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Abouzari M, Abiri A, Tawk K, Tsang C, Patel B, Khoshsar A, Djalilian HR. White Matter Hyperintensity in Patients with Sudden Sensorineural Hearing Loss. Diagnostics (Basel) 2024; 14:1109. [PMID: 38893635 PMCID: PMC11171904 DOI: 10.3390/diagnostics14111109] [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: 04/09/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To compare white matter hyperintensities (WMHs) on T2-weighted magnetic resonance imaging (MRI) of patients with sudden sensorineural hearing loss (SSNHL) and analyze subpopulations with age-matched controls. METHODS T2-weighted MRI scans of 150 patients with SSNHL were assessed for WMHs and compared with the data of 148 healthy age-matched adults. Assessments of WMHs included independent grading of deep white matter hyperintensities (DWMHs) and periventricular hyperintensities (PVHs). WMH severity was visually rated using the Fazekas and Mirsen scales by two independent observers. RESULTS Fazekas grades for PVHs (p < 0.001) and DWMHs (p < 0.001) of SSNHL patients were found to be significantly greater than those of healthy participants. The average Mirsen grades for DWMHs of healthy and SSNHL patients were evaluated to be 0.373 ± 0.550 and 2.140 ± 0.859, respectively. Mirsen grades for DWMHs of SSNHL patients were found to be significantly greater (p < 0.001) than those of healthy participants. The Mirsen scale was found to have higher sensitivity (p < 0.001) than the Fazekas scale in grading PVHs and DWMHs. No significant difference (p = 0.24) was found in specificities between the two scales. CONCLUSIONS Patients with sudden hearing loss have a much higher likelihood of having periventricular and deep white matter hyperintensities compared to age-matched controls. These findings indicate that sudden hearing loss patients are more likely to have microvascular changes in the brain, which may indicate a vascular and/or migraine origin to sudden sensorineural hearing loss.
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Affiliation(s)
- Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Arash Abiri
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Karen Tawk
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Cynthia Tsang
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Beenish Patel
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Avissa Khoshsar
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92697, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
- Department of Neurological Surgery, University of California, Irvine, CA 92697, USA
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Ceriani CEJ. Beyond Vertigo: Vestibular, Aural, and Perceptual Symptoms in Vestibular Migraine. Curr Pain Headache Rep 2024:10.1007/s11916-024-01245-3. [PMID: 38780828 DOI: 10.1007/s11916-024-01245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo. RECENT FINDINGS Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.
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Affiliation(s)
- Claire E J Ceriani
- Department of Neurology, Jefferson Headache Center, Thomas Jefferson University, 900 Walnut St., Ste 200, Philadelphia, PA, 19107, USA.
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3
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Shin SH, Byun SW, Lee HY. Initial Response to Combination Therapies for Tinnitus: Lessons Learned From a Retrospective Analysis. Otol Neurotol 2024; 45:100-106. [PMID: 37853724 DOI: 10.1097/mao.0000000000004030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate the initial reduction of tinnitus effects by combining common therapies applicable in general otology clinics and establishing optimal treatment strategies. STUDY DESIGN Retrospective cohort study. SETTING A tertiary university hospital. PATIENTS Patients with nonpulsatile subjective tinnitus who visited the hospital between January and December 2022. INTERVENTIONS Combination therapies consisting of at least one of the directive counseling based on the neurophysiological model, hearing aids, medication, and/or neuromodulation were performed. MAIN OUTCOME MEASURES Tinnitus Handicap Inventory (THI) questionnaire at both their initial visit and 1-month follow-up. RESULTS A total of 151 patients were enrolled. THI improvement of 20 points or more was observed in 31.8% of participants. One-way analysis of variance revealed that counseling had a significant reduction in THI, whereas neuromodulation, medication, and hearing aids did not. THI improvement was significantly associated with received counseling, severity of initial THI, and mean loudness discomfort level. Hearing aids and neuromodulation were not significant prognostic factors for improvement. CONCLUSION Counseling alone is the best treatment for most patients with tinnitus. There will be other patients with tinnitus that, in addition to counseling, would benefit from hearing aids, medications, and/or certain forms of neuromodulation.
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Affiliation(s)
- Seung-Ho Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, Seoul, Korea
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Awad M, Abdalla I, Jara SM, Huang TC, Adams ME, Choi JS. Association of Sleep Characteristics with Tinnitus and Hearing Loss. OTO Open 2024; 8:e117. [PMID: 38420352 PMCID: PMC10900921 DOI: 10.1002/oto2.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/21/2024] [Indexed: 03/02/2024] Open
Abstract
Objective The impact of poor sleep on tinnitus has been mainly attributed to central processes. There is an association between sleep disorders and hearing loss, but whether hearing levels mediate the association between sleep disorders and tinnitus is unknown. This study investigates the association between sleep characteristics, tinnitus, and hearing loss. Study Design Cross-sectional. Setting National Health and Nutrition Examination Survey (NHANES). Methods Study cohort includes 9693 adults (≥20 years) from the NHANES 2005 to 2018 who completed audiometric testing and questionnaires on tinnitus and sleep characteristics. Multivariable regression analyses were performed to quantify associations between sleep characteristics, tinnitus, and hearing loss. Results In this cohort, 29% (95% confidence interval [CI]: 28%-31%) reported trouble sleeping and 9% (95% CI: 8%-10%) reported being diagnosed with sleep disorders. Negative sleep characteristics (less hours of sleep, diagnosis of a sleep disorder, trouble sleeping, or OSA symptoms) were not associated with audiometry-measured hearing loss in multivariable models adjusted for demographics and comorbidities but were significantly associated with bothersome tinnitus. This association remained significant without substantial attenuation in multivariable models additionally adjusting for hearing levels: sleeping <8 h/day (vs ≥8) (odds ratio [OR]: 1.28 [95% CI: 1.08-1.52]), trouble sleeping (OR: 1.78 [95% CI: 1.45-2.19]), diagnosis of sleep disorders (OR: 1.57 [95% CI: 1.14-2.15]), and report of OSA symptoms (OR: 1.42 [95% CI: 1.08-1.88]). Conclusion Negative sleep characteristics were associated with tinnitus while there was no clinically meaningful association between sleep and hearing loss. Our findings suggest that the relationship between poor sleep and tinnitus is likely contributed by central processes without a major role of mediation via the peripheral auditory system.
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Affiliation(s)
- Matthew Awad
- University of Minnesota School of Medicine Minneapolis Minnesota USA
| | - Ibrahim Abdalla
- University of Minnesota School of Medicine Minneapolis Minnesota USA
| | - Sebastian M Jara
- Caruso Department of Otolaryngology-Head & Neck Surgery University of Southern California Los Angeles California USA
| | - Tina C Huang
- Department of Otolaryngology-Head & Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Meredith E Adams
- Department of Otolaryngology-Head & Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Janet S Choi
- Caruso Department of Otolaryngology-Head & Neck Surgery University of Southern California Los Angeles California USA
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Campello CP, Lemos CAA, Andrade WTLD, Melo LPFD, Nunes GRDS, Cavalcanti HG. Migraine associated with tinnitus and hearing loss in adults: a systematic review. Int J Audiol 2024; 63:1-7. [PMID: 36459425 DOI: 10.1080/14992027.2022.2151943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 11/21/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To describe evidence of migraine-associated tinnitus and hearing loss. DESIGN This study was registered in PROSPERO and followed the PRISMA guidelines. The inclusion criteria were observational studies with subjects aged ≥18 years, in which the association between migraine and tinnitus and/or hearing loss was evaluated. Reviews, case reports, commentaries, letters to the editor, and studies that included individuals with some diseases were excluded. STUDY SAMPLE The search yielded 698 articles from electronic databases. Six studies were eligible for this review with 26,166 participants. RESULTS Most studies have shown an association between migraine and tinnitus, and between migraine and hearing loss. Studies have concluded that migraine presented high odds ratio, and hazard ratio for tinnitus. Another study found a strong association between these conditions (p < 0.001), and two investigations detected the presence of migraine in 10.1 and 22.5% of tinnitus patients. Migraine presented high odds ratio and hazard ratio for hearing loss. Additionally, the studies included were of good quality, adhering to most of the requirements on the JBI Critical Appraisal Checklist. However, a limitation of this review is the small number of studies included. CONCLUSIONS Associations between migraine, tinnitus, and hearing loss were observed in the included studies.
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Affiliation(s)
- Camilla Porto Campello
- Postdoctoral in Speech Language Pathology, Associate Postgraduate Program in Speech Language Pathology-PPGFON, Federal University of Paraíba-UFPB, João Pessoa-PB, Brazil
| | | | | | | | - Glaurea Regina de Santana Nunes
- Associate Postgraduate Program in Speech Language Pathology-PPGFON, Federal University of Paraíba-UFPB, João Pessoa-PB, Brazil
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Gambacorta V, Ricci G, D’Orazio A, Stivalini D, Baietta I, Pettorossi VE, Faralli M. Evaluation of Cochlear Symptoms in Migraine Patients without Vestibular Migraine and/or Ménière's Disease. Audiol Res 2023; 13:967-977. [PMID: 38131809 PMCID: PMC10741063 DOI: 10.3390/audiolres13060084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Migraine pathogenic pathways may selectively target the cochlea. A qualitative and quantitative analysis of cochlear symptoms in migraine patients without vestibular migraine and/or Méniere's disease was conducted. We examined 60 consecutive patients with history of cochlear symptoms, including fullness, tinnitus, and hearing loss. Patients were divided into two groups based on migraine history: M (migraine) and nM (no migraine). The incidence of migraine was compared to a homogeneous control group with dysfunctional and inflammatory dysphonia without cochlear symptoms. The type, time of onset, recurrence, bilaterality of symptoms, and hearing threshold were analyzed. The incidence of migraine was significantly higher (p = 0.04) in patients with cochlear symptoms than in the control group. The onset of symptoms is significantly earlier (p < 0.05) in the presence of migraine. The fullness, recurrence, and bilaterality of symptoms are associated with migraine in a statistically significant way (p < 0.05). Pure tone audiometry shows a statistically significant increase in the hearing threshold (500-1000 Hz) in group M. Based on developing findings, cochlear migraine may be considered as a novel clinical entity, like vestibular migraine. It would be the expression, in the absence of vertiginous symptoms, of a selective suffering of the anterior labyrinth by known operating mechanisms of migraine.
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Affiliation(s)
- Valeria Gambacorta
- Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, 06132 Perugia, Italy
| | - Giampietro Ricci
- Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, 06132 Perugia, Italy
| | - Alessandra D’Orazio
- Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, 06132 Perugia, Italy
| | - Davide Stivalini
- Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, 06132 Perugia, Italy
| | - Irene Baietta
- Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, 06132 Perugia, Italy
| | - Vito Enrico Pettorossi
- Department of Medicine and Surgery, Section of Human Physiology, University of Perugia, 06132 Perugia, Italy
| | - Mario Faralli
- Department of Medicine and Surgery, Section of Otorhinolaryngology, University of Perugia, 06132 Perugia, Italy
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Frank M, Abouzari M, Djalilian HR. Meniere's disease is a manifestation of migraine. Curr Opin Otolaryngol Head Neck Surg 2023; 31:313-319. [PMID: 37266702 PMCID: PMC10527226 DOI: 10.1097/moo.0000000000000908] [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] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW To discuss the theory that Meniere's disease (MD) is a variation of otologic migraine rather than an isolated inner ear condition. RECENT FINDINGS In contrast to the approximately 12% of the general population suffering from migraine headaches, 51-60% of patients with MD experience migraine headaches. While pathognomonic for MD, endolymphatic hydrops has also been identified in patients with vestibular migraine. Treatment with the integrative neurosensory rehabilitation approach (diet and lifestyle changes, magnesium and riboflavin supplementation, and when needed, prophylactic medication) to treat the underlying migraine process has been highly effective in patients with MD. SUMMARY MD can be understood as a manifestation of migraine such that patients with MD can be effectively treated with migraine therapies.
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Affiliation(s)
- Madelyn Frank
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
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Brooks KA, Tawk K, Djalilian HR, Hobson CE. Migraine management for the otolaryngologist. Laryngoscope Investig Otolaryngol 2023; 8:1080-1093. [PMID: 37621262 PMCID: PMC10446291 DOI: 10.1002/lio2.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 08/26/2023] Open
Abstract
Objective To characterize migraine pathophysiology, presentation, and current treatment strategies, specifically in regard to vestibulocochlear manifestations of migraine. Methods Narrative review of available literature. Results Migraine disorder can be described as a spectrum of otologic manifestations, with vestibular migraine now recognized with fully-fledged diagnostic criteria. Otologic manifestations are theorized to be due, in part, to trigeminal innervation of the inner ear structures and calcitonin gene-related peptide (CGRP) expression within the labyrinth. Patients can experience vertigo, aural fullness, enhanced tinnitus, and hearing loss without the characteristic migraine headache, leading to under recognition of these symptoms as migraine-related. Meniere's disease, mal de débarquement syndrome, persistent postural perceptual dizziness, and recurrent benign paroxysmal positional vertigo have close associations to migraine and may exist on the migraine spectrum. Migraine treatment consists of two goals: halting acute attacks (abortive therapy) and preventing attacks (prophylactic therapy). Abortive medications include triptans, corticosteroids, anti-histamines, and anti-emetics. Pharmacologic prophylaxis in conjunction with lifestyle modifications can decrease frequency and severity of symptoms and include tricyclic antidepressants, calcium channel blockers, anti-epileptic medications, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, beta-blockers, gepants, and monoclonal antibodies to CGRP. Promising evidence is emerging regarding the ability of migraine medications to positively treat the various otologic symptoms of migraine. Conclusion Migraine disorder manifesting with primarily cochleovestibular symptoms can be challenging to diagnose and manage for practicing clinicians. Patients with various vestibulopathies that are closely related to migraine may benefit from migraine treatment. Lifestyle choices and prophylactic medications are key to satisfactorily preventing acute migrainous attacks and improve function.
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Affiliation(s)
- Kaitlyn A. Brooks
- Department of Otolaryngology–Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Karen Tawk
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CaliforniaIrvineCaliforniaUSA
- Department of Biomedical EngineeringUniversity of CaliforniaIrvineCaliforniaUSA
| | - Candace E. Hobson
- Department of Otolaryngology–Head and Neck SurgeryEmory University School of MedicineAtlantaGeorgiaUSA
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Bhatt IS, Washnik NJ, Kingsbury S, Deshpande AK, Kingsbury H, Bhagavan SG, Michel K, Dias R, Torkamani A. Identifying Health-Related Conditions Associated with Tinnitus in Young Adults. Audiol Res 2023; 13:546-562. [PMID: 37489384 PMCID: PMC10366783 DOI: 10.3390/audiolres13040048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/10/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE The present study investigated the epidemic of tinnitus in college-aged young adults. Our first objective was to identify health conditions associated with tinnitus in young adults. The second objective was to evaluate the predictive utility of some known risk factors. STUDY DESIGN A cross-sectional design was used to investigate the prevalence and risk factors for tinnitus. SETTING A questionnaire was distributed, reaching out to a large college-aged population. A total of 2258 young adults aged 18-30 years were recruited from April 2021 to February 2022. INTERVENTIONS A questionnaire was administered to investigate the epidemiology of tinnitus in a population of college-aged young adults. RESULTS About 17.7% of young adults reported bothersome tinnitus perception lasting for ≥5 min in the last 12 months. The prevalence of chronic tinnitus (bothersome tinnitus for ≥1 year) and acute tinnitus (bothersome tinnitus for <1 year) was 10.6% and 7.1%, respectively. About 19% of the study sample reported at least one health condition. Individuals reporting head injury, hypertension, heart disease, scarlet fever, and malaria showed significantly higher odds of reporting chronic tinnitus. Meningitis and self-reported hearing loss showed significant associations with bothersome tinnitus. The prevalence of chronic tinnitus was significantly higher in males reporting high noise exposure, a positive history of reoccurring ear infections, European ethnic background, and a positive health history. Risk modeling showed that noise exposure was the most important risk factor for chronic tinnitus, followed by sex, reoccurring ear infections, and a history of any health condition. A positive history of COVID-19 and self-reported severity showed no association with tinnitus. Individuals reporting reoccurring ear infections showed a significantly higher prevalence of COVID-19. CONCLUSIONS While young adults with health conditions are at a higher risk of reporting tinnitus, the predictive utility of a positive health history remains relatively low, possibly due to weak associations between health conditions and tinnitus. Noise, male sex, reoccurring ear infections, European ethnicity, and a positive health history revealed higher odds of reporting chronic tinnitus than their counterparts. These risk factors collectively explained about 16% variability in chronic tinnitus, which highlights the need for identifying other risk factors for chronic tinnitus in young adults.
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Affiliation(s)
- Ishan Sunilkumar Bhatt
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
| | - Nilesh J Washnik
- Department of Hearing Speech and Language Sciences, Ohio University, Athens, OH 45701, USA
| | - Sarah Kingsbury
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
| | - Aniruddha K Deshpande
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY 11549, USA
| | - Hailey Kingsbury
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
| | - Srividya Grama Bhagavan
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
| | - Klayre Michel
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
| | - Raquel Dias
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL 32603, USA
| | - Ali Torkamani
- Department of Integrative Structural and Computational Biology, Scripps Science Institute, La Jolla, CA 92037, USA
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Umemoto KK, Tawk K, Mazhari N, Abouzari M, Djalilian HR. Management of Migraine-Associated Vestibulocochlear Disorders. Audiol Res 2023; 13:528-545. [PMID: 37489383 PMCID: PMC10366928 DOI: 10.3390/audiolres13040047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/03/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
Migraine is a chronic neurological disorder that frequently coexists with different vestibular and cochlear symptoms (sudden hearing loss, tinnitus, otalgia, aural fullness, hyperacusis, dizziness, imbalance, and vertigo) and disorders (recurrent benign positional vertigo, persistent postural perceptual dizziness, mal de debarquement, and Menière's disease). Despite evidence of an epidemiological association and similar pathophysiology between migraine and these vestibulocochlear disorders, patients suffering from migraine-related symptoms are usually underdiagnosed and undertreated. Current migraine treatment options have shown success in treating vestibulocochlear symptoms. Lifestyle and dietary modifications (reducing stress, restful sleep, avoiding migraine dietary triggers, and avoiding starvation and dehydration) and supplements (vitamin B2 and magnesium) offer effective first-line treatments. Treatment with migraine prophylactic medications such as tricyclic antidepressants (e.g., nortriptyline), anticonvulsants (e.g., topiramate), and calcium channel blockers (e.g., verapamil) is implemented when lifestyle and dietary modifications are not sufficient in improving a patient's symptoms. We have included an algorithm that outlines a suggested approach for addressing these symptoms, taking into account our clinical observations. Greater recognition and understanding of migraine and its related vestibular and cochlear symptoms are needed to ensure the appropriate diagnosis and treatment of affected patients.
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Affiliation(s)
- Kayla K Umemoto
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | - Karen Tawk
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Najva Mazhari
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Mehdi Abouzari
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
| | - Hamid R Djalilian
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA 92697, USA
- Department of Biomedical Engineering, University of California, Irvine, CA 92617, USA
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Zhang L, Du H, You H. Correlation between the Degree of Hearing Loss and the Levels of Anxiety and Depression in Patients with Tinnitus. Noise Health 2023; 25:195-201. [PMID: 37815081 PMCID: PMC10747803 DOI: 10.4103/nah.nah_46_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 10/11/2023] Open
Abstract
Objectives This study aimed to explore the correlation between the degree of hearing loss (HL) and the degrees of anxiety and depression in patients with tinnitus. Materials and Methods This retrospective study involved the use of basic clinical data from 600 enrolled patients with tinnitus who visited the otolaryngology clinic in Affiliated Jinhua Hospital, Zhejiang University School of Medicine from April 2020 to June 2022. The tinnitus handicap inventory (THI) scale was used to assess the tinnitus status among the participants. The pure tone audiometry (PTA) test was used to conduct audiological assessments for all patients to determine their hearing condition. The self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the levels of anxiety and depression among the participants, respectively. The correlation between the HL and anxiety/depression scores from the questionnaires was tested through Pearson correlation analysis. Results Among the 600 enrolled patients with tinnitus, most patients had mild-to-moderate degree of tinnitus, accounting for 248 cases (41.3%) and 179 cases (29.8%), respectively. PTA results showed that a large proportion of patients with tinnitus were accompanied with HL (467 cases, 77.8%). Among them, patients with mild HL accounted for the largest proportion with a total of 241 cases (40.2%). Based on the results of SAS and SDS test, almost half of the patients had symptoms of anxiety and depression, accounting for 52.3% (314 cases) and 48.8% (293 cases), respectively. Similarly, patients with mild anxiety and depression occupy the largest proportion, accounting for 35.8% (215 cases) and 23% (138 cases), respectively. Pearson correlation analysis showed that the degree of HL was closely related to THI/SAS/SDS scores (P < 0.001). Conclusion These findings indicate a strong positive correlation between the degree of HL and anxiety/depression scores in patients with tinnitus.
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Affiliation(s)
| | | | - Huihua You
- Department of Otorhinolaryngology, Head and Neck Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang, China
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12
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Li H, Xu X, Zhou J, Dong L. Cluster and network analysis of non-headache symptoms in migraine patients reveals distinct subgroups based on onset age and vestibular-cochlear symptom interconnection. Front Neurol 2023; 14:1184069. [PMID: 37305749 PMCID: PMC10251495 DOI: 10.3389/fneur.2023.1184069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Objective The present study endeavors to identify natural subgroups of migraine patients based on the patterns of non-headache symptoms, utilizing cluster analysis. Subsequently, network analysis was performed to estimate the structure of symptoms and explore the potential pathophysiology of these findings. Method A total of 475 patients who met the diagnostic criteria for migraine were surveyed face-to-face during the period of 2019 to 2022. The survey included collecting demographic and symptom data. Four different solutions were generated by the K-means for mixed large data (KAMILA) clustering algorithm, from which the final cluster solutions were selected based on a series of cluster metrics. Subsequently, we performed network analysis using Bayesian Gaussian graphical models (BGGM) to estimate the symptom structure across subgroups and conducted global and pairwise comparisons between structures. Result Cluster analysis identified two distinct patient groups, and the onset age of migraine proved to be an effective characteristic differentiating the two patient groups. Participants assigned to late-onset group showed a longer course of migraine, higher frequency of monthly headache attacks, and greater tendency toward medication overuse. In contrast, patients in early-onset group exhibited a higher frequency of nausea, vomiting, and phonophobia compared to their counterparts in the other group. The network analysis revealed a different symptom structure between the two groups globally, while the pairwise differences indicated an increasing connection between tinnitus and dizziness, and a decreasing connection between tinnitus and hearing loss in the early-onset group. Conclusion Utilizing clustering and network analysis, we have identified two distinct non-headache symptom structures of migraine patients with early-onset age and late-onset age. Our findings suggest that the vestibular-cochlear symptoms may differ in the context of different onset ages of migraine patients, which may contribute to a better understanding of the pathology of vestibular-cochlear symptoms in migraine.
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Famili HP, Zalewski CK, Ibrahimy A, Mack J, Cantor F, Heiss JD, Brewer CC. Audiovestibular Findings in a Cohort of Patients with Chiari Malformation Type I and Dizziness. J Clin Med 2023; 12:jcm12082767. [PMID: 37109107 PMCID: PMC10142081 DOI: 10.3390/jcm12082767] [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: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Chiari Malformation Type I (CM1) is a neurological condition in which the cerebellar tonsils extend past the foramen magnum. While many studies have reported dizziness symptoms in patients with CM1, the prevalence of peripheral labyrinthine lesions is largely unknown. This study aimed to comprehensively describe the audiovestibular phenotype in a cohort of patients with CM1 expressly referred for dizziness. Twenty-four patients with CM1 and a complaint of dizziness/vertigo were evaluated. Hearing and auditory brainstem tract function were essentially normal. While vestibular abnormalities were most prevalent during rotational testing (33%), abnormal functional balance was the most common finding (40%). Patients with CM1 had a greater likelihood of exhibiting an abnormal sensory organization test (SOT) postural stability score for fixed platform conditions, and for the somatosensory analysis score. While no significant associations were identified between tonsillar ectopia extent and any vestibular/balance outcome measure, a significant negative association was identified between neck pain and the somatosensory sensory analysis score. Abnormal functional balance in the somatosensory domain was remarkable, with poorer scores associated with neck pain. An isolated peripheral vestibulopathy was present in only 8% of patients. Despite the low prevalence of vestibulopathy, vestibular/balance assessment is warranted to identify patients who may benefit from referral to specialized medical disciplines.
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Affiliation(s)
- Hannah P Famili
- Audiology Unit, NIDCD, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | | | - Alaaddin Ibrahimy
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jessica Mack
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Fredric Cantor
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - John D Heiss
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carmen C Brewer
- Audiology Unit, NIDCD, National Institutes of Health, Bethesda, MD 20892, USA
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Chen Z, Yu L, Li W, Zhang H, Huang X, Chen W, Wang D. Association of vitamins with hearing loss, vision disorder and sleep problem in the US general population. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:53876-53886. [PMID: 36867331 DOI: 10.1007/s11356-023-26164-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/23/2023] [Indexed: 06/19/2023]
Abstract
Based on nationally representative samples from US, we aimed to assess the associations of vitamins with hearing loss, vision disorder and sleep problem. A total of 25,312, 8425 and 24,234 participants were included in this study to investigate the relationship of vitamins with hearing loss, vision disorder and sleep problem from National Health and Nutrition Examination Survey, respectively. Vitamins including niacin, folic acid, vitamin B6, A, C, E and carotenoids were considered in our study. Logistic regression models were used to assess the associations between all included dietary vitamin intake concentrations and the prevalence of specific outcomes. Increased lycopene (odds ratio [OR]: 0.904, 95% confidence interval [CI]: 0.829-0.985) intake was associated with a deceased prevalence of hearing loss. Higher dietary intake of folic acid (OR: 0.637, 95% CI: 0.443-0.904), vitamin B6 (0.667, 0.465-0.947), alpha-carotene (0.695, 0.494-0.968), beta-carotene (0.703, 0.505-0.969) and lutein + zeaxanthin (0.640, 0.455-0.892) were associated with a decreased prevalence of vision disorder. The inversely associations of sleeping problem with niacin (OR: 0.902, 95% CI: 0.826-0.985), folic acid (0.882, 0.811-0.959), vitamin B6 (0.892, 0.818-0.973), vitamin C (0.908, 0.835-0.987), vitamin E (0.885, 0.813-0.963) and lycopene (0.919, 0.845-0.998) were also observed. Our findings provide evidence that increased specific vitamin intake is associated with decreased prevalence of hearing loss, vision disorder and sleep problem.
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Affiliation(s)
- Zhaomin Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Linling Yu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
| | - Haozhe Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xuezan Huang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Wang AR, Steenerson KK, Alyono JC. Abnormal Subjective and Audiometric Auditory Function in Migraine. Otolaryngol Head Neck Surg 2023; 168:1362-1370. [PMID: 36939529 DOI: 10.1002/ohn.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify if migraine is associated with auditory deficits and if the auditory profile of migraine is distinct from other pain syndromes, such as chronic pain. STUDY DESIGN Cross-sectional, retrospective. SETTING A total of 5273 respondents of the 1999 to 2004 National Health and Nutrition Examination Survey. METHODS Regression analyses assessed the association between migraine (n = 1245) and chronic pain (n = 430) status with subjectively endorsed hearing loss, tinnitus, pure-tone average (PTA) at 500, 1000, 2000, and 4000 Hz, and subjective-audiometric hearing mismatch (endorsed hearing loss but with a PTA ≤ 25 dB), correcting for confounding factors. RESULTS Migraine was associated with increased tinnitus (adjusted odds ratio [aOR] = 1.77, 95% confidence interval [CI]: 1.47-2.13, p < .001) and subjective hearing loss (aOR = 1.58, 95% CI: 1.29-1.94, p < .001). Migraine was associated with higher PTA (β = .89, p = .023). Migraine decreased the PTA threshold at which individuals endorsed subjective hearing loss (β = -1.94, p = .013) and was associated with a more subjective-audiometric hearing mismatch (aOR = 1.50, 95% CI: 1.18-1.89, p < .001). Chronic pain was not associated with tinnitus (aOR = 1.26, 95% CI: 0.97-1.63, p = 0.079), subjective hearing loss (aOR = 0.94, 95% CI: 0.71-1.23, p = .64), changes in PTA (β = -.22, p = .69), altered PTA threshold for endorsing hearing loss (β = 1.40, p = .19), or subjective-audiometric hearing mismatch (aOR = 0.98, 95% CI: 0.70-1.34, p = .88). CONCLUSION Migraine is associated with both worse pure-tone audiometry and higher sensitivity to changes in hearing ability, suggesting both peripheral and central auditory function abnormalities. In contrast, patients with chronic pain did not demonstrate these abnormalities. The etiology of abnormal auditory processing in migraine may be different from that of other pain syndromes.
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Affiliation(s)
- Allan R Wang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kristen K Steenerson
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer C Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Lee A, Abouzari M, Akbarpour M, Risbud A, Lin HW, Djalilian HR. A proposed association between subjective nonpulsatile tinnitus and migraine. World J Otorhinolaryngol Head Neck Surg 2022. [DOI: 10.1002/wjo2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ariel Lee
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Mehdi Abouzari
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Meleeka Akbarpour
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Adwight Risbud
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Harrison W. Lin
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
| | - Hamid R. Djalilian
- Department of Otolaryngology—Head and Neck Surgery University of California Irvine USA
- Department of Biomedical Engineering University of California Irvine USA
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Abouzari M, Tawk K, Lee D, Djalilian HR. Migrainous Vertigo, Tinnitus, and Ear Symptoms and Alternatives. Otolaryngol Clin North Am 2022; 55:1017-1033. [PMID: 36150941 PMCID: PMC9580398 DOI: 10.1016/j.otc.2022.06.017] [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] [Indexed: 11/23/2022]
Abstract
Migraine headaches frequently coexist with vestibular symptoms such as vertigo, motion sickness, and gait instability. Migraine-related vasospasm can also damage the inner ear, which results in symptoms such as sudden sensorineural hearing loss and resultant tinnitus. The pathophysiology of these symptoms is not yet fully understood, and despite their prevalence, there is no universally approved management. This review summarizes the data on complementary and integrative medicine in treating patients with migrainous ear disorders.
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Affiliation(s)
- Mehdi Abouzari
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, 19182 Jamboree Road, Otolaryngology-5386, Irvine, CA 92697, USA
| | - Karen Tawk
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, 19182 Jamboree Road, Otolaryngology-5386, Irvine, CA 92697, USA
| | - Darlene Lee
- Susan Samueli Integrative Health Institute, University of California, 5141 California Avenue, Suite 200B, Irvine, CA 92617, USA
| | - Hamid R Djalilian
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, 19182 Jamboree Road, Otolaryngology-5386, Irvine, CA 92697, USA; Department of Biomedical Engineering, University of California, Irvine, USA.
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Benjamin T, Gillard D, Abouzari M, Djalilian HR, Sharon JD. Vestibular and auditory manifestations of migraine. Curr Opin Neurol 2022; 35:84-89. [PMID: 34864754 PMCID: PMC8755616 DOI: 10.1097/wco.0000000000001024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to discuss current literature about vestibular migraine and other cochleovestibular symptoms related to migraine. RECENT FINDINGS Vestibular migraine affects 2.7% of the US population. Misdiagnosis is common. The pathophysiology is currently unknown but new research shows that calcitonin gene-related peptide, which is implicated in migraine headaches, is expressed in the audiovestibular periphery. A recent large-scale placebo-controlled trial looking at metoprolol for vestibular migraine was terminated early due to poor recruitment; however, at study completion, no differences were seen between treatment arms. Many other audiovestibular symptoms have been shown to be associated with migraine, including tinnitus, hearing loss, aural fullness, otalgia, and sinus symptoms. Migraine is also associated with risk for developing numerous otologic conditions, including Meniere's disease, vestibular loss, Benign Paroxysmal Positional Vertigo, and sudden sensorineural hearing loss. There is now some evidence that patients may experience fluctuating hearing loss and aural fullness without vertigo in association with migraine, which is called cochlear migraine. SUMMARY Migraine can cause a variety of audiologic and vestibular symptoms, and further research is required to understand how migraine affects the inner ear.
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Affiliation(s)
- Tania Benjamin
- University of California, San Francisco (UCSF) Department of Otolaryngology – Head and Neck Surgery, San Francisco, CA, USA
| | - Danielle Gillard
- University of California, San Francisco (UCSF) Department of Otolaryngology – Head and Neck Surgery, San Francisco, CA, USA
| | - Mehdi Abouzari
- University of California, Irvine (UCI) Department of Otolaryngology, Irvine, CA, USA
| | - Hamid R. Djalilian
- University of California, Irvine (UCI) Department of Otolaryngology, Irvine, CA, USA
- University of California, Irvine (UCI) Department of Biomedical Engineering, Irvine, CA, USA
| | - Jeffrey D. Sharon
- University of California, San Francisco (UCSF) Department of Otolaryngology – Head and Neck Surgery, San Francisco, CA, USA
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