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Bernal-Robledano A, Perez-Carpena P, Kikidis D, Mazurek B, Schoisswohl S, Staudinger S, Langguth B, Schlee W, Lopez-Escamez JA. Cognitive Screening and Hearing Assessment in Patients With Chronic Tinnitus. Clin Exp Otorhinolaryngol 2024; 17:15-25. [PMID: 37974057 PMCID: PMC10933812 DOI: 10.21053/ceo.2023.00808] [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: 06/13/2023] [Revised: 09/27/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The study aimed to assess the relationship of tinnitus with hyperacusis with cognitive impairment as indicated by the Montreal Cognitive Assessment (MoCA) tool. METHODS This multicenter cross-sectional study included individuals with chronic tinnitus from the "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI) database. Participants were recruited from four different tertiary clinical centers located in Athens and Granada (Mediterranean group), as well as Berlin and Regensburg (German group). In total, 380 individuals with a diagnosis of non-pulsatile chronic tinnitus (permanent and constant tinnitus lasting more than 6 months) and no evidence of severe cognitive impairment (MoCA score >22) were enrolled. The evaluation utilized the following tools: MoCA, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (GÜF), Patient Health Questionnaire (PHQ-9), and the European School for Interdisciplinary Tinnitus Research Screening Questionnaire. RESULTS MoCA scores differed between German and Mediterranean individuals (P<0.01), necessitating separate analyses for each group. In both cohorts, MoCA scores were significantly associated with education level, age, hearing threshold at 8 kHz, and THI. Furthermore, a significant correlation was observed between PHQ-9 scores and both THI and GÜF (P<0.01 for both Germans and those from the Mediterranean). CONCLUSION Our data suggest an association between tinnitus handicap, high-frequency hearing loss, and mild cognitive impairment. Additionally, PHQ-9 scores were associated with tinnitus and hyperacusis scores, independent of hearing loss thresholds.
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Affiliation(s)
- Alberto Bernal-Robledano
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
| | - Patricia Perez-Carpena
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
- Department of Otolaryngology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Dimitris Kikidis
- Department of Otolaryngology-Head and Neck Surgery, Hippocrateion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Birgit Mazurek
- Charité‒Universitätsmedizin Berlin, Tinnitus Center, Berlin, Germany
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Susanne Staudinger
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Jose Antonio Lopez-Escamez
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
- Meniere’s Disease Neuroscience Research Program, Faculty of Medicine and Health, School of Medical Sciences, The Kolling Institute, University of Sydney, Sydney, Australia
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Standardized Clinical Profiling in Spanish Patients with Chronic Tinnitus. J Clin Med 2022; 11:jcm11040978. [PMID: 35207250 PMCID: PMC8875075 DOI: 10.3390/jcm11040978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Tinnitus is a heterogeneous condition. The aim of this study as to compare the online and hospital responses to the Spanish version of European School for Interdisciplinary Tinnitus Research screening-questionnaire (ESIT-SQ) in tinnitus individuals by an unsupervised age clustering. Methods: A cross-sectional study was performed including 434 white Spanish patients with chronic tinnitus to assess the demographic and clinical profile through the ESIT-SQ, with 204 outpatients and 230 individuals from an online survey; a K-means clustering algorithm was used to classify both responses according to age. Results: Online survey showed a high proportion of Meniere’s disease (MD) patients compared to both the general population and the outpatient cohort. The responses showed statistically significant differences between groups regarding education level, tinnitus-related hearing disorders (MD, hyperacusis), sleep difficulties, dyslipidemia, and other tinnitus characteristics, including duration, type of onset, the report of mitigating factors and the use of treatments. However, these differences were partially confirmed after adjusting for age. Conclusions: Self-reported tinnitus surveys are a low confidence source for tinnitus phenotyping. Additional clinical evaluation is needed for tinnitus research to reach the diagnosis. Age-based cluster analysis might help to better define clinical profiles and to compare responses in ESIT-SQ among subgroups of patients with tinnitus.
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Amanat S, Gallego-Martinez A, Sollini J, Perez-Carpena P, Espinosa-Sanchez JM, Aran I, Soto-Varela A, Batuecas-Caletrio A, Canlon B, May P, Cederroth CR, Lopez-Escamez JA. Burden of rare variants in synaptic genes in patients with severe tinnitus: An exome based extreme phenotype study. EBioMedicine 2021; 66:103309. [PMID: 33813136 PMCID: PMC8047463 DOI: 10.1016/j.ebiom.2021.103309] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/22/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND tinnitus is a heterogeneous condition associated with audiological and/or mental disorders. Chronic, severe tinnitus is reported in 1% of the population and it shows a relevant heritability, according to twins, adoptees and familial aggregation studies. The genetic contribution to severe tinnitus is unknown since large genomic studies include individuals with self-reported tinnitus and large heterogeneity in the phenotype. The aim of this study was to identify genes for severe tinnitus in patients with extreme phenotype. METHODS for this extreme phenotype study, we used three different cohorts with European ancestry (Spanish with Meniere disease (MD), Swedes tinnitus and European generalized epilepsy). In addition, four independent control datasets were also used for comparisons. Whole-exome sequencing was performed for the MD and epilepsy cohorts and whole-genome sequencing was carried out in Swedes with tinnitus. FINDINGS we found an enrichment of rare missense variants in 24 synaptic genes in a Spanish cohort, the most significant being PRUNE2, AKAP9, SORBS1, ITGAX, ANK2, KIF20B and TSC2 (p < 2E-04), when they were compared with reference datasets. This burden was replicated for ANK2 gene in a Swedish cohort with 97 tinnitus individuals, and in a subset of 34 Swedish patients with severe tinnitus for ANK2, AKAP9 and TSC2 genes (p < 2E-02). However, these associations were not significant in a third cohort of 701 generalized epilepsy individuals without tinnitus. Gene ontology (GO) and gene-set enrichment analyses revealed several pathways and biological processes involved in severe tinnitus, including membrane trafficking and cytoskeletal protein binding in neurons. INTERPRETATION a burden of rare variants in ANK2, AKAP9 and TSC2 is associated with severe tinnitus. ANK2, encodes a cytoskeleton scaffolding protein that coordinates the assembly of several proteins, drives axonal branching and influences connectivity in neurons.
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Affiliation(s)
- Sana Amanat
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research-Pfizer/University of Granada/ Junta de Andalucía, PTS, Granada, Spain
| | - Alvaro Gallego-Martinez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research-Pfizer/University of Granada/ Junta de Andalucía, PTS, Granada, Spain
| | - Joseph Sollini
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Patricia Perez-Carpena
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research-Pfizer/University of Granada/ Junta de Andalucía, PTS, Granada, Spain; Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Juan M Espinosa-Sanchez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research-Pfizer/University of Granada/ Junta de Andalucía, PTS, Granada, Spain; Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Ismael Aran
- Department of Otolaryngology, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Andres Soto-Varela
- Division of Otoneurology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Barbara Canlon
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Patrick May
- Bioinformatics Core, Luxembourg Centre for System Biomedicine, University of Luxemburg, Esch-sur-Alzette, Luxembourg
| | - Christopher R Cederroth
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK; Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Ropewalk House, Nottingham, UK
| | - Jose A Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research-Pfizer/University of Granada/ Junta de Andalucía, PTS, Granada, Spain; Department of Otolaryngology, Instituto de Investigación Biosanitaria, ibs.Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain; Department of Surgery, Division of Otolaryngology, University of Granada, Granada, Spain.
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Amanat S, Gallego-Martinez A, Lopez-Escamez JA. Genetic Inheritance and Its Contribution to Tinnitus. Curr Top Behav Neurosci 2021; 51:29-47. [PMID: 32705497 DOI: 10.1007/7854_2020_155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tinnitus is the abnormal perception of sound that affects more than 15% of adult population around the globe. Severe tinnitus is considered a complex disorder that arises as result of the interaction of genetic and environmental factors, and it is associated with several comorbidities such as hearing loss, anxiety, and insomnia. We begin this review with an introduction to human molecular genetics and the role of genetic variation on the inheritance. There are some genetic reports on tinnitus heritability including concordance studies in twins and adoptees or aggregation in families providing some evidence for familial aggregation in patients with severe tinnitus and high concordance in monozygotic twins with bilateral tinnitus. So, sex differences in familial aggregation and heritability of bilateral tinnitus suggest a potential sexual dimorphism in tinnitus inheritance.Molecular genetic studies have been demonstrated to be a useful tool to understand the role of genetic variation in rare diseases and complex disorders. The reported associations in common variants in neurotrophic factors such as GDNF, BDNF, or potassium channels genes were underpowered, and the lack of replication questions these findings. Although candidate gene approaches have failed in replicating these genetic associations, the development of high throughput sequencing technology and the selection of extreme phenotypes are strategies that will allow the clinicians and researchers to combine genetic information with clinical data to implement a personalized diagnosis and therapy in patients with tinnitus.
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Affiliation(s)
- Sana Amanat
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer, University of Granada, Junta de Andalucía, PTS, Granada, Spain
| | - Alvaro Gallego-Martinez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer, University of Granada, Junta de Andalucía, PTS, Granada, Spain
| | - Jose A Lopez-Escamez
- Otology and Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for Genomics and Oncological Research - Pfizer, University of Granada, Junta de Andalucía, PTS, Granada, Spain.
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Granada, Spain.
- Division of Otolaryngology, Department of Surgery, Universidad de Granada, Granada, Spain.
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Bourez PH, Fournier P, Noreña AJ. The difference in poststimulus suppression between residual inhibition and forward masking. PROGRESS IN BRAIN RESEARCH 2020; 262:23-56. [PMID: 33931182 DOI: 10.1016/bs.pbr.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The phenomenon of tinnitus masking (TM) and residual inhibition (RI) of tinnitus are two ways to investigate how external sounds interact with tinnitus: TM provides insight on the fusion between external sound activity and tinnitus related activity while RI provides insight on how the external sound might suppress the tinnitus related activity for a period of time. Differences in masking level between the tinnitus and an external tone with tinnitus characteristics (frequency, loudness) have previously shown a high level of heterogeneity. The difference in poststimulus suppression between the two, that is, residual inhibition for the former, and forward masking for the latter, has never been explored. This study aims to investigate minimum masking levels (MMLs) and minimum residual inhibition levels (MRILs) of tinnitus and of an external tone mimicking tinnitus while using diotic and dichotic noises. Pulsed narrowband noises (1 octave width and centered at 1kHz, frequency of the hearing loss slope, tinnitus frequency) and white noise were randomly presented to 20 tinnitus participants and 20 controls with an external tone mimicking tinnitus (4kHz, intensity level corresponding to tinnitus loudness). The MML values obtained for the masking of tinnitus and for the mimicking external sounds were very similar. On the other hand, the MRILs were significantly different between the tinnitus and the mimicking external sounds within tinnitus participants. They were also different between the tinnitus participants and the controls. Overall, for both within and between comparisons, the MRIL values were much higher to produce a poststimulus suppression for the mimicking sound than for the tinnitus. The results showed no significant differences between the diotic and dichotic conditions. These results corroborate other findings suggesting that the tinnitus-related neural activity is very different from the stimulus-related neural activity. The consequences of this last finding are discussed.
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Affiliation(s)
- P H Bourez
- Laboratoire de Neurosciences Cognitives, UMR 7291, Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Philippe Fournier
- Laboratoire de Neurosciences Cognitives, UMR 7291, Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Arnaud J Noreña
- Laboratoire de Neurosciences Cognitives, UMR 7291, Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France.
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