement of limbic system structures, attention and memory networks are has been noted. Hearing aids (HA) provide compensation for comorbid hearing loss and may decrease tinnitus-related perception and annoyance. Using resting state positron emission tomography our goal was to analyze metabolic and functional brain changes after six months of effective HA use by patients with chronic tinnitus and associated sensorineural hearing loss. 33 age and hearing loss matched participants with mild/moderate hearing loss were enrolled in this study: 19 with tinnitus, and 14 without tinnitus. Participants with tinnitus of more than 6 months with moderate/severe Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores composed the tinnitus group. A full factorial 2X2 ANOVA was conducted for imaging analysis, with group (tinnitus and controls) and time point (pre-intervention and post-intervention) as factors. Six months after HA fitting, tinnitus scores reduced statistically and clinically. Analysis revealed increased glycolytic metabolism in the left orbitofrontal cortex, right temporal lobe and right hippocampus, and reduced glycolytic metabolism in the left cerebellum and inferior parietal lobe within the tinnitus group. The hearing loss control group showed no significant metabolic changes in the analysis. Parsing out the contribution of tinnitus independent of hearing loss, allowed us to identify areas implicated in declines in tinnitus handicap as a result of the intervention. Brain regions implicated in the present study may be part of chronic tinnitus-specific network.
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Neural Substrates of Tinnitus in an Auditory Brainstem Implant Patient: A Preliminary Molecular Imaging Study Using H2 15 O-PET Including a 5-year Follow-up of Auditory Performance and Tinnitus Perception. Otol Neurotol 2020; 41:e15-e20. [PMID: 31821261 DOI: 10.1097/mao.0000000000002474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION It was previously demonstrated that tinnitus due to profound unilateral hearing loss can be treated by the use of electrical stimulation via a cochlear implant (CI) with long-lasting positive effects. In cases where patients are not suitable for cochlear implantation due to aplasia/hypoplasia, cochlear malformations etc., an auditory brainstem implant (ABI) may be a solution. While auditory performance with ABI is well investigated, it is currently unknown whether stimulation through ABI also renders tinnitus reduction in patients with incapacitating tinnitus. The current case study reports on the subjective tinnitus perception during a 5-year follow-up period. In addition, a first H2O PET imaging study in an ABI patient is carried out revealing underlying neural substrates of tinnitus. METHODS A 56-year-old male single-sided deaf patient with incapacitating tinnitus received an ABI after insufficient auditory performances and only minor tinnitus reduction with CI. Audiological follow-up was carried out during a 5-year follow-up period comprising pure-tone audiometry, speech-in-quiet testing, speech-in-noise testing, tinnitus questionnaires (tinnitus questionnaire and numeric rating scale) and the HISQUI19 questionnaire. To investigate the neural substrates of tinnitus in this subject, H2O PET tomography scans were acquired in three different conditions: 1) ABI switched off which was considered as the resting-state measurement rendering the loudest possible tinnitus for the patient (ABI OFF); 2) ABI switched on causing a small suppression of tinnitus due to electrical stimulation (ABI ON); 3) ABI switched on and 70 dB SPL white noise presented directly to the external audio processor through a direct audio cable providing the maximum tinnitus suppression for the patient (NOISE). RESULTS Subjectively the patient reported a significant tinnitus reduction after implantation which remained stable over time with a decrease in tinnitus questionnaire from grade 4 to grade 2 and a 50% reduction in the numeric rating scale (from 8 to 4) during the 5-year period. Comparing the ABI OFF and ABI ON conditions, significant increase in regional cerebral blood flow (rCBF) was observed in brain areas involved in the salience network showing already suppression of tinnitus only by electrical stimulation in the absence of auditory stimuli. The NOISE condition showed relatively decreased rCBF in the insula (as well as in the orbitofrontal cortex) as compared with the ABI OFF condition. Abnormally activated areas comprising the salience network may have been significantly suppressed by the NOISE condition both by acoustic and electrical stimulations of the auditory pathway. Moreover, the NOISE condition showed significantly decreased rCBF in the parahippocampus as compared with the ABI OFF condition. This finding supports the idea of distinct tinnitus generators depending on the amount of hearing loss. CONCLUSION The reduction of tinnitus in the current ABI subject may be attributable to partial peripheral reafferentation-induced deactivation of the parahippocampus-based tinnitus generator as well as the salience network. Further validation is required by the use of a follow-up study with a larger number of subjects.
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Abstract
OBJECTIVE Determine the prevalence of clinical insomnia and its associations with anxiety, depression, and tinnitus in adult cochlear implant (CI) users. DESIGN Self-reported information on tinnitus, sleep, and demographic variables was collected from adult CI users (n = 127). Tinnitus presence, its persistence, related emotional distress, and difficulties with sleep were assessed using questions from the UK Biobank study (www.ukbiobank.ac.uk). Tinnitus-related handicap was assessed using the Tinnitus Handicap Inventory. Clinical insomnia symptoms were characterized using the Insomnia Severity Index (ISI), and clinical anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS). Regression models were used to compare the data from CI users with and without tinnitus, and to test the associations between clinical insomnia, anxiety, depression and tinnitus handicap. RESULTS About a half (53%) of CI users reported tinnitus, of whom 54% described it as persistent, 41% as emotionally distressing and 73% reported having difficulties with sleep based on the UK Biobank questions. The ISI suggested that clinically abnormal insomnia symptoms were more likely to occur with tinnitus (odds ratio [OR] = 2.60, 95% confidence interval 1.04 to 6.45; p = 0.040) and were found in 41% of CI users with tinnitus. Post-hoc exploratory analyses on the ISI suggested that CI users with tinnitus experienced greater levels of difficulty falling asleep, lower satisfaction with sleep patterns, greater interference of sleep problems with daily activities, and a greater impact on their quality of life. The HADS scores suggested that those with tinnitus were also more likely to have clinically abnormal anxiety (42%; OR = 3.50, 95% confidence interval 1.49 to 8.22; p = 0.004) and depression symptoms (14%; OR = 6.18, 95% confidence interval 1.17 to 32.82; p = 0.032). The clinical insomnia observed in CI users with tinnitus was associated with tinnitus handicap (p = 0.028), and the levels of clinical anxiety (p = 0.012) and depression (p < 0.001). CONCLUSIONS Clinically abnormal insomnia symptoms are prevalent, potentially affecting over 40% of CI users with tinnitus. The associations between clinical insomnia, anxiety, and depression symptoms, and tinnitus-related handicap suggest that all of these symptoms should be considered when assessing the tinnitus-related burden and its impact on the quality of life after cochlear implantation. The present findings also have potential implications for the clinical management of CI recipients with tinnitus, in whom it may be advisable to monitor sleep problems so that they can be addressed where appropriate. Further research is needed to investigate the mechanisms and causal links behind insomnia and tinnitus-related symptoms in this population. Future studies should also investigate the feasibility and effectiveness of night time use of CIs to alleviate tinnitus-related insomnia. The potential impact of insomnia on the quality of life of CI users with tinnitus highlights the importance of including sleep measures in future evaluations of the effectiveness of cochlear implantation for the alleviation of tinnitus.
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Abstract
This article reviews the use of human neuroimaging for chronic subjective tinnitus. Evidence-based guidance on the clinical use of imaging to identify relevant auditory lesions when evaluating tinnitus patients is given. After introducing the anatomy and imaging modalities most pertinent to the neuroscience of tinnitus, the article reviews tinnitus-associated alterations in key auditory and nonauditory networks in the central nervous system. Emphasis is placed on how these findings support proposed models of tinnitus and how this line of investigation is relevant to practicing clinicians.
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Affiliation(s)
- Meredith E Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 395, Minneapolis, MN 55455, USA.
| | - Tina C Huang
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street Southeast, MMC 395, Minneapolis, MN 55455, USA
| | - Srikantan Nagarajan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Avenue S362, San Francisco, CA 94143-0628, USA; Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2233 Post Street Suite 341, San Francisco, CA 94115-1225, USA
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2233 Post Street Suite 341, San Francisco, CA 94115-1225, USA
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Deklerck AN, Degeest S, Dhooge IJM, Keppler H. Test-Retest Reproducibility of Response Duration in Tinnitus Patients With Positive Residual Inhibition. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3531-3544. [PMID: 31433704 DOI: 10.1044/2019_jslhr-h-18-0514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Functional imaging is often used to try to elucidate the pathophysiological mechanism of tinnitus. Residual inhibition, the temporary suppression of tinnitus after application of a masking noise, could be an interesting technique to modulate tinnitus perception in functional imaging paradigms. The purposes of this study were to primarily assess reproducibility of the (partial) positive residual inhibition response duration in patients with tinnitus and to explore its utility in experimental designs. Method Patients with tinnitus exhibiting a (partial) positive residual inhibition response or tinnitus reduction after a 1-min white noise presentation were selected from a broad consulting tinnitus population. In 27 patients, this response was tested 4 times: twice during initial testing and twice during a retest of the psychoacoustic tinnitus measures, 4-8 weeks after initial consultation. In 17 patients with stable residual inhibition responses, reproducibility of response duration, the duration of tinnitus reduction up to pretesting state, was analyzed. Results Initial testing showed a residual inhibition duration of 29.5 s on average. Test-retest reproducibility of response duration was shown to be reliable with an ICC(3, 4) of .871 (95% CI [0.733, 0.948]) and a standard error of measurement of 6.64 s. Conclusions This study indicates the good test-retest reproducibility of residual inhibition duration in our subset of 17 patients with stable (partial) positive residual inhibition. Residual inhibition is, therefore, a technique that can potentially be used for temporary tinnitus manipulation in experimental paradigms to unravel tinnitus pathophysiology.
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Affiliation(s)
- Ann N Deklerck
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Belgium
| | - Sofie Degeest
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Belgium
| | - Ingeborg J M Dhooge
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Belgium
| | - Hannah Keppler
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Belgium
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Peter N, Liyanage N, Pfiffner F, Huber A, Kleinjung T. The Influence of Cochlear Implantation on Tinnitus in Patients with Single-Sided Deafness: A Systematic Review. Otolaryngol Head Neck Surg 2019; 161:576-588. [DOI: 10.1177/0194599819846084] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
ObjectivesThis systematic review provides an overview of the available studies (published by January 29, 2018) with descriptive data analysis about the influence of cochlear implantation on tinnitus in patients with single-sided deafness (SSD).Data SourcesPubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar.Review MethodsOriginal studies about the influence of cochlear implantation on tinnitus, measured with different tinnitus questionnaires or visual analog scale, in patients with SSD were included. The pre- and postimplantation tinnitus scores of the included studies were extracted for the further systematic review.ResultsThe systematic search yielded 1028 studies. After evaluating titles, abstracts, and full texts, 1011 of these were dismissed. From the remaining 17 studies, 4 showed a low directness of evidence or high risk of bias and were therefore excluded. Due to the nature of cochlear implantation in SSD, only cohort studies and no randomized trials exist, which limits the evaluation in a systematic review. Generally, the mean tinnitus questionnaire scores decreased after cochlear implantation in these 13 studies with a total of 153 patients. The most widely used tinnitus questionnaire was the Tinnitus Handicap Inventory. In these studies, 34.2% of patients demonstrated complete suppression, 53.7% an improvement, 7.3% a stable value, and 4.9% an increase of tinnitus, and none of the patients reported an induction of tinnitus.ConclusionThis review shows a clear improvement of tinnitus complaints after cochlear implantation in patients with SSD. Therefore, tinnitus might be considered as an additional indication for cochlear implantation in SSD.
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Affiliation(s)
- Nicole Peter
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Nuwan Liyanage
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Flurin Pfiffner
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Zeng FG, Richardson M, Tran P, Lin H, Djalilian H. Tinnitus Treatment Using Noninvasive and Minimally Invasive Electric Stimulation: Experimental Design and Feasibility. Trends Hear 2019; 23:2331216518821449. [PMID: 30803416 PMCID: PMC6330726 DOI: 10.1177/2331216518821449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/20/2018] [Accepted: 12/05/2018] [Indexed: 12/31/2022] Open
Abstract
Noninvasive transcranial or minimally invasive transtympanic electric stimulation may offer a desirable treatment option for tinnitus because it can activate the deafferented auditory nerve fibers while posing little to no risk to hearing. Here, we built a flexible research interface to generate and control accurately charge-balanced current stimulation as well as a head-mounted instrument capable of holding a transtympanic electrode steady for hours. We then investigated the short-term effect of a limited set of electric stimulation parameters on tinnitus in 10 adults with chronic tinnitus. The preliminary results showed that 63% of conditions of electric stimulation produced some degree of tinnitus reduction, with total disappearance of tinnitus in six subjects in response to at least one condition. The present study also found significant side effects such as visual, tactile, and even pain sensations during electric stimulation. In addition to masking and residual inhibition, neuroplasticity is likely involved in the observed tinnitus reduction. To translate the present electric stimulation into a safe and effective tinnitus treatment option, we need to optimize stimulation parameters that activate the deafferented auditory nerve fibers and reliably suppress tinnitus, with minimal side effects and tolerable sensations. Noninvasive or minimally invasive electric stimulation can be integrated with sound therapy, invasive cochlear implants, or other forms of coordinated stimulation to provide a systematic strategy for tinnitus treatment or even a cure.
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Affiliation(s)
- Fan-Gang Zeng
- Center for Hearing Research, University of California, Irvine, CA, USA
- Department of Anatomy and Neurobiology, University of California, Irvine, CA, USA
- Department of Biomedical Engineering, University of California, Irvine, CA, USA
- Department of Cognitive Sciences, University of California, Irvine, CA, USA
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Matthew Richardson
- Center for Hearing Research, University of California, Irvine, CA, USA
- Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Phillip Tran
- Center for Hearing Research, University of California, Irvine, CA, USA
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Harrison Lin
- Center for Hearing Research, University of California, Irvine, CA, USA
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA, USA
| | - Hamid Djalilian
- Center for Hearing Research, University of California, Irvine, CA, USA
- Department of Biomedical Engineering, University of California, Irvine, CA, USA
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA, USA
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The Cochleural Alternating Acoustic Beam Therapy (CAABT): A pre-clinical trial. Am J Otolaryngol 2018; 39:401-409. [PMID: 29655489 DOI: 10.1016/j.amjoto.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 04/01/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE We intend to assess the effectiveness of a novel tinnitus treatment therapy, the Cochleural Alternating Acoustic Beam Therapy (CAABT) using the psychoacoustic measures, the questionnaires and rs-fMRI. MATERIALS AND METHODS In this study, we enrolled 11 older than 18 years old Chinese patients with normal hearing who had unilateral, chronic (longer than 6 months), sensorineural tinnitus, of frequencies between 125-8000 Hz, and an average loudness of 31 dB. The patients underwent the treatment with the CAABT method for 12 weeks and the outcomes were evaluated with tinnitus questionnaire scores, a set of psychoacoustic measures, and rs-fMRI testing before treatment and at 3 months. This was an earlier study of the controlled randomized clinical trial which was registered with ClinicalTrials.gov, number NCT02774122. RESULTS Almost all the patients reported reduced tinnitus annoyance after the three-month treatment. The THI and VAS scores showed decreased tinnitus severity. The rs-fMRI results indicated that the right middle frontal gyrus and the right superior temporal gyrus displayed noticeable decreases of the ReHo values for the subjects between the before and after treatment, supporting the clinical evidence of significant tinnitus reduction. CONCLUSION The therapy seemed effective in patients of varying severities, and no side effects were observed in this trial. The CAABT can be an alternative for those who are suitable for sound therapy once a large scale of and better controlled clinical studies have validated the findings of this experiment.
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Chen YC, Chen H, Jiang L, Bo F, Xu JJ, Mao CN, Salvi R, Yin X, Lu G, Gu JP. Presbycusis Disrupts Spontaneous Activity Revealed by Resting-State Functional MRI. Front Behav Neurosci 2018; 12:44. [PMID: 29593512 PMCID: PMC5859072 DOI: 10.3389/fnbeh.2018.00044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/26/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose: Presbycusis, age-related hearing loss, is believed to involve neural changes in the central nervous system, which is associated with an increased risk of cognitive impairment. The goal of this study was to determine if presbycusis disrupted spontaneous neural activity in specific brain areas involved in auditory processing, attention and cognitive function using resting-state functional magnetic resonance imaging (fMRI) approach. Methods: Hearing and resting-state fMRI measurements were obtained from 22 presbycusis patients and 23 age-, sex- and education-matched healthy controls. To identify changes in spontaneous neural activity associated with age-related hearing loss, we compared the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) of fMRI signals in presbycusis patients vs. controls and then determined if these changes were linked to clinical measures of presbycusis. Results: Compared with healthy controls, presbycusis patients manifested decreased spontaneous activity mainly in the superior temporal gyrus (STG), parahippocampal gyrus (PHG), precuneus and inferior parietal lobule (IPL) as well as increased neural activity in the middle frontal gyrus (MFG), cuneus and postcentral gyrus (PoCG). A significant negative correlation was observed between ALFF/ReHo activity in the STG and average hearing thresholds in presbycusis patients. Increased ALFF/ReHo activity in the MFG was positively correlated with impaired Trail-Making Test B (TMT-B) scores, indicative of impaired cognitive function involving the frontal lobe. Conclusions: Presbycusis patients have disrupted spontaneous neural activity reflected by ALFF and ReHo measurements in several brain regions; these changes are associated with specific cognitive performance and speech/language processing. These findings mainly emphasize the crucial role of aberrant resting-state ALFF/ReHo patterns in presbycusis patients and will lead to a better understanding of the neuropathological mechanisms underlying presbycusis.
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Affiliation(s)
- Yu-Chen Chen
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China.,Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fan Bo
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Cun-Nan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Richard Salvi
- Center for Hearing and Deafness, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Jian-Ping Gu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Smit JV, Jahanshahi A, Janssen ML, Stokroos RJ, Temel Y. Hearing assessment during deep brain stimulation of the central nucleus of the inferior colliculus and dentate cerebellar nucleus in rat. PeerJ 2017; 5:e3892. [PMID: 29018625 PMCID: PMC5633028 DOI: 10.7717/peerj.3892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/15/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently it has been shown in animal studies that deep brain stimulation (DBS) of auditory structures was able to reduce tinnitus-like behavior. However, the question arises whether hearing might be impaired when interfering in auditory-related network loops with DBS. METHODS The auditory brainstem response (ABR) was measured in rats during high frequency stimulation (HFS) and low frequency stimulation (LFS) in the central nucleus of the inferior colliculus (CIC, n = 5) or dentate cerebellar nucleus (DCBN, n = 5). Besides hearing thresholds using ABR, relative measures of latency and amplitude can be extracted from the ABR. In this study ABR thresholds, interpeak latencies (I-III, III-V, I-V) and V/I amplitude ratio were measured during off-stimulation state and during LFS and HFS. RESULTS In both the CIC and the CNBN groups, no significant differences were observed for all outcome measures. DISCUSSION DBS in both the CIC and the CNBN did not have adverse effects on hearing measurements. These findings suggest that DBS does not hamper physiological processing in the auditory circuitry.
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Affiliation(s)
- Jasper V. Smit
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ali Jahanshahi
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcus L.F. Janssen
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J. Stokroos
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Wang Q, Li JN, Lei GX, Chen DS, Wang WZ, Chen AT, Mong MD, Li S, Jiao QS, Yang SM. Interaction of tinnitus suppression and hearing ability after cochlear implantation. Acta Otolaryngol 2017. [PMID: 28641038 DOI: 10.1080/00016489.2017.1336283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To study the postoperative impact of cochlear implants (CIs) on tinnitus, as well as the impact of tinnitus on speech recognition with CI switched on. METHODS Fifty-two postlingual deafened CI recipients (21 males and 31 females) were assessed using an established Tinnitus Characteristics Questionnaire and Tinnitus Handicap Inventory (THI) before and after cochlear implantation. The tinnitus loudness was investigated when CI was switched on and off in CI recipients with persistent tinnitus. The relation between tinnitus loudness and recipients' satisfaction of cochlear implantation was analyzed by the visual analogue scale (VAS) score. RESULTS With CI 'OFF', 42 CI recipients experienced tinnitus postimplant ipsilaterally and 44 contralaterally. Tinnitus was totally suppressed ipsilateral to the CI with CI 'ON' in 42.9%, partially suppressed in 42.9%, unchanged in 11.9% and aggravated in 2.4%. Tinnitus was totally suppressed contralaterally with CI 'ON' in 31.8% of CI recipients, partially suppressed in 47.7%, unchanged in 20.5%. Pearson correlation analysis showed that tinnitus loudness and the results of cochlear implant patients satisfaction was negatively correlated (r = .674, p < .001). CONCLUSION The study suggests six-month CI activation can be effective for suppressing tinnitus. The tinnitus loudness may affect patients' satisfaction with the use of CI.
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Affiliation(s)
- Qian Wang
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Jia-Nan Li
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Guan-Xiong Lei
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Dai-Shi Chen
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Wei-Ze Wang
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Ai-Ting Chen
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Meng-Di Mong
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Sun Li
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Qing-Shan Jiao
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
| | - Shi-Ming Yang
- Auditory Implantation Center, Department of Otolaryngology & Head and Neck Surgery, Beijing Key Laboratory of Hearing Impairment Prevention and Treatment, Key Laboratory of Hearing Impairment Science, Ministry of Education, Chinese PLA General Hospital, Beijing, P.R. China
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Chen YC, Xia W, Chen H, Feng Y, Xu JJ, Gu JP, Salvi R, Yin X. Tinnitus distress is linked to enhanced resting-state functional connectivity from the limbic system to the auditory cortex. Hum Brain Mapp 2017; 38:2384-2397. [PMID: 28112466 DOI: 10.1002/hbm.23525] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 02/04/2023] Open
Abstract
The phantom sound of tinnitus is believed to be triggered by aberrant neural activity in the central auditory pathway, but since this debilitating condition is often associated with emotional distress and anxiety, these comorbidities likely arise from maladaptive functional connections to limbic structures such as the amygdala and hippocampus. To test this hypothesis, resting-state functional magnetic resonance imaging (fMRI) was used to identify aberrant effective connectivity of the amygdala and hippocampus in tinnitus patients and to determine the relationship with tinnitus characteristics. Chronic tinnitus patients (n = 26) and age-, sex-, and education-matched healthy controls (n = 23) were included. Both groups were comparable for hearing level. Granger causality analysis utilizing the amygdala and hippocampus as seed regions were used to investigate the directional connectivity and the relationship with tinnitus duration or distress. Relative to healthy controls, tinnitus patients demonstrated abnormal directional connectivity of the amygdala and hippocampus, including primary and association auditory cortex, and other non-auditory areas. Importantly, scores on the Tinnitus Handicap Questionnaires were positively correlated with increased connectivity from the left amygdala to left superior temporal gyrus (r = 0.570, P = 0.005), and from the right amygdala to right superior temporal gyrus (r = 0.487, P = 0.018). Moreover, enhanced effective connectivity from the right hippocampus to left transverse temporal gyrus was correlated with tinnitus duration (r = 0.452, P = 0.030). The results showed that tinnitus distress strongly correlates with enhanced effective connectivity that is directed from the amygdala to the auditory cortex. The longer the phantom sensation, the more likely acute tinnitus becomes permanently encoded by memory traces in the hippocampus. Hum Brain Mapp 38:2384-2397, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
| | - Wenqing Xia
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
| | - Yuan Feng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
| | - Jian-Ping Gu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
| | - Richard Salvi
- Center for Hearing and Deafness, University at Buffalo, State University of New York, Buffalo, 14214, New York
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, 210006, Nanjing, China
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IMPLANTE COCLEAR. ESTADO ACTUAL Y FUTURO. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Chen YC, Feng Y, Xu JJ, Mao CN, Xia W, Ren J, Yin X. Disrupted Brain Functional Network Architecture in Chronic Tinnitus Patients. Front Aging Neurosci 2016; 8:174. [PMID: 27458377 PMCID: PMC4937025 DOI: 10.3389/fnagi.2016.00174] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/28/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose: Resting-state functional magnetic resonance imaging (fMRI) studies have demonstrated the disruptions of multiple brain networks in tinnitus patients. Nonetheless, several studies found no differences in network processing between tinnitus patients and healthy controls (HCs). Its neural bases are poorly understood. To identify aberrant brain network architecture involved in chronic tinnitus, we compared the resting-state fMRI (rs-fMRI) patterns of tinnitus patients and HCs. Materials and Methods: Chronic tinnitus patients (n = 24) with normal hearing thresholds and age-, sex-, education- and hearing threshold-matched HCs (n = 22) participated in the current study and underwent the rs-fMRI scanning. We used degree centrality (DC) to investigate functional connectivity (FC) strength of the whole-brain network and Granger causality to analyze effective connectivity in order to explore directional aspects involved in tinnitus. Results: Compared to HCs, we found significantly increased network centrality in bilateral superior frontal gyrus (SFG). Unidirectionally, the left SFG revealed increased effective connectivity to the left middle orbitofrontal cortex (OFC), left posterior lobe of cerebellum (PLC), left postcentral gyrus, and right middle occipital gyrus (MOG) while the right SFG exhibited enhanced effective connectivity to the right supplementary motor area (SMA). In addition, the effective connectivity from the bilateral SFG to the OFC and SMA showed positive correlations with tinnitus distress. Conclusions: Rs-fMRI provides a new and novel method for identifying aberrant brain network architecture. Chronic tinnitus patients have disrupted FC strength and causal connectivity mostly in non-auditory regions, especially the prefrontal cortex (PFC). The current findings will provide a new perspective for understanding the neuropathophysiological mechanisms in chronic tinnitus.
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Affiliation(s)
- Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Yuan Feng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Cun-Nan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Wenqing Xia
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Jun Ren
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University Nanjing, China
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Rauschecker JP, May ES, Maudoux A, Ploner M. Frontostriatal Gating of Tinnitus and Chronic Pain. Trends Cogn Sci 2016; 19:567-578. [PMID: 26412095 DOI: 10.1016/j.tics.2015.08.002] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 12/18/2022]
Abstract
Tinnitus and chronic pain are sensory-perceptual disorders associated with negative affect and high impact on well-being and behavior. It is now becoming increasingly clear that higher cognitive and affective brain systems are centrally involved in the pathology of both disorders. We propose that the ventromedial prefrontal cortex and the nucleus accumbens are part of a central 'gatekeeping' system in both sensory modalities, a system which evaluates the relevance and affective value of sensory stimuli and controls information flow via descending pathways. If this frontostriatal system is compromised, long-lasting disturbances are the result. Parallels in both systems are striking and mutually informative, and progress in understanding central gating mechanisms might provide a new impetus to the therapy of tinnitus and chronic pain.
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Affiliation(s)
- Josef P Rauschecker
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA; Department of Neurology and TUM-Neuroimaging Center, Technische Universität München, Munich, Germany; Institute for Advanced Study, Technische Universität München, Munich, Germany.
| | - Elisabeth S May
- Department of Neurology and TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
| | - Audrey Maudoux
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC, USA
| | - Markus Ploner
- Department of Neurology and TUM-Neuroimaging Center, Technische Universität München, Munich, Germany
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Greenberg D, Meerton L, Graham J, Vickers D. Developing an assessment approach for perceptual changes to tinnitus sound characteristics for adult cochlear implant recipients. Int J Audiol 2016; 55:392-404. [PMID: 27146518 DOI: 10.3109/14992027.2016.1172391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the impact of cochlear implantation on tinnitus suppression, characteristics, localization, and duration. DESIGN A cochlear implant (CI) recipient-focused postal questionnaire survey. STUDY SAMPLE The questionnaire was posted, with consent, to 100 adults who had received a unilateral CI at the RNTNEH between 1988 and 1999. All adults spoke English as their first language and were postlingually deafened. Sixty-eight adults (38 female, 29 male, one unspecified) aged 31-80 years (mean 61 years) completed and returned the questionnaire without interview. RESULTS With the processor 'ON', CI recipients experienced total or partial suppression of tinnitus ipsilateral to their CI in 57% of cases, and in 43% where tinnitus was perceived contralateral to the CI. The percentage of CI recipients who experienced high tone tinnitus was reduced from 60% pre-implant to 29% post-implant with the processor 'ON' while pulsatile tinnitus was reduced from 38% pre-implant to 13% post-implant. CIs were also found to reduce the tonal complexity and duration, and change the source localization of tinnitus post-implantation. CONCLUSIONS Perceptual changes to tinnitus can take place post-implantation. Changes can occur within the four categories explored: tinnitus suppression, characteristics, localization, and duration of awareness per day.
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Affiliation(s)
| | - Leah Meerton
- b Royal National Throat , Nose & Ear Hospital , London , UK
| | - John Graham
- b Royal National Throat , Nose & Ear Hospital , London , UK
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Arts RAGJ, George ELJ, Janssen M, Griessner A, Zierhofer C, Stokroos RJ. Tinnitus Suppression by Intracochlear Electrical Stimulation in Single Sided Deafness - A Prospective Clinical Trial: Follow-Up. PLoS One 2016; 11:e0153131. [PMID: 27111333 PMCID: PMC4844154 DOI: 10.1371/journal.pone.0153131] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 03/24/2016] [Indexed: 02/06/2023] Open
Abstract
Introduction Earlier studies show that a Cochlear Implant (CI), capable of providing intracochlear electrical stimulation independent of environmental sounds, appears to suppress tinnitus at least for minutes. The current main objective is to compare the long-term suppressive effects of looped (i.e. repeated) electrical stimulation (without environmental sound perception) with the standard stimulation pattern of a CI (with environmental sound perception). This could open new possibilities for the development of a “Tinnitus Implant” (TI), an intracochlear pulse generator for the suppression of tinnitus. Materials and Methods Ten patients with single sided deafness suffering from unilateral tinnitus in the deaf ear are fitted with a CI (MED-EL Corporation, Innsbruck, Austria). Stimulation patterns are optimized for each individual patient, after which they are compared using a randomized crossover design, with a follow-up of six months, followed by a 3 month period using the modality of patient’s choice. Results Results show that tinnitus can be suppressed with intracochlear electrical stimulation independent of environmental sounds, even long term. No significant difference in tinnitus suppression was found between the standard clinical CI and the TI. Conclusion It can be concluded that coding of environmental sounds is no requirement for tinnitus suppression with intracochlear electrical stimulation. It is therefore plausible that tinnitus suppression by CI is not solely caused by an attention shift from the tinnitus to environmental sounds. Both the standard clinical CI and the experimental TI are potential treatment options for tinnitus. These findings offer perspectives for a successful clinical application of the TI, possibly even in patients with significant residual hearing. Trial Registration TrialRegister.nl NTR3374
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Affiliation(s)
- Remo A. G. J. Arts
- Department of ENT/Head and Neck Surgery, Maastricht University Medical Center, MHeNS School for Mental Health and Neuroscience, Maastricht, the Netherlands
- * E-mail:
| | - Erwin L. J. George
- Department of ENT/Head and Neck Surgery, Maastricht University Medical Center, MHeNS School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Miranda Janssen
- Department of ENT/Head and Neck Surgery, Maastricht University Medical Center, MHeNS School for Mental Health and Neuroscience, Maastricht, the Netherlands
- Department of Methodology and Statistics, Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands
| | - Andreas Griessner
- Institute of Mechatronics, University of Innsbruck, Innsbruck, Austria
| | - Clemens Zierhofer
- Institute of Mechatronics, University of Innsbruck, Innsbruck, Austria
| | - Robert J. Stokroos
- Department of ENT/Head and Neck Surgery, Maastricht University Medical Center, MHeNS School for Mental Health and Neuroscience, Maastricht, the Netherlands
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Abstract
The cochlear implant became a very successful method of hearing rehabilitation for patients with profound sensorineural hearing loss. The benefits of the CI extend beyond the medical success and positively influence social and psychosocial areas, reflected by an improved HRQoL. Furthermore, variety of studies demonstrated that the tinnitus severity improves in 46-95 % of cases following the cochlear implantation. However, the parameters investigated in such studies are not always standardized or addressed by validated questionnaires, which explains the high outcome variation between the studies. The relationships between HRQoL and tinnitus distress before and after cochlear implantation have not been well studied. Nevertheless, it is believed that the improvement in HRQoL following CI affects particularly tinnitus.However, an existing tinnitus can also worsen or occur for the first time after the surgery. Since neither tinnitus frequency nor tinnitus loudness correlate with the tinnitus-induced distress, the measurement of HRQoL, distress factors, stress reactions and psychiatric comorbidities appears to be the meaningful assessment of positive or negative effects of CI on tinnitus.Initial studies demonstrated that also patients with unilateral hearing loss may benefit from CI supply, as shown by an improvement in HRQoL and reduction of tinnitus-induced distress. For those patients, who despite CI implantation experience severe tinnitus, there is an option of tinnitus-specific CI-fitting and tinnitus-specific therapy with psychosomatic and psychological approaches, and- in addition- a treatment of possible mental comorbidities.
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Arts R, Netz T, Janssen A, George E, Stokroos R. The occurrence of tinnitus after CI surgery in patients with severe hearing loss: A retrospective study. Int J Audiol 2015; 54:910-7. [DOI: 10.3109/14992027.2015.1079930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Arts RAGJ, George ELJ, Griessner A, Zierhofer C, Stokroos RJ. Tinnitus Suppression by Intracochlear Electrical Stimulation in Single-Sided Deafness: A Prospective Clinical Trial - Part I. Audiol Neurootol 2015; 20:294-313. [PMID: 26227468 DOI: 10.1159/000381936] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/28/2015] [Indexed: 11/19/2022] Open
Abstract
Cochlear implantation is a viable treatment option for tinnitus, but the underlying mechanism is yet unclear. Is the tinnitus suppression due to the reversal of the assumed maladaptive neuroplasticity or is it the shift in attention from the tinnitus to environmental sounds and therefore a reduced awareness that reduces tinnitus perception? In this prospective trial, 10 patients with single-sided deafness were fitted with a cochlear implant to investigate the effect of looped intracochlear electrical stimulation (i.e. stimulation that does not encode environmental sounds) on tinnitus, in an effort to find optimal stimulation parameters. Variables under investigation were: amplitude (perceived stimulus loudness), anatomical location inside the cochlea (electrode/electrodes), amplitude modulation, polarity (cathodic/anodic first biphasic stimulation) and stimulation rate. The results suggest that tinnitus can be reduced with looped electrical stimulation, in some cases even with inaudible stimuli. The optimal stimuli for tinnitus suppression appear to be subject specific. However, medium-to-loud stimuli suppress tinnitus significantly better than soft stimuli, which partly can be explained by the masking effect. Although the long-term effects on tinnitus would still have to be investigated and will be described in part II, intracochlear electrical stimulation seems a potential treatment option for tinnitus in this population.
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Affiliation(s)
- Remo A G J Arts
- Department of ENT/Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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23
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Eggermont JJ, Roberts LE. Tinnitus: animal models and findings in humans. Cell Tissue Res 2015; 361:311-36. [PMID: 25266340 PMCID: PMC4487353 DOI: 10.1007/s00441-014-1992-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/14/2014] [Indexed: 12/19/2022]
Abstract
Chronic tinnitus (ringing of the ears) is a medically untreatable condition that reduces quality of life for millions of individuals worldwide. Most cases are associated with hearing loss that may be detected by the audiogram or by more sensitive measures. Converging evidence from animal models and studies of human tinnitus sufferers indicates that, while cochlear damage is a trigger, most cases of tinnitus are not generated by irritative processes persisting in the cochlea but by changes that take place in central auditory pathways when auditory neurons lose their input from the ear. Forms of neural plasticity underlie these neural changes, which include increased spontaneous activity and neural gain in deafferented central auditory structures, increased synchronous activity in these structures, alterations in the tonotopic organization of auditory cortex, and changes in network behavior in nonauditory brain regions detected by functional imaging of individuals with tinnitus and corroborated by animal investigations. Research on the molecular mechanisms that underlie neural changes in tinnitus is in its infancy and represents a frontier for investigation.
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Affiliation(s)
- Jos J Eggermont
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, and Department of Psychology, University of Calgary, 2500 University Drive N.W, Calgary, AB, Canada,
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Han L, Zhaohui L, Fei Y, Pengfei Z, Ting L, Cheng D, Zhenchang W. Disrupted neural activity in unilateral vascular pulsatile tinnitus patients in the early stage of disease: evidence from resting-state fMRI. Prog Neuropsychopharmacol Biol Psychiatry 2015; 59:91-99. [PMID: 25645870 DOI: 10.1016/j.pnpbp.2015.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 02/07/2023]
Abstract
Numerous studies have shown that neurological changes are important findings of tinnitus patients. Previous studies on tinnitus have indicated that patients with pulsatile tinnitus (PT) often show altered baseline brain activity in the resting state. This study used resting-state functional magnetic resonance imaging (rs-fMRI) to investigate changes in spontaneous brain activity among patients with unilateral pulsatile tinnitus in the early stage of disease (less than forty-eight months) and determined the relationship of these changes with clinical data. The PT patients (n=34) and matched normal control subjects (n=34) were enrolled in this study. Spontaneous brain activity was revealed by the regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) values. Compared with normal controls, the patients with PT had significantly increased ReHo and ALFF in the posterior cingulate cortex, right inferior parietal lobule (IPL) and right cerebellum posterior lobe. The PT group showed increased ReHo in the posterior cingulate cortex (PCC), precuneus, right IPL, right superior frontal gyrus, some occipital areas and part of the right cerebellum posterior lobe. For ALFF, the increased clusters were in the PCC and precuneus and in some areas of the cerebellum posterior lobe, bilateral IPL and inferior frontal gyrus (IFG). Increased PT duration was correlated with increased ALFF in the bilateral inferior frontal gyrus (IFG) and precuneus. An increased THI score was correlated with ReHo and ALFF values in the precuneus. Taken together, the combined study of ReHo and ALFF measurements may yield a more comprehensive neurological pathophysiology framework for PT patients in the early stage of the disease.
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Affiliation(s)
- Lv Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Liu Zhaohui
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yan Fei
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zhao Pengfei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Li Ting
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Dong Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wang Zhenchang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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25
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Evidence for differential modulation of primary and nonprimary auditory cortex by forward masking in tinnitus. Hear Res 2015; 327:9-27. [PMID: 25937134 DOI: 10.1016/j.heares.2015.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 04/07/2015] [Accepted: 04/10/2015] [Indexed: 11/21/2022]
Abstract
It has been proposed that tinnitus is generated by aberrant neural activity that develops among neurons in tonotopic of regions of primary auditory cortex (A1) affected by hearing loss, which is also the frequency region where tinnitus percepts localize (Eggermont and Roberts 2004; Roberts et al., 2010, 2013). These models suggest (1) that differences between tinnitus and control groups of similar age and audiometric function should depend on whether A1 is probed in tinnitus frequency region (TFR) or below it, and (2) that brain responses evoked from A1 should track changes in the tinnitus percept when residual inhibition (RI) is induced by forward masking. We tested these predictions by measuring (128-channel EEG) the sound-evoked 40-Hz auditory steady-state response (ASSR) known to localize tonotopically to neural sources in A1. For comparison the N1 transient response localizing to distributed neural sources in nonprimary cortex (A2) was also studied. When tested under baseline conditions where tinnitus subjects would have heard their tinnitus, ASSR responses were larger in a tinnitus group than in controls when evoked by 500 Hz probes while the reverse was true for tinnitus and control groups tested with 5 kHz probes, confirming frequency-dependent group differences in this measure. On subsequent trials where RI was induced by masking (narrow band noise centered at 5 kHz), ASSR amplitude increased in the tinnitus group probed at 5 kHz but not in the tinnitus group probed at 500 Hz. When collapsed into a single sample tinnitus subjects reporting comparatively greater RI depth and duration showed comparatively larger ASSR increases after masking regardless of probe frequency. Effects of masking on ASSR amplitude in the control groups were completely reversed from those in the tinnitus groups, with no change seen to 5 kHz probes but ASSR increases to 500 Hz probes even though the masking sound contained no energy at 500 Hz (an "off-frequency" masking effect). In contrast to these findings for the ASSR, N1 amplitude was larger in tinnitus than control groups at both probe frequencies under baseline conditions, decreased after masking in all conditions, and did not relate to RI. These results suggest that aberrant neural activity occurring in the TFR of A1 underlies tinnitus and its modulation during RI. They indicate further that while neural changes occur in A2 in tinnitus, these changes do not reflect the tinnitus percept. Models for tinnitus and forward masking are described that integrate these findings within a common framework.
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Sedley W, Gander PE, Kumar S, Oya H, Kovach CK, Nourski KV, Kawasaki H, Howard MA, Griffiths TD. Intracranial Mapping of a Cortical Tinnitus System using Residual Inhibition. Curr Biol 2015; 25:1208-14. [PMID: 25913402 PMCID: PMC4425458 DOI: 10.1016/j.cub.2015.02.075] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/10/2015] [Accepted: 02/27/2015] [Indexed: 11/26/2022]
Abstract
Tinnitus can occur when damage to the peripheral auditory system leads to spontaneous brain activity that is interpreted as sound [1, 2]. Many abnormalities of brain activity are associated with tinnitus, but it is unclear how these relate to the phantom sound itself, as opposed to predisposing factors or secondary consequences [3]. Demonstrating “core” tinnitus correlates (processes that are both necessary and sufficient for tinnitus perception) requires high-precision recordings of neural activity combined with a behavioral paradigm in which the perception of tinnitus is manipulated and accurately reported by the subject. This has been previously impossible in animal and human research. Here we present extensive intracranial recordings from an awake, behaving tinnitus patient during short-term modifications in perceived tinnitus loudness after acoustic stimulation (residual inhibition) [4], permitting robust characterization of core tinnitus processes. As anticipated, we observed tinnitus-linked low-frequency (delta) oscillations [5–9], thought to be triggered by low-frequency bursting in the thalamus [10, 11]. Contrary to expectation, these delta changes extended far beyond circumscribed auditory cortical regions to encompass almost all of auditory cortex, plus large parts of temporal, parietal, sensorimotor, and limbic cortex. In discrete auditory, parahippocampal, and inferior parietal “hub” regions [12], these delta oscillations interacted with middle-frequency (alpha) and high-frequency (beta and gamma) activity, resulting in a coherent system of tightly coupled oscillations associated with high-level functions including memory and perception. Extensive intracranial recordings were made from an awake, behaving tinnitus patient Tinnitus intensity was modulated with tight control over other factors Tinnitus is linked to widespread coherent delta-band cortical oscillations Rich local cross-frequency interactions link delta to all other frequency bands
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Affiliation(s)
- William Sedley
- Human Brain Research Laboratory, Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA; Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, Tyne and Wear NE2 4HH, UK.
| | - Phillip E Gander
- Human Brain Research Laboratory, Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA.
| | - Sukhbinder Kumar
- Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, Tyne and Wear NE2 4HH, UK; Wellcome Trust Centre for Neuroimaging, University College London, London WC1N 3BG, UK
| | - Hiroyuki Oya
- Human Brain Research Laboratory, Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA
| | - Christopher K Kovach
- Human Brain Research Laboratory, Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA
| | - Kirill V Nourski
- Human Brain Research Laboratory, Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA
| | - Hiroto Kawasaki
- Human Brain Research Laboratory, Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA
| | - Matthew A Howard
- Human Brain Research Laboratory, Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA
| | - Timothy D Griffiths
- Human Brain Research Laboratory, Department of Neurosurgery, The University of Iowa, Iowa City, IA 52242, USA; Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, Tyne and Wear NE2 4HH, UK; Wellcome Trust Centre for Neuroimaging, University College London, London WC1N 3BG, UK
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Vanneste S, Van De Heyning P, De Ridder D. Tinnitus: a large VBM-EEG correlational study. PLoS One 2015; 10:e0115122. [PMID: 25781934 PMCID: PMC4364116 DOI: 10.1371/journal.pone.0115122] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/18/2014] [Indexed: 11/29/2022] Open
Abstract
A surprising fact in voxel-based morphometry (VBM) studies performed in tinnitus is that not one single region is replicated in studies of different centers. The question then rises whether this is related to the low sample size of these studies, the selection of non-representative patient subgroups, or the absence of stratification according to clinical characteristics. Another possibility is that VBM is not a good tool to study functional pathologies such as tinnitus, in contrast to pathologies like Alzheimer's disease where it is known the pathology is related to cell loss. In a large sample of 154 tinnitus patients VBM and QEEG (Quantitative Electroencephalography) was performed and evaluated by a regression analysis. Correlation analyses are performed between VBM and QEEG data. Uncorrected data demonstrated structural differences in grey matter in hippocampal and cerebellar areas related to tinnitus related distress and tinnitus duration. After control for multiple comparisons, only cerebellar VBM changes remain significantly altered. Electrophysiological differences are related to distress, tinnitus intensity, and tinnitus duration in the subgenual anterior cingulate cortex, dorsal anterior cingulate cortex, hippocampus, and parahippocampus, which confirms previous results. The absence of QEEG-VBM correlations suggest functional changes are not reflected by co-occurring structural changes in tinnitus, and the absence of VBM changes (except for the cerebellum) that survive correct statistical analysis in a large study population suggests that VBM might not be very sensitive for studying tinnitus.
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Affiliation(s)
- Sven Vanneste
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
- School for Behavioral & Brain Sciences, University of Texas at Dallas, Dallas, Texas, United States of America
| | - Paul Van De Heyning
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
- ENT Department, University Hospital Antwerp, Antwerp, Belgium
| | - Dirk De Ridder
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Deep brain stimulation in tinnitus: current and future perspectives. Brain Res 2015; 1608:51-65. [PMID: 25758066 DOI: 10.1016/j.brainres.2015.02.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/22/2022]
Abstract
Chronic tinnitus, also known as ringing in the ears, affects up to 15% of the adults and causes a serious socio-economic burden. At present, there is no treatment available which substantially reduces the perception of this phantom sound. In the past few years, preclinical and clinical studies have unraveled central mechanisms involved in the pathophysiology of tinnitus, replacing the classical periphery-based hypothesis. In subcortical auditory and non-auditory regions, increased spontaneous activity, neuronal bursting and synchrony were found. When reaching the auditory cortex, these neuronal alterations become perceptually relevant and consequently are perceived as phantom sound. A therapy with a potential to counteract deeply located pathological activity is deep brain stimulation, which has already been demonstrated to be effective in neurological diseases such as Parkinson's disease. In this review, several brain targets are discussed as possible targets for deep brain stimulation in tinnitus. The potential applicability of this treatment in tinnitus is discussed with examples from the preclinical field and clinical case studies.
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Offutt SJ, Ryan KJ, Konop AE, Lim HH. Suppression and facilitation of auditory neurons through coordinated acoustic and midbrain stimulation: investigating a deep brain stimulator for tinnitus. J Neural Eng 2014; 11:066001. [PMID: 25307351 PMCID: PMC4244264 DOI: 10.1088/1741-2560/11/6/066001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The inferior colliculus (IC) is the primary processing center of auditory information in the midbrain and is one site of tinnitus-related activity. One potential option for suppressing the tinnitus percept is through deep brain stimulation via the auditory midbrain implant (AMI), which is designed for hearing restoration and is already being implanted in deaf patients who also have tinnitus. However, to assess the feasibility of AMI stimulation for tinnitus treatment we first need to characterize the functional connectivity within the IC. Previous studies have suggested modulatory projections from the dorsal cortex of the IC (ICD) to the central nucleus of the IC (ICC), though the functional properties of these projections need to be determined. APPROACH In this study, we investigated the effects of electrical stimulation of the ICD on acoustic-driven activity within the ICC in ketamine-anesthetized guinea pigs. MAIN RESULTS We observed ICD stimulation induces both suppressive and facilitatory changes across ICC that can occur immediately during stimulation and remain after stimulation. Additionally, ICD stimulation paired with broadband noise stimulation at a specific delay can induce greater suppressive than facilitatory effects, especially when stimulating in more rostral and medial ICD locations. SIGNIFICANCE These findings demonstrate that ICD stimulation can induce specific types of plastic changes in ICC activity, which may be relevant for treating tinnitus. By using the AMI with electrode sites positioned with the ICD and the ICC, the modulatory effects of ICD stimulation can be tested directly in tinnitus patients.
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Affiliation(s)
- Sarah J. Offutt
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Kellie J. Ryan
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Alexander E. Konop
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Hubert H. Lim
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
- Institute for Translational Neuroscience, University of Minnesota, Minneapolis, USA
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, USA
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Boyen K, de Kleine E, van Dijk P, Langers DR. Tinnitus-related dissociation between cortical and subcortical neural activity in humans with mild to moderate sensorineural hearing loss. Hear Res 2014; 312:48-59. [DOI: 10.1016/j.heares.2014.03.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/21/2014] [Accepted: 03/04/2014] [Indexed: 01/17/2023]
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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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Kumar S, Sedley W, Barnes GR, Teki S, Friston KJ, Griffiths TD. A brain basis for musical hallucinations. Cortex 2013; 52:86-97. [PMID: 24445167 PMCID: PMC3969291 DOI: 10.1016/j.cortex.2013.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/05/2013] [Accepted: 12/06/2013] [Indexed: 01/22/2023]
Abstract
The physiological basis for musical hallucinations (MH) is not understood. One obstacle to understanding has been the lack of a method to manipulate the intensity of hallucination during the course of experiment. Residual inhibition, transient suppression of a phantom percept after the offset of a masking stimulus, has been used in the study of tinnitus. We report here a human subject whose MH were residually inhibited by short periods of music. Magnetoencephalography (MEG) allowed us to examine variation in the underlying oscillatory brain activity in different states. Source-space analysis capable of single-subject inference defined left-lateralised power increases, associated with stronger hallucinations, in the gamma band in left anterior superior temporal gyrus, and in the beta band in motor cortex and posteromedial cortex. The data indicate that these areas form a crucial network in the generation of MH, and are consistent with a model in which MH are generated by persistent reciprocal communication in a predictive coding hierarchy.
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Affiliation(s)
- Sukhbinder Kumar
- Institute of Neuroscience, Medical School, Newcastle University, Newcastle upon Tyne, UK; Wellcome Trust Centre for Neuroimaging, London, UK.
| | - William Sedley
- Institute of Neuroscience, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | | | - Sundeep Teki
- Wellcome Trust Centre for Neuroimaging, London, UK
| | | | - Timothy D Griffiths
- Institute of Neuroscience, Medical School, Newcastle University, Newcastle upon Tyne, UK; Wellcome Trust Centre for Neuroimaging, London, UK
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Bauer CA, Wisner KW, Baizer JS, Brozoski TJ. Tinnitus, unipolar brush cells, and cerebellar glutamatergic function in an animal model. PLoS One 2013; 8:e64726. [PMID: 23785405 PMCID: PMC3681784 DOI: 10.1371/journal.pone.0064726] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/17/2013] [Indexed: 11/18/2022] Open
Abstract
Unipolar brush cells (UBCs) are excitatory interneurons found in the dorsal cochlear nucleus (DCN) and the granule cell layer of cerebellar cortex, being particularly evident in the paraflocculus (PFL) and flocculus (FL). UBCs receive glutamatergic inputs and make glutamatergic synapses with granule cells and other UBCs. It has been hypothesized that UBCs comprise local networks of tunable feed-forward amplifiers. In the DCN they might also participate in feed-back amplification of signals from higher auditory centers. Recently it has been shown that UBCs, in the vestibulocerebellum and DCN of adult rats, express doublecortin (DCX), previously considered a marker of newborn and migrating neurons. In an animal model, both the DCN, and more recently the PFL, have been implicated in contributing to the sensation of acoustic-exposure-induced tinnitus. These studies support the working hypothesis that tinnitus emerges after loss of peripheral sensitivity because inhibitory processes homeostatically down regulate, and excitatory processes up regulate. Here we report the results of two sequential experiments that examine the potential role of DCN and cerebellar UBCs in tinnitus, and the contribution of glutamatergic transmission in the PFL. In Experiment 1 it was shown that adult rats with psychophysical evidence of tinnitus induced by a single unilateral high-level noise exposure, had elevated DCX in the DCN and ventral PFL. In Experiment 2 it was shown that micro-quantities of glutamatergic antagonists, delivered directly to the PFL, reversibly reduced chronically established tinnitus, while similarly applied glutamatergic agonists induced tinnitus-like behavior in non-tinnitus controls. These results are consistent with the hypothesis that UBC up regulation and enhanced glutamatergic transmission in the cerebellum contribute to the pathophysiology of tinnitus.
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Affiliation(s)
- Carol A. Bauer
- Department of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Kurt W. Wisner
- Department of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
| | - Joan S. Baizer
- Department of Physiology and Biophysics, University at Buffalo, Buffalo, New York, United States of America
| | - Thomas J. Brozoski
- Department of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois, United States of America
- * E-mail:
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Maudoux A, Lefebvre P, Cabay JE, Demertzi A, Vanhaudenhuyse A, Laureys S, Soddu A. Auditory resting-state network connectivity in tinnitus: a functional MRI study. PLoS One 2012; 7:e36222. [PMID: 22574141 PMCID: PMC3344851 DOI: 10.1371/journal.pone.0036222] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 04/02/2012] [Indexed: 11/18/2022] Open
Abstract
The underlying functional neuroanatomy of tinnitus remains poorly understood. Few studies have focused on functional cerebral connectivity changes in tinnitus patients. The aim of this study was to test if functional MRI “resting-state” connectivity patterns in auditory network differ between tinnitus patients and normal controls. Thirteen chronic tinnitus subjects and fifteen age-matched healthy controls were studied on a 3 tesla MRI. Connectivity was investigated using independent component analysis and an automated component selection approach taking into account the spatial and temporal properties of each component. Connectivity in extra-auditory regions such as brainstem, basal ganglia/NAc, cerebellum, parahippocampal, right prefrontal, parietal, and sensorimotor areas was found to be increased in tinnitus subjects. The right primary auditory cortex, left prefrontal, left fusiform gyrus, and bilateral occipital regions showed a decreased connectivity in tinnitus. These results show that there is a modification of cortical and subcortical functional connectivity in tinnitus encompassing attentional, mnemonic, and emotional networks. Our data corroborate the hypothesized implication of non-auditory regions in tinnitus physiopathology and suggest that various regions of the brain seem involved in the persistent awareness of the phenomenon as well as in the development of the associated distress leading to disabling chronic tinnitus.
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Affiliation(s)
- Audrey Maudoux
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
- OtoRhinoLaryngology Head and Neck Surgery Department, University of Liège, Liège, Belgium
- * E-mail: (AM); (AS)
| | - Philippe Lefebvre
- OtoRhinoLaryngology Head and Neck Surgery Department, University of Liège, Liège, Belgium
| | - Jean-Evrard Cabay
- Radiology Department, CHU Sart Tilman Hospital, University of Liège, Liège, Belgium
| | - Athena Demertzi
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
| | | | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
- Neurology Department, CHU Sart Tilman Hospital, University of Liège, Liège, Belgium
| | - Andrea Soddu
- Coma Science Group, Cyclotron Research Centre, University of Liège, Liège, Belgium
- * E-mail: (AM); (AS)
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Kompis M, Pelizzone M, Dillier N, Allum J, DeMin N, Senn P. Tinnitus before and 6 Months after Cochlear Implantation. ACTA ACUST UNITED AC 2012; 17:161-8. [DOI: 10.1159/000335126] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/15/2011] [Indexed: 11/19/2022]
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Olze H, Szczepek AJ, Haupt H, Zirke N, Graebel S, Mazurek B. The Impact of Cochlear Implantation on Tinnitus, Stress and Quality of Life in Postlingually Deafened Patients. ACTA ACUST UNITED AC 2012; 17:2-11. [PMID: 21540584 DOI: 10.1159/000323847] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 12/15/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Heidi Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Mahoney CJ, Rohrer JD, Goll JC, Fox NC, Rossor MN, Warren JD. Structural neuroanatomy of tinnitus and hyperacusis in semantic dementia. J Neurol Neurosurg Psychiatry 2011; 82:1274-8. [PMID: 21531705 PMCID: PMC3188784 DOI: 10.1136/jnnp.2010.235473] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Tinnitus and hyperacusis are common symptoms of excessive auditory perception in the general population; however, their anatomical substrates and disease associations continue to be defined. PATIENTS with semantic dementia (SemD) frequently report tinnitus and hyperacusis but the significance and basis for these symptoms have not been elucidated. METHODS 43 patients with a diagnosis of SemD attending a specialist cognitive disorders clinic were retrospectively studied. 14 patients (32% of the cohort) reported at least moderately severe chronic auditory symptoms: seven had tinnitus and a further seven had hyperacusis, and all had brain MRI while symptomatic. MRI data from SemD patients with and without auditory symptoms were compared using voxel based morphometry in order to identify neuroanatomical associations of tinnitus and hyperacusis. RESULTS Compared with SemD patients with no history of auditory symptoms, patients with tinnitus or hyperacusis had relative preservation of grey matter in the posterior superior temporal lobe and reduced grey matter in the orbitofrontal cortex and medial geniculate nucleus. CONCLUSIONS Tinnitus and hyperacusis may be a significant issue in SemD. Neuroanatomical evidence in SemD supports previous work implicating a distributed cortico-subcortical auditory and limbic network in the pathogenesis of these abnormal auditory percepts.
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Affiliation(s)
- Colin J Mahoney
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
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Zeng FG, Tang Q, Dimitrijevic A, Starr A, Larky J, Blevins NH. Tinnitus suppression by low-rate electric stimulation and its electrophysiological mechanisms. Hear Res 2011; 277:61-6. [PMID: 21447376 DOI: 10.1016/j.heares.2011.03.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 02/17/2011] [Accepted: 03/16/2011] [Indexed: 12/16/2022]
Abstract
Tinnitus is a phantom sensation of sound in the absence of external stimulation. However, external stimulation, particularly electric stimulation via a cochlear implant, has been shown to suppress tinnitus. Different from traditional methods of delivering speech sounds or high-rate (>2000 Hz) stimulation, the present study found a unique unilaterally-deafened cochlear implant subject whose tinnitus was completely suppressed by a low-rate (<100 Hz) stimulus, delivered at a level softer than tinnitus to the apical part of the cochlea. Taking advantage of this novel finding, the present study compared both event-related and spontaneous cortical activities in the same subject between the tinnitus-present and tinnitus-suppressed states. Compared with the results obtained in the tinnitus-present state, the low-rate stimulus reduced cortical N100 potentials while increasing the spontaneous alpha power in the auditory cortex. These results are consistent with previous neurophysiological studies employing subjects with and without tinnitus and shed light on both tinnitus mechanism and treatment.
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Affiliation(s)
- Fan-Gang Zeng
- Department of Otolaryngology-Head and Neck Surgery, 110 Medical Science E, University of California, Irvine, CA 92697-5320, USA.
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Masgoret Palau E, Merán Gil JL, Moreno Vidal C, Falcón González JC, Artiles Cabrera O, Ramos Macías Á. Acúfeno e implante coclear. Experiencia preliminar. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:405-11. [DOI: 10.1016/j.otorri.2010.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 07/02/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
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Hörgeräte, implantierbare Hörgeräte und Cochlear implants in der Therapie des chronischen Tinnitus. HNO 2010; 58:1004-12. [DOI: 10.1007/s00106-010-2181-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Langguth B, Kleinjung T, Landgrebe M, de Ridder D, Hajak G. rTMS for the treatment of tinnitus: The role of neuronavigation for coil positioning. Neurophysiol Clin 2010; 40:45-58. [DOI: 10.1016/j.neucli.2009.03.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 03/08/2009] [Indexed: 12/30/2022] Open
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Masgoret Palau E, Merán Gil JL, Moreno Vidal C, Falcón González JC, Artiles Cabrera O, Ramos Macías Á. Tinnitus and cochlear implantation. Preliminary experience. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lanting C, de Kleine E, van Dijk P. Neural activity underlying tinnitus generation: Results from PET and fMRI. Hear Res 2009; 255:1-13. [PMID: 19545617 DOI: 10.1016/j.heares.2009.06.009] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 06/15/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
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Adjamian P, Sereda M, Hall DA. The mechanisms of tinnitus: perspectives from human functional neuroimaging. Hear Res 2009; 253:15-31. [PMID: 19364527 DOI: 10.1016/j.heares.2009.04.001] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/02/2009] [Accepted: 04/05/2009] [Indexed: 10/20/2022]
Abstract
In this review, we highlight the contribution of advances in human neuroimaging to the current understanding of central mechanisms underpinning tinnitus and explain how interpretations of neuroimaging data have been guided by animal models. The primary motivation for studying the neural substrates of tinnitus in humans has been to demonstrate objectively its representation in the central auditory system and to develop a better understanding of its diverse pathophysiology and of the functional interplay between sensory, cognitive and affective systems. The ultimate goal of neuroimaging is to identify subtypes of tinnitus in order to better inform treatment strategies. The three neural mechanisms considered in this review may provide a basis for TI classification. While human neuroimaging evidence strongly implicates the central auditory system and emotional centres in TI, evidence for the precise contribution from the three mechanisms is unclear because the data are somewhat inconsistent. We consider a number of methodological issues limiting the field of human neuroimaging and recommend approaches to overcome potential inconsistency in results arising from poorly matched participants, lack of appropriate controls and low statistical power.
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Affiliation(s)
- Peyman Adjamian
- MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, United Kingdom.
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Ito M, Soma K, Ando R. Association between tinnitus retraining therapy and a tinnitus control instrument. Auris Nasus Larynx 2009; 36:536-40. [PMID: 19269119 DOI: 10.1016/j.anl.2009.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 01/21/2009] [Accepted: 01/21/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Tinnitus retraining therapy (TRT), which is an adaptation therapy for tinnitus based on the neurophysiological model proposed by Jastreboff in 1990,consists of directive counseling and acoustic therapy with a tinnitus control instrument (TCI) or other devices. For the past 5 years, our hospital has administered TRT characterized by the use of a TCI. METHOD In this study, we reviewed the clinical course of patients with tinnitus who presented to our outpatient clinic for tinnitus and hearing loss during the 3-year period from April 2004 to March 2007 and underwent TRT with a TCI. Among 188 patients with tinnitus (105 males and 83 females), 88 patients (51 males and 37 females, excluding dropouts) who purchased a TCI and continued therapy were included in the study. RESULTS Significant improvement in Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. Among the noises generated by the TCI, the sound pressure output from the TCI was set at just below tinnitus loudness level both of the first adjustment and the second adjustment. Speech noise and white noise were frequently selected, whereas high-frequency noise and pink noise were infrequently selected. Speech noise was most frequently selected at the first adjustment, and the number of patients selecting white noise increased at the second adjustment. The results that we compared the two also revealed that the mean hearing level and tinnitus loudness levels were higher in the white noise group than in the speech noise group, which suggested that the inner ear disorder was more harder in the white noise group. Both the THI score and VAS grade improved after 1 month of treatment in the speech noise group, whereas improvement in these parameters was observed in the white noise group after 6 months of treatment. These results suggest that it took much longer the patients in the white noise group to improve. CONCLUSION : Significant improvement in THI and VAS scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. It resulted that many patients chose the speech noise or the white noise. And also it was indicated that noise generators set at just below mixing point with tinnitus are more effective. In this study, however, speech noise was often selected probably because of the reduced output at high frequencies and the level of comfort. As white noise produces greater sound volume, patients tended to switch from other therapeutic sound to white noise at the second adjustment. These findings may help administer acoustic therapy in the future.
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Affiliation(s)
- Mari Ito
- Department of Otolaryngology, Nippon Kokan Hospital and Kokan Clinic, Kokan-tori, Kawasaki-ku, Kawasaki, Japan.
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Takao T, Tsujimura A, Miyagawa Y, Kiuchi H, Ueda T, Hirai T, Komori K, Takada S, Nonomura N, Osaki Y, Enomoto K, Hatazawa J, Okuyama A. Brain responses during the first desire to void: a positron emission tomography study. Int J Urol 2008; 15:724-8. [PMID: 18522679 DOI: 10.1111/j.1442-2042.2008.02076.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES First desire to void (FDV) is defined as the first feeling that would lead the patient to pass urine. The aim of the present study is to identify the brain regions activated during FDV. METHODS Six healthy right-handed male volunteers, aged 31-40 years, agreed to participate in this study. Rather than inserting a urethral catheter, we used a urinary volume monitoring unit and a self-adhesive external condom catheter for this study. Positron emission tomography (PET) scans obtained in the FDV and post-voiding (absence of urge to void) (REST) states were analyzed and compared. RESULTS First desire to void state was associated with increased blood flow in the right and left cerebellum, right parahippocampal gyrus (Brodmann area [BA] 30), left superior frontal gyrus (BA9), and left cingulate gyrus (BA32). Rest state was associated with decreased blood flow in the right superior temporal gyrus (BA22), right uncus (BA28), right cingulate gyrus (BA32), left middle temporal gyrus (BA21), and left medial frontal gyrus (BA25). According to region of interest analysis, regional cerebral blood flow of the periaqueductal grey and pons was significantly increased at FDV as opposed to REST. CONCLUSIONS We located possible brain activity associated with the FDV sensation. Combined activation of the right and left cerebellum, parahippocampal gyrus, superior frontal gyrus, and left cingulate gyrus could be associated with FDV.
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Affiliation(s)
- Tetsuya Takao
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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Quaranta N, Fernandez-Vega S, D'elia C, Filipo R, Quaranta A. The effect of unilateral multichannel cochlear implant on bilaterally perceived tinnitus. Acta Otolaryngol 2008; 128:159-63. [PMID: 17851950 DOI: 10.1080/00016480701387173] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSIONS Available multichannel cochlear implants (CIs) provide effective tinnitus suppression. More sophisticated speech strategies are more effective than analogue or slow strategies. The mechanisms by which tinnitus is suppressed by CIs are unclear; however, both acoustic masking and reorganization of the right auditory association cortex induced by the CI are possible mechanisms. CI significantly reduced the tinnitus-related Handicap as assessed by the Tinnitus handicap Inventory (THI). OBJECTIVE The objective of the study was to evaluate the effects of a unilateral CI on bilaterally perceived tinnitus. PATIENTS AND METHODS Forty-one profoundly deaf patients implanted with a multichannel CI reporting bilateral tinnitus were evaluated. All patients were asked to complete a questionnaire that evaluated the presence, location and intensity of tinnitus before and after cochlear implantation. RESULTS Seven patients (17%) reported the perception of a 'new tinnitus' after surgery. With the CI off tinnitus was abolished in 23 patients (56.1%) in the implanted ear and in 22 patients (53.6%) in the contralateral ear. With the CI on tinnitus was abolished in the ipsilateral ear in 27 patients (65.8%) and in the contralateral ear in 27 patients (65.8%). Statistical analysis showed a significant reduction of the total THI score and of each subscale score (p < 0.001).
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Affiliation(s)
- Nicola Quaranta
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy.
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Kahlbrock N, Weisz N. Transient reduction of tinnitus intensity is marked by concomitant reductions of delta band power. BMC Biol 2008; 6:4. [PMID: 18199318 PMCID: PMC2254377 DOI: 10.1186/1741-7007-6-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 01/16/2008] [Indexed: 12/04/2022] Open
Abstract
Background Tinnitus is an auditory phantom phenomenon characterized by the sensation of sounds without objectively identifiable sound sources. To date, its causes are not well understood. Previous research found altered patterns of spontaneous brain activity in chronic tinnitus sufferers compared to healthy controls, yet it is unknown whether these abnormal oscillatory patterns are causally related to the tinnitus sensation. Partial support for this notion comes from a neurofeedback approach developed by our group, in which significant reductions in tinnitus loudness could be achieved in patients who successfully normalized their patterns of spontaneous brain activity. The current work attempts to complement these studies by scrutinizing how modulations of tinnitus intensity alter ongoing oscillatory activity. Results In the present study the relation between tinnitus sensation and spontaneous brain activity was investigated using residual inhibition (RI) to reduce tinnitus intensity and source-space projected magnetencephalographic (MEG) data to index brain activity. RI is the sustained reduction (criteria: 50% for at least 30 s) in tinnitus loudness after cessation of a tonal tinnitus masker. A pilot study (n = 38) identified 10 patients who showed RI. A significant reduction of power in the delta (1.3–4.0 Hz) frequency band was observed in temporal regions during RI (p ≤ 0.001). Conclusion The current results suggest that changes of tinnitus intensity induced by RI are mediated by alterations in the pathological patterns of spontaneous brain activity, specifically a reduction of delta activity. Delta activity is a characteristic oscillatory activity generated by deafferented/deprived neuronal networks. This implies that RI effects might reflect the transient reestablishment of balance between excitatory and inhibitory neuronal assemblies, via reafferentation, that have been perturbed (in most tinnitus individuals) by hearing damage. As enhancements have been reported in the delta frequency band for tinnitus at rest, this result conforms to our assumption that a normalization of oscillatory properties of cortical networks is a prerequisite for attenuating the tinnitus sensation. For RI to have therapeutic significance however, this normalization would have to be stabilized.
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Affiliation(s)
- Nina Kahlbrock
- Department of Psychology, University of Konstanz, Konstanz, Germany.
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Laszig R, Chang SO, Kubo T, Ramos MA, Frijns JHM, Briggs R, Haynes DS. APSCI panel discussion I: imaging and surgical issues. Ear Hear 2007; 28:119S-123S. [PMID: 17496662 DOI: 10.1097/aud.0b013e318031548b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is a short overview on imaging techniques in pre-, peri- and postoperative evaluation of cochlear-implant patients. Surgery techniques are described as well as possible complications and how to avoid them.
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