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Tekumalla S, Perlov NM, Gokhale S, Awosanya S, Urdang ZD, Croce J, Bixler A, Willcox TO, Chiffer RC, Fitzgerald D. Evaluation of Subjective Tinnitus Severity and Distortion Product Otoacoustic Emissions and Extended High-Frequency Audiometry. Otolaryngol Head Neck Surg 2024; 171:517-520. [PMID: 38639322 DOI: 10.1002/ohn.777] [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: 10/08/2023] [Revised: 01/25/2024] [Accepted: 02/24/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Tinnitus is a multifactorial phenomenon with quality-of-life detriments for those affected by it. We aim to establish a relationship between subjective tinnitus severity with objective audiometric data in the extended high frequency (EHF) from 9 to 16 khz and with distortion product otoacoustic emissions (DPOAE). We hypothesize that severe subjective tinnitus as measured by the Tinnitus Handicap Inventory (THI) does not correlate with increased hearing thresholds in the EHF range. STUDY DESIGN Prospective. SETTING Single Tertiary Care Center. METHODS Patients identified with tinnitus and normal hearing thresholds within standard frequency range (250-8000 Hz) were consented for participation. Those with underlying otologic disease, trauma, radiotherapy, or ototoxic drug use were excluded. The THI questionnaire was given to eligible patients and audiometric test results were collected. THI scores were categorized by severity groups. An n = 20 to 30 was determined to have an effect size of 0.7 with a significance level of P = .05. RESULTS THI and audiometric data were collected for 38 patients and categorized into mild (n = 18, 47.4%), moderate (n = 8, 21.1%), slight (n = 7, 18.4%), and severe (n = 5, 13.2%) tinnitus severity groups. Mean THI score was 32.3 ± 19.6 with a statistically significant difference in scores by assigned THI severity group (P < .01). There were no significant differences or linear relationship among hearing thresholds in EHF range or DPOAE stratified by subjective tinnitus group (P = .49, r2 = 0.10) CONCLUSION: Subjective tinnitus severity is not predictive of audiometric outcomes. This finding can be used as a counseling tool to help tinnitus patients manage symptoms, expectations, and overall treatment outcomes.
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Affiliation(s)
- Sruti Tekumalla
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Natalie M Perlov
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Saket Gokhale
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samiat Awosanya
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Zachary D Urdang
- Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Julia Croce
- Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Anna Bixler
- Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Thomas O Willcox
- Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Rebecca C Chiffer
- Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Dennis Fitzgerald
- Thomas Jefferson Hospital Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
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Fabrizio-Stover EM, Oliver DL, Burghard AL. Tinnitus mechanisms and the need for an objective electrophysiological tinnitus test. Hear Res 2024; 449:109046. [PMID: 38810373 DOI: 10.1016/j.heares.2024.109046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/16/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
Tinnitus, the perception of sound with no external auditory stimulus, is a complex, multifaceted, and potentially devastating disorder. Despite recent advances in our understanding of tinnitus, there are limited options for effective treatment. Tinnitus treatments are made more complicated by the lack of a test for tinnitus based on objectively measured physiological characteristics. Such an objective test would enable a greater understanding of tinnitus mechanisms and may lead to faster treatment development in both animal and human research. This review makes the argument that an objective tinnitus test, such as a non-invasive electrophysiological measure, is desperately needed. We review the current tinnitus assessment methods, the underlying neural correlates of tinnitus, the multiple tinnitus generation theories, and the previously investigated electrophysiological measurements of tinnitus. Finally, we propose an alternate objective test for tinnitus that may be valid in both animal and human subjects.
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Affiliation(s)
- Emily M Fabrizio-Stover
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA; Department of Otolaryngology-Head and Neck Surgery, Medical University South Carolina, Charleston, SC, USA
| | - Douglas L Oliver
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Alice L Burghard
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT, USA.
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Miller RM, Dunn JA, O'Beirne GA, Whitney SL, Snell DL. Relationships between vestibular issues, noise sensitivity, anxiety and prolonged recovery from mild traumatic brain injury among adults: a scoping review. Brain Inj 2024; 38:607-619. [PMID: 38597651 DOI: 10.1080/02699052.2024.2337905] [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: 04/10/2023] [Accepted: 03/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND We investigated the extent of literature and findings on relationships between vestibular issues, noise sensitivity (NS), and anxiety. We were interested in how relationships among these factors impacted adults' recovery three months or more after mild traumatic brain injury (mTBI). METHODS We conducted a scoping review to evaluate the extent of evidence linking relationships between vestibular issues, NS and anxiety with recovery after mTBI. Data relating to study characteristics and key findings were extracted and used to inform a critical narrative synthesis of findings. RESULTS After screening and full-text review, we included two studies. Both studies considered the combination of vestibular issues, NS and anxiety and mTBI recovery. Vestibular issues, NS and anxiety were all significantly associated with one another and their presence was the strongest indicator that symptoms would extend beyond three-months after mTBI. CONCLUSION Few studies have focused on the relationships that vestibular issues, NS and anxiety have with one another and recovery after mTBI. Given the apparent strong relationships between these factors and prolonged recovery, we highlight this as an area warranting further investigation.
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Affiliation(s)
- Rebekah M Miller
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Greg A O'Beirne
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- Eisdell Moore Centre for Hearing and Balance Research, Univeristy of Auckland, Auckland, New Zealand
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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Tsang BKT, Collins GG, Anderson S, Westcott M. Tinnitus update: what can be done for the ringing? Intern Med J 2024; 54:1066-1076. [PMID: 38943335 DOI: 10.1111/imj.16414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 05/04/2024] [Indexed: 07/01/2024]
Abstract
Physicians will frequently encounter patients who report tinnitus. Tinnitus is a symptom whereby there is the perception of sound or sounds in the ear or head in the absence of an external source of sound. Most individuals experiencing tinnitus will have a neutral reaction to the percept, but in a small proportion of patients, tinnitus can be a debilitating symptom. When it causes burden, patients can be affected in multiple different facets of life, including impairment in sleep, hearing cognition and psychological and psychiatric well-being, often resulting in high healthcare utilisation and societal costs. Hence, chronic, disabling tinnitus is a complex condition with multifactorial causes and multiple perpetuating biopsychosocial factors. Despite efforts to increase knowledge about its pathophysiology and research into treatments, little impact on real-world clinical practice has been seen. There are no proven effective pharmacological treatments or complementary medicines specifically for chronic, disabling tinnitus. Despite this, there is a role for treating this condition through a multidisciplinary approach specifically targeting comorbid active psychiatric conditions, using hearing aids in appropriate clinical settings such as in those with a coassociated confirmed hearing loss, and specialised cognitive behavioural therapy for patients reporting bothersome tinnitus. Cognitive behavioural therapy remains the most valuable evidence-based intervention in this regard. This narrative review attempts to summarise the current understanding in terms of pathophysiology, assessment and treatment of tinnitus for the internal physician who may encounter patients with disabling, chronic tinnitus.
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Affiliation(s)
- Benjamin K T Tsang
- Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- School of Medicine, Griffith University, Sunshine Coast Health Institute, Sunshine Coast, Queensland, Australia
| | - Grant G Collins
- Queensland Vestibular and Cochlear Clinic, Townsville, Queensland, Australia
| | - Shane Anderson
- Department of Ear Nose and Throat Surgery, Townsville Hospital, Townsville, Queensland, Australia
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Inguscio BMS, Rossi D, Giliberto G, Vozzi A, Borghini G, Babiloni F, Greco A, Attanasio G, Cartocci G. Bridging the Gap between Psychophysiological and Audiological Factors in the Assessment of Tinnitus: An EEG Investigation in the Beta Band. Brain Sci 2024; 14:570. [PMID: 38928570 PMCID: PMC11202302 DOI: 10.3390/brainsci14060570] [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: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Despite substantial progress in investigating its psychophysical complexity, tinnitus remains a scientific and clinical enigma. The present study, through an ecological and multidisciplinary approach, aims to identify associations between electroencephalographic (EEG) and psycho-audiological variables. METHODS EEG beta activity, often related to stress and anxiety, was acquired from 12 tinnitus patients (TIN group) and 7 controls (CONT group) during an audio cognitive task and at rest. We also investigated psychological (SCL-90-R; STAI-Y; BFI-10) and audiological (THI; TQ12-I; Hyperacusis) variables using non-parametric statistics to assess differences and relationships between and within groups. RESULTS In the TIN group, frontal beta activity positively correlated with hyperacusis, parietal activity, and trait anxiety; the latter is also associated with depression in CONT. Significant differences in paranoid ideation and openness were found between groups. CONCLUSIONS The connection between anxiety trait, beta activity in the fronto-parietal cortices and hyperacusis provides insights into brain functioning in tinnitus patients, offering quantitative descriptions for clinicians and new multidisciplinary treatment hypotheses.
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Affiliation(s)
- Bianca Maria Serena Inguscio
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (B.M.S.I.); (D.R.); (G.G.); (G.B.); (F.B.)
- BrainSigns Srl, 00198 Rome, Italy;
| | - Dario Rossi
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (B.M.S.I.); (D.R.); (G.G.); (G.B.); (F.B.)
- BrainSigns Srl, 00198 Rome, Italy;
| | - Giovanna Giliberto
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (B.M.S.I.); (D.R.); (G.G.); (G.B.); (F.B.)
| | | | - Gianluca Borghini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (B.M.S.I.); (D.R.); (G.G.); (G.B.); (F.B.)
- BrainSigns Srl, 00198 Rome, Italy;
| | - Fabio Babiloni
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (B.M.S.I.); (D.R.); (G.G.); (G.B.); (F.B.)
- BrainSigns Srl, 00198 Rome, Italy;
- Department of Computer Science, Hangzhou Dianzi University, Hangzhou 310018, China
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy;
| | | | - Giulia Cartocci
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (B.M.S.I.); (D.R.); (G.G.); (G.B.); (F.B.)
- BrainSigns Srl, 00198 Rome, Italy;
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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.
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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
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Wake N, Shiramatsu TI, Takahashi H. Map plasticity following noise exposure in auditory cortex of rats: implications for disentangling neural correlates of tinnitus and hyperacusis. Front Neurosci 2024; 18:1385942. [PMID: 38881748 PMCID: PMC11176560 DOI: 10.3389/fnins.2024.1385942] [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: 02/14/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Both tinnitus and hyperacusis, likely triggered by hearing loss, can be attributed to maladaptive plasticity in auditory perception. However, owing to their co-occurrence, disentangling their neural mechanisms proves difficult. We hypothesized that the neural correlates of tinnitus are associated with neural activities triggered by low-intensity tones, while hyperacusis is linked to responses to moderate- and high-intensity tones. Methods To test these hypotheses, we conducted behavioral and electrophysiological experiments in rats 2 to 8 days after traumatic tone exposure. Results In the behavioral experiments, prepulse and gap inhibition tended to exhibit different frequency characteristics (although not reaching sufficient statistical levels), suggesting that exposure to traumatic tones led to acute symptoms of hyperacusis and tinnitus at different frequency ranges. When examining the auditory cortex at the thalamocortical recipient layer, we observed that tinnitus symptoms correlated with a disorganized tonotopic map, typically characterized by responses to low-intensity tones. Neural correlates of hyperacusis were found in the cortical recruitment function at the multi-unit activity (MUA) level, but not at the local field potential (LFP) level, in response to moderate- and high-intensity tones. This shift from LFP to MUA was associated with a loss of monotonicity, suggesting a crucial role for inhibitory synapses. Discussion Thus, in acute symptoms of traumatic tone exposure, our experiments successfully disentangled the neural correlates of tinnitus and hyperacusis at the thalamocortical recipient layer of the auditory cortex. They also suggested that tinnitus is linked to central noise, whereas hyperacusis is associated with aberrant gain control. Further interactions between animal experiments and clinical studies will offer insights into neural mechanisms, diagnosis and treatments of tinnitus and hyperacusis, specifically in terms of long-term plasticity of chronic symptoms.
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Affiliation(s)
- Naoki Wake
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Tomoyo I Shiramatsu
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Takahashi
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
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Aazh H, Moore BCJ, Erfanian M. Confirmatory factor analysis of the Tinnitus Impact Questionnaire using data from patients seeking help for tinnitus alone or tinnitus combined with hyperacusis. PLoS One 2024; 19:e0302837. [PMID: 38718050 PMCID: PMC11078403 DOI: 10.1371/journal.pone.0302837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
A confirmatory factor analysis (CFA) of the Tinnitus Impact Questionnaire (TIQ) was performed. In contrast to commonly used tinnitus questionnaires, the TIQ is intended solely to assess the impact of tinnitus by not including items related to hearing loss or tinnitus loudness. This was a psychometric study based on a retrospective cross-sectional analysis of clinical data. Data were available for 155 new patients who had attended a tinnitus and hyperacusis clinic in the UK within a five-month period and had completed the TIQ. The mean age was 54 years (standard deviation = 14 years). The TIQ demonstrated good internal consistency, with Cronbach's α = 0.84 and McDonald's ω = 0.89. CFA showed that two items of the TIQ had low factor loadings for both one-factor and two-factor models and their scores showed low correlations with scores for other items. Bi-factor analysis gave a better fit, indicated by a relative chi-square (χ2) of 18.5, a Root-Mean Square Error of Approximation (RMSEA) of 0.103, a Comparative Fit Index (CFI) of 0.97, a Tucker Lewis Index (TLI) of 0.92, and a Standardized Root-Mean Residual (SPMR) of 0.038. Total TIQ scores were moderately correlated with scores for the Visual Analogue Scale of effect of tinnitus on life and the Screening for Anxiety and Depression-Tinnitus questionnaire, supporting the convergent validity of the TIQ. The TIQ score was not correlated with the pure-tone average hearing threshold, indicating discriminant validity. A multiple-causes multiple-indicator (MIMIC) model showed no influences of age, gender or hearing status on TIQ item scores. The TIQ is an internally consistent tool. CFA suggests a bi-factor model with sufficient unidimensionality to support the use of the overall TIQ score for assessing the impact of tinnitus. TIQ scores are distinct from the impact of hearing impairment among patients who have tinnitus combined with hearing loss.
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Affiliation(s)
- Hashir Aazh
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd, London, United Kingdom
- Audiology Department, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Brian C. J. Moore
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd, London, United Kingdom
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Mercede Erfanian
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd, London, United Kingdom
- Institute for Environmental Design and Engineering, The Bartlett, University College London, London, United Kingdom
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Demoen S, Cardon E, Jacquemin L, Timmermans A, Van Rompaey V, Gilles A, Michiels S. Health-Related Quality of Life in Subjective, Chronic Tinnitus Patients: A Scoping Review. J Assoc Res Otolaryngol 2024; 25:103-129. [PMID: 38253898 PMCID: PMC11018725 DOI: 10.1007/s10162-024-00926-5] [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: 08/07/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE This scoping review aims to assess whether the severity or distress of subjective tinnitus is negatively associated or correlated with the level of health-related quality of life (HRQoL). A second objective is to examine whether tinnitus patients score differently on HRQoL questionnaires in comparison to subjects without tinnitus and whether HRQoL differs between specific subgroups of tinnitus. METHODS This scoping review adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA guidelines): the statement and extension for scoping reviews (PRISMA-ScR). The following databases were consulted (on the 20th of October 2023): PubMed, Cochrane Library, Web of Science, and Scopus. The search string was composed of the terms tinnitus, HRQoL, and synonyms. A double-blinded screening for eligibility was performed, first on the title and abstract and subsequently on the full-text articles. Studies were considered eligible if they looked at HRQoL questionnaire results for adult patients (> 18 years) reporting chronic (> 3 months), subjective tinnitus as a primary complaint. RESULTS In total, 37 studies with a total sample size of 33,900 participants were included in this scoping review, with some studies answering multiple study objectives. Seventeen studies demonstrated the presence of a significant negative correlation between tinnitus-related distress and HRQoL. Two studies indicated that HRQoL is mediated by tinnitus-related distress. Eighteen studies found that, in general, patients with tinnitus scored significantly lower on HRQoL questionnaires in comparison to subjects without tinnitus. Nineteen studies demonstrated that subgroups of patients with more severe tinnitus complaints or specific additional complaints scored worse on HRQoL questionnaires. CONCLUSION Based on the current literature, chronic subjective tinnitus-related distress has a significant impact on health-related quality of life. In addition, subjects without tinnitus generally score significantly higher on HRQoL questionnaires than patients with tinnitus. The heterogeneity in outcome measures between studies precludes meta-analysis. Increased homogeneity in the choice of HRQoL questionnaires would make a comparison between studies possible, which would give valuable information on both a clinical and an economic level, guiding future tinnitus treatment. REGISTRATION The protocol for the scoping review is registered at Open Science Framework: https://doi.org/10.17605/OSF.IO/F5S9C .
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Affiliation(s)
- Sara Demoen
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium.
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Emilie Cardon
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laure Jacquemin
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annick Timmermans
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, 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
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
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Parameshwarappa V, Norena AJ. The effects of acute and chronic noise trauma on stimulus-evoked activity across primary auditory cortex layers. J Neurophysiol 2024; 131:225-240. [PMID: 38198658 DOI: 10.1152/jn.00427.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
Exposure to intense noise environments is a major cause of sensorineural hearing loss and auditory perception disorders, such as tinnitus and hyperacusis, which may have a central origin. The effects of noise-induced hearing loss on the auditory cortex have been documented in many studies. One limitation of these studies, however, is that the effects of noise trauma have been mostly studied at the granular layer (i.e, the main cortical recipient of thalamic input), while the cortex is a very complex structure, with six different layers each having its own pattern of connectivity and role in sensory processing. The present study aims to investigate the effects of acute and chronic noise trauma on the laminar pattern of stimulus-evoked activity in the primary auditory cortex of the anesthetized guinea pig. We show that acute and chronic noise trauma are both followed by an increase in stimulus-evoked cortical responses, mostly in the granular and supragranular layers. The cortical responses are more monotonic as a function of the intensity level after noise trauma. There was minimal change, if any, in local field potential (LFP) amplitude after acute noise trauma, while LFP amplitude was enhanced after chronic noise trauma. Finally, LFP and the current source density analysis suggest that acute but more specifically chronic noise trauma is associated with the emergence of a new sink in the supragranular layer. This result suggests that supragranular layers become a major input recipient. We discuss the possible mechanisms and functional implications of these changes.NEW & NOTEWORTHY Our study shows that cortical activity is enhanced after trauma and that the sequence of cortical column activation during stimulus-evoked response is altered, i.e. the supragranular layer becomes a major input recipient. We speculate that these large cortical changes may play a key role in the auditory hypersensitivity (hyperacusis) that can be triggered after noise trauma in human subjects.
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Affiliation(s)
- Vinay Parameshwarappa
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Arnaud J Norena
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
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Wertz J, Rüttiger L, Bender B, Klose U, Stark RS, Dapper K, Saemisch J, Braun C, Singer W, Dalhoff E, Bader K, Wolpert SM, Knipper M, Munk MHJ. Differential cortical activation patterns: pioneering sub-classification of tinnitus with and without hyperacusis by combining audiometry, gamma oscillations, and hemodynamics. Front Neurosci 2024; 17:1232446. [PMID: 38239827 PMCID: PMC10794389 DOI: 10.3389/fnins.2023.1232446] [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: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 01/22/2024] Open
Abstract
The ongoing controversies about the neural basis of tinnitus, whether linked with central neural gain or not, may hamper efforts to develop therapies. We asked to what extent measurable audiometric characteristics of tinnitus without (T) or with co-occurrence of hyperacusis (TH) are distinguishable on the level of cortical responses. To accomplish this, electroencephalography (EEG) and concurrent functional near-infrared spectroscopy (fNIRS) were measured while patients performed an attentionally demanding auditory discrimination task using stimuli within the individual tinnitus frequency (fTin) and a reference frequency (fRef). Resting-state-fMRI-based functional connectivity (rs-fMRI-bfc) in ascending auditory nuclei (AAN), the primary auditory cortex (AC-I), and four other regions relevant for directing attention or regulating distress in temporal, parietal, and prefrontal cortex was compiled and compared to EEG and concurrent fNIRS activity in the same brain areas. We observed no group differences in pure-tone audiometry (PTA) between 10 and 16 kHz. However, the PTA threshold around the tinnitus pitch was positively correlated with the self-rated tinnitus loudness and also correlated with distress in T-groups, while TH experienced their tinnitus loudness at minimal loudness levels already with maximal suffering scores. The T-group exhibited prolonged auditory brain stem (ABR) wave I latency and reduced ABR wave V amplitudes (indicating reduced neural synchrony in the brainstem), which were associated with lower rs-fMRI-bfc between AAN and the AC-I, as observed in previous studies. In T-subjects, these features were linked with elevated spontaneous and reduced evoked gamma oscillations and with reduced deoxygenated hemoglobin (deoxy-Hb) concentrations in response to stimulation with lower frequencies in temporal cortex (Brodmann area (BA) 41, 42, 22), implying less synchronous auditory responses during active auditory discrimination of reference frequencies. In contrast, in the TH-group gamma oscillations and hemodynamic responses in temporoparietal regions were reversed during active discrimination of tinnitus frequencies. Our findings suggest that T and TH differ in auditory discrimination and memory-dependent directed attention during active discrimination at either tinnitus or reference frequencies, offering a test paradigm that may allow for more precise sub-classification of tinnitus and future improved treatment approaches.
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Affiliation(s)
- Jakob Wertz
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Lukas Rüttiger
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Uwe Klose
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Robert S. Stark
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Konrad Dapper
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
- Department of Biology, Technical University Darmstadt, Darmstadt, Germany
| | - Jörg Saemisch
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | | | - Wibke Singer
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Katharina Bader
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Stephan M. Wolpert
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Marlies Knipper
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre, University of Tübingen, Tübingen, Germany
| | - Matthias H. J. Munk
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Department of Biology, Technical University Darmstadt, Darmstadt, Germany
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12
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Naghdabadi Z, Jahed M. Heterogeneous correlate and potential diagnostic biomarker of tinnitus based on nonlinear dynamics of resting-state EEG recordings. PLoS One 2024; 19:e0290563. [PMID: 38166014 PMCID: PMC10760901 DOI: 10.1371/journal.pone.0290563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/09/2023] [Indexed: 01/04/2024] Open
Abstract
Tinnitus is a heterogeneous condition of hearing a rattling sound when there is no auditory stimulus. This rattling sound is associated with abnormal synchronous oscillations in auditory and non-auditory cortical areas. Since tinnitus is a highly heterogeneous condition with no objective detection criteria, it is necessary to search for indicators that can be compared between and within participants for diagnostic purposes. This study introduces heterogeneous though comparable indicators of tinnitus through investigation of spontaneous fluctuations in resting-state brain dynamics. The proposed approach uses nonlinear measures of chaos theory, to detect tinnitus and cross correlation patterns to reflect many of the previously reported neural correlates of tinnitus. These indicators may serve as effective measures of tinnitus risk even at early ages before any symptom is reported. The approach quantifies differences in oscillatory brain dynamics of tinnitus and normal subjects. It demonstrates that the left temporal areas of subjects with tinnitus exhibit larger lyapunov exponent indicating irregularity of brain dynamics in these regions. More complex dynamics is further recognized in tinnitus cases through entropy. We use this evidence to distinguish tinnitus patients from normal participants. Besides, we illustrate that certain anticorrelation patterns appear in these nonlinear measures across temporal and frontal areas in the brain perhaps corresponding to increased/decreased connectivity in certain brain networks and a shift in the balance of excitation and inhibition in tinnitus. Additionally, the main correlations are lost in tinnitus participants compared to control group suggesting involvement of distinct neural mechanisms in generation and persistence of tinnitus.
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Affiliation(s)
- Zahra Naghdabadi
- Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mehran Jahed
- Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran
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13
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Rosemann S, Rauschecker JP. Increased fiber density of the fornix in patients with chronic tinnitus revealed by diffusion-weighted MRI. Front Neurosci 2023; 17:1293133. [PMID: 38192511 PMCID: PMC10773749 DOI: 10.3389/fnins.2023.1293133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
Up to 45% of the elderly population suffer from chronic tinnitus - the phantom perception of sound that is often perceived as ringing, whistling, or hissing "in the ear" without external stimulation. Previous research investigated white matter changes in tinnitus patients using diffusion-weighted magnetic resonance imaging (DWI) to assess measures such as fractional anisotropy (a measure of microstructural integrity of fiber tracts) or mean diffusivity (a measure for general water diffusion). However, findings overlap only minimally and are sometimes even contradictory. We here present the first study encompassing higher diffusion data that allow to focus on changes in tissue microstructure, such as number of axons (fiber density) and macroscopic alterations, including axon diameter, and a combination of both. In order to deal with the crossing-fibers problem, we applied a fixel-based analysis using a constrained spherical deconvolution signal modeling approach. We investigated differences between tinnitus patients and control participants as well as how cognitive abilities and tinnitus distress are related to changes in white matter morphology in chronic tinnitus. For that aim, 20 tinnitus patients and 20 control participants, matched in age, sex and whether they had hearing loss or not, underwent DWI, audiometric and cognitive assessments, and filled in questionnaires targeting anxiety and depression. Our results showed increased fiber density in the fornix in tinnitus patients compared to control participants. The observed changes might, reflect compensatory structural alterations related to the processing of negative emotions or maladaptive changes related to the reinforced learning of the chronic tinnitus sensation. Due to the low sample size, the study should be seen as a pilot study that motivates further research to investigate underlying white matter morphology alterations in tinnitus.
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Affiliation(s)
- Stephanie Rosemann
- Laboratory of Integrative Neuroscience and Cognition, Department of Neuroscience, Georgetown University Medical Center, Washington, DC, United States
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14
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Jacquemin L, van der Poel N, Biot L, Schollaert J, Bonné F, Vanderveken OM, Lammers MJW, Van Rompaey V, Gilles A. Prevalence of tinnitus and hyperacusis in 9-12-year-old children. Eur Arch Otorhinolaryngol 2023; 280:4819-4825. [PMID: 37133498 PMCID: PMC10155651 DOI: 10.1007/s00405-023-07995-x] [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: 10/29/2022] [Accepted: 04/24/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To estimate the prevalence of tinnitus and hyperacusis in children aged 9-12 years in Flanders, as well as to explore the associations with hearing abilities and listening behaviours. DESIGN A cross-sectional survey was undertaken in four different Flemish schools. The questionnaire was distributed among 415 children, with a response rate of 97.3%. RESULTS The prevalence of permanent tinnitus was 10.5% and of hyperacusis was 3.3%. The hyperacusis prevalence was higher in girls (p < .05). Some children reported effects of tinnitus in terms of anxiety (20.1%), sleep (36.5%), and concentration (24.8%). When listening to personal listening devices, 33.5% of the children reported to listen for at least 1 h at 60% or higher of the volume range. Moreover, 54.9% of children stated to never wear hearing protection. CONCLUSIONS Tinnitus and hyperacusis are prevalent in children aged 9-12 years. Some of these children might be overlooked and, as such, not receiving the required follow-up or counselling. Development of guidelines for the assessment of these auditory symptoms in children would help to determine the prevalence numbers with greater accuracy. Sensibility campaigns for safe listening are warranted, as more than half of the children never use hearing protection.
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Affiliation(s)
- Laure Jacquemin
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - Nicolien van der Poel
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Lana Biot
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Joris Schollaert
- Medicine, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Fien Bonné
- Audiology, University College Ghent, Ghent, Belgium
| | - Olivier M Vanderveken
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J W Lammers
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
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15
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Musumano LB, Hatzopoulos S, Fancello V, Bianchini C, Bellini T, Pelucchi S, Skarżyński PH, Skarżyńska MB, Ciorba A. Hyperacusis: Focus on Gender Differences: A Systematic Review. Life (Basel) 2023; 13:2092. [PMID: 37895473 PMCID: PMC10608418 DOI: 10.3390/life13102092] [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: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND While gender differences of several diseases have been already described in the literature, studies in the area of hyperacusis are still scant. Despite the fact that hyperacusis is a condition that severely affects the patient's quality of life, it is not well investigated; a comprehensive understanding of its features, eventually including gender differences, could be a valuable asset in developing clinical intervention strategies. AIM To evaluate gender differences among subjects affected by hyperacusis. METHODS A literature search was conducted focused on adult patients presenting hyperacusis, using the MedLine bibliographic database. Relevant peer-reviewed studies, published in the last 20 years, were sought. A total of 259 papers have been identified, but only 4 met the inclusion criteria. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS The four selected papers included data from 604 patients; of these, 282 subjects resulted as affected by hyperacusis (125 females and 157 males). Questionnaires for analyzing factors affecting the attentional, social and emotional variance of hyperacusis (such as VAS, THI, TSCH, MASH) were administered to all included subjects. The data suggest that there are no hyperacusis gender-specific differences in the assessed population samples. CONCLUSIONS The literature data suggest that males and females exhibit a similar level of hyperacusis. However, in light of the subjective nature of this condition, the eventual set up of further tests to assess hyperacusis features could be very helpful in the near future.
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Affiliation(s)
- Lucia Belen Musumano
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.B.M.); (S.H.); (C.B.); (S.P.); (A.C.)
| | - Stavros Hatzopoulos
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.B.M.); (S.H.); (C.B.); (S.P.); (A.C.)
| | - Virginia Fancello
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.B.M.); (S.H.); (C.B.); (S.P.); (A.C.)
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.B.M.); (S.H.); (C.B.); (S.P.); (A.C.)
| | - Tiziana Bellini
- Centre for Studies on Gender Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.B.M.); (S.H.); (C.B.); (S.P.); (A.C.)
| | - Piotr Henryk Skarżyński
- Institute of Sensory Organs, 1 Mokra Street, 05-830 Kajetany, Poland; (P.H.S.); (M.B.S.)
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, 10 Mochnackiego Street, 02-042 Warsaw, Poland
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Dental Medicine, Medical University of Warsaw, 8 Kondratowicza Street, 03-242 Warsaw, Poland
| | - Magdalena B. Skarżyńska
- Institute of Sensory Organs, 1 Mokra Street, 05-830 Kajetany, Poland; (P.H.S.); (M.B.S.)
- Center of Hearing and Speech Medincus, 05-830 Warsaw, Poland
- Pharmacy Department, Department of Pharmacotherapy and Pharmaceutical Care, Medical University of Warsaw, 02-042 Warsaw, Poland
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.B.M.); (S.H.); (C.B.); (S.P.); (A.C.)
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16
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Raj-Koziak D, Gos E, Kutyba JJ, Skarzynski PH, Skarzynski H. Hyperacusis Assessment Questionnaire-A New Tool Assessing Hyperacusis in Subjects with Tinnitus. J Clin Med 2023; 12:6622. [PMID: 37892760 PMCID: PMC10607047 DOI: 10.3390/jcm12206622] [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: 07/04/2023] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 10/29/2023] Open
Abstract
Hyperacusis, a kind of decreased sound tolerance, is difficult to measure objectively. It often co-occurs with tinnitus. There is a need for valid and reliable patient-reported outcome measures to capture this subjective phenomenon. The aim of the study was to create a questionnaire capturing hyperacusis in terms of loudness, fear, and pain and to evaluate its psychometric properties. The study sample consisted of 106 adult patients with hyperacusis and tinnitus with a mean age of 45.2 years. A medical interview, an audiological examination, and several questionnaires (the Tinnitus Handicap Inventory, the Hyperacusis Questionnaire, the State-Trait Anxiety Inventory, and Visual Analog Scales) were applied. The final 14-item Hyperacusis Assessment Questionnaire showed an appropriate three-factor structure with 70.5% of the variance explained. Convergent and divergent validity were confirmed by correlations with other measures of hyperacusis, anxiety, tinnitus severity, misophonia, and hearing thresholds. The internal consistency assessed with Cronbach's alpha was excellent (α = 0.91), as was reproducibility (intraclass correlation, ICC = 0.96). The new Hyperacusis Assessment Questionnaire is a psychometrically sound and brief tool assessing the severity of hyperacusis in terms of loudness, fear, and pain. It can be used in clinical practice and scientific research for patients with hyperacusis and tinnitus.
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Affiliation(s)
- Danuta Raj-Koziak
- Tinnitus Department, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland;
| | - Elżbieta Gos
- Teleaudiology and Screening Department, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (J.J.K.); (P.H.S.)
| | - Justyna Jolanta Kutyba
- Teleaudiology and Screening Department, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (J.J.K.); (P.H.S.)
| | - Piotr H. Skarzynski
- Teleaudiology and Screening Department, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland; (J.J.K.); (P.H.S.)
- Institute of Sensory Organs, 05-830 Kajetany, Poland
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, 03-242 Warsaw, Poland
| | - Henryk Skarzynski
- Otorhinolaryngology Clinic, World Hearing Center, The Institute of Physiology and Pathology of Hearing, 02-042 Warsaw, Poland;
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17
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Xia Q, Yang S, Ji F. The characteristics of hearing loss in outpatients with tinnitus over the age of 60: a 11-year cross-sectional study. Acta Otolaryngol 2023; 143:753-758. [PMID: 37772756 DOI: 10.1080/00016489.2023.2259952] [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: 07/20/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Presbycusis with tinnitus has a significant impact on the quality of life of elderly patients, becoming a serious socioeconomic problem. OBJECTIVES We conducted an 11-year cross-sectional analysis of the audiometry results of elderly patients with tinnitus from 2011 to 2021. METHODS 9642 patients aged 60 and over were divided into three groups: young-old (YO) (60-74), old-old (OO) (75-89), and longevous (LON) (90 and over). Pure-tone audiometry results of all patients were analyzed. RESULTS Among 9642 patients, the cases of female with tinnitus were more than male in all years. The hearing curve showed a typical age-related decline. Hearing level of air conduction in female declined significantly at low frequencies while that of male was worse at high frequencies in YO and OO groups. Compared with right, left hearing level of air conduction was significantly decreased at all frequencies except 0.125 kHz. CONCLUSIONS When the chief complaint was tinnitus, women were likely to experience more distress than men. However, men suffered from more hearing loss than women, at least in high frequencies. The influence weight of presbycusis and tinnitus on the auditory cortices might be a possible reason for the lateral distinction of hearing loss at different ages.
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Affiliation(s)
- Qingqing Xia
- College of Medicine, Nankai University, Tianjin, China
| | - Shiming Yang
- College of Medicine, Nankai University, Tianjin, China
- Department of Otolaryngology Head and Neck Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Fei Ji
- Department of Otolaryngology Head and Neck Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
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18
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Makani P, Koops EA, Pyott SJ, van Dijk P, Thioux M. Hyperacusis is associated with smaller gray matter volumes in the supplementary motor area. Neuroimage Clin 2023; 38:103425. [PMID: 37137255 PMCID: PMC10176058 DOI: 10.1016/j.nicl.2023.103425] [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: 03/02/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
Hyperacusis is a disorder in loudness perception characterized by increased sensitivity to ordinary environmental sounds and associated with otologic conditions, including hearing loss and tinnitus (the phantom perception of sound) as well as neurologic and neuropsychiatric conditions. Hyperacusis is believed to arise centrally in the brain; however, the underlying causes are unknown. To gain insight into differences in brain morphology associated with hyperacusis, we undertook a retrospective case-control study comparing whole-brain gray matter morphology in participants with sensorineural hearing loss and tinnitus who either scored above or below the threshold for hyperacusis based on a standard questionnaire. We found that participants reporting hyperacusis had smaller gray matter volumes and cortical sheet thicknesses in the right supplementary motor area (SMA), independent of anxiety, depression, tinnitus burden, or sex. In fact, the right SMA volumes extracted from an independently defined volume of interest could accurately classify participants. Finally, in a subset of participants where functional data were also available, we found that individuals with hyperacusis showed increased sound-evoked responses in the right SMA compared to individuals without hyperacusis. Given the role of the SMA in initiating motion, these results suggest that in hyperacusis the SMA is involved in a motor response to sounds.
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Affiliation(s)
- Punitkumar Makani
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands; Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, FA30, P.O. Box 196, 9700 AD Groningen, the Netherlands.
| | - Elouise A Koops
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands; Department of Radiology, Massachusetts General Hospital-Harvard Medical School, Boston, USA
| | - Sonja J Pyott
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands; Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, FA30, P.O. Box 196, 9700 AD Groningen, the Netherlands
| | - Pim van Dijk
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands; Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, FA30, P.O. Box 196, 9700 AD Groningen, the Netherlands
| | - Marc Thioux
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands; Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, FA30, P.O. Box 196, 9700 AD Groningen, the Netherlands
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19
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Rosemann S, Rauschecker JP. Disruptions of default mode network and precuneus connectivity associated with cognitive dysfunctions in tinnitus. Sci Rep 2023; 13:5746. [PMID: 37029175 PMCID: PMC10082191 DOI: 10.1038/s41598-023-32599-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
Tinnitus is the perception of a ringing, buzzing or hissing sound "in the ear" without external stimulation. Previous research has demonstrated changes in resting-state functional connectivity in tinnitus, but findings do not overlap and are even contradictory. Furthermore, how altered functional connectivity in tinnitus is related to cognitive abilities is currently unknown. Here we investigated resting-state functional connectivity differences between 20 patients with chronic tinnitus and 20 control participants matched in age, sex and hearing loss. All participants underwent functional magnetic resonance imaging, audiometric and cognitive assessments, and filled in questionnaires targeting anxiety and depression. Significant differences in functional connectivity between tinnitus patients and control participants were not obtained. However, we did find significant associations between cognitive scores and functional coupling of the default mode network and the precuneus with the superior parietal lobule, supramarginal gyrus, and orbitofrontal cortex. Further, tinnitus distress correlated with connectivity between the precuneus and the lateral occipital complex. This is the first study providing evidence for disruptions of default mode network and precuneus coupling that are related to cognitive dysfunctions in tinnitus. The constant attempt to decrease the tinnitus sensation might occupy certain brain resources otherwise available for concurrent cognitive operations.
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Affiliation(s)
- Stephanie Rosemann
- Laboratory of Integrative Neuroscience and Cognition, Department of Neuroscience, Georgetown University Medical Center, 3970 Reservoir Rd NW, Washington, DC, 20057, USA.
| | - Josef P Rauschecker
- Laboratory of Integrative Neuroscience and Cognition, Department of Neuroscience, Georgetown University Medical Center, 3970 Reservoir Rd NW, Washington, DC, 20057, USA
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20
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Langguth B, Shiao AS, Lai JT, Chi TS, Weber F, Schecklmann M, Li LPH. Tinnitus and treatment-resistant depression. PROGRESS IN BRAIN RESEARCH 2023; 281:131-147. [PMID: 37806713 DOI: 10.1016/bs.pbr.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Tinnitus, a frequent disorder, is the conscious perception of a sound in the absence of a corresponding external acoustic sound source in the sense of a phantom sound. Although the majority of people who perceive a tinnitus sound can cope with it and are only minimaly impaired in their quality of lfe, 2-3% of the population perceive tinnitus as a major problem. Recently it has been proposed that the two groups should be differentiated by distict terms: "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. There is overwhelming evidence that a high tinnitus burden is associated with the increased occurrence of comorbidities, including depression. Since no causal therapeutic options are available for patients with tinnitus at the present time, the identification and adequate treatment of relevant comorbidities is of great importance for the reduction of tinnitus distress. This chapter deals with the relationship between tinnitus and depression. The neuronal mechanisms underlying tinnitus will first be discussed. There will also be an overview about depression and treatment resistant depression (TRD). A comprehensive review about the state-of-the-art evidences of the relationship between tinnitus and TRD will then be provided.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - An-Suey Shiao
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jen-Tsung Lai
- Department of Otolaryngology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Tai-Shih Chi
- Department of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Franziska Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Lieber Po-Hung Li
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan; Faculty of Medicine, and Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Integrated Brain Research Laboratory, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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21
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Validity and reliability study of the Khalfa's hyperacusis questionnaire with using ULL in tinnitus patients. Eur Arch Otorhinolaryngol 2023; 280:1485-1492. [PMID: 36334111 DOI: 10.1007/s00405-022-07727-7] [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: 09/02/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE This study aims to investigate the validity and reliability of the Khalfa's hyperacusis questionnaire (HQ) in Turkish tinnitus patients with hyperacusis using uncomfortable loudness levels (ULLs) and to determine a cutoff score for tinnitus patients specifically. MATERIALS AND METHODS One hundred and forty subjects with a mean age ± SD of 45.27 ± 14.43 years ranging from 18 to 75 participated in the study. HQ and ULLs were used as measures of hyperacusis. The participants were divided into two groups due to ULLs ≤ 90 dB in one or both ears (Group 1) and 56 participants have ULLs > 90 dB (Group 2). RESULTS The mean HQ score of the participants was 19.55 ± 7.18 points, Group 1 (n = 84) HQ mean score was 21.97 ± 7.08, and Group 2 (n = 56) 15.91 ± 5.56 points, and the cutoff point was found 16.50. Statistically significant differences were found between the groups in total HQ (p < 0.001), attention, social, and emotional subscales of HQ. CONCLUSIONS Hyperacusis questionnaire using with ULLs is a precise tool for the steps of identifying, categorizing, and managing the hyperacusis in patients with tinnitus. However, the effect of the tinnitus on hyperacusis should be considered, because it causes additional problems.
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22
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Demoen S, Michiels S, Gilles A, Vermeersch H, Joossen I, Vanderveken OM, Lammers MJW, Timmermans A, Van Rompaey V, Baguley D, Jacquemin L. Pilot study on the role of somatic modulation in hyperacusis. Eur Arch Otorhinolaryngol 2023; 280:1425-1435. [PMID: 36224398 DOI: 10.1007/s00405-022-07695-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hyperacusis is a reduced tolerance to sounds that often co-occurs with tinnitus. Both symptoms have convergent as well as divergent characteristics. Somatic modulation, changes in pitch or loudness during certain movements, is common in patients with a primary complaint of tinnitus. However, thus far, this is not documented in patients with hyperacusis. OBJECTIVES This study aimed to examine the influence of somatic manoeuvres on the perception of external sounds in patients with a primary complaint of hyperacusis. METHODOLOGY In this prospective cross-sectional pilot study, 18 patients with a primary complaint of hyperacusis were recruited at the Tinnitus Treatment and Research Center Antwerp (TINTRA). While patients listened to a 1 kHz broadband noise of 30 dB sensation level, six neck manoeuvres (flexion, extension, lateroflexion left/right, traction and compression), three jaw manoeuvres (protrusion, laterotrusion left/right) and one placebo manoeuvre (hand on head) were performed. The primary outcome measure was the change in the perception of the presented sound in terms of loudness and intrusiveness between baseline and each modulation measured by a visual analogue scale (VAS). RESULTS No overall significant changes were found; however, individual results indicated that five patients presented a clinically relevant change of more than three points out of ten on VAS in terms of hyperacusis after at least one of the executed somatic manoeuvres. CONCLUSIONS This pilot study did not demonstrate an overall significant change in hyperacusis after somatic manoeuvres but does not rule out the possibility of somatic modulation in some hyperacusis patients. TRIAL REGISTRATION The protocol of this prospective cross-sectional pilot study was registered on clinicaltrials.gov with registration number NCT04693819.
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Affiliation(s)
- Sara Demoen
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt University Campus Diepenbeek, Agoralaan, 3500, Hasselt, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium.
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University Antwerp, 2610, Antwerp, Belgium.
| | - Sarah Michiels
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt University Campus Diepenbeek, Agoralaan, 3500, Hasselt, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University Antwerp, 2610, Antwerp, Belgium
- Department of Education, Health and Social Work, University College Ghent, 9000, Ghent, Belgium
| | - Hanne Vermeersch
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
| | - Iris Joossen
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
| | - Olivier M Vanderveken
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University Antwerp, 2610, Antwerp, Belgium
| | - Marc J W Lammers
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University Antwerp, 2610, Antwerp, Belgium
| | - Annick Timmermans
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt University Campus Diepenbeek, Agoralaan, 3500, Hasselt, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University Antwerp, 2610, Antwerp, Belgium
| | - David Baguley
- Hearing Sciences, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, 0115, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, 0115, UK
- Nottingham Audiology Services, Nottingham University Hospitals NHS Trust, Nottingham, 0115, UK
| | - Laure Jacquemin
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University Antwerp, 2610, Antwerp, Belgium
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23
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Cardon E, Jacquemin L, Vermeersch H, Joossen I, Moyaert J, Mertens G, Vanderveken OM, Lammers MJW, Van de Heyning P, Van Rompaey V, Gilles A. Dual-site transcranial direct current stimulation to treat tinnitus: a randomized controlled trial. Brain 2022; 145:4222-4231. [PMID: 36450310 PMCID: PMC9762937 DOI: 10.1093/brain/awac263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 12/03/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been proposed as a potential intervention for subjective tinnitus, but supporting evidence remains limited. We aimed to investigate the effect of anodal high-definition tDCS of the left temporal area and right dorsolateral prefrontal cortex on tinnitus severity. This double-blind randomized controlled trial included 77 patients (age range 18-79, 43 male) with chronic subjective tinnitus as their primary complaint. Thirty-eight subjects received six consecutive sessions of dual-site sequential high-definition-tDCS with electrodes positioned over the left temporal area and right dorsolateral prefrontal cortex. Both areas were stimulated for 15 min per session, with total stimulation time amounting to 30 min. Thirty-nine subjects received sham stimulation. The primary outcome measure was the change in tinnitus severity, as evaluated by the Tinnitus Functional Index, from baseline to a follow-up visit at 8 ± 2 weeks after treatment completion. Secondary outcomes included changes in perceived tinnitus loudness, as measured with a visual analogue scale and a tinnitus matching procedure, as well as scores on the Hospital Anxiety and Depression Scale, and the Hyperacusis Questionnaire. No differences in Tinnitus Functional Index change scores were identified between the active treatment and sham control groups (linear regression: P = 0.86). The Tinnitus Functional Index scores decreased significantly over time in both groups (P = 0.0012), indicating the presence of a considerable placebo effect. These change scores were significantly influenced by sex (linear regression: P = 0.037) and baseline symptoms of anxiety (linear regression: P = 0.049) in both groups. In general, Tinnitus Functional Index scores decreased more profoundly in males and in subjects with a higher degree of anxiety at baseline. None of the included secondary measures differed significantly between experimental arms. Our results suggest that dual-site sequential high-definition-tDCS of the left temporal area and right dorsolateral prefrontal cortex does not alleviate tinnitus severity. Interestingly, in our study population, fluctuations in tinnitus severity were influenced by gender and concurrent mental condition. It is therefore important to take these factors into account when conducting or planning randomized controlled trials in tinnitus populations.
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Affiliation(s)
- Emilie Cardon
- Correspondence to: Emilie Cardon Department of Translational Neuroscience, Faculty of Medicine and Health Science University of Antwerp, Campus Drie Eiken, Antwerp, Belgium E-mail:
| | - Laure Jacquemin
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Hanne Vermeersch
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Iris Joossen
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Julie Moyaert
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Griet Mertens
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J W Lammers
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium,Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
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24
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What Should Be Considered When Assessing Hyperacusis? A Qualitative Analysis of Problems Reported by Hyperacusis Patients. Brain Sci 2022; 12:brainsci12121615. [PMID: 36552075 PMCID: PMC9775019 DOI: 10.3390/brainsci12121615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
Abstract
Hyperacusis (decreased sound tolerance) is a prevalent complaint. Yet, to date, no research has qualitatively evaluated the types of problems experienced by adults with hyperacusis. Our service evaluation aims to determine the hyperacusis-related problem domains reported by patients and the degree to which these domains were reported together. Retrospective analysis was conducted on an anonymised clinical dataset from 306 patients who attended a UK tinnitus and hyperacusis treatment centre between 1994 and 2017. Conventional content analysis was used to categorise responses to the question 'Why is hyperacusis a problem?' into domains which were then subjected to a cluster analysis. Twenty-five problem domains were identified, of which 12 were further classified into three overarching categories. 'Fear', 'Reduced quality of life' and 'Physical reaction to sound' were most frequently reported problems. Cluster analysis revealed that 'Sleep difficulties' and 'Despondency', were commonly reported together. Adults with hyperacusis face many challenges in their everyday lives. The nature of these problems indicates the need to develop complex interventions and assessments to aid management of hyperacusis. Current hyperacusis questionnaires may be useful in identifying some problem domains, but further assessment thorough patient interviews is required to fully explore all potential problems and make informed decisions about treatment.
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25
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Henry JA. Sound Therapy to Reduce Auditory Gain for Hyperacusis and Tinnitus. Am J Audiol 2022; 31:1067-1077. [DOI: 10.1044/2022_aja-22-00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose:
Hyperacusis is the most common of the different types of sound tolerance conditions. It has been defined as physical discomfort or pain when any sound reaches a certain level of loudness that would be comfortable for most people. Because hyperacusis and tinnitus occur together so often, it has been theorized that they have a common neural mechanism. A leading contender for that mechanism is enhancement of auditory gain. The purpose of this tutorial is to review the evidence that sound/acoustic therapy can reduce auditory gain and, thereby, can increase loudness tolerance for people with hyperacusis and/or suppress the percept of tinnitus.
Method:
The scientific literature was informally reviewed to identify and elucidate relationships between tinnitus, hyperacusis, sound therapy, and auditory gain.
Results:
Evidence exists, both in animal and human studies, that enhanced auditory gain is associated with hyperacusis and tinnitus. Further evidence supports the theory that certain forms of sound therapy can reduce neural hyperactivity, thereby reducing auditory gain. The evidence for sound therapy reducing auditory gain is stronger for hyperacusis than it is for tinnitus.
Conclusions:
Based on results from numerous studies, sound therapy clearly has application as a method of desensitization for hyperacusis. Enhanced auditory gain might be responsible for tinnitus, but other mechanisms have been theorized. A review of the relevant literature leads to the conclusion that some form(s) of sound therapy has the potential to suppress or eliminate tinnitus on a long-term basis. Systematic research is needed to evaluate this premise.
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Affiliation(s)
- James A. Henry
- VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland
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26
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Hyperacusis: Loudness Intolerance, Fear, Annoyance and Pain. Hear Res 2022; 426:108648. [DOI: 10.1016/j.heares.2022.108648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
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27
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McGill M, Hight AE, Watanabe YL, Parthasarathy A, Cai D, Clayton K, Hancock KE, Takesian A, Kujawa SG, Polley DB. Neural signatures of auditory hypersensitivity following acoustic trauma. eLife 2022; 11:e80015. [PMID: 36111669 PMCID: PMC9555866 DOI: 10.7554/elife.80015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
Neurons in sensory cortex exhibit a remarkable capacity to maintain stable firing rates despite large fluctuations in afferent activity levels. However, sudden peripheral deafferentation in adulthood can trigger an excessive, non-homeostatic cortical compensatory response that may underlie perceptual disorders including sensory hypersensitivity, phantom limb pain, and tinnitus. Here, we show that mice with noise-induced damage of the high-frequency cochlear base were behaviorally hypersensitive to spared mid-frequency tones and to direct optogenetic stimulation of auditory thalamocortical neurons. Chronic two-photon calcium imaging from ACtx pyramidal neurons (PyrNs) revealed an initial stage of spatially diffuse hyperactivity, hyper-correlation, and auditory hyperresponsivity that consolidated around deafferented map regions three or more days after acoustic trauma. Deafferented PyrN ensembles also displayed hypersensitive decoding of spared mid-frequency tones that mirrored behavioral hypersensitivity, suggesting that non-homeostatic regulation of cortical sound intensity coding following sensorineural loss may be an underlying source of auditory hypersensitivity. Excess cortical response gain after acoustic trauma was expressed heterogeneously among individual PyrNs, yet 40% of this variability could be accounted for by each cell's baseline response properties prior to acoustic trauma. PyrNs with initially high spontaneous activity and gradual monotonic intensity growth functions were more likely to exhibit non-homeostatic excess gain after acoustic trauma. This suggests that while cortical gain changes are triggered by reduced bottom-up afferent input, their subsequent stabilization is also shaped by their local circuit milieu, where indicators of reduced inhibition can presage pathological hyperactivity following sensorineural hearing loss.
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Affiliation(s)
- Matthew McGill
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Division of Medical Sciences, Harvard Medical SchoolBostonUnited States
| | - Ariel E Hight
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Division of Medical Sciences, Harvard Medical SchoolBostonUnited States
| | - Yurika L Watanabe
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
| | - Aravindakshan Parthasarathy
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical SchoolBostonUnited States
| | - Dongqin Cai
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical SchoolBostonUnited States
| | - Kameron Clayton
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical SchoolBostonUnited States
| | - Kenneth E Hancock
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical SchoolBostonUnited States
| | - Anne Takesian
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical SchoolBostonUnited States
| | - Sharon G Kujawa
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical SchoolBostonUnited States
| | - Daniel B Polley
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear InfirmaryBostonUnited States
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical SchoolBostonUnited States
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28
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Weber FC, Schlee W, Langguth B, Schecklmann M, Schoisswohl S, Wetter TC, Simões J. Low Sleep Satisfaction Is Related to High Disease Burden in Tinnitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11005. [PMID: 36078720 PMCID: PMC9518088 DOI: 10.3390/ijerph191711005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Previous studies have shown a high prevalence of sleep disturbances in tinnitus patients. However, no study has yet evaluated subjective sleep satisfaction. The present study aimed to investigate associations of self-reported sleep satisfaction with sociodemographic factors, tinnitus-related distress, depression, and self-reported quality of life. This is a retrospective analysis of 2344 outpatients with tinnitus presenting at a tertiary German tinnitus clinic from 2010 to 2020. Patients who filled in five questionnaires (Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire (TQ), Major Depression Inventory (MDI), Tinnitus Sample Case History Questionnaire (TSCHQ), and the World Health Organization Quality of Life Brief Version (WHOQOL-Bref)) were included. Based on the question about sleep satisfaction in the WHOQOL-Bref, group classification into (I) sleep-satisfied, (II) neither satisfied or dissatisfied, and (III) sleep-dissatisfied patients was performed. Associations between sleep satisfaction and quality of life, depression, tinnitus distress, and tinnitus characteristics were analyzed by group differences and a multinomial regression model with elastic net penalization. A total of 42.38% of patients were satisfied or very satisfied with sleep, whereas 40.91% of patients were dissatisfied or very dissatisfied with sleep. The remaining patients reported being neither satisfied nor dissatisfied with sleep. Sleep-dissatisfied patients were significantly more burdened in questionnaires on depressive symptoms (MDI), tinnitus distress (TQ, THI), and quality of life (WHOQOL-Bref). In addition, they suffered significantly more often from comorbidities such as headache, neck pain, or temporomandibular joint disorder (TMJ). The elastic net regression based on sum scores of THI, TQ, MDI, the four domains of WHOQOL-Bref, as well as all individual questions from the TSCHQ was able to classify patients satisfied with their sleep with an accuracy of 79%, 87.8% sensitivity, and 70.4% specificity. The model could not identify patients indifferent with the quality of their sleep (neither satisfied nor dissatisfied) (sensitivity: 0%; specificity: 100%). The accuracy of the model to predict patients dissatisfied with their sleep was 80.7%, with 83% sensitivity and 78.4% specificity. Poor physical and mental health (Domain I/II WHOQOL-Bref) as well as tinnitus distress were the strongest predictors of sleep dissatisfaction. Conversely, for sleep satisfaction, good physical and mental health as well as low tinnitus distress were the strongest predictors. The division into sleep-satisfied and sleep-dissatisfied tinnitus patients allows a very good discrimination regarding disease burden as indicated by depression, tinnitus distress, quality of life, and pain-related comorbidities. Physical and mental health as well as tinnitus distress seem to be strongly related to sleep satisfaction underscoring the concept of "tinnitus" versus "tinnitus disorder", but also the importance of sleep satisfaction as a global health indicator. Moreover, these data indicate the relevance of addressing sleep disorders in the therapeutic management of chronic tinnitus patients.
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Affiliation(s)
- Franziska C. Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Centre, University of Regensburg, 93053 Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Centre, University of Regensburg, 93053 Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Centre, University of Regensburg, 93053 Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Centre, University of Regensburg, 93053 Regensburg, Germany
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Centre, University of Regensburg, 93053 Regensburg, Germany
- Department of Psychology, Bundeswehr University Munich, 85577 Neubiberg, Germany
| | - Thomas C. Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Center for Sleep Medicine, University of Regensburg, 93053 Regensburg, Germany
| | - Jorge Simões
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Centre, University of Regensburg, 93053 Regensburg, Germany
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The Rapid Screening for Somatosensory Tinnitus Tool: a Data-Driven Decision Tree Based on Specific Diagnostic Criteria. Ear Hear 2022; 43:1466-1471. [DOI: 10.1097/aud.0000000000001224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Objective Detection of Tinnitus Based on Electrophysiology. Brain Sci 2022; 12:brainsci12081086. [PMID: 36009149 PMCID: PMC9406100 DOI: 10.3390/brainsci12081086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Tinnitus, a common disease in the clinic, is associated with persistent pain and high costs to society. Several aspects of tinnitus, such as the pathophysiology mechanism, effective treatment, objective detection, etc., have not been elucidated. Any change in the auditory pathway can lead to tinnitus. At present, there is no clear and unified mechanism to explain tinnitus, and the hypotheses regarding its mechanism include auditory plasticity theory, cortical reorganization theory, dorsal cochlear nucleus hypothesis, etc. Current theories on the mechanism of tinnitus mainly focus on the abnormal activity of the central nervous system. Unfortunately, there is currently a lack of objective diagnostic methods for tinnitus. Developing a method that can detect tinnitus objectively is crucial, only in this way can we identify whether the patient really suffers from tinnitus in the case of cognitive impairment or medical disputes and the therapeutic effect of tinnitus. Electrophysiological investigations have prompted the development of an objective detection of tinnitus by potentials recorded in the auditory pathway. However, there is no objective indicator with sufficient sensitivity and specificity to diagnose tinnitus at present. Based on recent findings of studies with various methods, possible electrophysiological approaches to detect the presence of tinnitus have been summarized. We analyze the change of neural activity throughout the auditory pathway in tinnitus subjects and in patients with tinnitus of varying severity to find available parameters in these methods, which is helpful to further explore the feasibility of using electrophysiological methods for the objective detection of tinnitus.
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Rosemann S, Rauschecker JP. Neuroanatomical alterations in middle frontal gyrus and the precuneus related to tinnitus and tinnitus distress. Hear Res 2022; 424:108595. [DOI: 10.1016/j.heares.2022.108595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/04/2022]
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Aazh H, Erfanian M, Danesh AA, Moore BCJ. Audiological and Other Factors Predicting the Presence of Misophonia Symptoms Among a Clinical Population Seeking Help for Tinnitus and/or Hyperacusis. Front Neurosci 2022; 16:900065. [PMID: 35864982 PMCID: PMC9294447 DOI: 10.3389/fnins.2022.900065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
This paper evaluates the proportion and the audiological and other characteristics of patients with symptoms of misophonia among a population seeking help for tinnitus and/or hyperacusis at an audiology clinic (n = 257). To assess such symptoms, patients were asked "over the last 2 weeks, how often have you been bothered by any of the following problems? Feeling angry or anxious when hearing certain sounds related to eating noises, lip-smacking, sniffling, breathing, clicking sounds, tapping?". The results of routine audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Measures included: pure tone audiometry, uncomfortable loudness levels (ULLs), and responses to the tinnitus impact questionnaire (TIQ), the hyperacusis impact questionnaire (HIQ), and the screening for anxiety and depression in tinnitus (SAD-T) questionnaire. The mean age of the patients was 53 years (SD = 16) (age range 17 to 97 years). Fifty four percent were female. Twenty-three percent of patients were classified as having misophonia. The presence and frequency of reporting misophonia symptoms were not related to audiometric thresholds, except that a steeply sloping audiogram reduced the likelihood of frequent misophonia symptoms. Those with more frequent misophonia symptoms had lower values of ULLmin (the across-frequency average of ULLs for the ear with lower average ULLs) than those with less frequent or no reported symptoms. The reported frequency of experiencing misophonia symptoms increased with increasing impact of tinnitus (TIQ score ≥9), increasing impact of hyperacusis (HIQ score >11), and symptoms of anxiety and depression (SAD-T score ≥4). It is concluded that, when assessing individuals with tinnitus and hyperacusis, it is important to screen for misophonia, particularly when ULLmin is abnormally low or the TIQ, HIQ or SAD-T score is high. This will help clinicians to distinguish patients with misophonia, guiding the choice of therapeutic strategies.
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Affiliation(s)
- Hashir Aazh
- Audiology Department, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, FL, United States
- Faculty of Engineering and Physical Sciences (FEPS), University of Surrey, Guildford, United Kingdom
| | - Mercede Erfanian
- UCL Institute for Environmental Design and Engineering, The Bartlett, University College London, London, United Kingdom
| | - Ali A. Danesh
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, FL, United States
| | - Brian C. J. Moore
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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Cortical auditory evoked potentials, brain signal variability and cognition as biomarkers to detect the presence of chronic tinnitus. Hear Res 2022; 420:108489. [DOI: 10.1016/j.heares.2022.108489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/03/2022] [Accepted: 03/19/2022] [Indexed: 12/31/2022]
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Aazh H, Taylor L, Danesh AA, Moore BCJ. The Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Tinnitus for Patients with Tinnitus Alone or Combined with Hyperacusis and/or Misophonia: A Preliminary Analysis. J Am Acad Audiol 2022; 33:405-416. [PMID: 37146649 PMCID: PMC11293900 DOI: 10.1055/a-2087-0262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/10/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND In the United Kingdom, audiologist-delivered cognitive behavioral therapy (CBT) is a key intervention to alleviate the distress caused by tinnitus and its comorbid hyperacusis. However, the availability of face-to-face CBT is limited, and such therapy involves significant costs. CBT provided via the internet provides a potential solution to improve access to CBT for tinnitus. PURPOSE The aim was to perform a preliminary assessment of the effect of a specific program of nonguided internet-based CBT for tinnitus, denoted iCBT(T), in alleviating the problems caused by tinnitus alone or tinnitus combined with hyperacusis. RESEARCH DESIGN This was a retrospective cross-sectional study. STUDY SAMPLE The data for 28 people with tinnitus who completed the iCBT(T) program and answered a series of questions about their tinnitus and hearing status were included in the study. Twelve patients also reported having hyperacusis (including five also with misophonia). DATA COLLECTION AND ANALYSIS The iCBT(T) program has seven self-help modules. Anonymous data were collected retrospectively from patients' answers to the questions in the iCBT(T) initial and final assessment modules. Questionnaires administered within the iCBT(T) program were: 4C Tinnitus Management Questionnaire (4C), Screening for Anxiety and Depression in Tinnitus (SAD-T), and the CBT Effectiveness Questionnaire (CBT-EQ). RESULTS Responses to the 4C showed a significant improvement from pre- to posttreatment, with a medium effect size. The mean improvement was similar for those with and without hyperacusis. Responses to the SAD-T questionnaire also showed a significant improvement from pre- to posttreatment with a medium effect size. The improvement was significantly greater for participants with tinnitus alone than for participants who also had hyperacusis. For both the 4C and the SAD-T, the improvements were not significantly related to age or gender. Participants' views of the effectiveness of the iCBT(T) program were assessed using the CBT-EQ. The mean score was 50 out of a maximum of 80, indicating moderately high effectiveness. CBT-EQ scores did not differ for those with and without hyperacusis. CONCLUSION Based on this preliminary analysis, the iCBT(T) program showed promising results in improving the ability to manage tinnitus and decreasing symptoms of anxiety and depression. Future studies with larger samples and control group(s) are required to further assess various aspects of this program.
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Affiliation(s)
- Hashir Aazh
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd., London, United Kingdom
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, Florida
- Faculty of Engineering and Physical Sciences, University of Surrey, United Kingdom
| | - Lauren Taylor
- Hashir International Specialist Clinics & Research Institute for Misophonia, Tinnitus and Hyperacusis Ltd., London, United Kingdom
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom
| | - Ali A. Danesh
- Department of Communication Sciences & Disorders, Florida Atlantic University, Boca Raton, Florida
| | - Brian C. J. Moore
- Cambridge Hearing Group, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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Jacquemin L, Cardon E, Michiels S, Luyten T, Van der Wal A, De Hertogh W, Vanderveken OM, Van de Heyning P, Lammers MJW, Van Rompaey V, Gilles A. Hyperacusis: demographic, audiological, and clinical characteristics of patients at the ENT department. Eur Arch Otorhinolaryngol 2022; 279:4899-4907. [PMID: 35298688 DOI: 10.1007/s00405-022-07336-4] [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: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To document whether patients with and without hyperacusis differ from each other on demographic, audiological, and clinical characteristics. METHODS Based on the Hyperacusis Questionnaire's (HQ) cut-off (HQ > 28), a total of 2301 participants were divided into patients with and without hyperacusis. Demographic data, scores on self-reported questionnaires [Tinnitus Functional Index (TFI), Visual Analogue Scale of tinnitus loudness (VASloudness), Hospital Anxiety Depression Scale (HADS)], and audiological parameters were retrospectively analysed to determine differential factors between the two groups. RESULTS In total, 10.9% of the patients was classified as hyperacusis patients (n = 251). They reported a significant, higher tinnitus severity (mean difference of 19 points on TFI) and mental distress (mean difference of 4 points on the HADS subscales) (p < 0.001) than patients without hyperacusis. Moreover, this group consisted of more women (45% % in hyperacusis group vs. 35% in non-hyperacusis group) and women scored significantly higher on the HQ (p < 0.001) and TFI (p < 0.01). CONCLUSION Patients with hyperacusis have distinctive characteristics. The presence of hyperacusis in combination with tinnitus can indicate a higher need for psychoeducation. Patients that present themselves with hyperacusis without tinnitus complaints remain a minority, yet might be underdiagnosed. Hence, future studies should disentangle tinnitus from hyperacusis. In clinical practice, greater efforts are required to increase knowledge about hyperacusis as a primary or secondary complaint and to provide individualized treatment for these patients.
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Affiliation(s)
- Laure Jacquemin
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium. .,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - Emilie Cardon
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Sarah Michiels
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Tine Luyten
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annemarie Van der Wal
- Department of Rehabilitation Sciences and Physiotherapy, Antwerp University, Antwerp, Belgium.,Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, VU Amsterdam, Amsterdam, The Netherlands
| | - Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Antwerp University, Antwerp, Belgium
| | - Olivier M Vanderveken
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marc J W Lammers
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annick Gilles
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
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Vidal JL, Park JM, Han JS, Alshaikh H, Park SN. Measurement of Loudness Discomfort Levels as a Test for Hyperacusis: Test-Retest Reliability and Its Clinical Value. Clin Exp Otorhinolaryngol 2022; 15:84-90. [PMID: 35144329 PMCID: PMC8901946 DOI: 10.21053/ceo.2021.00318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives The aims of this study were to investigate the test-retest reliability of measurements of loudness discomfort levels (LDLs), to suggest cut-off values for diagnosing patients with hyperacusis, and to evaluate the clinical value of-LDL measurements as a test for monitoring hyperacusis. Methods For the test-retest reliability of LDL measurements (study 1), a total of 68 patients who sought consultations at our clinic were subcategorized into four groups: patients with tinnitus (group 1), tinnitus and hearing loss (group 2), hyperacusis (group 3), and normal controls (group 4). Inter-hour and inter-day test-retest reliability values using different stimuli were investigated. For study 2, the clinical value of LDL measurements using pure tone stimuli was analyzed by comparing changes after sound generator use in patients with hyperacusis. Results In study 1, the group 3 patients showed significantly lower LDLs than the other groups. High test-retest reliability of LDL tests was demonstrated, regardless of the type of stimulus used. The cut-off values for screening patients with hyperacusis were 90 dB HL using pure tone stimuli and 62 dB HL using white-band noise stimuli. In study 2, significantly increased LDLs were correlated with improved symptoms and improved scores on tinnitus questionnaires after sound generator use, indicating that LDL measurement is a reliable test for monitoring hyperacusis during an intervention. Conclusion LDL measurement is a reliable diagnostic tool to reflect the condition of hyperacusis, especially during the course of treatment.
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Affiliation(s)
- Jaclyn Leigh Vidal
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Dr. Paulino J. Garcia Memorial Research and Medical Center, Nueva Ecija, Philippines.,Department of Otorhinolaryngology-Head and Neck Surgery, St. Luke's Medical Center, Quezon City, Philippines
| | - Jung Mee Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Sang Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hamzah Alshaikh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shi Nae Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Auditory Brainstem Response Wave I Amplitude Has Limited Clinical Utility in Diagnosing Tinnitus in Humans. Brain Sci 2022; 12:brainsci12020142. [PMID: 35203907 PMCID: PMC8870703 DOI: 10.3390/brainsci12020142] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Animal studies have discovered that noise, even at levels that produce no permanent threshold shift, may cause cochlear damage and selective nerve degeneration. A hallmark of such damage, or synaptopathy, is recovered threshold but reduced suprathreshold amplitude for the auditory brainstem response (ABR) wave I. The objective of the present study is to evaluate whether the ABR wave I amplitude or slope can be used to diagnose tinnitus in humans. A total of 43 human subjects, consisting of 21 with tinnitus and 22 without tinnitus, participated in the study. The subjects were on average 44 ± 24 (standard deviation) years old and 16 were female; a subgroup of 19 were young adults with normal audiograms from 125 to 8000 Hz. The ABR was measured using ear canal recording tiptrodes for clicks, 1000, 4000 and 8000 Hz tone bursts at 30, 50, and 70 dB nHL. Compared with control subjects, tinnitus subjects did not show reduced ABR wave I amplitude or slope in either the entire group of 21 tinnitus subjects or a subset of tinnitus subjects with normal audiograms. Despite the small sample size and diverse tinnitus population, the present result suggests that low signal-to-noise ratios in non-invasive measurement of the ABR limit its clinical utility in diagnosing tinnitus in humans.
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Chen F, Zhao F, Mahafza N, Lu W. Detecting Noise-Induced Cochlear Synaptopathy by Auditory Brainstem Response in Tinnitus Patients With Normal Hearing Thresholds: A Meta-Analysis. Front Neurosci 2021; 15:778197. [PMID: 34987358 PMCID: PMC8721093 DOI: 10.3389/fnins.2021.778197] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023] Open
Abstract
Noise-induced cochlear synaptopathy (CS) is defined as a permanent loss of synapses in the auditory nerve pathway following noise exposure. Several studies using auditory brainstem response (ABR) have indicated the presence of CS and increased central gain in tinnitus patients with normal hearing thresholds (TNHT), but the results were inconsistent. This meta-analysis aimed to review the evidence of CS and its pathological changes in the central auditory system in TNHT. Published studies using ABR to study TNHT were reviewed. PubMed, EMBASE, and Scopus databases were selected to search for relevant literature. Studies (489) were retrieved, and 11 were included for meta-analysis. The results supported significantly reduced wave I amplitude in TNHT, whereas the alternations in wave V amplitude were inconsistent among the studies. Consistently increased V/I ratio indicated noise-induced central gain enhancement. The results indicated the evidence of noise-induced cochlear synaptopathy in tinnitus patients with normal hearing. However, inconsistent changes in wave V amplitude may be explained by that the failure of central gain that triggers the pathological neural changes in the central auditory system and/or that increased central gain may be necessary to generate tinnitus but not to maintain tinnitus.
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Affiliation(s)
- Feifan Chen
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Department of Hearing and Speech Science, Guangzhou Xinhua College, Guangzhou, China
| | - Nadeem Mahafza
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Wei Lu
- Department of Otolaryngology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Klein A, Schankin CJ. Visual snow syndrome, the spectrum of perceptual disorders, and migraine as a common risk factor: A narrative review. Headache 2021; 61:1306-1313. [PMID: 34570907 PMCID: PMC9293285 DOI: 10.1111/head.14213] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this narrative review is to explore the relationship between visual snow syndrome (VSS), migraine, and a group of other perceptual disorders. BACKGROUND VSS is characterized by visual snow and additional visual and nonvisual disturbances. The clinical picture suggests a hypersensitivity to internal and external stimuli. Imaging and electrophysiological findings indicate a hyperexcitability of the primary and secondary visual areas of the brain possibly due to an impairment of inhibitory feedback mechanisms. Migraine is the most frequent comorbidity. Epidemiological and clinical studies indicate that other perceptual disorders, such as tinnitus, fibromyalgia, and dizziness, are associated with VSS. Clinical overlaps and parallels in pathophysiology might exist in relation to migraine. METHODS We performed a PubMed and Google Scholar search with the following terms: visual snow syndrome, entoptic phenomenon, fibromyalgia, tinnitus, migraine, dizziness, persistent postural-perceptual dizziness (PPPD), comorbidities, symptoms, pathophysiology, thalamus, thalamocortical dysrhythmia, and salience network. RESULTS VSS, fibromyalgia, tinnitus, and PPPD share evidence of a central disturbance in the processing of different stimuli (visual, somatosensory/pain, acoustic, and vestibular) that might lead to hypersensitivity. Imaging and electrophysiological findings hint toward network disorders involving the sensory networks and other large-scale networks involved in the management of attention and emotional processing. There are clinical and epidemiological overlaps between these disorders. Similarly, migraine exhibits a multisensory hypersensitivity even in the interictal state with fluctuation during the migraine cycle. All the described perceptual disorders are associated with migraine suggesting that having migraine, that is, a disorder of sensory processing, is a common link. CONCLUSION VSS, PPPD, fibromyalgia, and chronic tinnitus might lie on a spectrum of perceptual disorders with similar pathophysiological mechanisms and the common risk factor migraine. Understanding the underlying network disturbances might give insights into how to improve these currently very difficult to treat conditions.
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Affiliation(s)
- Antonia Klein
- Department of NeurologyInselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Christoph J. Schankin
- Department of NeurologyInselspitalBern University HospitalUniversity of BernBernSwitzerland
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Internal Consistency and Convergent Validity of the Inventory of Hyperacusis Symptoms. Ear Hear 2021; 42:917-926. [PMID: 33259445 DOI: 10.1097/aud.0000000000000982] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim was to assess the internal consistency and convergent and discriminant validity of a new questionnaire for hyperacusis, the Inventory of Hyperacusis Symptoms (IHS; Greenberg & Carlos 2018), using a clinical population. DESIGN This was a retrospective study. Data were gathered from the records of 100 consecutive patients who sought help for tinnitus and/or hyperacusis from an audiology clinic in the United Kingdom. The average age of the patients was 55 years (SD = 13 years). Audiological measures were the pure-tone average threshold (PTA) and uncomfortable loudness levels (ULL). Questionnaires administered were: IHS, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Insomnia Severity Index, Generalized Anxiety Disorder, and Patient Health Questionnaire-9. RESULTS Cronbach's alpha for the 25-item IHS questionnaire was 0.96. Neither the total IHS score nor scores for any of its five subscales were correlated with the PTA of the better or worse ear. This supports the discriminant validity of the IHS, as hyperacusis is thought to be independent of the PTA. There were moderately strong correlations between IHS total scores and scores for the HQ, Tinnitus Handicap Inventory, Generalized Anxiety Disorder, and Patient Health Questionnaire-9, with r = 0.58, 0.58, 0.61, 0.54, respectively. Thus, although IHS scores may reflect hyperacusis itself, they may also reflect the coexistence of tinnitus, anxiety, and depression. The total score on the IHS was significantly different between patients with and without hyperacusis (as diagnosed based on ULLs or HQ scores). Using the HQ score as a reference, the area under the receiver operating characteristic for the IHS was 0.80 (95% confidence interval = 0.71 to 0.89) and the cutoff point of the IHS with highest overall accuracy was 56/100. The corresponding sensitivity and specificity were 74% and 82%. CONCLUSIONS The IHS has good internal consistency and reasonably high convergent validity, as indicated by the relationship of IHS scores to HQ scores and ULLs, but IHS scores may also partly reflect the co-occurrence of tinnitus, anxiety, and depression. We propose an IHS cutoff score of 56 instead of 69 for diagnosing hyperacusis.
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Santacruz JL, Arnold R, Tuinstra J, Stewart RE, van Dijk P. Validation of a Dutch version of the Tinnitus Functional Index in a tertiary referral tinnitus clinic. Heliyon 2021; 7:e07733. [PMID: 34430732 PMCID: PMC8371215 DOI: 10.1016/j.heliyon.2021.e07733] [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: 04/19/2021] [Revised: 06/21/2021] [Accepted: 08/04/2021] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Tinnitus is a condition with a subjective nature that requires self-report questionnaires for its assessment. Aspects such as quality of life, sleep or intrusiveness have been addressed by multiple tinnitus questionnaires, but the high responsiveness to treatment effects of the Tinnitus Functional Index (TFI) makes this questionnaire part of the standard practice in tinnitus screening. To date, the TFI has been translated to more than 20 languages and used in more than 22 countries. In this study, the TFI was translated to Dutch and validated through a clinical population in the Netherlands. METHODS After a back-translation procedure, the Dutch TFI was filled-out by 377 patients in the tinnitus outpatient clinic at the Ear, Nose and Throat (ENT) department of the University Medical Center Groningen, in the Netherlands. Reliability and construct validity of the questionnaire were assessed by correlations with one other tinnitus questionnaire (Tinnitus Handicap Inventory, THI) and with three psychological functioning questionnaires (Rand-36, Cantril's ladder and the Hospital Anxiety and Depression Scale (HADS)). The eight-factor structure of the Dutch TFI was tested by means of exploratory factor analysis using three different models (ICM-CFA, ESEM and ESEM-CFA). RESULTS The Dutch TFI showed a high internal consistency (α = 0.95), and construct validity was proven by moderate-to high-convergent correlations with the THI (r = 0.47-0.79) and by moderate convergent (r = 0.55-0.67) and good-to moderate-divergent (r = 0.12-0.47) correlations with the psychological functioning questionnaires. The eight-factor structure of the TFI was confirmed for the Dutch version by the three models. CONCLUSION The Dutch version of the TFI is a reliable instrument for screening tinnitus impact in a clinical population, and its psychometric properties are comparable to the original TFI and other validated tinnitus questionnaires.
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Affiliation(s)
- Jose L. Santacruz
- 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 Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, the Netherlands
| | - Rosemarie Arnold
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jolanda Tuinstra
- University of Groningen, University Medical Center Groningen, Dept. of Health Sciences, the Netherlands
- University of Applied Sciences NHL Stenden, Dept. Health and Social Studies, Leeuwarden, the Netherlands
| | - Roy E. Stewart
- University of Groningen, University Medical Center Groningen, Dept. of Health Sciences, the Netherlands
| | - 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 Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, the Netherlands
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Fetoni AR, Di Cesare T, Settimi S, Sergi B, Rossi G, Malesci R, Marra C, Paludetti G, De Corso E. The evaluation of global cognitive and emotional status of older patients with chronic tinnitus. Brain Behav 2021; 11:e02074. [PMID: 34288570 PMCID: PMC8413806 DOI: 10.1002/brb3.2074] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Tinnitus is a common symptom largely impactful on quality of life, especially in the elderly. Our aim was to evaluate the efficacy of self-administered screening tests to correlate the severity of subjective perception of tinnitus with emotional disorders and the overall cognitive status. METHODS Patients aged ≥ 55 years with chronic tinnitus were recruited and submitted to a complete audiological evaluation; Tinnitus Handicap inventory (THI); Hospital Anxiety and Depression Scale (HADS-A and HADS-D) and Mini-Mental State Examination (MMSE). Demographic and audiological features of patients with and without cognitive impairment (MMSE score cut-off of 24/30) were analyzed in order to reveal the relationship among tinnitus, emotional disorders, and cognitive dysfunction. RESULTS 102 patients were recruited (mean age: 70.4 ± 9.6). THI score was directly related to HADS-A score (r = .63) HADS-D score (r = .66), whereas there was no relationship between tinnitus severity and MMSE (r = .13). CI and n-CI groups did not differ in the characteristics of tinnitus (p > .05), however, hearing threshold (p = .049) and anxious depressive traits measured with HADS-A (p = .044) and HADS-D (p = .016) were significantly higher in the group with cognitive impairment. Furthermore, age ≥ 75 years (p = .002, OR = 13.8), female sex (p = .032; OR = 6.5), severe hearing loss (p = .036; OR = 2.3), and anxiety (p = .029; OR = 9.2) resulted risk factors for CI. Therefore, in CI group MMSE score was inversely related to age (r = -.84). CONCLUSIONS Cognitive impairment and psychiatric discomfort should be considered in tinnitus patients, related to increasing age, female sex, and severe hearing loss. Thus, self-administered questionnaires can be useful in addressing clinical approach.
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Affiliation(s)
- Anna Rita Fetoni
- Institute of Otolaryngology, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Bruno Sergi
- Institute of Otolaryngology, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Rita Malesci
- Audiology and Vestibology Unit, Neuroscience Department, Federico II University Naples, Naples, Italy
| | - Camillo Marra
- Università Cattolica del Sacro Cuore, Rome, Italy.,Memory Clinic, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Institute of Otolaryngology, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio De Corso
- Institute of Otolaryngology, Fondazione Policlinico Agostino Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Zimdahl JW, Thomas H, Bolland SJ, Leggett K, Barry KM, Rodger J, Mulders WHAM. Excitatory Repetitive Transcranial Magnetic Stimulation Over Prefrontal Cortex in a Guinea Pig Model Ameliorates Tinnitus. Front Neurosci 2021; 15:693935. [PMID: 34366777 PMCID: PMC8339289 DOI: 10.3389/fnins.2021.693935] [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: 04/12/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
Tinnitus, a phantom auditory perception that can seriously affect quality of life, is generally triggered by cochlear trauma and associated with aberrant activity throughout the auditory pathways, often referred to as hyperactivity. Studies suggest that non-auditory structures, such as prefrontal cortex (PFC), may be involved in tinnitus generation, by affecting sensory gating in auditory thalamus, allowing hyperactivity to reach the cortex and lead to perception. Indeed, human studies have shown that repetitive transcranial magnetic stimulation (rTMS) of PFC can alleviate tinnitus. The current study investigated whether this therapeutic effect is achieved through inhibition of thalamic hyperactivity, comparing effects of two common clinical rTMS protocols with sham treatment, in a guinea pig tinnitus model. Animals underwent acoustic trauma and once tinnitus developed were treated with either intermittent theta burst stimulation (iTBS), 20 Hz rTMS, or sham rTMS (10 days, 10 min/day; weekdays only). Tinnitus was reassessed and extracellular recordings of spontaneous tonic and burst firing rates in auditory thalamus made. To verify effects in PFC, densities of neurons positive for calcium-binding proteins, calbindin and parvalbumin, were investigated using immunohistochemistry. Both rTMS protocols significantly reduced tinnitus compared to sham. However, spontaneous tonic firing decreased following 20 Hz stimulation and increased following iTBS in auditory thalamus. Burst rate was significantly different between 20 Hz and iTBS stimulation, and burst duration was increased only after 20 Hz treatment. Density of calbindin, but not parvalbumin positive neurons, was significantly increased in the most dorsal region of PFC indicating that rTMS directly affected PFC. Our results support the involvement of PFC in tinnitus modulation, and the therapeutic benefit of rTMS on PFC in treating tinnitus, but indicate this is not achieved solely by suppression of thalamic hyperactivity.
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Affiliation(s)
- Jack W Zimdahl
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Harrison Thomas
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Samuel J Bolland
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia.,Perron Institute for Neurological and Translational Research, Crawley, WA, Australia
| | - Kerry Leggett
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Kristin M Barry
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Jennifer Rodger
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia.,Perron Institute for Neurological and Translational Research, Crawley, WA, Australia
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Smit AL, Stegeman I, Eikelboom RH, Baguley DM, Bennett RJ, Tegg-Quinn S, Bucks RS, Stokroos RJ, Hunter M, Atlas MD. Prevalence of Hyperacusis and Its Relation to Health: The Busselton Healthy Ageing Study. Laryngoscope 2021; 131:E2887-E2896. [PMID: 34291459 PMCID: PMC9292021 DOI: 10.1002/lary.29768] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 07/04/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022]
Abstract
Importance The prevalence of hyperacusis and its relationship with mental and general health is unknown in a nonclinical sample. Therefore, we aimed to determine the prevalence of hyperacusis and its relation with hearing, general and mental health in a population‐based study. Study Design Prospective population‐based study. Material and Methods This study uses data from the Busselton Healthy Ageing Study (BHAS). A sample of 5,107 eligible inhabitants aged 45 to 70 years completed a detailed questionnaire and a clinical assessment. A positive answer to “Do you consider yourself sensitive or intolerant to everyday sounds” was used to indicate hyperacusis. Logistic regression was used to examine the association between hearing, mental and general health factors, and hyperacusis. Results Of 5,107 participants, 775 (15.2%) reported hyperacusis. The majority of participants with hyperacusis reported an occasional effect on daily life (72.0%). Being female, older in age, having a lower income, physical or mental health difficulties, more severe hearing loss, and tinnitus were all associated with the presence of hyperacusis. Individuals who experience hearing impairment, poorer general or mental health have a higher possibility of hyperacusis having an effect on their daily life. Conclusions In this community population‐based cohort study, we found a prevalence of hyperacusis of 15.2%. Individuals with hearing loss, mental health problems, and lower physical health have a higher possibility of experiencing effects on their daily life associated with their hyperacusis. Unravelling the relationship between hyperacusis hearing, general and mental health can be of major importance for a better understanding of the condition and its consequences. Level of Evidence 2 Laryngoscope, 131:E2887–E2896, 2021
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Affiliation(s)
- Adriana L Smit
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert H Eikelboom
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.,Ear Science Institute Australia, Subiaco, Australia
| | - David M Baguley
- Hearing Sciences, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, U.K.,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, U.K
| | - Rebecca J Bennett
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia.,Ear Science Institute Australia, Subiaco, Australia
| | - Susan Tegg-Quinn
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia.,Ear Science Institute Australia, Subiaco, Australia.,School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Romola S Bucks
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Robert J Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael Hunter
- Busselton Health Study Centre, Busselton Population Medical Research Institute, Perth, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Marcus D Atlas
- Ear Sciences Centre, The University of Western Australia, Nedlands, Australia.,Ear Science Institute Australia, Subiaco, Australia
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Abstract
BACKGROUND Tinnitus can be influenced by changes in somatosensory afference from the cervical spine or temporomandibular area, then called somatosensory or somatic tinnitus (ST). In 2018, a new set of diagnostic criteria for ST was agreed upon by a large group of ST experts. Currently, however, it still requires extensive and specific expertise to diagnose ST correctly. The next step in the development of easily applicable diagnostic criteria is to assess the diagnostic value of each individual criterion. OBJECTIVES The aim of this study was, therefore, to further investigate the diagnostic value of these criteria, validate them empirically, and identify their sensitivity and specificity. METHODS An online survey, questioning the presence of 12 diagnostic criteria for ST in a convenience sample of participants with tinnitus, was launched on the online forum Tinnitus Talk, managed by Tinnitus Hub. Participants were divided into three groups: a group with no somatic influence, a group with some somatic influence and a group with large somatic influence on their tinnitus. Chi-square tests were used to calculate differences between these groups. Afterward, sensitivity, specificity, positive and negative likelihood ratios (LR), and pre- and posttest probabilities were calculated for each ST diagnostic criterion. For this analysis, all patients with some and large somatic influence were compared as one group to the group with no somatic influence. RESULTS In total, 8221 participants filled out the online survey. As expected, the diagnostic criteria for ST are more prevalent in the groups with somatic influence, but the criterium of tinnitus modulation also often occurs in the group with no somatic influence. The simultaneous onset or increase and decrease of both tinnitus and pain complaints have the highest positive LR (6.29 and 10.72, respectively), next to the influence of certain postures on the tinnitus (+LR: 6.04). To rule out ST, the absence of neck pain or tension in the neck extensor muscles are most suited, as they decrease the posttest probability to 18% and 19%, respectively. CONCLUSION The simultaneous onset or increase and decrease of tinnitus and neck or jaw pain and the influence of certain postures are most suited to use as a single criterion for identifying patients with a somatic influence on their tinnitus. On the other hand, the absence of neck pain or tension in the neck extensor muscles is valid criterion to rule out a somatic influence. Additional analysis is needed to identify clusters of symptoms and criteria to further aid ST diagnosis.
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Genitsaridi E, Dode A, Qirjazi B, Mehdi M, Pryss R, Probst T, Reichert M, Hauck F, Hall DA. An Albanian translation of a questionnaire for self-reported tinnitus assessment. Int J Audiol 2021; 61:515-519. [PMID: 34182868 DOI: 10.1080/14992027.2021.1933221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To our knowledge, there is no published study investigating the characteristics of people experiencing tinnitus in Albania. Such a study would be important, providing the basis for further research in this region and contributing to a wider understanding of tinnitus heterogeneity across different geographic locations. The main objective of this study was to develop an Albanian translation of a standardised questionnaire for tinnitus research, namely the European School for Interdisciplinary Tinnitus Research-Screening Questionnaire (ESIT-SQ). A secondary objective was to assess its applicability and usefulness by conducting an exploratory survey on a small sample of the Albanian tinnitus population. DESIGN AND STUDY SAMPLE Three translators were recruited to create the Albanian ESIT-SQ translation following good practice guidelines. Using this questionnaire, data from 107 patients attending otolaryngology clinics in Albania were collected. RESULTS Participants reporting various degrees of tinnitus symptom severity had distinct phenotypic characteristics. Application of a random forest approach on this preliminary dataset showed that self-reported hearing difficulty, and tinnitus duration, pitch and temporal manifestation were important variables for predicting tinnitus symptom severity. CONCLUSIONS Our study provided an Albanian translation of the ESIT-SQ and demonstrated that it is a useful tool for tinnitus profiling and subgrouping.
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Affiliation(s)
- Eleni Genitsaridi
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, UK
| | - Albi Dode
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Birkena Qirjazi
- Department of ENT, Faculty of Medicine, University of Tirana, Tirana, Albania
| | - Muntazir Mehdi
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Manfred Reichert
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Franz Hauck
- Institute of Distributed Systems, Ulm University, Ulm, Germany
| | - Deborah Ann Hall
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.,National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, UK.,Department of Psychology, School of Social Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
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47
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Williams ZJ, Suzman E, Woynaroski TG. A Phenotypic Comparison of Loudness and Pain Hyperacusis: Symptoms, Comorbidity, and Associated Features in a Multinational Patient Registry. Am J Audiol 2021; 30:341-358. [PMID: 33877881 DOI: 10.1044/2021_aja-20-00209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Hyperacusis is a complex and poorly understood auditory disorder characterized by decreased tolerance to sound at levels that would not trouble most individuals. Recently, it has been suggested that individuals who experience otalgia in response to everyday sounds (termed pain hyperacusis) may differ clinically from those whose primary symptom is the perception of everyday sounds as excessively loud (termed loudness hyperacusis). Despite this theoretical distinction, there have been no empirical studies directly comparing these two populations of hyperacusis patients. Method Using data from a multinational patient registry (the Coordination of Rare Diseases at Sanford Registry), we examined self-reported demographics, symptoms, comorbidity, and response to treatment in a sample of 243 adults with hyperacusis, 152 of whom were classified as having pain hyperacusis based on reported symptoms. Bayesian statistical tests were used to investigate both the presence and absence of group differences between patients with loudness and pain hyperacusis. Results Individuals with pain hyperacusis presented with a more severe clinical phenotype, reporting a higher frequency of temporary symptom exacerbations (i.e., "setbacks"), less perceived symptom improvement over time, more severe comorbid headache disorders, and reduced benefit from sound therapy. However, the two hypothesized hyperacusis subtypes exhibited more similarities than differences, with the majority of symptoms and comorbidities being equally prevalent across groups. Multiple comorbidities were commonly observed, including tinnitus, primary headache disorders, psychiatric disorders, and functional somatic syndromes. Intolerance of sensory stimuli in other modalities was also frequently reported. Conclusion Although this study provides little evidence that loudness and pain hyperacusis are pathophysiologically distinct conditions, our findings indicate that a pain-predominant phenotype may be a meaningful prognostic marker in patients with hyperacusis.
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
| | - Evan Suzman
- Graduate Program in Biomedical Sciences, Vanderbilt University, Nashville, TN
| | - Tiffany G. Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN
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48
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Noise Damage Accelerates Auditory Aging and Tinnitus: A Canadian Population-Based Study. Otol Neurotol 2021; 41:1316-1326. [PMID: 32810017 DOI: 10.1097/mao.0000000000002848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Age-related hearing loss (ARHL) is the third most challenging disability in older adults. Noise is a known modifiable risk factor of ARHL, which can drive adverse health effects. Few large-scale studies, however, have shown how chronic noise exposure (CNE) impacts the progression of ARHL and tinnitus. STUDY DESIGN Retrospective large-scale study. SETTING Audiology clinical practice. PATIENTS In this study, 928 individuals aged 30-100 years without (n=497) or with the experience of CNE (n=431) were compared in their hearing assessments and tinnitus. In order to only investigate the impact of CNE on ARHL and tinnitus, people with other risk factors of hearing loss were excluded from the study. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES Noise damage was associated with a greater ARHL per age decades (pure-tone average(PTA)0.5-4kHz alterations 19.6-70.8 dB vs. 8.0-63.2 dB, ≤0.001), an acceleration of developing a significant ARHL at least by two decades (PTA0.5-4kHz 33.4 dB at 50-59yr vs. 28.2 dB at 30-39yr, ≤0.001), and an increased loss of word recognition scores (total average 84.7% vs. 80.0%, ≤0.001). Significant noise-associated growth in the prevalence of tinnitus also was shown, including more than a triple prevalence for constant tinnitus (28.10% vs. 8.85%, ≤0.001) and near to a double prevalence for intermittent tinnitus (19.10% vs. 11.10%, ≤0.001). Noise also resulted in the elevation of the static compliance of the tympanic membrane throughout age (total average 0.61 vs. 0.85 mmho, ≤0.001). CONCLUSIONS Our findings emphasize the significant contribution of CNE in auditory aging and the precipitation of both ARHL and tinnitus.
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Ljungberg E, Damestani NL, Wood TC, Lythgoe DJ, Zelaya F, Williams SCR, Solana AB, Barker GJ, Wiesinger F. Silent zero TE MR neuroimaging: Current state-of-the-art and future directions. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2021; 123:73-93. [PMID: 34078538 PMCID: PMC7616227 DOI: 10.1016/j.pnmrs.2021.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
Magnetic Resonance Imaging (MRI) scanners produce loud acoustic noise originating from vibrational Lorentz forces induced by rapidly changing currents in the magnetic field gradient coils. Using zero echo time (ZTE) MRI pulse sequences, gradient switching can be reduced to a minimum, which enables near silent operation.Besides silent MRI, ZTE offers further interesting characteristics, including a nominal echo time of TE = 0 (thus capturing short-lived signals from MR tissues which are otherwise MR-invisible), 3D radial sampling (providing motion robustness), and ultra-short repetition times (providing fast and efficient scanning).In this work we describe the main concepts behind ZTE imaging with a focus on conceptual understanding of the imaging sequences, relevant acquisition parameters, commonly observed image artefacts, and image contrasts. We will further describe a range of methods for anatomical and functional neuroimaging, together with recommendations for successful implementation.
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Affiliation(s)
- Emil Ljungberg
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Nikou L Damestani
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - David J Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Steven C R Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Gareth J Barker
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Florian Wiesinger
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; ASL Europe, GE Healthcare, Munich, Germany
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50
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Refat F, Wertz J, Hinrichs P, Klose U, Samy H, Abdelkader RM, Saemisch J, Hofmeier B, Singer W, Rüttiger L, Knipper M, Wolpert S. Co-occurrence of Hyperacusis Accelerates With Tinnitus Burden Over Time and Requires Medical Care. Front Neurol 2021; 12:627522. [PMID: 33815254 PMCID: PMC8012887 DOI: 10.3389/fneur.2021.627522] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Although tinnitus represents a major global burden, no causal therapy has yet been established. Ongoing controversies about the neuronal pathophysiology of tinnitus hamper efforts in developing advanced therapies. Hypothesizing that the unnoticed co-occurrence of hyperacusis and differences in the duration of tinnitus may possibly differentially influence the neural correlate of tinnitus, we analyzed 33 tinnitus patients without (T-group) and 20 tinnitus patients with hyperacusis (TH-group). We found crucial differences between the T-group and the TH-group in the increase of annoyance, complaints, tinnitus loudness, and central neural gain as a function of tinnitus duration. Hearing thresholds did not differ between T-group and TH-group. In the TH-group, the tinnitus complaints (total tinnitus score) were significantly greater from early on and the tinnitus intensity distinctly increased over time from ca. 12 to 17 dB when tinnitus persisted more than 5 years, while annoyance responses to normal sound remained nearly constant. In contrast, in the T-group tinnitus complaints remained constant, although the tinnitus intensity declined over time from ca. 27 down to 15 dB beyond 5 years of tinnitus persistence. This was explained through a gradually increased annoyance to normal sound over time, shown by a hyperacusis questionnaire. Parallel a shift from a mainly unilateral (only 17% bilateral) to a completely bilateral (100%) tinnitus percept occurred in the T-group, while bilateral tinnitus dominated in the TH-group from the start (75%). Over time in the T-group, ABR wave V amplitudes (and V/I ratios) remained reduced and delayed. By contrast, in the TH-group especially the ABR wave III and V (and III/I ratio) continued to be enhanced and shortened in response to high-level sound stimuli. Interestingly, in line with signs of an increased co-occurrence of hyperacusis in the T-group over time, ABR wave III also slightly increased in the T-group. The findings disclose an undiagnosed co-occurrence of hyperacusis in tinnitus patients as a main cause of distress and the cause of complaints about tinnitus over time. To achieve urgently needed and personalized therapies, possibly using the objective tools offered here, a systematic sub-classification of tinnitus and the co-occurrence of hyperacusis is recommended.
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Affiliation(s)
- Fatma Refat
- Audio-Vestibular Unit, Department of Ear Nose Throat, Minia University, Minia, Egypt.,Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Jakob Wertz
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Pauline Hinrichs
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Uwe Klose
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Hesham Samy
- Audio-Vestibular Unit, Department of Ear Nose Throat, Minia University, Minia, Egypt
| | | | - Jörg Saemisch
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Benedikt Hofmeier
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Wibke Singer
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Lukas Rüttiger
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Marlies Knipper
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Stephan Wolpert
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
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