Correlation Analysis of the Tinnitus Handicap Inventory and Distress Network in Chronic Tinnitus: An EEG Study

INTRODUCTION

Tinnitus is a common disorder with a considerable amount of distress that affects the patient's daily life. No objective tools were approved for measuring tinnitus distress. It can be estimated only by subjective scales and questionnaires, albeit, the Electroencephalography (EEG) studies have reported some alterations regarding tinnitus distress network. This study aimed to investigate the correlation between Tinnitus Handicap Inventory (THI) and the recorded EEG data.

METHODS

A total of 33 chronic tinnitus cases (9 females) with the mean age of 42.67 years were recruited. Their THI scores were collected, and a 3-minute EEG recorded with eye closed at resting-state. The correlation analysis was performed on THI scores and the current density in the selected Region of Interests (ROIs) concerning the distress network for the eight frequency bands. The patients grouped depending on the THI cutoff point of 56 into low and high THI groups, and then the groups were compared for source analysis and functional connectivity between ROIs using standardized low-resolution brain electromagnetic tomography.

RESULTS

A significant positive correlation was seen between THI scores and the electrical activity in the Anterior Cingulate Cortex (ACC), the prefrontal cortex, and the parahippocampus for an alpha band (P<0.05) and in the ACC for beta (P<0.01). Source analysis showed significant differences with increased activity in the high THI group for alpha, beta and gamma bands. Functional connectivity was also elevated in the high THI group between the ROIs in alpha and beta bands.

CONCLUSION

THI can be a useful tool for measuring tinnitus distress, and it has a high correlation with EEG data.

The potential role of auditory prediction error in decompensated tinnitus: An auditory mismatch negativity study

INTRODUCTION

Some tinnitus subjects habituate to their tinnitus but some others do not and complain of its annoyance tremendously. Normal sensory memory and change detection processes are needed for detecting the tinnitus signal as a prediction error and habituation to tinnitus. The purpose of this study was to compare auditory mismatch negativity as the index of sensory memory and change detection among the studied groups to search for the factors involving in the perception of tinnitus and preventing habituation in decompensated tinnitus subjects.

METHODS

Electroencephalography was recorded from scalp electrodes in compensated tinnitus, decompensated tinnitus, and no tinnitus control subjects. Mismatch negativity was obtained using the oddball paradigm with frequency, duration, and silent gap deviants. Amplitude, latency, and area under the curve of mismatch negativities were compared among the three studied groups.

RESULTS

The results showed lower mismatch negativity amplitude and area under the curve for the higher frequency deviant and for the silent gap deviant in decompensated tinnitus group compared to normal control and compensated tinnitus group.

CONCLUSIONS

This study revealed a deficit in sensory memory and change detection processing in decompensated tinnitus subjects. This causes persistent prediction errors; tinnitus signal is consistently detected as a new signal and activates the brain salience network and consequently prevents habituation to tinnitus. Mismatch negativity is proposed as an index for monitoring tinnitus rehabilitation.

The efficacy and safety of multiple sessions of multisite transcranial random noise stimulation in treating chronic tinnitus

Introduction

Objective

Methods

Results

Conclusions

Shannon entropy measures for EEG signals in tinnitus

BACKGROUND AND AIM

Tinnitus is known as a common clinical symptom, and it comprehensively is essential to understand the underlying mechanisms. Time-varying EEG is considered an appropriate technique to explore brain regions and related activities, and nonlinear methods may extract the irregularities in the EEG signal and gather more expanded information. Therefore, we studied Shannon Entropy in EEG raw data obtained from normal subjects and compared it to data from chronic tinnitus sufferers before and after an intervention.

METHODS

From the qEEG database of Iran University of Medical Sciences, the School of Rehabilitation Sciences, we have selected 23 healthy and 24 chronic tinnitus subjects. Nineteen subjects of the tinnitus group had benefited from a complete course of sound therapy (binaural beat for a month). QEEGs were measured with a 27-channel EEG amplifier in the sitting and eye-closed position for 3 min. Shannon entropy was investigated for all electrodes separately and compared among groups using a one-way ANOVA statistical test.

FINDINGS

Our results revealed a significant difference between healthy and tinnitus subjects (p < 0.05). Post-hoc comparisons using the Bonferroni test showed increased entropy in the tinnitus group for all electrodes (p < 0.05) at low frequencies and most electrodes at mid frequencies. In addition, after the intervention, paired t-test showed a reduction in entropy to somehow above normal control levels for all electrodes at low-frequencies. Such results were accompanying clinical improvement after the intervention.

CONCLUSION

The increased entropy in tinnitus patients might reflect the chaotic behavior of the brain. Nonlinear methods in EEG studies (Entropy) could be of great importance in understanding tinnitus neurophysiology and might potentially be a suitable criterion for clinical practice.

Study of the Effect of Minimal Sensorineural Hearing Loss on the Central Auditory Processing in Children: A Pilot Study

Hearing loss is a main cause of poor auditory, academic, and social performance especially in children. This study aimed to find out the relationship between minimal hearing loss (sensorineural or conductive) and the central auditory processing disorders in children. A cross-sectional study was conducted to compare the probability of having central auditory processing disorder in 159 children diagnosed with minimal sensorineural hearing loss and hearing loss caused by otitis media with effusion aged (6-7 years old) in 4 primary schools in Damascus Syria, and 155 children with normal hearing of the same age group using the children's auditory performance scale (C.H.A.P.S). A remarkable statistical difference was found between the two groups with higher scores of C.H.A.P.S scale in the minimal hearing loss group (P value = 0.000 < 0.05). The difference involved all the sub-scales of the C.H.A.P.S scale, which indicates that minimal hearing loss in children can be considered as one important predisposing factor for central auditory processing disorders.

Burnout levels and correlates among healthcare providers in Syria following the 2023 Turkish-Syrian earthquakes: A cross-sectional study

Background and Aims

This article examines the prevalence of burnout among healthcare providers in the aftermath of the recent earthquakes in Syria and Turkey and explores the associated risk factors.

Methods

This cross-sectional study included 270 healthcare providers in three Syrian cities damaged by earthquakes. Participants were asked to fill out a validated questionnaire on the fifth day of emergency response using the Geldard Occupational Burnout questionnaire.

Results

The mean score for the Geldard Occupational Burnout Questionnaire was 129.79, with 81.4% indicating moderate burnout risk and only 3% indicating high risk. Gender was not significantly associated with burnout, but there was a significant difference in burnout scores between city groups, with Latakia scoring significantly lower than Aleppo.

Conclusion

This study highlights the prevalence of burnout among healthcare providers in the aftermath of an earthquake in Syria, with the majority having a moderate risk of burnout. Gender was not significantly associated with burnout risk. Further research is needed to develop effective interventions and address study limitations. The study emphasizes the importance of prioritizing healthcare providers' mental health to ensure high-quality care after natural disasters.

Use of Some Relevant Parameters for Primary Prediction of Brain Activity in Idiopathic Tinnitus Based on a Machine Learning Application

INTRODUCTION

Tinnitus is one of the most common complaints, distressing about 15-24% of the adult population. Because of its pathophysiology heterogeneity, no curable treatment has been attained yet. Even though a neuromodulation management technique based on the tinnitus network model is currently being developed, it has not yet worked because the most involved brain areas still remain unpredictable from the patient's individual clinical and functional profile. A remarkable correlation between tinnitus network activity and the subjective measures of tinnitus like perceived loudness and annoyance and functional handicap is well established. Therefore, this study aimed to develop software for predicting the involved brain areas in the tinnitus network based on the subjective characteristics and clinical profile of patients using a supervised machine-learning method.

METHODS

The involved brain areas of 30 tinnitus patients ranging from 6 to 80 months in duration were recognized by using QEEG and sLORETA software. There was a correlation between subjective information and those areas of activities in all rhythms by which we wrote our software.

RESULTS

For verification and validation of the software, we compared and analyzed the results with SPSS data and the receiver operating characteristic (ROC) curves.

CONCLUSIONS

The findings of this study confirmed the effectiveness of the software in predicting the brain activity in tinnitus subjects; however, some other important parameters can be added to the model to strengthen its reliability and feasibility in clinical use.

Validity and Reliability of theArabicVersion of Children’s Auditory Performance Scale

Background and Aim: Central auditory processing disorder (CAPD) is seen  in  a wide array of populations, including children and adults. CAPD  is characterized  by deficits  in one or more auditory abilities, causes difficulties in auditory discrimination, temporal and binaural processing although hearing thresholds are in the normal range. Children’s auditory performance scale (CHAPS) is a screening instrument. This study examined the reliability and validity of the Arabic version of children’s auditory performance scale. Methods: In this cross-sectional study, 50 healthy children were included. The children’s ages ranged from seven to nine years, and they passed the screening test using distortion product otoacoustic emissions before administering the scale in the translation process, the back- translation method was used, in addition to the face validity procedure. Teachers fulfilled the questionnaire in the presence of an audiologist. After two weeks, the scale was re-administrated, and then the statistical analysis was done to examine the reliability and validity of Arabic version of CHAPS (CHAPS-AR). Results: The internal consistency was examined with Cronbach’s α (α=0.997), for test- retest reliability, Pearson›s (r) was examined (r=0.994) and when executing the face validity, five experts agreed that the CHAPS-AR has a clear structure, syntax and it is easy to understand and use. Conclusion: The Arabic version of CHAPS can be considered a reliable and valid screening instrument for clinical and research use   Keywords: Central auditory processing disorder; screening; children; auditory; Arabic; validity

An overview of the tinnitus network activity and its clinical implications

Background and Aim: Tinnitus, the phantom perception of sound, in which many cortical and subcortical areas are involved has become one of the popular subjects of neuroscience research. Neuroimaging studies have introduced the tinnitus network model to explain the involvement of auditory and non-auditory areas in this perception. In such a model, the cognitive and emotional aspects of tinnitus can be interpreted conveniently. Therefore, this paper aimed to review the neural basis of tinnitus networks, including data from neuroimaging studies, and discuss the clinical implication of this concept, as well.Recent Findings: The data from neuroimaging studies were reviewed and discussed in order to complete the overall image of tinnitus network and its correlates such as the distress network, attentional network and other cognitive mechanisms. In addition to the auditory system, the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC) were considered to be important hubs in tinnitus distress network, especially for having important connectivity with the other networks like attention and salience networks. Moreover, the top-down control of DLPFC over the other brain areas was regarded as the most important brain area to be targeted using the non-invasive interventions and the results were compelling.Conclusion: Understanding the network model has helped in optimizing the neuromodulation protocols like electrical stimulation techniques. Thus, the clinical implications of this model can be generalized to the other types of treatments and the outcomes might be satisfying.

Validation and cross-cultural adaptation of the Arabic version of the Ear Outcome Survey-16 (EOS-16)

Background

The Ear Outcome Survey-16 (EOS-16) has been validated according to the health-related quality of life (HRQol) survey guidelines. It has important compatible aspects in evaluating patients with chronic otitis media (COM) suitable for consultation. This study aimed to develop and standardize the Arabic version of the EOS-16 to be used by clinicians in the Arab world while maintaining the conceptual equivalence.

Methods

A prospective cross-sectional study was conducted in Damascus between July 2023 and November 2023 to develop an Arabic version of the EOS-16. The translation was produced according to the cross-cultural adaptation guidelines. Both experts' and participants' opinions as regards face validity were obtained in this study. Internal consistency was evaluated by the Cronbach alpha coefficient. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and Pearson correlation.

Results

A total of 81 patients enrolled in the study, with an average age of 34.75 years and a standard deviation of 11.84 years with a sex ratio of 0.62 for females. All had inactive mucosal COM (dry perforation). The overall score of the EOS-16 survey was 31.72 with a standard deviation of 13.42 suggesting bothering and influencing symptoms in COM patient's daily life. Excellent internal consistency was noted (Cronbach α = .89). Robust correlation was found between test-retest overall scores (r = .90). Reallocation of the items of the EOS-16 improved the internal consistency of the subdivisions in COM patients.

Conclusion

The Arabic version of the EOS-16 is a simple, clear, reliable, reproducible, and valid HRQoL survey. It is a useful and important instrument that helps physicians in making decisions regarding the patient's treatment and follow-up.

Diode Laser for Juvenile Recurrent Respiratory Papillomatosis: A Case Series of 13 Patients

Juvenile recurrent respiratory papillomatosis (JRRP) is the most common benign tumor in the larynx. It is uncommon; however, it is potentially life-threatening because it compromises the respiratory tract and required several surgeries to manage recurrences. Currently, the carbon dioxide laser is the treatment of choice. There are no studies about the role of the diode laser which is easy to use and has lower usage cost. This case series presentation reported on the therapeutic effects and recurrence rate of JRRP when using Diode laser. This is a case series presentation of 13 children, who were diagnosed with JRRP and operated for laryngeal papillomatosis with Diode laser in Otorhinolaryngology and Head and Nick Surgery Department et al. Mouwasat Hospital, Damascus, Syria between 2015 and 2022. 13 children required 56 surgeries at a rate of 1-2 surgeries/year, mean number of surgeries for each child was 4.31. That suggests that Diode laser might have a role in reducing the number of surgeries compared to a study used cold instrument and CO2 laser. The complications rate was 30.8%, which is considered a high rate compared to the other studies. In conclusion, we encourage using it when the CO2 laser device is not available. However, we suggest, reducing the power as low as possible and avoiding of two opposing raw surfaces, especially at the anterior commissure and deep excision. Further longitudinal studies are recommended to validate these results.

Unmasking vestibular schwannoma: A series of unusual cases

INTRODUCTION

Vestibular schwannoma (VS) is a benign, slow-growing tumor that accounts for 80-90 % of cerebellopontine angle (CPA) tumors. While classic symptoms like hearing loss, tinnitus, and vertigo are well-recognized, atypical presentations can delay diagnosis.

CASE PRESENTATION

We present four unusual cases of VS. The first patient, a 33-year-old woman, initially presented with transient tinnitus and later developed peripheral vertigo. The second case involved a 52-year-old man with sudden hearing loss, vertigo, and aural fullness. The third case was a 17-year-old female with unilateral auditory neuropathy. The fourth patient, a 39-year-old woman, presented with intermittent tinnitus, balance disturbances, and facial stiffness.

DISCUSSION

Detailed history, physical examination, and audiological evaluation are crucial for identifying patients at risk for vestibular schwannoma, especially with atypical audiological findings, to avoid misdiagnosis.

CONCLUSION

This case series emphasizes the significance of considering VS as a differential diagnosis for atypical symptoms. Early recognition and proper practice can lead to optimal outcomes for patients and contribute valuable insights to the scientific field by broadening the understanding of the diverse spectrum of VS symptoms.

Evaluating the Efficacy of a 5-Min Music Listening Intervention for State Anxiety Reduction in College Students: A Randomized Controlled Trial

Objective

The primary objective of this research was to investigate the impact of a brief 5-min period of listening to a standardized piece of music (Oriental Jazz) on state anxiety among Syrian college students, providing insights into the potential effectiveness of music as a pre-lecture anxiety reduction tool.

Methods

A two-phase randomized controlled trial conducted in Damascus, Syria. The participants were college students aged 18-24 who met specific criteria and were randomly assigned to either a music intervention group or a control group. State anxiety was measured pre- and post-intervention using the spielberger state anxiety inventory (STAI-S).

Results

In total, 69 participants were included in this study. The mean score decreased non-significantly in the intervention group (37.9-36.8, p = 0.258) and the control group (46-43.6, p = 0.444). The changes in the anxiety score on phase 2 were insignificant between both study arms (p = 0.622). These results indicate that music has no significant effect on STAI scores.

Conclusion

Our study did not find evidence supporting the anxiety-reducing effects of a brief exposure to a unified piece of music (Oriental Jazz). Given these findings, this intervention does not appear to have benefits for reducing anxiety when applied before lectures. Future investigations should consider personalized music interventions, duration, and individual preferences.