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Yu HZ, Gong JM, Hong GW, Zhou RQ, Fu XP, Fan T, Zheng YQ, Peng YQ, Li J, Wang YF. The Effect of Physical Therapy on Somatosensory Tinnitus. J Clin Med 2024; 13:3496. [PMID: 38930025 DOI: 10.3390/jcm13123496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Objective: The objective of this work was to assess the effect of physical therapy in patients with somatosensory tinnitus (ST) and explore the influence of physical therapy on clinical variables obtained before treatment. Methods: A total of 43 patients with ST were randomized to the immediate-start group (n = 20) and delayed-start group (n = 23). All patients received physical therapy for 1 week (seven sessions). Each session lasted 60 min. The Visual Analogue Scale (VAS), Tinnitus Handicap Inventory (THI), and numerical pain rating scale (NPRS) scores were documented at baseline and after treatment (week 1) for all patients. For subjects in the immediate-start group, the THI, VAS, and NPRS scores were measured after therapy (weeks 6, 9, and 12, respectively). Medical history characteristic functional activity scale (HCFA) scores were measured at baseline to assess the association between somatic symptoms and tinnitus. Results: At week 1, VAS, THI, and NPRS scores of patients in the immediate-start group were improved by 1.25 ± 1.59, 11.10 ± 15.10, and 0.95 ± 1.54 points, respectively, and were significantly higher than those in the delayed-start group (p < 0.05). The change in VAS, THI, and NPRS scores in the treatment group was significantly positively correlated with the scores of the HCFA before treatment (r = 0.786, p < 0.001; r = 0.680, p = 0.001; r = 0.796, p < 0.001). There was no significant difference in THI, VAS, and NPRS scores among patients in the immediate-start group between weeks 1, 6, 9, and 12 after treatment (p > 0.05). Conclusions: Although more participants were necessary in the further study, the study implies that physical therapy can reduce physical pain, improve tinnitus symptoms, and quality of life in ST patients without hearing loss, and the short-term curative effect is stable, especially for tinnitus patients with clear somatic symptoms.
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Affiliation(s)
- Hong-Zhe Yu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
| | - Jia-Min Gong
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Guo-Wei Hong
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Ruo-Qiao Zhou
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
| | - Xin-Ping Fu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Ting Fan
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
| | - Yu-Qing Zheng
- Department of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Ying-Qiu Peng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
| | - Jian Li
- Clinical Laboratory Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Yun-Feng Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
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Michiels S. Somatosensory Tinnitus: Recent Developments in Diagnosis and Treatment. J Assoc Res Otolaryngol 2023; 24:465-472. [PMID: 37794291 PMCID: PMC10695899 DOI: 10.1007/s10162-023-00912-3] [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: 07/06/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Somatosensory tinnitus (ST) is a type of tinnitus where changes in somatosensory input from the head-neck area are one of the influencing factors of a patient's tinnitus. As there are often several influencing factors, identifying a clear somatosensory influence on an individual patient's tinnitus is often a challenge. Therefore, a decision tree using four clinical criteria has been proposed that can help diagnose ST with an accuracy of 82.2%, a sensitivity of 82.5%, and a specificity of 79%. Once correctly diagnosed, patients can be successfully treated using a musculoskeletal physical therapy treatment. This type of treatment can either be directed at cervical spine dysfunctions, temporomandibular disorders, or both and consists of a combination of counseling, exercises, and manual techniques to restore normal function of the cervical spine and temporomandibular area. Other techniques have been suggested but need further investigation in larger RCTs. In most cases, ST treatment shows a decrease in tinnitus severity or loudness, but in rare cases, total remission of the tinnitus is achieved.
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Affiliation(s)
- Sarah Michiels
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, BE, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.
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Lee S, Jin TJ, Jin IK. Methods, Applications, and Limitations of Somatic Maneuvers for the Modulation of Tinnitus. Audiol Res 2022; 12:644-652. [PMID: 36412657 PMCID: PMC9680272 DOI: 10.3390/audiolres12060062] [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: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
The modulation of tinnitus through somatic maneuvers is a well-documented phenomenon in tinnitus patients with somatic disorders. The purpose of this study was to review the methods, applications, and limitations of somatic maneuvers. First, 35 somatic maneuvers proposed by various research groups were summarized according to four body areas (jaw, head and neck, eye, and limbs), following which their applications and limitations were assessed. Although some studies have shown that somatic maneuvers can aid in screening for somatic tinnitus and may help alleviate symptoms with repeated practice, the limited number of studies and inconsistent results among studies make it difficult to draw definitive conclusions. Therefore, follow-up studies are required to overcome these limitations and determine whether the treatment of somatic disorders can also aid in alleviating somatic tinnitus.
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Affiliation(s)
- Sumin Lee
- Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon-si 24252, Republic of Korea
| | - Tae-Jun Jin
- Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon-si 24252, Republic of Korea
| | - In-Ki Jin
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, Hallym University, Chuncheon-si 24252, Republic of Korea
- Correspondence:
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Yang L, Li Y, Pang X, Li D, Wu Y, Chen X, Peng B. Anterior Cervical Decompression and Fusion Surgery for Cervical Spondylosis with Concomitant Tinnitus: A Multicenter Prospective Cohort Study. Orthop Surg 2022; 15:133-140. [PMID: 36394075 PMCID: PMC9837213 DOI: 10.1111/os.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Cervical spondylosis is often accompanied by tinnitus. Up to now, there is a lack of large samples and prospective studies to investigate the effect of anterior cervical decompression and fusion (ACDF) on tinnitus associate with cervical spondylosis. To this end, we performed a prospective cohort study to assess the effectiveness of ACDF on the relief of tinnitus. METHODS This was a multicenter, prospective, cohort clinical study. Between August 2017 and August 2018, 174 patients with cervical spondylosis accompanied by tinnitus were enrolled, with a follow-up of 12 months. Among the 174 patients, 142 received anterior cervical surgery (surgery group) and 32 received conservative treatment (conservative group). The primary end point was the mean change in scores on the tinnitus functional index (TFI). The secondary end points included tinnitus loudness, modified Japanese orthopaedic association scores (mJOA) for spinal cord function, and visual analogue scale (VAS) for neck pain. All the above indexes were measured before treatments and at 1, 3, 6, and 12 months after treatments. One-way analysis of variance and paired samples t-test was adopted for statistical analysis. RESULTS The TFI score was reduced immediately after cervical decompression surgery (from 54.7 ± 15.6 to 32.3 ± 12.5, P < 0.001) and this was sustained at 12 months (P < 0.001). The TFI score of the conservative group also decreased (from 53.9 ± 16.8 to 45.2 ± 13.6, P < 0.001), but the effect was not maintained at 12 months (P = 0.069). There was a significant improvement in tinnitus loudness (from 5.2 ± 1.6 to 2.6 ± 1.9, P < 0.001), mJOA (from 12.0 ± 1.6 to 14.2 ± 1.6, P < 0.001), and VAS for neck pain (from 58.5 ± 9.6 to 22.0 ± 16.4, P < 0.001) in the surgical group. Improvements in the surgical group were statistically significantly greater than that in the conservative group (P < 0.001). CONCLUSION This study indicates that anterior cervical surgery can relieve tinnitus in patients with cervical spondylosis and that tinnitus is an accompanying manifestation of cervical spondylosis.
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Affiliation(s)
- Liang Yang
- Department of OrthopaedicsFeatured Medical Center of Chinese People's Armed Police ForcesTianjingChina,Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yongchao Li
- Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xiaodong Pang
- Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
| | - Duanming Li
- Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
| | - Ye Wu
- Department of OrthopaedicsBeijing 304th HospitalBeijingChina
| | - Xiongsheng Chen
- Spine Center, Department of OrthopaedicsShanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Baogan Peng
- Department of OrthopaedicsThe Third Medical Center of Chinese PLA General HospitalBeijingChina
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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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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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8
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Santacruz JL, de Kleine E, van Dijk P. Investigating the relation between minimum masking levels and hearing thresholds for tinnitus subtyping. PROGRESS IN BRAIN RESEARCH 2021; 263:81-94. [PMID: 34243892 DOI: 10.1016/bs.pbr.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Heterogeneity of tinnitus imposes a challenge for its treatment. Identifying tinnitus subtypes might help to establish individualized diagnosis and therapies. The minimum masking level (MML) is a clinical tool defined as the minimum intensity of a masking sound required to cover tinnitus. Understanding the differences among masking patterns in patients could facilitate the task of subtyping tinnitus. Here, we studied the variability of hearing thresholds and MMLs among patients with tinnitus to identify tinnitus subgroups. A population of 366 consecutive patients from a specialized tinnitus clinic were included in the analysis. Hearing thresholds and MMLs were determined for octave frequencies from 0.25 to 8kHz, as well as for 3 and 6kHz. Subjects were divided into two groups according to whether their tinnitus was maskable (M, 329 subjects) or non-maskable (NM, 37 subjects). Hearing thresholds and tinnitus loudness did not differ significantly between both groups. The dimensionality of the data was reduced by means of principal component analysis (PCA), and the largest resulting components were used for clustering the data. The cluster analysis resulted in five clusters with differences in tinnitus pitch, lateralization, hearing thresholds and MML, as well as on age and gender. Clusters differed in contours of hearing thresholds and MML, describing patterns of low or high thresholds in combination with low or high MML. The clustering solution presented a low silhouette value (0.45), implying that the clustering is weak and could be artificial. The analysis pointed out the diversity across tinnitus patients. Our results suggest that there might be a continuum of patients' characteristics rather than discrete subgroups.
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Affiliation(s)
- Jose L Santacruz
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands.
| | - Emile de Kleine
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, Netherlands
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Han BI, Lee HW, Ryu S, Kim JS. Tinnitus Update. J Clin Neurol 2021; 17:1-10. [PMID: 33480192 PMCID: PMC7840320 DOI: 10.3988/jcn.2021.17.1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022] Open
Abstract
This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss, somatosensory system dysfunction, or auditory cortex dysfunction, with hearing loss being the most common cause and serious underlying pathologies being rare. Hearing loss does not always lead to tinnitus, and patients with tinnitus do not always suffer from hearing loss. The first scenario is explained by a so-called inhibitory gating mechanism, whereas the second assumes that all tinnitus sufferers have some degree of hearing impairment, which might not be detected in standard audiological examinations. The treatments should aim at symptomatic relief and management of associated distress. Current treatment options include pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy.
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Affiliation(s)
| | - Ho Won Lee
- Department of Neurology, Kyungpook National University, Daegu, Korea
| | - Sanghyo Ryu
- Department of Neurology, Haedong Hospital, Busan, Korea.
| | - Ji Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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10
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Genitsaridi E, Hoare DJ, Kypraios T, Hall DA. A Review and a Framework of Variables for Defining and Characterizing Tinnitus Subphenotypes. Brain Sci 2020; 10:E938. [PMID: 33291859 PMCID: PMC7762072 DOI: 10.3390/brainsci10120938] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
Tinnitus patients can present with various characteristics, such as those related to the tinnitus perception, symptom severity, and pattern of comorbidities. It is speculated that this phenotypic heterogeneity is associated with differences in the underlying pathophysiology and personal reaction to the condition. However, there is as yet no established protocol for tinnitus profiling or subtyping, hindering progress in treatment development. This review summarizes data on variables that have been used in studies investigating phenotypic differences in subgroups of tinnitus, including variables used to both define and compare subgroups. A PubMed search led to the identification of 64 eligible articles. In most studies, variables for subgrouping were chosen by the researchers (hypothesis-driven approach). Other approaches included application of unsupervised machine-learning techniques for the definition of subgroups (data-driven), and subgroup definition based on the response to a tinnitus treatment (treatment response). A framework of 94 variable concepts was created to summarize variables used across all studies. Frequency statistics for the use of each variable concept are presented, demonstrating those most and least commonly assessed. This review highlights the high dimensionality of tinnitus heterogeneity. The framework of variables can contribute to the design of future studies, helping to decide on tinnitus assessment and subgrouping.
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Affiliation(s)
- Eleni Genitsaridi
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (D.J.H.); (D.A.H.)
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK
| | - Derek J. Hoare
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (D.J.H.); (D.A.H.)
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK
| | - Theodore Kypraios
- School of Mathematical Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Deborah A. Hall
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (D.J.H.); (D.A.H.)
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- University of Nottingham Malaysia, Semenyih 43500, Selangor Darul Ehsan, Malaysia
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van der Wal A, Van de Heyning P, Gilles A, Jacquemin L, Topsakal V, Van Rompaey V, Braem M, Visscher CM, Truijen S, Michiels S, De Hertogh W. Prognostic Indicators for Positive Treatment Outcome After Multidisciplinary Orofacial Treatment in Patients With Somatosensory Tinnitus. Front Neurosci 2020; 14:561038. [PMID: 33041758 PMCID: PMC7525007 DOI: 10.3389/fnins.2020.561038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/18/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Subjective tinnitus that is influenced by the somatosensory system is called somatosensory tinnitus (ST). When ST is related to the temporomandibular area, multidisciplinary orofacial treatment can reduce tinnitus severity. It is, however, unknown if we can predict this positive outcome. The aim of this study is to look for prognostic indicators that can predict a positive outcome after multidisciplinary orofacial treatment in patients with ST. Methods Patients were included when they were diagnosed with temporomandibular-related ST and received a maximum of 18 sessions of orofacial treatment during a 9-week program. Predictors for positive treatment outcome were identified using univariate and multiple logistic regression analyses with the Tinnitus Questionnaire (TQ) and the Tinnitus Functional Index (TFI) as dependent variables. Results The results of 101 patients were included in the analysis. Immediately after multidisciplinary orofacial treatment, a clinically relevant decrease in TQ score was significantly associated with “shorter duration of tinnitus” [odds ratio (OR) 0.99], “higher initial score on the TQ somatic subscale” (OR 1.52), and “painful palpation of the temporomandibular joint (TMJ)” (OR 2.46). After 9 weeks of follow-up, the “higher initial score on the TQ somatic subscale” remained as the sole predictor (OR 1.44). A clinically relevant decrease on TFI after 9 weeks of follow-up was predicted by “female gender” (OR 2.70), “younger age” (OR 0.96), “shorter duration of the tinnitus” (OR 0.99), “lower pressure pain thresholds (PPT) on TMJ” (OR 0.99), “lower PPT on sternocleidomastoid origin” (OR 0.99), and “better speech in noise perception” (OR 0.88). A multivariate model comprising “shorter duration of tinnitus” and “higher initial score on the somatic subscale of the TQ” correctly predicts the clinically relevant decrease in TQ score after treatment in 68.5%. A second multivariate model comprising “female gender,” “younger age,” and “shorter duration of the tinnitus” correctly predicts a clinically significant decrease on TFI after follow-up in 68.1%. Conclusion We were able to identify various prognostic indicators. “Younger female patients” with a “shorter duration of tinnitus” and a “higher initial score on the TQ somatic subscale” appear to have the best prognosis after multimodal orofacial therapy.
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Affiliation(s)
- Annemarie van der Wal
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multidisciplinary Motor Centre Antwerp, University of Antwerp, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Human and Social Welfare, University College Ghent, Ghent, Belgium
| | - Laure Jacquemin
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vedat Topsakal
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marc Braem
- Lab Dental Materials, University of Antwerp, Antwerp, Belgium.,Special Care Dentistry, University Hospital Antwerp, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Corine Mirjam Visscher
- Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam, Research Institute MOVE Amsterdam, University of Amsterdam, VU University Amsterdam, Amsterdam, Netherlands
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sarah Michiels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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12
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Abstract
Tinnitus is spoken of as if it were a single thing, but there are many different causes, likely many different mechanisms, and many different subtypes. This article reviews a broad range of approaches to understand and demarcate different tinnitus subtypes, which will be critical for exploring and finding cures for different subtypes.
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13
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Edvall NK, Gunan E, Genitsaridi E, Lazar A, Mehraei G, Billing M, Tullberg M, Bulla J, Whitton J, Canlon B, Hall DA, Cederroth CR. Impact of Temporomandibular Joint Complaints on Tinnitus-Related Distress. Front Neurosci 2019; 13:879. [PMID: 31548840 PMCID: PMC6736614 DOI: 10.3389/fnins.2019.00879] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 12/26/2022] Open
Abstract
There is increasing evidence of associations between the presence of temporomandibular joint (TMJ) disorders and tinnitus. It has been recently proposed that tinnitus patients with TMJ complaints could constitute a subtype, meaning a subgroup of tinnitus patients responsive to specific treatments. Tinnitus patients with TMJ complaints are often young women with somatosensory features of their tinnitus. Here, we investigate the socio-economic factors, phenotypic characteristics and psychological variables of tinnitus subjects from the Swedish Tinnitus Outreach Project, with (n = 486) or without (n = 1,996) TMJ complaints. The prevalence of TMJ complaints was greater in tinnitus subjects with severe tinnitus (36%) when compared to those with any tinnitus (19%), strongly indicating the contribution of TMJ problems to the severity of tinnitus. Comparing subgroups with or without TMJ complaints in the whole sample, differences were found regarding a large number of socioeconomic, phenotypic, and psychological characteristics. Subjects with TMJ complaints were more often women, more often reported stress as the cause of tinnitus, were more severely affected by tinnitus, scored worse in measures of psychological well-being and life quality, and were more often affected by problems tolerating sounds, headache, vertigo/dizziness, and neck pain. In addition, they more often reported pulsating and tonal tinnitus, somatic modulation of tinnitus, and aggravation of tinnitus by loud sounds and stress. When focusing the analysis in subjects with tinnitus as a big problem using the Tinnitus Functional Index cut-off ≥ 48, or with severe tinnitus according to the Tinnitus Handicap Inventory cut-off ≥ 58, the impact of somatosensory modulations and stress on tinnitus were greater in subjects with TMJ complaints in comparison to those without. In light of these results, we hypothesize that stress could contribute to the co-occurrence of TMJ problems and tinnitus and also to the development of severe tinnitus. Our study supports the need of involving dental care and stress management in the holistic treatment of patients with severe tinnitus.
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Affiliation(s)
- Niklas K Edvall
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Edis Gunan
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Eleni Genitsaridi
- National Institute of Health Research, Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andra Lazar
- Hörsel och Balansmottagningen, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | | | | | | | - Jan Bulla
- Department of Mathematics, University of Bergen, Bergen, Norway.,Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | | | - Barbara Canlon
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Deborah A Hall
- National Institute of Health Research, Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,University of Nottingham Malaysia, Semenyih, Malaysia
| | - Christopher R Cederroth
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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14
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Michiels S, Harrison S, Vesala M, Schlee W. The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey. Interact J Med Res 2019; 8:e14519. [PMID: 31364603 PMCID: PMC6691675 DOI: 10.2196/14519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/03/2019] [Accepted: 06/12/2019] [Indexed: 01/26/2023] Open
Abstract
Background Tinnitus, or ringing in the ears, is a phantom perception of sound in the absence of overt acoustic stimulation. Many patients indicate that the perception of their tinnitus is not constant and can vary from moment to moment. This tinnitus fluctuation is one of the diagnostic criteria for somatosensory tinnitus (ST), a tinnitus subtype that is influenced by cervical spine or temporomandibular dysfunctions, although various factors have been reported to cause fluctuations in tinnitus, such as stress, anxiety, and physical activity. Objective The aim of this study was twofold: (1) to investigate the presence of physical symptoms in a large group of participants with tinnitus and (2) to investigate if these physical symptoms are more frequently present in a subgroup of participants with ST. Methods A Web-based survey, questioning the presence of physical symptoms in a convenience sample of participants with tinnitus, was launched on the online forum, Tinnitus Talk, managed by Tinnitus Hub. After a general analysis of the physical symptoms present in our survey population, we further analyzed the group of participants who were diagnosed by a physician (n=1262). This subgroup was divided into 2 groups, one group diagnosed with ST and another group diagnosed with other types of tinnitus. Results In total, 6115 participants with a mean age of 54.08 years (SD 13.8) completed the survey. Physical symptoms were frequently present in our sample of participants with tinnitus: 4221 participants (69.02%) reported some form of neck pain, 429 (7.01%) were diagnosed with temporomandibular disorders, 2730 (44.64%) indicated they have bruxism, and between 858 and 1419 (14.03%-23.20%) participants were able to modulate their tinnitus by voluntary movements. ST was diagnosed in 154 out of 1262 (12.20%) participants whose tinnitus cause was diagnosed by a physician. Symptoms referring to the known diagnostic criteria were evidently more present in the ST group than in the non-ST group. Additionally, participants with ST more often indicated a negative effect of a bad night’s sleep (P=.01) and light intensity exercise (P=.01). Conclusions Physical activity and movement (disorders) frequently affect tinnitus severity. Head-neck related symptoms are more frequently reported in the ST group, as is the ability to modulate the tinnitus by head or jaw movements. Additionally, participants with ST more often report fluctuations of their tinnitus and reaction to sleeping difficulties and low intensity exercise.
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Affiliation(s)
- Sarah Michiels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Otorhinolaryngology, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | | | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany
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15
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Standardised profiling for tinnitus research: The European School for Interdisciplinary Tinnitus Research Screening Questionnaire (ESIT-SQ). Hear Res 2019; 377:353-359. [DOI: 10.1016/j.heares.2019.02.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/25/2019] [Accepted: 02/27/2019] [Indexed: 12/25/2022]
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16
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Omidvar S, Jafari Z. Association Between Tinnitus and Temporomandibular Disorders: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2019; 128:662-675. [PMID: 30991812 DOI: 10.1177/0003489419842577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Tinnitus is one of the most common otological symptoms in patients with temporomandibular disorders. This study aimed to investigate the possible association between tinnitus and temporomandibular disorders. METHODS The online databases of PubMed, Ovid, ScienceDirect, and Web of Science were explored for all English articles published until September 2018 using the combined keywords tinnitus and temporomandibular. Cross-sectional, cohort, or case-control studies that investigated the association between tinnitus and temporomandibular disorders (TMDs) were considered. The quality of the included papers was assessed by the Crowe Critical Appraisal Tool. RESULTS Twenty-two papers met the eligibility criteria and were included in the systematic review. Meta-analysis was performed on 8 papers to investigate the possible relationship between tinnitus and TMDs by calculating the odds ratios. Odds ratios ranged from 1.78 to 7.79 in the studies related to tinnitus frequency in temporomandibular disorders and from 1.80 to 7.79 in the papers linked to temporomandibular disorder frequency in tinnitus, indicating a significant association between tinnitus and temporomandibular disorders. CONCLUSIONS There was a strong relationship between tinnitus occurrence and TMDs. The findings implied the significance of exploring the signs of TMDs in patients with tinnitus as well as tinnitus in those who complain from temporomandibular disorders.
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Affiliation(s)
- Shaghayegh Omidvar
- 1 Department of Audiology, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.,2 Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Zahra Jafari
- 3 Department of Neuroscience, Canadian Center for Behavioral Neuroscience (CCBN), University of Lethbridge, Lethbridge, AB, Canada
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17
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Bousema EJ, Koops EA, van Dijk P, Dijkstra PU. Association Between Subjective Tinnitus and Cervical Spine or Temporomandibular Disorders: A Systematic Review. Trends Hear 2019; 22:2331216518800640. [PMID: 30269683 PMCID: PMC6168723 DOI: 10.1177/2331216518800640] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Movements of the neck and jaw may modulate the loudness and pitch of tinnitus. The aim of the present study was to systematically analyze the strength of associations between subjective tinnitus, cervical spine disorders (CSD), and temporomandibular disorders (TMD). A systematic literature search of the Medline, Embase, and Pedro databases was carried out on articles published up to September 2017. This covered studies in which tinnitus and CSD or TMD were studied as a primary or a secondary outcome and in which outcomes were compared with a control group. Included articles were evaluated on nine methodological quality criteria. Associations between tinnitus and CSD or TMD were expressed as odds ratios. In total, 2,139 articles were identified, of which 24 studies met the inclusion criteria. Twice, two studies were based on the same data set; consequently, 22 studies were included in the meta-analysis. Methodological quality was generally limited by a lack of blinding, comparability of groups, and nonvalidated instruments for assessing CSD. Results indicated that patients with tinnitus more frequently reported CSD than subjects without tinnitus. The odds ratio was 2.6 (95% CI [1.1, 6.4]). For TMD, a bidirectional association with tinnitus was found; odds ratios ranged from 2.3 (95%CI [1.5, 3.6]) for arthrogenous TMD to 6.7 (95%CI [2.4, 18.8]) for unspecified TMD. Funnel plots suggested a publication bias. After adjusting for this, the odds ratios decreased, but associations persisted. There is weak evidence for an association between subjective tinnitus and CSD and a bidirectional association between tinnitus and TMD.
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Affiliation(s)
- E J Bousema
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Groningen, University of Groningen, the Netherlands.,2 Fysiotherapie Sittard Oost, the Netherlands
| | - E A Koops
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Groningen, University of Groningen, the Netherlands.,3 Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, the Netherlands
| | - P van Dijk
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Groningen, University of Groningen, the Netherlands.,3 Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, the Netherlands
| | - P U Dijkstra
- 4 Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, the Netherlands.,5 Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
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18
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Michiels S, Ganz Sanchez T, Oron Y, Gilles A, Haider HF, Erlandsson S, Bechter K, Vielsmeier V, Biesinger E, Nam EC, Oiticica J, de Medeiros ÍRT, Bezerra Rocha C, Langguth B, Van de Heyning P, De Hertogh W, Hall DA. Diagnostic Criteria for Somatosensory Tinnitus: A Delphi Process and Face-to-Face Meeting to Establish Consensus. Trends Hear 2019; 22:2331216518796403. [PMID: 30213235 PMCID: PMC6144502 DOI: 10.1177/2331216518796403] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Since somatic or somatosensory tinnitus (ST) was first described as a subtype of subjective tinnitus, where altered somatosensory afference from the cervical spine or temporomandibular area causes or changes a patient’s tinnitus perception, several studies in humans and animals have provided a neurophysiological explanation for this type of tinnitus. Due to a lack of unambiguous clinical tests, many authors and clinicians use their own criteria for diagnosing ST. This resulted in large differences in prevalence figures in different studies and limits the comparison of clinical trials on ST treatment. This study aimed to reach an international consensus on diagnostic criteria for ST among experts, scientists and clinicians using a Delphi survey and face-to-face consensus meeting strategy. Following recommended procedures to gain expert consensus, a two-round Delphi survey was delivered online, followed by an in-person consensus meeting. Experts agreed upon a set of criteria that strongly suggest ST. These criteria comprise items on somatosensory modulation, specific tinnitus characteristics, and symptoms that can accompany the tinnitus. None of these criteria have to be present in every single patient with ST, but in case they are present, they strongly suggest the presence of ST. Because of the international nature of the survey, we expect these criteria to gain wide acceptance in the research field and to serve as a guideline for clinicians across all disciplines. Criteria developed in this consensus paper should now allow further investigation of the extent of somatosensory influence in individual tinnitus patients and tinnitus populations.
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Affiliation(s)
- Sarah Michiels
- 1 Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,2 Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Antwerp University Hospital, Edegem, Belgium.,3 Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Tanit Ganz Sanchez
- 4 Instituto Ganz Sanchez, São Paulo, Brazil.,5 ENT Department, School of Medicine, University of Sao Paulo, Brazil
| | - Yahav Oron
- 6 Department of Otolaryngology, Head, Neck and Maxillofacial Surgery, Sackler School of Medicine, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Israel
| | - Annick Gilles
- 2 Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Antwerp University Hospital, Edegem, Belgium.,3 Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,7 Department of Human and Social Welfare, University College Ghent, Belgium
| | - Haúla F Haider
- 8 ENT Department, Hospital Cuf Infante Santo, NOVA Medical School, Lisbon, Portugal
| | - Soly Erlandsson
- 9 Center for Child and Youth Studies, University West, Trollhättan, Sweden
| | - Karl Bechter
- 10 Clinic for Psychiatry and Psychotherapy II, Bezirkskrankenhaus Günzburg, University of Ulm, Germany
| | | | - Eberhard Biesinger
- 12 ENT-Clinic and Otolaryngology Department, Klinikum Traunstein, Germany
| | - Eui-Cheol Nam
- 13 Department of Otolaryngolgy, School of Medicine, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Jeanne Oiticica
- 5 ENT Department, School of Medicine, University of Sao Paulo, Brazil
| | | | | | - Berthold Langguth
- 14 Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Paul Van de Heyning
- 2 Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Antwerp University Hospital, Edegem, Belgium.,3 Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,15 Multidisciplinary Motor Centre Antwerp, University of Antwerp, Wilrijk, Belgium
| | - Willem De Hertogh
- 1 Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Deborah A Hall
- 16 NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,17 Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.,18 Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK.,19 University of Nottingham Malaysia, Semeniyh, Selangor Darul Ehsan, Malaysia
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19
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Subtyping patients with somatic tinnitus: Modulation of tinnitus and history for somatic dysfunction help identify tinnitus patients with temporomandibular joint disorders. PLoS One 2018; 13:e0202050. [PMID: 30102717 PMCID: PMC6089421 DOI: 10.1371/journal.pone.0202050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/26/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Determine in a cohort of patients with normal hearing and chronic tinnitus if self-reported history for temporomandibular joint (TMJ) dysfunction and a positive modulation of tinnitus in the TMJ region could be suggestive of an underlying TMJ disorder. PATIENTS AND METHODS The study included 226 patients presenting to the Head and Neck Service of our University Hospital. Following audiological and somatic tinnitus evaluation, patients were divided into two groups. The study group (n = 134) included subjects that met both the following criteria: A) a self-reported history for TMJ dysfunction and B) a positive modulation of tinnitus following somatic maneuvers in the TMJ region. The control group (n = 92) included patients with similar demographic and tinnitus characteristics that did not meet the proposed criteria for somatic tinnitus. Afterwards, patients underwent clinical TMJ evaluation in the Service of Clinical Gnathology of our University. RESULTS One hundred thirty-one patients (57.9%) received a clinical diagnosis of TMJ disorder according to DC/TMD Axis I; 79.1% in the study group and 27.2% in the control group. Ninety-five (42.1%) patients were negative for TMJ disorders; 20.9% in the study group and 72.8% in the control group. A significantly higher number of TMJ disorders was found in patients in the study group compared to the control group (p<0.0001). Most patients had joint disorders (67.2%), followed by other (29.8%) and pain disorders (29%). Logistic regression analysis in the study group showed that female gender was more prevalent in patients with TMJ disorders. CONCLUSION Our findings in patients with chronic tinnitus and normal hearing suggest that self-reported history for somatic dysfunction and modulation of tinnitus, when occurring simultaneously in the TMJ region, can be useful to preliminarily identify patients with TMJ disorders.
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Vielsmeier V, Schecklmann M, Schlee W, Kreuzer PM, Poeppl TB, Rupprecht R, Langguth B, Lehner A. A Pilot Study of Peripheral Muscle Magnetic Stimulation as Add-on Treatment to Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus. Front Neurosci 2018. [PMID: 29515350 PMCID: PMC5826218 DOI: 10.3389/fnins.2018.00068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While brain stimulation techniques have been examined as treatment options for chronic tinnitus for many years, they have recently been extended to multimodal treatment approaches. As chronic tinnitus is often accompanied by comorbid muscular tension in the neck and back, we performed a one-arm pilot study to explore the feasibility of a new multimodal treatment approach. In detail, repetitive peripheral magnetic stimulation (rPMS) of the back was performed before and after each session of repetitive transcranial magnetic stimulation (rTMS) of the brain. Data of 41 patients were analyzed, all of which were treated with ten sessions of rTMS of the left prefrontal and left temporoparietal cortex followed by rPMS of the neck and back muscles. Tinnitus severity was measured using the tinnitus questionnaire (TQ). Neck pain was assessed using the neck pain and disability scale (NPAD). The new treatment approach was feasible and well accepted by the majority of patients. However, the overall patient group did not improve significantly in either of the questionnaires. If patients were divided in different subgroups depending on whether they were suffering from neck pain or somatosensory tinnitus, explorative post-hoc tests suggested differential effects: patients with both neck pain and somatosensory tinnitus had better outcomes than patients without those conditions or with neck pain only. This was true for both the TQ and the NPAD. This effect was of transient nature though: the TQ score went back to its baseline level after a follow-up period of 12 weeks. Based on our results we recommend that in studies that investigate tinnitus treatments targeting somatosensory afferents patients should be stratified according to somatic co-morbidities and somatosensory influence on the tinnitus percept. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT02306447.
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Affiliation(s)
- Veronika Vielsmeier
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Timm B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Astrid Lehner
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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21
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Ralli M, Greco A, Turchetta R, Altissimi G, de Vincentiis M, Cianfrone G. Somatosensory tinnitus: Current evidence and future perspectives. J Int Med Res 2017; 45:933-947. [PMID: 28553764 PMCID: PMC5536427 DOI: 10.1177/0300060517707673] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/10/2017] [Indexed: 11/15/2022] Open
Abstract
In some individuals, tinnitus can be modulated by specific maneuvers of the temporomandibular joint, head and neck, eyes, and limbs. Neuroplasticity seems to play a central role in this capacity for modulation, suggesting that abnormal interactions between the sensory modalities, sensorimotor systems, and neurocognitive and neuroemotional networks may contribute to the development of somatosensory tinnitus. Current evidence supports a link between somatic disorders and higher modulation of tinnitus, especially in patients with a normal hearing threshold. Patients with tinnitus who have somatic disorders seems to have a higher chance of modulating their tinnitus with somatic maneuvers; consistent improvements in tinnitus symptoms have been observed in patients with temporomandibular joint disease following targeted therapy for temporomandibular disorders. Somatosensory tinnitus is often overlooked by otolaryngologists and not fully investigated during the diagnostic process. Somatic disorders, when identified and treated, can be a valid therapeutic target for tinnitus; however, somatic screening of subjects for somatosensory tinnitus is imperative for correct selection of patients who would benefit from a multidisciplinary somatic approach.
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Affiliation(s)
- Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
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22
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Haider HF, Hoare DJ, Costa RFP, Potgieter I, Kikidis D, Lapira A, Nikitas C, Caria H, Cunha NT, Paço JC. Pathophysiology, Diagnosis and Treatment of Somatosensory Tinnitus: A Scoping Review. Front Neurosci 2017; 11:207. [PMID: 28503129 PMCID: PMC5408030 DOI: 10.3389/fnins.2017.00207] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 03/27/2017] [Indexed: 11/13/2022] Open
Abstract
Somatosensory tinnitus is a generally agreed subtype of tinnitus that is associated with activation of the somatosensory, somatomotor, and visual-motor systems. A key characteristic of somatosensory tinnitus is that is modulated by physical contact or movement. Although it seems common, its pathophysiology, assessment and treatment are not well defined. We present a scoping review on the pathophysiology, diagnosis, and treatment of somatosensory tinnitus, and identify priority directions for further research. Methods: Literature searches were conducted in Google Scholar, PubMed, and EMBASE databases. Additional broad hand searches were conducted with the additional terms etiology, diagnose, treatment. Results: Most evidence on the pathophysiology of somatosensory tinnitus suggests that somatic modulations are the result of altered or cross-modal synaptic activity within the dorsal cochlear nucleus or between the auditory nervous system and other sensory subsystems of central nervous system (e.g., visual or tactile). Presentations of somatosensory tinnitus are varied and evidence for the various approaches to treatment promising but limited. Discussion and Conclusions: Despite the apparent prevalence of somatosensory tinnitus its underlying neural processes are still not well understood. Necessary involvement of multidisciplinary teams in its diagnosis and treatment has led to a large heterogeneity of approaches whereby tinnitus improvement is often only a secondary effect. Hence there are no evidence-based clinical guidelines, and patient care is empirical rather than research-evidence-based. Somatic testing should receive further attention considering the breath of evidence on the ability of patients to modulate their tinnitus through manouvers. Specific questions for further research and review are indicated.
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Affiliation(s)
- Haúla F. Haider
- ENT Department, Hospital Cuf Infante Santo—Nova Medical SchoolLisbon, Portugal
| | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Division of Clinical Neuroscience, School of Medicine, University of NottinghamNottingham, UK
| | - Raquel F. P. Costa
- Centro em Rede de Investigação em Antropologia (CRIA), Network Centre for Research in Anthropology, Universidade Nova de LisboaLisbon, Portugal
| | - Iskra Potgieter
- NIHR Nottingham Biomedical Research Centre, Division of Clinical Neuroscience, School of Medicine, University of NottinghamNottingham, UK
| | - Dimitris Kikidis
- First Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General HospitalAthens, Greece
| | - Alec Lapira
- Institute of Health Care, Mater Dei HospitalMsida, Malta
| | - Christos Nikitas
- First Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General HospitalAthens, Greece
| | - Helena Caria
- Deafness Research Group, BTR Unit, BioISI, Faculty of Sciences, University of LisbonLisbon, Portugal
- ESS/IPS–Biomedical Sciences Department, School of Health, Polytechnic Institute of SetubalLisbon, Portugal
| | - Nuno T. Cunha
- ENT Department, Hospital Pedro Hispano—MatosinhosLisbon, Portugal
| | - João C. Paço
- ENT Department, Hospital Cuf Infante Santo—Nova Medical SchoolLisbon, Portugal
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23
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Lina-Granade G, Truy E, Ionescu E, Garnier P, Thai Van H. [Tinnitus and temporomandibular joint: State of the art]. ACTA ACUST UNITED AC 2016; 117:458-462. [PMID: 27836443 DOI: 10.1016/j.revsto.2016.10.005] [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: 10/03/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Abstract
Tinnitus has been described in temporomandibular joint dysfunction for a long time. Yet, other disorders, such as hearing loss, stress, anxiety and depression, play a major role in the pathophysiology of tinnitus. Temporomandibular joint dysfunctions seem to increase the risk of tinnitus in patients with other predisposing factors. Especially somatosensory tinnitus, which is characterized by sound modulations with neck or mandible movements, is frequently associated with temporomandibular joint dysfunction, but it is not pathognomonic of such a disorder. In such cases, functional therapy of the temporomandibular joint should be part of the multidisciplinary rehabilitation of patients with tinnitus.
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Affiliation(s)
- G Lina-Granade
- Service d'ORL, de chirurgie cervico-faciale et d'audiophonologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
| | - E Truy
- Université de Lyon, université Claude-Bernard Lyon I, secteur santé, 8, avenue Rockefeller, 69008 Lyon, France; Centre de recherche en neurosciences de Lyon (CRNL), équipe dynamique cérébrale et cognition, Inserm U1028, CNRS UMR5292, centre hospitalier Le Vinatier, bâtiment 452, 95, boulevard Pinel, 69675 Bron, France
| | - E Ionescu
- Service d'audiologie et explorations otoneurologiques, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| | - P Garnier
- Service d'audiologie et explorations otoneurologiques, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France
| | - H Thai Van
- Université de Lyon, université Claude-Bernard Lyon I, secteur santé, 8, avenue Rockefeller, 69008 Lyon, France; Centre de recherche en neurosciences de Lyon (CRNL), équipe dynamique cérébrale et cognition, Inserm U1028, CNRS UMR5292, centre hospitalier Le Vinatier, bâtiment 452, 95, boulevard Pinel, 69675 Bron, France
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Lopez-Escamez JA, Bibas T, Cima RFF, Van de Heyning P, Knipper M, Mazurek B, Szczepek AJ, Cederroth CR. Genetics of Tinnitus: An Emerging Area for Molecular Diagnosis and Drug Development. Front Neurosci 2016; 10:377. [PMID: 27594824 PMCID: PMC4990555 DOI: 10.3389/fnins.2016.00377] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/03/2016] [Indexed: 12/13/2022] Open
Abstract
Subjective tinnitus is the perception of sound in the absence of external or bodily-generated sounds. Chronic tinnitus is a highly prevalent condition affecting over 70 million people in Europe. A wide variety of comorbidities, including hearing loss, psychiatric disorders, neurodegenerative disorders, and temporomandibular joint (TMJ) dysfunction, have been suggested to contribute to the onset or progression of tinnitus; however, the precise molecular mechanisms of tinnitus are not well understood and the contribution of genetic and epigenetic factors remains unknown. Human genetic studies could enable the identification of novel molecular therapeutic targets, possibly leading to the development of novel pharmaceutical therapeutics. In this article, we briefly discuss the available evidence for a role of genetics in tinnitus and consider potential hurdles in designing genetic studies for tinnitus. Since multiple diseases have tinnitus as a symptom and the supporting genetic evidence is sparse, we propose various strategies to investigate the genetic underpinnings of tinnitus, first by showing evidence of heritability using concordance studies in twins, and second by improving patient selection according to phenotype and/or etiology in order to control potential biases and optimize genetic data output. The increased knowledge resulting from this endeavor could ultimately improve the drug development process and lead to the preventive or curative treatment of tinnitus.
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Affiliation(s)
- Jose A Lopez-Escamez
- Otology and Neurotology Group, Department of Genomic Medicine, Pfizer - Universidad de Granada - Junta de Andalucía Centro de Genómica e Investigación Oncológica, PTSGranada, Spain; Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospital Universitario GranadaGranada, Spain
| | - Thanos Bibas
- 1st Department of Otolaryngology, National and Kapodistrian University of Athens, Hippocrateion HospitalAthens, Greece; Ear Institute, UCLLondon, UK
| | - Rilana F F Cima
- Department of Clinical Psychological Science, Maastricht University Maastricht, Netherlands
| | - Paul Van de Heyning
- University Department ENT and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp Antwerp, Belgium
| | - Marlies Knipper
- Hearing Research Centre Tübingen, Molecular Physiology of Hearing Tübingen, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité-Universitätsmedizin Berlin Berlin, Germany
| | | | - Christopher R Cederroth
- Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet Stockholm, Sweden
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