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De Ridder D, Adhia D, Vanneste S. The brain's duck test in phantom percepts: Multisensory congruence in neuropathic pain and tinnitus. Brain Res 2024; 1844:149137. [PMID: 39103069 DOI: 10.1016/j.brainres.2024.149137] [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: 02/27/2024] [Revised: 06/26/2024] [Accepted: 08/01/2024] [Indexed: 08/07/2024]
Abstract
Chronic neuropathic pain and chronic tinnitus have been likened to phantom percepts, in which a complete or partial sensory deafferentation results in a filling in of the missing information derived from memory. 150 participants, 50 with tinnitus, 50 with chronic pain and 50 healthy controls underwent a resting state EEG. Source localized current density is recorded from all the sensory cortices (olfactory, gustatory, somatosensory, auditory, vestibular, visual) as well as the parahippocampal area. Functional connectivity by means of lagged phase synchronization is also computed between these regions of interest. Pain and tinnitus are associated with gamma band activity, reflecting prediction errors, in all sensory cortices except the olfactory and gustatory cortex. Functional connectivity identifies theta frequency connectivity between each of the sensory cortices except the chemical senses to the parahippocampus, but not between the individual sensory cortices. When one sensory domain is deprived, the other senses may provide the parahippocampal 'contextual' area with the most likely sound or somatosensory sensation to fill in the gap, applying an abductive 'duck test' approach, i.e., based on stored multisensory congruence. This novel concept paves the way to develop novel treatments for pain and tinnitus, using multisensory (i.e. visual, vestibular, somatosensory, auditory) modulation with or without associated parahippocampal targeting.
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Affiliation(s)
- Dirk De Ridder
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Divya Adhia
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sven Vanneste
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute & Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland. https://www.lab-clint.org
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Chen F, Fahimi Hnazaee M, Vanneste S, Yasoda-Mohan A. Effective Connectivity Network of Aberrant Prediction Error Processing in Auditory Phantom Perception. Brain Connect 2024; 14:430-444. [PMID: 39135479 DOI: 10.1089/brain.2024.0013] [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] [Indexed: 09/06/2024] Open
Abstract
Introduction: Prediction error (PE) is key to perception in the predictive coding framework. However, previous studies indicated the varied neural activities evoked by PE in tinnitus patients. Here, we aimed to reconcile the conflict by (1) a more nuanced view of PE, which could be driven by changing stimulus (stimulus-driven PE [sPE]) and violation of current context (context-driven PE [cPE]) and (2) investigating the aberrant connectivity networks that are engaged in the processing of the two types of PEs in tinnitus patients. Methods: Ten tinnitus patients with normal hearing and healthy controls were recruited, and a local-global auditory oddball paradigm was applied to measure the electroencephalographic difference between the two groups during sPE and cPE conditions. Results: Overall, the sPE condition engaged bottom-up and top-down connections, whereas the cPE condition engaged mostly top-down connections. The tinnitus group showed decreased sensitivity to the sPE and increased sensitivity to the cPE condition. Particularly, the auditory cortex and posterior cingulate cortex were the hubs for processing cPE in the control and tinnitus groups, respectively, showing the orientation to an internal state in tinnitus. Furthermore, tinnitus patients showed stronger connectivity to the parahippocampus and pregenual anterior cingulate cortex for the establishment of the prediction during the cPE condition. Conclusion: These results begin to dissect the role of changes in stimulus characteristics versus changes in the context of processing the same stimulus in mechanisms of tinnitus generation. Impact Statement This study delves into the number dynamics of prediction error (PE) in tinnitus, proposing a dual framework distinguishing between stimulus-driven PE (sPE) and context-driven PE (cPE). Electroencephalographic data from tinnitus patients and controls revealed distinct connectivity patterns during sPE and cPE conditions. Tinnitus patients exhibited reduced sensitivity to sPE and increased sensitivity to cPE. The auditory cortex and posterior cingulate cortex emerged as pivotal regions for cPE processing in controls and tinnitus patients, indicative of an internal state orientation in tinnitus. Enhanced connectivity to the parahippocampus and pregenual anterior cingulate cortex underscores the role of context in tinnitus pathophysiology.
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Affiliation(s)
- Feifan Chen
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Mansoureh Fahimi Hnazaee
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, Trinity College Institute for Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Heiland LD, Owen JM, Nguyen SA, Labadie RF, Lambert PR, Meyer TA. Neuromodulation for Treatment of Tinnitus: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024; 170:1234-1245. [PMID: 38353342 DOI: 10.1002/ohn.671] [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: 09/22/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 04/30/2024]
Abstract
OBJECTIVE To evaluate the treatment efficacy of neuromodulation versus sham for the treatment of tinnitus. DATA SOURCES Cochrane Library, CINAHL, PubMed, Scopus. REVIEW METHODS The Cochrane Library, CINAHL, PubMed, and Scopus were searched from inception through May 2023 for English language articles documenting "neuromodulation" and "tinnitus" stratified by sham-controlled randomized control trials with 40 or more patients. Data collected included Beck Anxiety Inventory, Beck Depression Inventory (BDI), Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire, and Visual Analog Scale. A Meta-analysis of continuous measures (mean) and proportions (%) were conducted. RESULTS A total of 19 randomized control trials (N = 1186) were included. The mean age was 48.4 ± 5.3 (range: 19-74), mean duration of tinnitus was 3.8 ± 3.4 years, 61% [56.2-65.7] male, and 55.7% [46-65] with unilateral tinnitus. The short-term effect of transcutaneous electrical nerve stimulation and transcranial direct current stimulation on THI score is -16.2 [-23.1 to -9.3] and -19 [-30.1 to -7.8], respectively. The long-term effect of repetitive transcranial magnetic stimulation on THI score is -8.6 [-11.5 to -5.7]. Transcranial direct current stimulation decreases BDI score by -11.8 [-13.3 to -10.3]. CONCLUSION As measured by the Tinnitus Handicap Index, our findings suggest the effects of transcutaneous electrical nerve stimulation and transcranial direct current stimulation reach significant benefit in the short term, whereas repetitive transcranial magnetic stimulation reaches significant benefit in the long term. Based on the BDI, transcranial direct current stimulation significantly reduces comorbid depression in patients with tinnitus.
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Affiliation(s)
- Luke D Heiland
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Johnny M Owen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Tan HT, Smith PF, Zheng Y. Time-dependent effects of acoustic trauma and tinnitus on extracellular levels of amino acids in the inferior colliculus of rats. Hear Res 2024; 443:108948. [PMID: 38219615 DOI: 10.1016/j.heares.2024.108948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
Chronic tinnitus is a debilitating condition with very few management options. Acoustic trauma that causes tinnitus has been shown to induce neuronal hyperactivity in multiple brain areas in the auditory pathway, including the inferior colliculus. This neuronal hyperactivity could be attributed to an imbalance between excitatory and inhibitory neurotransmission. However, it is not clear how the levels of neurotransmitters, especially neurotransmitters in the extracellular space, change over time following acoustic trauma and the development of tinnitus. In the present study, a range of amino acids were measured in the inferior colliculus of rats during acoustic trauma as well as at 1 week and 5 months post-trauma using in vivo microdialysis and high-performance liquid chromatography. Amino acid levels in response to sound stimulation were also measured at 1 week and 5 months post-trauma. It was found that unilateral exposure to a 16 kHz pure tone at 115 dB SPL for 1 h caused immediate hearing loss in all the animals and chronic tinnitus in 58 % of the animals. Comparing to the sham condition, extracellular levels of GABA were significantly increased at both the acute and 1 week time points after acoustic trauma. However, there was no significant difference in any of the amino acid levels measured between sham, tinnitus positive and tinnitus negative animals at 5 months post-trauma. There was also no clear pattern in the relationship between neurochemical changes and sound frequency/acoustic trauma/tinnitus status, which might be due to the relatively poorer temporal resolution of the microdialysis compared to electrophysiological responses.
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Affiliation(s)
- Huey Tieng Tan
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand; Brain Health Research Centre, University of Otago, Dunedin, New Zealand; Eisdell Moore Centre for Research on Hearing and Balance Disorders, University of Auckland, New Zealand
| | - Paul F Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand; Brain Health Research Centre, University of Otago, Dunedin, New Zealand; Eisdell Moore Centre for Research on Hearing and Balance Disorders, University of Auckland, New Zealand
| | - Yiwen Zheng
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand; Brain Health Research Centre, University of Otago, Dunedin, New Zealand; Eisdell Moore Centre for Research on Hearing and Balance Disorders, University of Auckland, New Zealand.
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Kong Q, Li T, Reddy S, Hodges S, Kong J. Brain stimulation targets for chronic pain: Insights from meta-analysis, functional connectivity and literature review. Neurotherapeutics 2024; 21:e00297. [PMID: 38237403 PMCID: PMC10903102 DOI: 10.1016/j.neurot.2023.10.007] [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: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 02/16/2024] Open
Abstract
Noninvasive brain stimulation (NIBS) techniques have demonstrated their potential for chronic pain management, yet their efficacy exhibits variability across studies. Refining stimulation targets and exploring additional targets offer a possible solution to this challenge. This study aimed to identify potential brain surface targets for NIBS in treating chronic pain disorders by integrating literature review, neuroimaging meta-analysis, and functional connectivity analysis on 90 chronic low back pain patients. Our results showed that the primary motor cortex (M1) (C3/C4, 10-20 EEG system) and prefrontal cortex (F3/F4/Fz) were the most used brain stimulation targets for chronic pain treatment according to the literature review. The bilateral precentral gyrus (M1), supplementary motor area, Rolandic operculum, and temporoparietal junction, were all identified as common potential NIBS targets through both a meta-analysis sourced from Neurosynth and functional connectivity analysis. This study presents a comprehensive summary of the current literature and refines the existing NIBS targets through a combination of imaging meta-analysis and functional connectivity analysis for chronic pain conditions. The derived coordinates (with integration of the international electroencephalography (EEG) 10/20 electrode placement system) within the above brain regions may further facilitate the localization of these targets for NIBS application. Our findings may have the potential to expand NIBS target selection beyond current clinical trials and improve chronic pain treatment.
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Affiliation(s)
- Qiao Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Tingting Li
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Sveta Reddy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Sierra Hodges
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA.
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Jeon SY, Choi JH, Kang SS, An YH, Shim HJ. Personalized Neuromodulation: A Novel Strategy for Improving Tinnitus Treatment. J Clin Med 2023; 12:6987. [PMID: 38002601 PMCID: PMC10672003 DOI: 10.3390/jcm12226987] [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: 10/02/2023] [Revised: 10/28/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
This study evaluated the efficacy of personalized neuromodulation, where treatment modalities are chosen based on the patient's responses in a pilot trial. A total of 71 patients with tinnitus were divided into two groups: a personalized group and a randomized neuromodulation group. In the personalized group (n = 35), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) were assessed in a pilot trial, and responsive modalities were administered to 16 patients, while the non-responders (n = 19) were randomly assigned to rTMS, tDCS, or combined modalities. Patients in the randomized group (n = 36) were randomly allocated to rTMS, tDCS, or combined modalities. The Tinnitus Handicap Inventory (THI) score improvement after 10 sessions of each neuromodulation was significantly greater in the personalized group than in the randomized group (p = 0.043), with no significant differences in tinnitus loudness, distress, or awareness. The treatment success rate was highest in the personalized responder subgroup (92.3%), and significantly greater than that in the non-responder subgroup (53.0%; p = 0.042) and the randomized group (56.7%; p = 0.033). Personalized neuromodulation, where the treatment modality is chosen based on the patient's responses in a pilot trial, is an advantageous strategy for treating tinnitus.
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Affiliation(s)
| | | | | | | | - Hyun Joon Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Republic of Korea; (S.Y.J.); (J.H.C.); (S.S.K.); (Y.-H.A.)
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7
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Nikakhlagh S, Fatahiasl J, Saki Malehi A, Tabibzadeh SM. The Evaluation of Effects of Electrical Stimulation in Treatment of Patients with Chronic Tinnitus with Normal Hearing Sensitivity. Indian J Otolaryngol Head Neck Surg 2023; 75:409-415. [PMID: 37206773 PMCID: PMC10188872 DOI: 10.1007/s12070-023-03503-z] [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: 10/04/2021] [Accepted: 01/14/2023] [Indexed: 02/09/2023] Open
Abstract
Tinnitus is usually associated with different comorbidities such as anxiety, annoyance and depression. Evidences have targeted two main places for tinnitus treatment, namely the auditory cortex and the dorsolateral prefrontal cortex (DLPFC). Transcranial direct current stimulation (tDCS) has been reportedly associated with improvement of cognitive functions in individuals. This study was conducted to evaluate the therapeutic effects of repeated sessions of anodal bifrontal tDCS on tinnitus symptoms. Furthermore, the tDCS impacts on the comorbid depression and anxiety of the patients were investigated. Forty-two voluntaries that suffers from chronic tinnitus were randomly assigned into "real tDCS" (n = 21) and "sham tDCS" (n = 21) groups. The tDCS group, received tDCS with the protocol consisted of 2 mA current, daily one session of 20 min, 6 consecutive days per week and for 4 consecutive weeks. The tinnitus handicap inventory (THI) scale, was measured before the first tDCS session and at one-week and two weeks follow-up. With the same intervals; the distress-related tinnitus was evaluated using visual analogue scale. Depression and anxiety scores were also measured using the Beck depression inventory and Beck anxiety inventory scales, respectively. Our findings indicated that THI score, depression and anxiety level has been gradually diminished across subsequent measurement intervals. We also find significant reduction of distress-related tinnitus in the real-tDCS group after treatment. We conclude that application of tDCS to the bilateral DLPFC region alleviates chronic tinnitus and it should be considered in patients with refractory tinnitus.
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Affiliation(s)
- Soheila Nikakhlagh
- Hearing Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Jafar Fatahiasl
- Hearing Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Amal Saki Malehi
- Hearing Research Center, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
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8
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Cardon E, Jacquemin L, Vermeersch H, Joossen I, Moyaert J, Mertens G, Vanderveken OM, Lammers MJW, Van de Heyning P, Van Rompaey V, Gilles A. Dual-site transcranial direct current stimulation to treat tinnitus: a randomized controlled trial. Brain 2022; 145:4222-4231. [PMID: 36450310 PMCID: PMC9762937 DOI: 10.1093/brain/awac263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 12/03/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been proposed as a potential intervention for subjective tinnitus, but supporting evidence remains limited. We aimed to investigate the effect of anodal high-definition tDCS of the left temporal area and right dorsolateral prefrontal cortex on tinnitus severity. This double-blind randomized controlled trial included 77 patients (age range 18-79, 43 male) with chronic subjective tinnitus as their primary complaint. Thirty-eight subjects received six consecutive sessions of dual-site sequential high-definition-tDCS with electrodes positioned over the left temporal area and right dorsolateral prefrontal cortex. Both areas were stimulated for 15 min per session, with total stimulation time amounting to 30 min. Thirty-nine subjects received sham stimulation. The primary outcome measure was the change in tinnitus severity, as evaluated by the Tinnitus Functional Index, from baseline to a follow-up visit at 8 ± 2 weeks after treatment completion. Secondary outcomes included changes in perceived tinnitus loudness, as measured with a visual analogue scale and a tinnitus matching procedure, as well as scores on the Hospital Anxiety and Depression Scale, and the Hyperacusis Questionnaire. No differences in Tinnitus Functional Index change scores were identified between the active treatment and sham control groups (linear regression: P = 0.86). The Tinnitus Functional Index scores decreased significantly over time in both groups (P = 0.0012), indicating the presence of a considerable placebo effect. These change scores were significantly influenced by sex (linear regression: P = 0.037) and baseline symptoms of anxiety (linear regression: P = 0.049) in both groups. In general, Tinnitus Functional Index scores decreased more profoundly in males and in subjects with a higher degree of anxiety at baseline. None of the included secondary measures differed significantly between experimental arms. Our results suggest that dual-site sequential high-definition-tDCS of the left temporal area and right dorsolateral prefrontal cortex does not alleviate tinnitus severity. Interestingly, in our study population, fluctuations in tinnitus severity were influenced by gender and concurrent mental condition. It is therefore important to take these factors into account when conducting or planning randomized controlled trials in tinnitus populations.
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Affiliation(s)
- Emilie Cardon
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Laure Jacquemin
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Hanne Vermeersch
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Iris Joossen
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Julie Moyaert
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Griet Mertens
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J W Lammers
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
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Smeele SJ, Adhia DB, De Ridder D. Feasibility and Safety of High-Definition Infraslow Pink Noise Stimulation for Treating Chronic Tinnitus—A Randomized Placebo-Controlled Trial. Neuromodulation 2022:S1094-7159(22)01339-3. [DOI: 10.1016/j.neurom.2022.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022]
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Olszewski J, Bielińska M, Kowalski AJ. Assessment of Subjective Tinnitus Treatment Results Using a Prototype Device for Electrical and Magnetic Stimulation of the Ear-Preliminary Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12060918. [PMID: 35743949 PMCID: PMC9225432 DOI: 10.3390/life12060918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Abstract
Background: The aim of the study was to evaluate the effectiveness of subjective tinnitus treatment in patients with cochlear sensorineural hearing loss with magnetic ear stimulation using a prototype device. Since the 1970s, studies have been conducted on the use of electrical stimulation of the ear in the treatment of tinnitus. The available literature contains various hypotheses about the influence of electrical stimulation of the ear on tinnitus. Material and Methods: Preclinical studies were performed for 100 patients, 40 women and 60 men (124 ears in total), aged 38-72 years, treated for tinnitus. A subjective assessment of the loudness of tinnitus was performed, and the frequency and intensity as well as hearing threshold were determined using a prototype device for electro-magnetic stimulation of the ear. The treatment cycle consisted of 10 five-minute stimulations performed daily 5 times a week. Results: Before treatment, persistent tinnitus was found in 100 ears (80.6%) and periodic tinnitus in 24 ears (19.4%). Immediately after treatment, persistent tinnitus was present only in 50 ears (40.3%) and periodic tinnitus in 40 ears (32.3%). Complete resolution of tinnitus was noted in 34 ears (27.4%). On the other hand, the examination performed 3 months after the treatment showed persistent tinnitus in 40 ears (32.3%) and periodic tinnitus in 50 ears (40.3%), and complete resolution of tinnitus was recorded in 34 ears (27.4%). Based on the VAS analog scale, there was an improvement in tinnitus in 98 ears (79.0%) immediately after treatment and no improvement in 26 ears (20.0%). The mean VAS scale before treatment was 4.9 points, after treatment it was 2.1 points and 3 months after treatment it was 1.9 points. Conclusions: The preliminary research results show the high effectiveness of magnetic stimulation in the treatment of tinnitus with the use of a prototype device for electromagnetic stimulation of the ear. There was no negative effect of the stimulation on hearing or tinnitus.
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Random Forest Classification to Predict Response to High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief: A Preliminary Feasibility Study. Ear Hear 2022; 43:1816-1823. [PMID: 35666538 PMCID: PMC9592176 DOI: 10.1097/aud.0000000000001246] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex has been hypothesized to reduce tinnitus severity by modifying cortical activity in brain regions associated with the perception of tinnitus. However, individual response to tDCS has proven to be variable. We investigated the feasibility of using random forest classification to predict the response to high-definition (HD) tDCS for tinnitus relief. DESIGN A retrospective analysis was performed on a dataset consisting of 99 patients with subjective tinnitus receiving six consecutive sessions of HD-tDCS at the Antwerp University Hospital. A baseline assessment consisted of pure-tone audiometry and a set of questionnaires including the Tinnitus Functional Index (TFI), Hospital Anxiety and Depression Scale, and Edinburgh Handedness Inventory. Random forest classification was applied to predict, based on baseline questionnaire scores and hearing levels, whether each individual responded positively to the treatment (defined as a decrease of at least 13 points on the TFI). Further testing of the model was performed on an independent cohort of 32 patients obtained from the tinnitus center at the University of Regensburg. RESULTS Twenty-four participants responded positively to the HD-tDCS treatment. The random forest classifier predicted treatment response with an accuracy of 85.71% (100% sensitivity, 81.48% specificity), significantly outperforming a more traditional logistic regression approach. Performance of the classifier on an independent cohort was slightly but not significantly above chance level (71.88% accuracy, 66.67% sensitivity, 73.08% specificity). Feature importance analyses revealed that baseline tinnitus severity, co-occurrence of depressive symptoms and handedness were the most important predictors of treatment response. Baseline TFI scores were significantly higher in responders than in nonresponders. CONCLUSIONS The proposed random forest classifier predicted treatment response with a high accuracy, significantly outperforming a more traditional statistical approach. Machine learning methods to predict treatment response might ultimately be used in a clinical setting to guide targeted treatment recommendations for individual tinnitus patients.
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Martins ML, Souza DDS, Cavalcante MEDOB, Barboza HN, de Medeiros JF, Dos Santos Andrade SMM, Machado DGDS, da Rosa MRD. Effect of transcranial Direct Current Stimulation for tinnitus treatment: A systematic review and meta-analysis. Neurophysiol Clin 2022; 52:1-16. [PMID: 35027291 DOI: 10.1016/j.neucli.2021.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To evaluate the effect of tDCS on tinnitus distress, loudness and psychiatric symptoms. METHODS A systematic literature search of PubMed, Web of Science, Cochrane Library, VHL, EMBASE, PsycINFO, OVID, and CINAHL databases was carried out on articles published until July 2021. Inclusion criteria were published controlled trials using tDCS intervention with tinnitus patients, using a sham/control group, and measuring tinnitus loudness, distress and/or psychiatric symptoms. A meta-analysis was performed for the overall effect as well as to compare subgroups according to tDCS target (left temporoparietal area (LTA) and dorsolateral prefrontal cortex (DLPFC)). RESULTS Fourteen articles with 1031 participants were included. Six studies applied tDCS over the DLPFC, six over the LTA and two over both areas. Although the overall meta-analysis showed that tDCS significantly decreased tinnitus loudness (SMD=-0.35; 95%CI=-0.62 to -0.08, p = 0.01) and distress (SMD=-0.50, 95%CI=-0.91 to -0.10, p = 0.02).The subgroup analysis showed a significant effect only for tDCS over LTA for loudness (SMD=-0.46, 95%CI=-0.80 to -0.12, p = 0.009), and no other area resulted in significant change. There was no significant effect of treatment on psychiatric symptoms. CONCLUSION tDCS may improve tinnitus loudness and distress with a small to moderate effect size. Despite the overall positive effect, only LTA tDCS yielded a significant effect. Further well-controlled studies with larger sample sizes and broader exploration of tDCS montages and doses are warranted.
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Affiliation(s)
- Mariana Lopes Martins
- Department of Speech-Language Pathology, Federal University of Paraiba, João Pessoa, PB 58051-900, Brazil.
| | - Dayse da Silva Souza
- Department of Neuroscience and Cognition, Federal University of ABC, São Paulo, SP 09606-070, Brazil
| | | | - Hionara Nascimento Barboza
- Department of Speech-Language Pathology, Federal University of Paraiba, João Pessoa, PB 58051-900, Brazil
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13
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Mares T, Albrecht J, Buday J, Podgorna G, Le TH, Magyarova E, Poshor K, Halik J, Buna J, Capek V, Kostylkova L, Klasova J, Fabian V, Anders M. Long-term effect of transcranial direct current stimulation in the treatment of chronic tinnitus: A randomized, placebo-controlled trial. Front Psychiatry 2022; 13:969800. [PMID: 36311525 PMCID: PMC9606613 DOI: 10.3389/fpsyt.2022.969800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Tinnitus is an intrusive and chronic illness affecting a significant portion of the population, decreasing affected individuals' quality of life and socioeconomic functioning. Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulatory method utilizing weak electrical currents to elicit short and long-term central nervous system changes. Several studies have proven its effect on tinnitus. We aimed to broaden the knowledge and provide data on the effect and its retention. METHODS In the randomized, double-blinded, sham-controlled trial, 39 patients (active n = 19, sham n = 20) underwent bifrontal tDCS (anode over right dorsolateral prefrontal cortex (DLPFC), cathode left DLPFC, current of 1.5 mA, 20 min, 6 sessions in 2 weeks). Tinnitus Functional Index (TFI), Iowa Tinnitus Handicap Questionnaire (ITHQ), Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (SDS), and WHO-Quality of Life-BREF were employed in 4 evaluation points, including the follow-ups of 6 weeks and 6 months. RESULTS We reached a delayed, significant long-term improvement (p < 0.05) in auditory difficulties associated with tinnitus and noticed it even after 6 months compared to placebo. We also reached a short-term, negative effect in the psychological domain of WHO-Quality of Life-BREF (p < 0.05). Not all subdomains of TFI and ITHQ reached statistical significance during the data analysis, even though specific positive trends were noticed. CONCLUSION We proved partial, positive, long-term effects of tDCS on tinnitus and short-term, negative, transient effect on a specific aspect of the general quality of life. We expanded upon the results of previous trials and provided data concerning the longevity and the precise effect of multiple sessions, bifrontal DLPFC tDCS. Our sample size (n = 39) was limited, which might have contributed to the lesser statistical power of the analyzed items. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT05437185].
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Affiliation(s)
- Tadeas Mares
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Jakub Albrecht
- Department of Psychiatry, Krajska zdravotni a.s. - Most Hospital, Most, Czechia
| | - Jozef Buday
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Gabriela Podgorna
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Thai Hong Le
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Eva Magyarova
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Katerina Poshor
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jakub Halik
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jan Buna
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Vaclav Capek
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Lenka Kostylkova
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Johana Klasova
- Department of Internal Medicine, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czechia
| | - Vratislav Fabian
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Martin Anders
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
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14
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Yang T, Zhang J, Wang B, Zhang W, Xu M, Yang S, Liu H. Electrical stimulation to treat tinnitus: a meta-analysis and systemic review of randomized controlled trials. Ther Adv Chronic Dis 2021; 12:20406223211041069. [PMID: 34729140 PMCID: PMC8442493 DOI: 10.1177/20406223211041069] [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: 04/14/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIMS Tinnitus is one of the most common otological symptoms that patients experience, and it can be debilitating. No effective drug treatments are available for tinnitus, although considerable research investigating its mechanisms and possible treatments is underway. Electrical stimulation has been considered a promising and well-tolerated therapeutic strategy for tinnitus. This meta-analysis study was aimed to investigate the efficacy, safety and tolerability of electrical stimulation in patients with tinnitus. METHODS Relevant studies were retrieved from the Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature (CBM), Wanfang and Weipu databases. The Tinnitus Handicap Inventory (THI) and the visual analogue scale (VAS) which focus on loudness and distress evaluation (0-10 points) were used to assess perceived tinnitus suppression after treatment. Subgroup analysis was also performed based on different stimulating areas and methods, follow-up times, tinnitus duration and electrical current intensity. Review Manager 5.4 software was used for data synthesis, and Stata 15.1 software was used for analyses of publication bias and sensitivity. RESULTS Our meta-analysis included 11 studies involving a total of 447 patients with tinnitus. The results showed that electrical stimulation significantly reduced THI scores [mean difference (MD) = -9.69; 95% confidence interval (CI) = -14.25, -5.13; p < 0.0001; I 2 = 80%] and VAS scores between the two groups (VAS loudness scores, MD = -0.72; 95% CI = -1.20, -0.25; VAS distress scores, MD = -0.90; 95% CI = -1.17, -0.63). In addition, subgroup analysis showed that THI scores in electrical stimulation group of different stimulating areas and methods follow-up times, tinnitus duration and electrical current intensity were generally reduced, regardless of the acute or subacute tinnitus group or left temporoparietal area (LTA) group with no statistical significance between two groups. CONCLUSION Overall, electrical stimulation may be an effective and well-tolerated treatment option for tinnitus.
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Affiliation(s)
- Ting Yang
- Xi’an Medical University, Xi’an, China
| | - Jin Zhang
- Department of Otolaryngology, Shaanxi
Provincial People’s Hospital, Xi’an, China
| | - Bing Wang
- Department of Otolaryngology, Shaanxi
Provincial People’s Hospital, Xi’an, China
| | - Wen Zhang
- Department of Otolaryngology, Shaanxi
Provincial People’s Hospital, Xi’an, China
| | - Min Xu
- Department of Otolaryngology, Shaanxi
Provincial People’s Hospital, Xi’an, China
| | | | - Hui Liu
- Department of Otolaryngology, Shaanxi
Provincial People’s Hospital, Xi’an, 710068, China
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15
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Kok TE, Varley R, Shekhawat GS. Survey of tinnitus patients' acceptance of high-definition transcranial direct current stimulation as a management option. Int J Audiol 2021; 61:507-514. [PMID: 34120554 DOI: 10.1080/14992027.2021.1933622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate acceptance of high-definition transcranial direct current stimulation (HD-tDCS) as a management option for tinnitus. DESIGN Participants completed an online version of the Tinnitus Functional Index (TFI), after which they recorded their satisfaction ratings with different hypothetical intervention outcomes on a 10-point rating scale using Opinio survey software. STUDY SAMPLE Data from 272 tinnitus sufferers from English-speaking regions worldwide were collected, of which the majority had moderate to severe tinnitus as per TFI. RESULTS The survey showed that HD-tDCS was considered an acceptable form of tinnitus management, and that the satisfaction rating depended significantly on a number of factors: (1) the strength of the tinnitus reduction following the intervention (p < 0.001); 2) the duration of the intervention (p < 0.001); and (3) the effects of the intervention on either tinnitus loudness or tinnitus-related distress (p < 0.001). Respondents rated their satisfaction with the intervention 10/10 only if it completely eliminated tinnitus loudness, although reductions of 50-80% were also rated highly acceptable. No association was found between tinnitus severity and acceptability ratings. CONCLUSIONS These findings are important for future HD-tDCS trials for tinnitus, as they demonstrate the need to optimise stimulation protocols to increase effect sizes and decrease time spent on the treatment.
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Affiliation(s)
| | - Rosemary Varley
- Psychology and Language Sciences, University College London, London, UK
| | - Giriraj Singh Shekhawat
- Ear Institute, University College London, London, UK.,College of Nursing & Health Sciences, Flinders University, Adelaide, Australia.,Public Relations Manager, Tinnitus Research Initiative, Germany
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16
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Simoes JP, Daoud E, Shabbir M, Amanat S, Assouly K, Biswas R, Casolani C, Dode A, Enzler F, Jacquemin L, Joergensen M, Kok T, Liyanage N, Lourenco M, Makani P, Mehdi M, Ramadhani AL, Riha C, Santacruz JL, Schiller A, Schoisswohl S, Trpchevska N, Genitsaridi E. Multidisciplinary Tinnitus Research: Challenges and Future Directions From the Perspective of Early Stage Researchers. Front Aging Neurosci 2021; 13:647285. [PMID: 34177549 PMCID: PMC8225955 DOI: 10.3389/fnagi.2021.647285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/19/2021] [Indexed: 12/15/2022] Open
Abstract
Tinnitus can be a burdensome condition on both individual and societal levels. Many aspects of this condition remain elusive, including its underlying mechanisms, ultimately hindering the development of a cure. Interdisciplinary approaches are required to overcome long-established research challenges. This review summarizes current knowledge in various tinnitus-relevant research fields including tinnitus generating mechanisms, heterogeneity, epidemiology, assessment, and treatment development, in an effort to highlight the main challenges and provide suggestions for future research to overcome them. Four common themes across different areas were identified as future research direction: (1) Further establishment of multicenter and multidisciplinary collaborations; (2) Systematic reviews and syntheses of existing knowledge; (3) Standardization of research methods including tinnitus assessment, data acquisition, and data analysis protocols; (4) The design of studies with large sample sizes and the creation of large tinnitus-specific databases that would allow in-depth exploration of tinnitus heterogeneity.
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Affiliation(s)
- Jorge Piano Simoes
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Elza Daoud
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Maryam Shabbir
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sana Amanat
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research Pfizer/University of Granada/Junta de Andalucía, PTS, Granada, Spain
| | - Kelly Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Clinical and Experimental Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
- Cochlear Technology Centre, Mechelen, Belgium
| | - Roshni Biswas
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Laboratory of Lifestyle Epidemiology, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Chiara Casolani
- Hearing Systems, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
- Oticon A/S, Smoerum, Denmark
- Interacoustics Research Unit, Lyngby, Denmark
| | - Albi Dode
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Falco Enzler
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Laure Jacquemin
- Department of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Mie Joergensen
- Hearing Systems, Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
- WS Audiology, Lynge, Denmark
| | - Tori Kok
- Ear Institute, University College London, London, United Kingdom
| | - Nuwan Liyanage
- University of Zurich, Zurich, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matheus Lourenco
- Experimental Health Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
- Health Psychology Research Group, Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Punitkumar Makani
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
| | - Muntazir Mehdi
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Anissa L. Ramadhani
- Radiological Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Constanze Riha
- Chair of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jose Lopez Santacruz
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
| | - Axel Schiller
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Natalia Trpchevska
- Department of Physiology and Pharmacology, Experimental Audiology Laboratory, Karolinska Institutet, Stockholm, Sweden
| | - Eleni Genitsaridi
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottingham Biomedical Research Centre, National Institute for Health Research, Nottingham, United Kingdom
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17
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Rucker B, Umbarger E, Ottwell R, Arthur W, Brame L, Woodson E, Wright DN, Hartwell M, Khojasteh J, Vassar M. Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses Focused on Tinnitus. Otol Neurotol 2021; 42:1237-1244. [PMID: 33973954 DOI: 10.1097/mao.0000000000003178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HYPOTHESIS The objective was to investigate the prevalence of spin in abstracts of systematic reviews and meta-analyses covering the treatment of tinnitus. We hypothesized that spin would be present in these articles and a significant relationship would exist between spin usage and extracted study characteristics. BACKGROUND Spin, the misrepresentation of study findings, can alter a clinician's interpretation of a study's results, potentially affecting patient care. Previous work demonstrates that spin is present in abstracts of randomized clinical trials. METHODS Using a cross-sectional analysis, we conducted a systematic search using MEDLINE and Embase databases on June 2, 2020, for systematic reviews focused on tinnitus treatment. Investigators performed screening and data extraction in a masked, duplicate fashion. RESULTS Forty systematic reviews met inclusion criteria, and spin was identified in four of them. Spin in abstracts most frequently occurred when conclusions claimed the beneficial effect of the experimental treatment despite high risk of bias in primary studies (n = 3). The other form of spin found was the conclusion claims safety based on nonstatistically significant results with a wide confidence interval (n = 1). There was no significant association between spin and any of our extracted study characteristics. CONCLUSION Spin was observed in 10% of abstracts of systematic reviews and meta-analyses covering the treatment of tinnitus. Although this percentage may be small, we recommend that medical journals provide a more detailed framework for abstract structure and require the inclusion of risk of bias assessment results in abstracts to prevent the incorporation of spin.
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Affiliation(s)
| | | | | | | | - Lacy Brame
- Office of Medical Student Research
- Department of Otolaryngology-Head and Neck Surgery, Oklahoma State University Medical Center
| | - Elena Woodson
- Department of Otolaryngology-Head and Neck Surgery, Oklahoma State University Medical Center
| | - Drew N Wright
- Samuel J. Wood Library & C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York
| | - Micah Hartwell
- Office of Medical Student Research
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences
| | - Jam Khojasteh
- School of Educational Foundations, Leadership and Aviation, Oklahoma State University, Tulsa, Oklahoma
| | - Matt Vassar
- Office of Medical Student Research
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences
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18
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Labree B, Hoare DJ, Gascoyne LE, Sereda M. Determining the effects of transcranial direct current stimulation on tinnitus and tinnitus-related outcomes: protocol for a systematic review. BMJ Open 2021; 11:e047191. [PMID: 33771831 PMCID: PMC8006855 DOI: 10.1136/bmjopen-2020-047191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Tinnitus is the awareness of a sound in the ear or head in the absence of an external source. It affects around 10%-15% of people. About 20% of people with tinnitus also experience symptoms such as depression or anxiety that negatively affect their life. Transcranial direct current stimulation (tDCS) is a technique involving constant low-intensity direct current delivered via electrodes on the head. It is postulated to modulate (suppress or enhance) neural activity in the region between electrodes. As such, it represents a potential treatment option for tinnitus, as well as comorbid depression or anxiety. This systematic review will estimate the effects of tDCS on outcomes relevant to tinnitus. In addition, it will determine whether there is any relationship between stimulation parameters (electrode montage, current intensity, and length and frequency of stimulation sessions) and the effect of tDCS on these outcomes. METHODS AND ANALYSIS Electronic searches for peer-reviewed journal articles will be performed in the Cochrane Register of Studies online (the Cochrane Ear, Nose and Throat Disorders Group Register and CENTRAL, current issue), PubMed, EMBASE, CINAHL, LILACS, KoreaMed, IndMed, PakMediNet, CNKI, AMED, PsycINFO, Web of Science, ClinicalTrials.gov, ICTRP and Google Scholar using the following search terms: transcranial Direct Current Stimulation OR tDCS AND tinnitus OR depression OR anxiety OR quality of life OR adverse effects OR neurophys*.Searches were not limited by date. Methods are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Randomised controlled trials will be included if they report at least one of the following outcomes: tinnitus symptom severity, anxiety or depression as measured by relevant validated instruments. Where available, data on quality of life, adverse effects and neurophysiological changes will also be reviewed. In addition to an analysis of the effect of each parameter, an analysis will be performed to uncover any interactions between parameters. Where appropriate, meta-analyses will be performed. ETHICS AND DISSEMINATION This systematic review will make use of secondary data only. As no data will be obtained from participants directly, ethical approval has not been sought. No other ethical issues are foreseen. Findings will be submitted for peer-reviewed publication and presented at academic conferences. The results of this review will inform future research. PROSPERO REGISTRATION NUMBER CRD42020185567.
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Affiliation(s)
- Bas Labree
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Derek J Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Lauren E Gascoyne
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham, UK
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19
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Chen JJ, Zeng BS, Wu CN, Stubbs B, Carvalho AF, Brunoni AR, Su KP, Tu YK, Wu YC, Chen TY, Lin PY, Liang CS, Hsu CW, Hsu SP, Kuo HC, Chen YW, Tseng PT, Li CT. Association of Central Noninvasive Brain Stimulation Interventions With Efficacy and Safety in Tinnitus Management: A Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 146:801-809. [PMID: 32644131 DOI: 10.1001/jamaoto.2020.1497] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Tinnitus has a prevalence of 10% to 25% and is frequently associated with numerous complications, such as neuropsychiatric disease. Traditional treatments have failed to meet the needs of patients with tinnitus. Noninvasive brain stimulation (NIBS) can focally modify cortical functioning and has been proposed as a strategy for reducing tinnitus severity. However, the results have been inconclusive. Objective To evaluate the association between different central NIBS therapies and efficacy and acceptability for treatment of tinnitus. Data Sources ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, and Web of Science databases were searched from inception to August 4, 2019. No language restriction was applied. Manual searches were performed for potentially eligible articles selected from the reference lists of review articles and pairwise meta-analyses. Study Selection Randomized clinical trials (RCTs) examining the central NIBS method used in patients with unilateral or bilateral tinnitus were included in the current network meta-analysis. The central NIBS method was compared with sham, waiting list, or active controls. Studies that were not clinical trials or RCTs and did not report the outcome of interest were excluded. Data Extraction and Synthesis Two authors independently screened the studies, extracted the relevant information, and evaluated the risk of bias in the included studies. In cases of discrepancy, a third author became involved. If manuscript data were not available, the corresponding authors or coauthors were approached to obtain the original data. This network meta-analysis was based on the frequentist model. Main Outcomes and Measures The primary outcome was change in the severity of tinnitus. Secondary outcomes were changes in quality of life and the response rate related to the NIBS method in patients with tinnitus. Results Overall, 32 unique RCTs were included with 1458 unique participants (mean female proportion, 34.4% [range, 0%-81.2%]; mean age, 49.6 [range, 40.0-62.8] years; median age, 49.8 [interquartile range, 48.1-52.4] years). The results of the network meta-analysis revealed that cathodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex combined with transcranial random noise stimulation over the bilateral auditory cortex was associated with the greatest improvement in tinnitus severity (standardized mean difference [SMD], -1.89; 95% CI, -3.00 to -0.78) and quality of life (SMD, -1.24; 95% CI, -2.02 to -0.45) compared with the controls. Improvement in tinnitus severity ranked more favorably for continuous theta-burst stimulation (cTBS) over both auditory cortices (SMD, -0.79; 95% CI = -1.57 to -0.01) than cTBS over only the left auditory cortex (SMD, -0.30; 95% CI, -0.87 to 0.28), compared with controls. Repetitive transcranial magnetic stimulation with priming had a superior beneficial association with tinnitus severity compared with the strategies without priming. None of the investigated NIBS types had a significantly different dropout rate compared with that of the control group. Conclusions and Relevance This network meta-analysis suggests a potential role of NIBS interventions in tinnitus management. Future large-scale RCTs focusing on longer follow-up and different priming procedure NIBS are warranted to confirm these findings.
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Affiliation(s)
- Jiann-Jy Chen
- Department of Neurology, E-Da Cancer Hospital, Kaohsiung, Taiwan.,Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung City, Taiwan
| | - Bing-Syuan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychological Medicine, London, United Kingdom.,Physiotherapy Department, South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom.,Positive Ageing Research Institute (PARI), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of Sao Paulo, Sao Paulo, Brazil.,Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Kuan-Pin Su
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychological Medicine, London, United Kingdom.,Department of Psychiatry and Mind-Body Interface Laboratory, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital/School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hung-Chang Kuo
- Department of Neurology, E-Da Hospital/School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung City, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung City, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Comparison of Treatment Outcome between Repetitive Transcranial Magnetic Stimulation (rTMS) and Transcutaneous Direct Current Stimulation (tDCS) in Intractable Tinnitus. J Clin Med 2021; 10:jcm10040635. [PMID: 33562396 PMCID: PMC7916028 DOI: 10.3390/jcm10040635] [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: 01/06/2021] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) and transcutaneous direct current stimulation (tDCS) are non-invasive treatments for chronic tinnitus based on neuromodulation of cortical activity. Both are considered effective, but with heterogeneous results due to lack of established protocols. Because the target groups for both modalities overlap, it is difficult to recommend one of them. We tried to unify the inclusion criteria and treatment schedules to compare the two modalities. The medical charts of 36 patients who underwent rTMS as part of clinical routine were reviewed and data for 34 patients who underwent tDCS about 7 years later were collected prospectively. Both groups had chronic unilateral tinnitus refractory to medication. Patients were treated for 5 consecutive days, and tinnitus symptoms were evaluated by survey both at the end of the treatment schedule and 1 month after the treatment. The ratio of responders who showed >20% reduction in tinnitus handicap inventory scores were compared. At the end of the treatment, the rTMS group showed a rapid response compared to the tDCS group (rTMS, 30.6%; tDCS, 12.1%; p = 0.054). However, both groups showed a significant and similar reduction in tinnitus symptoms 1 month after the treatment (rTMS, 47.2%; tDCS, 36.4%; p = 0.618). As both groups showed comparable results for tinnitus reduction, tDCS may be superior in terms of cost-effectiveness.
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21
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Jacquemin L, Mertens G, Shekhawat GS, Van de Heyning P, Vanderveken OM, Topsakal V, De Hertogh W, Michiels S, Beyers J, Moyaert J, Van Rompaey V, Gilles A. High Definition transcranial Direct Current Stimulation (HD-tDCS) for chronic tinnitus: Outcomes from a prospective longitudinal large cohort study. PROGRESS IN BRAIN RESEARCH 2021; 263:137-152. [PMID: 34243886 DOI: 10.1016/bs.pbr.2020.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Transcranial Direct Current Stimulation (tDCS) aims to induce cortical plasticity by modulating the activity of brain structures. The broad stimulation pattern, which is one of the main limitations of tDCS, can be overcome with the recently developed technique called High-Definition tDCS (HD-tDCS). OBJECTIVE Investigation of the effect of HD-tDCS on tinnitus in a large patient cohort. METHODS This prospective study included 117 patients with chronic, subjective, non-pulsatile tinnitus who received six sessions of anodal HD-tDCS of the right Dorsolateral Prefrontal Cortex (DLPFC). Therapy effects were assessed by use of a set of standardized tinnitus questionnaires filled out at the pre-therapy (Tpre), post-therapy (T3w) and follow-up visit (T10w). Besides collecting the questionnaire data, the perceived effect (i.e., self-report) was also documented at T10w. RESULTS The Tinnitus Functional Index (TFI) and Tinnitus Questionnaire (TQ) total scores improved significantly over time (pTFI<0.01; pTQ<0.01), with the following significant post hoc comparisons: Tpre vs. T10w (pTFI<0.05; pTQ<0.05) and T3w vs. T10w (pTFI<0.01; pTQ<0.01). The percentage of patients reporting an improvement of their tinnitus at T10w was 47%. Further analysis revealed a significant effect of gender with female patients showing a larger improvement on the TFI and TQ (pTFI<0.01; pTQ<0.05). CONCLUSIONS The current study reported the effects of HD-tDCS in a large tinnitus population. HD-tDCS of the right DLPFC resulted in a significant improvement of the tinnitus perception, with a larger improvement for the female tinnitus patients.
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Affiliation(s)
- Laure Jacquemin
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.
| | - Griet Mertens
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Giriraj Singh Shekhawat
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Ear Institute, University College London, London, United Kingdom; Tinnitus Research Initiative, Regensburg, Germany
| | - Paul Van de Heyning
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Olivier M Vanderveken
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Vedat Topsakal
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Sarah Michiels
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Jolien Beyers
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Julie Moyaert
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Annick Gilles
- University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium; Department of Education, Health & Social Work, University College Ghent, Ghent, Belgium
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Abstract
The pathophysiological mechanisms that underlie the generation and maintenance of tinnitus are being unraveled progressively. Based on this knowledge, a large variety of different neuromodulatory interventions have been developed and are still being designed, adapting to the progressive mechanistic insights in the pathophysiology of tinnitus. rTMS targeting the temporal, temporoparietal, and the frontal cortex has been the mainstay of non-invasive neuromodulation. Yet, the evidence is still unclear, and therefore systematic meta-analyses are needed for drawing conclusions on the effectiveness of rTMS in chronic tinnitus. Different forms of transcranial electrical stimulation (tDCS, tACS, tRNS), applied over the frontal and temporal cortex, have been investigated in tinnitus patients, also without robust evidence for universal efficacy. Cortex and deep brain stimulation with implanted electrodes have shown benefit, yet there is insufficient data to support their routine clinical use. Recently, bimodal stimulation approaches have revealed promising results and it appears that targeting different sensory modalities in temporally combined manners may be more promising than single target approaches.While most neuromodulatory approaches seem promising, further research is required to help translating the scientific outcomes into routine clinical practice.
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Milner R, Lewandowska M, Ganc M, Nikadon J, Niedziałek I, Jędrzejczak WW, Skarżyński H. Electrophysiological correlates of focused attention on low- and high-distressed tinnitus. PLoS One 2020; 15:e0236521. [PMID: 32756593 PMCID: PMC7406215 DOI: 10.1371/journal.pone.0236521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/07/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The study aimed at determining the EEG correlates of concentration on either low or high-distressed tinnitus. METHODS Sixty-seven patients (36 women, mean age = 50.34 ± 12.94 years) with chronic tinnitus were assigned to either a high (HD) or low (LD) tinnitus-related distress group based on THI results. All participants took part in the EEG study comprising two 3-4 min blocks of focusing on either tinnitus (Tinnitus Focus Condition, TFC) or the sensations from one's own body (Body Focus Condition, BFC). The absolute power and current density of 8 frequency bands in 7 clusters were compared between conditions and groups. RESULTS The most pronounced differences were found in the HD patients in the TFC, relative to the BFC, i.e. reduced power of frontally distributed low alpha (8-10 Hz) and posterior high alpha (10-12 Hz) as well as lower current density of 8-10 Hz rhythm over the right frontal/anterior cingulate cortex and higher middle beta (15-18 Hz) density in the precuneus. The HD, relative to LD patients, in both conditions, exhibited increased low beta (12-15 Hz) power over the left middle area and greater higher beta (15-25 Hz) power in the left posterior region. CONCLUSIONS The present study contrasted bioelectrical activity, acquired when concentrating on tinnitus with EEG data collected whilst patients focused on their body. Decreased alpha power and current density in the frontal/cingulate cortex when listening to bothersome tinnitus might reflect greater cortical arousal whereas increased beta power and density in the precuneus/posterior cingulate activity in this condition could be indicative for elevated tension or augmented cognitive/emotional processing of tinnitus sound. Enhanced beta rhythm in patients with high versus low tinnitus distress, observed independently of the study condition, may be due to greater self-focused attention or more active processing of sensations derived from the own body.
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Affiliation(s)
- Rafał Milner
- Department of Experimental Audiology, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
| | - Monika Lewandowska
- Institute of Psychology, Faculty of Philosophy and Social Sciences, Nicolaus Copernicus University, Toruń, Poland
| | - Małgorzata Ganc
- Department of Experimental Audiology, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
| | - Jan Nikadon
- Centre for Modern Interdisciplinary Technologies, Nicolaus Copernicus University, Toruń, Poland
| | - Iwona Niedziałek
- Audiology and Phoniatrics Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
| | - Wiesław Wiktor Jędrzejczak
- Department of Experimental Audiology, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
| | - Henryk Skarżyński
- Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw, Poland
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Deklerck AN, Marechal C, Pérez Fernández AM, Keppler H, Van Roost D, Dhooge IJM. Invasive Neuromodulation as a Treatment for Tinnitus: A Systematic Review. Neuromodulation 2019; 23:451-462. [DOI: 10.1111/ner.13042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/09/2019] [Accepted: 07/31/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Ann N. Deklerck
- Faculty of Medicine and Health Sciences, Department of Head and Skin Gent University Ghent Belgium
| | - Celine Marechal
- Faculty of Medicine and Health Sciences, Department of Head and Skin Gent University Ghent Belgium
| | | | - Hannah Keppler
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences Ghent University Ghent Belgium
- Department of Otorhinolaryngology Ghent University Hospital Ghent Belgium
| | - Dirk Van Roost
- Department of Neurosurgery Ghent University Hospital Ghent Belgium
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair Ghent University Ghent Belgium
| | - Ingeborg J. M. Dhooge
- Faculty of Medicine and Health Sciences, Department of Head and Skin Gent University Ghent Belgium
- Department of Otorhinolaryngology Ghent University Hospital Ghent Belgium
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Abstract
PURPOSE OF REVIEW Recent enthusiasm for cannabinoid drugs for the treatment of chronic pain and some forms of epilepsy, raises the question of whether they could be useful for other disorders associated with abnormal neuronal activity in the brain, such as subjective tinnitus. Indeed, there is evidence to indicate that some tinnitus sufferers self-medicate using Cannabis. The aim of this review is to critically evaluate the available evidence relating to the effects of cannabinoids on tinnitus. RECENT FINDINGS Despite the fact that cannabinoids have been shown to decrease neuronal hyperactivity in many parts of the brain, the current evidence suggests that in auditory brain regions such as the dorsal cochlear nucleus, they have the potential to facilitate neuronal hyperactivity and exacerbate tinnitus. All of the available experimental evidence from animal studies suggests that cannabinoid CB1 receptor agonists will either have no effect on tinnitus or will worsen it. SUMMARY In our opinion, the use of the available cannabinoid drugs to alleviate tinnitus, based on their alleged efficacy for neuropathic pain conditions and some forms of epilepsy, is premature and not supported by the available evidence.
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Aplin FP, Fridman GY. Implantable Direct Current Neural Modulation: Theory, Feasibility, and Efficacy. Front Neurosci 2019; 13:379. [PMID: 31057361 PMCID: PMC6482222 DOI: 10.3389/fnins.2019.00379] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/02/2019] [Indexed: 12/25/2022] Open
Abstract
Implantable neuroprostheses such as cochlear implants, deep brain stimulators, spinal cord stimulators, and retinal implants use charge-balanced alternating current (AC) pulses to recover delivered charge and thus mitigate toxicity from electrochemical reactions occurring at the metal-tissue interface. At low pulse rates, these short duration pulses have the effect of evoking spikes in neural tissue in a phase-locked fashion. When the therapeutic goal is to suppress neural activity, implants typically work indirectly by delivering excitation to populations of neurons that then inhibit the target neurons, or by delivering very high pulse rates that suffer from a number of undesirable side effects. Direct current (DC) neural modulation is an alternative methodology that can directly modulate extracellular membrane potential. This neuromodulation paradigm can excite or inhibit neurons in a graded fashion while maintaining their stochastic firing patterns. DC can also sensitize or desensitize neurons to input. When applied to a population of neurons, DC can modulate synaptic connectivity. Because DC delivered to metal electrodes inherently violates safe charge injection criteria, its use has not been explored for practical applicability of DC-based neural implants. Recently, several new technologies and strategies have been proposed that address this safety criteria and deliver ionic-based direct current (iDC). This, along with the increased understanding of the mechanisms behind the transcutaneous DC-based modulation of neural targets, has caused a resurgence of interest in the interaction between iDC and neural tissue both in the central and the peripheral nervous system. In this review we assess the feasibility of in-vivo iDC delivery as a form of neural modulation. We present the current understanding of DC/neural interaction. We explore the different design methodologies and technologies that attempt to safely deliver iDC to neural tissue and assess the scope of application for direct current modulation as a form of neuroprosthetic treatment in disease. Finally, we examine the safety implications of long duration iDC delivery. We conclude that DC-based neural implants are a promising new modulation technology that could benefit from further chronic safety assessments and a better understanding of the basic biological and biophysical mechanisms that underpin DC-mediated neural modulation.
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Affiliation(s)
- Felix P Aplin
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Gene Y Fridman
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States.,Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
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27
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Abstract
Tinnitus is the sensation of hearing a sound with no external auditory stimulus present. It is a public health issue correlated with multiple comorbidities and precipitating factors such as noise exposure, military service, and traumatic brain injury, migraine, insomnia, small vessel disease, smoking history, stress exposure, anxiety, depression, and socioeconomic status. Clinical experience and a recent literature review point at tinnitus as a neuropsychiatric condition involving both auditory and nonauditory cortical areas of the brain and affecting brain-auditory circuitry. In fact, brain-ear connections have been highlighted in different models. Forward management of this disorder should take this body of research into consideration as tinnitus remains a challenging condition to evaluate and treat with current management protocols still symptomatic at best. With a better understanding of the etiologic factors and comorbidities of tinnitus, additional research trials and new therapeutic approaches could see the light to tackle this public health disability bringing hope to patients and doctors.
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Affiliation(s)
- Zeina Chemali
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - R Nehmé
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Jacquemin L, Shekhawat GS, Van de Heyning P, Mertens G, Fransen E, Van Rompaey V, Topsakal V, Moyaert J, Beyers J, Gilles A. Effects of Electrical Stimulation in Tinnitus Patients: Conventional Versus High-Definition tDCS. Neurorehabil Neural Repair 2018; 32:714-723. [PMID: 30019630 DOI: 10.1177/1545968318787916] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Contradictory results have been reported for transcranial direct current stimulation (tDCS) as treatment for tinnitus. The recently developed high-definition tDCS (HD tDCS) uses smaller electrodes to limit the excitation to the desired brain areas. OBJECTIVE The current study consisted of a retrospective part and a prospective part, aiming to compare 2 tDCS electrode placements and to explore effects of HD tDCS by matched pairs analyses. METHODS Two groups of 39 patients received tDCS of the dorsolateral prefrontal cortex (DLPFC) or tDCS of the right supraorbital-left temporal area (RSO-LTA). Therapeutic effects were assessed with the tinnitus functional index (TFI), a visual analogue scale (VAS) for tinnitus loudness, and the hyperacusis questionnaire (HQ) filled out at 3 visits: pretherapy, posttherapy, and follow-up. With a new group of patients and in a similar way, the effects of HD tDCS of the right DLPFC were assessed, with the tinnitus questionnaire (TQ) and the hospital anxiety and depression scale (HADS) added. RESULTS TFI total scores improved significantly after both tDCS and HD tDCS (DLPFC: P < .01; RSO-LTA: P < .01; HD tDCS: P = .05). In 32% of the patients, we observed a clinically significant improvement in TFI. The 2 tDCS groups and the HD tDCS group showed no differences on the evolution of outcomes over time (TFI: P = .16; HQ: P = .85; VAS: P = .20). CONCLUSIONS TDCS and HD tDCS resulted in a clinically significant improvement in TFI in 32% of the patients, with the 3 stimulation positions having similar results. Future research should focus on long-term effects of electrical stimulation.
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Affiliation(s)
- Laure Jacquemin
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,2 Faculty of Medicine, Campus Drie Eiken, Antwerp University, Wilrijk, Belgium
| | - Giriraj Singh Shekhawat
- 3 University of Auckland, Auckland, New Zealand.,4 Tinnitus Research Initiative, Regensburg, Germany
| | - Paul Van de Heyning
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,2 Faculty of Medicine, Campus Drie Eiken, Antwerp University, Wilrijk, Belgium
| | - Griet Mertens
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,2 Faculty of Medicine, Campus Drie Eiken, Antwerp University, Wilrijk, Belgium
| | - Erik Fransen
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,5 Center for Medical Genetics, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.,6 StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,2 Faculty of Medicine, Campus Drie Eiken, Antwerp University, Wilrijk, Belgium
| | - Vedat Topsakal
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,2 Faculty of Medicine, Campus Drie Eiken, Antwerp University, Wilrijk, Belgium
| | - Julie Moyaert
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Jolien Beyers
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,2 Faculty of Medicine, Campus Drie Eiken, Antwerp University, Wilrijk, Belgium
| | - Annick Gilles
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,2 Faculty of Medicine, Campus Drie Eiken, Antwerp University, Wilrijk, Belgium.,7 Department of Human and Social Welfare, University College Ghent, Ghent, Belgium
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Peter N, Kleinjung T. Neuromodulation for tinnitus treatment: an overview of invasive and non-invasive techniques. J Zhejiang Univ Sci B 2018; 20:116-130. [PMID: 29770647 DOI: 10.1631/jzus.b1700117] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Tinnitus is defined as a perception of sound without any external sound source. Chronic tinnitus is a frequent condition that can affect the quality of life. So far, no causal cure for tinnitus has been documented, and most pharmacologic and psychosomatic treatment modalities aim to diminish tinnitus' impact on the quality of life. Neuromodulation, a novel therapeutic modality, which aims at alternating nerve activity through a targeted delivery of a stimulus, has emerged as a potential option in tinnitus treatment. This review provides a brief overview of the current neuromodulation techniques as tinnitus treatment options. The main intention is to provide updated knowledge especially for medical professionals counselling tinnitus patients in this emerging field of medicine. Non-invasive methods such as repetitive transcranial magnetic stimulation, transcranial electrical stimulation, neurofeedback, and transcutaneous vagus nerve stimulation were included, as well as invasive methods such as implanted vagus nerve stimulation and invasive brain stimulation. Some of these neuromodulation techniques revealed promising results; nevertheless, further research is needed, especially regarding the pathophysiological principle as to how these neuromodulation techniques work and what neuronal change they induce. Various studies suggest that individually different brain states and networks are involved in the generation and perception of tinnitus. Therefore, in the future, individually tailored neuromodulation strategies could be a promising approach in tinnitus treatment for achieving a more substantial and longer lasting improvement of complaints.
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Affiliation(s)
- Nicole Peter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich 8091, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zürich, Zürich 8091, Switzerland
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Abtahi H, Okhovvat A, Heidari S, Gharagazarloo A, Mirdamadi M, Nilforoush MH, Ghazavi H. Effect of transcranial direct current stimulation on short-term and long-term treatment of chronic tinnitus. Am J Otolaryngol 2018; 39:94-96. [PMID: 29336898 DOI: 10.1016/j.amjoto.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/04/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was conducted to investigate the effectiveness of anodal and cathodal methods in reducing the intensity of tinnitus and to compare them with the control. METHODOLOGY This randomized double-blind clinical trial with case and control groups was conducted in Al-Zahra Hospital in Isfahan between 2015 and 2016. In this trial, 51 patients with tinnitus, for at least one year, were selected among those outpatients visiting the throat, nose and ear clinic within this period. Inclusion criteria were patients on electrical stimulation prohibition, with Ménière's disease, otosclerosis, chronic headache, and pulsatile tinnitus. Patients were randomly divided in three equal-sized groups: anodal stimulation group, cathodal stimulation group, and control group. The subjects received 20-min current stimulation (2 mA). Five subjects were selected from those with a significant difference between the stimulated states (anodal or cathodal) and/or control. They received weekly transcranial electrical stimulation for two months, and their long-term recovery from tinnitus was investigated. Data analysis was done with SPSS20. RESULTS Findings showed no significant between-groups difference in mean scores of tinnitus before the intervention (p = .68); whereas, this difference was significant immediately after the intervention (p = .02) and 1 h after it (p = .03). The mean score of tinnitus in the anodal stimulation group was significantly lower than the control; whereas, no significant difference was observed between the anodal and cathodal stimulation groups, and between the cathodal and control groups (p < .05). Findings also showed that the mean scores of tinnitus in two cathodal stimulation groups (p = .24) and control group (p = .62) were not significantly different at three different points of time; whereas, this score was significantly different in the anodal group at these time points (p = .01). CONCLUSION In conclusion, anodal stimulation was more effective than the cathodal and control stimulation in reducing the intensity of tinnitus in the short term.
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Affiliation(s)
- Hamidreza Abtahi
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Okhovvat
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somaiie Heidari
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azar Gharagazarloo
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Motahare Mirdamadi
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Nilforoush
- Communication Disorders Research Center, Rehabilitation Sciences Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Ghazavi
- Department of Otorhinolaryngology-Head and Neck Surgery, Isfahan University of Medical Sciences, Isfahan, Iran.
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Thibaut A, French M, Vasquez A, Fregni F. Optimization of Noninvasive Brain Stimulation Clinical Trials. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00138-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wang TC, Tyler RS, Chang TY, Chen JC, Lin CD, Chung HK, Tsou YA. Effect of Transcranial Direct Current Stimulation in Patients With Tinnitus: A Meta-Analysis and Systematic Review. Ann Otol Rhinol Laryngol 2017; 127:79-88. [PMID: 29192507 DOI: 10.1177/0003489417744317] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tang-Chuan Wang
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Richard S. Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Ta-Yuan Chang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Jui-Cheng Chen
- College of Medicine, China Medical University, Taichung, Taiwan
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Der Lin
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiung-Kwang Chung
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Yung-An Tsou
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
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Rabau S, Shekhawat GS, Aboseria M, Griepp D, Van Rompaey V, Bikson M, Van de Heyning P. Comparison of the Long-Term Effect of Positioning the Cathode in tDCS in Tinnitus Patients. Front Aging Neurosci 2017; 9:217. [PMID: 28804455 PMCID: PMC5532430 DOI: 10.3389/fnagi.2017.00217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 06/21/2017] [Indexed: 01/30/2023] Open
Abstract
Objective: Transcranial direct current stimulation (tDCS) is one of the methods described in the literature to decrease the perceived loudness and distress caused by tinnitus. However, the main effect is not clear and the number of responders to the treatment is variable. The objective of the present study was to investigate the effect of the placement of the cathode on the outcome measurements. Methods: Patients considered for the trial were chronic non-pulsatile tinnitus patients with complaints for more than 3 months and a Tinnitus Functional Index (TFI) score that exceeded 25. The anode was placed on the right dorsolateral prefrontal cortex (DLPFC). In the first group-"bifrontal"-the cathode was placed on the left DLPFC, while in the second group-"shoulder"-the cathode was placed on the shoulder. Each patient received two sessions of tDCS weekly and eight sessions in total. Evaluations took place on the first visit for an ENT consultation, at the start of therapy, after eight sessions of tDCS and at the follow-up visit, which took place 84 days after the start of the therapy. Subjective outcome measures such as TFI, Visual Analog Scales (VAS) for loudness and percentage of consciousness of tinnitus were administered in every patient. Results: There was no difference in the results for tinnitus loudness and the distress experienced between the placement of the cathode on the left DLPFC or on the shoulder. In addition, no statistically significant overall effect was found between the four test points. However, up to 39.1% of the patients experienced a decrease in loudness, measured by the VAS for loudness. Moreover, 72% of those in the bifrontal group, but only 46.2% of those in the shoulder group reported some improvement in distress. Conclusion: While some improvement was noted, this was not statistically significant. Both electrode placements stimulated the right side of the hippocampus, which could be responsible for the effect found in both groups. Further research should rule out the placebo effect and investigate alternative electrode positions.
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Affiliation(s)
- Sarah Rabau
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University HospitalEdegem, Belgium.,Faculty of Medicine, Campus Drie Eiken, University of AntwerpAntwerp, Belgium
| | - Giriraj S Shekhawat
- Section of Audiology/Health Systems, University of AucklandAuckland, New Zealand.,Centre for Brain Research, University of AucklandAuckland, New Zealand.,Tinnitus Research InitiativeRegensburg, Germany
| | - Mohamed Aboseria
- Department of Biomedical Engineering, City College of New York, The City University of New YorkNew York, NY, United States
| | - Daniel Griepp
- Department of Biomedical Engineering, City College of New York, The City University of New YorkNew York, NY, United States
| | - Vincent Van Rompaey
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University HospitalEdegem, Belgium.,Faculty of Medicine, Campus Drie Eiken, University of AntwerpAntwerp, Belgium
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, The City University of New YorkNew York, NY, United States
| | - Paul Van de Heyning
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University HospitalEdegem, Belgium.,Faculty of Medicine, Campus Drie Eiken, University of AntwerpAntwerp, Belgium
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Lee HY, Choi MS, Chang DS, Cho CS. Combined Bifrontal Transcranial Direct Current Stimulation and Tailor-Made Notched Music Training in Chronic Tinnitus. J Audiol Otol 2017; 21:22-27. [PMID: 28417104 PMCID: PMC5392009 DOI: 10.7874/jao.2017.21.1.22] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/06/2016] [Accepted: 12/27/2016] [Indexed: 01/16/2023] Open
Abstract
Background and Objectives We evaluated the short-term treatment outcomes of combined bifrontal transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) in tinnitus patients. The associations of patient characteristics with treatment responsiveness were investigated. Subjects and Methods Four sessions of bifrontal tDCS (F4: anode, F3: cathode) and TMNMT were conducted over a 2-week period in tinnitus patients. For tDCS, the stimulation intensity was 1.5 mA and the duration was approximately 20 min. During tDCS, patients listened to music lacking the frequency band within 1 octave of the tinnitus frequency. Patients were also instructed to listen to this music at home for at least 2 hours per day. One month after the final tDCS session, loudness (LD), awareness (AW), annoyance (AN), and effect on life (EL) of tinnitus were assessed subjectively using a visual analog scale. Results A total of 14 patients were enrolled in this study. After treatment, a 50% or greater improvement in AN, AW, EL, and LD was observed in 57.1, 42.9, 35.7, and 28.6% of patients, respectively. Furthermore, 78.6% of patients showed a 50% or greater improvement in their tinnitus handicap inventory scores. For AN, the absence of sleep disturbance was significantly associated with treatment responsiveness (p=0.041, OR=24.0). Conclusions Combined bifrontal tDCS and TMNMT is a promising treatment for chronic tinnitus. To maximize the treatment outcomes of this therapy, sleep disturbances should also be addressed in candidate patients.
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Affiliation(s)
- Ho Yun Lee
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
| | - Myoung Su Choi
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
| | - Dong Sik Chang
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
| | - Chin-Saeng Cho
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
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Mielczarek M, Michalska J, Polatyńska K, Olszewski J. An Increase in Alpha Band Frequency in Resting State EEG after Electrical Stimulation of the Ear in Tinnitus Patients-A Pilot Study. Front Neurosci 2016; 10:453. [PMID: 27766069 PMCID: PMC5052278 DOI: 10.3389/fnins.2016.00453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/21/2016] [Indexed: 11/22/2022] Open
Abstract
In our clinic invasive transtympanal promontory positive DC stimulations were first used, with a success rate of 42%. However, non-invasive hydrotransmissive negative DC stimulations are now favored, with improvement being obtained in 37.8% directly after the treatment, and 51.3% in a follow up 1 month after treatment. The further improvement after 1 month may be due to neuroplastic changes at central level as a result of altered peripheral input. The aim of the study was to determine how/whether a single electrical stimulation of the ear influences cortical activity, and whether changes observed in tinnitus after electrical stimulation are associated with any changes in cortical activity recorded in EEG. The study included 12 tinnitus patients (F–6, M-6) divided into two groups. Group I comprised six patients with unilateral tinnitus - unilateral, ipsilateral ES was performed. Group II comprised six patients with bilateral tinnitus—bilateral ES was performed. ES was performed using a custom-made apparatus. The active, silver probe—was immersed inside the external ear canal filled with saline. The passive electrode was placed on the forehead. The stimulating frequency was 250 Hz, the intensity ranged from 0.14 to 1.08 mA. The voltage was kept constant at 3 V. The duration of stimulation was 4 min. The EEG recording (Deymed QEST 32) was performed before and after ES. The patients assessed the intensity of tinnitus on the VAS 1-10. Results: In both groups an improvement in VAS was observed—in group I—in five ears (83.3%), in group II—in seven ears (58.3%). In Group I, a significant increase in the upper and lower limit frequency of alpha band was observed in the central temporal and frontal regions following ES. These changes, however, were not correlated with improvement in tinnitus. No significant changes were observed in the beta and theta bands and in group II. Preliminary results of our research reveal a change in cortical activity after electrical stimulations of the ear. However, it remains unclear if it is primary or secondary to peripheral auditory excitation. No similar studies had been found in the literature.
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Affiliation(s)
- Marzena Mielczarek
- Department of Otolaryngology, Laryngological Oncology, Audiology, and Phoniatrics, Medical University of Lodz Lodz, Poland
| | - Joanna Michalska
- Department of Otolaryngology, Laryngological Oncology, Audiology, and Phoniatrics, Medical University of Lodz Lodz, Poland
| | - Katarzyna Polatyńska
- Department of Neurology, Polish Mother's Memorial Hospital Research Institute Lodz, Poland
| | - Jurek Olszewski
- Department of Otolaryngology, Laryngological Oncology, Audiology, and Phoniatrics, Medical University of Lodz Lodz, Poland
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Electrical Stimulation of the Ear, Head, Cranial Nerve, or Cortex for the Treatment of Tinnitus: A Scoping Review. Neural Plast 2016; 2016:5130503. [PMID: 27403346 PMCID: PMC4925995 DOI: 10.1155/2016/5130503] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/22/2016] [Accepted: 05/18/2016] [Indexed: 11/18/2022] Open
Abstract
Tinnitus is defined as the perception of sound in the absence of an external source. It is often associated with hearing loss and is thought to result from abnormal neural activity at some point or points in the auditory pathway, which is incorrectly interpreted by the brain as an actual sound. Neurostimulation therapies therefore, which interfere on some level with that abnormal activity, are a logical approach to treatment. For tinnitus, where the pathological neuronal activity might be associated with auditory and other areas of the brain, interventions using electromagnetic, electrical, or acoustic stimuli separately, or paired electrical and acoustic stimuli, have been proposed as treatments. Neurostimulation therapies should modulate neural activity to deliver a permanent reduction in tinnitus percept by driving the neuroplastic changes necessary to interrupt abnormal levels of oscillatory cortical activity and restore typical levels of activity. This change in activity should alter or interrupt the tinnitus percept (reduction or extinction) making it less bothersome. Here we review developments in therapies involving electrical stimulation of the ear, head, cranial nerve, or cortex in the treatment of tinnitus which demonstrably, or are hypothesised to, interrupt pathological neuronal activity in the cortex associated with tinnitus.
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Fujimoto S, Kon N, Otaka Y, Yamaguchi T, Nakayama T, Kondo K, Ragert P, Tanaka S. Transcranial Direct Current Stimulation Over the Primary and Secondary Somatosensory Cortices Transiently Improves Tactile Spatial Discrimination in Stroke Patients. Front Neurosci 2016; 10:128. [PMID: 27064531 PMCID: PMC4814559 DOI: 10.3389/fnins.2016.00128] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
Abstract
In healthy subjects, dual hemisphere transcranial direct current stimulation (tDCS) over the primary (S1) and secondary somatosensory cortices (S2) has been found to transiently enhance tactile performance. However, the effect of dual hemisphere tDCS on tactile performance in stroke patients with sensory deficits remains unknown. The purpose of this study was to investigate whether dual hemisphere tDCS over S1 and S2 could enhance tactile discrimination in stroke patients. We employed a double-blind, crossover, sham-controlled experimental design. Eight chronic stroke patients with sensory deficits participated in this study. We used a grating orientation task (GOT) to measure the tactile discriminative threshold of the affected and non-affected index fingers before, during, and 10 min after four tDCS conditions. For both the S1 and S2 conditions, we placed an anodal electrode over the lesioned hemisphere and a cathodal electrode over the opposite hemisphere. We applied tDCS at an intensity of 2 mA for 15 min in both S1 and S2 conditions. We included two sham conditions in which the positions of the electrodes and the current intensity were identical to that in the S1 and S2 conditions except that current was delivered for the initial 15 s only. We found that GOT thresholds for the affected index finger during and 10 min after the S1 and S2 conditions were significantly lower compared with each sham condition. GOT thresholds were not significantly different between the S1 and S2 conditions at any time point. We concluded that dual-hemisphere tDCS over S1 and S2 can transiently enhance tactile discriminative task performance in chronic stroke patients with sensory dysfunction.
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Affiliation(s)
- Shuhei Fujimoto
- Tokyo Bay Rehabilitation HospitalChiba, Japan; Laboratory of Psychology, Hamamatsu University School of MedicineShizuoka, Japan; Department of Public Health, Kyoto University Graduate School of MedicineKyoto, Japan; Medley, Inc.Tokyo, Japan
| | - Noriko Kon
- Department of Public Health, Kyoto University Graduate School of Medicine Kyoto, Japan
| | - Yohei Otaka
- Tokyo Bay Rehabilitation HospitalChiba, Japan; Department of Rehabilitation Medicine, Keio University School of MedicineTokyo, Japan
| | - Tomofumi Yamaguchi
- Tokyo Bay Rehabilitation HospitalChiba, Japan; Department of Rehabilitation Medicine, Keio University School of MedicineTokyo, Japan
| | - Takeo Nakayama
- Department of Public Health, Kyoto University Graduate School of Medicine Kyoto, Japan
| | | | - Patrick Ragert
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany; Faculty of Sport Science, Institute for General Kinesiology and Exercise Science, University of LeipzigLeipzig, Germany
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine Shizuoka, Japan
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van Zwieten G, Smit JV, Jahanshahi A, Temel Y, Stokroos RJ. Tinnitus: Is there a place for brain stimulation? Surg Neurol Int 2016; 7:S125-9. [PMID: 26958429 PMCID: PMC4765244 DOI: 10.4103/2152-7806.176134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/05/2016] [Indexed: 12/16/2022] Open
Abstract
Tinnitus is the perception of a “phantom sound” and has a high prevalence. Although many therapies have been investigated within the last decades, there is still no effective standard therapy. Animal studies and human functional imaging studies revealed that tinnitus perception is associated with many complex changes in multiple brain structures. There is growing evidence that brain stimulation might be able to interrupt the local altered neuronal activity and hereby inhibit tinnitus perception. In this editorial review, an update is given on the most promising targets for brain stimulation. Promising structures for stimulation are the dorsal cochlear nucleus, the inferior colliculus and the medial geniculate body of the thalamus. For cortical stimulation, the auditory cortex is considered as a target. Nevertheless, the field is waiting for evidence from well-designed clinical trials, based on supporting evidence from experimental/mechanistic research, to support or discourage the application of brain stimulation in tinnitus.
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Affiliation(s)
- Gusta van Zwieten
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jasper V Smit
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ali Jahanshahi
- Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Robert J Stokroos
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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The effect of Transcranial Direct Current Stimulation in addition to Tinnitus Retraining Therapy for treatment of chronic tinnitus patients: a study protocol for a double-blind controlled randomised trial. Trials 2015; 16:514. [PMID: 26554670 PMCID: PMC4641380 DOI: 10.1186/s13063-015-1041-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 10/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Currently, there still is no treatment that eliminates tinnitus in all patients. Recent studies have shown that Tinnitus Retraining Therapy (TRT) significantly improves quality of life for tinnitus patients. Also, several studies have reported that transcranial Direct Current Stimulation (tDCS) has a positive effect on attention, working memory, long-term memory and other cognitive processes. The aim of this randomised placebo-controlled double-blind study is to evaluate the added effect of tDCS to TRT in chronic tinnitus patients. To our knowledge, this is the first study to combine both methods. Methods Patients with chronic, non-pulsatile tinnitus will be randomised in two treatment groups: TRT and real tDCS versus TRT and sham tDCS. Evaluations will take place at baseline before therapy starts, at the end of the TRT and 3 months after therapy starts. The Tinnitus Functional Index will be used as the primary outcome measurement. Secondary outcome measurements will be the Visual Analogue Scale of Loudness, Hospital Anxiety and Depression Scale (HADS), Hyperacusis Questionnaire, psychoacoustic measurements and Event-related potential (ERP). Discussion To our knowledge this is the first study to combine TRT and tDCS. The objective is to evaluate whether tDCS can provide faster and/or more relief from the annoyance experienced in chronic tinnitus patients’ daily lives. The advantage of the study is that it is double-blind and placebo-controlled. Trial registration The present study protocol was registered on 31 October 2014 at Clinicaltrials.gov: NCT02285803.
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Thibaut A, Di Perri C, Chatelle C, Bruno MA, Bahri MA, Wannez S, Piarulli A, Bernard C, Martial C, Heine L, Hustinx R, Laureys S. Clinical Response to tDCS Depends on Residual Brain Metabolism and Grey Matter Integrity in Patients With Minimally Conscious State. Brain Stimul 2015; 8:1116-23. [DOI: 10.1016/j.brs.2015.07.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/08/2015] [Accepted: 07/09/2015] [Indexed: 11/17/2022] Open
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Forogh B, Mirshaki Z, Raissi GR, Shirazi A, Mansoori K, Ahadi T. Repeated sessions of transcranial direct current stimulation for treatment of chronic subjective tinnitus: a pilot randomized controlled trial. Neurol Sci 2015; 37:253-9. [PMID: 26498289 DOI: 10.1007/s10072-015-2393-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
Subjective tinnitus is an auditory phantom sensation characterized by the perception of sound in the absence of an identifiable external source. This distressing audiological symptom can severely affect the quality of life. Transcranial direct current stimulation (tDCS) is a noninvasive technique that can induce short-term relief in tinnitus in some patients. The purpose of this pilot double-blind randomized controlled trial was to investigate whether repeated application of anodal tDCS over left temporoparietal area could induce long-lasting relief in patients with chronic tinnitus. Twenty-two patients with chronic tinnitus for at least 6 months were randomly allocated into two groups and received five sessions of anodal (N = 11) or sham (N = 11) stimulation in five consecutive days. A current intensity of 2 mA for 20 min was used for anodal stimulation. Outcomes were assessed using Persian version of tinnitus handicap inventory (THI), loudness and distress visual analog scale (VAS) scores and clinical global impression (CGI) scale. The trial is registered at the Iranian Registry of Clinical Trials (IRCT) with the reference ID of IRCT2014082018871N1. No statistically significant difference was found between anodal and sham stimulation regarding either immediate or long-lasting effects over the 2 weeks follow-up period. Deterioration of symptoms and alteration in tinnitus characteristics were reported by a few patients. There were no significant long-term beneficial effects following tDCS of the left temporoparietal area.
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Affiliation(s)
- Bijan Forogh
- Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran
| | - Zohre Mirshaki
- Physical Medicine and Rehabilitation Specialist at Iran University of Medical Sciences, Firoozgar Hospital, Valiasr Square, Tehran, Iran
| | - Gholam Reza Raissi
- Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran
| | - Ali Shirazi
- Department of Otolaryngology, Firoozgar Hospital, Valiasr square, Tehran, Iran
| | - Korosh Mansoori
- Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran
| | - Tannaz Ahadi
- Department of Physical Medicine and Rehabilitation, Firoozgar Hospital, Iran University of Medical Sciences, Valiasr Square, Tehran, Iran.
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Neural substrates of conversion deafness in a cochlear implant patient: a molecular imaging study using H₂¹⁵O-PET. Otol Neurotol 2015; 35:1780-4. [PMID: 25166017 DOI: 10.1097/mao.0000000000000560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Conversion deafness is characterized by sudden hearing loss without any identifiable cause. In the current study, we investigated presumed conversion deafness in a cochlear implant user using H₂¹⁵O-positron emission tomography (PET) scan with speech and noise stimuli in conjunction with audiologic tests such as impedance test and auditory response telemetry. Also, by performing a follow-up PET scan after recovery and comparing prerecovery and postrecovery scans, we attempted to find possible neural substrates of conversion deafness. PATIENT A 51-year-old man with conversion deafness after 4 years of successful cochlear implant use. INTERVENTION Supportive psychotherapy. MAIN OUTCOME MEASURES Prerecovery and postrecovery H₂¹⁵O-PET scans RESULTS The prerecovery H₂¹⁵O-PET scan revealed auditory cortex activation by sound stimuli, which verified normal stimulation of the central auditory pathway. Notably, compared with the prerecovery state, the postrecovery state showed relative activation in the right auditory cortex both under the speech and noise stimulus conditions. Moreover, the bilateral prefrontal and parietal areas were activated more in the postrecovery state than in the prerecovery state. In other words, relative deactivation of the prefronto-parieto-temporal network, a network responsible for conscious sensory perception, or relative dysfunction of top-down and bottom-up attention shifting mediated by the ventral and the dorsal parietal cortices, may have resulted in conversion deafness in the patient. CONCLUSION Relative deactivation of the prefronto-parieto-temporal network or dysfunction in the ventral and the dorsal parietal cortices may be related to the development of conversion deafness.
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Donaldson PH, Rinehart NJ, Enticott PG. Noninvasive stimulation of the temporoparietal junction: A systematic review. Neurosci Biobehav Rev 2015; 55:547-72. [DOI: 10.1016/j.neubiorev.2015.05.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 01/15/2023]
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Inter- and Intra-individual Variability in Response to Transcranial Direct Current Stimulation (tDCS) at Varying Current Intensities. Brain Stimul 2015; 8:1130-7. [PMID: 26294061 DOI: 10.1016/j.brs.2015.07.031] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Translation of transcranial direct current stimulation (tDCS) from research to clinical practice is hindered by a lack of consensus on optimal stimulation parameters, significant inter-individual variability in response, and in sufficient intra-individual reliability data. OBJECTIVES Inter-individual differences in response to anodal tDCS at a range of current intensities were explored. Intra-individual reliability in response to anodal tDCS across two identical sessions was also investigated. METHODS Twenty-nine subjects participated in a crossover study. Anodal-tDCS using four different current intensities (0.2, 0.5, 1 and 2 mA), with an anode size of 16 cm2, was tested. The 0.5 mA condition was repeated to assess intra-individual variability. TMS was used to elicit 40 motor-evoked potentials (MEPs) before 10 min of tDCS, and 20 MEPs at four time-points over 30 min following tDCS. RESULTS ANOVA revealed no main effect of TIME for all conditions except the first 0.5 mA condition, and no differences in response between the four current intensities. Cluster analysis identified two clusters for the 0.2 and 2 mA conditions only. Frequency distributions based on individual subject responses (excitatory, inhibitory or no response) to each condition indicate possible differential responses between individuals to different current intensities. Test-retest reliability was negligible (ICC(2,1) = -0.50). CONCLUSIONS Significant inter-individual variability in response to tDCS across a range of current intensities was found. 2 mA and 0.2 mA tDCS were most effective at inducing a distinct response. Significant intra-individual variability in response to tDCS was also found. This has implications for interpreting results of single-session tDCS experiments.
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Shekhawat GS, Sundram F, Bikson M, Truong D, De Ridder D, Stinear CM, Welch D, Searchfield GD. Intensity, Duration, and Location of High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief. Neurorehabil Neural Repair 2015; 30:349-59. [DOI: 10.1177/1545968315595286] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Objective. Tinnitus is the perception of a phantom sound. The aim of this study was to compare current intensity (center anode 1 mA and 2 mA), duration (10 minutes and 20 minutes), and location (left temporoparietal area [LTA] and dorsolateral prefrontal cortex [DLPFC]) using 4 × 1 high-definition transcranial direct current stimulation (HD-tDCS) for tinnitus reduction. Methods. Twenty-seven participants with chronic tinnitus (>2 years) and mean age of 53.5 years underwent 2 sessions of HD-tDCS of the LTA and DLPFC in a randomized order with a 1 week gap between site of stimulation. During each session, a combination of 4 different settings were used in increasing dose (1 mA, 10 minutes; 1 mA, 20 minutes; 2 mA, 10 minutes; and 2 mA, 20 minutes). The impact of different settings on tinnitus loudness and annoyance was documented. Results. Twenty-one participants (77.78%) reported a minimum of 1 point reduction on tinnitus loudness or annoyance scales. There were significant changes in loudness and annoyance for duration of stimulation, F(1, 26) = 10.08, P < .005, and current intensity, F(1, 26) = 14.24, P = .001. There was no interaction between the location, intensity, and duration of stimulation. Higher intensity (2 mA) and longer duration (20 minutes) of stimulation were more effective. Conclusions. A current intensity of 2 mA for 20-minute duration was the most effective setting used for tinnitus relief. The stimulation of the LTA and DLPFC were equally effective for suppressing tinnitus loudness and annoyance.
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Affiliation(s)
| | | | | | | | - Dirk De Ridder
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Tinnitus Research Initiative, Regensburg, Germany
| | | | | | - Grant D. Searchfield
- University of Auckland, New Zealand
- Tinnitus Research Initiative, Regensburg, Germany
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Pal N, Maire R, Stephan MA, Herrmann FR, Benninger DH. Transcranial Direct Current Stimulation for the Treatment of Chronic Tinnitus: A Randomized Controlled Study. Brain Stimul 2015. [PMID: 26198363 DOI: 10.1016/j.brs.2015.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Tinnitus is an often disabling condition for which there is no effective therapy. Current research suggests that tinnitus may develop due to maladaptive plastic changes and altered activity in the auditory and prefrontal cortex. Transcranial direct current stimulation (tDCS) modulates brain activity and has been shown to transiently suppress tinnitus in trials. OBJECTIVE To investigate the efficacy and safety of tDCS in the treatment of chronic subjective tinnitus. METHODS In a randomized, parallel, double-blind, sham-controlled study, the efficacy and safety of cathodal tDCS to the auditory cortex with anode over the prefrontal cortex was investigated in five sessions over five consecutive days. Tinnitus was assessed after the last session on day 5, and at follow-up visits 1 and 3 months post stimulation using the Tinnitus Handicap Inventory (THI, primary outcome measure), Subjective Tinnitus Severity Scale, Hospital Anxiety and Depression scale, Visual Analogue Scale, and Clinical Global Impression scale. RESULTS 42 patients were investigated, 21 received tDCS and 21 sham stimulation. There were no beneficial effects of tDCS on tinnitus as assessed by primary and secondary outcome measures. Effect size assessed with Cohen's d amounted to 0.08 (95% CI: -0.52 to 0.69) at 1 month and 0.18 (95% CI: -0.43 to 0.78) at 3 months for the THI. CONCLUSION tDCS of the auditory and prefrontal cortices is safe, but does not improve tinnitus. Different tDCS protocols might be beneficial.
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Affiliation(s)
- Natassja Pal
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Raphael Maire
- Clinic of Otolaryngology, Head Neck & Ear Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Marianne A Stephan
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland
| | - David H Benninger
- Clinic of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Markovitz CD, Hogan PS, Wesen KA, Lim HH. Pairing broadband noise with cortical stimulation induces extensive suppression of ascending sensory activity. J Neural Eng 2015; 12:026006. [PMID: 25686163 PMCID: PMC4359690 DOI: 10.1088/1741-2560/12/2/026006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The corticofugal system can alter coding along the ascending sensory pathway. Within the auditory system, electrical stimulation of the auditory cortex (AC) paired with a pure tone can cause egocentric shifts in the tuning of auditory neurons, making them more sensitive to the pure tone frequency. Since tinnitus has been linked with hyperactivity across auditory neurons, we sought to develop a new neuromodulation approach that could suppress a wide range of neurons rather than enhance specific frequency-tuned neurons. APPROACH We performed experiments in the guinea pig to assess the effects of cortical stimulation paired with broadband noise (PN-Stim) on ascending auditory activity within the central nucleus of the inferior colliculus (CNIC), a widely studied region for AC stimulation paradigms. MAIN RESULTS All eight stimulated AC subregions induced extensive suppression of activity across the CNIC that was not possible with noise stimulation alone. This suppression built up over time and remained after the PN-Stim paradigm. SIGNIFICANCE We propose that the corticofugal system is designed to decrease the brain's input gain to irrelevant stimuli and PN-Stim is able to artificially amplify this effect to suppress neural firing across the auditory system. The PN-Stim concept may have potential for treating tinnitus and other neurological disorders.
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Affiliation(s)
- Craig D. Markovitz
- University of Minnesota, Department of Biomedical Engineering, Minneapolis, MN USA
| | - Patrick S. Hogan
- University of Minnesota, Department of Biomedical Engineering, Minneapolis, MN USA
| | - Kyle A. Wesen
- University of Minnesota, Department of Biomedical Engineering, Minneapolis, MN USA
| | - Hubert H. Lim
- University of Minnesota, Department of Biomedical Engineering, Minneapolis, MN USA
- University of Minnesota, Department of Otolaryngology-Head and Neck Surgery, Minneapolis, MN USA
- University of Minnesota, Institute for Translational Neuroscience, Minneapolis, MN USA
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50
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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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