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Reisinger L, Demarchi G, Weisz N. Eavesdropping on Tinnitus Using MEG: Lessons Learned and Future Perspectives. J Assoc Res Otolaryngol 2023; 24:531-547. [PMID: 38015287 PMCID: PMC10752863 DOI: 10.1007/s10162-023-00916-z] [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: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Tinnitus has been widely investigated in order to draw conclusions about the underlying causes and altered neural activity in various brain regions. Existing studies have based their work on different tinnitus frameworks, ranging from a more local perspective on the auditory cortex to the inclusion of broader networks and various approaches towards tinnitus perception and distress. Magnetoencephalography (MEG) provides a powerful tool for efficiently investigating tinnitus and aberrant neural activity both spatially and temporally. However, results are inconclusive, and studies are rarely mapped to theoretical frameworks. The purpose of this review was to firstly introduce MEG to interested researchers and secondly provide a synopsis of the current state. We divided recent tinnitus research in MEG into study designs using resting state measurements and studies implementing tone stimulation paradigms. The studies were categorized based on their theoretical foundation, and we outlined shortcomings as well as inconsistencies within the different approaches. Finally, we provided future perspectives on how to benefit more efficiently from the enormous potential of MEG. We suggested novel approaches from a theoretical, conceptual, and methodological point of view to allow future research to obtain a more comprehensive understanding of tinnitus and its underlying processes.
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Affiliation(s)
- Lisa Reisinger
- Centre for Cognitive Neuroscience and Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria.
| | - Gianpaolo Demarchi
- Centre for Cognitive Neuroscience and Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Nathan Weisz
- Centre for Cognitive Neuroscience and Department of Psychology, Paris-Lodron-University Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
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2
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Ye T, Chen K, Li D, Yin K, Li Y, Long J, Hui L. Global research hot spot and trends in tinnitus treatment between 2000 and 2021: A bibliometric and visualized study. Front Neurol 2023; 13:1085684. [PMID: 36686526 PMCID: PMC9847583 DOI: 10.3389/fneur.2022.1085684] [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: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023] Open
Abstract
Background In the 21st century, the prevalence of tinnitus is increasing, impacting approximately one in five people. It is a very complicated condition that significantly affects quality of life. Despite the availability of hundreds of tinnitus treatment options, none are very successful. In light of this, there has been a steady increase in studies on tinnitus treatments in the recent past. To comprehend them better, this study used bibliometric approaches to analyze and summarize 21st century scientific research accomplishments in tinnitus treatment. Methods The Web of Science Core Collection (WoSCC) was searched for papers that had been published and related to the treatment of tinnitus. VOSviewer, CiteSpace, R, and Tableau software programs were used to conduct bibliometric studies. To evaluate and visualize the results. Results 2,933 publications on tinnitus treatment were found in 74 countries. Between 2000 and 2021, publications increased steadily. Otolaryngology-Head & Neck Surgery had the highest impact factor, whereas Otology & Neurotology had the most magazines and the highest h, g, and m index. Langguth B was the most prolific author in terms of productivity during the past 21 years. Numerous eminent authors and organizations from multiple nations collaborated. With 626 papers, the United States of America (USA) contributed the most to this field, making them the leading contributor. Neuroplasticity, sound therapy, and cognitive behavioral therapy (CBT) have attracted the attention of researchers, leading to the development of innovative diagnostic and treatment strategies for tinnitus. Conclusion This bibliometric study provides a comprehensive analysis of worldwide publications, cooperation, and research hotspots in tinnitus therapy, revealing the present status of research on this issue and guiding tinnitus treatment research in the coming years.
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Affiliation(s)
- Tao Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kefan Chen
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dongyang Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kailong Yin
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yuan Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jin Long
- Department of Pancreatic-Biliary Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China,Jin Long ✉
| | - Lian Hui
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China,*Correspondence: Lian Hui ✉
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Lan L, Liu Y, Wu Y, Xu ZG, Xu JJ, Song JJ, Salvi R, Yin X, Chen YC, Cai Y. Specific brain network predictors of interventions with different mechanisms for tinnitus patients. EBioMedicine 2022; 76:103862. [PMID: 35104784 PMCID: PMC8814370 DOI: 10.1016/j.ebiom.2022.103862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aberrant brain network that gives rise to the phantom sound of tinnitus is believed to determine the effectiveness of tinnitus therapies involving neuromodulation with repetitive transcranial magnetic stimulation (rTMS) and sound therapy utilizing tailor-made notch music training (TMNMT). To test this hypothesis, we determined how effective rTMS or TMNMT were in ameliorating tinnitus in patients with different functional brain networks. METHODS Resting-state functional MRI was used to construct brain functional networks in patients with tinnitus (41 males/45 females, mean age 49.53±11.19 years) and gender-matched healthy controls (22 males/35 females, mean age 46.23±10.23 years) with independent component analysis (ICA). A 2 × 2 analysis of variance with treatment outcomes (Effective group, EG/Ineffective group, IG) and treatment types (rTMS/TMNMT) was used to test the interaction between outcomes and treatment types associated with functional network connections (FNCs). FINDINGS The optimal neuroimaging indicator for responding to rTMS (AUC 0.804, sensitivity 0.700, specificity 0.913) was FNCs in the salience network-right frontoparietal network (SN-RFPN) while for responding to TMNMT (AUC 0.764, sensitivity 0.864, specificity 0.667) was the combination of FNCs in the auditory network- salience network (AUN-SN) and auditory network-cerebellar network (AUN-CN). INTERPRETATION Tinnitus patients with higher FNCs in the SN-RFPN is associated with a recommendation for rTMS whereas patients with lower FNCs in the AUN-SN and AUN-CN would suggest TMNMT as the better choice. These results indicate that brain network-based measures aid in the selection of the optimal form of treatment for a patient contributing to advances in precision medicine. FUNDING Yuexin Cai is supported by Key R&D Program of Guangdong Province, China (Grant No. 2018B030339001), National Natural Science Foundation of China (82071062), Natural Science Foundation of Guangdong province (2021A1515012038), the Fundamental Research Funds for the Central Universities (20ykpy91), and Sun Yat-Sen Clinical Research Cultivating Program (SYS-Q-201903). Yu-Chen Chen is supported by Medical Science and Technology Development Foundation of Nanjing Department of Health (No. ZKX20037), and Natural Science Foundation of Jiangsu Province (No. BK20211008).
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Affiliation(s)
- Liping Lan
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, Guangdong 510120, China
| | - Yin Liu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing 210006, China
| | - Yuanqing Wu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhen-Gui Xu
- Department of Otolaryngology, Nanjing Pukou Central Hospital, Pukou Branch Hospital of Jiangsu Province Hospital, Nanjing, China
| | - Jin-Jing Xu
- Department of Otolaryngology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Richard Salvi
- Center for Hearing and Deafness, University at Buffalo, The State University of New York, Buffalo, United States
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing 210006, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing 210006, China.
| | - Yuexin Cai
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, Guangdong 510120, China; Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, China.
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Jain S, Cherian R, Nataraja NP, Narne VK. The Relationship Between Tinnitus Pitch, Audiogram Edge Frequency, and Auditory Stream Segregation Abilities in Individuals With Tinnitus. Am J Audiol 2021; 30:524-534. [PMID: 34139145 DOI: 10.1044/2021_aja-20-00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose Around 80%-93% of the individuals with tinnitus have hearing loss. Researchers have found that tinnitus pitch was related to the frequencies of hearing loss, but unclear about the relationship between tinnitus pitch and audiometry edge frequency. The comorbidity of tinnitus and speech perception in noise problems had also been reported, but the relationship between tinnitus pitch and speech perception in noise had seldom been investigated. This study was designed to estimate the relationship between tinnitus pitch, audiogram edge frequency, and speech perception in noise. The speech perception in noise was measured using auditory stream segregation paradigm. Method Thirteen individuals with bilateral mild-to-severe tonal tinnitus and minimal-to-mild cochlear hearing loss were selected. Thirteen individuals with hearing loss without tinnitus were also selected. The audiogram of each participant with tinnitus was matched with that of the participant without tinnitus. Tinnitus pitch of the participants with tinnitus was measured and compared with audiogram edge frequency. The stream segregation thresholds were calculated at the participants' admitted tinnitus pitch and one octave below the tinnitus pitch. The stream segregation thresholds were estimated at fission and fusion boundary using pure-tone stimuli in ABA paradigm. Results High correlation between tinnitus pitch and audiogram edge frequency was noted. Overall stream segregation thresholds were higher for individuals with tinnitus. Higher thresholds indicated poorer stream segregation abilities. Within tinnitus participants, the thresholds were significantly lesser at frequency corresponding to admitted tinnitus pitch than at one octave below the tinnitus pitch. Conclusions The information from this study may be helpful in educating the patients about the relationship between hearing loss and tinnitus. The findings may also account for speech-perception-in-noise difficulties often reported by the individuals with tinnitus.
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Affiliation(s)
- Saransh Jain
- Department of Speech and Hearing, Jagadguru Sri Shivarathreeshwara Institute of Speech and Hearing, Mysuru, India
| | - Riya Cherian
- Department of ENT, Sree Gokulam Medical College & Research Foundation, Venjaranmood, India
| | - Nuggehalli P. Nataraja
- Department of Speech and Hearing, Jagadguru Sri Shivarathreeshwara Institute of Speech and Hearing, Mysuru, India
| | - Vijaya Kumar Narne
- Department of Mechanical Engineering, Indian Institute of Technology Kanpur, India
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Partyka M, Neff P, Bacri T, Michels J, Weisz N, Schlee W. Gender differentiates effects of acoustic stimulation in patients with tinnitus. PROGRESS IN BRAIN RESEARCH 2021; 263:25-57. [PMID: 34243890 DOI: 10.1016/bs.pbr.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gender constitutes a major factor to consider when tailoring subtype-based therapies for tinnitus. Previous reports showed important differences between men and women concerning basic perceptual tinnitus characteristics (i.e., laterality, frequency, tinnitus loudness) as well as psychological reactions linked to this condition. Therapeutic approaches based on acoustic stimulation involve processes beyond a pure masking effect and consist of sound presentation temporarily altering or alleviating tinnitus perception via residual and/or lateral inhibition mechanisms. Presented stimuli may include pure tones, noise, and music adjusted to or modulated to filter out tinnitus pitch and therefore trigger reparative functional and structural changes in the auditory system. Furthermore, recent findings suggest that in tonal tinnitus, the presentation of pitch-adjusted sounds which were altered by a 10Hz modulation of amplitude was more efficient than unmodulated stimulation. In this paper, we investigate sex differences in the outcome of different variants of acoustic stimulation, looking for factors revealing predictive value in the efficiency of tinnitus relief.
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Affiliation(s)
- Marta Partyka
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Patrick Neff
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria; University of Zurich, Zurich, Switzerland
| | - Timothée Bacri
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Jakob Michels
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Nathan Weisz
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Winfried Schlee
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Korth D, Wollbrink A, Lukas C, Ivansic D, Guntinas-Lichius O, Salvari V, Paraskevopoulos E, Pantev C, Dobel C. Comparing pure tone and narrow band noise to measure tonal tinnitus pitch-match frequency. PROGRESS IN BRAIN RESEARCH 2020; 262:115-137. [PMID: 33931175 DOI: 10.1016/bs.pbr.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tinnitus assessment is a precursor for individualized treatment and outcome measurement. In the recent years, several studies proposed two-alternative forced choice (2AFC) recursive matching as a method to determine tinnitus pitch-match frequency in a standardized reliable manner. Currently, pure tones are used as comparison stimuli to assess pitch-match frequency. In this study, we investigated the psychometric quality of the method comparing different sound types. We measured 20 chronic tinnitus patients in 2 runs on 3 days. To assess pitch-match frequency, we used 2AFC recursive matching and compared results between pure tones and narrow band noise (NBN). Test-retest reliability between runs and across sound types was high (α>0.9) and increased across days. Perceived matching difficulty and time to completion decreased over repetitions. Importantly, the difference of matched frequencies (DMF) between runs was significantly less for NBN. When patients matched the spectral bandwidth of a test tone to their tinnitus, consistency was high (α=0.86) and no patient indicated continuously a pure tone. In conclusion, we recommend using NBN sounds in 2AFC recursive matching to assess pitch-match frequency as a standardized reliable method. Such a procedure could be offered as smartphone-based application to monitor tinnitus symptomatology for individualized assessment and treatment outcome.
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Affiliation(s)
- Daniela Korth
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Cosima Lukas
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Daniela Ivansic
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Vasiliki Salvari
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Evangelos Paraskevopoulos
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
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Fournier P, Wrzosek M, Paolino M, Paolino F, Quemar A, Noreña AJ. Comparing Tinnitus Tuning Curves and Psychoacoustic Tuning Curves. Trends Hear 2020; 23:2331216519878539. [PMID: 31588855 PMCID: PMC6783663 DOI: 10.1177/2331216519878539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tinnitus masking patterns have long been known to differ from those used for masking external sound. In the present study, we compared the shape of tinnitus tuning curves (TTCs) to psychophysical tuning curves (PTCs), the latter using as a target, an external sound that mimics the tinnitus characteristics. A secondary goal was to compare sound levels required to mask tinnitus to those required to mask tinnitus-mimicking sounds. The TTC, PTC, audiometric thresholds, tinnitus pitch, and level matching results of 32 tinnitus patients were analyzed. Narrowband noise maskers were used for both PTC and TTC procedures. Patients were categorized into three groups based on a combination of individual PTC-TTC results. Our findings indicate that in 41% of cases, the PTC was sharp (V shape), but the TTC showed a flat configuration, suggesting that the tinnitus-related activity in that subgroup does not behave as a regular stimulus-induced activity. In 30% of cases, V-shape PTC and TTC were found, indicating that the tinnitus-related activity may share common properties with stimulus-induced activity. For a masker centered at the tinnitus frequency, the tinnitus was more difficult to mask than the mimicking tone in 72% of patients; this was particularly true for the subset with V-shape PTCs and flat TTCs. These results may have implications for subtyping tinnitus and acoustic therapies, in particular those targeting the tinnitus frequency.
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Affiliation(s)
- Philippe Fournier
- Centre National de la Recherche Scientifique, Aix-Marseille University, France
| | | | | | | | | | - Arnaud J Noreña
- Centre National de la Recherche Scientifique, Aix-Marseille University, France
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Sense and Sensibility: A Review of the Behavioral Neuroscience of Tinnitus Sound Therapy and a New Typology. Curr Top Behav Neurosci 2020; 51:213-247. [PMID: 33547596 DOI: 10.1007/7854_2020_183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tinnitus Sound Therapy is not a single strategy. It consists of many different sound types, targeting many different mechanisms. Therapies that use sound to cover, reduce attention to, or facilitate habituation of tinnitus are among the most common tinnitus treatment paradigms. Recent history has seen a proliferation of sound therapies, but they have each been criticized for having limited empirical support. In this review, Sound Therapy's modern history will be described, and a typology will be introduced and discussed in light of current behavioral neuroscience research. It will be argued that contributing factors to the limited evidence for the efficacy of Sound Therapy are its diversity, plural modes of action, and absence of a clear typology. Despite gaps in understanding the efficacy of sound's effects on tinnitus, there is compelling evidence for its multiple, but related, neurophysiological mechanisms. Evidence suggests that sound may reduce tinnitus through its presence, context, reaction, and potentially adaptation. This review provides insights into the neurocognitive basis of these tinnitus Sound Therapy modes. It concludes that a unifying classification is needed to secure and advance arguments in favor of Sound Therapy.
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Maladaptive alterations of resting state cortical network in Tinnitus: A directed functional connectivity analysis of a larger MEG data set. Sci Rep 2019; 9:15452. [PMID: 31664058 PMCID: PMC6820754 DOI: 10.1038/s41598-019-51747-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/02/2019] [Indexed: 12/29/2022] Open
Abstract
The present study used resting state MEG whole-head recordings to identify how chronic tonal tinnitus relates to altered functional connectivity of brain's intrinsic cortical networks. Resting state MEG activity of 40 chronic tinnitus patients and 40 matched human controls was compared identifying significant alterations in intrinsic networks of the tinnitus population. Directed functional connectivity of the resting brain, at a whole cortex level, was estimated by means of a statistical comparison of the estimated phase Transfer Entropy (pTE) between the time-series of cortical activations, as reconstructed by LORETA. As pTE identifies the direction of the information flow, a detailed analysis of the connectivity differences between tinnitus patients and controls was possible. Results indicate that the group of tinnitus patients show increased connectivity from right dorsal prefrontal to right medial temporal areas. Our results go beyond previous findings by indicating that the role of the left para-hippocampal area is dictated by a modulation from dmPFC; a region that is part of the dorsal attention network (DAN), as well as implicated in the regulation of emotional processing. Additionally, this whole cortex analysis showed a crucial role of the left inferior parietal cortex, which modulated the activity of the right superior temporal gyrus, providing new hypotheses for the role of this area within the context of current tinnitus models. Overall, these maladaptive alterations of the structure of intrinsic cortical networks show a decrease in efficiency and small worldness of the resting state network of tinnitus patients, which is correlated to tinnitus distress.
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Hébert S. Individual Reliability of the Standard Clinical Method vs Patient-Centered Tinnitus Likeness Rating for Assessment of Tinnitus Pitch and Loudness Matching. JAMA Otolaryngol Head Neck Surg 2019; 144:1136-1144. [PMID: 30267085 DOI: 10.1001/jamaoto.2018.2416] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Current individualized sound therapies for tinnitus rely on tinnitus pitch assessment, which is commonly derived from the standard clinical 2-alternative forced-choice (2-AFC) approach driven by the examiner. However, this method is limited by lack of individual test-retest reliability and focuses on a single rather than multiple tinnitus frequencies. Objective To assess individual test-retest reliability of the 2-AFC, with a single final frequency (and corresponding loudness), and the tinnitus likeness rating (TLR), with the participant exposed to the entire audible frequency spectrum, from which 3 dominant frequencies and corresponding loudness were extracted. Design, Setting, and Participants In this case series, participants with tinnitus underwent testing twice with both methods at a 1-month interval by experienced clinicians from January 6 through March 17, 2017. Each clinician tested each patient only once at visit 1 or 2 in a university audiology training setting with standardized equipment and was blind to previous assessment. Participants with bilateral or unilateral chronic tinnitus for longer than 6 months, in good health, without total deafness in either ear, and without cerumen in the ear canal were recruited through advertisements (community and clinics) and word of mouth (volunteer sample). The audiologists were likewise participants in the planned comparison between TLR and 2-AFC in the test-retest measures. Main Outcomes and Measures Test-retest concordance with 95% CIs for each method, calculated as the proportion of participants with the same final frequency between the 2 visits (2-AFC) or with at least 1 concordant dominant frequency (TLR) as well as loudness differences of no greater than 10 dB. Results The study sample included 31 participants (55% men; mean [SD] age, 50.7 [13.7] years). For TLR, 26 of 31 participants had at least 1 concordant dominant frequency between the 2 visits (proportion, 0.84; 95% CI, 0.66-0.95), whereas for 2-AFC, 7 of 31 participants had a concordant final tinnitus pitch in either ear (proportion, 0.23; 95% CI, 0.10-0.41). Loudness reliability followed the same pattern, with more concordant loudness levels in the TLR (proportion, 0.73; 95% CI, 0.52-0.88) than in the 2-AFC (proportion, 0.40; 95% CI, 0.05-0.85). Mean time taken to complete the tests was less than 15 minutes, and general appreciation by participants with tinnitus and audiologists were overall similar for both. Conclusions and Relevance Superior test-retest concordance can be demonstrated at the individual level using the several dominant frequencies extracted from the patient-centered TLR.
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Affiliation(s)
- Sylvie Hébert
- School of Speech Pathology and Audiology, Faculty of Medicine, University de Montreal, Montreal, Quebec, Canada.,International Laboratory for Research on Brain, Music, and Sound, Montreal, Quebec, Canada
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Abstract
In recent years, applications (apps) for medical purposes have been developed and introduced, including apps that perform diagnostics and documentation for hearing loss and tinnitus in combination with smartphones. Even therapeutic apps, particularly for chronic tinnitus, have been launched. This review discusses the existing scientific literature for these smartphone applications. For tinnitus, Internet-based cognitive behavioral therapy has been developed and evaluated. For tinnitus therapy, introduced apps combine acoustic stimulation and music, or serve acoustic stimulation of cortical regions around the tinnitus frequency. Although these apps appear very innovative, their effectiveness has not yet been scientifically proven. A general problem associated with using smartphone apps lies in their safety in terms of possible side effects and personal data protection. However, Internet programs and apps can be a useful supplement to multimodal tinnitus therapies.
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Affiliation(s)
- G Hesse
- Tinnitus-Klinik am Krankenhaus Bad Arolsen, Große Allee 50, 34454, Bad Arolsen, Deutschland. .,Universität Witten/Herdecke, Witten, Deutschland.
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12
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Haab L, Lehser C, Corona-Strauss FI, Bernarding C, Seidler H, Hannemann R, Strauss DJ. Implementation and Long-Term Evaluation of a Hearing Aid Supported Tinnitus Treatment Using Notched Environmental Sounds. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2019; 7:1600109. [PMID: 31037231 PMCID: PMC6483592 DOI: 10.1109/jtehm.2019.2897570] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/21/2018] [Accepted: 12/06/2018] [Indexed: 11/20/2022]
Abstract
Recent work has shown that sharp spectral edges in acoustic stimuli might have advantageous effects in the treatment of tonal tinnitus. In the course of this paper, we evaluate the long-term effects of spectrally notched hearing aids on the subjective tinnitus distress. By merging recent experimental work with a computational tinnitus model, we modified the commercially available behind-the-ear hearing aids so that a frequency band of 0.5 octaves, centered on the patient’s individual tinnitus frequency, was blocked out. Those hearing aids employ a steep notch filter that filters environmental sounds to suppress the tinnitus-related changes in neural firing by lateral inhibition. The computational model reveals a renormalization of pathologically increased neural response reliability and synchrony in response to spectrally modified input. The target group, fitted with spectrally notched hearing aids, was matched with a comparable control group, fitted with standard hearing aids of the same type but without a notch filter. We analyze the subjective self-assessment by tinnitus questionnaires, and we monitor the objective distress correlates in auditory evoked response phase data. Both, subjective and objective results show a noticeable trend of a larger therapeutic benefit for notched hearing correction.
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Affiliation(s)
- Lars Haab
- Systems Neuroscience and Neurotechnology UnitSaarland University Hospital, University of Applied Sciences66117HomburgGermany
| | - Caroline Lehser
- Systems Neuroscience and Neurotechnology UnitSaarland University Hospital, University of Applied Sciences66117HomburgGermany
| | - Farah I Corona-Strauss
- Systems Neuroscience and Neurotechnology UnitSaarland University Hospital, University of Applied Sciences66117HomburgGermany.,Key Numerics Medical Engineering GmbH66129SaarbrückenGermany
| | - Corinna Bernarding
- Systems Neuroscience and Neurotechnology UnitSaarland University Hospital, University of Applied Sciences66117HomburgGermany.,Key Numerics Medical Engineering GmbH66129SaarbrückenGermany
| | - Harald Seidler
- Ear, Nose and Throat Center, MediClin Bosenberg KlinikenMediClin AG66606Sankt WendelGermany
| | | | - Daniel J Strauss
- Systems Neuroscience and Neurotechnology UnitSaarland University Hospital, University of Applied Sciences66117HomburgGermany.,Key Numerics Medical Engineering GmbH66129SaarbrückenGermany.,INM Leibniz Institute for New Materials66123SaarbrückenGermany
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Manipulation of Auditory Inputs as Rehabilitation Therapy for Maladaptive Auditory Cortical Reorganization. Neural Plast 2018; 2018:2546250. [PMID: 29887880 PMCID: PMC5985139 DOI: 10.1155/2018/2546250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/08/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
Neurophysiological and neuroimaging data suggest that the brains of not only children but also adults are reorganized based on sensory inputs and behaviors. Plastic changes in the brain are generally beneficial; however, maladaptive cortical reorganization in the auditory cortex may lead to hearing disorders such as tinnitus and hyperacusis. Recent studies attempted to noninvasively visualize pathological neural activity in the living human brain and reverse maladaptive cortical reorganization by the suitable manipulation of auditory inputs in order to alleviate detrimental auditory symptoms. The effects of the manipulation of auditory inputs on maladaptively reorganized brain were reviewed herein. The findings obtained indicate that rehabilitation therapy based on the manipulation of auditory inputs is an effective and safe approach for hearing disorders. The appropriate manipulation of sensory inputs guided by the visualization of pathological brain activities using recent neuroimaging techniques may contribute to the establishment of new clinical applications for affected individuals.
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14
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Lau P, Wollbrink A, Wunderlich R, Engell A, Löhe A, Junghöfer M, Pantev C. Targeting Heterogeneous Findings in Neuronal Oscillations in Tinnitus: Analyzing MEG Novices and Mental Health Comorbidities. Front Psychol 2018; 9:235. [PMID: 29551983 PMCID: PMC5841018 DOI: 10.3389/fpsyg.2018.00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/12/2018] [Indexed: 12/12/2022] Open
Abstract
Tinnitus is a prevalent phenomenon and bothersome for people affected by it. Its occurrence and maintenance have a clear neuroscientific tie and one aspect are differences in the neuronal oscillatory pattern, especially in auditory cortical areas. As studies in this field come to different results, the aim of this study was to analyze a large number of participants to achieve more stable results. Furthermore, we expanded our analysis to two variables of potential influence, namely being a novice to neuroscientific measurements and the exclusion of psychological comorbidities. Oscillatory brain activity of 88 subjects (46 with a chronic tinnitus percept, 42 without) measured in resting state by MEG was investigated. In the analysis based on the whole group, in sensor space increased activity in the delta frequency band was found in tinnitus patients. Analyzing the subgroup of novices, a significant difference in the theta band emerged additionally to the delta band difference (sensor space). Localizing the origin of the activity, we found a difference in theta and gamma band for the auditory regions for the whole group and the same significant difference in the subgroup of novices. However, no differences in oscillatory activity were observed between tinnitus and control groups once subjects with mental health comorbidity were excluded. Against the background of previous studies, the study at hand underlines the fragility of the results in the field of neuronal cortical oscillations in tinnitus. It supports the body of research arguing for low frequency oscillations and gamma band activity as markers associated with tinnitus.
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Affiliation(s)
- Pia Lau
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Robert Wunderlich
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Alva Engell
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Alwina Löhe
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Markus Junghöfer
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
| | - Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Münster, Germany
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15
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Neff P, Michels J, Meyer M, Schecklmann M, Langguth B, Schlee W. 10 Hz Amplitude Modulated Sounds Induce Short-Term Tinnitus Suppression. Front Aging Neurosci 2017; 9:130. [PMID: 28579955 PMCID: PMC5437109 DOI: 10.3389/fnagi.2017.00130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/19/2017] [Indexed: 01/24/2023] Open
Abstract
Objectives: Acoustic stimulation or sound therapy is proposed as a main treatment option for chronic subjective tinnitus. To further probe the field of acoustic stimulations for tinnitus therapy, this exploratory study compared 10 Hz amplitude modulated (AM) sounds (two pure tones, noise, music, and frequency modulated (FM) sounds) and unmodulated sounds (pure tone, noise) regarding their temporary suppression of tinnitus loudness. First, it was hypothesized that modulated sounds elicit larger temporary loudness suppression (residual inhibition) than unmodulated sounds. Second, with manipulation of stimulus loudness and duration of the modulated sounds weaker or stronger effects of loudness suppression were expected, respectively. Methods: We recruited 29 participants with chronic tonal tinnitus from the multidisciplinary Tinnitus Clinic of the University of Regensburg. Participants underwent audiometric, psychometric and tinnitus pitch matching assessments followed by an acoustic stimulation experiment with a tinnitus loudness growth paradigm. In a first block participants were stimulated with all of the sounds for 3 min each and rated their subjective tinnitus loudness to the pre-stimulus loudness every 30 s after stimulus offset. The same procedure was deployed in the second block with the pure tone AM stimuli matched to the tinnitus frequency, manipulated in length (6 min), and loudness (reduced by 30 dB and linear fade out). Repeated measures mixed model analyses of variance (ANOVA) were calculated to assess differences in loudness growth between the stimuli for each block separately. Results: First, we found that all sounds elicit a short-term suppression of tinnitus loudness (seconds to minutes) with strongest suppression right after stimulus offset [F(6, 1331) = 3.74, p < 0.01]. Second, similar to previous findings we found that AM sounds near the tinnitus frequency produce significantly stronger tinnitus loudness suppression than noise [vs. Pink noise: t(27) = -4.22, p < 0.0001]. Finally, variants of the AM sound matched to the tinnitus frequency reduced in sound level resulted in less suppression while there was no significant difference observed for a longer stimulation duration. Moreover, feasibility of the overall procedure could be confirmed as scores of both tinnitus loudness and questionnaires were lower after the experiment [tinnitus loudness: t(27) = 2.77, p < 0.01; Tinnitus Questionnaire: t(27) = 2.06, p < 0.05; Tinnitus Handicap Inventory: t(27) = 1.92, p = 0.065]. Conclusion: Taken together, these results imply that AM sounds, especially in or around the tinnitus frequency, may induce larger suppression than unmodulated sounds. Future studies should thus evaluate this approach in longitudinal studies and real life settings. Furthermore, the putative neural relation of these sound stimuli with a modulation rate in the EEG α band to the observed tinnitus suppression should be probed with respective neurophysiological methods.
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Affiliation(s)
- Patrick Neff
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of ZurichZurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of ZurichZurich, Switzerland
| | - Jakob Michels
- Department of Medicine, University of RegensburgRegensburg, Germany
| | - Martin Meyer
- Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Department of Psychology, University of ZurichZurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of ZurichZurich, Switzerland.,Cognitive Psychology Unit, University of KlagenfurtKlagenfurt, Austria
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of RegensburgRegensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of RegensburgRegensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of RegensburgRegensburg, Germany
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16
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Lee HY, Choi MS, Chang DS, Cho CS. Combined Bifrontal Transcranial Direct Current Stimulation and Tailor-Made Notched Music Training in Chronic Tinnitus. J Audiol Otol 2017; 21:22-27. [PMID: 28417104 PMCID: PMC5392009 DOI: 10.7874/jao.2017.21.1.22] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/06/2016] [Accepted: 12/27/2016] [Indexed: 01/16/2023] Open
Abstract
Background and Objectives We evaluated the short-term treatment outcomes of combined bifrontal transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) in tinnitus patients. The associations of patient characteristics with treatment responsiveness were investigated. Subjects and Methods Four sessions of bifrontal tDCS (F4: anode, F3: cathode) and TMNMT were conducted over a 2-week period in tinnitus patients. For tDCS, the stimulation intensity was 1.5 mA and the duration was approximately 20 min. During tDCS, patients listened to music lacking the frequency band within 1 octave of the tinnitus frequency. Patients were also instructed to listen to this music at home for at least 2 hours per day. One month after the final tDCS session, loudness (LD), awareness (AW), annoyance (AN), and effect on life (EL) of tinnitus were assessed subjectively using a visual analog scale. Results A total of 14 patients were enrolled in this study. After treatment, a 50% or greater improvement in AN, AW, EL, and LD was observed in 57.1, 42.9, 35.7, and 28.6% of patients, respectively. Furthermore, 78.6% of patients showed a 50% or greater improvement in their tinnitus handicap inventory scores. For AN, the absence of sleep disturbance was significantly associated with treatment responsiveness (p=0.041, OR=24.0). Conclusions Combined bifrontal tDCS and TMNMT is a promising treatment for chronic tinnitus. To maximize the treatment outcomes of this therapy, sleep disturbances should also be addressed in candidate patients.
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Affiliation(s)
- Ho Yun Lee
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
| | - Myoung Su Choi
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
| | - Dong Sik Chang
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
| | - Chin-Saeng Cho
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
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17
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Sekiya K, Takahashi M, Murakami S, Kakigi R, Okamoto H. Broadened population-level frequency tuning in the auditory cortex of tinnitus patients. J Neurophysiol 2017; 117:1379-1384. [PMID: 28053240 PMCID: PMC5350267 DOI: 10.1152/jn.00385.2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 12/29/2016] [Accepted: 12/31/2016] [Indexed: 11/22/2022] Open
Abstract
Although subjective tinnitus is one of the most common public health concerns that impair the quality of life of many individuals, no standard treatment or objective diagnostic method currently exists. We herein revealed that population-level frequency tuning was significantly broader in the tinnitus ear than in the nontinnitus ear. The results of the present study provide an insight into the development of an objective diagnostic method for subjective tinnitus. Tinnitus is a phantom auditory perception without an external sound source and is one of the most common public health concerns that impair the quality of life of many individuals. However, its neural mechanisms remain unclear. We herein examined population-level frequency tuning in the auditory cortex of unilateral tinnitus patients with similar hearing levels in both ears using magnetoencephalography. We compared auditory-evoked neural activities elicited by a stimulation to the tinnitus and nontinnitus ears. Objective magnetoencephalographic data suggested that population-level frequency tuning corresponding to the tinnitus ear was significantly broader than that corresponding to the nontinnitus ear in the human auditory cortex. The results obtained support the hypothesis that pathological alterations in inhibitory neural networks play an important role in the perception of subjective tinnitus. NEW & NOTEWORTHY Although subjective tinnitus is one of the most common public health concerns that impair the quality of life of many individuals, no standard treatment or objective diagnostic method currently exists. We herein revealed that population-level frequency tuning was significantly broader in the tinnitus ear than in the nontinnitus ear. The results of the present study provide an insight into the development of an objective diagnostic method for subjective tinnitus.
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Affiliation(s)
- Kenichi Sekiya
- Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan.,Department of Otolaryngology, Head, and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan; and
| | - Mariko Takahashi
- Department of Otolaryngology, Head, and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan; and
| | - Shingo Murakami
- Department of Otolaryngology, Head, and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan; and
| | - Ryusuke Kakigi
- Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan.,The Graduate University for Advanced Studies (SOKENDAI), Hayama, Japan
| | - Hidehiko Okamoto
- Department of Integrative Physiology, National Institute for Physiological Sciences, Okazaki, Japan; .,The Graduate University for Advanced Studies (SOKENDAI), Hayama, Japan
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18
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Moore DR, Zobay O, Mackinnon RC, Whitmer WM, Akeroyd MA. Lifetime leisure music exposure associated with increased frequency of tinnitus. Hear Res 2016; 347:18-27. [PMID: 27825859 PMCID: PMC5417322 DOI: 10.1016/j.heares.2016.10.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/02/2016] [Accepted: 10/31/2016] [Indexed: 02/05/2023]
Abstract
Tinnitus has been linked to noise exposure, a common form of which is listening to music as a leisure activity. The relationship between tinnitus and type and duration of music exposure is not well understood. We conducted an internet-based population study that asked participants questions about lifetime music exposure and hearing, and included a hearing test involving speech intelligibility in noise, the High Frequency Digit Triplets Test. 4950 people aged 17-75 years completed all questions and the hearing test. Results were analyzed using multinomial regression models. High exposure to leisure music, hearing difficulty, increasing age and workplace noise exposure were independently associated with increased tinnitus. Three forms of music exposure (pubs/clubs, concerts, personal music players) did not differ in their relationship to tinnitus. More males than females reported tinnitus. The objective measure of speech reception threshold had only a minimal relationship with tinnitus. Self-reported hearing difficulty was more strongly associated with tinnitus, but 76% of people reporting usual or constant tinnitus also reported little or no hearing difficulty. Overall, around 40% of participants of all ages reported never experiencing tinnitus, while 29% reported sometimes, usually or constantly experiencing tinnitus that lasted more than 5 min. Together, the results suggest that tinnitus is much more common than hearing loss, but that there is little association between the two, especially among the younger adults disproportionately sampled in this study.
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Affiliation(s)
- David R Moore
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK; Communication Sciences Research Center, Cincinnati Children Hospital Medical Center, Cincinnati, OH, 45229, USA; Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA.
| | - Oliver Zobay
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK.
| | | | - William M Whitmer
- MRC/CSO Institute of Hearing Research - Scottish Section, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
| | - Michael A Akeroyd
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK; School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK; MRC/CSO Institute of Hearing Research - Scottish Section, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK.
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19
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Stein A, Wunderlich R, Lau P, Engell A, Wollbrink A, Shaykevich A, Kuhn JT, Holling H, Rudack C, Pantev C. Clinical trial on tonal tinnitus with tailor-made notched music training. BMC Neurol 2016; 16:38. [PMID: 26987755 PMCID: PMC4797223 DOI: 10.1186/s12883-016-0558-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/10/2016] [Indexed: 11/26/2022] Open
Abstract
Background Tinnitus is a result of hyper-activity/hyper-synchrony of auditory neurons coding the tinnitus frequency, which has developed due to synchronous mass activity owing to the lack of inhibition. We assume that removal of exactly these frequencies from a complex auditory stimulus will cause the brain to reorganize around tonotopic regions coding the tinnitus frequency through inhibition-induced plasticity. Based on this assumption, a novel treatment for tonal tinnitus - tailor-made notched music training (TMNMT) - has been introduced and was tested in this clinical trial. Methods A randomized controlled trial in parallel group design was performed in a double-blinded manner. We included 100 participants with chronic, tonal tinnitus who listened to tailor-made notched music for two hours a day for three consecutive months. Our primary outcome measures were the Tinnitus Handicap Questionnaire and Visual Analog Scales measuring perceived tinnitus loudness, awareness, distress and handicap. Participants rated their tinnitus before and after the training as well as one month after cessation of the training. Results While no effect was found for the primary outcome measures, tinnitus distress, as measured by the Tinnitus Questionnaire, a secondary outcome measure, developed differently in the two groups. The treatment group showed higher distress scores while the placebo group revealed lower distress scores after the training. However, this effect did not reach significance in post-hoc analysis and disappeared at follow-up measurements. At follow-up, tinnitus loudness in the treatment group was significantly reduced as compared to the control group. Post hoc analysis, accounting for low reliability scores in the Visual Analog Scales, showed a significant reduction of the overall Visual Analog Scale mean score in the treatment group even at the post measurement. Conclusion This is the first study on TMNMT that was planned and conducted following the CONSORT statement standards for clinical trials. The current work is one more step towards a final evaluation of TMNMT. Already after three months the effect of training with tailor-made notched music is observable in the most direct rating of tinnitus perception – the tinnitus loudness, while more global measures of tinnitus distress do not show relevant changes. Trial registration Current Controlled Trials ISRCTN04840953; Trial registration date: 17.07.2013
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Affiliation(s)
- Alwina Stein
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany
| | - Robert Wunderlich
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany.,Institute for Physiological Psychology, University of Bielefeld, Bielefeld, Germany
| | - Pia Lau
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany
| | - Alva Engell
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany
| | | | - Jörg-Tobias Kuhn
- Institute for Psychology, University of Münster, Fliednerstraße 21, 48149, Münster, Germany
| | - Heinz Holling
- Institute for Psychology, University of Münster, Fliednerstraße 21, 48149, Münster, Germany
| | - Claudia Rudack
- Department of ENT, University Clinic Münster, University of Münster, Cardinal-von-Galen Ring 10, 48149, Münster, Germany
| | - Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149, Münster, Germany.
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20
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Shim HJ, Kwak MY, An YH, Kim DH, Kim YJ, Kim HJ. Feasibility and Safety of Transcutaneous Vagus Nerve Stimulation Paired with Notched Music Therapy for the Treatment of Chronic Tinnitus. J Audiol Otol 2015; 19:159-67. [PMID: 26771015 PMCID: PMC4704553 DOI: 10.7874/jao.2015.19.3.159] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/17/2015] [Accepted: 11/30/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A recent study demonstrated that tinnitus could be eliminated by vagus nerve stimulation (VNS) paired with notched sounds in a rat tinnitus model. The aims of this clinical study were to investigate the effects and safety of transcutaneous VNS (tVNS) by patch-type electrode paired with notched music for treating chronic tinnitus. SUBJECTS AND METHODS Thirty patients with refractory chronic tinnitus for >12 months were included in this study. A patch-type electrode was attached to the auricular concha of the patient's left ear and tVNS was performed for 30 min (pulse rate 25 Hz, pulse width 200 µs, and amplitude 1-10 mA) using a transcutaneous electric nerve stimulation eco2. During tVNS, the patients listened to notched music cleared of the frequency spectrum corresponding to the tinnitus with a 0.5 octave notch width. RESULTS After 10 treatment sessions, 15/30 patients (50%) reported symptom relief in terms of a global improvement questionnaire. The mean tinnitus loudness (10-point scale) and the mean tinnitus awareness score (%) improved significantly from 6.32±2.06 to 5.16±1.52 and from 82.40±24.37% to 65.60±28.15%, respectively (both p<0.05). None of the patients had any specific side effects, such as changes in heart rate or blood pressure. CONCLUSIONS This study has demonstrated the feasibility and safety of tVNS paired with notched music therapy in patients with chronic tinnitus, with the use of a pad-type electrode attached to the auricular concha.
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Affiliation(s)
- Hyun Joon Shim
- Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Min Young Kwak
- Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Yong-Hwi An
- Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Yun Jin Kim
- Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hyo Jung Kim
- Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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