Using Extracochlear Multichannel Electrical Stimulation to Relieve Tinnitus and Reverse Tinnitus-Related Auditory-Somatosensory Plasticity in the Cochlear Nucleus

Anatomy of superior olivary complex and lateral lemniscus in Etruscan shrew

Based on the auditory periphery and the small head size, Etruscan shrews (Suncus etruscus) approximate ancestral mammalian conditions. The auditory brainstem in this insectivore has not been investigated. Using labelling techniques, we assessed the structures of their superior olivary complex (SOC) and the nuclei of the lateral lemniscus (NLL). There, we identified the position of the major nuclei, their input pattern, transmitter content, expression of calcium binding proteins (CaBPs) and two voltage-gated ion channels. The most prominent SOC structures were the medial nucleus of the trapezoid body (MNTB), the lateral nucleus of the trapezoid body (LNTB), the lateral superior olive (LSO) and the superior paraolivary nucleus (SPN). In the NLL, the ventral (VNLL), a specific ventrolateral VNLL (VNLLvl) cell population, the intermediate (INLL) and dorsal (DNLL) nucleus, as well as the inferior colliculus's central aspect were discerned. INLL and VNLL were clearly separated by the differential distribution of various marker proteins. Most labelled proteins showed expression patterns comparable to rodents. However, SPN neurons were glycinergic and not GABAergic and the overall CaBPs expression was low. Next to the characterisation of the Etruscan shrew's auditory brainstem, our work identifies conserved nuclei and indicates variable structures in a species that approximates ancestral conditions.

[The Erlangen model of tinnitus development-New perspective and treatment strategy]

BACKGROUND

About one sixth of the population of western industrialized nations suffers from chronic, subjective tinnitus, causing socioeconomic treatment and follow-up costs of almost 22 billion euros per year in Germany alone. According to the prevailing view, tinnitus develops as a consequence of a maladaptive neurophysiological process in the brain triggered by hearing loss.

OBJECTIVES

The Erlangen model of tinnitus development presented here is intended to propose a comprehensive neurophysiological explanation for the initial occurrence of the phantom sound after hearing loss. Based on the model, a new treatment strategy will be developed.

MATERIALS AND METHODS

The model summarized here is based on various animal and human physiological studies conducted in recent years.

RESULTS

The Erlangen model considers subjective tinnitus as a side effect of a physiological mechanism that permanently optimizes information transmission into the auditory system by means of stochastic resonance (SR) even in the healthy auditory system. In fact, hearing-impaired patients with tinnitus hear better on average than those without tinnitus. This unfamiliar perspective on the phantom percept may already help affected patients to cope better with their suffering. In addition, based on the model, low intensity noise tinnitus suppression (LINTS) has been developed as a new, individually adapted treatment strategy for tonal tinnitus and has already been successfully tested in patients.

CONCLUSIONS

A possible limiting factor for the model and treatment strategy is the pitch of the tinnitus percept, which may require adjustments to the treatment strategy for frequencies above about 5 kHz.