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Succop B, Thompson NJ, Dedmon MM, Gelinne A, Selleck A, Reed S, Sindelar MBD. Noninvasive Treatment of Venous Pulsatile Tinnitus with an Internal Jugular Vein Compression Collar. Laryngoscope 2024; 134:3342-3348. [PMID: 38345081 DOI: 10.1002/lary.31326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/11/2023] [Accepted: 01/17/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE The study was conducted to evaluate the safety and efficacy of mild internal jugular (IJV) compression via an FDA approved compression collar for symptomatic treatment of venous pulsatile tinnitus. METHODS This is a prospective study that recruited 20 adult patients with venous pulsatile tinnitus. Participants completed the Tinnitus Handicap Inventory (THI), were fitted with the collar, and rated symptom intensity on a 10-point tinnitus intensity scale before and during collar use. Once weekly for 4 weeks, they answered a survey quantifying days used, average tinnitus intensity before and after wearing the collar each day of use, and any safety concerns. Lastly, they completed an exit interview. The primary outcome was symptomatic relief, with secondary outcomes of safety, effect of treatment setting, effect of time, and quality of life assessed via nonparametric testing. RESULTS 18 participants completed the study, and 276 paired daily before use/during use intensity scores were submitted. The median symptom intensity without the collar was 6 (IQR 4, 7), whereas with the collar it was 3 (IQR 2, 5), for a median symptomatic relief of 50%. The collar had a significant effect in reducing symptom intensity (p < 0.0001) and burden of illness via the THI (p < 0.0001). There was no effect of setting, frequency, or time on symptomatic relief with the collar. There were no adverse safety events reported aside from minor discomfort upon initial application. CONCLUSIONS Venous compression collars offer acute symptom relief for patients with venous pulsatile tinnitus. Further study is needed to assess safety and efficacy of longitudinal use. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3342-3348, 2024.
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Affiliation(s)
- Benjamin Succop
- Chapel Hill School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nicholas J Thompson
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew M Dedmon
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron Gelinne
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anne Selleck
- Chapel Hill Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samuel Reed
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Maj Brian D Sindelar
- Chapel Hill Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Shao N, Jiang S, Younger D, Chen T, Brown M, Rao KVR, Skotak M, Gan RZ, Chandra N. Central and peripheral auditory abnormalities in chinchilla animal model of blast-injury. Hear Res 2021; 407:108273. [PMID: 34139381 DOI: 10.1016/j.heares.2021.108273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
Exposure to blast overpressure or high-intensity sound can cause injuries to the auditory system, which leads to hearing loss or tinnitus. In this study, we examined the involvement of peripheral auditory system (PAS), and central auditory system (CAS) changes after exposure to blast overpressure (15-25 psi) on Day 1 and additionally during 7 days of post blast time period in chinchillas. Auditory brainstem response (ABR), distortion product otoacoustic emission (DPOAE), and cochlear hair cell changes were measured or identified in post-blast period within 7 days to detect injuries in the PAS. In the CAS, changes in NMDAR1 (excitatory receptor) and GABAA (inhibitory receptor) as well as changes in serotonin (5-HT2A) and acetylcholine (AChR) receptors were examined in different brain regions: auditory cortex (AC), geniculate body (GB), inferior colliculus (IC) and amygdala by immunofluorescence staining. We observed the PAS abnormalities of increased ABR threshold and decreased DPOAE response in animals after blast exposure with hearing protection devices (e.g., earplug). Blast exposure also caused a reduction in both NMDAR1 and GABAA receptor levels in acute condition (post-blast or Day 1) in AC and IC, while serotonin and acetylcholine receptor levels displayed a biphasic response at Day 1 and Day 7 post-exposure. Results demonstrate that the earplug can protect the tympanic membrane and middle ear against structural damage, but the hearing level, cochlear outer hair cell, and the central auditory system (levels of excitatory and inhibitory neurotransmitter receptors) were only partially protected at the tested blast overpressure level. The findings in this study indicate that blast exposure can cause both peripheral and central auditory dysfunctions, and the central auditory response is independent of peripheral auditory damage. The CAS dysfunction is likely mediated by direct transmission of shockwaves in all the regions of central nervous system (CNS), including nerves and surrounding tissues along the auditory pathways. Hence, targeting central auditory neurotransmitter abnormalities may have a therapeutic benefit to attenuate blast-induced hearing loss and tinnitus.
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Affiliation(s)
- Ningning Shao
- Center for Injury Biomechanics, Materials, and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States.
| | - Shangyuan Jiang
- School of Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, United States.
| | - Daniel Younger
- Center for Injury Biomechanics, Materials, and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States.
| | - Tao Chen
- School of Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, United States.
| | - Marcus Brown
- School of Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, United States.
| | - Kakulavarapu V Rama Rao
- Center for Injury Biomechanics, Materials, and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States.
| | - Maciej Skotak
- Center for Injury Biomechanics, Materials, and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States.
| | - Rong Z Gan
- School of Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, United States.
| | - Namas Chandra
- Center for Injury Biomechanics, Materials, and Medicine, Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States; Blast Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience (CMPN), Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States.
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Shin DH, Hooten KG, Sindelar BD, Corliss BM, Carlton WRY, Carroll CP, Tomlin JM, Fox WC. Direct enhancement of readiness for wartime critical specialties by civilian-military partnerships for neurosurgical care: residency training and beyond. Neurosurg Focus 2019; 45:E17. [PMID: 30544307 DOI: 10.3171/2018.8.focus18387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/28/2018] [Indexed: 11/06/2022]
Abstract
Military neurosurgery has played an integral role in the development and innovation of neurosurgery and neurocritical care in treating battlefield injuries. It is of paramount importance to continue to train and prepare the next generation of military neurosurgeons. For the Army, this is currently primarily achieved through the military neurosurgery residency at the National Capital Consortium and through full-time out-service positions at the Veterans Affairs-Department of Defense partnerships with the University of Florida, the University of Texas-San Antonio, and Baylor University. The authors describe the application process for military neurosurgery residency and highlight the training imparted to residents in a busy academic and level I trauma center at the University of Florida, with a focus on how case variety and volume at this particular civilian-partnered institution produces neurosurgeons who are prepared for the complexities of the battlefield. Further emphasis is also placed on collaboration for research as well as continuing education to maintain the skills of nondeployed neurosurgeons. With ongoing uncertainty regarding future conflict, it is critical to preserve and expand these civilian-military partnerships to maintain a standard level of readiness in order to face the unknown with the confidence befitting a military neurosurgeon.
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Affiliation(s)
- David H Shin
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Kristopher G Hooten
- 2Division of Neurosurgery, Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii; and
| | - Brian D Sindelar
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Brian M Corliss
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - William R Y Carlton
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | | | - Jeffrey M Tomlin
- 3Department of Neurological Surgery, Naval Medical Center, San Diego, California
| | - W Christopher Fox
- 1Department of Neurological Surgery, University of Florida, Gainesville, Florida
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Yuan W, Barber Foss KD, Dudley J, Thomas S, Galloway R, DiCesare C, Leach J, Scheifele P, Farina M, Valencia G, Smith D, Altaye M, Rhea CK, Talavage T, Myer GD. Impact of Low-Level Blast Exposure on Brain Function after a One-Day Tactile Training and the Ameliorating Effect of a Jugular Vein Compression Neck Collar Device. J Neurotrauma 2018; 36:721-734. [PMID: 30136637 DOI: 10.1089/neu.2018.5737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Special Weapons and Tactics (SWAT) personnel who conduct breacher exercises are at risk for blast-related head trauma. We aimed to investigate the potential impact of low-level blast exposure during breacher training on the neural functioning of working memory and auditory network connectivity. We also aimed to evaluate the effects of a jugular vein compression collar, designed to internally mitigate slosh energy absorption, preserving neural functioning and connectivity, following blast exposure. A total of 23 SWAT personnel were recruited and randomly assigned to a non-collar (n = 11) and collar group (n = 12). All participants completed a 1-day breacher training with multiple blast exposure. Prior to and following training, 18 participants (non-collar, n = 8; collar, n = 10) completed functional magnetic resonance imaging (fMRI) of working memory using N-Back task; 20 participants (non-collar, n = 10; collar, n = 12) completed resting-state fMRI. Key findings from the working memory analysis include significantly increased fMRI brain activation in the right insular, right superior temporal pole, right inferior frontal gyrus, and pars orbitalis post-training for the non-collar group (p < 0.05, threshold-free cluster enhancement corrected), but no changes were noted for the collar group. The elevation in fMRI activation in the non-collar group was found to correlate significantly (n = 7, r = 0.943, p = 0.001) with average peak impulse amplitude experienced during the training. In the resting-state fMRI analysis, significant pre- to post-training increase in connectivity between the auditory network and two discrete regions (left middle frontal gyrus and left superior lateral occipital/angular gyri) was found in the non-collar group, while no change was observed in the collar group. These data provided initial evidence of the impact of low-level blast on working memory and auditory network connectivity as well as the protective effect of collar on brain function following blast exposure, and is congruent with previous collar findings in sport-related traumatic brain injury.
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Affiliation(s)
- Weihong Yuan
- 1 Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,10 University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Kim D Barber Foss
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Jonathan Dudley
- 1 Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Staci Thomas
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Ryan Galloway
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Christopher DiCesare
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - James Leach
- 3 Division of Radiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,10 University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Pete Scheifele
- 4 Department of Communication Sciences and Disorders, University of Cincinnati , Ohio
| | - Megan Farina
- 4 Department of Communication Sciences and Disorders, University of Cincinnati , Ohio
| | - Gloria Valencia
- 4 Department of Communication Sciences and Disorders, University of Cincinnati , Ohio
| | - David Smith
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Mekibib Altaye
- 5 Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Christopher K Rhea
- 6 Department of Kinesiology, University of North Carolina at Greensboro , Greensboro, North Carolina
| | - Thomas Talavage
- 7 School of Electrical and Computer Engineering, Purdue University , West Lafayette, Indiana
| | - Gregory D Myer
- 2 The SPORT Center, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.,8 Departments of Pediatrics and Orthopedic Surgery, University of Cincinnati , Ohio.,9 The Micheli Center for Sports Injury Prevention , Waltham, Massachusetts
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Reduction in Temporary and Permanent Audiological Injury Through Internal Jugular Vein Compression in a Rodent Blast Injury Model. Otol Neurotol 2017; 38:1205-1212. [DOI: 10.1097/mao.0000000000001500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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