Hearing fluctuation during migraine attacks. Activity of propranolol-HCl in rats

Percutaneous Radiofrequency Lesion of the Superior Cervical Sympathetic Ganglion in Patients with Tinnitus

OBJECTIVE

The aim of this study was to determine the efficacy of radiofrequency lesioning of the superior cervical sympathetic ganglion for patients with tinnitus.

STUDY DESIGN

This is a retrospective long-term clinical review of patients with tinnitus treated with a blockade of the superior cervical sympathetic ganglion.

SETTING

The human subjects were 366 consecutive patients who came to the DC Klinieken in Almere and Amsterdam from January 2010 to January 2014 for consultations on their tinnitus that persisted for 1 month or longer.

SUBJECTS AND METHODS

Data were recorded from patients whose charts were reviewed retrospectively to identify the patients who were treated with a blockade of the superior cervical sympathetic ganglion for tinnitus. An independent observer conducted a long-term follow-up assessment of the therapy by telephone interview.

RESULTS

Relief of tinnitus at 7-week follow-up was achieved in 64% of the patients treated with a radiofrequency lesion of the superior cervical sympathetic ganglion after a positive test blockade of this structure. Two years after the treatment, the maintenance of a tinnitus relief occurred in almost 40% of the patients with a follow-up period of two years or longer.

CONCLUSIONS

A radiofrequency lesion of the superior cervical sympathetic ganglion may be a useful alternative for patients with tinnitus not responding to conventional therapy.

Assessment of cochlear and auditory pathways in patients with migraine

PURPOSE

In this study, we aimed to determine the function of the cochlea and peripheral and central auditory pathways with migraine.

MATERIALS AND METHODS

Fifty-eight patients with migraine and 40 healthy subjects were assessed using routine diagnostic audiometry along with transient evoked otoacoustic emissions (TOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brainstem response (ABR) at high and low repetition rate frequencies.

RESULTS

Nearly two thirds of patients with migraine had one or more abnormalities in electrophysiological testing. Compared with control subjects, patients reported significant lowering of TOAEs amplitude at frequencies of 1 kHz (right: P = .0003; left: P = .002), 3 kHz (right: P = .025), and 4 kHz (right: P = .019); prolonged wave III latency (right: P = .009); and I-V interpeak latency (IPL) (left: P = .024) at high repetition rate frequencies. Significant correlations were identified between age, duration of illness and frequency of migraine and TOAEs total response and at amplitude of 4 kHz, amplitudes of DPOAEs at 1, 1.5, 2, 3, and 5 kHz and I, III and wave latencies and I-V IPL of ABR at high rate frequencies.

CONCLUSIONS

These data suggest that subclinical changes in cochlear function and auditory pathways are associated with chronic migraine. It is possible that migraine could be accompanied by compromise of blood supply of auditory system.

Auditory brainstem response in pediatric migraine: during the attack and asymptomatic period

OBJECTIVE

The aim of this study was to evaluate the hearing parameters of children with migraine during ictal and interictal period.

METHOD

16 pediatric patients with migraine and normal otolaryngologic examination were evaluated. Hearing parameters were assessed with auditory brainstem response (ABR) testing between and during the migraine attacks. Binaural absolute latencies of waves I, III and V, interpeak latencies I-III, III-V and I-V of ABR in response to 80 dB nHL clicks were calculated. Initial findings were compared with those of 20 healthy volunteers.

RESULTS

Peak latencies of wave V and interpeak latencies of I-V were prolonged during the attack in migraineurs on the left. The side of latency elongation was not affected by the side of headache. When these parameters were separately compared for gender, they were prolonged in boys during the attack in migraineurs; however in girls, while there was statistically significant difference at interpeak latencies of I-V, no significant difference was noted at peak latencies of wave V.

CONCLUSIONS

ABR waves did not exceed clinical norms in migraine patients in headache-free period. But, important effects on sensorineural hearing parameters were detected during the attack. Our results indicated a transient impairment of the auditory brainstem function during the headache in pediatric migraine patients.

Capsaicin stimulation of the cochlea and electric stimulation of the trigeminal ganglion mediate vascular permeability in cochlear and vertebro-basilar arteries: a potential cause of inner ear dysfunction in headache

Trigeminal neurogenic inflammation is one explanation for the development of vascular migraine. The triggers for this inflammation and pain are not well understood, but are probably vasoactive components acting on the blood vessel wall. Migraine-related inner ear symptoms like phonophobia, tinnitus, fluctuation in hearing perception and increased noise sensitivity provide indirect evidence that cochlear blood vessels are also affected by basilar artery migraine. The purpose of this investigation was to determine if a functional connection exists between the cochlea and the basilar artery. Neuronally mediated permeability changes in the cochlea and basilar artery were measured by colloidal silver and Evans Blue extravasation, following orthodromic and antidromic stimulation of the trigeminal ganglion innervating the cochlea. Capsaicin and electrical stimulation induced both dose- and time-dependent plasma extravasation of colloidal silver and Evans Blue from the basilar artery and anterior inferior cerebellar artery. Both orthodromic and antidromic activation of trigeminal sensory fibers also induced cochlear vascular permeability changes and significant quantitative differences between the treated and control groups in spectrophotometric assays. These results characterize a vasoactive connection between the cochlea and vertebro-basilar system through the trigeminal sensory neurons. We propose that vertigo, tinnitus and hearing deficits associated with basilar migraine could arise by excitation of the trigeminal nerve fibers in the cochlea, resulting in local plasma extravasation. In addition, cochlear "dysfunction" may also trigger basilar and cluster headache by afferent input to the trigeminal system.