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Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
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Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
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2
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Anastasios G, Magioula G, Konstantinos K, Ioannis A. Noise and Health: Review. Indian J Otolaryngol Head Neck Surg 2022; 74:5482-5491. [PMID: 36742745 PMCID: PMC9895353 DOI: 10.1007/s12070-021-02797-1] [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: 06/04/2021] [Accepted: 08/01/2021] [Indexed: 02/07/2023] Open
Abstract
Noise in human societies is unavoidable, but it tends to become a modern epidemic that induces various detrimental effects to several organs and functions in humans. Increased cardiovascular danger, anxiety and sleep disturbance are just few of these effects. It is noteworthy that children, even neonates and their developing organism are especially vulnerable to noise-related health problems. Noise is measured with special noise-meters. These devices express results in decibels by transforming random noise to a continuous sound. This sound is characterized by equivalent acoustic energy to the random noise for a defined time interval. Human auditory apparatus is principally endangered by acute noises but also by chronic noise exposure, in the context of both occupational and recreational activities. Various mechanisms are implicated in the pathogenesis of noise-induced hearing loss that can cause either temporary or permanent damage. Among them, emphasis is given to the impairment by free radicals and inflammatory mediators, to the activation of apoptotic molecular pathways, but also to glutamate excitotoxicity. A hidden hearing loss, synaptopathy, is attributed to the latter. The irreversible nature of hearing loss, as well as the idiosyncratic sensitivity of individuals, imposes the necessity of early diagnosis of auditory impairment by noise. Super high frequency audiograms, otoacoustic emissions and electrophysiological examinations can address diagnosis. Thankfully, there is extensive research on acoustic trauma therapeutic approaches. However, until we succeed in regenerating the sensory organ of hearing, chronic noise-induced hearing loss cannot be treated. Thus, it is fundamental that society protects people from noise, by laws and regulations.
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Affiliation(s)
- Goulioumis Anastasios
- Department of Otorhinolaryngology, Pediatric Hospital “Karamandanio”, Patras, Greece
| | | | - Kourelis Konstantinos
- Department of Otorhinolaryngology, Pediatric Hospital “Karamandanio”, Patras, Greece
| | - Athanasopoulos Ioannis
- Department of Otorhinolaryngology, Pediatric Center of “Iatriko Athinon” Hospital, Athens, Greece
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3
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Hyperacusis: Loudness Intolerance, Fear, Annoyance and Pain. Hear Res 2022; 426:108648. [DOI: 10.1016/j.heares.2022.108648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
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Fournier P, Paleressompoulle D, Esteve Fraysse MJ, Paolino F, Devèze A, Venail F, Noreña A. Exploring the middle ear function in patients with a cluster of symptoms including tinnitus, hyperacusis, ear fullness and/or pain. Hear Res 2022; 422:108519. [PMID: 35644108 DOI: 10.1016/j.heares.2022.108519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/04/2022]
Abstract
Middle ear muscle (MEM) abnormalities have been proposed to be involved in the development of ear-related symptoms such as tinnitus, hyperacusis, ear fullness, dizziness and/or otalgia. This cluster of symptoms have been called the Tonic Tensor Tympani Syndrome (TTTS) because of the supposed involvement of the tensor tympani muscle (TTM). However, the putative link between MEM dysfunction and the symptoms has not been proven yet and the detailed mechanisms (the causal chain) of TTTS are still elusive. It has been speculated that sudden loud sound (acoustic shock) may impair the functioning of the MEM, specifically the TTM, after an excessive contraction. This would result in inflammatory processes, activation of the trigeminal nerve and a change of the MEMs state into a hypersensitive one, that may be associated to the cluster of symptoms listed above. The goal of this study is to provide further insights into the mechanisms of TTTS. The middle ear function of 11 patients who reported TTTS symptoms has been investigated using either admittancemetry and/or measurement of air pressure in the sealed external auditory canal. While the former method measured the middle ear stiffness the latter provides an estimate of the tympanic membrane displacement. Most patients displayed results consistent with phasic contractions of the TTM (n = 9) and/or Eustachian Tube (ET) dysfunction (n = 6). The MEM contraction or ET dysfunction could be evoked by acoustic stimulation (n = 3), somatic maneuvers (n = 3), or pressure changes in the ear canal (n = 3). Spontaneous TTM contraction (n = 1) or ET opening (n = 1) could also be observed. Finally, voluntary contraction of MEM was also reported (n = 5). On the other hand, tonic contraction of the TTM could not be observed in any patient. The implications of these results for the mechanisms of TTTS are discussed.
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Affiliation(s)
- Philippe Fournier
- Centre National de la Recherche Scientifique (CNRS), Université d'Aix-Marseille, Centre St-Charles-Pôle 3C, Marseille, France; School of Rehabilitation, Faculty of Medecine, Université Laval, Québec, QC, Canada
| | - Dany Paleressompoulle
- Centre National de la Recherche Scientifique (CNRS), Université d'Aix-Marseille, Centre St-Charles-Pôle 3C, Marseille, France
| | - Marie-José Esteve Fraysse
- Service d'Oto-Rhino-Laryngologie, d'Oto-Neurologie et d'ORL Pédiatrique, Centre Hospitalier Universitaire de Toulouse, Place du Dr Baylac, France
| | - Fabien Paolino
- ORL and Skull Base Surgery, Clairval Hospital, Ramsay GDS Health Care, Marseille, France
| | - Arnaud Devèze
- ORL and Skull Base Surgery, Clairval Hospital, Ramsay GDS Health Care, Marseille, France; Laboratory of Biomechanism, IFSTTAR UMR T24, Faculty of Medicine Nord, Aix Marseille University, Marseille, France
| | - Frédéric Venail
- Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Arnaud Noreña
- Centre National de la Recherche Scientifique (CNRS), Université d'Aix-Marseille, Centre St-Charles-Pôle 3C, Marseille, France.
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5
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Fournier P, Paquette S, Paleressompoulle D, Paolino F, Devèze A, Noreña A. An exploratory multi-method investigation of middle ear muscle contraction. Hear Res 2022; 420:108509. [DOI: 10.1016/j.heares.2022.108509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/18/2022] [Accepted: 04/20/2022] [Indexed: 11/04/2022]
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Parameshwarappa V, Pezard L, Norena AJ. Changes in the spatiotemporal pattern of spontaneous activity across a cortical column after noise trauma. J Neurophysiol 2021; 127:239-254. [PMID: 34936500 DOI: 10.1152/jn.00262.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the auditory modality, noise trauma has often been used to investigate cortical plasticity as it causes cochlear hearing loss. One limitation of these past studies, however, is that the effects of noise trauma have been mostly documented at the granular layer, which is the main cortical recipient of thalamic inputs. Importantly, the cortex is composed of six different layers each having its own pattern of connectivity and specific role in sensory processing. The present study aims at investigating the effects of acute and chronic noise trauma on the laminar pattern of spontaneous activity in primary auditory cortex of the anesthetized guinea pig. We show that spontaneous activity is dramatically altered across cortical layers after acute and chronic noise-induced hearing loss. First, spontaneous activity was globally enhanced across cortical layers, both in terms of firing rate and amplitude of spike-triggered average of local field potentials. Second, current source density on (spontaneous) spike-triggered average of local field potentials indicates that current sinks develop in the supra- and infragranular layers. These latter results suggest that supragranular layers become a major input recipient and that the propagation of spontaneous activity over a cortical column is greatly enhanced after acute and chronic noise-induced hearing loss. We discuss the possible mechanisms and functional implications of these changes.
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Affiliation(s)
- Vinay Parameshwarappa
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Laurent Pezard
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
| | - Arnaud Jean Norena
- Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
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Noreña AJ, Lacher-Fougère S, Fraysse MJ, Bizaguet E, Grevin P, Thai-Van H, Moati L, Le Pajolec C, Fournier P, Ohresser M. A contribution to the debate on tinnitus definition. PROGRESS IN BRAIN RESEARCH 2021; 262:469-485. [PMID: 33931192 DOI: 10.1016/bs.pbr.2021.01.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tinnitus is generally defined as an auditory perception in the absence of environmental sound stimulation. However, this definition is quite incomplete as it omits an essential aspect, the patient's point of view. This point of view constitutes, first and foremost, a global and unified lived experience, which is not only sensory (localization, loudness, pitch and tone), but also cognitive (thoughts, attentiveness, behaviors) and emotional (discomfort, suffering). This experience can be lived in a very unpleasant way and consequently have a very negative impact on quality of life. This article proposes and justifies a new definition for tinnitus elaborated by a group of French clinicians and researchers, which is more in line with its phenomenology. It also provides a minimum knowledge base, including possibilities for clinical care, hoping to eradicate all misinformation, misconceptions and inappropriate attitudes or practices toward this condition. Here is the short version of our definition: Tinnitus is an auditory sensation without an external sound stimulation or meaning, which can be lived as an unpleasant experience, possibly impacting quality of life.
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Affiliation(s)
- Arnaud J Noreña
- Laboratoire de Neurosciences Cognitives, UMR 7291, Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France.
| | | | | | | | | | - Hung Thai-Van
- Hôpital Edouard Herriot, Pavillon U, Place d'Arsonval, Lyon, France
| | | | | | - Philippe Fournier
- Laboratoire de Neurosciences Cognitives, UMR 7291, Centre National de la Recherche Scientifique, Aix-Marseille University, Marseille, France
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8
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Zhang J, Huang S, Nan W, Zhou H, Wang J, Wang H, Salvi R, Yin S. Switching Tinnitus-On: Maps and source localization of spontaneous EEG. Clin Neurophysiol 2020; 132:345-357. [PMID: 33450557 DOI: 10.1016/j.clinph.2020.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify the spectrotemporal changes and sources in patients that could "turn on" tinnitus with multichannel electroencephalography (EEG) system. METHODS Multichannel EEG was recorded from six patients during the Tinnitus-On and Tinnitus-Off states. The EEG power spectrum and eLORETA-based sources were measured. RESULTS There was a global increase in delta and theta during Tinnitus-On plus large changes in alpha 1 and alpha 2. During the Tinnitus-On state, many new sources in delta, theta, alpha 1 and gamma bands emerged in the opposite hemisphere in the inferior temporal gyrus (Brodmann area, BA 20), middle temporal gyrus (BA 21), lateral perirhinal cortex (BA 36), ventral entorhinal cortex (BA 28) and anterior pole of the temporal gyrus (BA 38). CONCLUSIONS The emergence of new delta, theta and gamma band sources in the inferior temporal gyrus (BA 20), middle temporal gyrus (BA 21) and lateral perirhinal cortex (BA 36) plus the appearance of new delta and theta sources in the ventral entorhinal cortex (BA28) and anterior pole of the temporal lobe (BA 38) may comprise a network capable of evoking the phantom sound of tinnitus by simultaneously engaging brain regions involved in memory, sound recognition, and distress which together contribute to tinnitus severity. SIGNIFICANCE The sudden appearance of new sources of activity in the opposite hemisphere within the inferior temporal gyrus, middle temporal gyrus and perirhinal cortex may initiate the perception of tinnitus perception.
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Affiliation(s)
- Jiajia Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
| | - Shujian Huang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
| | - Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai 200234, China
| | - Huiqun Zhou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China.
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, Canada
| | - Hui Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China.
| | - Richard Salvi
- SUNY Distinguished Professor Center for Hearing and Deafness, 137 Cary Hall, University at Buffalo, Buffalo, NY, USA
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai 200233, China
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9
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Parker WAE, Parker VL, Parker G, Parker AJ. Acoustic shock: an update review. J Laryngol Otol 2020; 134:1-6. [PMID: 33004086 DOI: 10.1017/s0022215120001991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This paper discusses the concept of acoustic shock based on a literature review and the results of our own research into cases seen in both clinical and medicolegal practice. With the demise of traditional 'metal bashing' and 'smoke stack' heavy industries, there has been a decline in the incidence of noise-induced hearing loss and tinnitus in this form of employment. However, with the increasing establishment of call centre work, the emergence of acoustic shock has been noted. Acoustic shock is recognised as a clinical entity distinct from noise-induced hearing loss and acoustic trauma. OBJECTIVE This article discusses clinical implications, medicolegal considerations in light of a recent high-profile court case and proposed criteria for diagnosis.
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Affiliation(s)
- W A E Parker
- Peak Medical Practice, Matlock Green, UK
- Medical School, University of Sheffield, UK
| | - V L Parker
- Medical School, University of Sheffield, UK
| | - G Parker
- Peak Medical Practice, Matlock Green, UK
| | - A J Parker
- Peak Medical Practice, Matlock Green, UK
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Noreña AJ, Fournier P, Londero A, Ponsot D, Charpentier N. An Integrative Model Accounting for the Symptom Cluster Triggered After an Acoustic Shock. Trends Hear 2019; 22:2331216518801725. [PMID: 30249168 PMCID: PMC6156190 DOI: 10.1177/2331216518801725] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Acoustic shocks and traumas sometimes result in a cluster of debilitating symptoms, including tinnitus, hyperacusis, ear fullness and tension, dizziness, and pain in and outside the ear. The mechanisms underlying this large variety of symptoms remain elusive. In this article, we elaborate on the hypothesis that the tensor tympani muscle (TTM), the trigeminal nerve (TGN), and the trigeminal cervical complex (TCC) play a central role in generating these symptoms. We argue that TTM overuse (due to the acoustic shock), TTM overload (due to muscle tension), and ultimately, TTM injury (due to hypoxia and "energy crisis") lead to inflammation, thereby activating the TGN, TCC, and cortex. The TCC is a crossroad structure integrating sensory inputs coming from the head-neck complex (including the middle ear) and projecting back to it. The multimodal integration of the TCC may then account for referred pain outside the ear when the middle ear is inflamed and activates the TGN. We believe that our model proposes a synthetic and explanatory framework to explain the phenomena occurring postacoustic shock and potentially also after other nonauditory causes. Indeed, due to the bidirectional properties of the TCC, musculoskeletal disorders in the region of the head-neck complex, including neck injury due to whiplash or temporomandibular disorders, may impact the middle ear, thereby leading to otic symptoms. This previously unavailable model type is experimentally testable and must be taken as a starting point for identifying the mechanisms responsible for this particular subtype of tinnitus and its associated symptoms.
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Affiliation(s)
- Arnaud J Noreña
- 1 Aix-Marseille Université, UMR CNRS 7260, Laboratoire Neurosciences Intégratives et Adaptatives-Centre Saint-Charles, Marseille, France
| | - Philippe Fournier
- 1 Aix-Marseille Université, UMR CNRS 7260, Laboratoire Neurosciences Intégratives et Adaptatives-Centre Saint-Charles, Marseille, France
| | - Alain Londero
- 2 Service ORL et CCF, Hôpital Européen G. Pompidou, Paris, France
| | - Damien Ponsot
- 3 Académie de Lyon-Lycée Germaine Tillion, Sain-Bel, France
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Cederroth CR, Dyhrfjeld-Johnsen J, Langguth B. An update: emerging drugs for tinnitus. Expert Opin Emerg Drugs 2018; 23:251-260. [DOI: 10.1080/14728214.2018.1555240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | | | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
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