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Ciralli B, Malfatti T, Lima TZ, Silva SRB, Cederroth CR, Leao KE. Alterations of auditory sensory gating in mice with noise-induced tinnitus treated with nicotine and cannabis extract. J Psychopharmacol 2023; 37:1116-1131. [PMID: 37837354 DOI: 10.1177/02698811231200879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Tinnitus is a phantom sound perception affecting both auditory and limbic structures. The mechanisms of tinnitus remain unclear and it is debatable whether tinnitus alters attention to sound and the ability to inhibit repetitive sounds, a phenomenon also known as auditory gating. Here we investigate if noise exposure interferes with auditory gating and whether natural extracts of cannabis or nicotine could improve auditory pre-attentional processing in noise-exposed mice. We used 22 male C57BL/6J mice divided into noise-exposed (exposed to a 9-11 kHz narrow band noise for 1 h) and sham (no sound during noise exposure) groups. Hearing thresholds were measured using auditory brainstem responses, and tinnitus-like behavior was assessed using Gap prepulse inhibition of acoustic startle. After noise exposure, mice were implanted with multi-electrodes in the dorsal hippocampus to assess auditory event-related potentials in response to paired clicks. The results showed that mice with tinnitus-like behavior displayed auditory gating of repetitive clicks, but with larger amplitudes and longer latencies of the N40 component of the aERP waveform. The combination of cannabis extract and nicotine improved the auditory gating ratio in noise-exposed mice without permanent hearing threshold shifts. Lastly, the longer latency of the N40 component appears due to an increased sensitivity to cannabis extract in noise-exposed mice compared to sham mice. The study suggests that the altered central plasticity in tinnitus is more sensitive to the combined actions on the cholinergic and the endocannabinoid systems. Overall, the findings contribute to a better understanding of pharmacological modulation of auditory sensory gating.
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Affiliation(s)
- Barbara Ciralli
- Brain Institute, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Thawann Malfatti
- Brain Institute, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Sweden
| | - Thiago Z Lima
- Brain Institute, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Department of Applied Mathematics and Statistics, Exact and Earth Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Christopher R Cederroth
- Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Sweden
- Translational Hearing Research, Tübingen Hearing Research Center, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Katarina E Leao
- Brain Institute, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Bhat V, Onaivi ES, Sharma V. Endocannabinoid system components as potential neuroimmune therapeutic targets in tinnitus. Front Neurol 2023; 14:1148327. [PMID: 37305742 PMCID: PMC10248455 DOI: 10.3389/fneur.2023.1148327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Research interest in understanding tinnitus has increased severalfold in the last decade to find a cure for this auditory disorder. Hyperacusis can also accompany tinnitus, although the mechanisms involved in hyperacusis and tinnitus are different. Millions of people suffer from some degree of tinnitus with hearing loss. Tinnitus is believed to be a form of sensory epilepsy, spawning neuronal hyperactivity from the cochlear nucleus and inferior colliculus of the auditory brainstem region. Cannabis has been used for recreation, medicinal purposes, and served as an entheogen from time immemorial. With the current and increasing global medical and recreational cannabis legalization, there is renewed enthusiasm for the use of cannabinoid drugs, and the role of the endocannabinoid system (ECS) in several health disorders including tinnitus which is associated with COVID-19. The ECS signaling pathways have been proposed to affect the underlying pathophysiology of tinnitus. Cannabinoid receptors (CBRs) have been found in the auditory system, raising interest in ECS signaling in hearing and tinnitus. However, previous studies mostly in animal models of tinnitus did not investigate the involvement of CB2Rs but focused on CB1R-based responses, which suggested that CB1R ligands had no effect and may even be harmful and worsen tinnitus. With new molecular techniques and transgenic approaches used to dissect the complexity of the ECS, the role of ECS/CB2R neuroimmunological function in the auditory system and tinnitus is emerging. This perspective proposes the role of emerging neuroimmune crosstalk of the ECS in sound-sensing structures of the auditory system as a potential pharmacogenomic therapeutic target using cannabinoid CB2R ligands in tinnitus in the era of the COVID-19 pandemic.
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Affiliation(s)
- Vishweshwara Bhat
- Speech Language Pathology, William Paterson University, Wayne, NJ, United States
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Mavedatnia D, Levin M, Lee JW, Hamour AF, Dizon K, Le T. Cannabis use amongst tinnitus patients: consumption patterns and attitudes. J Otolaryngol Head Neck Surg 2023; 52:19. [PMID: 36823672 PMCID: PMC9951523 DOI: 10.1186/s40463-022-00603-8] [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: 07/26/2022] [Accepted: 10/20/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Tinnitus has a significant impact on quality of life and causes considerable psychological distress. Cannabis is known to modulate neuron hyperexcitability, provide protection against auditory damage, and has been used for treatment for many diseases which have physiological similarities with tinnitus. The objective of this study was to survey patients presenting with tinnitus regarding their perspectives and usage patterns of cannabis. METHODS Patients with a primary presenting complaint of tinnitus in a tertiary neuro-otology clinic completed a 18-item questionnaire assessing perception, attitudes, and cannabis usage patterns. RESULTS Forty five patients completed the survey (mean age: 54.5 years, 31 females and 14 males). Overall, 96% of patients reported that they would consider cannabis as treatment for their tinnitus. Patients considered cannabis use for auditory symptoms (91%), and symptoms related to their tinnitus, such as emotional complaints (60%), sleep disturbances (64%), and functional disturbances (56%). 36% of patients had previously used cannabis and 22% of patients reported cannabis use at the time of the study. 80% of patients that were actively using cannabis reported that it helped with tinnitus-related symptoms, such as dizziness, anxiety, bodily pain, and sleep disturbances. Most patients would prefer to use edibles (62%), tablet (58%) and cream (47%) formulations of cannabis. Patients were concerned about the cost (29%), potential physical health implications (53%) and psychosocial side effects (60%) of cannabis. Over half of patients learned about cannabis from a friend or family member and only 22% of patients learned about cannabis from a physician or nurse. CONCLUSION Cannabis use is common amongst patients with tinnitus and current users of cannabis reported that it helped with their symptoms. Most patients would consider its use as a potential treatment to alleviate their tinnitus-related symptoms and are interested in learning more regarding its use. By understanding how cannabis is perceived by tinnitus patients, healthcare providers can provide appropriate patient education.
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Affiliation(s)
- Dorsa Mavedatnia
- grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Marc Levin
- grid.17063.330000 0001 2157 2938Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON Canada
| | - Jong Wook Lee
- grid.17063.330000 0001 2157 2938Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON Canada
| | - Amr F. Hamour
- grid.17063.330000 0001 2157 2938Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON Canada
| | - Kaye Dizon
- grid.413104.30000 0000 9743 1587Sunnybrook Health Sciences Center, Toronto, ON Canada
| | - Trung Le
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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Mazurek B, Hesse G, Sattel H, Kratzsch V, Lahmann C, Dobel C. S3 Guideline: Chronic Tinnitus : German Society for Otorhinolaryngology, Head and Neck Surgery e. V. (DGHNO-KHC). HNO 2022; 70:795-827. [PMID: 36227338 PMCID: PMC9581878 DOI: 10.1007/s00106-022-01207-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Gerhard Hesse
- Tinnitus-Klinik, KH Bad Arolsen, Große Allee 50, 34454, Bad Arolsen, Germany.
- Universität Witten/Herdecke, Witten, Germany.
| | - Heribert Sattel
- Klinikum rechts der Isar, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technical University of Munich, Langerstr. 3, 81675, Munich, Germany
| | - Volker Kratzsch
- Abt. Hörbehinderung, Tinnitus und Schwindelerkrankungen, VAMED Rehaklinik Bad Grönenbach, Sebastian-Kneipp-Allee 3-5, 87730, Bad Grönenbach, Germany
| | - Claas Lahmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 8, 79104, Freiburg, Germany
| | - Christian Dobel
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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Tapasak B, Edelmayer L, Seidman MD. Endocannabinoid System and the Otolaryngologist. Otolaryngol Clin North Am 2022; 55:1101-1110. [PMID: 36088164 DOI: 10.1016/j.otc.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The endocannabinoid system is located throughout the central and peripheral nervous systems, endocrine system, gastrointestinal system, and within inflammatory cells. The use of medical cannabinoids has been gaining traction as a viable treatment option for varying illnesses in recent years. Research is ongoing looking at the effect of cannabinoids for treatment of common otolaryngologic pathologies. This article identifies common otolaryngologic pathologies where cannabinoids may have benefit, discusses potential drawbacks to cannabinoid use, and suggests future directions for research in the application of medical cannabinoids.
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Affiliation(s)
- Brandon Tapasak
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA.
| | - Luke Edelmayer
- Advent Health Celebration, 400 Celebration Place, Kissimmee, FL 34747, USA
| | - Michael D Seidman
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA; Advent Health Celebration, 400 Celebration Place, Kissimmee, FL 34747, USA; University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Boulevard, Tampa, FL 33612, USA
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Barth SW, Lehner MD, Dietz GPH, Schulze H. Pharmacologic treatments in preclinical tinnitus models with special focus on Ginkgo biloba leaf extract EGb 761®. Mol Cell Neurosci 2021; 116:103669. [PMID: 34560255 DOI: 10.1016/j.mcn.2021.103669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/26/2021] [Accepted: 09/17/2021] [Indexed: 02/09/2023] Open
Abstract
Tinnitus is defined as the perception of sound in the absence of external acoustic stimuli. Frequent comorbidities or associated factors are depression, anxiety, concentration problems, insomnia, resignation, helplessness, headache, bruxism, or social isolation, just to name a few. Although many therapeutic approaches have already been tested with varying success, there still is no cure available for tinnitus. The search for an effective treatment has been hampered by the fact that the mechanisms of tinnitus development are still not fully understood, although several models are available and discussed in this review. Our review will give a brief overview about preclinical models, presenting the heterogeneity of tinnitus sub-types depending on the different inner ear and brain structures involved in tinnitus etiology and pathogenesis. Based on these models we introduce the different target structures and transmitter systems implicated in tinnitus development and provide an extensive overview on preclinical drug-based therapeutic approaches that have been explored in various animal models. As the special extract from Ginkgo biloba leaves EGb 761® has been the most widely tested drug in both non-clinical tinnitus models as well as in clinical trials, a special focus will be given to EGb 761®. The efficacy of terpene lactones, flavone glycosides and proanthocyanidines with their distinct contribution to the overall efficacy profile of the multi-constituent drug EGb 761® will be discussed.
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Affiliation(s)
- Stephan W Barth
- Department of Global Medical Affairs, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany.
| | - Martin D Lehner
- Department of Preclinical Research & Development, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany.
| | - Gunnar P H Dietz
- Department of Global Medical Affairs, Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, Germany.
| | - Holger Schulze
- Experimental Otolaryngology, ENT-Hospital, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Narwani V, Bourdillon A, Nalamada K, Manes RP, Hildrew DM. Does cannabis alleviate tinnitus? A review of the current literature. Laryngoscope Investig Otolaryngol 2020; 5:1147-1155. [PMID: 33364406 PMCID: PMC7752070 DOI: 10.1002/lio2.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Endocannabinoid pathways have been proposed to affect the underlying pathophysiology of tinnitus. The aim of this study is to evaluate the scope and findings of existing literature on the relationship between cannabis and cannabinoid pathways and tinnitus. METHODS We conducted a review of animal, clinical and survey studies investigating the relationship between the use of cannabis-derived agents and tinnitus. Using pertinent keywords and MeSH terms on PubMed, relevant studies were identified, yielding four animal studies, two large cross-sectional survey studies, one clinical cross-over study, and one case report. RESULTS Animal studies revealed that cannabinoid receptor expression in the cochlear nucleus varied with tinnitus symptomatology and the use of cannabinoid agents either increased or had no effect on tinnitus-related behavior. Survey studies yielded conflicting results between cannabis use and tinnitus in the general population. Clinical data is largely lacking, although a small cohort study showed a dose-dependent relationship between tetrahydrocannabinol consumption and frequency of tinnitus episodes in patients receiving treatment for cancer. CONCLUSION While animal studies have revealed that cannabinoid receptors likely have a role in modulating auditory signaling, there is no compelling data either from animal or human studies for the use of cannabinoids to alleviate tinnitus. Further research is necessary to elucidate their precise role to guide development of therapeutic interventions. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Vishal Narwani
- Division of Otolaryngology – Head and Neck Surgery, Department of SurgeryYale University School of MedicineNew HavenConnecticutUSA
| | | | - Keerthana Nalamada
- Department of NeurologyUniversity of ConnecticutFarmingtonConnecticutUSA
| | - R. Peter Manes
- Division of Otolaryngology – Head and Neck Surgery, Department of SurgeryYale University School of MedicineNew HavenConnecticutUSA
| | - Douglas M. Hildrew
- Division of Otolaryngology – Head and Neck Surgery, Department of SurgeryYale University School of MedicineNew HavenConnecticutUSA
- Division of Otolaryngology – Head and Neck Surgery, Department of SurgeryVA Connecticut Healthcare SystemWest HavenConnecticutUSA
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Perin P, Mabou Tagne A, Enrico P, Marino F, Cosentino M, Pizzala R, Boselli C. Cannabinoids, Inner Ear, Hearing, and Tinnitus: A Neuroimmunological Perspective. Front Neurol 2020; 11:505995. [PMID: 33329293 PMCID: PMC7719758 DOI: 10.3389/fneur.2020.505995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
Cannabis has been used for centuries for recreational and therapeutic purposes. Whereas, the recreative uses are based on the psychotropic effect of some of its compounds, its therapeutic effects range over a wide spectrum of actions, most of which target the brain or the immune system. Several studies have found cannabinoid receptors in the auditory system, both at peripheral and central levels, thus raising the interest in cannabinoid signaling in hearing, and especially in tinnitus, which is affected also by anxiety, memory, and attention circuits where cannabinoid effects are well described. Available studies on animal models of tinnitus suggest that cannabinoids are not likely to be helpful in tinnitus treatment and could even be harmful. However, the pharmacology of cannabinoids is very complex, and most studies focused on neural CB1R-based responses. Cannabinoid effects on the immune system (where CB2Rs predominate) are increasingly recognized as essential in understanding nervous system pathological responses, and data on immune cannabinoid targets have emerged in the auditory system as well. In addition, nonclassical cannabinoid targets (such as TRP channels) appear to play an important role in the auditory system as well. This review will focus on neuroimmunological mechanisms for cannabinoid effects and their possible use as protective and therapeutic agents in the ear and auditory system, especially in tinnitus.
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Affiliation(s)
- Paola Perin
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | | | | | | | - Roberto Pizzala
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Cinzia Boselli
- Department of Drug Sciences, University of Pavia, Pavia, Italy
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Valentino WL, McKinnon BJ. What is the evidence for cannabis use in otolaryngology?: A narrative review. Am J Otolaryngol 2019; 40:770-775. [PMID: 31174932 DOI: 10.1016/j.amjoto.2019.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Review of the English literature for all studies involving cannabis and Otolaryngology. METHODS PubMed was searched using a combination of the terms cannabis, marijuana, otolaryngology, hearing, tinnitus, vestibular, rhinology, sinusitis, laryngology, voice, airway, head and neck, head and neck cancer, facial trauma, spasm, pediatric otolaryngology, sleep medicine, obstructive sleep apnea, and other variations. Literature included in the review provided substantive research on cannabis in Otolaryngology. RESULTS Seventy-nine unique publications were found in the literature. The majority were published in the last decade and pertain to the subspecialty of Head and Neck; specifically, its association with incident cancers. A small number of studies exist that suggest cannabis may be a useful therapy for Otolaryngological patients suffering from blepharospasm, the effects of radiation, and the psychological sequelae of receiving a cancer diagnosis. CONCLUSION Further research is required to determine the potential therapeutic roles and adverse effects of cannabis on conditions related to Otolaryngology. This study serves the Otolaryngological researcher with the most current, comprehensive literature review for the exploration into possible projects to undertake.
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Affiliation(s)
| | - Brian J McKinnon
- Department of Otolaryngology - Head and Neck Surgery, Department of Neurosurgery, Drexel University College of Medicine, United States of America.
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