1
|
Tyler RS, Varghese L, Furman AC, Snell K, Ji H, Rabinowitz WM. An Exploratory Study of Bimodal Electro-Aural Stimulation Through the Ear Canals for Tinnitus. Am J Audiol 2024; 33:455-464. [PMID: 38564491 DOI: 10.1044/2024_aja-23-00144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE The aim of this study was to explore the potential for bimodal auditory and noninvasive electrical stimulation at the ears to alleviate tonal, somatic tinnitus that was investigated in a small preliminary trial (11 participants). DESIGN Auditory stimulation took the form of short "notched noise" bursts customized to each participant's tinnitus percept. Simultaneous pulsed electrical stimulation, intended to facilitate neuroplasticity, was delivered via hydrogel electrodes placed in opposite ears. RESULTS After a 6-week intervention period, average Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ) scores were consistent with clinically meaningful improvements in the study population. Magnitudes and effect sizes of improvements in TFI and TPFQ are comparable to those reported in other recent bimodal therapy studies using different auditory and electrical stimulation parameters. CONCLUSIONS Our results should be considered preliminary given the small sample size, lack of crossover data, and small subject pool. When considered alongside other recent bimodal therapy results, we do believe that there are therapeutic benefits of bimodal stimulation for tinnitus sufferers that have the potential to help some with tinnitus, with a variety of stimulation parameters and electrode placements. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25444546.
Collapse
Affiliation(s)
- Richard S Tyler
- Department of Otolaryngology, The University of Iowa, Iowa City
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | | | | | - Kimberly Snell
- Department of Communication Sciences and Disorders, The University of Iowa, Iowa City
| | - Helena Ji
- Department of Otolaryngology, The University of Iowa, Iowa City
| | | |
Collapse
|
2
|
Langguth B, de Ridder D, Schlee W, Kleinjung T. Tinnitus: Clinical Insights in Its Pathophysiology-A Perspective. J Assoc Res Otolaryngol 2024; 25:249-258. [PMID: 38532055 PMCID: PMC11150221 DOI: 10.1007/s10162-024-00939-0] [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: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Tinnitus, the perception of sound without a corresponding external sound source, and tinnitus disorder, which is tinnitus with associated suffering, present a multifaceted clinical challenge due to its heterogeneity and its incompletely understood pathophysiology and especially due to the limited therapeutic options. In this narrative review, we give an overview on various clinical aspects of tinnitus including its heterogeneity, contributing factors, comorbidities and therapeutic pathways with a specific emphasis on the implications for its pathophysiology and future research directions. Tinnitus exhibits high perceptual variability between affected individuals (heterogeneity) and within affected individuals (temporal variability). Hearing loss emerges as predominant risk factor and the perceived pitch corresponds to areas of hearing loss, supporting the compensatory response theory. Whereas most people who have tinnitus can live a normal life, in 10-20% tinnitus interferes severely with quality of life. These patients suffer frequently from comorbidities such as anxiety, depression or insomnia, acting as both risk factors and consequences. Accordingly, neuroimaging studies demonstrate shared brain networks between tinnitus and stress-related disorders shedding light on the intricate interplay of mental health and tinnitus. The challenge lies in deciphering causative relationships and shared pathophysiological mechanisms. Stress, external sounds, time of day, head movements, distraction, and sleep quality can impact tinnitus perception. Understanding these factors provides insights into the interplay with autonomic, sensory, motor, and cognitive processes. Counselling and cognitive-behavioural therapy demonstrate efficacy in reducing suffering, supporting the involvement of stress and anxiety-related networks. Hearing improvement, especially through cochlear implants, reduces tinnitus and thus indirectly validates the compensatory nature of tinnitus. Brain stimulation techniques can modulate the suffering of tinnitus, presumably by alteration of stress-related brain networks. Continued research is crucial for unravelling the complexities of tinnitus. Progress in management hinges on decoding diverse manifestations, identifying treatment-responsive subtypes, and advancing targeted therapeutic approaches.
Collapse
Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany.
| | - Dirk de Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
- Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Kang YJ, Zheng Y. Current understanding of subjective tinnitus in adults. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08633-w. [PMID: 38632112 DOI: 10.1007/s00405-024-08633-w] [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: 02/12/2024] [Accepted: 03/14/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE An up-to-date overview of epidemiology, etiology and pathophysiological mechanisms, diagnostic and evaluation methods, current treatment status and future directions of subjective tinnitus in adults. METHODS Review of current evidence-based literature on subjective tinnitus in adults. RESULTS The prevalence of subjective tinnitus in the adult population is estimated to be around 14%, and it tends to increase with age. Subjective tinnitus is a complex condition with multiple factors contributing to its origin. However, the exact causes and underlying mechanisms remain unknown. Potential causes may include hearing loss, dysfunction in the somatosensory system, and auditory cortical dysfunction, although severe underlying pathology is rare. Currently, diagnosis primarily relies on patient self-reported medical history and physician-based clinical assessment due to the lack of objective testing. Various treatment and management options have been proposed, but their effectiveness varies, and there is no universally agreed-upon treatment option. CONCLUSIONS Tinnitus is a complex and heterogeneous disease with a high incidence rate and a tendency to increase with age. A holistic perspective is needed to understand the generation, perception, and emotional responses to tinnitus. Diagnosis requires a comprehensive assessment based on medical history and relevant examinations, identification of concurrent psychosomatic comorbidities, and active pursuit of objective diagnostic methods. At the same time, on the basis of existing treatment plans and combining emerging technologies, we will develop new personalized, precise, and combined treatment plans.
Collapse
Affiliation(s)
- Yao-Jie Kang
- Hearing Center, Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
- Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Tujia and Miao Autonomous Prefecture, China
| | - Yun Zheng
- Hearing Center, Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China.
| |
Collapse
|
4
|
Yasoda-Mohan A, Adcock K, Leong SL, Meade E, Langguth B, Schecklmann M, Lim H, Vanneste S. Tinnitus: A Dimensionally Segregated, yet Perceptually Integrated Heterogeneous Disorder. J Assoc Res Otolaryngol 2024; 25:215-227. [PMID: 38238526 PMCID: PMC11018723 DOI: 10.1007/s10162-023-00923-0] [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: 10/13/2023] [Accepted: 12/13/2023] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVES Tinnitus subtypes are proposed to lie on a continuum of different symptom dimensions rather than be categorical. However, there is no comprehensive empirical data showing this complex relationship between different tinnitus symptoms. The objective of this study is to provide empirical evidence for the dimensional nature of tinnitus and how different auditory and non-auditory symptoms interact with each other through complex interactions. We do this using graph theory, a mathematical tool that empirically maps this complex interaction. This way, graph theory can be utilised to highlight a new and possibly important outlook on how we can understand the heterogeneous nature of tinnitus. DESIGN In the current study, we use the screening databases of the Treatment Evaluation of Neuromodulation for Tinnitus-Stage A1 (TENT-A1) and A2 (TENT-A2) randomised trials to delineate the dimensional relationship between different clinical measures of tinnitus as a secondary data analysis. We first calculate the empirical relationship by computing the partial correlation. Following this, we use different measures of centrality to describe the contribution of different clinical measures to the overall network. We also calculate the stability of the network and compare the similarity and differences between TENT-A1 and TENT-A2. RESULTS Components of the auditory subnetwork (loudness discomfort level, sound sensitivity, average hearing loss and high frequency hearing loss) are highly inter-connected in both networks with sound sensitivity and loudness discomfort level being highly influential with high measures of centrality. Furthermore, the relationship between the densely connected auditory subnetwork with tinnitus-related distress seems to vary at different levels of distress, hearing loss, duration and age of the participants. CONCLUSION Our findings provide first-time evidence for tinnitus varying in a dimensional fashion illustrating the heterogeneity of this phantom percept and its ability to be perceptually integrated, yet behaviourally segregated on different symptomatic dimensions.
Collapse
Affiliation(s)
| | - Katherine Adcock
- Trinity Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | | | - Emma Meade
- Neuromod Devices Limited, Dublin, D08 R2YP, Ireland
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, 93053, Germany
- Interdisciplinary Tinnitus Center of University of Regensburg, Regensburg, 93053, Germany
| | - Martin Schecklmann
- Interdisciplinary Tinnitus Center of University of Regensburg, Regensburg, 93053, Germany
| | - Hubert Lim
- Neuromod Devices Limited, Dublin, D08 R2YP, Ireland
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Sven Vanneste
- Trinity Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
5
|
Gu D, Wu L, Tang D. Development of a Prognostic Nomogram for Modified Tinnitus Relieving Sound Therapy for Subjective Tinnitus. Otolaryngol Head Neck Surg 2024; 170:1066-1073. [PMID: 38091373 DOI: 10.1002/ohn.611] [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: 06/02/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 03/24/2024]
Abstract
OBJECTIVE We aimed to develop a modified tinnitus-relieving sound system and establish a model for predicting its treatment effects. STUDY DESIGN Retrospective study. SETTING Tinnitus Specialist Clinic of Eye & ENT Hospital, Fudan University. METHODS We recruited 107 patients undergoing modified tinnitus-relieving sounds between August 2020 and May 2021. Patients were divided into training (n = 75) and validation (n = 32) cohorts in a 7:3 ratio. The treatment outcome was Tinnitus Handicapped Inventory scores. Features were established using a least absolute shrinkage and selection operator-derived logistic regression model, where the selected clinical risk factors were included in the multivariate logistic regression, and a nomogram was established based on the model. The discrimination and calibration abilities of the nomogram were evaluated using the Hosmer-Lemeshow test and calibration curves. Decision curve analysis (DCA) was used to evaluate the net benefit of predictive efficacy. RESULTS Multivariate logistic analysis indicated that the initial Tinnitus Handicapped Inventory score (odds ratio [OR]: 1.13 [1.07-1.19], P < .001) and treatment duration (OR: 3.4 [1.34-8.62], P < .001) were positive factors for improved tinnitus. The nomogram model that included baseline Tinnitus Handicapped Inventory score and treatment duration achieved a better concordance index of 0.880. DCA revealed that the nomogram model could lead to net benefits and exhibited a wider range of threshold probabilities for the prediction of therapeutic effects. CONCLUSION Our study suggests that the nomogram model, including baseline Tinnitus Handicapped Inventory score and treatment duration, could achieve optimal performance in the preoperative prediction of the therapeutic effect of modified tinnitus-relieving sound.
Collapse
Affiliation(s)
- Dantong Gu
- Clinical Research Unit of Eye, ENT Hospital, Fudan University, Shanghai, PR China
| | - Lingjie Wu
- Department of Otorhinolaryngology, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, PR China
| | - Dongmei Tang
- Department of Otorhinolaryngology, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, PR China
- Shanghai ZEHNIT Medical Technology Co., Ltd., Shanghai, PR China
| |
Collapse
|
6
|
Wang Y, Zeng P, Gu Z, Liu H, Han S, Liu X, Huang X, Shao L, Tao Y. Objective Neurophysiological Indices for the Assessment of Chronic Tinnitus Based on EEG Microstate Parameters. IEEE Trans Neural Syst Rehabil Eng 2024; 32:983-993. [PMID: 38376977 DOI: 10.1109/tnsre.2024.3367982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Chronic tinnitus is highly prevalent but lacks precise diagnostic or effective therapeutic standards. Its onset and treatment mechanisms remain unclear, and there is a shortage of objective assessment methods. We aim to identify abnormal neural activity and reorganization in tinnitus patients and reveal potential neurophysiological markers for objectively evaluating tinnitus. By way of analyzing EEG microstates, comparing metrics under three resting states (OE, CE, and OECEm) between tinnitus sufferers and controls, and correlating them with tinnitus symptoms. This study reflected specific changes in the EEG microstates of tinnitus patients across multiple resting states, as well as inconsistent correlations with tinnitus symptoms. Microstate parameters were significantly different when patients were in OE and CE states. Specifically, the occurrence of Microstate A and the transition probabilities (TP) from other Microstates to A increased significantly, particularly in the CE state (32-37%, p ≤ 0.05 ); and both correlated positively with the tinnitus intensity. Nevertheless, under the OECEm state, increases were mainly observed in the duration, coverage, and occurrence of Microstate B (15-47%, ), which negatively correlated with intensity ( [Formula: see text]-0.513, ). Additionally, TPx between Microstates C and D were significantly reduced and positively correlated with HDAS levels ( [Formula: see text] 0.548, ). Furthermore, parameters of Microstate D also correlated with THI grades ( [Formula: see text]-0.576, ). The findings of this study could offer compelling evidence for central neural reorganization associated with chronic tinnitus. EEG microstate parameters that correlate with tinnitus symptoms could serve as neurophysiological markers, contributing to future research on the objective assessment of tinnitus.
Collapse
|
7
|
Gninenko N, Trznadel S, Daskalou D, Gramatica L, Vanoy J, Voruz F, Robyn CL, Spadazzi A, Yulzari A, Sitaram R, Van De Ville D, Senn P, Haller S. Functional MRI Neurofeedback Outperforms Cognitive Behavioral Therapy for Reducing Tinnitus Distress: A Prospective Randomized Clinical Trial. Radiology 2024; 310:e231143. [PMID: 38349241 DOI: 10.1148/radiol.231143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Background Cognitive behavioral therapy (CBT) is the current standard treatment for chronic severe tinnitus; however, preliminary evidence suggests that real-time functional MRI (fMRI) neurofeedback therapy may be more effective. Purpose To compare the efficacy of real-time fMRI neurofeedback against CBT for reducing chronic tinnitus distress. Materials and Methods In this prospective controlled trial, participants with chronic severe tinnitus were randomized from December 2017 to December 2021 to receive either CBT (CBT group) for 10 weekly group sessions or real-time fMRI neurofeedback (fMRI group) individually during 15 weekly sessions. Change in the Tinnitus Handicap Inventory (THI) score (range, 0-100) from baseline to 6 or 12 months was assessed. Secondary outcomes included four quality-of-life questionnaires (Beck Depression Inventory, Pittsburgh Sleep Quality Index, State-Trait Anxiety Inventory, and World Health Organization Disability Assessment Schedule). Questionnaire scores between treatment groups and between time points were assessed using repeated measures analysis of variance and the nonparametric Wilcoxon signed rank test. Results The fMRI group included 21 participants (mean age, 49 years ± 11.4 [SD]; 16 male participants) and the CBT group included 22 participants (mean age, 53.6 years ± 8.8; 16 male participants). The fMRI group showed a greater reduction in THI scores compared with the CBT group at both 6 months (mean score change, -28.21 points ± 18.66 vs -12.09 points ± 18.86; P = .005) and 12 months (mean score change, -30 points ± 25.44 vs -4 points ± 17.2; P = .01). Compared with baseline, the fMRI group showed improved sleep (mean score, 8.62 points ± 4.59 vs 7.25 points ± 3.61; P = .006) and trait anxiety (mean score, 44 points ± 11.5 vs 39.84 points ± 10.5; P = .02) at 1 month and improved depression (mean score, 13.71 points ± 9.27 vs 6.53 points ± 5.17; P = .01) and general functioning (mean score, 24.91 points ± 17.05 vs 13.06 points ± 10.1; P = .01) at 6 months. No difference in these metrics over time was observed for the CBT group (P value range, .14 to >.99). Conclusion Real-time fMRI neurofeedback therapy led to a greater reduction in tinnitus distress than the current standard treatment of CBT. ClinicalTrials.gov registration no.: NCT05737888; Swiss Ethics registration no.: BASEC2017-00813 © RSNA, 2024 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Nicolas Gninenko
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Stéphanie Trznadel
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Dimitrios Daskalou
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Luca Gramatica
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Julie Vanoy
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - François Voruz
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Claudia Lardi Robyn
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Anne Spadazzi
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Aude Yulzari
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Ranganatha Sitaram
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Dimitri Van De Ville
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Pascal Senn
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| | - Sven Haller
- From the Medical Image Processing Laboratory, Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Campus Biotech, Chemin des Mines 9, Geneva 1202, Switzerland (N.G., D.V.D.V.); Department of Radiology and Medical Informatics (N.G., D.V.D.V.) and Department of Medicine (S.H.), University of Geneva, Geneva, Switzerland; Department of Neurology, Psychosomatic Medicine Unit, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland (N.G.); Wyss Center for Bio and Neuroengineering, Campus Biotech, Geneva, Switzerland (S.T., A.Y.); Service of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences (D.D., L.G., J.V., F.V., P.S.) and Department of Psychiatry (C.L.R., A.S.), Geneva University Hospitals, Geneva, Switzerland; Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tenn (R.S.); Centre d'Imagerie Médicale de Cornavin, Geneva, Switzerland (S.H.); and Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden (S.H.)
| |
Collapse
|
8
|
Lee D, Jeong Y, Lee S, Jin TJ, Jin IK. The Effectiveness of Microcurrent Stimulation Combined with Sound Therapy for Tinnitus Relief: A Preliminary Study. Audiol Res 2024; 14:139-150. [PMID: 38391769 PMCID: PMC10885923 DOI: 10.3390/audiolres14010012] [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: 12/25/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Various stimulation-based rehabilitation approaches have been proposed to alleviate tinnitus. This study aimed to determine the efficacy of a rehabilitation approach that simultaneously provides microcurrent and sound stimulation for tinnitus relief. Twenty-eight participants with chronic sensorineural tinnitus were randomly assigned to one of two groups based on the rehabilitation approaches (sound therapy-only group and combined microcurrent and sound therapy group). Each participant underwent sound therapy or simultaneous stimulation for approximately 2 h daily for 3 months. The effectiveness of the rehabilitation approaches was determined based on changes in the Korean version of the tinnitus primary function questionnaire (K-TPFQ) and visual analog scale for loudness (VAS-L) scores at baseline, 1.5 months, and 3 months. For the K-TPFQ scores, both groups exhibited a large effect of rehabilitation; however, for the VAS-L scores, the simultaneous stimulation group demonstrated a large effect of rehabilitation, whereas the sound therapy group exhibited a small effect. Therefore, a rehabilitation approach that combines sound stimulation with microcurrent stimulation can improve response and perception in tinnitus.
Collapse
Affiliation(s)
- Donghyeok Lee
- Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon-si 24252, Gangwon-do, Republic of Korea
| | - Youngchan Jeong
- Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon-si 24252, Gangwon-do, Republic of Korea
| | - Sumin Lee
- Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon-si 24252, Gangwon-do, Republic of Korea
| | - Tae-Jun Jin
- Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon-si 24252, Gangwon-do, Republic of Korea
| | - In-Ki Jin
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, Hallym University, Chuncheon-si 24252, Gangwon-do, Republic of Korea
| |
Collapse
|
9
|
Schilling A, Sedley W, Gerum R, Metzner C, Tziridis K, Maier A, Schulze H, Zeng FG, Friston KJ, Krauss P. Predictive coding and stochastic resonance as fundamental principles of auditory phantom perception. Brain 2023; 146:4809-4825. [PMID: 37503725 PMCID: PMC10690027 DOI: 10.1093/brain/awad255] [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: 10/26/2022] [Revised: 06/27/2023] [Accepted: 07/15/2023] [Indexed: 07/29/2023] Open
Abstract
Mechanistic insight is achieved only when experiments are employed to test formal or computational models. Furthermore, in analogy to lesion studies, phantom perception may serve as a vehicle to understand the fundamental processing principles underlying healthy auditory perception. With a special focus on tinnitus-as the prime example of auditory phantom perception-we review recent work at the intersection of artificial intelligence, psychology and neuroscience. In particular, we discuss why everyone with tinnitus suffers from (at least hidden) hearing loss, but not everyone with hearing loss suffers from tinnitus. We argue that intrinsic neural noise is generated and amplified along the auditory pathway as a compensatory mechanism to restore normal hearing based on adaptive stochastic resonance. The neural noise increase can then be misinterpreted as auditory input and perceived as tinnitus. This mechanism can be formalized in the Bayesian brain framework, where the percept (posterior) assimilates a prior prediction (brain's expectations) and likelihood (bottom-up neural signal). A higher mean and lower variance (i.e. enhanced precision) of the likelihood shifts the posterior, evincing a misinterpretation of sensory evidence, which may be further confounded by plastic changes in the brain that underwrite prior predictions. Hence, two fundamental processing principles provide the most explanatory power for the emergence of auditory phantom perceptions: predictive coding as a top-down and adaptive stochastic resonance as a complementary bottom-up mechanism. We conclude that both principles also play a crucial role in healthy auditory perception. Finally, in the context of neuroscience-inspired artificial intelligence, both processing principles may serve to improve contemporary machine learning techniques.
Collapse
Affiliation(s)
- Achim Schilling
- Neuroscience Lab, University Hospital Erlangen, 91054 Erlangen, Germany
- Cognitive Computational Neuroscience Group, University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - William Sedley
- Translational and Clinical Research Institute, Newcastle University Medical School, Newcastle upon Tyne NE2 4HH, UK
| | - Richard Gerum
- Cognitive Computational Neuroscience Group, University Erlangen-Nürnberg, 91058 Erlangen, Germany
- Department of Physics and Astronomy and Center for Vision Research, York University, Toronto, ON M3J 1P3, Canada
| | - Claus Metzner
- Neuroscience Lab, University Hospital Erlangen, 91054 Erlangen, Germany
| | | | - Andreas Maier
- Pattern Recognition Lab, University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - Holger Schulze
- Neuroscience Lab, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Fan-Gang Zeng
- Center for Hearing Research, Departments of Anatomy and Neurobiology, Biomedical Engineering, Cognitive Sciences, Otolaryngology–Head and Neck Surgery, University of California Irvine, Irvine, CA 92697, USA
| | - Karl J Friston
- Wellcome Centre for Human Neuroimaging, Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Patrick Krauss
- Neuroscience Lab, University Hospital Erlangen, 91054 Erlangen, Germany
- Cognitive Computational Neuroscience Group, University Erlangen-Nürnberg, 91058 Erlangen, Germany
- Pattern Recognition Lab, University Erlangen-Nürnberg, 91058 Erlangen, Germany
| |
Collapse
|
10
|
Monaco A, Cattaneo R, Di Nicolantonio S, Strada M, Altamura S, Ortu E. Central effects of trigeminal electrical stimulation. Cranio 2023:1-24. [PMID: 38032105 DOI: 10.1080/08869634.2023.2280153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This is a review of the literature on the main neuromodulation techniques, focusing on the possibility of introducing sensory threshold ULFTENS into them. Electro neuromodulation techniques have been in use for many years as promising methods of therapy for cognitive and emotional disorders. One of the most widely used forms of stimulation for orofacial pain is transcutaneous trigeminal stimulation on three levels: supraorbital area, dorsal surface of the tongue, and anterior skin area of the tragus. The purpose of this review is to trigger interest on using dental ULFTENS as an additional trigeminal neurostimulation and neuromodulation technique in the context of TMD. In particular, we point out the possibility of using ULFTENS at a lower activation level than that required to trigger a muscle contraction that is capable of triggering effects at the level of the autonomic nervous system, with extreme ease of execution and few side effects.
Collapse
Affiliation(s)
- Annalisa Monaco
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Ruggero Cattaneo
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | | | - Marco Strada
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Serena Altamura
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| | - Eleonora Ortu
- MeSVA Department, Dental Unit, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
11
|
Park KW, Kullar P, Malhotra C, Stankovic KM. Current and Emerging Therapies for Chronic Subjective Tinnitus. J Clin Med 2023; 12:6555. [PMID: 37892692 PMCID: PMC10607630 DOI: 10.3390/jcm12206555] [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: 09/07/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
IMPORTANCE Chronic subjective tinnitus, the perception of sound without an external source for longer than six months, may be a greatly debilitating condition for some people, and is associated with psychiatric comorbidities and high healthcare costs. Current treatments are not beneficial for all patients and there is a large need for new therapies for tinnitus. OBSERVATIONS Unlike rarer cases of objective tinnitus, chronic subjective tinnitus often has no obvious etiology and a diverse pathophysiology. In the absence of objective testing, diagnosis is heavily based on clinical assessment. Management strategies include hearing aids, sound masking, tinnitus retraining therapy, cognitive behavioral therapy, and emerging therapies including transcranial magnetic stimulation and electrical stimulation. CONCLUSIONS AND RELEVANCE Although current treatments are limited, emerging diagnostics and treatments provide promising avenues for the management of tinnitus symptoms.
Collapse
Affiliation(s)
- Ki Wan Park
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Peter Kullar
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Charvi Malhotra
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
| | - Konstantina M. Stankovic
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd., Palo Alto, CA 94305, USA
- Department of Neurosurgery, Stanford University School of Medicine, 453 Quarry Rd., Palo Alto, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, 290 Jane Stanford Way, Stanford, CA 94305, USA
| |
Collapse
|
12
|
Schilling A, Schaette R, Sedley W, Gerum RC, Maier A, Krauss P. Editorial: Auditory perception and phantom perception in brains, minds and machines. Front Neurosci 2023; 17:1293552. [PMID: 37869508 PMCID: PMC10588478 DOI: 10.3389/fnins.2023.1293552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Achim Schilling
- Neuroscience Lab, University Hospital Erlangen, Erlangen, Germany
- Cognitive Computational Neuroscience Group, University Erlangen-Nürnberg, Erlangen, Germany
| | - Roland Schaette
- UCL Ear Institute, University College London, London, United Kingdom
| | - William Sedley
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard Carl Gerum
- Department of Physics and Astronomy, York University, Toronto, ON, Canada
| | - Andreas Maier
- Pattern Recognition Lab, University Erlangen-Nürnberg, Erlangen, Germany
| | - Patrick Krauss
- Neuroscience Lab, University Hospital Erlangen, Erlangen, Germany
- Cognitive Computational Neuroscience Group, University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
13
|
Mercante B, Enrico P, Deriu F. Cognitive Functions following Trigeminal Neuromodulation. Biomedicines 2023; 11:2392. [PMID: 37760833 PMCID: PMC10525298 DOI: 10.3390/biomedicines11092392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/13/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Vast scientific effort in recent years have been focused on the search for effective and safe treatments for cognitive decline. In this regard, non-invasive neuromodulation has gained increasing attention for its reported effectiveness in promoting the recovery of multiple cognitive domains after central nervous system damage. In this short review, we discuss the available evidence supporting a possible cognitive effect of trigeminal nerve stimulation (TNS). In particular, we ask that, while TNS has been widely and successfully used in the treatment of various neuropsychiatric conditions, as far as research in the cognitive field is concerned, where does TNS stand? The trigeminal nerve is the largest cranial nerve, conveying the sensory information from the face to the trigeminal sensory nuclei, and from there to the thalamus and up to the somatosensory cortex. On these bases, a bottom-up mechanism has been proposed, positing that TNS-induced modulation of the brainstem noradrenergic system may affect the function of the brain networks involved in cognition. Nevertheless, despite the promising theories, to date, the use of TNS for cognitive empowering and/or cognitive decline treatment has several challenges ahead of it, mainly due to little uniformity of the stimulation protocols. However, as the field continues to grow, standardization of practice will allow for data comparisons across studies, leading to optimized protocols targeting specific brain circuitries, which may, in turn, influence cognition in a designed manner.
Collapse
Affiliation(s)
- Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (B.M.); (P.E.)
| | - Paolo Enrico
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (B.M.); (P.E.)
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (B.M.); (P.E.)
- AOU Sassari, Unit of Endocrinology, Nutritional and Metabolic Disorders, 07100 Sassari, Italy
| |
Collapse
|
14
|
Singh A, Smith PF, Zheng Y. Targeting the Limbic System: Insights into Its Involvement in Tinnitus. Int J Mol Sci 2023; 24:9889. [PMID: 37373034 DOI: 10.3390/ijms24129889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Tinnitus is originally derived from the Latin verb tinnire, which means "to ring". Tinnitus, a complex disorder, is a result of sentient cognizance of a sound in the absence of an external auditory stimulus. It is reported in children, adults, and older populations. Patients suffering from tinnitus often present with hearing loss, anxiety, depression, and sleep disruption in addition to a hissing and ringing in the ear. Surgical interventions and many other forms of treatment have been only partially effective due to heterogeneity in tinnitus patients and a lack of understanding of the mechanisms of tinnitus. Although researchers across the globe have made significant progress in understanding the underlying mechanisms of tinnitus over the past few decades, tinnitus is still deemed to be a scientific enigma. This review summarises the role of the limbic system in tinnitus development and provides insight into the development of potential target-specific tinnitus therapies.
Collapse
Affiliation(s)
- Anurag Singh
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
- The Eisdell Moore Centre for Research in Hearing and Balance Disorders, University of Auckland, Auckland 1023, New Zealand
| | - Paul F Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
- The Eisdell Moore Centre for Research in Hearing and Balance Disorders, University of Auckland, Auckland 1023, New Zealand
| | - Yiwen Zheng
- Department of Pharmacology and Toxicology, School of Biomedical Sciences, University of Otago, Dunedin 9016, New Zealand
- Brain Health Research Centre, University of Otago, Dunedin 9016, New Zealand
- The Eisdell Moore Centre for Research in Hearing and Balance Disorders, University of Auckland, Auckland 1023, New Zealand
| |
Collapse
|
15
|
Luckey AM, McLeod LS, Huang Y, Mohan A, Vanneste S. Making memories last using the peripheral effect of direct current stimulation. eLife 2023; 12:e75586. [PMID: 37204308 PMCID: PMC10241520 DOI: 10.7554/elife.75586] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/18/2023] [Indexed: 05/20/2023] Open
Abstract
Most memories that are formed are forgotten, while others are retained longer and are subject to memory stabilization. We show that non-invasive transcutaneous electrical stimulation of the greater occipital nerve (NITESGON) using direct current during learning elicited a long-term memory effect. However, it did not trigger an immediate effect on learning. A neurobiological model of long-term memory proposes a mechanism by which memories that are initially unstable can be strengthened through subsequent novel experiences. In a series of studies, we demonstrate NITESGON's capability to boost the retention of memories when applied shortly before, during, or shortly after the time of learning by enhancing memory consolidation via activation and communication in and between the locus coeruleus pathway and hippocampus by plausibly modulating dopaminergic input. These findings may have a significant impact for neurocognitive disorders that inhibit memory consolidation such as Alzheimer's disease.
Collapse
Affiliation(s)
- Alison M Luckey
- Global Brain Health Institute and Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Lauren S McLeod
- School of Medicine, Texas Tech School of MedicineLubbockUnited States
| | - Yuefeng Huang
- Department of Psychiatry, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Anusha Mohan
- Global Brain Health Institute and Institute of Neuroscience, Trinity College DublinDublinIreland
| | - Sven Vanneste
- Global Brain Health Institute and Institute of Neuroscience, Trinity College DublinDublinIreland
| |
Collapse
|
16
|
Langguth B, Kleinjung T, Schlee W, Vanneste S, De Ridder D. Tinnitus Guidelines and Their Evidence Base. J Clin Med 2023; 12:jcm12093087. [PMID: 37176527 PMCID: PMC10178961 DOI: 10.3390/jcm12093087] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Evidence-based medicine (EBM) is generally accepted as the gold standard for high-quality medicine and, thus, for managing patients with tinnitus. EBM integrates the best available scientific information with clinical experience and patient values to guide decision-making about clinical management. To help health care providers and clinicians, the available evidence is commonly translated into medical or clinical guidelines based on a consensus. These involve a systematic review of the literature and meta-analytic aggregation of research findings followed by the formulation of clinical recommendations. However, this approach also has limitations, which include a lack of consideration of individual patient characteristics, the susceptibility of guideline recommendations to material and immaterial conflicts of interest of guideline authors and long latencies till new knowledge is implemented in guidelines. A further important aspect in interpreting the existing literature is that the absence of evidence is not evidence of absence. These circumstances could result in the decoupling of recommendations and their supporting evidence, which becomes evident when guidelines from different countries differ in their recommendations. This opinion paper will discuss how these weaknesses can be addressed in tinnitus.
Collapse
Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, 93053 Regensburg, Germany
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, 93053 Regensburg, Germany
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland
| | - Sven Vanneste
- Trinity Institute for Neuroscience, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
- School of Psychology, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
| |
Collapse
|
17
|
Schoisswohl S, Langguth B, Weber FC, Abdelnaim MA, Hebel T, Schecklmann M. Activate & fire: a feasibility study in combining acoustic stimulation and continuous theta burst stimulation in chronic tinnitus. BMC Neurol 2023; 23:14. [PMID: 36635645 PMCID: PMC9834682 DOI: 10.1186/s12883-022-03036-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Low frequency repetitive transcranial magnetic stimulation (rTMS) is commonly used to inhibit pathological hyperactivity of the auditory cortex in tinnitus. Novel and supposedly superior and faster inhibitory protocols such as continuous theta burst stimulation (cTBS) were examined as well, but so far there is not sufficient evidence for a treatment application in chronic tinnitus. rTMS effects in general are dependent on the brain state immediate before stimulation. This feasibility study was designed based on the concept to shift the pathological intrinsic brain state of tinnitus patients via acoustic stimulation ("activate") and induce inhibitory effects via cTBS ("fire"). METHODS Seven tinnitus patients with response in residual inhibition received 10 consecutive daily sessions of a combinatory treatment comprised of 3-minute acoustic stimulation with white noise followed by 600 pulses of cTBS over the left temporo-parietal cortex (activate & fire). A control group of 5 patients was treated parallel to the activate & fire data collection with 10 sessions á 3000 pulses of 1 Hz rTMS over the left temporo-parietal cortex. RESULTS The activate & fire protocol was well tolerated except in one patient with tinnitus loudness increase. This patient was excluded from analyses. No statistical superiority of the activate & fire treatment approach in alleviating tinnitus-related symptoms was evident. Power calculations showed an effect size of 0.706 and a needed sample size of 66 for statistical significant group differences. On a descriptive level the activate & fire group demonstrated a stronger decrease in tinnitus-related symptoms. CONCLUSION The present feasibility study showed that combining acoustic stimulation with magnetic brain stimulation may be well-tolerable in the majority of patients and represents a promising treatment approach for tinnitus by hypothetically alter the intrinsic state prior to brain stimulation.
Collapse
Affiliation(s)
- Stefan Schoisswohl
- grid.7727.50000 0001 2190 5763Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany ,grid.7752.70000 0000 8801 1556Department of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Berthold Langguth
- grid.7727.50000 0001 2190 5763Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Franziska C. Weber
- grid.7727.50000 0001 2190 5763Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Mohamed A. Abdelnaim
- grid.7727.50000 0001 2190 5763Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Tobias Hebel
- grid.7727.50000 0001 2190 5763Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| | - Martin Schecklmann
- grid.7727.50000 0001 2190 5763Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053 Regensburg, Germany
| |
Collapse
|
18
|
Liu Y, Liu S, Tang C, Tang K, Liu D, Chen M, Mao Z, Xia X. Transcranial alternating current stimulation combined with sound stimulation improves cognitive function in patients with Alzheimer's disease: Study protocol for a randomized controlled trial. Front Aging Neurosci 2023; 14:1068175. [PMID: 36698862 PMCID: PMC9869764 DOI: 10.3389/fnagi.2022.1068175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Background The number of patients with Alzheimer's disease (AD) worldwide is increasing yearly, but the existing treatment methods have poor efficacy. Transcranial alternating current stimulation (tACS) is a new treatment for AD, but the offline effect of tACS is insufficient. To prolong the offline effect, we designed to combine tACS with sound stimulation to maintain the long-term post-effect. Materials and methods To explore the safety and effectiveness of tACS combined with sound stimulation and its impact on the cognition of AD patients. This trial will recruit 87 patients with mild to moderate AD. All patients were randomly divided into three groups. The change in Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) scores from the day before treatment to the end of treatment and 3 months after treatment was used as the main evaluation index. We will also explore the changes in the brain structural network, functional network, and metabolic network of AD patients in each group after treatment. Discussion We hope to conclude that tACS combined with sound stimulation is safe and tolerable in 87 patients with mild to moderate AD under three standardized treatment regimens. Compared with tACS alone or sound alone, the combination group had a significant long-term effect on cognitive improvement. To screen out a better treatment plan for AD patients. tACS combined with sound stimulation is a previously unexplored, non-invasive joint intervention to improve patients' cognitive status. This study may also identify the potential mechanism of tACS combined with sound stimulation in treating mild to moderate AD patients. Clinical Trial Registration Clinicaltrials.gov, NCT05251649. Registered on February 22, 2022.
Collapse
Affiliation(s)
- Yang Liu
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | | | - Can Tang
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Keke Tang
- Guangzhou Kangzhi Digital Technology Co., Ltd., Guangzhou, China
| | - Di Liu
- Guangzhou Kangzhi Digital Technology Co., Ltd., Guangzhou, China
| | - Meilian Chen
- Guangzhou Kangzhi Digital Technology Co., Ltd., Guangzhou, China
| | - Zhiqi Mao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China,*Correspondence: Zhiqi Mao, ; Xuewei Xia,
| | - Xuewei Xia
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, China,*Correspondence: Zhiqi Mao, ; Xuewei Xia,
| |
Collapse
|
19
|
Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
Collapse
Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
20
|
Monaco A, Cattaneo R, Smurra P, Di Nicolantonio S, Cipriano F, Pietropaoli D, Ortu E. Trigeminal electrical stimulation with ULFTENS of the dorsal anterior mucosal surface of the tongue: Effects on Heart Rate Variability (HRV). PLoS One 2023; 18:e0285464. [PMID: 37163499 PMCID: PMC10171590 DOI: 10.1371/journal.pone.0285464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Trigeminal electrical stimulation of the dorsal anterior mucosal surface of the tongue has demonstrated its efficacy in a variety of neurological disorders in which anatomical or functional alterations are present. The pathogenesis of such disorders is often linked to altered arousal circuits, and the benefits of tongue stimulation are attributed to the rebalancing of this system. Dental ULFTENS shows efficacy in acting on the muscular, autonomic system and control of the descending pathways that modulate pain. It is administered at the skin level in the area anterior to the tragus and not on the mucosal surface of the tongue. The use of this stimulation technique at the tongue level could have new applications and clinical results if it were able to reduce the activity of arousal circuits. MATERIAL AND METHOD A new intraoral device allowed electrical stimulation of the dorsal anterior mucosa of the tongue in 32 healthy young women. The effects on HRV were monitored by photoplethysmographic wave (PPG) and compared with a control group. The HRV parameters studied were RMSSD, HF, LF, LF/HF, REC, DET. RESULTS The group of stimulated subjects showed a significant change in some of the HRV parameters that was maintained even in the epoch after the end of electrical stimulation. This effect can be considered as a vagal activation and a change of HRV trend. The control group of unstimulated subjects showed an opposite trend. There were no undesirable or annoying effects of stimulation. CONCLUSION Stimulation of the dorsal anterior (trigeminal) mucosal surface of the tongue with ULFTENS applied with an intraoral device was shown to be able to increase HRV.
Collapse
Affiliation(s)
- A Monaco
- Departement of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - R Cattaneo
- Departement of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Smurra
- Departement of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Di Nicolantonio
- Departement of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Cipriano
- Departement of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - D Pietropaoli
- Departement of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - E Ortu
- Departement of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
21
|
Li X, Zhao Y, Hui Y, Wu Y, Chen Q, Shi H, Lv H, Li M, Zhao P, Zhang W, Zhao X, Li J, Cui L, Wang Z. Lateralization of cerebral blood flow in the auditory cortex of patients with idiopathic tinnitus and healthy controls: An arterial spin labeling study. Front Neurosci 2022; 16:992758. [PMID: 36636575 PMCID: PMC9831675 DOI: 10.3389/fnins.2022.992758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives To assess the lateralization of cerebral blood flow (CBF) in the auditory cortex of idiopathic tinnitus patients and healthy controls (HCs) using 3D pseudocontinuous arterial spin labeling (pcASL). Methods Thirty-six patients with idiopathic tinnitus and 43 sex- and age-matched HCs underwent 3D-pcASL scanning using a 3.0 T MRI system. For both groups, region of interest analysis was performed on the primary auditory cortex (PAC), auditory associative cortex (AAC), and secondary auditory cortex (SAC). The clinical data of all subjects were analyzed. Results In both tinnitus patients and HCs, CBF of the left PAC was significantly higher than that of the right (HCs: P = 0.02; patients: P = 0.043), but CBF of the right AAC and SAC was significantly higher than that of the left (AAC: HCs, P < 0.001; patients: P < 0.001. SAC: HCs, P < 0.001; patients: P = 0.001). Compared with HCs, tinnitus patients exhibited significantly higher CBF in the bilateral PAC (right: P = 0.008; left: P = 0.022). CBF in the left PAC was positively correlated with tinnitus severity (r = 0.399, P = 0.016). Conclusion This study confirms the asymmetry of the auditory cortex and investigates the underlying neuropathology of idiopathic tinnitus in terms of CBF.
Collapse
Affiliation(s)
- Xiaoshuai Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yansheng Zhao
- Department of MRI Room, Kailuan General Hospital, Tangshan, Hebei, China
| | - Ying Hui
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuntao Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huijing Shi
- Department of Rheumatology and Immunology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mengning Li
- Department of MRI Room, Kailuan General Hospital, Tangshan, Hebei, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenfei Zhang
- Department of MRI Room, Kailuan General Hospital, Tangshan, Hebei, China
| | - Xinyu Zhao
- Clinical Epidemiology and Evidence-Based Medicine Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China,*Correspondence: Jing Li,
| | - Liufu Cui
- Department of Rheumatology and Immunology, Kailuan General Hospital, Tangshan, Hebei, China,Liufu Cui,
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China,Zhenchang Wang,
| |
Collapse
|
22
|
Koh YI, Oh KS, Kim JA, Noh B, Choi HJ, Joo SY, Rim JH, Kim HY, Kim DY, Yu S, Kim DH, Lee SG, Jung J, Choi JY, Gee HY. OSBPL2 mutations impair autophagy and lead to hearing loss, potentially remedied by rapamycin. Autophagy 2022; 18:2593-2614. [PMID: 35253614 PMCID: PMC9629061 DOI: 10.1080/15548627.2022.2040891] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Intracellular accumulation of mutant proteins causes proteinopathies, which lack targeted therapies. Autosomal dominant hearing loss (DFNA67) is caused by frameshift mutations in OSBPL2. Here, we show that DFNA67 is a toxic proteinopathy. Mutant OSBPL2 accumulated intracellularly and bound to macroautophagy/autophagy proteins. Consequently, its accumulation led to defective endolysosomal homeostasis and impaired autophagy. Transgenic mice expressing mutant OSBPL2 exhibited hearing loss, but osbpl2 knockout mice or transgenic mice expressing wild-type OSBPL2 did not. Rapamycin decreased the accumulation of mutant OSBPL2 and partially rescued hearing loss in mice. Rapamycin also partially improved hearing loss and tinnitus in individuals with DFNA67. Our findings indicate that dysfunctional autophagy is caused by mutant proteins in DFNA67; hence, we recommend rapamycin for DFNA67 treatment.Abbreviations: ABR: auditory brainstem response; ACTB: actin beta; CTSD: cathepsin D; dB: decibel; DFNA67: deafness non-syndromic autosomal dominant 67; DPOAE: distortion product otoacoustic emission; fs: frameshift; GFP: green fluorescent protein; HsQ53R-TG: human p.Q53Rfs*100-transgenic: HEK 293: human embryonic kidney 293; HFD: high-fat diet; KO: knockout; LAMP1: lysosomal associated membrane protein 1; MAP1LC3/LC3: microtubule-associated protein 1 light chain 3; MTOR: mechanistic target of rapamycin kinase; NSHL: non-syndromic hearing loss; OHC: outer hair cells; OSBPL2: oxysterol binding protein-like 2; SEM: scanning electron microscopy; SGN: spiral ganglion neuron; SQSTM1/p62: sequestosome 1; TEM: transmission electron microscopy; TG: transgenic; WES: whole-exome sequencing; YUHL: Yonsei University Hearing Loss; WT: wild-type.
Collapse
Affiliation(s)
- Young Ik Koh
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Kyung Seok Oh
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Jung Ah Kim
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Byunghwa Noh
- Department of Otorhinolaryngology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Hye Ji Choi
- Department of Otorhinolaryngology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Sun Young Joo
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - John Hoon Rim
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Hye-Youn Kim
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Dong Yun Kim
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Seyoung Yu
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Da Hye Kim
- Department of Otorhinolaryngology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, SeoulSeoul03722Republic of Korea
| | - Jinsei Jung
- Department of Otorhinolaryngology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea,CONTACT Jinsei Jung Department of Otorhinolaryngology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea,Jae Young Choi Department of Otorhinolaryngology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seou, 03722, Republic of Korea
| | - Heon Yung Gee
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul03722, Republic of Korea,Heon Yung Gee Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| |
Collapse
|
23
|
Mazurek B, Hesse G, Sattel H, Kratzsch V, Lahmann C, Dobel C. S3 Guideline: Chronic Tinnitus : German Society for Otorhinolaryngology, Head and Neck Surgery e. V. (DGHNO-KHC). HNO 2022; 70:795-827. [PMID: 36227338 PMCID: PMC9581878 DOI: 10.1007/s00106-022-01207-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Gerhard Hesse
- Tinnitus-Klinik, KH Bad Arolsen, Große Allee 50, 34454, Bad Arolsen, Germany.
- Universität Witten/Herdecke, Witten, Germany.
| | - Heribert Sattel
- Klinikum rechts der Isar, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technical University of Munich, Langerstr. 3, 81675, Munich, Germany
| | - Volker Kratzsch
- Abt. Hörbehinderung, Tinnitus und Schwindelerkrankungen, VAMED Rehaklinik Bad Grönenbach, Sebastian-Kneipp-Allee 3-5, 87730, Bad Grönenbach, Germany
| | - Claas Lahmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 8, 79104, Freiburg, Germany
| | - Christian Dobel
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| |
Collapse
|
24
|
Liu Y, Tang C, Wei K, Liu D, Tang K, Chen M, Xia X, Mao Z. Transcranial alternating current stimulation combined with sound stimulation improves the cognitive function of patients with Alzheimer's disease: A case report and literature review. Front Neurol 2022; 13:962684. [PMID: 36212652 PMCID: PMC9539040 DOI: 10.3389/fneur.2022.962684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Transcranial alternating current stimulation (tACS) is a relatively new non-invasive brain electrical stimulation method for the treatment of patients with Alzheimer's disease (AD), but it has poor offline effects. Therefore, we applied a new combined stimulation method to observe the offline effect on the cognitive function of patients with AD. Here, we describe the clinical results of a case in which tACS combined with sound stimulation was applied to treat moderate AD. The patient was a 73-year-old woman with a 2-year history of persistent cognitive deterioration despite the administration of Aricept and Sodium Oligomannate. Therefore, the patient received tACS combined with sound stimulation. Her cognitive scale scores improved after 15 sessions and continued to improve at 4 months of follow-up. Although the current report may provide a new alternative therapy for patients with AD, more clinical data are needed to support its efficacy.
Collapse
Affiliation(s)
- Yang Liu
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Can Tang
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Kailun Wei
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Di Liu
- Guangzhou Kangzhi Digital Technology Co., Ltd., Guangzhou, China
| | - Keke Tang
- Guangzhou Kangzhi Digital Technology Co., Ltd., Guangzhou, China
| | - Meilian Chen
- Guangzhou Kangzhi Digital Technology Co., Ltd., Guangzhou, China
| | - Xuewei Xia
- Department of Neurosurgery, Affiliated Hospital of Guilin Medical University, Guilin, China
- *Correspondence: Xuewei Xia
| | - Zhiqi Mao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
- Zhiqi Mao
| |
Collapse
|
25
|
Vittorini P, Chamoso P, De la Prieta F. A device and an app for the diagnosis and self-management of tinnitus. J Integr Bioinform 2022; 19:jib-2022-0004. [PMID: 36039680 PMCID: PMC9534487 DOI: 10.1515/jib-2022-0004] [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: 01/14/2022] [Accepted: 06/12/2022] [Indexed: 11/22/2022] Open
Abstract
Tinnitus is an annoying ringing in the ears, in varying shades and intensities. Tinnitus can affect a person’s overall health and social well-being (e.g., sleep problems, trouble concentrating, anxiety, depression and inability to work). The diagnostic procedure of tinnitus usually consists of three steps: an audiological examination, psychoacoustic measurement, and a disability evaluation. All steps are performed by physicians, who use specialised hardware/software and administer questionnaires. This paper presents a system, to be used by patients, for the diagnosis and self-management of tinnitus. The system is made up of an app and a device. The app is responsible for executing – through the device – a part of the required audiological and psychoacoustic examinations, as well as administering questionnaires that evaluate disability. The paper reviews the quality of the automated audiometric reporting and the user experience provided by the app. Descriptive and inferential statistics were used to support the findings. The results show that automated reporting is comparable with that of physicians and that user experience was improved by re-designing and re-developing the acufenometry of the app. As for the user experience, two experts in Human-Computer Interaction evaluated the first version of the app: their agreement was good (Cohen’s K = 0.639) and the average rating of the app was 1.43/2. Also patients evaluated the app in its initial version: the satisfactory tasks (audiometry and questionnaires) were rated as 4.31/5 and 4.65/5. The unsatisfactory task (acufenometry) was improved and the average rating increased from 2.86/5 to 3.96/5 (p = 0.0005). Finally, the general usability of the app was increased from the initial value of 73.6/100 to 85.4/100 (p = 0.0003). The strengths of the project are twofold. Firstly, the automated reporting feature, which – to the best of our knowledge – is the first attempt in this area. Secondly, the overall app usability, which was evaluated and improved during its development. In summary, the conclusion drawn from the conducted project is that the system works as expected, and despite some weaknesses, also the replication of the device would not be expensive, and it can be used in different scenarios.
Collapse
Affiliation(s)
- Pierpaolo Vittorini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Pablo Chamoso
- IBSAL/BISITE Research Group, University of Salamanca, Calle Espejo 12, Edificio I+D+i, 37007 Salamanca, Spain
| | - Fernando De la Prieta
- IBSAL/BISITE Research Group, University of Salamanca, Calle Espejo 12, Edificio I+D+i, 37007 Salamanca, Spain
| |
Collapse
|
26
|
Wu M, Luo B, Yu Y, Li X, Gao J, Li J, Sorger B, Riecke L. Rhythmic musical-electrical trigeminal nerve stimulation improves impaired consciousness. Neuroimage Clin 2022; 36:103170. [PMID: 36063757 PMCID: PMC9460811 DOI: 10.1016/j.nicl.2022.103170] [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: 03/09/2022] [Revised: 07/27/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022]
Abstract
Accumulating evidence shows that consciousness is linked to neural oscillations in the thalamocortical system, suggesting that deficits in these oscillations may underlie disorders of consciousness (DOC). However, patient-friendly non-invasive treatments targeting this functional anomaly are still missing and the therapeutic value of oscillation restoration has remained unclear. We propose a novel approach that aims to restore DOC patients' thalamocortical oscillations by combining rhythmic trigeminal-nerve stimulation with comodulated musical stimulation ("musical-electrical TNS"). In a double-blind, placebo-controlled, parallel-group study, we recruited 63 patients with DOC and randomly assigned them to groups receiving gamma, beta, or sham musical-electrical TNS. The stimulation was applied for 40 min on five consecutive days. We measured patients' consciousness before and after the stimulation using behavioral indicators and neural responses to rhythmic auditory speech. We further assessed their outcomes one year later. We found that musical-electrical TNS reliably lead to improvements in consciousness and oscillatory brain activity at the stimulation frequency: 43.5 % of patients in the gamma group and 25 % of patients in the beta group showed an improvement of their diagnosis after being treated with the stimulation. This group of benefitting patients still showed more positive outcomes one year later. Moreover, patients with stronger behavioral benefits showed stronger improvements in oscillatory brain activity. These findings suggest that brain oscillations contribute to consciousness and that musical-electrical TNS may serve as a promising approach to improve consciousness and predict long-term outcomes in patients with DOC.
Collapse
Affiliation(s)
- Min Wu
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China,Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Benyan Luo
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China,Corresponding author.
| | - Yamei Yu
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoxia Li
- Department of Neurology & Brain Medical Centre, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Gao
- Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou, China
| | - Jingqi Li
- Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou, China
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Lars Riecke
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
27
|
Spencer S, Mielczarek M, Olszewski J, Sereda M, Joossen I, Vermeersch H, Gilles A, Michiels S. Effectiveness of bimodal auditory and electrical stimulation in patients with tinnitus: A feasibility study. Front Neurosci 2022; 16:971633. [PMID: 36090280 PMCID: PMC9449838 DOI: 10.3389/fnins.2022.971633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTinnitus is a common symptom, affecting about 10–15% of the adult population. When input from the somatosensory system can influence and/or elicit tinnitus, this type of subjective tinnitus is called somatosensory tinnitus. Recently, a new type of bimodal neurostimulation treatment has shown promising results for a specific subgroup within the somatosensory tinnitus population. It is, however, not clear if this bimodal stimulation is also effective in patients with other types of subjective tinnitus.AimThe aim of this study was to evaluate the feasibility and efficacy of non-invasive bimodal auditory-somatosensory stimulation in reducing tinnitus severity among a general population of people with subjective tinnitus.MethodsChronic subjective tinnitus patients were recruited from the ENT department of the Antwerp University Hospital. Somatosensory stimulation was delivered by Transcutaneous Electrical Nerve Stimulation (TENS), and it was combined with auditory stimulation via headphones. The therapy comprised six sessions of thirty minutes twice a week for a period of 3 consecutive weeks. Follow up measurements were scheduled 9–12 weeks after the last treatment session. The change of the Tinnitus Functional Index (TFI) score, a questionnaire evaluating tinnitus burden and effects on the quality of life, was the primary outcome measure.ResultsTwenty-nine patients were enrolled in the study. A linear mixed-effects model was used to analyze the efficacy of bimodal treatment. The results of this analysis showed a statistically significant decrease (by 6, 9 points) in average TFI score at the follow up visit when compared to baseline. The ability to modulate tinnitus did not have an influence on the treatment results.ConclusionOur study showed that bimodal stimulation is a feasible and safe method of tinnitus treatment. The method might be an effective treatment for some participants with tinnitus, especially those who have accompanying neck/temporomandibular problems, although, the evidence from this trial is quite weak. Additional research is needed toward establishing the optimal treatment protocol, as well as selecting the most appropriate inclusion criteria.
Collapse
Affiliation(s)
- Shikha Spencer
- Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, Lodz, Poland
| | - Marzena Mielczarek
- Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, Lodz, Poland
| | - Jurek Olszewski
- Department of Otolaryngology, Laryngological Oncology, Audiology and Phoniatrics, Medical University of Lodz, Lodz, Poland
| | - Magdalena Sereda
- School of Medicine, Hearing Sciences, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Iris Joossen
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
| | - Hanne Vermeersch
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Sarah Michiels
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium
- REVAL—Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- *Correspondence: Sarah Michiels,
| |
Collapse
|
28
|
Searchfield GD, Sanders PJ. A randomized single-blind controlled trial of a prototype digital polytherapeutic for tinnitus. Front Neurol 2022; 13:958730. [PMID: 35989940 PMCID: PMC9389120 DOI: 10.3389/fneur.2022.958730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This randomized single-blind controlled trial tested the hypothesis that a prototype digital therapeutic developed to provide goal-based counseling with personalized passive and active game-based sound therapy would provide superior tinnitus outcomes, and similar usability, to a popular passive sound therapy app over a 12 week trial period. Methods The digital therapeutic consisted of an app for iPhone or Android smartphone, Bluetooth bone conduction headphones, neck pillow speaker, and a cloud-based clinician dashboard to enable messaging and app personalization. The control app was a popular self-help passive sound therapy app called White Noise Lite (WN). The primary outcome measure was clinically meaningful change in Tinnitus Functional Index (TFI) between baseline and 12 weeks of therapy. Secondary tinnitus measures were the TFI total score and subscales across sessions, rating scales and the Client Oriented Scale of Improvement in Tinnitus (COSIT). Usability of the US and WN interventions were assessed using the System Usability Scale (SUS) and the mHealth App Usability Questionnaire (MAUQ). Ninety-eight participants who were smartphone app users and had chronic moderate-severe tinnitus (>6 months, TFI score > 40) were enrolled and were randomly allocated to one of the intervention groups. Thirty-one participants in the USL group and 30 in the WN group completed 12 weeks of trial. Results Mean changes in TFI for the USL group at 6 (16.36, SD 17.96) and 12 weeks (17.83 points, SD 19.87) were clinically meaningful (>13 points reduction), the mean change in WN scores were not clinically meaningful (6 weeks 10.77, SD 18.53; 12 weeks 10.12 points, SD 21.36). A statistically higher proportion of USL participants achieved meaningful TFI change at 6 weeks (55%) and 12 weeks (65%) than the WN group at 6 weeks (33%) and 12 weeks (43%). Mean TFI, rating and COSIT scores favored the US group but were not statistically different from WN. Usability measures were similar for both groups. Conclusions The USL group demonstrated a higher proportion of responders than the WN group. The usability of the USL therapeutic was similar to the established WN app. The digital polytherapeutic demonstrated significant benefit for tinnitus reduction supporting further development.
Collapse
Affiliation(s)
- Grant D. Searchfield
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
- *Correspondence: Grant D. Searchfield
| | - Philip J. Sanders
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
29
|
Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial. Sci Rep 2022; 12:10845. [PMID: 35773272 PMCID: PMC9246951 DOI: 10.1038/s41598-022-13875-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
More than 10% of the population suffers from tinnitus, which is a phantom auditory condition that is coded within the brain. A new neuromodulation approach to treat tinnitus has emerged that combines sound with electrical stimulation of somatosensory pathways, supported by multiple animal studies demonstrating that bimodal stimulation can elicit extensive neural plasticity within the auditory brain. More recently, in a large-scale clinical trial, bimodal neuromodulation combining sound and tongue stimulation drove significant reductions in tinnitus symptom severity during the first 6 weeks of treatment, followed by diminishing improvements during the second 6 weeks of treatment. The primary objective of the large-scale randomized and double-blinded study presented in this paper was to determine if background wideband noise as used in the previous clinical trial was necessary for bimodal treatment efficacy. An additional objective was to determine if adjusting the parameter settings after 6 weeks of treatment could overcome treatment habituation effects observed in the previous study. The primary endpoint at 6-weeks involved within-arm and between-arm comparisons for two treatment arms with different bimodal neuromodulation settings based on two widely used and validated outcome instruments, Tinnitus Handicap Inventory and Tinnitus Functional Index. Both treatment arms exhibited a statistically significant reduction in tinnitus symptoms during the first 6-weeks, which was further reduced significantly during the second 6-weeks by changing the parameter settings (Cohen’s d effect size for full treatment period per arm and outcome measure ranged from − 0.7 to − 1.4). There were no significant differences between arms, in which tongue stimulation combined with only pure tones and without background wideband noise was sufficient to reduce tinnitus symptoms. These therapeutic effects were sustained up to 12 months after the treatment ended. The study included two additional exploratory arms, including one arm that presented only sound stimuli during the first 6 weeks of treatment and bimodal stimulation in the second 6 weeks of treatment. This arm revealed the criticality of combining tongue stimulation with sound for treatment efficacy. Overall, there were no treatment-related serious adverse events and a high compliance rate (83.8%) with 70.3% of participants indicating benefit. The discovery that adjusting stimulation parameters overcomes previously observed treatment habituation can be used to drive greater therapeutic effects and opens up new opportunities for optimizing stimuli and enhancing clinical outcomes for tinnitus patients with bimodal neuromodulation.
Collapse
|
30
|
Gloeckner CD, Nocon JC, Lim HH. Topographic and widespread auditory modulation of the somatosensory cortex: potential for bimodal sound and body stimulation for pain treatment. J Neural Eng 2022; 19. [PMID: 35671702 DOI: 10.1088/1741-2552/ac7665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE There has been growing interest in understanding multisensory integration in the cortex through activation of multiple sensory and motor pathways to treat brain disorders, such as tinnitus or essential tremors. For tinnitus, previous studies show that combined sound and body stimulation can modulate the auditory pathway and lead to significant improvements in tinnitus symptoms. Considering that tinnitus is a type of chronic auditory pain, bimodal stimulation could potentially alter activity in the somatosensory pathway relevant for treating chronic pain. As an initial step towards that goal, we mapped and characterized neuromodulation effects in the somatosensory cortex (SC) in response to sound and/or electrical stimulation of the body. APPROACH We first mapped the topographic organization of activity across the SC of ketamine-anesthetized guinea pigs through electrical stimulation of different body locations using subcutaneous needle electrodes or with broadband acoustic stimulation. We then characterized how neural activity in different parts of the SC could be facilitated or suppressed with bimodal stimulation. MAIN RESULTS The topography in the SC of guinea pigs in response to electrical stimulation of the body aligns consistently to that shown in previous rodent studies. Interestingly, auditory broadband noise stimulation primarily excited SC areas that typically respond to stimulation of lower body locations. Although there was only a small subset of SC locations that were excited by acoustic stimulation alone, all SC recording sites could be altered (facilitated or suppressed) with bimodal stimulation. Furthermore, specific regions of the SC could be modulated by stimulating an appropriate body region combined with broadband noise. SIGNIFICANCE These findings show that bimodal stimulation can excite or modulate firing across a widespread yet targeted population of SC neurons. This approach may provide a non-invasive method for altering or disrupting abnormal firing patterns within certain parts of the SC for chronic pain treatment.
Collapse
Affiliation(s)
- Cory D Gloeckner
- University of Minnesota Duluth, 1305 Ordean Court, Duluth, Minnesota, 55812, UNITED STATES
| | - Jian C Nocon
- Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, Massachusetts, 02215, UNITED STATES
| | - Hubert H Lim
- Department of Biomedical Engineering, University of Minnesota, 7-105 Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, USA, Minneapolis, Minnesota, 55455, UNITED STATES
| |
Collapse
|
31
|
Polley DB, Schiller D. The promise of low-tech intervention in a high-tech era: Remodeling pathological brain circuits using behavioral reverse engineering. Neurosci Biobehav Rev 2022; 137:104652. [PMID: 35385759 DOI: 10.1016/j.neubiorev.2022.104652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/09/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
As an academic pursuit, neuroscience is enjoying a golden age. From a clinical perspective, our field is failing. Conventional 20th century drugs and devices are not well-matched to the heterogeneity, scale, and connectivity of neural circuits that produce aberrant mental states and behavior. Laboratory-based methods for editing neural genomes and sculpting activity patterns are exciting, but their applications for hundreds of millions of people with mental health disorders is uncertain. We argue that mechanisms for regulating adult brain plasticity and remodeling pathological activity are substantially pre-wired, and we suggest new minimally invasive strategies to harness and direct these endogenous systems. Drawing from studies across the neuroscience literature, we describe approaches that identify neural biomarkers more closely linked to upstream causes-rather than downstream consequences-of disordered behavioral states. We highlight the potential for innovation and discovery in reverse engineering approaches that refine bespoke behavioral "agonists" to drive upstream neural biomarkers in normative directions and reduce clinical symptoms for select classes of neuropsychiatric disorders.
Collapse
Affiliation(s)
- Daniel B Polley
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.
| | - Daniela Schiller
- Department of Psychiatry, Nash Family Department of Neuroscience, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
32
|
Hesse G, Mazurek B. [Chronic tinnitus - Therapeutic aspects, based on the new german guideline]. Dtsch Med Wochenschr 2022; 147:682-687. [PMID: 35636419 DOI: 10.1055/a-1780-4882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic tinnitus is a symptom of disturbed auditory perception. More than 90 % of tinnitus patients suffer from hearing loss. Many people experience tinnitus and seek for treatment, but suffering and the actual burden of tinnitus is individually very different, sometimes it disappears after a certain time even without treatment. This process is called habituation. Up to date there is no therapy that can completely switch off tinnitus, mainly because origin and expression of tinnitus is individual and very different.This publication summarizes and evaluates scientific therapeutic approaches for chronic tinnitus. It is based on the newly elaborated S3-Guideline "Chronic Tinnitus", under the lead management of the German Society of ENT, Head and Neck-Surgery, published in 2021.
Collapse
|
33
|
Transcranial electric and acoustic stimulation for tinnitus: study protocol for a randomized double-blind controlled trial assessing the influence of combined transcranial random noise and acoustic stimulation on tinnitus loudness and distress. Trials 2022; 23:418. [PMID: 35590399 PMCID: PMC9118607 DOI: 10.1186/s13063-022-06253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
Background Tinnitus is the result of aberrant neuronal activity. As a novel treatment form, neuromodulation is used to modify neuronal activity of brain areas involved in tinnitus generation. Among the different forms of electric stimulation, transcranial random noise stimulation (tRNS) has been shown to be a promising treatment option for tinnitus. In addition, recent studies indicate that the reduction in tinnitus can be more pronounced when different modalities of stimulation techniques are combined (“bimodal stimulation”). TRNS can be used in combination with acoustic stimulation (AS), a further treatment option recognized in the literature. The aim of the proposed study is to investigate whether simultaneous tRNS and AS improve levels of tinnitus loudness and distress. Methods The intervention consists of bilateral high-definition tRNS (HD-tRNS) over the auditory cortex combined with the application of AS which is studied in a crossover design. The visits will be performed in 26 sessions. There will be 20 treatment sessions, divided into two blocks: active and sham HD-tRNS. Within the blocks, the interventions are divided into group A: HD-tRNS and AS, and group B: HD-tRNS alone. Furthermore, in addition to the assessments directly following the intervention sessions, there will be six extra sessions performed subsequently at the end of each block, after a period of some days (follow-ups 1 and 2) and a month after the last intervention (C). Primary outcome measures are analog scales for evaluation of subjective tinnitus loudness and distress, and the audiological measurement of minimum masking level (MML). Secondary outcome measures are brain activity as measured by electroencephalography and standardized questionnaires for evaluating tinnitus distress and severity. Discussion To the best of our knowledge, this is the first study which uses HD-tRNS combined with AS for tinnitus treatment. The crossover design permits the comparison between HD-tRNS active vs. sham and with vs. without AS. Thus, it will be possible to evaluate the efficacy of the combined approach to HD-tRNS alone. In addition, the use of different objective and subjective evaluations for tinnitus enable more reliable and valid results. Trial registration Swiss Ethics Committee (BASEC-Nr. 2020-02027); Swiss Federal Complementary Database (kofam.ch: SNCTP000004051); and ClinicalTrials.gov (clinicaltrials.gov: NCT04551404).
Collapse
|
34
|
Mazurek B, Hesse G, Dobel C, Kratzsch V, Lahmann C, Sattel H. Clinical practice guideline: Chronic tinnitus—diagnosis and treatment. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2022; 119:219-225. [PMID: 35197187 PMCID: PMC9342131 DOI: 10.3238/arztebl.m2022.0135] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/13/2022] [Accepted: 02/04/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic tinnitus is a commonly occurring symptom of the auditory system. Epidemiological studies assume a lifetime prevalence in men and women of 3.5% for chronic tinnitus requiring treatment. Almost 25% of all Germans have experienced at least one episode of tinnitus. No causal therapy is yet available, but numerous treatment strategies are being pursued. Rigorous scientific assessment of these procedures is essential. METHODS For this exhaustive revision of the German clinical practice guideline, the literature in the medical databases PubMed and Cochrane Library, including existing guidelines from various countries, was systematically searched using keywords on the topic of chronic tinnitus. On the basis of the revised guideline, a separate guideline was written in language accessible to patients. RESULTS Chronic tinnitus is often associated with hearing loss, but the mental distress caused by the ear noise is another crucial element. Apart from expert counseling, the recommended treatment comprises psychotherapeutic interventions, particularly cognitive behavioral therapy (with effect sizes of 0.54 to 0.91 for reduction of the tinnitus-related distress), and measures to improve the hearing. There is insufficient evidence regarding the effects of drug treatment, sound and music therapy, and neuromodulation (magnetic stimulation or electrostimulation). CONCLUSION Alongside thorough and sound diagnosis and counseling, the principal treatment options for chronic tinnitus are specific cognitive behavioral therapy and expert psychotherapeutic interventions on an individual or group basis. Future-preferably interdisciplinary-research should evaluate the long-term effects of the treatment options, with particular attention to psychosomatic comorbidity.
Collapse
|
35
|
Chen Q, Lv H, Wang Z, Wei X, Liu J, Liu F, Zhao P, Yang Z, Gong S, Wang Z. Distinct brain structural-functional network topological coupling explains different outcomes in tinnitus patients treated with sound therapy. Hum Brain Mapp 2022; 43:3245-3256. [PMID: 35332961 PMCID: PMC9189078 DOI: 10.1002/hbm.25848] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 12/13/2022] Open
Abstract
Topological properties, which serve as the core of the neural network, and their couplings can reflect different therapeutic effects in tinnitus patients. We hypothesized that tinnitus patients with different outcomes after sound therapy (narrowband noise) would have distinct brain network topological alterations. Diffusion tensor imaging and resting‐state functional magnetic resonance imaging (fMRI) were prospectively performed in 60 patients with idiopathic tinnitus and 57 healthy controls (HCs). Graph‐theoretical network analyses of structural connectivity (SC), functional connectivity (FC), and SC and FC coupling were performed. Associations between clinical performance and graph‐theoretical features were also analyzed. Treatment was effective (effective group; EG) in 28 patients and ineffective (ineffective group; IG) in 32 patients. For FC, the patients in the EG showed higher local efficiency than patients in the IG. For SC, patients in both the EG and IG displayed lower normalized characteristic path length, characteristic path length, and global efficiency than the HCs. More importantly, patients in the IG had higher coupling than the HCs, whereas there was no difference in coupling between patients in the EG and HCs. Additionally, there were significant associations between the SC features and clinical performance in patients in the EG. Our findings demonstrate that tinnitus patients exhibited significant brain network topological alterations, especially in the structural brain network. More importantly, patients who demonstrated different curative effects showed distinct SC‐FC topological coupling properties. SC‐FC coupling could be an indicator that could be used to predict prognoses in patients with idiopathic tinnitus before sound therapy.
Collapse
Affiliation(s)
- Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhaodi Wang
- Department of Otolaryngology, Beijing Jingmei Group General Hospital, Beijing, China
| | - Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiao Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fang Liu
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
36
|
Tinnitus Perception in Light of Parietal Operculo–Insular Involvement: A Review. Brain Sci 2022; 12:brainsci12030334. [PMID: 35326290 PMCID: PMC8946618 DOI: 10.3390/brainsci12030334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 12/07/2022] Open
Abstract
In tinnitus literature, researchers have increasingly been advocating for a clearer distinction between tinnitus perception and tinnitus-related distress. In non-bothersome tinnitus, the perception itself can be more specifically investigated: this has provided a body of evidence, based on resting-state and activation fMRI protocols, highlighting the involvement of regions outside the conventional auditory areas, such as the right parietal operculum. Here, we aim to conduct a review of available investigations of the human parietal operculo–insular subregions conducted at the microscopic, mesoscopic, and macroscopic scales arguing in favor of an auditory–somatosensory cross-talk. Both the previous literature and new results on functional connectivity derived from cortico–cortical evoked potentials show that these subregions present a dense tissue of interconnections and a strong connectivity with auditory and somatosensory areas in the healthy brain. Disrupted integration processes between these modalities may thus result in erroneous perceptions, such as tinnitus. More precisely, we highlight the role of a subregion of the right parietal operculum, known as OP3 according to the Jülich atlas, in the integration of auditory and somatosensory representation of the orofacial muscles in the healthy population. We further discuss how a dysfunction of these muscles could induce hyperactivity in the OP3. The evidence of direct electrical stimulation of this area eliciting auditory hallucinations further suggests its involvement in tinnitus perception. Finally, a small number of neuroimaging studies of therapeutic interventions for tinnitus provide additional evidence of right parietal operculum involvement.
Collapse
|
37
|
Sirh SJ, Sirh SW, Mun HY, Sirh HM. Integrative Treatment for Tinnitus Combining Repeated Facial and Auriculotemporal Nerve Blocks With Stimulation of Auditory and Non-auditory Nerves. Front Neurosci 2022; 16:758575. [PMID: 35299621 PMCID: PMC8923298 DOI: 10.3389/fnins.2022.758575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTinnitus is a prevalent condition (>10% of the population) affecting the quality of life of 0.5–3% of the population. Although several treatments have been proposed, most of these lack evidence of efficacy in the treatment of chronic tinnitus. Thus, we aimed to evaluate an integrative treatment strategy for subacute and chronic tinnitus.MethodsThis retrospective chart review study included 55 patients with tinnitus (subacute, n = 15; chronic, n = 40) who underwent repeated nerve blocks after stimulation of the trigeminal (V) and facial (VII) nerves to modulate the auditory and non-auditory nervous systems via the vestibulocochlear (VIII) cranial nerve pathways. We used a simplified smiley tinnitus-visual analog scale (T-VAS) with scores ranging from 0 to 10 combining the effect of tinnitus loudness, distress, and quality of life as the outcome measure to evaluate the efficacy of our treatment method. Statistical analyses were performed using SPSS (version 18.0, SPSS Inc., Chicago, IL, United States), one-way and two-way analysis of variance.ResultsIn more than 87.5% of patients (14/15 subacute, 35/40 chronic), tinnitus disappeared or had significantly reduced by the end of the treatment. The mean T-VAS score reduced significantly from 7.13 to 0.60 in the subacute group and from 7.73 to 1.53 in the chronic group by the end of treatment (p < 0.05). The benefits were maintained after treatment cessation and at the 1-year follow-up. The average number of treatment procedures was 9.8 ± 3.589 (range, 5–15) in the subacute group and 9.775 ± 3.717 (range, 5–18) in the chronic group.ConclusionOur results show that the proposed integrative approach is highly effective in treating subacute and chronic tinnitus and represents a promising therapeutic approach.
Collapse
Affiliation(s)
- Soo Ji Sirh
- Department of Neurosurgery, Sirh’s Private Pain Clinic, Seoul, South Korea
| | - So Woon Sirh
- Department of Anesthesiology and Pain Medicine, Wiltse Memorial Hospital, Suwon-si, South Korea
| | - Hah Yong Mun
- Department of Neurosurgery, Yangju Armed Forces Hospital, Yangju-si, South Korea
| | - Heon Man Sirh
- Department of Anesthesiology and Pain Medicine, Sirh’s Private Pain Clinic, Seoul, South Korea
- *Correspondence: Heon Man Sirh,
| |
Collapse
|
38
|
Hall DA, Pierzycki RH, Thomas H, Greenberg D, Sereda M, Hoare DJ. Systematic Evaluation of the T30 Neurostimulator Treatment for Tinnitus: A Double-Blind Randomised Placebo-Controlled Trial with Open-Label Extension. Brain Sci 2022; 12:brainsci12030317. [PMID: 35326273 PMCID: PMC8946033 DOI: 10.3390/brainsci12030317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Tinnitus is often triggered by cochlear damage and has been linked with aberrant patterns of neuronal activity. Acoustic Coordinated Reset (CR®) Neuromodulation is a sound therapy hypothesised to reduce tinnitus symptoms by desynchronising pathological brain activity using a portable acoustic device (the T30 neurostimulator). We report results of a pivotal trial to test the efficacy of this intervention. This two-centre, double-blind randomised controlled trial with long-term open-label extension, was undertaken between February 2012 and February 2014 in the UK. Participants were 100 adults with tinnitus as a primary complaint, recruited through hearing clinics and media advertisements. Intervention was the device programmed either with the proprietary sound sequence or placebo algorithm, fit by one of five trained audiologists. Minimisation software provided group allocation (1:1 randomisation), with groups matched for age, gender, hearing loss and tinnitus severity. Allocation was masked from participants and assessors during the trial. The primary measure of efficacy was change in tinnitus symptom severity between groups, measured using the Tinnitus Handicap Questionnaire at 12 weeks. Secondary outcomes were other measures of tinnitus symptom severity, health-related quality of life, and perceptual characteristics (pitch, loudness, bandwidth) at 12 weeks, and Tinnitus Handicap Questionnaire at 36 weeks (open-label extension). A statistician blinded to the allocation conducted an intention-to-treat analysis that employed linear regressions on minimisation variables, trial centre and intervention group, with multiple imputations for missing data. The study was registered on clinicaltrials.gov (NCT01541969). We screened 391 individuals and assigned interventions to 100 eligible participants. The primary outcome was not statistically significant between groups (mean group = −0.45, 95% CI −5.25 to 4.35; p = 0.85), nor were any of the secondary outcomes. Four adverse events occurred during the trial. Analysis of tinnitus symptom severity data collected across the 24-week open-label extension showed no statistically significant within-group changes after 12, 24, or 36 weeks treatment with the proprietary sound sequence. While individual participants may benefit from sound therapy, Acoustic CR® Neuromodulation did not lead to group-mean reductions on tinnitus symptom severity or other measures compared to placebo, or over time.
Collapse
Affiliation(s)
- Deborah Ann Hall
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- School of Social Sciences, Heriot-Watt University Malaysia, No. 1, Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Robert Henryk Pierzycki
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Holly Thomas
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Department of Ear, Nose and Throat (ENT), Nottingham University Hospitals (NHS) Trust, Queen’s Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK
| | - David Greenberg
- Ear Institute, University College London (UCL), 332 Gray’s Inn Road, London WC1X 8EE, UK;
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Derek James Hoare
- NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham NG1 5DU, UK; (D.A.H.); (R.H.P.); (H.T.); (M.S.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Correspondence: ; Tel.: +44-115-823-2630
| |
Collapse
|
39
|
Buechner A, Lesinski-Schiedat A, Becker P, Lenarz T. Real-world clinical experience with bimodal neuromodulation for the treatment of tinnitus - A case series. Brain Stimul 2022; 15:383-384. [PMID: 35123145 DOI: 10.1016/j.brs.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Andreas Buechner
- Department of Otolaryngology, Hannover Medical School, Hannover, Hearing Center Hanover (DHZ), Karl-Wiechert-Allee 3, 30625, Hannover, Germany.
| | - Anke Lesinski-Schiedat
- Department of Otolaryngology, Hannover Medical School, Hannover, Hearing Center Hanover (DHZ), Karl-Wiechert-Allee 3, 30625, Hannover, Germany.
| | - Philipp Becker
- HörSys GmbH, Karl-Wiechert-Allee 3, 30625, Hannover, Germany.
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Hearing Center Hanover (DHZ), Karl-Wiechert-Allee 3, 30625, Hannover, Germany.
| |
Collapse
|
40
|
|
41
|
Wei X, Lv H, Chen Q, Wang Z, Zhao P, Liu C, Gong S, Yang Z, Wang Z. Surface-Based Amplitude of Low-Frequency Fluctuation Alterations in Patients With Tinnitus Before and After Sound Therapy: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurosci 2021; 15:709482. [PMID: 34867147 PMCID: PMC8635858 DOI: 10.3389/fnins.2021.709482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to investigate abnormal tinnitus activity by evaluating brain surface-based amplitude of low-frequency fluctuation (ALFF) changes detected by resting-state functional magnetic resonance imaging (RS-fMRI) in patients with idiopathic tinnitus before and after 24 weeks of sound therapy. We hypothesized that sound therapy could gradually return cortical local brain function to a relatively normal range. In this prospective observational study, we recruited thirty-three tinnitus patients who had undergone 24 weeks of sound therapy and 26 matched healthy controls (HCs). For the two groups of subjects, we analyzed the spontaneous neural activity of tinnitus patients by cortical ALFF and detected its correlation with clinical indicators of tinnitus. Patients’ Tinnitus Handicap Inventory (THI) scores were assessed to determine the severity of their tinnitus before and after treatment. Two-way mixed model analysis of variance and Pearson’s correlation analysis were used in the statistical analysis. Student–Newman–Keuls tests were used in the post hoc analysis. Interaction effects between the two groups and between the two scans revealing local neural activity as assessed by ALFF were observed in the bilateral dorsal stream visual cortex (DSVC), bilateral posterior cingulate cortex (PCC), bilateral anterior cingulate and medial prefrontal cortex (ACC and MPC), left temporo-parieto-occipital junction (TPOJ), left orbital and polar frontal cortex (OPFC), left paracentral lobular and mid cingulate cortex (PCL and MCC), right insular and frontal opercular cortex (IFOC), and left early visual cortex (EVC). Importantly, local functional activity in the left TPOJ and right PCC in the patient group was significantly lower than that in the HCs at baseline and was increased to relatively normal levels after treatment. The 24-week sound therapy tinnitus group demonstrated significantly higher ALFF in the left TPOJ and right PCC than in the tinnitus baseline group. Also, compared with the HC baseline group and the 24-week HC group, the 24-week sound therapy tinnitus group demonstrated slightly lower or higher ALFF in the left TPOJ and right PCC, and there were no differences between the 24-week sound therapy tinnitus and HC groups. Decreased THI scores and ALFF changes in the abovementioned brain regions were not correlated. Taken together, surface-based RS-fMRI can provide more subtle local functional activity to explain the mechanism of tinnitus treatment, and long-term sound therapy had a normalizing effect on tinnitus patients.
Collapse
Affiliation(s)
- Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhaodi Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunli Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
42
|
Schoisswohl S, Langguth B, Schecklmann M, Bernal-Robledano A, Boecking B, Cederroth CR, Chalanouli D, Cima R, Denys S, Dettling-Papargyris J, Escalera-Balsera A, Espinosa-Sanchez JM, Gallego-Martinez A, Giannopoulou E, Hidalgo-Lopez L, Hummel M, Kikidis D, Koller M, Lopez-Escamez JA, Marcrum SC, Markatos N, Martin-Lagos J, Martinez-Martinez M, Martinez-Martinez M, Ferron MM, Mazurek B, Mueller-Locatelli N, Neff P, Oppel K, Perez-Carpena P, Robles-Bolivar P, Rose M, Schiele T, Schiller A, Simoes J, Stark S, Staudinger S, Stege A, Verhaert N, Schlee W. Unification of Treatments and Interventions for Tinnitus Patients (UNITI): a study protocol for a multi-center randomized clinical trial. Trials 2021; 22:875. [PMID: 34863270 PMCID: PMC8642746 DOI: 10.1186/s13063-021-05835-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tinnitus represents a relatively common condition in the global population accompanied by various comorbidities and severe burden in many cases. Nevertheless, there is currently no general treatment or cure, presumable due to the heterogeneity of tinnitus with its wide variety of etiologies and tinnitus phenotypes. Hence, most treatment studies merely demonstrated improvement in a subgroup of tinnitus patients. The majority of studies are characterized by small sample sizes, unstandardized treatments and assessments, or applications of interventions targeting only a single organ level. Combinatory treatment approaches, potentially targeting multiple systems as well as treatment personalization, might provide remedy and enhance treatment responses. The aim of the present study is to systematically examine established tinnitus therapies both alone and in combination in a large sample of tinnitus patients. Further, it wants to provide the basis for personalized treatment approaches by evaluating a specific decision support system developed as part of an EU-funded collaborative project (Unification of treatments and interventions for tinnitus patients; UNITI project). METHODS/STUDY DESIGN This is a multi-center parallel-arm randomized clinical trial conducted at five different clinical sites over the EU. The effect of four different tinnitus therapy approaches (sound therapy, structured counseling, hearing aids, cognitive behavioral therapy) applied over a time period of 12 weeks as a single or rather a combinatory treatment in a total number of 500 chronic tinnitus patients will be investigated. Assessments and interventions are harmonized over the involved clinical sites. The primary outcome measure focuses on the domain tinnitus distress assessed via the Tinnitus Handicap Inventory. DISCUSSION Results and conclusions from the current study might not only provide an essential contribution to combinatory and personalized treatment approaches in tinnitus but could also provide more profound insights in the heterogeneity of tinnitus, representing an important step towards a cure for tinnitus. TRIAL REGISTRATION ClinicalTrials.gov NCT04663828 . Registered on 11 December 2020.
Collapse
Affiliation(s)
- Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany.
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Alberto Bernal-Robledano
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Benjamin Boecking
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | | | | | - Rilana Cima
- Department of Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sam Denys
- Department of Neurosciences, Research group Experimental Oto-Rhino-Laryngology, University of Leuven, Leuven, Belgium.,Department of Otorhinolaryngology - Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium.,Multidisciplinary University Center for Speech-Language Pathology and Audiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Alba Escalera-Balsera
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Juan Manuel Espinosa-Sanchez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Alvaro Gallego-Martinez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | | | - Leyre Hidalgo-Lopez
- Department of Mental Health, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Michael Hummel
- Central Biobank Charité, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Dimitris Kikidis
- Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Jose A Lopez-Escamez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain.,Department of Surgery, Division of Otolaryngology, Universidad de Granada, Granada, Spain
| | - Steven C Marcrum
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Nikolaos Markatos
- Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Juan Martin-Lagos
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Maria Martinez-Martinez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Marta Martinez-Martinez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Maria Mata Ferron
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Birgit Mazurek
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Nicolas Mueller-Locatelli
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Patrick Neff
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany.,Center for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Kevin Oppel
- Terzo-Institute for Applied Hearing Research, ISMA, Sonneberg, Germany
| | - Patricia Perez-Carpena
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Paula Robles-Bolivar
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Matthias Rose
- Department of Psychosomatic and Psychotherapy, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Tabea Schiele
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Axel Schiller
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Jorge Simoes
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Sabine Stark
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Susanne Staudinger
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Alexandra Stege
- Central Biobank Charité, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Nicolas Verhaert
- Department of Neurosciences, Research group Experimental Oto-Rhino-Laryngology, University of Leuven, Leuven, Belgium.,Department of Otorhinolaryngology - Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium.,Multidisciplinary University Center for Speech-Language Pathology and Audiology, University Hospitals Leuven, Leuven, Belgium
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| |
Collapse
|
43
|
Knipper M, Mazurek B, van Dijk P, Schulze H. Too Blind to See the Elephant? Why Neuroscientists Ought to Be Interested in Tinnitus. J Assoc Res Otolaryngol 2021; 22:609-621. [PMID: 34686939 PMCID: PMC8599745 DOI: 10.1007/s10162-021-00815-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/30/2021] [Indexed: 01/13/2023] Open
Abstract
A curative therapy for tinnitus currently does not exist. One may actually exist but cannot currently be causally linked to tinnitus due to the lack of consistency of concepts about the neural correlate of tinnitus. Depending on predictions, these concepts would require either a suppression or enhancement of brain activity or an increase in inhibition or disinhibition. Although procedures with a potential to silence tinnitus may exist, the lack of rationale for their curative success hampers an optimization of therapeutic protocols. We discuss here six candidate contributors to tinnitus that have been suggested by a variety of scientific experts in the field and that were addressed in a virtual panel discussion at the ARO round table in February 2021. In this discussion, several potential tinnitus contributors were considered: (i) inhibitory circuits, (ii) attention, (iii) stress, (iv) unidentified sub-entities, (v) maladaptive information transmission, and (vi) minor cochlear deafferentation. Finally, (vii) some potential therapeutic approaches were discussed. The results of this discussion is reflected here in view of potential blind spots that may still remain and that have been ignored in most tinnitus literature. We strongly suggest to consider the high impact of connecting the controversial findings to unravel the whole complexity of the tinnitus phenomenon; an essential prerequisite for establishing suitable therapeutic approaches.
Collapse
Affiliation(s)
- Marlies Knipper
- Molecular Physiology of Hearing, Tübingen Hearing Research Centre (THRC), Department of Otolaryngology, Head & Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany.
| | - Birgit Mazurek
- Tinnitus Center Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands
| | - Holger Schulze
- Experimental Otolaryngology, Friedrich-Alexander Universität Erlangen-Nürnberg, Waldstrasse 1, 91054, Erlangen, Germany
| |
Collapse
|
44
|
Beukes EW, Baguley DM, Manchaiah V, Andersson G, Allen PM, Kaldo V, Jacquemin L, Lourenco MPCG, Onozuka J, Stockdale D, Maidment DW. Investigating tinnitus subgroups based on hearing-related difficulties. Int J Clin Pract 2021; 75:e14684. [PMID: 34331723 DOI: 10.1111/ijcp.14684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Meaningfully grouping individuals with tinnitus who share a common characteristics (ie, subgrouping, phenotyping) may help tailor interventions to certain tinnitus subgroups and hence reduce outcome variability. The purpose of this study was to test if the presence of tinnitus subgroups are discernible based on hearing-related comorbidities, and to identify predictors of tinnitus severity for each subgroup identified. METHODS An exploratory cross-sectional study was used. The study was nested within an online survey distributed worldwide to investigate tinnitus experiences during the COVID-19 pandemic. The main outcome measure was the tinnitus Handicap Inventory- Screening Version. RESULTS From the 3400 respondents, 2980 were eligible adults with tinnitus with an average age of 58 years (SD = 14.7) and 49% (n = 1457) being female. A three-cluster solution identified distinct subgroups, namely, those with tinnitus-only (n = 1306; 44%), those presenting with tinnitus, hyperacusis, hearing loss and/or misophonia (n = 795; 27%), and those with tinnitus and hearing loss (n = 879; 29%). Those with tinnitus and hyperacusis reported the highest tinnitus severity (M = 20.3; SD = 10.5) and those with tinnitus and no hearing loss had the lowest tinnitus severity (M = 15.7; SD = 10.4). Younger age and the presence of mental health problems predicted greater tinnitus severity for all groups (β ≤ -0.1, P ≤ .016). CONCLUSION Further exploration of these potential subtypes are needed in both further research and clinical practice by initially triaging tinnitus patients prior to their clinical appointments based on the presence of hearing-related comorbidities. Unique management pathways and interventions could be tailored for each tinnitus subgroup.
Collapse
Affiliation(s)
- Eldré W Beukes
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Vision and Hearing Sciences Research Group, School of Psychology and Sports Sciences, Anglia Ruskin University, Cambridge, UK
| | - David M Baguley
- National Institute for Health Research, Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham Audiology Services, Nottingham University Hospitals, Nottingham, UK
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Peter M Allen
- Vision and Hearing Sciences Research Group, School of Psychology and Sports Sciences, Anglia Ruskin University, Cambridge, UK
| | - Viktor Kaldo
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Laure Jacquemin
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Matheus P C G Lourenco
- Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
- Research Group Health Psychology, KU Leuven University, Leuven, Belgium
| | - Joy Onozuka
- American Tinnitus Association, Washington, DC, USA
| | | | - David W Maidment
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| |
Collapse
|
45
|
Searchfield GD, Sanders PJ, Doborjeh Z, Doborjeh M, Boldu R, Sun K, Barde A. A State-of-Art Review of Digital Technologies for the Next Generation of Tinnitus Therapeutics. Front Digit Health 2021; 3:724370. [PMID: 34713191 PMCID: PMC8522011 DOI: 10.3389/fdgth.2021.724370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Digital processing has enabled the development of several generations of technology for tinnitus therapy. The first digital generation was comprised of digital Hearing Aids (HAs) and personal digital music players implementing already established sound-based therapies, as well as text based information on the internet. In the second generation Smart-phone applications (apps) alone or in conjunction with HAs resulted in more therapy options for users to select from. The 3rd generation of digital tinnitus technologies began with the emergence of many novel, largely neurophysiologically-inspired, treatment theories that drove development of processing; enabled through HAs, apps, the internet and stand-alone devices. We are now of the cusp of a 4th generation that will incorporate physiological sensors, multiple transducers and AI to personalize therapies. Aim: To review technologies that will enable the next generations of digital therapies for tinnitus. Methods: A "state-of-the-art" review was undertaken to answer the question: what digital technology could be applied to tinnitus therapy in the next 10 years? Google Scholar and PubMed were searched for the 10-year period 2011-2021. The search strategy used the following key words: "tinnitus" and ["HA," "personalized therapy," "AI" (and "methods" or "applications"), "Virtual reality," "Games," "Sensors" and "Transducers"], and "Hearables." Snowballing was used to expand the search from the identified papers. The results of the review were cataloged and organized into themes. Results: This paper identified digital technologies and research on the development of smart therapies for tinnitus. AI methods that could have tinnitus applications are identified and discussed. The potential of personalized treatments and the benefits of being able to gather data in ecologically valid settings are outlined. Conclusions: There is a huge scope for the application of digital technology to tinnitus therapy, but the uncertain mechanisms underpinning tinnitus present a challenge and many posited therapeutic approaches may not be successful. Personalized AI modeling based on biometric measures obtained through various sensor types, and assessments of individual psychology and lifestyles should result in the development of smart therapy platforms for tinnitus.
Collapse
Affiliation(s)
- Grant D. Searchfield
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Philip J. Sanders
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Zohreh Doborjeh
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Maryam Doborjeh
- School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Roger Boldu
- Augmented Human Laboratory, Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Kevin Sun
- Section of Audiology, The University of Auckland, Auckland, New Zealand
| | - Amit Barde
- Empathic Computing Laboratory, Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
46
|
Chen Q, Lv H, Wang Z, Wei X, Liu J, Zhao P, Yang Z, Gong S, Wang Z. Pretreatment intranetwork connectivity can predict the outcomes in idiopathic tinnitus patients treated with sound therapy. Hum Brain Mapp 2021; 42:4762-4776. [PMID: 34231944 PMCID: PMC8410522 DOI: 10.1002/hbm.25584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
Previous studies demonstrated that brain morphological differences and distinct patterns of neural activation exist in tinnitus patients with different prognoses after sound therapy. This study aimed to explore possible differences in intrinsic network‐level functional connectivity (FC) in patients with different outcomes after sound therapy (narrow band noise). We examined intrinsic FC using resting‐state functional magnetic resonance imaging in 78 idiopathic tinnitus patients (including 35 effectively treated and 43 ineffectively treated) and 52 healthy controls (HCs) via independent component analysis. We also investigated the associations between the differences in FC and clinical variables. Analyses revealed significantly altered intranetwork connectivity in the auditory network (AUN) and some nonauditory‐related networks in the EG/IG patients compared to HCs; compared with EG patients, IG patients showed decreased intranetwork connectivity in the anterior default mode network (aDMN) and AUN. Meanwhile, robust differences were also evident in internetwork connectivity between some nonauditory‐related networks (salience network and executive control network; posterior default mode network and dorsal attention network) in the EG relative to IG patients. We combined intranetwork connectivity in the aDMN and AUN as an imaging indicator to evaluate patient outcomes and screen patients before treatment; this approach reached a sensitivity of 94.3% and a specificity of 76.7%. Our study suggests that tinnitus patients with different outcomes show distinct network‐level functional reorganization patterns. Intranetwork connectivity in the aDMN and AUN may be indicators that can be used to predict prognoses in patients with idiopathic tinnitus and screen patients before sound therapy.
Collapse
Affiliation(s)
- Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhaodi Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, General Hospital of Beijing Jingmei Group, Beijing, China
| | - Xuan Wei
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiao Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shusheng Gong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
Development of ebselen for the treatment of sensorineural hearing loss and tinnitus. Hear Res 2021; 413:108209. [PMID: 33678494 DOI: 10.1016/j.heares.2021.108209] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/29/2020] [Accepted: 02/13/2021] [Indexed: 02/08/2023]
Abstract
The global impact of hearing loss and related auditory dysfunction including tinnitus and hyperacusis on human health is significant and growing. A substantial body of literature has found that these hearing diseases and disorders result from significant number of genetic variations and molecular mechanisms. Investigational new drugs have been tested and several approved drugs have been repurposed in clinical trials, but no therapeutics for any auditory related indication have been FDA approved. A unique investigational new drug called ebselen (SPI-1005), that is anti-inflammatory and neuroprotective, has been shown to reduce noise-induced and aminoglycoside-induced hearing loss in animals. Multiple phase 2 clinical trials have demonstrated the safety and efficacy of SPI-1005 treatment in Meniere's disease and acute noise-induced hearing loss. SPI-1005 is currently being tested to prevent and treat tobramycin-induced ototoxicity in cystic fibrosis patients with acute lung infections. This review summarizes the published and presented data involving SPI-1005 and other drugs being tested to prevent or treat sensorineural hearing loss. Additionally, recent clinical data showing the relationship between pure tone audiometry and words-in-noise test results in a Meniere's disease are presented, which may have larger implications for the field of hearing research.
Collapse
|
49
|
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.
Collapse
|
50
|
Abstract
This volume has highlighted the many recent advances in tinnitus theory, models, diagnostics, therapies, and therapeutics. But tinnitus knowledge is far from complete. In this chapter, contributors to the Behavioral Neuroscience of Tinnitus consider emerging topics and areas of research needed in light of recent findings. New research avenues and methods to explore are discussed. Issues pertaining to current assessment, treatment, and research methods are outlined, along with recommendations on new avenues to explore with research.
Collapse
|