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Xing MJ, Moulin TA, Suresh T, Gira JP, Sheybani A, Van Stavern GP. Migraine is a risk factor for pseudophakic positive dysphotopsia following monofocal lens implantation. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00059-0. [PMID: 38503405 DOI: 10.1016/j.jcjo.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/13/2023] [Accepted: 02/25/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To identify neuroadaptation-related risk factors for persistent positive dysphotopsia (>6 months) following monofocal lens implantation. DESIGN Retrospective cohort study. PARTICIPANTS Patients of an academic institution and a private practice in Saint Louis, Missouri. Inclusion criteria were adults with cataract extraction between January 2010 and April 2021 with monofocal intraocular lens implantation. Exclusion criteria included dementia, <20/40 acuity, visual pathway damage, visual field loss, and significant pathology causing photopsia. METHODS Participants were surveyed via telephone. RESULTS There were 385 participants (385 eyes), of whom 66 had persistent dysphotopsia (58 positive), 298 had none, and 21 had nonpersistent dysphotopsia. Among the 58 who had positive persistent dysphotopsia, mean Pseudophakic Dysphotopsia Questionnaire 6 (PDQ-6) score was 14.11 (SD, 8.46). There were no significant differences in sex or race. Migraine prevalence was greater among those with dysphotopsia (21.2%) than among those without (11.4%; p = 0.054). History of migraine was associated with an increase in PDQ-6 score of 2.76 points (p = 0.006). Six people in each group had Visual Aura Rating Scale (VARS) scores greater than zero. Mean VARS score was 0.48 for those with dysphotopsia and 0.14 for those without (p = 0.03). History of migraine or increased VARS score, younger age, and female sex were associated with lower satisfaction. CONCLUSION History of migraine was associated with increased dysphotopsia severity and decreased patient satisfaction. Although further study with a larger sample size is warranted, these preliminary results highlight the potential of simple questions to individualize lens choice, reduce the risk of dysphotopsia, and improve patient satisfaction.
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Affiliation(s)
- Maggie J Xing
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Thiago A Moulin
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Tara Suresh
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | | | - Arsham Sheybani
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Gregory P Van Stavern
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO.
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Xing M, Kallogjeri D, Piccirillo JF. Investigating the Impact of Cognitive Training for Individuals With Bothersome Tinnitus: A Randomized Controlled Trial. Otolaryngol Head Neck Surg 2021; 165:854-861. [PMID: 33650921 DOI: 10.1177/0194599821994742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of cognitive training in improving tinnitus bother and to identify predictors of patient response. STUDY DESIGN Prospective open-label randomized controlled trial. SETTING Online. METHODS Participants were adults with subjective idiopathic nonpulsatile tinnitus causing significant tinnitus-related distress. The intervention group trained by using auditory-intensive exercises for 20 minutes per day, 5 days per week, for 8 weeks. The active control group trained on the same schedule with non-auditory intensive games. Surveys were completed at baseline, 8 weeks, and 12 weeks. RESULTS A total of 64 participants completed the study. The median age was 63 years (range, 25-69) in the intervention group and 61 years (34-68) in the control group. Mixed model analysis revealed that within-subject change in Tinnitus Functional Index in the intervention group was not different than the control group, with marginal mean differences (95% CI): 0.24 (-11.20 to 10.7) and 2.17 (-8.50 to 12.83) at 8 weeks and 2.33 (-8.6 to 13.3) and 3.36 (-7.91 to 14.6) at 12 weeks, respectively. When the 2 study groups were compared, the control group had higher Tinnitus Functional Index scores than the intervention group by 10.5 points at baseline (95% CI, -0.92 to 29.89), 8.1 at 8 weeks (95% CI, -3.27 to 19.42), and 9.4 at 12 weeks (95% CI, -2.45 to 21.34). CONCLUSION Auditory-intensive cognitive training was not associated with changes in self-reported tinnitus bother. Given the potential for neuroplasticity to affect tinnitus, we believe that future studies on cognitive training for tinnitus remain relevant.
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Affiliation(s)
- Maggie Xing
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Danioth L, Brotschi G, Croy I, Friedrich H, Caversaccio MD, Negoias S. Multisensory environmental sensitivity in patients with chronic tinnitus. J Psychosom Res 2020; 135:110155. [PMID: 32534321 DOI: 10.1016/j.jpsychores.2020.110155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aimed at investigating the sensitivity to noise and chemosensory environmental stressors as well as the relation to perceived stress, depression and anxiety in subjects with chronic tinnitus as compared to subjects without tinnitus. METHODS We included 75 subjects with chronic tinnitus and 75 age and sex-matched subjects without tinnitus. Standardized questionnaires assessing the level of distress and impairment of quality of life caused by tinnitus, perceived level of stress, anxiety and depression, environmental noise and chemosensory sensitivity were used. A subgroup of 27 subjects with chronic tinnitus and 20 age-matched subjects without tinnitus underwent testing of olfactory function with the Sniffin' Sticks test and testing of intranasal trigeminal function using CO2 thresholds. RESULTS Our data confirmed the increased environmental noise sensitivity (NSS) in patients with tinnitus. Furthermore, we observed an increased environmental chemosensory sensitivity (CSS), but no difference in measured chemosensory function. Subjects with tinnitus showed also significant higher levels of perceived stress, anxiety and depression and those symptoms partially correlated to CSS and NSS. Predictors of both NSS and CSS results were the presence / absence of tinnitus and high anxiety levels while neither stress nor depression were found as predicting variables. CONCLUSIONS The results suggest that chronic tinnitus is related to a multisensory environmental hypersensitivity. Anxiety seems to be a predictor of this environmental vulnerability.
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Affiliation(s)
- Laura Danioth
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Gladys Brotschi
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, Technische Universität Dresden, Fetscherstraße 74, Dresden 01307, Germany
| | - Hergen Friedrich
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland; Department of Otorhinolaryngology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Marco-Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland
| | - Simona Negoias
- Department of Otorhinolaryngology, Head and Neck Surgery, lnselspital, Bern University Hospital, University of Bern, Bern CH-3010, Switzerland; Department of Otorhinolaryngology, Head and Neck Surgery, Basel University Hospital, University of Basel, Basel CH-4051, Switzerland.
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Viziano A, Micarelli A, Alessandrini M. Noise sensitivity and hyperacusis in patients affected by multiple chemical sensitivity. Int Arch Occup Environ Health 2016; 90:189-196. [PMID: 27838888 DOI: 10.1007/s00420-016-1185-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 11/02/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of this study was to investigate the presence of noise sensitivity and hyperacusis in patients suffering from multiple chemical sensitivity (MCS), a chronic condition characterized by several symptoms following low-level chemical exposure. Moreover, distortion product otoacoustic emissions (DPOAE) were performed to further study cochlear function. METHODS A questionnaire-based survey was performed. Eighteen MCS patients, selected with strict diagnostic criteria, and 20 healthy age- and gender-matched subjects filled Weinstein's Noise Sensitivity Questionnaire (WNS) and Khalfa's Hyperacusis Questionnaire (HQ). Results were compared with scores from the quick Environmental Exposure Sensitivity Index (qEESI), a routinarily used questionnaire to screen MCS symptoms, and with DPOAE values. An analysis of variance (ANOVA) was performed between MCS and control subjects scores; moreover, Spearman's rank correlation test was performed between questionnaire results. RESULTS ANOVA testing on DPOAE values showed any significant difference between groups, while WNS, HQ and qEESI scores were significantly higher in MCS group compared to controls. Correlation analysis showed strong positive correlation between WNS, HQ and qEESI in MCS subjects. CONCLUSIONS For the first time, auditory-related perceptual disorders were studied in MCS. A strong association between WNS, HQ results and MCS symptoms severity has been highlighted. These findings suggest that decreased sound tolerance and noise sensitivity could be considered as possible new aspects of this syndrome, contributing to its peculiar phenotype. Furthermore, as DPOAE values did not differ from healthy subjects, present findings might suggest a 'central' source for such disorders in this group of patients.
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Affiliation(s)
- Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, 'Tor Vergata' University, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy
| | - Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, 'Tor Vergata' University, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy. .,Department of Systems Medicine - Neuroscience Unit, 'Tor Vergata' University, Rome, Italy.
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, 'Tor Vergata' University, Via Montpellier, 1, E sud Tower, 00133, Rome, Italy
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Medeiros LN, Sanchez TG. Tinnitus and cell phones: the role of electromagnetic radiofrequency radiation. Braz J Otorhinolaryngol 2016; 82:97-104. [PMID: 26602000 PMCID: PMC9444668 DOI: 10.1016/j.bjorl.2015.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 04/07/2015] [Accepted: 04/17/2015] [Indexed: 10/27/2022] Open
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The Relevance of Interoception in Chronic Tinnitus: Analyzing Interoceptive Sensibility and Accuracy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:487372. [PMID: 26583114 PMCID: PMC4637048 DOI: 10.1155/2015/487372] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022]
Abstract
In order to better understand tinnitus and distress associated with tinnitus, psychological variables such as emotional and cognitive processing are a central element in theoretical models of this debilitating condition. Interoception, that is, the perception of internal processes, may be such a psychological factor relevant to tinnitus. Against this background, 20 participants suffering from chronic tinnitus and 20 matched healthy controls were tested with questionnaires, assessing interoceptive sensibility, and participated in two tasks, assessing interoceptive accuracy: the Schandry task, a heartbeat estimation assignment, and a skin conductance fluctuations perception task assessing the participants' ability to perceive phasic increases in sympathetic activation were used. To test stress reactivity, a construct tightly connected to tinnitus onset, we also included a stress induction. No differences between the groups were found for interoceptive accuracy and sensibility. However, the tinnitus group tended to overestimate the occurrence of phasic activation. Loudness of the tinnitus was associated with reduced interoceptive performance under stress. Our results indicate that interoceptive sensibility and accuracy do not play a significant role in tinnitus. However, tinnitus might be associated with a tendency to overestimate physical changes.
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Nordin S, Neely G, Olsson D, Sandström M. Odor and noise intolerance in persons with self-reported electromagnetic hypersensitivity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8794-805. [PMID: 25166918 PMCID: PMC4198991 DOI: 10.3390/ijerph110908794] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/10/2014] [Accepted: 08/19/2014] [Indexed: 11/16/2022]
Abstract
Lack of confirmation of symptoms attributed to electromagnetic fields (EMF) and triggered by EMF exposure has highlighted the role of individual factors. Prior observations indicate intolerance to other types of environmental exposures among persons with electromagnetic hypersensitivity (EHS). This study assessed differences in odor and noise intolerance between persons with EHS and healthy controls by use of subscales and global measures of the Chemical Sensitivity Scale (CSS) and the Noise Sensitivity Scale (NSS). The EHS group scored significantly higher than the controls on all CSS and NSS scales. Correlation coefficients between CSS and NSS scores ranged from 0.60 to 0.65 across measures. The findings suggest an association between EHS and odor and noise intolerance, encouraging further investigation of individual factors for understanding EMF-related symptoms.
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Affiliation(s)
- Steven Nordin
- Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
| | - Gregory Neely
- Department of Psychology, Umeå University, SE-901 87 Umeå, Sweden.
| | - David Olsson
- Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden.
| | - Monica Sandström
- Department of Public Health and Clinical Medicine, Umeå University, SE-901 87 Umeå, Sweden.
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Vanneste S, Joos K, Langguth B, To WT, De Ridder D. Neuronal correlates of maladaptive coping: an EEG-study in tinnitus patients. PLoS One 2014; 9:e88253. [PMID: 24558383 PMCID: PMC3928191 DOI: 10.1371/journal.pone.0088253] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 01/07/2014] [Indexed: 02/05/2023] Open
Abstract
Here we aimed to investigate the neuronal correlates of different coping styles in patients suffering from chronic tinnitus. Adaptive and maladaptive coping styles were determined in 85 tinnitus patients. Based on resting state EEG recordings, coping related differences in brain activity and connectivity were found. Maladaptive coping behavior was related to increases in subjective tinnitus loudness and distress, higher tinnitus severity and higher depression scores. EEG recordings demonstrated increased alpha activity over the left dorsolateral prefrontal cortex (DLPFC) and subgenual anterior cingulate cortex (sgACC) as well as increased connectivity in the default (i.e. resting state) network in tinnitus patients with a maladaptive coping style. Correlation analysis revealed that the changes in the DLPFC correlate primarily with maladaptive coping behavior, whereas the changes in the sgACC correlate with tinnitus severity and depression. Our findings are in line with previous research in the field of depression that during resting state a alpha band hyperconnectivity exists within the default network for patients who use a maladaptive coping style, with the sgACC as the dysfunctional node and that the strength of the connectivity is related to focusing on negative mood and catastrophizing about the consequences of tinnitus.
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Affiliation(s)
- Sven Vanneste
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, United States of America
| | - Kathleen Joos
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Wing Ting To
- Faculty of Social Work and Welfare Studies, University College Ghent, Ghent, Belgium
| | - Dirk De Ridder
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- BRAIN, Sint Augustinus Hospital, Antwerp, Belgium
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Abstract
Background Many people with tinnitus also suffer from hyperacusis. Both clinical and basic scientific data indicate an overlap in pathophysiologic mechanisms. In order to further elucidate the interplay between tinnitus and hyperacusis we compared clinical and demographic characteristics of tinnitus patients with and without hyperacusis by analyzing a large sample from an international tinnitus patient database. Materials The default dataset import [November 1st, 2012] from the Tinnitus Research Initiative [TRI] Database was used for analyses. Hyperacusis was defined by the question “Do sounds cause you pain or physical discomfort?” of the Tinnitus Sample Case History Questionnaire. Patients who answered this question with “yes” were contrasted with “no”-responders with respect to 41 variables. Results 935 [55%] out of 1713 patients were characterized as hyperacusis patients. Hyperacusis in tinnitus was associated with younger age, higher tinnitus-related, mental and general distress; and higher rates of pain disorders and vertigo. In relation to objective audiological assessment patients with hyperacusis rated their subjective hearing function worse than those without hyperacusis. Similarly the tinnitus pitch was rated higher by hyperacusis patients in relation to the audiometrically determined tinnitus pitch. Among patients with tinnitus and hyperacusis the tinnitus was more frequently modulated by external noise and somatic maneuvers, i.e., exposure to environmental sounds and head and neck movements change the tinnitus percept. Conclusions Our findings suggest that the comorbidity of hyperacusis is a useful criterion for defining a sub-type of tinnitus which is characterized by greater need of treatment. The higher sensitivity to auditory, somatosensory and vestibular input confirms the notion of an overactivation of an unspecific hypervigilance network in tinnitus patients with hyperacusis.
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Huang J, Tang T, Hu G, Zheng J, Wang Y, Wang Q, Su J, Zou Y, Peng X. Association between exposure to electromagnetic fields from high voltage transmission lines and neurobehavioral function in children. PLoS One 2013; 8:e67284. [PMID: 23843999 PMCID: PMC3700989 DOI: 10.1371/journal.pone.0067284] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/15/2013] [Indexed: 11/22/2022] Open
Abstract
Background Evidence for a possible causal relationship between exposure to electromagnetic fields (EMF) emitted by high voltage transmission (HVT) lines and neurobehavioral dysfunction in children is insufficient. The present study aims to investigate the association between EMF exposure from HVT lines and neurobehavioral function in children. Methods Two primary schools were chosen based on monitoring data of ambient electromagnetic radiation. A cross-sectional study with 437 children (9 to 13 years old) was conducted. Exposure to EMF from HVT lines was monitored at each school. Information was collected on possible confounders and relevant exposure predictors using standardized questionnaires. Neurobehavioral function in children was evaluated using established computerized neurobehavioral tests. Data was analyzed using multivariable regression models adjusted for relevant confounders. Results After controlling for potential confounding factors, multivariable regression revealed that children attending a school near 500 kV HVT lines had poorer performance on the computerized neurobehavioral tests for Visual Retention and Pursuit Aiming compared to children attending a school that was not in close proximity to HVT lines. Conclusions The results suggest long-term low-level exposure to EMF from HVT lines might have a negative impact on neurobehavioral function in children. However, because of differences in results only for two of four tests achieved statistical significance and potential limitations, more studies are needed to explore the effects of exposure to extremely low frequency EMF on neurobehavioral function and development in children.
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Affiliation(s)
- Jiongli Huang
- Center for Environmental Health Research, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, Guangdong, China
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Tiantong Tang
- School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Guocheng Hu
- Center for Environmental Health Research, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, Guangdong, China
| | - Jing Zheng
- Center for Environmental Health Research, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, Guangdong, China
| | - Yuyu Wang
- Center for Environmental Health Research, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, Guangdong, China
| | - Qiang Wang
- Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Bejing, China
| | - Jing Su
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yunfeng Zou
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- * E-mail: (YZ); (XP)
| | - Xiaowu Peng
- Center for Environmental Health Research, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, Guangdong, China
- * E-mail: (YZ); (XP)
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Langguth B, De Ridder D. Tinnitus: therapeutic use of superficial brain stimulation. HANDBOOK OF CLINICAL NEUROLOGY 2013; 116:441-467. [PMID: 24112915 DOI: 10.1016/b978-0-444-53497-2.00036-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Tinnitus is a common disorder and traditional treatment approaches such as medication, active or passive sound enhancement, and cognitive behavioral therapy have limited efficacy. Thus, there is an urgent need for more effective treatment approaches. Functional imaging studies in patients with tinnitus have revealed alterations in neuronal activity of central auditory pathways, probably resulting as a consequence of sensory deafferentation. However, nonauditory brain areas are also involved. These nonauditory brain areas might represent both an "awareness" network involved in the conscious perception of the tinnitus signal as well as areas related to a nontinnitus-specific distress network consisting of the anterior cingulate cortex, anterior insula, and amygdala. Moreover, memory mechanisms involving the hippocampus and the parahippocampal region may play a role in the persistence of the awareness of the phantom percept, as well as in the reinforcement of the associated distress. All of these networks represent potential targets for treatment via pharmacological treatment or noninvasive and invasive brain stimulation. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method of applying electromagnetic fields to the brain that can induce alterations of neuronal activity that outlast the stimulation period. Single sessions of rTMS over the temporal or temporoparietal cortex have been successful in transiently reducing tinnitus perception. Repeated sessions of rTMS have resulted in tinnitus relief in a subgroup of patients, lasting from several days to several months. However, effect sizes of rTMS in the treatment of tinnitus are only moderate, and interindividual variability is high. Larger and longer lasting effects have been observed with direct electrical stimulation of the auditory cortex via implanted epidural electrodes. Transcranial direct current stimulation (tDCS) has also shown potential for the treatment of tinnitus. Both auditory and frontal tDCS have shown tinnitus reduction in a subgroup of patients. In spite of the promising results of the different brain stimulation approaches, further research is needed before these techniques can be recommended for routine clinical use.
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Affiliation(s)
- Berthold Langguth
- Interdisciplinary Tinnitus Clinic, Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
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Reavis KM, Rothholtz VS, Tang Q, Carroll JA, Djalilian H, Zeng FG. Temporary suppression of tinnitus by modulated sounds. J Assoc Res Otolaryngol 2012; 13:561-71. [PMID: 22526737 DOI: 10.1007/s10162-012-0331-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 04/03/2012] [Indexed: 12/21/2022] Open
Abstract
Despite high prevalence of tinnitus and its impact on quality life, there is no cure for tinnitus at present. Here, we report an effective means to temporarily suppress tinnitus by amplitude- and frequency-modulated tones. We systematically explored the interaction between subjective tinnitus and 17 external sounds in 20 chronic tinnitus sufferers. The external sounds included traditionally used unmodulated stimuli such as pure tones and white noise and dynamically modulated stimuli known to produce sustained neural synchrony in the central auditory pathway. All external sounds were presented in a random order to all subjects and at a loudness level that was just below tinnitus loudness. We found some tinnitus suppression in terms of reduced loudness by at least one of the 17 stimuli in 90% of the subjects, with the greatest suppression by amplitude-modulated tones with carrier frequencies near the tinnitus pitch for tinnitus sufferers with relatively normal loudness growth. Our results suggest that, in addition to a traditional masking approach using unmodulated pure tones and white noise, modulated sounds should be used for tinnitus suppression because they may be more effective in reducing hyperactive neural activities associated with tinnitus. The long-term effects of the modulated sounds on tinnitus and the underlying mechanisms remain to be investigated.
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Affiliation(s)
- Kelly M Reavis
- Center for Hearing Research Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, 110 Medical Science E, Irvine, CA 92697-5320, USA
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Langguth B, Schecklmann M, Lehner A, Landgrebe M, Poeppl TB, Kreuzer PM, Schlee W, Weisz N, Vanneste S, De Ridder D. Neuroimaging and neuromodulation: complementary approaches for identifying the neuronal correlates of tinnitus. Front Syst Neurosci 2012; 6:15. [PMID: 22509155 PMCID: PMC3321434 DOI: 10.3389/fnsys.2012.00015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/01/2012] [Indexed: 11/13/2022] Open
Abstract
An inherent limitation of functional imaging studies is their correlational approach. More information about critical contributions of specific brain regions can be gained by focal transient perturbation of neural activity in specific regions with non-invasive focal brain stimulation methods. Functional imaging studies have revealed that tinnitus is related to alterations in neuronal activity of central auditory pathways. Modulation of neuronal activity in auditory cortical areas by repetitive transcranial magnetic stimulation (rTMS) can reduce tinnitus loudness and, if applied repeatedly, exerts therapeutic effects, confirming the relevance of auditory cortex activation for tinnitus generation and persistence. Measurements of oscillatory brain activity before and after rTMS demonstrate that the same stimulation protocol has different effects on brain activity in different patients, presumably related to interindividual differences in baseline activity in the clinically heterogeneous study cohort. In addition to alterations in auditory pathways, imaging techniques also indicate the involvement of non-auditory brain areas, such as the fronto-parietal "awareness" network and the non-tinnitus-specific distress network consisting of the anterior cingulate cortex, anterior insula, and amygdale. Involvement of the hippocampus and the parahippocampal region putatively reflects the relevance of memory mechanisms in the persistence of the phantom percept and the associated distress. Preliminary studies targeting the dorsolateral prefrontal cortex, the dorsal anterior cingulate cortex, and the parietal cortex with rTMS and with transcranial direct current stimulation confirm the relevance of the mentioned non-auditory networks. Available data indicate the important value added by brain stimulation as a complementary approach to neuroimaging for identifying the neuronal correlates of the various clinical aspects of tinnitus.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg Regensburg, Germany
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Frei P, Mohler E, Braun-Fahrländer C, Fröhlich J, Neubauer G, Röösli M. Cohort study on the effects of everyday life radio frequency electromagnetic field exposure on non-specific symptoms and tinnitus. ENVIRONMENT INTERNATIONAL 2012; 38:29-36. [PMID: 21982030 DOI: 10.1016/j.envint.2011.08.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 07/17/2011] [Accepted: 08/05/2011] [Indexed: 05/20/2023]
Abstract
BACKGROUND There is public concern regarding potential health effects of radio frequency electromagnetic fields (RF-EMF) exposure, as produced by mobile phones or broadcast transmitters. The objective of this study was to investigate the association between RF-EMF exposure and non-specific symptoms and tinnitus in a prospective cohort study. METHODS In 2008, 1375 randomly selected participants from Basel, Switzerland, were enrolled in a questionnaire survey with follow-up after one year (participation rate 82%). A score for somatic complaints (von Zerssen list) and headache (HIT-6) was assessed. Far-field environmental RF-EMF exposure was predicted using a validated prediction model. Regarding near-field exposure, self-reported mobile and cordless phone use as well as mobile phone operator data were collected. In multivariate regression models, we investigated whether exposure at baseline (cohort analysis) or changes in exposure between baseline and follow-up (change analysis) were related to changes in health scores. RESULTS For participants in the top decile of environmental far-field RF-EMF exposure at baseline, in comparison to participants exposed below the median value, the change in the von Zerssen- and HIT-6-scores between baseline and follow-up was -0.12 (95%-CI: -1.79 to 1.56) and -0.37 (95%-CI: -1.80 to 1.07) units, respectively. Exposure to near-field sources and a change in exposure between baseline and follow-up were not related to non-specific symptoms. Similarly, no association between RF-EMF exposure and tinnitus was observed. CONCLUSIONS In this first cohort study using objective and well-validated RF-EMF exposure measures, we did not observe an association between RF-EMF exposure and non-specific symptoms or tinnitus.
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Affiliation(s)
- Patrizia Frei
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Genuis SJ, Lipp CT. Electromagnetic hypersensitivity: fact or fiction? THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 414:103-112. [PMID: 22153604 DOI: 10.1016/j.scitotenv.2011.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 05/31/2023]
Abstract
As the prevalence of wireless telecommunication escalates throughout the world, health professionals are faced with the challenge of patients who report symptoms they claim are connected with exposure to some frequencies of electromagnetic radiation (EMR). Some scientists and clinicians acknowledge the phenomenon of hypersensitivity to EMR resulting from common exposures such as wireless systems and electrical devices in the home or workplace; others suggest that electromagnetic hypersensitivity (EHS) is psychosomatic or fictitious. Various organizations including the World Health Organization as well as some nation states are carefully exploring this clinical phenomenon in order to better explain the rising prevalence of non-specific, multi-system, often debilitating symptoms associated with non-ionizing EMR exposure. As well as an assortment of physiological complaints, patients diagnosed with EHS also report profound social and personal challenges, impairing their ability to function normally in society. This paper offers a review of the sparse literature on this perplexing condition and a discussion of the controversy surrounding the legitimacy of the EHS diagnosis. Recommendations are provided to assist health professionals in caring for individuals complaining of EHS.
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Lowden A, Åkerstedt T, Ingre M, Wiholm C, Hillert L, Kuster N, Nilsson JP, Arnetz B. Sleep after mobile phone exposure in subjects with mobile phone-related symptoms. Bioelectromagnetics 2010; 32:4-14. [DOI: 10.1002/bem.20609] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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