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October 2014
Number 28
TRI NEWSLETTER
Research Highlights
3
EDITORIAL
News
4
Upcoming Meetings
6
Coming together is a beginning. Keeping together is progress.
Working together is success.
Recently published literature
IEpidemiology
10
IIPathophysiology
15
IIIDiagnostics
29
IVImaging
37
VPharmacotherapy
43
VI
Auditive Stimulation
52
VII
Brain Stimulation
61
VIII Behavioral Therapy
69
IX
Somatic Tinnitus
71
X
Surgical Treatment
71
XIHolistic
77
XIIReview
78
XIIIOthers
86
XIV Case Reports
89
XV Specific Forms of Tinnitus 103
Over the last years tinnitus research developed enormously in quantity,
methodological quality, internationality and multidisciplinarity. This is true both for basic
and clinical research and can be easily illustrated by some recent facts:
1. Continuing the tradition of yearly world-wide tinnitus meetings bringing
together researchers and clinicians from all over the world, the 9th International TRI
Tinnitus Conference "Tinnitus: from cochlea to brain and back" will take place
from 7-10 June, 2015 in Ann Arbor, Michigan, organized by Prof. Susan Shore.
Registration to the meeting and abstract submission will open November 10 on the
conference website.
2. Since June 2014 a growing amount of European clinicians and researchers
are cooperating within the project “Better understanding the Heterogeneity of
Tinnitus to Improve and Develop New Treatments (TINNET)" which is funded
by the European COST program (http://tinnet.tinnitusresearch.net). For a project
duration of 4 years, over 150 experts from 26 European countries will work together to
understand the tinnitus heterogeneity. Organized in 5 workgroups (Clinical, Database,
Neuroimaging, Genetics and Outcome Measures) the researchers and clinicians will
meet several times every year to develop new ways for the diagnosis and treatment of
tinnitus subtypes.
3. Very recently a clinical practice guideline for the management of tinnitus patients
has been published by clinicians in the US.
XVI Animal Models
103
XVII Psychological Factors
112
XVIIIHyperacusis
113
4. Tinnitus related publications are increasing, and so are tinnitus-related Special
Issues in renowned open access journals:
Clinical Trials
114
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DISCLAIMER
The Tinnitus Research Initiative Foundation, its representatives and employees (TRI) make no representations or warranties with
respect to this newsletter.
This newsletter provides INFORMATION – and does not provide medical advice. All the information and contents provided in this
newsletter are provided for educational and informational purposes only. The scientific and medical information contained in this
newsletter is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the
advice of qualified healthcare professionals who are familiar with your individual medical needs.
TRI, its representatives and employees, to the fullest extent permitted by law, disclaim all warranties, either express or implied,
statutory or otherwise, including but not limited to all implied warranties of merchantability, non- infringement of third party rights, and
fitness for a particular purpose. Specifically, TRI makes no representations or warranties as to the reliability, accuracy, timeliness or
completeness of the information and content of this newsletter.
Image Source: Photocase Imprint
Contact
© 2014 Tinnitus Research Initiative Foundation (www.tinnitusresearch.org)
Figure: PubMed listed publications on tinnitus per year.
The special issue "Plasticity of Neural Systems in Tinnitus" has just been published
in the journal “Neural Plasticity”.
In a further special issue of Frontiers in Neuro-Otology various tinnitus models are
contrasted: "Tinnitus: an attempt to confront the diverse models".
A special issue in Biomed Research International has just been opened for
submissions: "Pathology of Tinnitus and Hyperacusis-Clinical Implications".
The relevance of free availability of high-quality tinnitus research papers all over
the world cannot be underestimated. Some of these papers may teach, inspire and
motivate young researchers worldwide, or even tinnitus patients themselves, to come
up with innovative ideas for the development of better tinnitus therapies.
And in the spirit of Thomas Alva Edison we have to remain humble but positive
at the same time: ”I have not failed, I have just found 10,000 ways that won’t work.”
Thus even though most treatments that have been attempted to conquer the enigmatic
symptom of tinnitus have failed, the failures will ultimately result in success, just like the
removal of marble pieces from a big stone ultimately results in a beautiful statue. The
more we understand what is not involved in the pathophysiology of tinnitus the closer
we get to the answer of finding cure(s) for tinnitus.
Ana Belén Elgoyhen Dirk De Ridder Berthold Langguth
Winfried Schlee
Sylvia Dorner-Mitschke
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2
RESEARCH HIGHLIGHTS
Pape J et al. (2014) Playing and listening to tailor-made notched music: cortical plasticity induced
by unimodal and multimodal training in tinnitus patients. Neural Plast. 2014;2014:516163. doi:
10.1155/2014/516163. Epub 2014 May 8.
The authors replicated their findings that listening to tailor-made notched music induces plastic
changes in the auditory cortex which counteracts the tinnitus. Furthermore, they demonstrated
the importance of an unisensory training where the participant attends the auditory stream only.
Farinetti A et al. (2014) Cochlear implant complications in 403 patients: Comparative study of
adults and children and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis. 2014
May 30. pii: S1879-7296(14)00009-X. doi: 10.1016/j.anorl.2013.05.005. Epub 2014 Jun 2.
A large number of 403 CI surgeries was assessed and analysed with respect to post-surgery
complications. Overall, the complication rate was 19.9% (5% major, 14.0% minor) with a reduced
complication rate for children.
Park B et al. (2014) Analysis of the Prevalence of and Risk Factors for Tinnitus in a Young
Population. Otol Neurotol. 2014 Jun 9. [Epub ahead of print]
In a large Korean sample of over 3000 teenagers, the authors found a tinnitus prevalence of
17.7% - but only 0.3% of them report to be severely disturbed by it. Noise exposure, lack of sleep
and female gender have been identified to be the major risk factors in this population.
Jasper K et al. (2014) Internet-Based Guided Self-Help versus Group Cognitive Behavioral
Therapy for Chronic Tinnitus: A Randomized Controlled Trial. Psychother Psychosom.
2014;83(4):234-46. doi: 10.1159/000360705. Epub 2014 Jun 19.
A face-to-face group cognitive behavioural therapy intervention for tinnitus (n=43) was compared
with an internet-based cognitive behavioural therapy (n=41). Both groups showed significant
improvements in the THI and Mini-TQ scores. There was no significant difference between the
face-to-face and the internet-based intervention.
Schneider DM et al. (2014) A synaptic and circuit basis for corollary discharge in the auditory
cortex. Nature. 2014 Aug 27. doi: 10.1038/nature13724. [Epub ahead of print]
In a mouse model, the authors demonstrated the suppression of excitatory neurons in the
auditory cortex during movement. A subset of neurons in the secondary motor cortex directly
inhibits the auditory cortex activity while the mouse is moving. This work might have an impact
on tinnitus research and therapy.
Meyer M et al. (2014) Disentangling Tinnitus Distress and Tinnitus Presence by Means of EEG
Power Analysis. Hindawi Publishing Corporation, Neural Plasticity, Volume 2014, Article ID
468546, 13 pages. http://dx.doi.org/10.1155/2014/468546.
Using a component analysis of EEG data on 48 participants, the authors Meyer et al. identified
two distinct and independent components: tinnitus distress and tinnitus presence.
Knudson IM et al. (2014). Increased Contralateral Suppression of Otoacoustic Emissions
Indicates a Hyper-responsive Medial Olivocochlear System in Humans with Tinnitus and
Hyperacusis. J Neurophysiol. 2014 Sep 17. pii: jn.00576.2014. [Epub ahead of print]
Is it top-down or bottom-up? The work of the authors Knudson et al. emphasizes atypical topdown activity from the brainstem to the cochlea to be responsible for reduced sound tolerance
and tinnitus.
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3
Registration and Abstract Submission
opens on
November 10, 2014
http://tri2015.org
Local Committee
Scientific Committee
Richard Altschuler, PhD
Gabriel Corfas, PhD
Kara Leyzac, PhD
Silvana Papagerakis, MD, PhD
Susan Shore, PhD (Symposium Chair)
Anthony Cacace, PhD
Jennifer Melcher, PhD
Larry Roberts, PhD
Jinsheng Zhang, PhD
Invited Speakers
Invited Discussants
Eberhard Biesinger, MD (Germany)
Donald Caspary, PhD (USA)
Gabriel Corfas; PhD (USA)
James Kaltenbach, PhD (USA)
Marlies Knipper, PhD (Germany)
Sharon Kujawa, PhD (USA)
Berthold Langguth, PhD (Germany)
Jennifer Melcher, PhD (USA)
Alexander Meredith, PhD (USA)
Yehoash Raphael, PhD (USA)
Larry Roberts, PhD (Canada)
Tanit Sanchez, MD, PhD (Brazil)
Martin Sarter, PhD (USA)
Winfried Schlee, PhD (Germany)
Michael D Seidman, MD FACS (USA)
Susan Shore, PhD, Symposium Chair (USA)
Michael Sutton, PhD (USA)
Jeremy Turner, PhD (USA)
Jos Eggermont, PhD (USA)
Belen Elgoyhen, PhD (Argentina)
Sylvie Hebert, PhD (Canada)
Joseph Rauschecker, PhD (USA)
Richard Salvi, PhD (USA)
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4
TRACK YOUR TINNITUS WITH THE
FREE SMARTPHONE APP
The Tinnitus Research Initiative has released a smartphone app that allows to track the tinnitus during the
everyday routine. The TrackYourTinnitus app is available in the iTunes® App StoreSM and the Google
PlayTM store in English and German language. Please register at the website www.trackyourtinnitus.org.
http://www.trackyourtinnitus.org
iTunes® App StoreSM
Google PlayTM Store
Apple, the Apple logo, and iTunes are trademarks of Apple Inc., registered in the U.S. and other countries.
Google Play is a trademark of Google Inc.
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5
Upcoming Meetings Meetings exclusively dedicated to Tinnitus are marked red
October 2014
EUHA 2014 - 59. International Congress of Hearing Aid Acousticians
When:
October 15 – 17, 2014
Where:Hannover, Germany
Detailed Information: http://www.euha.org/veranstaltungen/
168th Meeting of the Acoustical Society of America
When:
October 27 – 31, 2014
Where:Indianapolis, USA
Detailed Information: acousticalsociety.org
November 2014
Innner Ear Biology Workshop 2014
When:
Where:
November 01 - 04, 2014
Kyoto International Conference Center, Kyoto, Japan
Detailed Information: http://www.acplan.jp/ieb-kyoto2014/index.html
IAPA 2014 - 17th International Congress in Audiological Medicine
in conntction with Hearing International Annual Meeting
When:
November 05 - 07, 2014
Where:Pattaya, Thailand
Detailed Information: http://www.iapa2014.org/registration.aspx
Implantable Devices 2014: The State of the Art
When:
November 07, 2014
Where:
National College for School Leadership, Nottingham, UK
Detailed Information: http://www.earfoundation.org.uk/
BTA Tinnitus Information Day
When:
November 15, 2014
Where:
Caversham Bridge, Reading, UK
Detailed Information: http://www.tinnitus.org.uk/events/944
The COMET IV Meeting 2014
When:
Where:
Detailed Information:
November 19 - 20, 2014
Pontificia Universita Lateranense
Piazza San Giovanni in Laterano,
400120 Città del Vaticano, Italy
http://www.comet-initiative.org/meeting
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6
ASHA 2014 Annual Convention
When:
November 20 - 22, 2014
Where:
Orlando, FL, USA
Detailed Information: http://www.asha.org/events/convention/
DGPPN Congress 2014
When:
November 26 - 29, 2014
Where:
Citycube, Berlin, Germany
Detailed Information: http://www.dgppn.de/en/congress.html
January 2015
Masterclass: Tinnitus Hyperacusis in Adults and Children
When:
January 20 – 22, 2015
Where:
UCL Ear Institute, London, UK
Detailed Information: http://www.ucl.ac.uk/ear/courses/shortcourses/aamc/aamc-pages/tinnitusandhyperacusis
February 2015
BTA Tinnitus Advisor Training
When:
February 06 – 07, 2015
Where:
Sheffield, UK
Detailed Information: www.tinnitus.org.uk/tinnitus-adviser-training
ARO (The Association for Research in Otolaryngology) 38th MidWinter
Meeting
When:
February 21 – 25, 2015
Where:
Baltimore, MD, USA
Detailed Information: http://www.aro.org/mwm/mwm.html
March 2015
Tinnitus & Hyperacusis Therapy Masterclass
When:March 2015
Where:
Birkbeck College, University of London, UK
Detailed Information: http://tinnitustherapy.org.uk/
18. Jahrestagung der Deutschen Gesellschaft für Audiologie (DGA e.V.)
When: March 04 – 07, 2015
Where:Bochum, Germany
Detailed Information: Flyer
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7
42st Annual AAS Scientific and Technology Conference of the American
Auditory Society
When:
March 05 – 07, 2015
Where:
Chaparral Suites in Scottsdale, AZ, USA
Detailed Information: http://www.amauditorysoc.org/
April 2015
10th Asia Pacific Symposium on Cochlear Implants and Related Sciences
When:
April 30 – May 03, 2015
Where:Beijing, China
Detailed Information: http://www.apsci2015.com/enindex.aspx
May 2015
AudiologyNOW! 2015
When: May 25 – 28, 2015
Where:
San Antonio, TX, USA
Detailed Information: www.audiologynow.org
12th EFAS Congress
When: May 27 – 30, 2015
Where:Istanbul, Turkey
Detailed Information: http://www.efas2015.org/
June 2015
8th INTERNATIONAL TRI TINNITUS CONFERENCE
Tinnitus: from cochlea to brain and back
When:
June 07 – 10, 2015
Where:
Ann Arbor, MI, USA
Detailed Information: http://www.tinnitusresearch.org
23th Annual Management of the Tinnitus Patient Course
When: June 12 – 13, 2015
Where:
University of Iowa, IA, USA
Detailed Information: http://www.medicine.uiowa.edu/oto/tinnituscourse/
OHBM 2015: 21st Annual Meeting of the Organization for Human Brain
Mapping
When: June 14 – 18, 2015
Where:
Honolulu, Hawaii, USA
Detailed Information: http://www.humanbrainmapping.org/i4a/pages/index.cfm?pageid=3298
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8
17th International Symposium on Hearing (ISH)
(The meeting is a sequel to the meeting held in Cambridge in 2012)
When: June 15 – 19, 2015
Where:
Familiehotel Paterswolde, Groningen, NL
Detailed Information: http://www.ish2015.nl
BTA Advisor Training
When: June 26 – 27, 2015
Where:London, UK
Detailed Information: www.tinnitus.org.uk/tinnitus-adviser-training
30th Polizter Society Meeting
When: June 30 – 05, 2015
Where:Niigata, Japan
Detailed Information: http://www.c-linkage.co.jp/politzer2015/
July 2015
2nd International Conference on Hyperacusis
When: July 09 – 10, 2015
Where:
Birkbeck College, University of London, UK
Detailed Information: http://hyperacusisresearch.co.uk/
October 2015
BTA Advisor Training
When:
October 09 – 10, 2015
Where:
Sheffield, UK
Detailed Information: www.tinnitus.org.uk/tinnitus-adviser-training
7th International Symposium on Meniere's Disease and Inner Ear Disorders
When:
October 17 – 20, 2015
Where:Rome, Italy
Detailed Information: https://www.etouches.com/ehome/76981/155439/?&
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9
Recently published literature (articles of authors who are collaborating with TRI are marked in blue)
IEpidemiology
Laterality of sudden sensorineural hearing loss.
Ear Nose Throat J. 2014 Aug;93(8):318-20.
Reiss M1, Reiss G.
1
Department of Ear, Nose and Throat, Elblandklinikum Radebeul, Heinrich-Zille-Str. 13, D-01445
Radebeul, Germany. [email protected].
It is known that sudden sensorineural hearing loss and other otoneurologic diseases, such as tinnitus or
Ménière disease, occur more frequently in the left ear than in the right. We studied lateralization of sudden
deafness in 489 patients treated at Radebeul Hospital from January 2004 to December 2009. The maleto-female ratio was 1:1.24; we found a predominance of the left side only in female patients. The cause for
this predominance is unclear. The slight asymmetry might indicate a greater vulnerability of the left inner
ear in women, suggesting hormonal factors in the genesis of sudden deafness.
Clinical observations and risk factors for tinnitus in a Sicilian cohort.
Eur Arch Otorhinolaryngol. 2014 Sep 5. [Epub ahead of print]
Martines F1, Sireci F, Cannizzaro E, Costanzo R, Martines E, Mucia M, Plescia F, Salvago P.
1
Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, (BioNeC), Sezione di
Otorinolaringoiatria, Università degli Studi di Palermo, Via del Vespro, 129, 90127, Palermo, Italy,
[email protected].
The aims of this study were to determine the distribution of risk factors associated with tinnitus analysing
their role in the development of tinnitus and the effects of their interaction; to evidence the importance
of a suitable and adequate clinical and audiologic assessment to avoid those modifiable risk factors
responsible for cochlear dysfunction and tinnitus onset. 46 subjects with tinnitus and 74 controls were
studied according to: age, sex, Body Mass Index (BMI), neck circumference, tobacco smoking, feeling
fatigue or headache, self reporting snoring, hypertension, diabetes, coronary heart disease, and/or
hyperlipidemia, and laboratory finding as lipid profile and levels of reactive oxygen metabolites (d-ROM).
Audiological assessment was performed by multi-frequency audiometry (PTA0.5-16 kHz) and transientevoked otoacoustic emissions (TEOAE diagnostic). Univariate analysis was performed to examine the
association between determinants and occurrence of tinnitus; Mantel-Haenszel test (G.or) was used to
investigate the joint effect of determinants on tinnitus. Tinnitus was more frequent among males with age
>50 years; BMI >30 kg/m2, neck circumference >40 cm, headache, hypertension, hypercholesterolemia
resulted significant risk factors for tinnitus (P < 0.0001). Tinnitus group had more comorbidity (P < 0.0001)
and worse audiometric thresholds (60.87 Vs 21.62 % hearing loss; P < 0.0001) with respect to control group.
The interaction between hypertension-BMI ≥ 30 kg/m2 (G.or = 8.45) and smoking-hypercholesterolemia
(G.or = 5.08) increases the risk of tinnitus (P < 0.0001). Our results underline that several factors either
individually or jointly contribute to tinnitus onset; a comprehensive knowledge about tinnitus risk factors
and associated clinical conditions could contribute to minimizing this disorder.
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Seasonal trends in tinnitus symptomatology: evidence from Internet search engine query data.
Eur Arch Otorhinolaryngol. 2014 Sep 19. [Epub ahead of print]
Plante DT1, Ingram DG.
1
Department of Psychiatry, Wisconsin Psychiatric Institute and Clinics, University of Wisconsin School
of Medicine and Public Health, 6001 Research Park Blvd., Madison, WI, 53719, USA, dplante@wisc.
edu.
The primary aim of this study was to test the hypothesis that the symptom of tinnitus demonstrates a
seasonal pattern with worsening in the winter relative to the summer using Internet search engine query
data. Normalized search volume for the term 'tinnitus' from January 2004 through December 2013 was
retrieved from Google Trends. Seasonal effects were evaluated using cosinor regression models. Primary
countries of interest were the United States and Australia. Secondary exploratory analyses were also
performed using data from Germany, the United Kingdom, Canada, Sweden, and Switzerland. Significant
seasonal effects for 'tinnitus' search queries were found in the United States and Australia (p < 0.00001 for
both countries), with peaks in the winter and troughs in the summer. Secondary analyses demonstrated
similarly significant seasonal effects for Germany (p < 0.00001), Canada (p < 0.00001), and Sweden (p =
0.0008), again with increased search volume in the winter relative to the summer. Our findings indicate that
there are significant seasonal trends for Internet search queries for tinnitus, with a zenith in winter months.
Further research is indicated to determine the biological mechanisms underlying these findings, as they
may provide insights into the pathophysiology of this common and debilitating medical symptom.
Auditory risk behaviours and hearing problems among college students in Serbia.
Med Glas (Zenica). 2014 Aug;11(2):361-6.
Budimčić M1, Seke K, Krsmanović S, Zivić L.
1
Departement for Sanitary Ecology, High Medical School of Professional Studies, Belgrade,
Aim: To investigate an association of auditory lifestyle and risk behaviours with hearing loss and to identify
the leading hearing problems among college students in Serbia exposed to loud music. Methods: The
participants of the study comprised 780 college students of the High Medical School of Professional
Studies of Belgrade (653 females and 127 males), the majority of whom were between 19 to 24 years
of age. A cross sectional study was conducted in order to investigate the association between exposure
to noise in one's leisure time and subsequent hearing problems using a self-reporting questionnaire.
Results: A total of 640 (82.1%) of students had a habit of listening to loud music, 421 (65.8%) experienced
tinnitus and 79 (10.1%) had a subjective feeling of hearing loss. The most significant association between
self-reported hearing loss was living in noisy environments (p=0.000), and the appearance of difficulties
(vertigo, anxiety) (p=0.000), as well as usage of personal music devices (p=0.087). Conclusion: While
students who were exposed to loud sound levels may still not have shown serious hearing problems or
hearing loss, a great number did experience tinnitus or some other difficulties after listening to music at
loud volumes. Key words: young people, loud music, life style, hearing loss.
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11
Clinical and audiometric features of presbycusis in Nigerians.
Afr Health Sci. 2013 Dec;13(4):886-892.
Sogebi O1, Olusoga-Peters O2, Oluwapelumi O2.
1
Department of e of Health Sciences, Olabisi Onabanjo University, Sagamu. Nigeria.
BACKGROUND: Presbycusis is the most common sensory impairment associated with ageing and it
presents with variability of symptoms. Physicians need to recognize early clinical and audiometric signs of
presbycusis in order to render adequate and quality care to patients and reduce associated morbidities.
OBJECTIVE: To characterize the clinical modes of presentation and the typical audiometric tracings
among patients with presbycusis. METHODS: This descriptive, prospective hospital-based study was
conducted in the Ear, Nose and Throat (ENT) clinic of Olabisi Ona hing Hospital, (OOUTH) Sagamu,
Nigeria. Patients with clinical diagnosis of presbycusis confirmed with bilateral sensorineural hearing
loss (SNHL) on diagnostic audiometry were administered with questionnaires. Information obtained was
analyzed using SPSS statistical package version 17.0 and presented in descriptive forms as percentages,
means and graphs. RESULTS: Sixty-nine patients were diagnosed with presbycusis (M:F =1.6:1). Modal
age group was 71-80 years. Hearing loss 88.4%, tinnitus 79.7% and vertigo 33.3% were the major
symptoms on presentation. The average duration of symptoms before presentation was 2.6 years. There
was positive history of ototoxic drugs usage in 24.6 %, family history in 11.6 %, hypertension in 34.8% and
osteoarthritis in 13.0%. The most common type of audiometric pattern was strial. Hearing losses increased
with age both at the speech and at the higher frequencies of sounds. CONCLUSIONS: We found hearing
impairment affected both speech and higher frequencies and the strial type of audiometric pattern was
most common. The need for screening for hearing impairment from early middle age in symptomatic
individuals is emphasized. Free PMC Article.
Occupational hearing loss of market mill workers in the city of Accra, Ghana.
Noise Health. 2014 May-Jun;16(70):183-8. doi: 10.4103/1463-1741.134919.
Kitcher ED1, Ocansey G, Abaidoo B, Atule A.
1
Department of Surgery, University of Ghana Medical School, Accra, Ghana.
Noise induced hearing loss (NIHL) is an irreversible sensorineural hearing loss associated with exposure
to high levels of excessive noise. Prevention measures are not well established in developing countries.
This comparative cross sectional study aims to determine the prevalence of hearing loss in both a group
of high risk workers and a control group and to assess their knowledge of the effects of noise on hearing
health. A total of 101 market mill workers and 103 controls employed within markets in the city of Accra,
Ghana, were evaluated using a structured questionnaire and pure tone audiometry. The questionnaire
assessed factors including self-reported hearing loss, tinnitus, knowledge on the effects of noise on
hearing health and the use of hearing protective devices. Pure tone audiometric testing was conducted
for both mill workers and controls. Noise levels at the work premises of the mill workers and controls were
measured. Symptoms of hearing loss were reported by 24 (23.76%) and 8 (7.7%) mill workers and controls
respectively. Fifty-five (54.5%) and fifty-four (52.37%) mill workers and controls exhibited knowledge of
the effects of noise on hearing health. Five (5.0%) mill workers used hearing protective devices. There
was significant sensorineural hearing loss and the presence of a 4 kHz audiometric notch among mill
workers when compared with controls for the mean thresholds of 2 kHz, 3 kHz and 4 kHz (P = 0. 001).
The prevalence of hearing loss in the better hearing ears of the mill workers and controls was 24.8% and
4.8% respectively (P < 0.5). The prevalence of hearing loss, which may be characteristic of NIHL in the
better hearing ears of the mill workers and controls was 24.8% and 4.8% respectively. The majority of mill
workers did not use hearing protection. Free Article.
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12
0069 Psychosocial work factors, occupational noise exposure, common mental disorders, and
the risk of tinnitus.
Occup Environ Med. 2014 Jun;71 Suppl 1:A67-8. doi: 10.1136/oemed-2014-102362.210.
Winther Frederiksen T1, Ramlau-Hansen CH2, Stokholm ZA3, Vestergaard JM3, Kolstad HA3.
Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus,
DenmarkDepartment of Otology, Head and Neck Surgery, Hospitalsenheden Vest, Holstebro, Denmark.
1
OBJECTIVES: Tinnitus is common, can be disabling, and may impair concentration, hearing and sleep.
Noise induced hearing loss, other subtypes of hearing loss and ototoxic drugs are well-documented risk
factors for tinnitus. Psychosocial work factors, depression and anxiety may exacerbate tinnitus, cause
tinnitus, or both. The objective is to investigate the relationship between noise exposure, psychosocial
work factors, common mental disorders, and tinnitusMETHOD: A total of 554 workers within 10
manufacturing trades and children day-care participated in this cross-sectional study from 2009-2010.
The study database contained information on individual short-term and long-term noise exposure levels,
hearing levels and questionnaire information on common mental disorders and psychosocial work factors.
Associations between noise exposure levels, hearing levels, depression, anxiety, burn-out symptoms,
work-related stress and tinnitus will be analysed by use of multiple logistic regression analysis, taking a
priori selected potential confounders into account. RESULTS: Preliminary results show that of the 554
participants, 77% were males an the mean age was 43 years, ranging from 20-64 years. Among the
participants, 17% reported tinnitus, 16% had a hearing handicap (WHO-definition), 3% anxiety disorder,
14% burn-out symptoms, 4% depression, and 8% reported work-related stress. CONCLUSIONS: Tinnitus
is expected to represent a heterogeneous group of underlying disorders. We aim at contributing to a better
understanding of the relative importance of the possible underlying factors in a population of occupationally
noise exposed workers. Risk analyses are in progress, and results will be presented at the conference. ©
2014, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted
under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Analysis of the Prevalence of and Risk Factors for Tinnitus in a Young Population.
Otol Neurotol. 2014 Jun 9. [Epub ahead of print]
Park B1, Choi HG, Lee HJ, An SY, Kim SW, Lee JS, Hong SK, Kim HJ.
1
*Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital,
Anyang; and †Department of Otorhinolaryngology-Head & Neck Surgery, Thyroid/Head & Neck Cancer
Center of the Dongnam Institute of Radiological & Medical Sciences, Busan, Korea.
BACKGROUND: Tinnitus in children and adolescents is known to be as common as in adults. However,
tinnitus in this young population is often overlooked, and a large population-based study designed to
adjust for various risk factors for tinnitus is lacking. METHODS: A cross-sectional study was conducted
using data from the Korea National Health and Nutrition Examination Survey, with 3047 participants aged
12 to 19 years, from 2008 through 2011. We investigated the tinnitus prevalence by questionnaire and
analyzed risk factors for tinnitus of three types: personal, otologic, and parental factors. RESULTS: The
prevalence of tinnitus in the young population was 17.7%, although only 0.3% of subjects reported severe
discomfort caused by tinnitus. The tinnitus prevalence increased with age (adjusted odds ratio [AOR],
1.087). Female gender (AOR, 1.401), sleeping less than 9 hours (sleep 7 or 8 h: AOR, 1.437; sleep 6 h or
less: AOR, 1.737), noise exposure in other places (AOR, 6.395), and momentary noise exposure (AOR,
5.504) increased the risk of tinnitus. Participants whose mother had a history of tinnitus showed higher
AORs. However, high body mass index, alcohol consumption, stress, monthly household income, having
an abnormal tympanic membrane, unilateral or bilateral hearing loss, noise exposure caused by earphone,
and noise exposure in the workplace, all reported risk factors for tinnitus, showed no statistically significant
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difference. A tinnitus history in the father was also not associated with tinnitus in children.
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13
Prevalence and Associated Factors of Tinnitus: Data From the Korean National Health and
Nutrition Examination Survey 2009-2011.
J Epidemiol. 2014 Jun 21. [Epub ahead of print]
Park KH1, Lee SH, Koo JW, Park HY, Lee KY, Choi YS, Oh KW, Lee A, Yang JE, Woo SY, Kim SW,
Cho YS.
1
Department of Otorhinolaryngology, Catholic University of Korea, College of Medicine.
Background: Tinnitus is a common condition and frequently can be annoying to affected individuals.
We investigated the prevalence and associated factors for tinnitus in South Korea using the data from
the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2009-2011.Methods:
KNHANES is a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n =
21 893). A field survey team that included an otolaryngologist moved with a mobile examination unit and
performed interviews and physical examinations.Results: Among the population over 12 years of age, the
prevalence of any tinnitus was 19.7% (95% CI 18.8%-20.6%). Tinnitus was more prevalent in women, and
the prevalence rate increased with age (P < 0.001). Among those with any tinnitus, 29.3% (95% CI 27.3%31.3%) experienced annoying tinnitus that affected daily life. Annoying tinnitus also increased with age (P
< 0.001), but no sex difference was demonstrated (P = 0.25). In participants aged 40 years or older, age,
quality of life, depressive mood, hearing loss, feeling of dizziness, and rhinitis were associated with any
tinnitus (P < 0.05). Age, hearing loss, history of cardiovascular disease, and stress were associated with
annoying tinnitus (P < 0.05).Conclusions: Tinnitus is a common condition, and a large population suffers
from annoying tinnitus in South Korea. Public understanding of associated factors might contribute to
better management of tinnitus. Free full text.
Prevalence, Associated Factors, and Comorbid Conditions for Ménière's Disease.
Ear Hear. 2014 Jul-Aug;35(4):e162-9. doi: 10.1097/AUD.0000000000000041.
Tyrrell JS1, Whinney DJ, Ukoumunne OC, Fleming LE, Osborne NJ.
1
European Centre for Environment and Human Health, University of Exeter Medical School, The
Knowledge Spa, Truro Campus, Cornwall, United Kingdom; 2Department of ENT Surgery, Royal
Cornwall Hospital, Truro, United Kingdom; and 3PenCLAHRC, University of Exeter Medical School,
Exeter, United Kingdom.
OBJECTIVES: The aims of this study were to estimate the prevalence of Ménière's disease and investigate
its relationship with: demographic factors; symptoms and conditions that are known or hypothesized to be
associated with Ménière's disease; other physical diseases; mental health. DESIGN: The authors used
cross-sectional data from the UK Biobank to compare 1376 self-reported Ménière's participants with over
500,000 without Ménière's. The data set has comprehensive anthropometric measures, questionnaire
data investigating health, well-being, diet, and medical and drug-prescribing history for each participant.
The authors used logistic regression models to investigate the relationship of Ménière's disease with:
demographic factors; symptoms and conditions that are known or hypothesized to be associated with
Ménière's disease; other physical diseases; and mental health. RESULTS: Ménière's disease was more
common in participants who were older (adjusted odds ratio per 10-year increase: 1.5 [95% confidence
interval:1.4-1.6]), white (odds ratio: 1.7;1.2-2.3), female (1.4;1.3-1.6), and having higher body mass index
categories (p < 0.001). The Ménière's group had greater odds of hearing difficulty (10.9;9.6-12.5), current
tinnitus (68.3;47.8-97.5), and had fallen more than once in the last year (2.1;1.8-2.5). Ménière's participants
had greater odds of reporting at least one disease from each grouping of allergic, immune dysfunction,
or autonomic dysfunction (2.2;1.8-2.6), and poor mental health (2.1;1.8-2.5). CONCLUSIONS: This study
provides an evidence base that improves understanding of Ménière's disease. Associations were noted
with a number of diseases, and the authors hypothesize a role for the autonomic nervous system and
immune system dysfunction in Ménière's etiology. The study also highlights the physical and mental health
correlates of the condition.
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14
IIPathophysiology
Evaluation of internal auditory canal structures in tinnitus of unknown origin.
Clin Exp Otorhinolaryngol. 2014 Sep;7(3):160-4. doi: 10.3342/ceo.2014.7.3.160. Epub 2014 Aug 1.
Polat C1, Baykara M2, Ergen B3.
1
Department of Otolaryngology, Elazig Training and Research Hospital, Elazig, Turkey.
OBJECTIVES: The aim of the present study was to evaluate the internal auditory canal (IAC) and the
nerves inside it to define possible structural differences in cases with subjective tinnitus of unknown origin.
METHODS: Cases applying to the ear, nose and throat department with the complaint of tinnitus with
unknown origin and having normal physical examination and test results were included in the study (n=78).
Patients admitted to the radiology clinic for routine cranial magnetic resonance imaging (MRI) and whose
MRI findings revealed no pathologies were enrolled as the control group (n=79). Data for the control group
were obtained from the radiology department and informed consent was obtained from all the patients.
Diameters of the IAC and the nerves inside it were measured through enhanced images obtained by
routine temporal bone MRIs in all cases. Statistical evaluations were performed using Student t-test and
statistical significance was defined as P<0.05. RESULTS: Measurements of IAC diameters revealed
statistically significant differences between the controls and the tinnitus group (P<0.05). Regarding the
diameters of the cochlear nerve, facial nerve, inferior vestibular nerve, superior vestibular nerve, and total
vestibular nerve, no statistically significant difference was found between the controls and the tinnitus
group. CONCLUSION: Narrowed IAC has to be assessed as an etiological factor in cases with subjective
tinnitus of unknown origin. Free PMC Article.
Audio-vestibular signs and symptoms in Chiari malformation type i. Case series and literature
review.
Acta Otorrinolaringol Esp. 2014 Sep 4. pii: S0001-6519(14)00129-0. doi: 10.1016/j.otorri.2014.05.002.
[Epub ahead of print] English, Spanish.
Guerra Jiménez G1, Mazón Gutiérrez A2, Marco de Lucas E3, Valle San Román N3, Martín Laez R4,
Morales Angulo C2.
1
Servicio de ORL, Complejo Hospitalario Insular Materno Infantil, Las Palmas, Gran Canaria, España.
Electronic address: [email protected].
INTRODUCTION: Chiari malformation is an alteration of the base of the skull with herniation through the
foramen magnum of the brain stem and cerebellum. Although the most common presentation is occipital
headache, the association of audio-vestibular symptoms is not rare. The aim of our study was to describe
audio-vestibular signs and symptoms in Chiari malformation type i (CM-I). MATERIALS AND METHODS:
We performed a retrospective observational study of patients referred to our unit during the last 5 years.
We also carried out a literature review of audio-vestibular signs and symptoms in this disease. RESULTS:
There were 9 patients (2 males and 7 females), with an average age of 42.8 years. Five patients presented
a Ménière-like syndrome; 2 cases, a recurrent vertigo with peripheral features; one patient showed a
sudden hearing loss; and one case suffered a sensorineural hearing loss with early childhood onset. The
most common audio-vestibular symptom indicated in the literature in patients with CM-I is unsteadiness
(49%), followed by dizziness (18%), nystagmus (15%) and hearing loss (15%). Nystagmus is frequently
horizontal (74%) or down-beating (18%). Other audio-vestibular signs and symptoms are tinnitus (11%),
aural fullness (10%) and hyperacusis (1%). Occipital headache that increases with Valsalva manoeuvres
and hand paresthesias are very suggestive symptoms. CONCLUSIONS: The appearance of audiovestibular manifestations in CM-I makes it common to refer these patients to neurotologists. Unsteadiness,
vertiginous syndromes and sensorineural hearing loss are frequent. Nystagmus, especially horizontal and
down-beating, is not rare. It is important for neurotologists to familiarise themselves with CM-I symptoms
to be able to consider it in differential diagnosis. Copyright © 2014 Elsevier España, S.L.U. y Sociedad
Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved. Free full text.
15
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'Acoustic shock': A new occupational disease? Observations from clinical and medico-legal
practice.
Int J Audiol. 2014 Oct;53(10):764-9. doi: 10.3109/14992027.2014.943847.
Parker W1, Parker V, Parker G, Parker A.
1
*Department of Medicine, Chesterfield Royal Hospital NHS Foundation Trust , Chesterfield , UK.
Abstract Objective: 'Acoustic Shock' injury has arisen with the proliferation of telephone-based employment
but is not yet fully understood. This study aimed to further characterize this phenomenon by reviewing the
current literature and analysing a case series. DESIGN: Cases were identified from medicolegal and clinical
practice. Case notes, including General Practitioner and occupational health records where available, were
scrutinised and information on demographics and medical history obtained. Patients underwent interview,
examination, and pure-tone audiometry. STUDY SAMPLE: Thirty cases were included. Eighteen (60%)
were female. Mean age was 41.6 years. RESULTS: There was a range of otological symptoms (mean
3.2 per patient), most commonly tinnitus which was present in 27 (90%), accompanied by diverse nonotological symptoms. Twenty-one (70%) had previous oto-pathology, 19 (63%) psychopathology, and five
(17%) head injury. Examination was normal in 28 (93%), as was audiometry in 13 (43%). Eleven (50%)
smoked. Hearing loss was not necessarily a feature. CONCLUSIONS: The condition known as 'acoustic
shock' injury is a complex disorder producing a range of symptoms with psychological overlay. However,
there is often little clinical evidence of pathology and it has not been adequately defined as yet. By further
characterization, epidemiology and aetiology can be better understood.
Perceptual Consequences of "Hidden" Hearing Loss.
Trends Hear. 2014 Sep 9;18. pii: 2331216514550621. Review.
Plack CJ1, Barker D2, Prendergast G2.
1
University of Manchester, UK [email protected].
Dramatic results from recent animal experiments show that noise exposure can cause a selective loss
of high-threshold auditory nerve fibers without affecting absolute sensitivity permanently. This cochlear
neuropathy has been described as hidden hearing loss, as it is not thought to be detectable using standard
measures of audiometric threshold. It is possible that hidden hearing loss is a common condition in humans
and may underlie some of the perceptual deficits experienced by people with clinically normal hearing. There
is some evidence that a history of noise exposure is associated with difficulties in speech discrimination
and temporal processing, even in the absence of any audiometric loss. There is also evidence that the
tinnitus experienced by listeners with clinically normal hearing is associated with cochlear neuropathy, as
measured using Wave I of the auditory brainstem response. To date, however, there has been no direct
link made between noise exposure, cochlear neuropathy, and perceptual difficulties. Animal experiments
also reveal that the aging process itself, in the absence of significant noise exposure, is associated
with loss of auditory nerve fibers. Evidence from human temporal bone studies and auditory brainstem
response measures suggests that this form of hidden loss is common in humans and may have perceptual
consequences, in particular, regarding the coding of the temporal aspects of sounds. Hidden hearing loss
is potentially a major health issue, and investigations are ongoing to identify the causes and consequences
of this troubling condition. © The Author(s) 2014.
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16
Investigation of the mechanism of soft tissue conduction explains several perplexing auditory
phenomena.
J Basic Clin Physiol Pharmacol. 2014 Sep 1;25(3):269-72. doi: 10.1515/jbcpp-2014-0037.
Adelman C, Chordekar S, Perez R, Sohmer H.
Abstract Soft tissue conduction (STC) is a recently expounded mode of auditory stimulation in which the
clinical bone vibrator delivers auditory frequency vibratory stimuli to skin sites on the head, neck, and
thorax. Investigation of the mechanism of STC stimulation has served as a platform for the elucidation
of the mechanics of cochlear activation, in general, and to a better understanding of several perplexing
auditory phenomena. This review demonstrates that it is likely that the cochlear hair cells can be directly
activated at low sound intensities by the fluid pressures initiated in the cochlea; that the fetus in utero,
completely enveloped in amniotic fluid, hears by STC; that a speaker hears his/her own voice by air
conduction and by STC; and that pulsatile tinnitus is likely due to pulsatile turbulent blood flow producing
fluid pressures that reach the cochlea through the soft tissues.
Idiopathic intracranial hypertension: Clinical nosography and field-testing of the ICHD diagnostic
criteria. A case-control study.
Cephalalgia. 2014 Sep 16. pii: 0333102414550109. [Epub ahead of print]
Yri HM1, Jensen RH2.
1
Danish Headache Centre, Department of Neurology, Glostrup Hospital, University of Copenhagen,
Denmark.
AIMS: The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH)
and to field-test the ICHD diagnostic criteria for headache attributed to IIH. MATERIALS AND METHODS:
We included 44 patients with new-onset IIH. Thirty-four patients with suspected but unconfirmed IIH
served as controls. Headache and other IIH-related symptoms were assessed by a detailed standardized
interview. In participants referred before diagnostic lumbar puncture (n = 67), we recorded headache
intensity before and after cerebrospinal fluid (CSF) withdrawal. RESULTS: Headache in patients with IIH
was daily occurring in 86%, focal in 84% and pulsating in 52%. Aggravation of headache by coughing
or straining and relief after CSF withdrawal were significantly more frequent in patients than in controls
(p ≤ 0.002). From the ICHD-2 to the ICHD-3 beta classification the sensitivity increased from 60% to 86%
whereas the specificity decreased from 86% to 53%. Based on our data the headache criteria can be
revised to increase sensitivity to 95% and specificity to 65%. CONCLUSION: Aggravation of headache
by coughing or straining, relief after CSF withdrawal, retrobulbar pain and pulsatile tinnitus may suggest
intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the
ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity.
© International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.
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17
Increased Contralateral Suppression of Otoacoustic Emissions Indicates a Hyper-responsive
Medial Olivocochlear System in Humans with Tinnitus and Hyperacusis.
J Neurophysiol. 2014 Sep 17. pii: jn.00576.2014. [Epub ahead of print]
Knudson IM1, Shera CA2, Melcher JR3.
1
Massachusetts Eye & Ear Infirmary [email protected].
Atypical medial olivo-cochlear (MOC) feedback from brainstem to cochlea has been proposed to play a
role in tinnitus, but even well-constructed tests of this idea have yielded inconsistent results. Here, it was
hypothesized that low sound tolerance (mild to moderate hyperacusis), which can accompany tinnitus
or occur on its own, might contribute to the inconsistency. Sound-level tolerance (SLT) was assessed in
subjects (all men) with clinically normal or near-normal thresholds to form threshold-, age-, and sex-matched
groups: (1) no tinnitus/high SLT, (2) no tinnitus/low SLT, (3) tinnitus/high SLT, and (4) tinnitus/low SLT. MOC
function was measured from the ear canal as the change in magnitude of distortion-product otoacoustic
emissions (DPOAE) elicited by broadband noise presented to the contralateral ear. The noise reduced
DPOAE magnitude in all groups ("contralateral suppression"), but significantly more reduction occurred in
groups with tinnitus and/or low SLT, indicating hyper-responsiveness of the MOC system compared to the
group with no tinnitus/high SLT. The results suggest hyper-responsiveness of the interneurons of the MOC
system residing in the cochlear nucleus and/or MOC neurons themselves. The present data, combined
with previous human and animal data, indicate that neural pathways involving every major division of the
cochlear nucleus manifest hyperactivity and/or hyper-responsiveness in tinnitus and/or low SLT. The overactivation may develop in each pathway separately. However, a more parsimonious hypothesis is that topdown neuromodulation is the driving force behind ubiquitous over-activation of the auditory brainstem and
may correspond to attentional spotlighting on the auditory domain in tinnitus and hyperacusis. Copyright ©
2014, Journal of Neurophysiology.
[Study on hearing impairment at high frequency among the flight cadets].
[Article in Chinese]
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Jul;28(13):968-71.
Zhang H, Zhu X, Guo R, Li D, Li J, Li L.
OBJECTIVE: To study the incidence of hearing loss at high frequency and the related influence factors
among the flight cadets. METHOD: Using multi-stage sampling method, 312 flight cadets were randomly
selected from grade 2011,2012,2013. The level of binaural hearing threshold at 4 kHz, 6 kHz, 8 kHz
were measured by hearing-assistant evaluative apparatus. Whether or not have hearing loss was chosen
as dependent variable. Territory, smoking, dietary habit, previous history of tinnitus, the noise exposure
time, the vestibular function and the psychological quality were chosen as independent vailables. T test,
ANOVA and accumulative logistic regression were performed to analyze the factors influence on hearing
impairment by software SPSS 18.0. RESULT: The morbidity of hearing impairment among flight cadets
was 18.9%. Results from single factor analysis showed that the levels of hearing thresholds at 4 kHz, 6
kHz frequency had statistically significant differences between smoking group and non-smoking group
(P < 0.05). The levels of hearing thresholds at 4 kHz frequency had statistically significant differences
between spicy diet group and not spicy diet group (P < 0.05). The levels of hearing thresholds at 4 kHz,
6 kHz, 8 kHz frequency had statistically significant differences among different strong noise exposure
groups (P < 0.05), and that at a same frequency hearing loss increased when noise exposing increased.
The levels of hearing thresholds at 4 kHz, 6 kHz frequency had statistically significant difference among
different vestibular function groups (P < 0.05). Results of accumulative logistics regression showed that
smoking and strong noise exposure were risk factors causing hearing impairment at 4 kHz frequency, and
excellent vestibular function seemed to be a preventive factor. Smoking and strong noise exposure were
also risk factors causing hearing impairment at 6 kHz frequency. CONCLUSION: Hearing impairment
appears higher morbidity among flight cadets, and it has statistical correlation with smoking, strong noise
exposure and vestibular function.
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18
MT-45 - en livsfarlig och potentiellt ototoxisk internetdrog.
[Article in Swedish]
Lakartidningen. 2014 Sep 11;111. pii: CZR4. Swedish.
Lindeman E1, Bäckberg M1, Personne M2, Helander A3.
1
Läkemedelsverket - Giftinformationscentralen Stockholm, Sweden Läkemedelsverket Giftinformationscentralen Stockholm, Sweden.
During the last years several synthetic opioids have been introduced on Internet sites selling new
psychoactive substances (NPS). One of these, called MT-45, a piperazine derivative originally synthesized
as a therapeutic drug candidate in the 1970s, has recently been detected in 21 deaths, according to
unpublished data from the Swedish National Board of Forensic Medicine. We present clinical data from
12 analytically confirmed hospital cases of MT-45 poisoning. The cases demonstrate that MT-45, like
other opioids, can induce potentially life threatening respiratory depression and loss of consciousness
in users and that symptoms are usually reversed by standard doses of the opioid receptor antagonist
naloxone. Significant auditory symptoms with transient tinnitus and hearing loss occurred in two cases and
a pronounced sensorineural hearing loss still present at two weeks follow-up in one case. This indicates
that MT-45 may be an ototoxic substance, illustrating the ubiquitous risk of unintended adverse effects
NPSs pose to users.
Determination of correlation among heart rate variability, left atrium global strain, and nighttime
blood pressure among patients with tinnitus.
Med Sci Monit. 2014 Sep 24;20:1714-9. doi: 10.12659/MSM.890949.
Değirmenci H1, Bakırcı EM1, Salcan I2, Demirelli S3, Duman H4, Ceyhun G1, Küçüksu Z1.
1
Department of Cardiology, Mengücek Gazi Education and Research Hospital, Erzincan University,
Erzincan, Turkey.
Background We aimed to examine the correlation among nighttime blood pressure, heart rate variability,
and left atrium peak systolic global longitudinal strain among patients with subjective tinnitus. Material and
Methods Eighty patients with tinnitus were assigned to Group 1 and 80 healthy individuals were assigned
to Group 2. Clinical blood pressure measurements, ambulatory blood pressure monitoring, and Holter
electrocardiography monitoring were performed. All of the cases included in the study were examined
with conventional echocardiography and 2-dimensional speckle tracking echocardiography. Results Mean
nighttime systolic blood pressure (130.3±5.4) and mean nighttime diastolic blood pressure (82.8±3.9) in
Group 1 were higher than in Group 2 (125.1±5.4 and 80.7±4.7, respectively) (p<0.05). Mean heart rate in
Group 1 was significantly lower than in Group 2 but there was no statistically significant difference between
the groups in terms of heart rate variability parameters and left atrium peak systolic global longitudinal strain
values (p>0.05). Conclusions Nighttime systolic blood pressure and nighttime diastolic blood pressure
were higher among the patients with tinnitus. In light of these results, we can conclude that both clinical
blood pressure measurement and ambulatory blood pressure monitoring are important for patients with
tinnitus. Free PMC Article.
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19
[Acoustic trauma generated by exposure to gun powder].
Cir Cir. 2014 Sep-Oct;82(5):528-36. Spanish.
Arch-Tirado E1, Garnica-Escamilla MA2, Delgado-Hernández A1, Campos-Muñoz T1, RodríguezRodríguez L2, Verduzco-Mendoza A1.
1
Laboratorio de Bioacústica, Instituto Nacional de Rehabilitación, Instituto Nacional de Rehabilitación,
México DF, Mexico.
BACKGROUND: Noise-induced hearing loss has increased due to factors such as industrialization. It
is estimated that one third of the world's population suffers from some degree of hearing loss caused
by exposure to high-intensity noise. Exposure to noise can cause disease of various ear structures,
especially destruction of outer hair cells, causing varying degrees of hearing lossObjective: To describe
the audiological findings in a group of subjects who were exposed to a source of fireworks explosion in the
state of Tlaxcala Mexico. METHODOLOGY: We carried out an audiometric study in eight patients admitted
to CENIAQ-INR who were exposed to a firecracker explosion. In each subject, airway with conventional
pure tone audiometry from 125 to 8000 Hz was assessed using a clinical audiometer (model 622, Minimate,
Madsen) Clinical case: Hearing loss at all frequencies was found in all eight patients, from mild to severe
in both ears. Audiogram showed decreases from 4000 Hz, diagnosing third-degree acoustic trauma in all
patients. CONCLUSIONS: The main symptom was reported by patients with tinnitus. Other scenarios in
which patients report the presence of tinnitus are acoustic trauma due to use of audio players in symphony
orchestra musicians and detonating military firearms. Audiometric assessment is recommended after an
explosive accident as an accurate method to determine if there is any hearing impairment.
Hemorrhagic Stroke and Cerebral Paragonimiasis.
Stroke. 2014 Sep 30. pii: STROKEAHA.114.007267. [Epub ahead of print]
Xia Y, Ju Y, Chen J, You C.
From the Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's
Republic of China.
BACKGROUND AND PURPOSE: We retrospectively analyzed the clinical and imaging characteristics,
diagnosis, and treatment outcomes of 10 patients with hemorrhagic cerebral paragonimiasis (CP), and we
evaluated the influence of Paragonimus infection on cerebrovascular damage. METHODS: Ten patients
(7 male and 3 female; median age 15.7 years, range 4-46 years) with hemorrhagic CP were diagnosed
between April 2009 and January 2013. All patients underwent the head computed tomography scans and
9 patients underwent MRI examinations. Four patients underwent computed tomographic angiography,
magnetic resonance angiography, and digital subtraction angiography. Liquid-based cytological
examination of cerebrospinal fluid was performed in 7 patients. Follow-up examinations were performed
for 9 cases for a period of 12 to 62 months. RESULTS: Hemorrhagic CP accounted for 37% of CP cases
(10/27). No patients were initially diagnosed with CP. The major symptoms of hemorrhagic CP included
acute headache, vomiting, hemiparalysis, epilepsy, blurred vision, sensory impairment, and tinnitus. Four
cases were surgically treated. Most symptoms markedly improved, but fine motor dysfunction and mental
dysfunction remained in 3 surgical patients. CONCLUSIONS: Hemorrhagic stroke typically occurred during
the acute stage and in the early stages of further Paragonimus migration. Delay of treatment increased the
risk of initial and recurrent stroke. © 2014 American Heart Association, Inc.
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20
Temporal bone fracture causing superior semicircular canal dehiscence.
Case Rep Otolaryngol. 2014;2014:817291. doi: 10.1155/2014/817291. Epub 2014 Sep 10.
Peng KA1, Ahmed S1, Yang I2, Gopen Q1.
1
Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California,
Los Angeles, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA.
Importance. Superior semicircular canal dehiscence (SCD) is a third window lesion of the inner ear causing
symptoms of vertigo, autophony, tinnitus, and hearing loss. A "two-hit" hypothesis has traditionally been
proposed, whereby thinly developed bone overlying the superior canal is disrupted by a sudden change
in intracranial pressure. Although the symptoms of SCD may be precipitated by head injury, no previous
reports have described a temporal bone fracture directly causing SCD. Observations. Two patients
sustained temporal bone fractures after closed head trauma, and developed unilateral otologic symptoms
consistent with SCD. In each instance, computed tomography imaging revealed fractures extending
through the bony roof of the superior semicircular canal. Conclusions and Relevance. Temporal bone
fractures, which are largely treated nonoperatively, have not previously been reported to cause SCD.
As it is a potentially treatable entity, SCD resulting from temporal bone fracture must be recognized as a
possibility and diagnosed promptly if present. Free PMC Article.
Identification of two novel mutations in FAM136A and DTNA genes in autosomal dominant
familial Meniere's disease.
Hum Mol Genet. 2014 Oct 9. pii: ddu524. [Epub ahead of print]
Requena T1, Cabrera S1, Martín-Sierra C1, Price SD2, Lysakowski A2, Lopez-Escamez JA3.
Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO - Centre for
Genomics and Oncological Research - Pfizer/University of Granada/ Junta de Andalucía, PTS,
Granada, 18016 Spain.
1
Meniere's disease is a chronic disorder of the inner ear defined by sensorineural hearing loss, tinnitus
and episodic vertigo, and familial Meniere's disease is observed in 5-15% of sporadic cases. Although
its pathophysiology is largely unknown, studies in human temporal bones have found an accumulation of
endolymph in the scala media of the cochlea. By whole-exome sequencing, we have identified two novel
heterozygous single nucleotide variants in FAM136A and DTNA genes, both in a Spanish family with
three affected cases in consecutive generations, highly suggestive of autosomal dominant inheritance.
The nonsense mutation in the FAM136A gene leads to a stop codon that disrupts the FAM136A protein
product. Sequencing revealed two mRNA transcripts of FAM136A in lymphoblast from patients, which
were confirmed by immunoblotting. Carriers of the FAM136A mutation showed a significant decrease in
the expression level of both transcripts in lymphoblastoid cell lines. The missense mutation in the DTNA
gene produces a novel splice-site which skips exon 21 and leads to a shorter alternative transcript. We
also demonstrated that FAM136A and DTNA proteins are expressed in the neurosensorial epithelium
of the crista ampullaris of the rat by immunohistochemistry. While FAM136A encodes a mitochondrial
protein with unknown function, DTNA encodes a cytoskeleton-interacting membrane protein involved in
the formation and stability of synapses with a crucial role in the permeability of the blood-brain barrier.
Neither of these genes has been described in patients with hearing loss, FAM136A and DTNA being
candidate gene for familiar Meniere's disease. © The Author 2014. Published by Oxford University Press.
All rights reserved. For Permissions, please email: [email protected].
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21
A synaptic and circuit basis for corollary discharge in the auditory cortex.
Nature. 2014 Aug 27. doi: 10.1038/nature13724. [Epub ahead of print]
Schneider DM1, Nelson A1, Mooney R2.
1
Department of Neurobiology, Duke University School of Medicine, Durham, North Carolina 27710, USA.
Sensory regions of the brain integrate environmental cues with copies of motor-related signals important
for imminent and ongoing movements. In mammals, signals propagating from the motor cortex to the
auditory cortex are thought to have a critical role in normal hearing and behaviour, yet the synaptic and
circuit mechanisms by which these motor-related signals influence auditory cortical activity remain poorly
understood. Using in vivo intracellular recordings in behaving mice, we find that excitatory neurons in
the auditory cortex are suppressed before and during movement, owing in part to increased activity of
local parvalbumin-positive interneurons. Electrophysiology and optogenetic gain- and loss-of-function
experiments reveal that motor-related changes in auditory cortical dynamics are driven by a subset of
neurons in the secondary motor cortex that innervate the auditory cortex and are active during movement.
These findings provide a synaptic and circuit basis for the motor-related corollary discharge hypothesized
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to facilitate hearing and auditory-guided behaviours.
Cervical Arterial Dissections and Association With Cervical Manipulative Therapy: A Statement
for Healthcare Professionals From the American Heart Association/American Stroke Association.
Stroke. 2014 Aug 7. pii: STR.0000000000000016. [Epub ahead of print]
Biller J, Sacco RL, Albuquerque FC, Demaerschalk BM, Fayad P, Long PH, Noorollah LD, Panagos
PD, Schievink WI, Schwartz NE, Shuaib A, Thaler DE, Tirschwell DL; on behalf of the American
Heart Association Stroke Council.
PURPOSE: Cervical artery dissections (CDs) are among the most common causes of stroke in young
and middle-aged adults. The aim of this scientific statement is to review the current state of evidence
on the diagnosis and management of CDs and their statistical association with cervical manipulative
therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by
a healthcare professional. METHODS: Members of the writing group were appointed by the American
Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart
Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of
expertise and reviewed appropriate literature, references to published clinical and epidemiology studies,
morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal
files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge.
RESULTS: Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or
retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial
nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough
history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is
debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid
arteries and result in CD. Disability levels vary among CD patients with many having good outcomes,
but serious neurological sequelae can occur. No evidence-based guidelines are currently available to
endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for
prevention of local thrombus and secondary embolism. Case-control and other articles have suggested
an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear
whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT.
Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic
resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done
with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.
CONCLUSIONS: CD is an important cause of ischemic stroke in young and middle-aged patients. CD is
most prevalent in the upper cervical spine and can involve the internal carotid artery or vertebral artery.
Although current biomechanical evidence is insufficient to establish the claim that CMT causes CD, clinical
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22
reports suggest that mechanical forces play a role in a considerable number of CDs and most population
controlled studies have found an association between CMT and VAD stroke in young patients. Although
the incidence of CMT-associated CD in patients who have previously received CMT is not well established,
and probably low, practitioners should strongly consider the possibility of CD as a presenting symptom,
and patients should be informed of the statistical association between CD and CMT prior to undergoing
manipulation of the cervical spine. © 2014 American Heart Association, Inc.
Value of clinical data and vestibular testing in a population of 101 patients with recurrent
vestibulopathy.
Clin Otolaryngol. 2014 Jul 16. doi: 10.1111/coa.12287. [Epub ahead of print]
Martin-Sanz E1, Salamanca EV, Cabrero AM, Esteban J, Muerte I, Sanz-Fernández R.
1
Department of Otolaryngology, University Hospital of Getafe, Madrid, Spain.
Meniere's disease (MD) is characterised by episodic vertigo, fluctuating hearing loss, aural pressure, and
tinnitus. Vestibular testing is not even a recommendation in the AAO-HNS guidelines, one of the most used
classifications to diagnose MD. Vestibular migraine (VM) is a term used to describe a vertigo syndrome in
patients with a history of migraines with or without aura that may affect up to 1% of the general population
This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights
reserved.
Measurement of subtle auditory deficit in tinnitus patients with normal audiometric thresholds
using evoked otoacoustic emissions and threshold equalizing noise tests.
Int Tinnitus J. 2013;18(1):35-44. doi: 10.5935/0946-5448.20130006.
Ishak WS, Zhao F, Rajenderkumar D, Arif M.
INTRODUCTION: The general consensus on the roles of hearing loss in triggering tinnitus seems not
applicable in patients with normal hearing thresholds. The absence of hearing loss on the audiogram in
this group of patients poses a serious challenge to the cochlear theories in explaining tinnitus generation in
this group of patients. OBJECTIVE: To scrutinize auditory functioning in a sample of tinnitus subjects with
normal hearing thresholds and non-tinnitus normally hearing control participants using transient evoked
and distortion product otoacoustic emission (TEOAE and DPOAE) and Threshold Equalising Noise (TEN)
test. METHODS: Twenty-seven tinnitus adult patients with normal hearing thresholds and 27 normally
hearing volunteers were tested with TEOAE, DPOAE and TEN test. RESULTS: Abnormal TEOAE was
significantly more in tinnitus group than in controls. No significant difference was observed in DPOAE and
TEN test. Only one patient was found with a positive TEN test result, who was confirmed by Magnetic
Resonance Imaging to have acoustic neuroma on the affected ear. CONCLUSION: These results suggest
the possible existence of subtle auditory deficit in normally hearing tinnitus patients, which may be an early
sign of diseases that are only diagnosed after the onset of hearing loss.
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23
Benign paroxysmal positional vertigo and tinnitus.
Int Tinnitus J. 2013;18(1):16-9. doi: 10.5935/0946-5448.20130003.
Barozzi S, Socci M, Ginocchio D, Filipponi E, Martinazzoli MG, Cesarani A.
INTRODUCTION: In our clinical experience, some of the patients affected by benign paroxysmal positional
vertigo (BPPV) reported the onset of tinnitus shortly before or in association with the positional vertigo.
OBJECTIVES: The aim of this study was to describe the prevalence and the clinical patterns of tinnitus
episodes which occurred in association with BPPV and to suggest possible interpretative hypotheses.
METHODS: 171 normal hearing patients affected by BPPV (50 males and 122 females; age range: 2577 years; mean age 60.3 years ± 14.9) underwent pure tone audiometry, immittance test and a clinical
vestibular evaluation before and after repositioning manoeuvers. Those suffering from tinnitus were also
assessed using visual analogue scales and tinnitus handicap inventory. RESULTS: 19.3% of the patients
reported the appearance of tinnitus concurrently with the onset of the positional vertigo. It was mostly
unilateral, localized on the same ear as the BPPV, slight in intensity and intermittent. Tinnitus disappeared or
decreased in all patients except two, either spontaneously, before performing the therapeutic manoeuvers,
or shortly after. CONCLUSIONS: A possible vestibular origin of tinnitus determined by the detachment of
macular debris into the ductus reuniens and cochlear duct is discussed.
Noise-induced tinnitus: auditory evoked potential in symptomatic and asymptomatic patients.
Clinics (Sao Paulo). 2014 Jul;69(7):487-490.
Dos Santos-Filha VA, Samelli AG, Matas CG.
Speech-language Pathology and Audiology, Occupational Therapy, Department of Physical Therapy,
Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
OBJECTIVES: We evaluated the central auditory pathways in workers with noise-induced tinnitus with
normal hearing thresholds, compared the auditory brainstem response results in groups with and without
tinnitus and correlated the tinnitus location to the auditory brainstem response findings in individuals
with a history of occupational noise exposure. METHOD: Sixty individuals participated in the study and
the following procedures were performed: anamnesis, immittance measures, pure-tone air conduction
thresholds at all frequencies between 0.25-8 kHz and auditory brainstem response. RESULTS: The mean
auditory brainstem response latencies were lower in the Control group than in the Tinnitus group, but no
significant differences between the groups were observed. Qualitative analysis showed more alterations
in the lower brainstem in the Tinnitus group. The strongest relationship between tinnitus location and
auditory brainstem response alterations was detected in individuals with bilateral tinnitus and bilateral
auditory brainstem response alterations compared with patients with unilateral alterations. CONCLUSION:
Our findings suggest the occurrence of a possible dysfunction in the central auditory nervous system
(brainstem) in individuals with noise-induced tinnitus and a normal hearing threshold.
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Assessment of the noise annoyance among subway train conductors in Tehran, Iran.
Noise Health. 2014 May-Jun;16(70):177-82. doi: 10.4103/1463-1741.134918.
Hamidi M1, Kavousi A, Zaheri S, Hamadani A, Mirkazemi R.
1
Department of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences,
Tehran, Iran.
Subway transportation system is a new phenomenon in Iran. Noise annoyance interferes with the
individual's task performance, and the required alertness in the driving of subway trains. This is the first study
conducted to measure the level of noise and noise annoyance among conductors of subway organization
in Tehran, Iran. This cross sectional study was conducted among 167 randomly selected train conductors.
Information related to noise annoyance was collected by using a self-administered questionnaire. The
dosimetry and sound metering was done for the conductors and inside the cabins. There were 41 sound
metering measuring samples inside the conductors' cabin, and there were 12 samples of conductors' noise
exposure. The results of sound level meter showed that the mean Leq was 73.0 dBA ± 8.7 dBA and the
dosimetry mean measured Leq was 82.1 dBA ± 6.8 dBA. 80% of conductors were very annoyed/annoyed
by noise in their work place. 53.9% of conductors reported that noise affected their work performance and
63.5% reported that noise causes that they lose their concentration. The noise related to movement of
train wheels on rail was reported as the worst by 83.2% followed by the noise of brakes (74.3%) and the
ventilation noise (71.9%). 56.9% of conductors reported that they are suffering from sleeplessness, 40.1%
from tinnitus and 80.2% feeling fatigue and sleepy. The study results showed the high level of noise and
noise annoyance among train conductors and the poor health outcome of their exposure to this level of
noise. Free Article.
Adverse health problems among municipality workers in alexandria (egypt).
Int J Prev Med. 2014 May;5(5):545-56.
Abd El-Wahab EW1, Eassa SM1, Lotfi SE2, El Masry SA3, Shatat HZ1, Kotkat AM1.
1
Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
BACKGROUND: Solid waste management has emerged as an important human and environmental
health issue. Municipal solid waste workers (MSWWs) are potentially exposed to a variety of occupational
biohazards and safety risks. The aim of this study was to describe health practices and safety measures
adopted by workers in the main municipal company in Alexandria (Egypt) as well as the pattern of the
encountered work related ill health. METHODS: A cross-sectional study was conducted between January
and April 2013. We interviewed and evaluated 346 workers serving in about 15 different solid waste
management activities regarding personal hygiene, the practice of security and health care measures
and the impact of solid waste management. RESULTS: Poor personal hygiene and self-care, inadequate
protective and safety measures for potentially hazardous exposure were described. Impact of solid waste
management on health of MSWWs entailed high prevalence of gastrointestinal, respiratory, skin and
musculoskeletal morbidities. Occurrence of accidents and needle stick injuries amounted to 46.5% and
32.7% respectively. The risk of work related health disorders was notably higher among workers directly
exposed to solid waste when compared by a group of low exposure potential particularly for diarrhea (odds
ratio [OR] = 2.2, 95% confidence interval [CI] = 1.2-3.8), vomiting (OR = 2.7, 95% CI = 1.1-6.6), abdominal
colic (OR = 1.9, 95% CI = 1.1-3.2), dysentery (OR = 3.6, 95% CI = 1.3-10), dyspepsia (OR = 1.8, 95%
CI = 1.1-3), low back/sciatic pain (OR = 3.5, 95% CI = 1.8-7), tinnitus (OR = 6.2, 95% CI = 0.3-122) and
needle stick injury (OR = 3.4, 95% CI = 2.1-5.5). CONCLUSIONS: Workers exposed to solid waste exhibit
significant increase in risk of ill health. Physician role and health education could be the key to assure the
MSWWs health safety. Free PMC Article.
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25
Asymmetric hearing loss and tinnitus.
BMJ. 2014 Jun 3;348:g3601. doi: 10.1136/bmj.g3601.
Kontorinis G1, Crowther JA2.
1
Department of Otolaryngology, Institute of Neurological Sciences, Southern Teaching Hospital,
Glasgow G51 4TF, UK [email protected].
No abstract available.
Rabeprazole-Induced Tinnitus.
Ann Pharmacother. 2014 Jun 10;48(7):943. [Epub ahead of print] No abstract available.
Kekilli M, Tanoglu A, Ocal S, Beyazit Y.
No abstract available
Different infusion durations for preventing platinum-induced hearing loss in children with cancer.
Cochrane Database Syst Rev. 2014 Jun 26;6:CD010885. doi: 10.1002/14651858.CD010885.pub2.
van As JW1, van den Berg H, van Dalen EC.
1
c/o Cochrane Childhood Cancer Group, Emma Children's Hospital/Academic Medical Center, PO Box
22660, Amsterdam, Netherlands, 1100 DD.
BACKGROUND: Platinum-based therapy, including cisplatin, carboplatin or oxaliplatin, or a combination
of these, is used to treat a variety of paediatric malignancies. Unfortunately, one of the most important
adverse effects is the occurrence of hearing loss or ototoxicity. In an effort to prevent this ototoxicity,
different platinum infusion durations have been studied. OBJECTIVES: To assess the effects of different
durations of platinum infusion to prevent hearing loss or tinnitus, or both, in children with cancer.
Secondary objectives were to assess possible effects of these infusion durations on: a) anti-tumour
efficacy of platinum-based therapy, b) adverse effects other than hearing loss or tinnitus, and c) quality of
life. SEARCH METHODS: We searched the electronic databases Cochrane Central Register of Controlled
Trials (CENTRAL 2013, Issue 12), MEDLINE (PubMed) (1945 to 4 December 2013) and EMBASE (Ovid)
(1980 to 4 December 2013). In addition, we handsearched reference lists of relevant articles and the
conference proceedings of the International Society for Paediatric Oncology (2009 to 2013). We scanned
ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization International Clinical Trials
Registry Platform (WHO ICTRP) (http://www.who.int/ictrp/en/) for ongoing trials (both searched on 13
December 2013). SELECTION CRITERIA: Randomised controlled trials (RCTs) or controlled clinical trials
(CCTs) comparing different platinum infusion durations in children with cancer. Only the platinum infusion
duration could differ between the treatment groups. DATA COLLECTION AND ANALYSIS: Two review
authors independently performed the study selection, risk of bias assessment and GRADE assessment
of included studies, and data extraction including adverse effects. Analyses were performed according
to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS:
We identified one RCT and no CCTs. The RCT (total number of children = 91) evaluated the use of a
continuous cisplatin infusion (N = 43) versus a one hour bolus cisplatin infusion (N = 48) in children with
neuroblastoma. For the continuous infusion, cisplatin was administered on days 1 to 5 of the cycle but
it is unclear if the infusion duration was a total of 5 days. Methodological limitations were present. Only
results from shortly after induction therapy were provided. No clear evidence of a difference in hearing loss
(defined as asymptomatic and symptomatic disease combined) between the different infusion durations
was identified as results were imprecise (RR 1.39; 95% CI 0.47 to 4.13, low quality evidence). Although
the numbers of children were not provided, it was stated that tumour response was equivalent in both
treatment arms. With regard to adverse effects other than ototoxicity we were only able to assess toxic
deaths. Again, the confidence interval of the estimated effect was too wide to exclude differences between
the treatment groups (RR 1.12; 95% CI 0.07 to 17.31, low quality evidence). No data were available for the
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26
other outcomes of interest (i.e. tinnitus, overall survival, event-free survival and quality of life) or for other
(combinations of) infusion durations or other platinum analogues. AUTHORS' CONCLUSIONS: Since only
one eligible RCT evaluating the use of a continuous cisplatin infusion versus a one hour bolus cisplatin
infusion was found, and that had methodological limitations, no definitive conclusions can be made. It
should be noted that 'no evidence of effect', as identified in this review, is not the same as 'evidence of
no effect'. For other (combinations of) infusion durations and other platinum analogues no eligible studies
were identified. More high quality research is needed.
[Decompensated chronic tinnitus and high-dose benzodiazepine dependence : Between Scylla
and Charybdis].
[Article in German]
Nervenarzt. 2014 Jul;85(7):865-9. doi: 10.1007/s00115-012-3670-y. German. No abstract available.
Bonnet U.
Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches Krankenhaus Castrop-Rauxel,
Akademisches Lehrkrankenhaus der Universität Duisburg/Essen, Grutholzallee 21, 44577, CastropRauxel, Deutschland, [email protected].
No abstract available.
China rubra for side-effects of quinine: a prospective, randomised study in pregnant women with
malaria in Cotonou, Benin.
Homeopathy. 2014 Jul;103(3):165-71. doi: 10.1016/j.homp.2014.03.002. Epub 2014 Apr 14.
Danno K1, Rerolle F2, de Sigalony S3, Colas A4, Terzan L5, Bordet MF6.
1
Laboratoires Boiron, 20 rue de la Libération, Sainte-Foy-lès-Lyon, France. Electronic address: karine.
[email protected].
BACKGROUND: In endemic areas, gestational malaria is responsible for low birth weight and maternal
anaemia. Quinine is the reference treatment for acute malaria in pregnant women, irrespective of term.
However, quinine administration is associated with various side-effects. We evaluated the impact of
the homeopathic medicine China rubra 7CH on the side-effects of quinine used as treatment for acute
malaria in pregnant women in Cotonou, Benin. METHODS: This prospective, comparative, randomised
study was carried out between June and December 2007 in the Saint Jean-Baptiste Medical Centre,
Cotonou. Women were included if they were >3 months pregnant and had a clinical diagnosis of malaria
confirmed by a positive thick blood smear. The study population was divided into two groups: (i) patients
who presented between the 1st and 15th of each month and who received China rubra 7CH plus quinine
(China group); and (ii) patients who presented from the 16th to the end of each month and who received
treatment with quinine only (Standard group). The aim was to compare the frequency of side-effects of
quinine in the two groups until day 6 after the start of treatment. Neither the patients nor the care givers
were blinded to study treatment. Statistical comparison of the two groups was carried out with an alpha
risk fixed at 5%.RESULTS: 211 women were recruited: 105 received quinine plus China rubra 7CH (China
group) and 106 received quinine only (Standard group). A decrease in proportion of patients presenting
with side-effects was observed in the China group from day 0 to day 6 of follow-up (53.9%-23.3%) whereas
the proportion of patients with side-effects in the Standard group did not change significantly (85.9% on
day 0 vs. 82.5% on day 6). Ninety-six (72.4%) patients in the China group and 103 (97.2%) in the Standard
group reported at least one side-effect during follow-up (p < 0.0001). The most frequently reported sideeffects were tinnitus, dizziness and asthenia. CONCLUSIONS: This preliminary study shows the interest of
China rubra 7CH in limiting the side-effects of quinine used for the treatment of acute malaria in pregnant
women. Copyright © 2014 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.
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27
Ototoxicity in Nigeria: Why it persists.
Ear Nose Throat J. 2014 Jul;93(7):256-264.
Kokong DD1, Bakari A, Ahmad BM.
1
Department of Otorhinolaryngology, Jos University Teaching Hospital, PMB 2076, Jos Plateau State,
Nigeria. [email protected].
No therapy is currently available to reverse the serious damage that can be caused by ototoxic drugs, such
as permanent hearing loss and balance disorders. Otolaryngologists in various regions of the world have
developed strategies aimed at curtailing drug-induced ototoxicity, but similar efforts in most developing
nations have yet to be well established. We conducted a study to document our experience in Nigeria. Our
study population was made up of 156 patients-66 males and 90 females, aged 5 to 85 years (mean: 32.1
± 30.7)-who were diagnosed with drug-induced ototoxicity over a 3-year period. Tinnitus was the first and
the predominant symptom in 140 patients (89.7%). The most common cause of drug-induced ototoxicity
among the 156 patients was injection of an unknown agent (n = 55 [35.3%]); among the known agents, the
most common were chloramphenicol (n = 25 [16.0%]), chloroquine (n = 22 [14.1%]), and gentamicin (n =
20 [12.8%]). One pregnant woman experienced a miscarriage at 4 months after receiving intramuscular
chloroquine, and another woman fell into a coma after receiving intramuscular streptomycin. Two agents
that have not been linked to ototoxicity-oxytocin and thiopentone sodium-were found to be ototoxic in our
study (1 case each). Of the 312 ears, 31 (9.9%) showed normal audiometric patterns; on the other end
of the spectrum, 155 ears (49.7%) had profound sensorineural hearing loss (SNHL). Mixed hearing loss
was seen in 90 ears (28.8%). Hearing loss was bilaterally symmetrical in 127 patients (81.4%), bilaterally
asymmetrical in 15 patients (9.6%), and unilateral in 14 patients (9.0%). Treatment was primarily medical;
hearing aids were fitted for 7 patients (4.5%). Only 41 patients (26.3%) kept as many as 3 scheduled followup appointments. Ototoxicity remains prevalent in the developing countries of Africa. Numerous drugs and
other agents are responsible, and management outcomes are difficult to ascertain. Thus, our emphasis
must be placed on prevention if we are to minimize the potentially devastating effects of ototoxicity.
Risky Music Listening, Permanent Tinnitus and Depression, Anxiety, Thoughts about Suicide and
Adverse General Health.
PLoS One. 2014 Jun 4;9(6):e98912. doi: 10.1371/journal.pone.0098912. eCollection 2014.
Vogel I1, van de Looij-Jansen PM2, Mieloo CL2, Burdorf A3, de Waart F2.
1
Dept of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Dept of
Youth Policy, Municipal Public Health Service for Rotterdam Area, Rotterdam, the Netherlands.
OBJECTIVE: To estimate the extent to which exposure to music through earphones or headphones with
MP3 players or at discotheques and pop/rock concerts exceeded current occupational safety standards for
noise exposure, to examine the extent to which temporary and permanent hearing-related symptoms were
reported, and to examine whether the experience of permanent symptoms was associated with adverse
perceived general and mental health, symptoms of depression, and thoughts about suicide. METHODS:
A total of 943 students in Dutch inner-city senior-secondary vocational schools completed questionnaires
about their sociodemographics, music listening behaviors and health. Multiple logistic regression analyses
were used to examine associations. RESULTS: About 60% exceeded safety standards for occupational
noise exposure; about one third as a result of listening to MP3 players. About 10% of the participants
experienced permanent hearing-related symptoms. Temporary hearing symptoms that occurred after
using an MP3 player or going to a discotheque or pop/rock concert were associated with exposure to highvolume music. However, compared to participants not experiencing permanent hearing-related symptoms,
those experiencing permanent symptoms were less often exposed to high volume music. Furthermore,
they reported at least two times more often symptoms of depression, thoughts about suicide and adverse
self-assessed general and mental health. CONCLUSIONS: Risky music-listening behaviors continue up to
at least the age of 25 years. Permanent hearing-related symptoms are associated with people's health and
wellbeing. Participants experiencing such symptoms appeared to have changed their behavior to be less
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28
risky. In order to induce behavior change before permanent and irreversible hearing-related symptoms
occur, preventive measurements concerning hearing health are needed. Free Article.
IIIDiagnostics
Evaluation of internal auditory canal structures in tinnitus of unknown origin.
Clin Exp Otorhinolaryngol. 2014 Sep;7(3):160-4. doi: 10.3342/ceo.2014.7.3.160. Epub 2014 Aug 1.
Polat C1, Baykara M2, Ergen B3.
1
Department of Otolaryngology, Elazig Training and Research Hospital, Elazig, Turkey.
OBJECTIVES: The aim of the present study was to evaluate the internal auditory canal (IAC) and the
nerves inside it to define possible structural differences in cases with subjective tinnitus of unknown origin.
METHODS: Cases applying to the ear, nose and throat department with the complaint of tinnitus with
unknown origin and having normal physical examination and test results were included in the study (n=78).
Patients admitted to the radiology clinic for routine cranial magnetic resonance imaging (MRI) and whose
MRI findings revealed no pathologies were enrolled as the control group (n=79). Data for the control group
were obtained from the radiology department and informed consent was obtained from all the patients.
Diameters of the IAC and the nerves inside it were measured through enhanced images obtained by
routine temporal bone MRIs in all cases. Statistical evaluations were performed using Student t-test and
statistical significance was defined as P<0.05. RESULTS: Measurements of IAC diameters revealed
statistically significant differences between the controls and the tinnitus group (P<0.05). Regarding the
diameters of the cochlear nerve, facial nerve, inferior vestibular nerve, superior vestibular nerve, and total
vestibular nerve, no statistically significant difference was found between the controls and the tinnitus
group. CONCLUSION: Narrowed IAC has to be assessed as an etiological factor in cases with subjective
tinnitus of unknown origin. Free PMC Article.
Determination of correlation among heart rate variability, left atrium global strain, and nighttime
blood pressure among patients with tinnitus.
Med Sci Monit. 2014 Sep 24;20:1714-9. doi: 10.12659/MSM.890949.
Değirmenci H1, Bakırcı EM1, Salcan I2, Demirelli S3, Duman H4, Ceyhun G1, Küçüksu Z1.
1
Department of Cardiology, Mengücek Gazi Education and Research Hospital, Erzincan University,
Erzincan, Turkey.
Background We aimed to examine the correlation among nighttime blood pressure, heart rate variability,
and left atrium peak systolic global longitudinal strain among patients with subjective tinnitus. Material and
Methods Eighty patients with tinnitus were assigned to Group 1 and 80 healthy individuals were assigned
to Group 2. Clinical blood pressure measurements, ambulatory blood pressure monitoring, and Holter
electrocardiography monitoring were performed. All of the cases included in the study were examined
with conventional echocardiography and 2-dimensional speckle tracking echocardiography. Results Mean
nighttime systolic blood pressure (130.3±5.4) and mean nighttime diastolic blood pressure (82.8±3.9) in
Group 1 were higher than in Group 2 (125.1±5.4 and 80.7±4.7, respectively) (p<0.05). Mean heart rate in
Group 1 was significantly lower than in Group 2 but there was no statistically significant difference between
the groups in terms of heart rate variability parameters and left atrium peak systolic global longitudinal strain
values (p>0.05). Conclusions Nighttime systolic blood pressure and nighttime diastolic blood pressure
were higher among the patients with tinnitus. In light of these results, we can conclude that both clinical
blood pressure measurement and ambulatory blood pressure monitoring are important for patients with
tinnitus. Free PMC Article.
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29
Clinical practice guideline: tinnitus executive summary.
Otolaryngol Head Neck Surg. 2014 Oct;151(4):533-41. doi: 10.1177/0194599814547475.
Tunkel DE1, Bauer CA2, Sun GH3, Rosenfeld RM4, Chandrasekhar SS5, Cunningham ER Jr6, Archer
SM7, Blakley BW8, Carter JM9, Granieri EC10, Henry JA11, Hollingsworth D12, Khan FA13, Mitchell
S14, Monfared A15, Newman CW16, Omole FS17, Phillips CD18, Robinson SK19, Taw MB20, Tyler RS21,
Waguespack R22, Whamond EJ23.
1
Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA
[email protected].
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has
published a supplement to this issue featuring the new Clinical Practice Guideline: Tinnitus. To assist in
implementing the guideline recommendations, this article summarizes the rationale, purpose, and key
action statements. The 13 recommendations developed address the evaluation of patients with tinnitus,
including selection and timing of diagnostic testing and specialty referral to identify potential underlying
treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary
tinnitus, with recommendations to guide the evaluation and measurement of the impact of tinnitus and to
determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers.
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Abnormal cross-frequency coupling in the tinnitus network.
Front Neurosci. 2014 Sep 25;8:284. doi: 10.3389/fnins.2014.00284. eCollection 2014.
Adamchic I1, Langguth B2, Hauptmann C1, Tass PA3.
1
Jülich Research Center, Institute of Neuroscience and Medicine, INM-7, Neuromodulation Jülich,
Germany.
Neuroimaging studies have identified networks of brain areas and oscillations associated with tinnitus
perception. However, how these regions relate to perceptual characteristics of tinnitus, and how
oscillations in various frequency bands are associated with communications within the tinnitus network is
still incompletely understood. Recent evidence suggests that apart from changes of the tinnitus severity
the changes of tinnitus dominant pitch also have modulating effect on the underlying neuronal activity in
a number of brain areas within the tinnitus network. Therefore, in a re-analysis of an existing dataset, we
sought to determine how the oscillations in the tinnitus network in the various frequency bands interact. We
also investigate how changes of tinnitus loudness, annoyance and pitch affect cross-frequency interaction
both within and between nodes of the tinnitus network. Results of this study provide, to our knowledge, the
first evidence that in tinnitus patients, aside from the previously described changes of oscillatory activity,
there are also changes of cross-frequency coupling (CFC); phase-amplitude CFC was increased in tinnitus
patients within the auditory cortex and the dorsolateral prefrontal regions between the phase of deltatheta and the amplitude of gamma oscillations (Modulation Index [MI] 0.17 in tinnitus patients vs. 0.08
in tinnitus free controls). Moreover, theta phase in the anterior cingulate region modulated gamma in the
auditory (MI 0.1) and dorsolateral prefrontal regions (MI 0.19). Reduction of tinnitus severity after acoustic
coordinated reset therapy led to a partial normalization of abnormal CFC. Also treatment induced changes
in tinnitus pitch significantly modulated changes in CFC. Thus, tinnitus perception is associated with a
more pronounced CFC within and between nodes of the tinnitus network. CFC can coordinate tinnitusrelevant activity in the tinnitus network providing a mechanism for effective communication between nodes
of this network.
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A Bayesian Perspective on Tinnitus Pitch Matching.
Ear Hear. 2014 Aug 27. [Epub ahead of print]
McMillan GP1, Thielman EJ, Wypych K, Henry JA.
1
VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, Oregon,
USA;
OBJECTIVES: New tinnitus therapies are being developed and marketed that target the patient's tinnitus
frequency. This frequency is estimated clinically by pitch matching, which has the patient identify the
pure tone that is closest to the perceived tinnitus frequency. Though widely used, pitch matching is
heavily criticized as unreliable, and the degree of reliability varies among patients. At the very least, it is
recommended that multiple pitch matches be used to identify the patient's tinnitus frequency. Even so, it is
not clear how many pitch matches to collect, how they should be combined, or how doing so will enhance
the audiologist's certainty about the true tinnitus frequency. In this article, we describe a simple Bayesian
method of sequentially combining pitch matches until acceptable precision is achieved and illustrate
the method in 10 patients with chronic tinnitus. DESIGN: Subjects were recruited from previous study
participants and support group attendees at the National Center for Rehabilitative Auditory Research.
Thirty tinnitus pitch matches were elicited from 10 patients with chronic, monotonal tinnitus. RESULTS: A
Bayesian sequential analysis yielded estimated tinnitus frequencies for 7 patients that were within onequarter octave of their true value with 90% certainty. Between four and twenty pitch matches were required
to achieve acceptable results in these seven patients. CONCLUSIONS: Despite criticism, pitch matching
is widely used to estimate tinnitus frequency. We address reliability concerns with a Bayesian sequential
analysis to jointly estimate tinnitus frequency and reliability. The method is easily applied.
Clinical signs and symptoms of tinnitus in temporomandibular joint disorders: a pilot study
comparing patients and non-patients.
S Afr J Commun Disord. 2013 Dec;60:16-20.
Kanji A, Khoza-Shangase K.
BACKGROUND: Tinnitus is one of the otologic symptoms commonly reported to be associated with
temporomandibular disorder (TMD), and questions regarding its nature and cause continue to plague the
clinical and research community. OBJECTIVES: The current pilot study aimed to investigate the clinical
signs and symptoms of presenting tinnitus in a group of individuals with TMD (group A), and compare them
with a group with tinnitus but without TMD (group B). Twenty participants were included in the study, 10
from each group. METHODS: All participants underwent basic audiological as well as ear, nose and throat
(ENT) evaluations to establish group A and group B. For tinnitus assessment, all participants completed
a tinnitus survey questionnaire, and their tinnitus was evaluated using tinnitus matching procedures.
RESULTS: Findings revealed clinically relevant differences in attributes of tinnitus in patients with and
without TMD. Most of the participants in group A matched their tinnitus to a 6 000 Hz tone or noise, at
lower intensity levels than participants in group B, although these results were not statistically significant.
Participants in group A associated their tinnitus with a single sound whereas some participants in group B
associated it with more than one sound. More participants in group B reported the duration of their tinnitus
as constant. CONCLUSIONS: Tinnitus may occur in patients with TMD, and be of high frequency. This
highlights the importance of thorough assessment for patients with tinnitus as this might have implications
for diagnosis and management.
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Our experience: how are we managing sudden sensorineural hearing loss in the united kingdom?
Clin Otolaryngol. 2014 Aug 14. doi: 10.1111/coa.12302. [Epub ahead of print]
Stobbs N1, Goswamy J, Ramamurthy L.
1
Department of Otolaryngology Head and Neck Surgery, Stepping Hill Hospital, Cheshire, UK.
Sudden sensori-neural hearing loss (SSNHL) is a potentially devastating otological condition, often
presenting to Otolaryngologists via emergency departments or emergency outpatient clinics. Definitions
in the literature vary; the most frequently used is greater than 30 dB sensori-neural hearing loss in at
least three contiguous audiometric frequencies occurring over 72 hours or less1 . Often presentation is
unilateral, but may occur bilaterally and can also be associated with tinnitus, vertigo and aural fullness.
This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights
reserved.
Validation of a French (Québec) version of the Tinnitus Handicap Inventory.
Int J Audiol. 2014 Aug 20:1-7. [Epub ahead of print]
Bolduc D1, Désilets F, Tardif M, Leroux T.
1
Institut Raymond-Dewar, Centre de recherche interdisciplinaire en réadaptation , Montréal, Québec ,
Canada.
Objective: To assess the psychometric properties of the Quebec French translation of the Tinnitus Handicap
Inventory (THI-FQ). Design: The original version of the THI was translated into French by two different
people, and then revised before being administered to 221 study participants. A subgroup of 75 participants
also completed the French versions of the Beck Depression Inventory II (BDI-II) and the Tinnitus Reaction
Questionnaire (TRQ). Study sample: The study participants used French as their home language, had
completed an otolaryngology (ENT) assessment, and had sought help with disabling tinnitus. Results: No
differences were found according to gender, age, or degree of hearing loss. The THI-FQ was very stable
over a period of approximately 32 days. Internal consistency was 0.93 for the total score. Convergent
validity with the TRQ was 0.81 (p < 0.001) while construct validity, as obtained with the BDI-II, was 0.74 (p
< 0.001). As in other studies, the factor analysis did not confirm the structure proposed by Newman et al in
the original study (1996). Conclusions: The THI-FQ presents very good reliability and validity, comparable
to translations in other languages and the original version.
Carotid Cavernous Sinus Fistulas Without Superior Ophthalmic Vein Enlargement.
Ophthal Plast Reconstr Surg. 2014 Aug 7. [Epub ahead of print]
Jacobs SM1, Arias EJ, Derdeyn CP, Couch SM, Custer PL.
1
*Department of Ophthalmology and Visual Sciences, †Department of Neurosurgery, and ‡Departments
of Neurology and Radiology, Washington University, St. Louis, Missouri, U.S.A.
PURPOSE: Diagnosis of carotid cavernous fistula (CCF) relies on clinical findings, such as proptosis,
chemosis, and pulsatile tinnitus, plus imaging features including enlargement of the superior ophthalmic
vein (SOV). This study reviewed patients with CCF, with a focus on those who were clinically symptomatic
but had a normal-appearing SOV on routine scans. METHODS: Retrospective review was conducted on
the clinical records of patients with CCF seen by ophthalmology or interventional neuroradiology, with
attention to clinical and imaging features, angiography findings, management, and outcomes. RESULTS:
Forty patients presented with CCF. History of head trauma was present in 13 (average age 43.8 years; all
direct or complex), while the remainder occurred spontaneously (average 66 years; 85% indirect). The most
common presenting ophthalmologic signs or symptoms were proptosis (65%), binocular diplopia (60%),
redness (57.5%), and chemosis (47.5%). After diagnosis, 36 underwent endovascular treatment, with
successful occlusion achieved in 90% of cases for whom follow-up data was available (n = 21). Notably, 3
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32
patients with CCF did not have SOV enlargement on any imaging modality including catheter angiography.
CONCLUSIONS: In this series of patients with clinical signs of CCF, there was no radiologic evidence of
enlarged SOV in 26% of patients on noninvasive imaging and in 8% on catheter angiography. To avoid
inappropriate interventions or delays in diagnosis and care, it is important to recognize that CCF can exist
without SOV enlargement. Patients with clinical features suspicious for CCF should undergo catheter
angiography if treatment is being considered. Endovascular treatment can produce clinical improvement
or resolution.
[Acceptance of Tinnitus: Validation of the ‛Akzeptanzfragebogen bei chronischem Tinnitus'
(AFCT).]
Laryngorhinootologie. 2014 Aug 6. [Epub ahead of print] German.
Riedl D1, Rumpold G1, Schmidt A2, Bliem HR3, Moschen R1.
1
Department für Psychiatrie und Psychotherapie, Univ.-Klinik für Medizinische Psychologie, Innsbruck,
Austria.
Background: Tinnitus is a widely spread symptom, which is perceived chronically by approximately 10%
of the population. The vast majority of the tinnitus patients doesn´t feel impaired through the ear noise,
but about 5-30% of the tinnitus patient are suffering in their everyday life. Whether severe distress is
experienced cannot be explained by the quality of the ear noise itself (i. e. loudness or duration). Newer
research tends to explain the difference in the experienced strain by the concept of acceptance. The aim
of this study was to analyze the psychometric quality of a German Version of the "Chronic Pain Acceptance
Ques-tionnaire" (CPAQ), namely the "Akzeptanzfragebogen bei chronischem Tinnitus" (AFCT) which has
been adapted for tinnitus. Methods: 97 patients with chronic tinnitus have been tested at the start of
an outpatient tinnitus group therapy. The following questionnaires were used: "Akzeptanzfragebogen bei
chronischem Tinnitus" (AFCT) and "Tinnitusfragebogen" (TF). The structure of the AFCT was determined
by a factor analysis. The reliability was evaluated by the estimation of the internal consistency (Cronbach
Alpha). Results: Due to psychometric weakness and unclear factorial loadings 8 items have been removed.
Out of the remaining 12 items the AFCT-12 has been developed. The AFCT-12 consists of 2 factors,
which explain a variance of 54.9%. Both AFCT-12 and AFCT have a satisfactory reliability and validity.
Conclusion: The results demonstrate that the AFCT-12 is a reliable and valid instrument to measure the
acceptance of patients suffering from chronic tinnitus. © Georg Thieme Verlag KG Stuttgart • New York.
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33
Flammer syndrome.
EPMA J. 2014 Jul 8;5(1):11. doi: 10.1186/1878-5085-5-11. eCollection 2014. Review.
Konieczka K1, Ritch R2, Traverso CE3, Kim DM4, Kook MS5, Gallino A6, Golubnitschaja O7, Erb C8,
Reitsamer HA9, Kida T10, Kurysheva N11, Yao K12.
1
Department of Ophthalmology, University of Basel, Mittlere Strasse 91, 4031 Basel, Switzerland.
The new term Flammer syndrome describes a phenotype characterized by the presence of primary
vascular dysregulation together with a cluster of symptoms and signs that may occur in healthy people
as well as people with disease. Typically, the blood vessels of the subjects with Flammer syndrome
react differently to a number of stimuli, such as cold and physical or emotional stress. Nearly all organs,
particularly the eye, can be involved. Although the syndrome has some advantages, such as protection
against the development of atherosclerosis, Flammer syndrome also contributes to certain diseases, such
as normal tension glaucoma. The syndrome occurs more often in women than in men, in slender people
than in obese subjects, in people with indoor rather than outdoor jobs, and in academics than in blue collar
workers. Affected subjects tend to have cold extremities, low blood pressure, prolonged sleep onset time,
shifted circadian rhythm, reduced feeling of thirst, altered drug sensitivity, and increased general sensitivity,
including pain sensitivity. The plasma level of endothelin-1 is slightly increased, and the gene expression
in lymphocytes is changed. In the eye, the retinal vessels are stiffer and their spatial variability larger; the
autoregulation of ocular blood flow is decreased. Glaucoma patients with Flammer syndrome have an
increased frequency of the following: optic disc hemorrhages, activated retinal astrocytes, elevated retinal
venous pressure, optic nerve compartmentalization, fluctuating diffuse visual field defects, and elevated
oxidative stress. Further research should lead to a more concise definition, a precise diagnosis, and tools
for recognizing people at risk. This may ultimately lead to more efficient and more personalized treatment.
A mouse model validates the utility of electrocochleography in verifying endolymphatic hydrops.
J Assoc Res Otolaryngol. 2014 Jun;15(3):413-21. doi: 10.1007/s10162-014-0445-0. Epub 2014 Feb 8.
Melki SJ1, Li Y, Semaan MT, Zheng QY, Megerian CA, Alagramam KN.
1
Ear Nose and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve
University, Cleveland, OH, 44106, USA, [email protected].
Endolymphatic hydrops (ELH) is a disorder of the inner ear that causes tinnitus, vertigo, and hearing
loss. An elevated ratio of the summating potential (SP) to the action potential (AP) measured by
electrocochleography has long been considered to be the electrophysiological correlate of ELH-related
clinical conditions, such as Meniere's disease, but in vivo confirmation and correlation between an elevated
SP/AP ratio and ELH has not yet been possible. Confirming this relationship will be important to show that
elevated SP/AP ratio is indeed diagnostic of ELH. Here, we sought to confirm that an elevated SP/AP ratio
is associated with ELH and test the hypothesis that severity of ELH and hearing loss would also correlate
with the SP/AP ratio in vivo using the Phex(Hyp-Duk)/Y mouse model of postnatal ELH. In addition, we
describe a minimally invasive approach for electrocochleography in mice. Auditory brainstem responses
and electrocochleography data were collected from controls and Phex(Hyp-Duk)/Y mutants at postnatal
day 21 and the mice (all male) were euthanized immediately for cochlear histology. Our results show that
(1) the SP/AP ratio was significantly elevated in mice with histological ELH compared to controls, (2) the
SP/AP ratio was not correlated with the severity of histological ELH or hearing loss, and (3) the severity
of hearing loss correlated with the severity of histological ELH. Our study demonstrates that an elevated
SP/AP ratio is diagnostic of ELH and that the severity of hearing loss is a better predictor of the severity
of ELH than is the SP/AP ratio.
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34
What is the best imaging modality in evaluating patients with unilateral pulsatile tinnitus?
Laryngoscope. 2014 Jul 9. doi: 10.1002/lary.24822. [Epub ahead of print] No abstract available.
Ahsan SF1, Seidman M, Yaremchuk K.
1
Department of Otolaryngolog-Head and Neck Surgery, Henry Ford Health Systems, Detroit, Michigan,
U.S.A.
No abstract available.
Development of the Tinnitus Response Scales: Factor analyses, subscale reliability and validity
analyses.
Int Tinnitus J. 2013;18(1):45-56. doi: 10.5935/0946-5448.20130007.
Croft C, Brown RF, Thorsteinsson EB, Noble W.
OBJECTIVE: Patients suffering with tinnitus are often advised to accept the noise, but few studies have
examined what tinnitus acceptance entails. The present project developed and tested a new instrument to
assess the mindfulnessbased constructs of acceptance, control, and defeat, in relation to the experience of
chronic tinnitus. METHOD: Initial scale development involved an expert panel. Participants were recruited
from the general population and tinnitus support organizations and complete the first version of the Tinnitus
Response Scales (TRS) and measures of tinnitus coping, severity and distress, general distress, illness
cognitions, and tinnitus and health characteristics. RESULTS: Three interpretable TRS factors were found:
acceptance, control and defeat (an Internet sample, N = 273) and confirmed using another sample (hardcopy sample, N = 278). Factors were shown to have high internal consistency and testretest reliabilities
and differed in terms of their related cognitions, behaviour, and emotional responses to tinnitus, and
their tinnitus characteristics. CONCLUSION: The TRS factors provide an alternative conceptualisation of
tinnitus responding. TRS is a brief psychometrically valid measure of tinnitus responding that appears to
distinguish between adaptive and non-adaptive responses to tinnitus noise, and should prove useful as a
clinical measure.
Hungarian adaptation of the Tinnitus Handicap Inventory: reliability and validity.
Eur Arch Otorhinolaryngol. 2014 Jun 27. [Epub ahead of print]
Bencsik B1, Tamás L, Trimmel K, Stauder A.
1
Department of Otorhinolaryngology and Head and Neck Surgery, Semmelweis University, Szigony
Street 36, Budapest, 1083, Hungary, [email protected].
The objective of this study was to determine the reliability and validity of the Hungarian version of the
original Tinnitus Handicap Inventory (THI). In the study design the original THI (THI-US) was translated into
Hungarian by three independent investigators. The final Hungarian version (THI-HUN) was constructed on
the basis of these Hungarian interpretations and then administered to 72 patients suffering from chronic
tinnitus. Construct validity was assessed using short version of Beck's Depression Inventory (BDI),
Perceived Stress Scale (PSS4 version), Visual Analogue Scale (VAS) (loudness, annoyance and pitch
of tinnitus), pure tone audiometry and tinnitometry. The 72 participants were 43 women and 29 men.
Their mean age was 49.86 years with a mean tinnitus duration of 4.16 years. In the results THI-HUN and
its subscales showed good internal consistency reliabilities (α = 0.95-0.74), with significant correlation
between THI-HUN total score and subscales and the BDI, PSS4 and VAS annoyance. There was a high or
moderate correlation between THI-HUN total score and VAS loudness, tinnitus duration, hearing loss and
subjective perception of tinnitus loudness. The VAS pitch of tinnitus, the subjective perception of tinnitus
pitch, age, gender and level of education did not show any correlation with THI-HUN total score. The testretest reliability was high (r = 0.97). We conclude that a valid and reliable THI-HUN questionnaire was
constructed.
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35
Toward development of a tinnitus magnitude index.
Ear Hear. 2014 Jul-Aug;35(4):476-84. doi: 10.1097/AUD.0000000000000017.
Schmidt CJ1, Kerns RD, Griest S, Theodoroff SM, Pietrzak RH, Henry JA.
1
VA Connecticut Healthcare System, West Haven, Connecticut, USA; 2Yale University School of
Medicine, New Haven, Connecticut, USA; 3VA Rehabilitation Research and Development (RR&D)
National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, Oregon, USA;
and 4Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University,
Portland, Oregon, USA.
OBJECTIVES: The aim of the study was to provide preliminary evidence of a unique "tinnitus magnitude"
domain describing intensity of tinnitus perception that will assist in the development of a cognitive-behavioral
mediation model of psychological distress associated with tinnitus. DESIGN: A sample of 347 participants
with tinnitus was previously recruited from four audiology clinics for the purpose of developing a tinnitus
distress measure, the Tinnitus Functional Index (TFI). From the questions used for TFI development,
potential tinnitus magnitude items were selected by including those that minimally overlapped with tinnitus
reactions. The three items having the least overlap were analyzed retrospectively to assess internal
consistency, test-retest reliability, group differences using demographics and tinnitus-relevant descriptive
variables, and discriminant validity. The three-item scale was developed in an effort to establish a model for
prospective development of a Tinnitus Magnitude Index (TMI) that would assess the magnitude of tinnitus
variables independent of reactions to tinnitus. RESULTS: Internal consistency (α = 0.86) and repeated
measures tests (r = 0.74, df = 29, p < 0.001) indicate the three-item scale is reliable. Discriminant validity
was supported by only moderate correlations (r≥ 0.30 and r ≤ 0.69) of the scale with the Tinnitus Handicap
Inventory (r = 0.62), the Beck Depression Inventory for Primary Care (r = 0.38), and the seven independent
domains of tinnitus reactions measured using subscales of the TFI (r = 0.49 to 0.72). Correlations between
the scale and two tinnitus reactions (distress) subscales were high (r > 0.70) as compared with moderate
correlations. CONCLUSIONS: This study involved a retrospective analysis of data from questions that
were originally evaluated for use in a tinnitus outcome questionnaire. The analysis was conducted to
establish a model for prospective development of a TMI. Results of this analysis suggest that a TMI can be
developed that would provide a reliable and valid measure of tinnitus magnitude that overlaps minimally
in content with measures of cognitive, behavioral, and emotional tinnitus reactions. A fully validated TMI
would provide a measure of tinnitus magnitude that is not confounded by emotional reactions to tinnitus
or general depressive symptoms and would be useful in developing a testable model of psychological
distress due to tinnitus. Although the primary goal is to develop a measure of tinnitus magnitude that
predicts cognitive, behavioral, and emotional reactions to tinnitus, a TMI may also have utility in assessing
this construct in clinical settings.
Socio-Demographic, Health, and Tinnitus Related Variables Affecting Tinnitus Severity.
Ear Hear. 2014 Jul 8. [Epub ahead of print]
Hoekstra CE1, Wesdorp FM, van Zanten GA.
1
Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht,
Utrecht, The Netherlands;
OBJECTIVES:: Tinnitus is a highly prevalent symptom with potential severe morbidity. Fortunately, only
a small proportion of the population experience problems due to their tinnitus in such a degree that it
adversely affects their quality of life (clinically significant tinnitus). It is not known why these individuals
develop more burden from tinnitus. It seems likely that the severity of tinnitus can be influenced by different
factors, such as socio-demographic or tinnitus characteristics or additional health complaints. It remains
unclear from the current literature as to what are the main independent variables that have a bearing on
tinnitus severity. This study addresses this problem by investigating variables previously described in the
literature as well as additional variables. The aim of this study is to identify socio-demographic, health, and
tinnitus variables that independently relate to tinnitus severity the most. DESIGN:: This is a retrospective
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36
cohort study performed at the Tinnitus Care Group of the University Medical Center, Utrecht, in 309
consecutively seen chronic tinnitus patients. At this care group, patients are examined according to a
structured diagnostic protocol, including history-taking by an otorhinolaryngologist and audiologist, physical
examination, and audiometry. Based on results from previous research and theoretical considerations, a
subset of data acquired through this diagnostic protocol were selected and used in this study. Univariate
and multivariate correlations with tinnitus severity were investigated for 28 socio-demographic, health,
and tinnitus variables. Tinnitus severity was measured with the Tinnitus Questionnaire (TQ) and the
Tinnitus Handicap Inventory (THI). RESULTS:: Eighteen variables related univariately with the TQ and 16
variables related univariately with the THI. Among these, 14 variables related univariately with both the
TQ and the THI. Multivariate analyses showed three variables with an independent significant effect on
both the TQ and the THI: percentage of tinnitus awareness during the day, self-reported depression and/
or anxiety, and loudness on a Visual Analogue Scale. Three additional variables contributed independently
significantly to the explained variance in either the TQ or the THI: level of education, somatic complaints,
and tinnitus variability in loudness and/or pitch on a Visual Analogue Scale. These variables were among
the first not to reach significance on the other questionnaire. CONCLUSIONS:: Tinnitus severity is shown
to be strongly related to percentage of tinnitus awareness during the day, self-reported depression and/or
anxiety, subjectively experienced loudness, level of education, existence of additional somatic complaints,
and subjectively experienced variability in loudness and/or pitch. Further research is needed to investigate
the causal relationship between these variables and tinnitus severity. This knowledge may contribute to a
better recognition, follow-up, and/or counseling of more vulnerable patients.
IVImaging
Magnetic Resonance Imaging Findings in Children With Tinnitus.
Ann Otol Rhinol Laryngol. 2014 Aug 28. pii: 0003489414546605. [Epub ahead of print]
Levi E1, Bekhit EK2, Berkowitz RG3.
1
Department of Otolaryngology, Royal Children's Hospital Melbourne, Victoria, Australia eric.levi@
yahoo.com.
OBJECTIVE: Tinnitus in adults is generally investigated by contrast-enhanced magnetic resonance imaging
(MRI) to rule out the diagnosis of acoustic neuroma. Acoustic neuroma is rare in children and, therefore,
the role of MRI in children with tinnitus is unclear. This study was undertaken to determine the value of
MRI in the investigation of tinnitus in children. METHODS: Retrospective study of children younger than
18 years who underwent MRI for the investigation of tinnitus over a 10-year period. RESULTS: Sixty-five
patients were identified, but there were only 34 who had also undergone audiologic assessment. Among
the 25 patients with normal audiology, MRI abnormalities were present in 9, but these were all thought to
be nonspecific. Nine patients had abnormal audiograms and the MRI was abnormal in 4 of these cases,
which included 3 children who were found to have multiple sclerosis. CONCLUSION: Magnetic resonance
imaging would appear to be mandatory in the investigation of tinnitus in children who are found to have
sensorineural hearing loss, particularly to rule out the diagnosis of multiple sclerosis. Although our study
does not support the routine use of MRI in children with normal audiology, the numbers in our series are
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too small for a conclusive recommendation. © The Author(s) 2014.
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37
Electroencephalographic Effects of Transcranial Random Noise Stimulation in the Auditory
Cortex.
Brain Stimul. 2014 Aug 26. pii: S1935-861X(14)00305-2. doi: 10.1016/j.brs.2014.08.007. [Epub ahead of
print]
Van Doren J1, Langguth B2, Schecklmann M3.
1
Department of Psychiatry and Psychotherapy, University of Regensburg, Germany; Experimental and
Clinical Neuroscience, University of Regensburg, Elite Network Bavaria, Germany.
BACKGROUND: Transcranial random noise stimulation (tRNS) is an innovative technique of non-invasive
electrical stimulation. tRNS over the parietal cortex has improved cognitive function in healthy controls and,
applied to the auditory cortex, tRNS has shown beneficial effects on tinnitus. OBJECTIVE/HYPOTHESIS:
Here we aimed to investigate the effects of tRNS over the auditory cortex on resting state and evoked
activity in healthy subjects. METHODS: We used EEG to measure tRNS induced changes in resting state
activity and in auditory steady state responses (ASSRs). Stimuli were 1000 Hz carrier frequency tones,
amplitude modulated at 20 Hz and 40 Hz and applied in randomized order. Fourteen subjects participated
in a placebo-controlled randomized design study; each received 20 min of tRNS applied over auditory
cortices with 2 mA, with a one week interval between real and sham stimulation. RESULTS: We found
a significant increase in the ASSR in response to 40 Hz frequency modulated tone and a non-significant
trend toward an increase in mean theta band power and variability of the theta band power for the resting
state data. CONCLUSIONS: Our finding of tRNS induced increased excitability in the auditory cortex
parallels previous findings of tRNS effects on motor cortex excitability and is in line with current concepts
of tRNS mechanisms such as increase of stochastic resonance. Copyright © 2014 Elsevier Inc. All rights
reserved.
Disentangling Tinnitus Distress and Tinnitus Presence by Means of EEG Power Analysis
Hindawi Publishing Corporation, Neural Plasticity, Volume 2014, Article ID 468546, 13 pages. http://
dx.doi.org/10.1155/2014/468546
Martin Meyer,1,2,3,4 Matthias S. Luethi, 5 Patrick Neff,1,3,6 Nicolas Langer,7,8,9,10 and Stefan Büchi10,11
Neuroplasticity and Learning in the Healthy Aging Brain (HAB LAB), Institute of Psychology, University
of Zurich, Andreasstrasse 15/2, 8050 Zurich, Switzerland
2
International Normal Aging and Plasticity Imaging Center, University of Zurich, Zurich, Switzerland
3
University Research Priority Program “Dynamics of Healthy Aging”, University of Zurich, Zurich,
Switzerland
4
Cognitive Psychology Unit (CPU), University of Klagenfurt, Klagenfurt am Worthersee, Austria
1
The present study investigated 24 individuals suffering from chronic tinnitus (TI) and 24 nonaffected controls
(CO). We recorded resting-stateEEGandcollectedpsychometricdatatoobtaininformationabouthowchronicti
nnitusexperienceaffectsthecognitive and emotional state of TI. The study was meant to disentangle TI with
high distress from those who suffer less from persistent tinnitus based on both neurophysiological and
behavioral data. A principal component analysis of psychometric data uncovers two distinct independent
dimensions characterizing the individual tinnitus experience. These independent states are distress
and presence, the latter is described as the perceived intensity of sound experience that increases with
tinnitus duration devoid of any considerable emotional burden. Neuroplastic changes correlate with the
two independent components. TI with high distress display increased EEG activity in the oscillatory range
around 25Hz (upper β-band) that agglomerates over frontal recording sites. TI with high presence show
enhanced EEG signal strength in the δ-, α-, and lower γ-bands (30–40Hz) over bilateral temporal and left
perisylvian electrodes. Based on these differential patterns we suggest that the two dimensions, namely,
distress and presence, should be considered as independent dimensions of chronic subjective tinnitus.
Free Article.
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38
Endolymphatic space size in patients with vestibular migraine and Ménière's disease.
J Neurol. 2014 Aug 7. [Epub ahead of print]
Nakada T1, Yoshida T, Suga K, Kato M, Otake H, Kato K, Teranishi M, Sone M, Sugiura S, Kuno K,
Pyykkö I, Naganawa S, Watanabe H, Sobue G, Nakashima T.
1
Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65 TsurumaiCho, Showa-ku, Nagoya, 466-8550, Japan, [email protected].
Ménière's disease (MD) is characterized by episodic vertigo, fluctuating hearing loss and tinnitus. Vestibular
migraine (VM) is a relatively new disorder that is characterized by episodic vertigo or dizziness, coexisting
migraine and absence of hearing loss. It is occasionally difficult to distinguish between VM and vestibular
MD with headache. Because endolymphatic hydrops (EH) is a characteristic sign of MD, we attempted
to evaluate endolymphatic space size in both diseases. Endolymphatic space size in the vestibule and
the cochlea was evaluated in seven patients with VM and in seven age- and sex-matched patients with
vestibular MD. For visualization of the endolymphatic space, 3T magnetic resonance imaging was taken
4 h after intravenous injection of gadolinium contrast agents using three-dimensional fluid-attenuated
inversion recovery and HYbriD of reversed image of positive endolymph signal and native image of positive
perilymph signal techniques. In the vestibule of VM patients, EH was not observed, with the exception of
two patients with unilateral or bilateral EH. In contrast, in the vestibule of patients with vestibular MD, all
patients had significant EH, bilaterally or unilaterally. These results indicate that endolymphatic space size
is significantly different between patients with VM and vestibular MD.
What is the best imaging modality in evaluating patients with unilateral pulsatile tinnitus?
Laryngoscope. 2014 Jul 9. doi: 10.1002/lary.24822. [Epub ahead of print] No abstract available.
Ahsan SF1, Seidman M, Yaremchuk K.
1
Department of Otolaryngolog-Head and Neck Surgery, Henry Ford Health Systems, Detroit, Michigan,
U.S.A.
No abstract available.
Diffusion imaging of auditory and auditory-limbic connectivity in tinnitus: preliminary evidence
and methodological challenges.
Neural Plast. 2014;2014:145943. doi: 10.1155/2014/145943. Epub 2014 Jun 22.
Seydell-Greenwald A1, Raven EP2, Leaver AM3, Turesky TK4, Rauschecker JP5.
1
Laboratory of Integrative Neuroscience and Cognition, Department of Neuroscience, Georgetown
University Medical Center, 3970 Reservoir Road NW, New Research Building, Washington, DC 20007,
USA ; Center for Brain Plasticity and Recovery, Department of Neurology, Georgetown University
Medical Center, 4000 Reservoir Road NW, Building D, Washington, DC 20007, USA.
Subjective tinnitus, or "ringing in the ears," is perceived by 10 to 15 percent of the adult population and
causes significant suffering in a subset of patients. While it was originally thought of as a purely auditory
phenomenon, there is increasing evidence that the limbic system influences whether and how tinnitus is
perceived, far beyond merely determining the patient's emotional reaction to the phantom sound. Based
on functional imaging and electrophysiological data, recent articles frame tinnitus as a "network problem"
arising from abnormalities in auditory-limbic interactions. Diffusion-weighted magnetic resonance imaging
is a noninvasive method for investigating anatomical connections in vivo. It thus has the potential to
provide anatomical evidence for the proposed changes in auditory-limbic connectivity. However, the few
diffusion imaging studies of tinnitus performed to date have inconsistent results. In the present paper, we
briefly summarize the results of previous studies, aiming to reconcile their results. After detailing analysis
methods, we then report findings from a new dataset. We conclude that while there is some evidence for
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39
tinnitus-related increases in auditory and auditory-limbic connectivity that counteract hearing-loss related
decreases in auditory connectivity, these results should be considered preliminary until several technical
challenges have been overcome. Free PMC Article.
Reduced variability of auditory alpha activity in chronic tinnitus.
Neural Plast. 2014;2014:436146. doi: 10.1155/2014/436146. Epub 2014 May 19.
Schlee W, Schecklmann M, Lehner A, Kreuzer PM, Vielsmeier V, Poeppl TB, Langguth B.
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstrasse 84, 93053
Regensburg, Germany.
Subjective tinnitus is characterized by the conscious perception of a phantom sound which is usually
more prominent under silence. Resting state recordings without any auditory stimulation demonstrated
a decrease of cortical alpha activity in temporal areas of subjects with an ongoing tinnitus perception.
This is often interpreted as an indicator for enhanced excitability of the auditory cortex in tinnitus. In this
study we want to further investigate this effect by analysing the moment-to-moment variability of the alpha
activity in temporal areas. Magnetoencephalographic resting state recordings of 21 tinnitus subjects and
21 healthy controls were analysed with respect to the mean and the variability of spectral power in the
alpha frequency band over temporal areas. A significant decrease of auditory alpha activity was detected
for the low alpha frequency band (8-10 Hz) but not for the upper alpha band (10-12 Hz). Furthermore, we
found a significant decrease of alpha variability for the tinnitus group. This result was significant for the
lower alpha frequency range and not significant for the upper alpha frequencies. Tinnitus subjects with a
longer history of tinnitus showed less variability of their auditory alpha activity which might be an indicator
for reduced adaptability of the auditory cortex in chronic tinnitus. Free PMC Article.
Correlation between brain cortex metabolic and perfusion functions in subjective idiopathic
tinnitus.
Int Tinnitus J. 2013;18(1):20-8. doi: 10.5935/0946-5448.20130004.
Mahmoudian S, Farhadi M, Gholami S, Saddadi F, Jalesi M, Karimian AR, Darbeheshti M, Momtaz
S, Fardin S.
OBJECTIVES: Subjective tinnitus has associated with abnormal brain metabolism and perfusion found
in functional imaging studies by fluorodeoxyglucose (FDG) and technetium99m (TC99m). But there is
no study evaluating the association of brain metabolism and perfusion abnormalities in a group of these
subjects. The aim of this study was to investigate if there is any significant correlation between the brain
perfusion and metabolism abnormalities in subjects with tinnitus. MATERIALS AND METHODS: In this
cross-sectional study, 52 patients were undergone TC99m-ECD single photon emission computerized
tomography (SPECT) scan and F18-FDG positron emission tomography (PET). The results of PET and
SPECT scanning were fused with MRI to accurate anatomical localization of abnormalities. The analysis
was performed using Kendal's correlation, t-test and chi square. RESULTS: Assessing these 52 tinnitus
subjects (containing 42 males [76.4%]) showed that a significant correlation was found between the brain
metabolic function and perfusion (p value 0.001).
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40
Modulation of Electrocortical Brain Activity by Attention in Individuals with and without Tinnitus.
Neural Plast. 2014;2014:127824. doi: 10.1155/2014/127824. Epub 2014 Jun 12.
Paul BT1, Bruce IC2, Bosnyak DJ3, Thompson DC1, Roberts LE3.
1
Department of Psychology, Neuroscience & Behaviour, McMaster University, 1280 Main Street West,
Hamilton, ON, Canada L8S 4K1.
Age and hearing-level matched tinnitus and control groups were presented with a 40 Hz AM sound using
a carrier frequency of either 5 kHz (in the tinnitus frequency region of the tinnitus subjects) or 500 Hz
(below this region). On attended blocks subjects pressed a button after each sound indicating whether a
single 40 Hz AM pulse of variable increased amplitude (target, probability 0.67) had or had not occurred.
On passive blocks subjects rested and ignored the sounds. The amplitude of the 40 Hz auditory steadystate response (ASSR) localizing to primary auditory cortex (A1) increased with attention in control groups
probed at 500 Hz and 5 kHz and in the tinnitus group probed at 500 Hz, but not in the tinnitus group probed
at 5 kHz (128 channel EEG). N1 amplitude (this response localizing to nonprimary cortex, A2) increased
with attention at both sound frequencies in controls but at neither frequency in tinnitus. We suggest that
tinnitus-related neural activity occurring in the 5 kHz but not the 500 Hz region of tonotopic A1 disrupted
attentional modulation of the 5 kHz ASSR in tinnitus subjects, while tinnitus-related activity in A1 distributing
nontonotopically in A2 impaired modulation of N1 at both sound frequencies. Free PMC Article.
Functional mapping of the auditory tract in rodent tinnitus model using manganese-enhanced
magnetic resonance imaging.
Neuroimage. 2014 Jun 28. pii: S1053-8119(14)00532-1. doi: 10.1016/j.neuroimage.2014.06.055. [Epub
ahead of print]
Jung DJ1, Han M2, Jin SU2, Lee SH3, Park I4, Cho HJ5, Kwon TJ5, Lee HJ6, Cho JH7, Lee KY8, Chang
Y9.
1
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National
University Hospital, Daegu, Republic of Korea.
Animal models of salicylate-induced tinnitus have demonstrated that salicylate modulates neuronal activity
in several brain structures leading to neuronal hyperactivity in auditory and non-auditory brain areas. In
addition, these animal tinnitus models indicate that tinnitus can be a perceptual consequence of altered
spontaneous neural activity along the auditory pathway. Peripheral and/or central effects of salicylate can
account for neuronal activity changes in salicylate-induced tinnitus. Because of this ambiguity, an in vivo
imaging study would be able to address the peripheral and/or central involvement of salicylate-induced
tinnitus. Therefore, in the present study, we developed a novel manganese-enhanced magnetic resonance
imaging (MEMRI) method to map the in vivo functional auditory tract in a salicylate-induced tinnitus
animal model by administrating manganese through the round window. We found that acute salicylateinduced tinnitus resulted in higher manganese uptake in the cochlea and in the central auditory structures.
Furthermore, serial MRI scans demonstrated that the manganese signal increased in an anterograde
fashion from the cochlea to the cochlear nucleus. Therefore, our in vivo MEMRI data suggest that acute
salicylate-induced tinnitus is associated with higher spontaneous neural activity both in peripheral and
central auditory pathways. Copyright © 2014 Elsevier Inc. All rights reserved.
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41
Erratum to: Hyperacusis-associated pathological resting-state brain oscillations in the tinnitus
brain: a hyperresponsiveness network with paradoxically inactive auditory cortex.
Brain Struct Funct. 2014 Jul;219(4):1511. doi: 10.1007/s00429-014-0707-y.
Song JJ1, De Ridder D, Weisz N, Schlee W, Van de Heyning P, Vanneste S.
1
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang
Hospital, 166 Gumi-Ro, Bundang-Gu, Gyeonggi-Do, 463-707, Korea, [email protected].
No abstract available.
Abnormal baseline brain activity in patients with pulsatile tinnitus: a resting-state FMRI study.
Neural Plast. 2014;2014:549162. doi: 10.1155/2014/549162. Epub 2014 Apr 24.
Han L1, Zhaohui L1, Fei Y1, Ting L1, Pengfei Z1, Wang D1, Cheng D2, Pengde G1, Xiaoyi H2, Xiao W2,
Rui L2, Zhenchang W2.
1
Department of Radiology Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730,
China.
Numerous investigations studying the brain functional activity of the tinnitus patients have indicated that
neurological changes are important findings of this kind of disease. However, the pulsatile tinnitus (PT)
patients were excluded in previous studies because of the totally different mechanisms of the two subtype
tinnitus. The aim of this study is to investigate whether altered baseline brain activity presents in patients
with PT using resting-state functional magnetic resonance imaging (rs-fMRI) technique. The present study
used unilateral PT patients (n = 42) and age-, sex-, and education-matched normal control subjects (n
= 42) to investigate the changes in structural and amplitude of low-frequency (ALFF) of the brain. Also,
we analyzed the relationships between these changes with clinical data of the PT patients. Compared
with normal controls, PT patients did not show any structural changes. PT patients showed significant
increased ALFF in the bilateral precuneus, and bilateral inferior frontal gyrus (IFG) and decreased ALFF in
multiple occipital areas. Moreover, the increased THI score and PT duration was correlated with increased
ALFF in precuneus and bilateral IFG. The abnormalities of spontaneous brain activity reflected by ALFF
measurements in the absence of structural changes may provide insights into the neural reorganization in
PT patients. Free PMC Article.
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42
VPharmacotherapy
Oral gabapentin and intradermal injection of lidocaine: is there any role in the treatment of
moderate/severe tinnitus?
Eur Arch Otorhinolaryngol. 2014 Sep 28. [Epub ahead of print]
Ciodaro F1, Mannella VK, Cammaroto G, Bonanno L, Galletti F, Galletti B.
1
Department of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98100, Messina,
Italy.
The objective of our work is to evaluate recovery induced by gabapentin alone and in association with
intradermal infiltration of lidocaine in patients affected by moderate/severe tinnitus. Seventy-two patients
suffering from moderate/severe unilateral non-pulsatile subjective tinnitus were enrolled. Severity and
behaviour of tinnitus were assessed by Tinnitus handicap Index (THI) on the 8th, 22nd and 36th days
from onset of therapy, and on the 3rd and 6th month after the end of therapy in patients treated with oral
gabapentin (Group I), oral gabapentin and intradermal injection of lidocaine (Group II), and placebo (Group
III) Significant differences in THI scores from the 8th day of therapy to the 22nd (p < 0.0001) and from
the 22nd day to the 36th (p = 0.0002 and p = 0.0004, respectively) were found in Group I and Group II. In
Group II, another relevant decrease of THI scores from the 36th day of therapy to 3 months from the end of
treatment (p = 0.0004) was found. A significant difference in THI scores between Group I and Group II was
found after 8 days of treatment (p = 0.05) with a more relevant decrease registered in Group II; significant
differences were also found in THI scores between Group I and Group III after 8 days of treatment (p =
0.01), with a more relevant decrease registered in Group III; significant differences in THI scores between
Group II and Group III were found after 36 days of treatment (p = 0.009), 3 and 6 months after the end of
therapy (p = 0.005 and p = 0.007, respectively), with a more relevant decrease registered in Group II. In
conclusion, the use of gabapentin associated to lidocaine seems to be superior to placebo and gabapentin
in relieving tinnitus.
Drybonioside, a new glucoside from the Drynaria bonii H. Christ Rhizomes.
Nat Prod Res. 2014 Oct 9:1-4. [Epub ahead of print]
Pham TN1, Mai DT, Huynh TM, Le TD.
1
aDepartment of Chemistry, Faculty of General Science, Tiengiang University, National Highway No. 1,
Chau Thanh Dist, Tiengiang Province, Vietnam.
Drynaria bonii H. Christ, a Vietnam traditional medicinal plant, is used for the treatment of osteoporosis, bone
fractures, tinnitus, etc. (Ho PH. 2002. Vietnamese plants. Hanoi: Publisher of Young; Loi DT. 2004. Medicinal
plants and remedy of Vietnam. Hanoi: Publisher of Medicine). Based on column chromatography, a new
glucoside named drybonioside (5) and four known compounds α-tocopherol (1), 24-methylencycloartan3β-ol (2), triphyllol (3) and ethyl β-d-fructopyranoside (4) were isolated and identified from hexane and
methanol extracts of D. bonii. The structures of new compound were elucidated on the basis of NMR and
MS spectroscopic analysis.
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43
Effects of the reduction of caffeine consumption on tinnitus perception.
Braz J Otorhinolaryngol. 2014 September - October;80(5):416-421. doi: 10.1016/j.bjorl.2014.05.033.
Epub 2014 Jun 12.
Figueiredo RR1, Rates MJ2, de Azevedo AA3, Moreira RK4, Penido ND5.
1
Post-Graduate Program in Otorhynolaryngology, Universidade Federal de São Paulo (UNIFESP), São
Paulo, SP, Brazil; Faculdade de Medicina de Valença, Rio de Janeiro, RJ, Brazil; Tinnitus Research
Initiative, Regensburg, Germany. Electronic address: [email protected].
INTRODUCTION: For many years, excessive caffeine consumption has been touted as an aggravating
factor for tinnitus. The pathophysiology behind this effect is probably related to the blockage of adenosine
receptors by the action of caffeine on the central nervous system. OBJECTIVE: To evaluate the effects
of reduction of coffee consumption on tinnitus sensation and to identify subgroups more prone to benefit
from this therapeutic strategy. STUDY DESIGN: Prospective. METHODS: Twenty-six tinnitus patients
who consumed at least 150mL of coffee per day were selected. All were asked to reduce their coffee
consumption. The Tinnitus Handicap Inventory (THI) questionnaire was completed by the patients before
and after the reduction of coffee consumption, as well as a visual-analog scale (VAS) graduated from 1
to 10. RESULTS: THI and VAS scores were significantly reduced (p<0.05). In the subgroups less than 60
years old, bilateral tinnitus and daily coffee consumption between 150 and 300mL showed a significantly
greater reduction of THI and VAS scores. CONCLUSION: Patients under 60 years of age with bilateral
tinnitus and daily coffee consumption between 150 and 300mL are more prone to benefit from consumption
reduction. Thirty-day observation periods may be helpful for a better therapeutical decision. Copyright
© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier
Editora Ltda. All rights reserved. Free full text.
Prognostic Factors for the Outcomes of Intratympanic Dexamethasone in the Treatment of Acute
Subjective Tinnitus.
Otol Neurotol. 2014 Jul 30. [Epub ahead of print]
An YH1, Yu KK, Kwak MY, Yoon SW, Shim HJ.
1
Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University
School of Medicine, Seoul, Korea.
OBJECTIVE: To determine the prognostic factors for the outcomes of treating acute subjective tinnitus with
intratympanic dexamethasone (ITD). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary
referral center. PATIENTS: We enrolled 139 subjects who were treated with ITD for acute subjective
tinnitus with symptoms lasting for 3 months or less. Overall, 114 of 139 subjects completed questionnaires
3 months after treatment or fully recovered within 3 months. Audiograms were performed 3 months after
treatment in 43 patients. INTERVENTION: ITD for acute subjective tinnitus. MAIN OUTCOME MEASURE:
Quantitative assessment of the severity of tinnitus by questionnaires and changes in hearing thresholds
at all frequencies by pure-tone audiometry. RESULTS: Tinnitus was cured in 43 of 114 patients (37.7%)
within 3 months. The mean tinnitus loudness score, the mean tinnitus awareness score, and the mean
tinnitus handicap inventory score were significantly reduced at 3 months after ITD. Audiometric responses
were detected in 12 of 43 patients (27.9%) who underwent follow-up audiograms. The cure rate was
significantly greater in patients with symptoms lasting for 2 weeks or less than in patients with symptoms
lasting for more than 1 month (64.7% vs. 15.7%; p < 0.05). The mean global improvement index for
tinnitus was significantly greater in patients with unilateral tinnitus than in patients with bilateral tinnitus
(6.2 ± 1.9 vs. 5.0 ± 2.0; p < 0.05). Among patients with unilateral tinnitus, the audiometric response rate
was significantly greater in patients with asymmetric hearing threshold than in patients with symmetric
hearing threshold (48.8% vs. 4.8%; p < 0.01). The cure rate was significantly associated with the duration
of symptoms. Unilateral tinnitus and audiologic asymmetry were positively associated with the audiometric
response rate. CONCLUSIONS: The duration of symptoms affected the cure rate of ITD for acute subjective
tinnitus. Unilateral tinnitus was associated with better improvements in symptoms than bilateral tinnitus.
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44
Furthermore, unilateral tinnitus and audiologic asymmetry were positively associated with the audiometric
response.
Intratympanic dexamethasone plus melatonin versus melatonin only in the treatment of unilateral
acute idiopathic tinnitus.
Am J Otolaryngol. 2014 Jul 2. pii: S0196-0709(14)00142-2. doi: 10.1016/j.amjoto.2014.06.009. [Epub
ahead of print]
Albu S1, Chirtes F2.
1
II-nd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca,
Cluj-Napoca, Romania. Electronic address: [email protected].
PURPOSE: The aim of our study was to determine whether the combination of intratympanic (IT) corticosteroid
with melatonin could be associated with decreased tinnitus in patients with unilateral acute idiopathic
tinnitus developed within 3months. MATERIALS AND METHODS: We evaluated this hypothesis through
a prospective, randomized, controlled, double-blinded trial. Patients included in the study were randomly
allocated into two groups: Group A - comprising 30 patients, received melatonin and IT dexamethazone,
and Group B - including 30 patients receiving melatonin alone. After 3months, improvement in tinnitus was
assessed using different outcome measures: tinnitus loudness score, tinnitus awareness score, Tinnitus
Handicap Inventory (THI), Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI).
RESULTS: We have demonstrated significant improvements in each of the above mentioned outcomes
subsequent to treatment in both groups. However, patients in the IT dexamathazone and melatonin group
attained statistically significant better outcomes. Besides, the differences in improvement rate and cure
rate were highly significant between the two groups, favoring the IT dexamethazone and melatonin group.
CONCLUSIONS: Our preliminary study demonstrated that IT dexamethazone plus melatonin is efficient
in improvement of idiopathic unilateral tinnitus developed within 3months. Copyright © 2014 Elsevier Inc.
All rights reserved.
[Intratympanic corticosteroid perfusion in the therapy of Meniere's disease].
[Article in Serbian]
Srp Arh Celok Lek. 2014 May-Jun;142(5-6):291-5.
Sanković-Babić S, Kosanović R, Ivanković Z, Babac S, Tatović M.
INTRODUCTION: Over the last two decades the intratympanic perfusion of corticosteroids has been
used as a minimally invasive surgical therapy of Meniere's disease. According to experimental studies
the antiinflammatory, immunoprotective, antioxidant and neuroprotective role of the locally perfused
corticosteroids was noticed in the inner ear structures. The recovery of action potentials in the cells of the
Corti organ was confirmed as well as a decreased expression of aquaporine-1, a glycoprotein responsible for
labyrinth hydrops and N and K ions derangement. OBJECTIVE: The study showed results of intratympanic
perfusion therapy with dexamethasone in patients with retractable Meniere's disease who are resistant to
conservative treatment. METHODS: Single doses of 4 mg/ml dexamethasone were given intratympanically
in 19 patients with retractable Meniere's disease. Six single successive doses of dexamethasone were
administered in the posteroinferior quadrant of the tympanic membrane. Follow-up of the patients was
conducted by using a clinical questionnaire a month after completed perfusion series as well as on every
third month up to one year. RESULTS: One month after completed first course of perfusions, in 78% of
patients, vertigo problems completely ceased or were markedly reduced. The recovery of hearing function
was recorded in 68% and marked tinnitus reduction in 84% of patients. After a year of follow-up, in 63% of
patients the reduction of vertigo persisted, while hearing function was satisfactory in 52%. Tinitus reduction
was present in 73% of patients. CONCLUSION: Intratympanic perfusion of dexamethasone in patients
with Meniere's disease is a minimally invasive therapeutic method that contributes to the reduction of
the intensity of vertigo recurrent attacks, decrease of the intensity of tinnitus and improvement of the
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45
average hearing threshold. Patients with chronic diseases and Meniere's disease who are contraindicted
for systemic administration of cortocosteroids (hypertension, diabetes, glaucoma, peptic ulcer, etc.) have
an additional therapeutic option by dexamethasone intratympanic perfusion.
[Epidural anaesthesia: Simulated intravascular test dose with S(+) ketamine, lidocaine and
adrenaline. A prospective, randomized, double blind and placebo controlled study.]
[Article in Spanish]
Rev Esp Anestesiol Reanim. 2014 Jul 15. pii: S0034-9356(14)00123-6. doi: 10.1016/j.redar.2014.04.004.
[Epub ahead of print] Spanish.
Higueras R1, Errando CL2, Soriano-Bru JL2.
1
Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Unversitario Dr. Peset,
Valencia, España. Electronic address: [email protected].
OBJECTIVE: The use of a test dose in epidural anaesthesia is a safety recommendation. However
specificity and sensitivity of the drugs used with this indication have been not conclusive. The main objective
of this study was to compare the effectiveness and the adverse effects of a simulated intravascular test
dose of adrenaline, lidocaine and S(+)-ketamine. MATERIAL AND METHODS: A prospective, randomized,
double blinded, placebo controlled study was designed. ASA I patients scheduled for elective surgery
were included. These were randomized to the following study groups: S(+)-ketamine 0.5 mg.kg-1 (S+K
group), 5% lidocaine 1.5 mg.kg-1 (L5% group), adrenaline 15μg (ADR group), and physiological saline
3 ml (SF group; control group). An evaluation was made during the first 15 minutes after the study drug
was administered. Variables including heart rate (HR) systolic and diastolic blood pressure (sBP and
dBP), mean arterial pressure (MAP), and SpO2 were recorded at 0 min (baseline) and at 2, 5, 8, 10
and 15 minutes after drug injection. An increase of at least 20 beats per minute (bpm) in relation to the
baseline measurement was considered a positive result, as was an increase sBP >15 mmHg. The clinical
effects described as related to iv injection of the study drugs recorded were: sedation-hypnosis, dizziness,
nystagmus, metallic taste perception, perioral or facial paresthesias, tinnitus, as well as any other effect
the patients mentioned. Sensitivity and specificity were calculated as was the percent increase in the
parameters in order to see if these were clinically useful. RESULTS: A total of 80 patients, 20 per group, were
included. The sBP, dBP, and MAP were significantly raised at the 2, 5, 8 and 10 minutes measurements in
the S(+)K group compared to the rest of the groups (P<.05), as well as HR in the 2, 5, 8, 10 and 15 minute
measurements in the S(+)K compared to the rest of the groups (P<.05). Sensitivity and specificity were
high, and significant in the S(+)K group from minute 2 to minute 8 compared with the placebo group, as well
as percentage points differences in the same interval. There were significant differences in the incidence
of sedation-hypnosis, nystagmus and dizziness, which were more frequent in the S(+)K group. There were
no differences in the incidence of metallic taste, perioral and facial paresthesias or tinnitus. The effects in
the S(+)K group always occurred before minute 5 after drug injection. CONCLUSION: Both lidocaine an
adrenaline at the scheduled doses showed low sensitivity and specificity as a simulated iv epidural test
dose. S(+)-ketamine could be a feasible marker after accidental iv injection during epidural anaesthesia or
analgesia. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor.
Published by Elsevier España. All rights reserved.
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46
[Pharmacotherapy for tinnitus: much ado about nothing].
[Article in Spanish]
Rev Neurol. 2014 Aug 16;59(4):164-74.
Espinosa-Sanchez JM1, Heitzmann-Hernandez T, Lopez-Escamez JA.
1
Hospital San Agustin, Linares, Espana.
INTRODUCTION. Chronic tinnitus affects 5-15% of the general population; in 1% of individuals with
tinnitus this condition severely affects their quality of life. Pharmacological treatment is one of the options
for the management of tinnitus patients, but their efficacy remains controversial. AIM. To evaluate the level
of evidence to support the use of different drugs in reducing the severity of tinnitus. DEVELOPMENT.
The pharmacological groups that have been investigated for the treatment of tinnitus include anesthetics,
anticonvulsants, antidepressants, antihistamines, benzodiazepines, diuretics, corticosteroids, and of
other substances. Intravenous lidocaine seems to be effective, but the short duration of the effect and the
adverse reactions prevent its use. Compared with placebo, carbamazepine and gabapentine have not
demonstrated effectiveness although they may be effective in some patients with auditory nerve vascular
compression or myoclonus. Tricyclic antidepressants are no more effective than placebo at reducing tinnitus
severity although they may improve comorbid depression. There is insufficient evidence to evaluate the
effectiveness of selective serotonin reuptake inhibitors and benzodiazepines. Acamprosate may decrease
the severity of tinnitus, but the level of evidence is low. There are no consistent results in the studies
with intratympanic gentamicin or steroids in tinnitus associated with Meniere's disease. CONCLUSIONS.
The use of pharmacotherapy in reducing the severity of tinnitus is not well supported by prospective,
randomized, placebo-controlled clinical trials. Various drugs have been shown to be effective in some
studies, but the clinical evidence is limited. Large randomized clinical trials are needed.
Protective Effects of Ginkgo biloba Extract EGb 761 against Noise Trauma-Induced Hearing Loss
and Tinnitus Development.
Neural Plast. 2014;2014:427298. doi: 10.1155/2014/427298. Epub 2014 Jun 17.
Tziridis K, Korn S, Ahlf S, Schulze H.
Experimental Otolaryngology, University of Erlangen-Nuremberg, Waldstraße 1, 91054 Erlangen,
Germany.
Noise-induced hearing loss (NIHL) and resulting comorbidities like subjective tinnitus are common diseases
in modern societies. A substance shown to be effective against NIHL in an animal model is the Ginkgo biloba
extract EGb 761. Further effects of the extract on the cellular and systemic levels of the nervous system
make it a promising candidate not only for protection against NIHL but also for its secondary comorbidities
like tinnitus. Following an earlier study we here tested the potential effectiveness of prophylactic EGb 761
treatment against NIHL and tinnitus development in the Mongolian gerbil. We monitored the effects of
EGb 761 and noise trauma-induced changes on signal processing within the auditory system by means
of behavioral and electrophysiological approaches. We found significantly reduced NIHL and tinnitus
development upon EGb 761 application, compared to vehicle treated animals. These protective effects of
EGb 761 were correlated with changes in auditory processing, both at peripheral and central levels. We
propose a model with two main effects of EGb 761 on auditory processing, first, an increase of auditory
brainstem activity leading to an increased thalamic input to the primary auditory cortex (AI) and second, an
asymmetric effect on lateral inhibition in AI.
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47
Commentary on "does melatonin have therapeutic use in tinnitus?".
South Med J. 2014 Jun;107(6):367. doi: 10.14423/01.SMJ.0000450713.38550.1a.
Dion GR.
From the San Antonio Military Medical Center, Fort Sam Houston, Texas.
No abstract available.
Does Melatonin Have Therapeutic Use in Tinnitus?
South Med J. 2014 Jun;107(6):362-366. Review.
Merrick L, Youssef D, Tanner M, Peiris AN.
From the Sycamore Shoals Hospital, Elizabethton, the Department of Internal Medicine, Division of
Infectious Diseases, and the James H. Quillen College of Medicine, East Tennessee State University,
and the Department of Medicine, Mountain Home Veterans Affairs Medical Center, Johnson City,
Tennessee.
Melatonin, a hormone produced by the pineal gland, may be a promising treatment option for tinnitus. The
primary functions of this hormone are believed to be the initiation and maintenance of sleep because its
secretions coincide with circadian rhythms. Some investigators have noted that melatonin may alleviate
subjective symptoms of tinnitus. Moreover, melatonin may have properties protective against ototoxic drugs
such as amikacin, gentamicin, or cancer therapeutic agents that are dose dependent. In vitro, melatonin
has demonstrated antioxidative properties and it has been postulated that these antioxidative properties
contribute to the alleviation of tinnitus. Melatonin levels used to obtain these findings in vitro, however, are
at supraphysiologic levels; therefore, it is more likely that the benefits from taking supplemental melatonin
occur from minimal antioxidative properties, sleep enhancement, or other potential methods of action that
are not yet understood. Melatonin offers minimal risk of toxicity with modest daily doses such as 1 to 3 mg,
as well as a low cost and favorable adverse effect profile for older adults. In addition to potential benefits in
the treatment of tinnitus, melatonin also may have beneficial neurogenerative properties. We recommend
that melatonin be considered for use in patients with significant tinnitus.
Improvement in symptoms and cochlear flow with pycnogenol in patients with Meniere's disease
and tinnitus.
Minerva Med. 2014 Jun;105(3):245-54.
Luzzi R1, Belcaro G, Hu S, Dugall M, Hosoi M, Cacchio M, Ippolito E, Corsi M.
1
IRVINE3 Vascular/Circulation Labs Deparment of Biomedical Sciences CH-PE University, Pescara,
Italy - [email protected].
AIM: The aim of this supplement registry was to evaluate the efficacy of the Pycnogenol® in improving
cochlear flow and symptoms in a 6-month follow-up for patients with Meniere's disease (MD), tinnitus
and cochlear hypoperfusion. METHODS: Main signs/symptoms were considered: Spontaneous vertigo,
positional vertigo, hearing loss, tinnitus, pressure in the ear, unsteady gait, associated clinical problems,
alterations in daily life. All subjects were managed with the best available management (BM); one group
used the supplement Pycnogenol (150 mg/day). Cochlear flow and tinnitus were also evaluated. Out
of 120 patients incuded in the registry, 55 used Pycnogenol and 52 (controls) were managed only with
BM. RESULTS: There was a more significant improvement in all registry items at 3 and 6 months in the
Pycnogenol group (P<0.05). The number of lost working days was lower in the Pycnogenol group. At 3
months, 45.4% of subjects using Pycnogenol were completely asymptomatic in comparison with 23.07%
of controls. At 6 months 87.3% of the Pycnogenol subjects were asymptomatic compared with 34.6% of
controls. Cochlear flow velocity was significantly better (higher flow, higher diastolic component) in the
Pycnogenol group (P<0.05). The subjective tinnitus scale decreased in both groups (P<0.05); the decrease
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48
was more significant in Pycnogenol subjects (P<0.05) at 3 and 6 months. CONCLUSION: Symptoms of
Meniere's disease, flow at cochlear level and tinnitus improved in Pycnogenol subjects in comparison with
best management.
In reference to Intratympanic dexamethasone injection for refractory tinnitus: prospective
placebo-controlled study.
Laryngoscope. 2014 Jun;124(6):E255. doi: 10.1002/lary.24438. Epub 2014 Apr 1.
Chandrasekhar SS.
New York Otology, New York, New York.
Comment in: In response to Intratympanic dexamethasone injection for refractory tinnitus: prospective
placebo-controlled study. [Laryngoscope. 2014]
Comment on: Intratympanic dexamethasone injection for refractory tinnitus: prospective placebo-controlled
study. [Laryngoscope. 2013]
No abstract available.
Pharmacological profile of sulodexide.
Int Angiol. 2014 Jun;33(3):229-35.
Hoppensteadt DA1, Fareed J.
1
Departments of Pathology and Pharmacology, Loyola University Chicago, Maywood, IL USA [email protected].
Since its introduction, sulodexide has been used on and off for several indications. More recently this agent
has become revitalized and tested in newer indications. Sulodexide is composed of glycosaminoglycan
that includes a mixture of fast-moving heparin and dermatan sulfate. It exerts its anticoagulant and
antithrombotic action through interactions with both AT and HCII. Sulodexide has been proven to have effects
on the fibrinolytic system, platelets, endothelial cells, inflammation and more recently metalloproteases.
The administration of sulodexide results in the release of lipoprotein lipase and has been shown to reduce
the circulating level of lipids. It has also shown to decrease the viscosity of both whole blood and plasma.
Sulodexide differs from heparin in its oral bioavailability and longer half-life. There is also less bleeding
associated with sulodexide. In addition, oral administration of sulodexide does not interfere with the
pharmacologic actions of commonly used agents. Similar to heparin, sulodexide releases TFPI which
contributes to its antithrombotic effect and anti-inflammatory properties. Sulodexide has been proven to be
effective in peripheral arterial thrombosis and venous thrombosis. It is also clinically active in the treatment
of venous leg ulcers and intermittent claudication. More recent data suggest that sulodexide can be used
in tinnitus and in vascular vertigo. Additional studies in these indications are required. Sulodexide was
generally safe and well tolerated in the clinical trials, without any severe bleeding complications. Therefore
sulodexide appears to be a good treatment for all arterial and venous diseases and for the prevention of
progression of disease.
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49
Different infusion durations for preventing platinum-induced hearing loss in children with cancer.
Cochrane Database Syst Rev. 2014 Jun 26;6:CD010885. doi: 10.1002/14651858.CD010885.pub2.
van As JW1, van den Berg H, van Dalen EC.
1
c/o Cochrane Childhood Cancer Group, Emma Children's Hospital/Academic Medical Center, PO Box
22660, Amsterdam, Netherlands, 1100 DD.
BACKGROUND: Platinum-based therapy, including cisplatin, carboplatin or oxaliplatin, or a combination
of these, is used to treat a variety of paediatric malignancies. Unfortunately, one of the most important
adverse effects is the occurrence of hearing loss or ototoxicity. In an effort to prevent this ototoxicity,
different platinum infusion durations have been studied. OBJECTIVES: To assess the effects of different
durations of platinum infusion to prevent hearing loss or tinnitus, or both, in children with cancer.
Secondary objectives were to assess possible effects of these infusion durations on: a) anti-tumour
efficacy of platinum-based therapy, b) adverse effects other than hearing loss or tinnitus, and c) quality of
life. SEARCH METHODS: We searched the electronic databases Cochrane Central Register of Controlled
Trials (CENTRAL 2013, Issue 12), MEDLINE (PubMed) (1945 to 4 December 2013) and EMBASE (Ovid)
(1980 to 4 December 2013). In addition, we handsearched reference lists of relevant articles and the
conference proceedings of the International Society for Paediatric Oncology (2009 to 2013). We scanned
ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization International Clinical Trials
Registry Platform (WHO ICTRP) (http://www.who.int/ictrp/en/) for ongoing trials (both searched on 13
December 2013). SELECTION CRITERIA: Randomised controlled trials (RCTs) or controlled clinical trials
(CCTs) comparing different platinum infusion durations in children with cancer. Only the platinum infusion
duration could differ between the treatment groups. DATA COLLECTION AND ANALYSIS: Two review
authors independently performed the study selection, risk of bias assessment and GRADE assessment
of included studies, and data extraction including adverse effects. Analyses were performed according
to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS:
We identified one RCT and no CCTs. The RCT (total number of children = 91) evaluated the use of a
continuous cisplatin infusion (N = 43) versus a one hour bolus cisplatin infusion (N = 48) in children with
neuroblastoma. For the continuous infusion, cisplatin was administered on days 1 to 5 of the cycle but
it is unclear if the infusion duration was a total of 5 days. Methodological limitations were present. Only
results from shortly after induction therapy were provided. No clear evidence of a difference in hearing loss
(defined as asymptomatic and symptomatic disease combined) between the different infusion durations
was identified as results were imprecise (RR 1.39; 95% CI 0.47 to 4.13, low quality evidence). Although
the numbers of children were not provided, it was stated that tumour response was equivalent in both
treatment arms. With regard to adverse effects other than ototoxicity we were only able to assess toxic
deaths. Again, the confidence interval of the estimated effect was too wide to exclude differences between
the treatment groups (RR 1.12; 95% CI 0.07 to 17.31, low quality evidence). No data were available for the
other outcomes of interest (i.e. tinnitus, overall survival, event-free survival and quality of life) or for other
(combinations of) infusion durations or other platinum analogues. AUTHORS' CONCLUSIONS: Since only
one eligible RCT evaluating the use of a continuous cisplatin infusion versus a one hour bolus cisplatin
infusion was found, and that had methodological limitations, no definitive conclusions can be made. It
should be noted that 'no evidence of effect', as identified in this review, is not the same as 'evidence of
no effect'. For other (combinations of) infusion durations and other platinum analogues no eligible studies
were identified. More high quality research is needed.
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Efficacy and Safety of AM-111 in the Treatment of Acute Sensorineural Hearing Loss: A DoubleBlind, Randomized, Placebo-Controlled Phase II Study.
Otol Neurotol. 2014 Jun 27. [Epub ahead of print]
Suckfuell M1, Lisowska G, Domka W, Kabacinska A, Morawski K, Bodlaj R, Klimak P, Kostrica R,
Meyer T.
1
*Department of ENT, Head and Neck Surgery, Martha Maria Hospital, Munich, Germany; †Dept. of
Otolaryngology in Zabrze, Medical University of Silesia, Katowice; ‡Dept. of Otolaryngology, District
Specialist Hospital, Rzeszow; §Dept. of Otolaryngology and ENT Oncology, Pomeranian Medical
University, Szczecin; Dept. of Otolaryngology, Medical University of Warsaw, Warsaw, Poland;
¶Private ENT practice, Lichtenfels, Germany; #Dept. of ENT, Head and Neck Surgery, Regional
Hospital, Kladno; **Dept. of ENT, Head and Neck Surgery, Masaryk University, Brno, Czech Republic;
and ††Auris Medical AG, Basel, Switzerland.
OBJECTIVE: To evaluate the efficacy and safety of AM-111, a c-Jun N-terminal Kinase (JNK) ligand,
in patients with acute sensorineural hearing loss (ASNHL). STUDY DESIGN: Prospective, double-blind,
randomized, placebo-controlled study with follow-up visits on Days 3, 7, 30, and 90. SETTING: Twentyfive European sites (academic tertiary referral centers, private ENT practices). PATIENTS: Approximately
210 patients aged 18 to 61 years presenting within 48 hours after acute acoustic trauma or idiopathic
sudden sensorineural hearing loss with mean hearing loss of 30 dB or greater at the 3 most affected
contiguous test frequencies. INTERVENTIONS: Single-dose intratympanic injection of AM-111 (0.4 or
2.0 mg/ml) or placebo; optionally, oral prednisolone if hearing improvement was less than 10 dB at Day
7. MAIN OUTCOME MEASURES: Efficacy was assessed by absolute hearing improvement (primary
end point, Day 7), percentage hearing improvement, complete hearing recovery, speech discrimination
improvement, and complete tinnitus remission. Safety was evaluated by the frequency of clinically relevant
hearing deterioration and adverse events. RESULTS: The study failed to demonstrate a treatment benefit
for the entire study population because mild-to-moderate ASNHL cases showed unexpectedly strong
spontaneous recovery. In severe-to-profound ASNHL patients (threshold ≥60 dB), AM-111 0.4 mg/ml
showed statistically significant, clinically relevant, and persistent improvements in hearing and speech
discrimination and higher tinnitus remission compared with placebo. The study drug and the intratympanic
injections were well tolerated. CONCLUSION: The study established proof of concept for AM-111 in the
treatment of severe-to-profound ASNHL. Control for spontaneous hearing recovery is essential for ASNHL
studies.This is an open-access article distributed under the terms of the Creative Commons AttributionNonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work
provided it is properly cited. The work cannot be changed in any way or used commercially.
Effect of Intratympanic Dexamethasone on Controlling Tinnitus and Hearing loss in Menier's
Disease.
Iran J Otorhinolaryngol. 2014 Jul;26(76):129-33.
Memari F, Hassannia F.
Department of Otorhinolaryngology, Head and Neck Surgery. Iran University of Medical Sciences.
Hazrate Rasul Medical Center, Tehran, Iran.
INTRODUCTION: We investigated the effect of intratympanic dexamethasone on control of tinnitus and
hearing loss in patients with Menier's disease. MATERIALS AND METHODS: 100 consecutive patients with
a diagnosis of Menier's disease according to the 1995 criteria of The American Academy of Otolaryngology
- Head and Neck Surgery (AAO-HNS) who remained symptomatic despite medical therapy were assigned
to receive intratympanic dexamethasone. The results were assessed with respect to changes in hearing
symptoms and tinnitus. RESULTS: Hearing improvement and improvement in SDS was observed in 52%
and 35% of patients, respectively. Tinnitus score was improved in 57% of patients. There was no relationship
between age, sex, duration of disease, unilaterality of disease, or response to therapy. CONCLUSION:
Intratympanic dexamethasone may be effective in the symptomatic control of hearing loss and tinnitus in
Menier's disease. Free PMC Article.
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51
Loudness perception affected by high doses of salicylate-A behavioral model of hyperacusis.
Behav Brain Res. 2014 May 29. pii: S0166-4328(14)00348-9. doi: 10.1016/j.bbr.2014.05.045. [Epub
ahead of print]
Zhang C1, Flowers E2, Li JX3, Wang Q4, Sun W5.
1
Department of Otolaryngology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, PR
China; Center for Hearing & Deafness, Department of Communicative Disorders and Sciences, State
University of New York at Buffalo, 3435 Main Street, Buffalo, NY 14214, United States.
The major side-effects of high doses of salicylate include sensorial hearing loss and tinnitus. Although
salicylate decreases cochlear output, it enhances the evoked potentials recorded from the central auditory
system (CAS), suggesting an increase to sound sensitivity. However, the loudness change after salicylate
administration has not yet been directly measured. In this study, we established an operant conditioning
based behavioral task in rats and measured their loudness perception changes before and after high
doses of salicylate injection (250mg/kg, i.p.). We found that high doses of salicylate induced a significant
increase to loudness response in 40% of the rats (out of 20 rats), suggesting a hyperacusis behavior. In
another 40% of rats, a rapid increase of loudness response was detected, suggesting loudness recruitment.
The reaction time of the rats was also measured during the loudness tests before and after salicylate
exposure. The reaction time level functions are highly correlated to the loudness response functions. Our
studies confirmed that increased sound sensitivity, which is commonly seen in patients with tinnitus and
hyperacusis, can be induced by high doses of salicylate. This loudness change induced by salicylate may
be related with hypersensitivity in the CAS. Copyright © 2014. Published by Elsevier B.V.
VI
Auditive Stimulation
Validation of a Novel Combination Hearing Aid and Tinnitus Therapy Device.
Ear Hear. 2014 Sep 10. [Epub ahead of print]
Henry JA1, Frederick M, Sell S, Griest S, Abrams H.
1
1VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, Oregon,
USA; 2Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University
(OHSU), Portland, Oregon, USA; 3Department of Education, Pacific University, Forest Grove, Oregon,
USA; and 4Starkey Hearing Technologies, Minneapolis, Minnesota, USA.
OBJECTIVES:: Most patients with tinnitus also have hearing loss. Hearing aids have been well-documented
to provide amelioration for both hearing and tinnitus problems. Some hearing aids have built-in noise/
sound generators that are intended to provide added benefit to patients with tinnitus. It has not been
proven, however, whether these "combination instruments" are more effective for tinnitus management
than hearing aids alone. The purpose of this study was to collect initial data addressing this question.
DESIGN: Thirty individuals meeting study requirements (bothersome tinnitus, hearing aid candidate,
and no use of hearing aids for the previous 12 months) were enrolled. All participants initially completed
the primary outcome questionnaire (Tinnitus Functional Index [TFI]) and then returned to be fitted with
combination instruments. The hearing aid portion of the devices was adjusted to optimize hearing ability.
Participants were then randomized to either the experimental group (n = 15) or the control group (n = 15).
The experimental group had the noise feature of the instruments activated and adjusted to achieve optimal
relief from tinnitus. The control group did not have the noise portion activated. Following the hearing aid
fitting, all study participants also received brief tinnitus counseling. Participants returned 1 to 2 weeks
later for a follow-up appointment to confirm proper fit of the instruments and to make any necessary
programming adjustments. Additionally, they returned 3 months after the fitting to complete the TFI, which
also concluded their participation in the study. RESULTS: Both groups revealed significant improvement,
as indicated by reductions in mean TFI index scores. Differences between groups at 3 months were not
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52
statistically significant. However, the experimental group showed a mean reduction in the TFI score that
was 6.4 points greater than that for the control group. The difference approached significance (p = 0.09),
suggesting that a larger group of participants may have resulted in a significant difference between groups.
This possibility is tempered by the fact that effect sizes, which control for variation, were very similar
between groups. CONCLUSIONS: Results of this study suggest that the use of hearing aids alone or
hearing aids plus the use of sound generators both provide significant benefit with respect to alleviating
effects of tinnitus. A larger controlled clinical trial is needed to obtain more definitive results regarding the
two configurations of hearing aids.
Gameplay as a source of intrinsic motivation in a randomized controlled trial of auditory training
for tinnitus.
PLoS One. 2014 Sep 12;9(9):e107430. doi: 10.1371/journal.pone.0107430. eCollection 2014.
Hoare DJ1, Van Labeke N2, McCormack A1, Sereda M1, Smith S1, Taher HA3, Kowalkowski VL4,
Sharples M2, Hall DA1.
1
National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham,
United Kingdom; Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine,
University of Nottingham, Nottingham, United Kingdom.
BACKGROUND: Previous studies of frequency discrimination training (FDT) for tinnitus used repetitive
task-based training programmes relying on extrinsic factors to motivate participation. Studies reported
limited improvement in tinnitus symptoms. PURPOSE: To evaluate FDT exploiting intrinsic motivations by
integrating training with computer-gameplay. METHODS: Sixty participants were randomly assigned to
train on either a conventional task-based training, or one of two interactive game-based training platforms
over six weeks. Outcomes included assessment of motivation, tinnitus handicap, and performance on
tests of attention. RESULTS: Participants reported greater intrinsic motivation to train on the interactive
game-based platforms, yet compliance of all three groups was similar (~70%) and changes in self-reported
tinnitus severity were not significant. There was no difference between groups in terms of change in
tinnitus severity or performance on measures of attention. CONCLUSION: FDT can be integrated within
an intrinsically motivating game. Whilst this may improve participant experience, in this instance it did
not translate to additional compliance or therapeutic benefit. TRIAL REGISTRATION: ClinicalTrials.gov
NCT02095262. Free PMC Article.
The effectiveness of neuro-music therapy according to the Heidelberg model compared to a
single session of educational counseling as treatment for tinnitus: A controlled trial.
J Psychosom Res. 2014 Sep 3. pii: S0022-3999(14)00314-6. doi: 10.1016/j.jpsychores.2014.08.012.
[Epub ahead of print]
Argstatter H1, Grapp M2, Hutter E2, Plinkert PK3, Bolay HV4.
1
Deutsches Zentrum für Musiktherapieforschung (German Center for Music Therapy Research) (Viktor
Dulger Institute), Heidelberg, Germany. Electronic address: [email protected].
OBJECTIVES: Tinnitus is a very common symptom, yet the quest for an effective treatment is challenging.
Results from several clinical trials support the notion that neuro-music therapy is an effective means to
reduce tinnitus distress with short duration and long lasting effect. However, until now, the effectiveness
has not been tested in a controlled trial against an active comparator. METHODS: The trial was designed
as two-center, parallel intervention group controlled study with two intervention groups: Counseling
(50minute individualized personal instruction) or neuro-music therapy (counseling plus eight 50-minute
sessions of individualized music therapy). Data of n=290 patients suffering from chronic tinnitus were
analyzed. Outcome measure was the change in Tinnitus Questionnaire Total Scores (TQ) from baseline
(admission) to end of treatment. RESULTS: Both treatment groups achieved a statistically relevant
reduction in TQ scores, though 66% of patients in the music therapy group attained a clinically meaningful
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53
improvement compared to 33% in the counseling group. A binary logistic regression revealed two variables
significantly influencing therapy outcome: initial tinnitus score and type of therapy with an OR for the music
therapy compared to the counseling of 4.34 (CI 2.33-8.09). CONCLUSIONS: Counseling is an appropriate
treatment option with well above chance of improvement. The neuro-music therapy outperformed the
counseling. This treatment targets the tinnitus sound itself, is short in duration, intrinsically motivating and
easy to operate and thus presents a possible complement to the therapeutic spectrum in chronic tinnitus.
The trial was registered at the ClinicalTrials.gov registry (ID: NCT01845155). Copyright © 2014 Elsevier
Inc. All rights reserved.
Suppression of putative tinnitus-related activity by extra-cochlear electrical stimulation.
J Neurophysiol. 2014 Oct 8. pii: jn.00580.2014. [Epub ahead of print]
Norena AJ1, Mulders WH2, Robertson D2.
1
CNRS [email protected].
Studies on animals have shown that noise-induced hearing loss is followed by an increase of spontaneous
firing at several stages of the central auditory system. This central hyperactivity has been suggested to
underpin the perception of tinnitus. It was shown that decreasing cochlear activity can abolish the noiseinduced central hyperactivity. This latter result further suggests that an approach consisting of reducing
cochlear activity may provide a therapeutic avenue for tinnitus. In this context, extra-cochlear electric
stimulation (ECES) may be a good candidate to modulate cochlear activity and suppress tinnitus. Indeed,
it has been shown that a positive current applied at the round window reduces cochlear nerve activity
and can suppress tinnitus reliably in tinnitus subjects. The present study investigates whether ECES with
a positive current can abolish the noise-induced central hyperactivity, i.e. the putative tinnitus-related
activity. Spontaneous and stimulus-evoked neural activity before, during and after ECES was assessed
from single-unit recordings in the inferior colliculus of anesthetized guinea pigs. We found that ECES with
positive current significantly decreases the spontaneous firing rate of neurons with high characteristic
frequencies (CF) whereas negative current produces the opposite effect. The effects of the ECES are
absent or even reversed for neurons with low CFs. Importantly, ECES with positive current had only a
marginal effect on thresholds and tone-induced activity of collicular neurons, suggesting that the main
action of positive current is to modulate the spontaneous firing. Overall, cochlear electrical stimulation may
be a viable approach for suppressing some forms of (peripheral-dependent) tinnitus. Copyright © 2013,
Journal of Neurophysiology.
Cochlear Implantation in Patients With Advanced Ménière's Disease.
Otol Neurotol. 2014 Aug;35(7):1172-8. doi: 10.1097/MAO.0000000000000202.
Mick P1, Amoodi H, Arnoldner C, Shipp D, Friesen L, Lin V, Nedzelski J, Chen J.
1
*Harvard School of Public Health, Boston, Massachusetts, U.S.A.; and †Department of Otolaryngology
- Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario,
Canada.
BACKGROUND/OBJECTIVES: Ménière's disease (MD) that results in bilateral severe to profound
sensorineural hearing loss is a rare indication for cochlear implantation; only a few studies exist documenting
performance in these patients. The primary objective was to compare the difference in preoperative to 12-month
postoperative speech perception scores among subjects with MD and controls. Groupwise comparisons of
secondary postoperative outcomes (Tinnitus Handicap Inventory [THI] scores, 36-Item Short Form [SF-36]
scores, and postoperative dizziness) were also performed. METHODS: A retrospective cohort study was
conducted. Subjects with MD and controls matched by age, device manufacturer and model, preoperative
sentence score, and sentence test used for preimplantation and postimplantation performance assessments
were identified from 1,130 patients in the prospectively maintained cochlear implant database at our center.
Speech perception, THI, and SF-36 scores and demographic variables were obtained from the database.
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54
Vestibular outcomes were obtained by retrospective chart review. Statistical comparisons were performed to
compare preoperative to postoperative change between groups. RESULTS: Twenty patients with MD were
identified. At 1 year after CI, improvements in sentence and word understanding did not differ in magnitude
from the controls. Tinnitus was reduced significantly in patients with MD, whereas there was a trend for
improvement in the controls. Quality of life as measured by the SF-36 improved in both groups. Patients
with MD had significant improvements in 1 domain compared with 5 domains for the controls. Subjects with
MD had significantly more chronic dizziness in the postoperative period than did controls. CONCLUSIONS:
Patients with MD who have bilateral severe to profound sensorineural hearing loss benefit significantly from
CI. Ongoing dizziness in some patients with MD may result in quality of life improvements that are slightly less
than seen for the average adult patient with CI. Larger studies are needed to corroborate the results.
Loudness modulation after transient and permanent hearing loss: Implications for tinnitus and
hyperacusis.
Neuroscience. 2014 Aug 15. pii: S0306-4522(14)00656-3. doi: 10.1016/j.neuroscience.2014.08.007.
[Epub ahead of print] Review.
Fournier P1, Schönwiesner M2, Hébert S3.
School of Speech Pathology and Audiology, Université de Montréal, Montréal, Québec, Canada;
International Laboratory for Research on Brain, Music, and Sound (BRAMS), Université de Montréal,
Montréal, Québec, Canada; Centre de recherche de l'Institut Universitaire de Gériatrie de Montréal
(CRIUGM), Montréal, Québec, Canada.
1
Loudness is the primary perceptual correlate of sound intensity. The relationship between sound intensity
and loudness is not fixed, and can be modified by short-term sound deprivation or stimulation. Deprivation
increases sound sensitivity, whereas stimulation decreases it. We review the effects of short-term auditory
deprivation and stimulation on the auditory central nervous system of humans and animals, and we extend
the discussion to permanent auditory deprivation (hearing loss) and auditory pathologies of loudness
perception. Although there is sufficient evidence to conclude that loudness can be modulated in normal
hearing listeners by temporary sound deprivation and stimulation, evidence is scanter for the hearingimpaired listeners. In addition, cortical effects of sound deprivation and stimulation in humans, which
may correlate with loudness coding, are still largely unknown and should be the target of future research.
Copyright © 2014. Published by Elsevier Ltd.
[Hearing function and hearing loss in the elderly.]
[Article in German]
HNO. 2014 Aug 9. [Epub ahead of print]
Hesse G1, Eichhorn S, Laubert A.
1
Tinnitus-Klinik Dr. Hesse am Krankenhaus Bad Arolsen, Universität Witten-Herdecke, Große Allee 50,
34454, Bad Arolsen, Deutschland, [email protected].
Statistically, hearing function decreases with advancing age, but not all people are affected to the same
extent. Environmental influences, such as noise exposure in particular, also play an important role in the
development of hearing loss. Since the functional capacity of parts of the central auditory processing
system can also diminish with age, these should also be evaluated in diagnostic procedures. Rehabilitative
treatment of older people with hearing aids in particular, has to be improved. Audiotherapy can enhance
the acceptance of hearing aids and optimize central auditory processing.
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55
Music therapy for chronic tinnitus: variability of tinnitus pitch in the course of therapy.
J Am Acad Audiol. 2014 Apr;25(4):335-42. doi: 10.3766/jaaa.25.4.5.
Hutter E1, Grapp M1, Argstatter H1, Bolay HV2.
1
German Center for Music Therapy Research (Deutsches Zentrum für Musiktherapieforschung (Viktor
Dulger Institut) DZM e.V.).
BACKGROUND: In general, tinnitus pitch has been observed to be variable across time for most patients
experiencing tinnitus. Some tinnitus therapies relate to the dominant tinnitus pitch in order to adjust
therapeutic interventions. As studies focusing on tinnitus pitch rarely conduct consecutive pitch matching
in therapeutic settings, little is known about the course and variability of tinnitus pitch during therapeutic
interventions. PURPOSE: The purpose of this study was to investigate the variability and development of
tinnitus pitch in the course of therapeutic interventions. Tinnitus pitch was suspected to be highly variable.
RESEARCH DESIGN: The researchers conducted a descriptive, retrospective analysis of data. STUDY
SAMPLE: A total of 175 adult patients experiencing chronic tinnitus served as participants. All patients had
received a neuro-music therapy according to the "Heidelberg Model of Music Therapy for Chronic Tinnitus."
DATA COLLECTION AND ANALYSIS: During therapeutic interventions lasting for 5 consecutive days, the
individual tinnitus frequency was assessed daily by means of a tinnitus pitch-matching procedure. The
extent of variability in tinnitus pitch was calculated by mean ratios of frequencies between subsequent
tinnitus measurements. Analysis of variance of repeated measures and post hoc paired samples t-tests
were used for comparison of means in tinnitus frequencies, and the test-retest reliability of measurements
was obtained by the Pearson product-moment correlation coefficient. RESULTS: Tinnitus pitch displayed a
variability of approximately 3/5 to 4/5 octaves per day. Overall, the mean frequency declined in the course
of the therapy. Detailed analysis revealed three groups of patients with diverging tinnitus progression. The
test-retest reliability between assessments turned out to be robust (r = 0.74 or higher). CONCLUSIONS:
Considerable variation in tinnitus pitch was found. Consequently, a frequent rechecking of tinnitus frequency
is suggested during frequency-specific acoustic stimulation in order to train appropriate frequency bands.
American Academy of Audiology.
Optimizing Intracochlear Electrical Stimulation to Suppress Tinnitus.
Ear Hear. 2014 Aug 1. [Epub ahead of print]
Arts RA1, George EL, Chenault MN, Stokroos RJ.
1
Department of ENT/Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The
Netherlands.
OBJECTIVES: Research on tinnitus suppression by intracochlear electrical stimulation has gained interest
over the past few decades and it has become easier to apply since the introduction of cochlear implants (CI).
This study attempted to gain more insight into optimal stimulation characteristics for tinnitus suppression.
DESIGN: Eleven subjects with unilateral CI and tinnitus were recruited from our CI clinic. Electrical
stimulation, independent of acoustic sounds, was generated using their CI. The current prospective (single
blinded) experimental study systematically assessed two stimulation parameters, namely current level
and the anatomical stimulation site inside the cochlea and their short-term effect on tinnitus. RESULTS:
Approximately one-third of the tested conditions were successful in which case tinnitus loudness was
reduced by at least 30%. At least one successful condition was achieved for nine subjects (82%).
Complete suppression was achieved in 6 out of 107 tested conditions (6%). The effect of subthreshold
electrical stimulation on tinnitus suppression did not differ significantly from above threshold electrical
stimulation. However, a positive relation between mean percentage tinnitus suppression and current level
was observed. Pitch-matched electrical stimulation did not appear to suppress tinnitus better than other
tested conditions. CONCLUSIONS: The majority of the subjects were able to experience tinnitus reduction
through intracochlear electrical stimulation independent of acoustic sounds. Tinnitus can be reduced with
audible or even inaudible, subthreshold stimuli. Clear trends in optimal stimulation characteristics were not
found. Optimal stimulus characteristics for tinnitus reduction therefore appear to be highly subject-specific.
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The influence of sound generator associated with conventional amplification for tinnitus control:
randomized blind clinical trial.
Trends Hear. 2014 Jul 23;18. pii: 2331216514542657. doi: 10.1177/2331216514542657.
Dos Santos GM1, Bento RF2, de Medeiros IR2, Oiticcica J2, da Silva EC2, Penteado S2.
1
Department of Otorhinolaryngology, University of São Paulo, Brazil [email protected].
Hearing aids with an integrated sound generator have been used to enhance the treatment of tinnitus. The
main aim of this study was to verify whether the combined use of amplification and sound generator is
more effective than conventional amplification alone in reducing tinnitus annoyance by means of the use of
a new hearing aid with an integrated sound generator. A total of 49 patients underwent a blind randomized
clinical trial. Tinnitus annoyance was measured by Tinnitus Handicap Inventory and numerical scales, and
psychoacoustic measures of tinnitus were also performed. The sound generator was set at the lowest
intensity capable of providing relief from tinnitus. Results showed that 62.5% of the patients presented a
reduction in tinnitus annoyance in the combined fitting group and in the group with amplification alone, 78%
showed a reduction. This difference between the groups was not statistically significant. © The Author(s)
2014.
Cochlear implantation and single-sided deafness.
Curr Opin Otolaryngol Head Neck Surg. 2014 Jul 22. [Epub ahead of print]
Tokita J1, Dunn C, Hansen MR.
1
Departments of Otolaryngology-Head and Neck Surgery bNeurosurgery, University of Iowa, Iowa City,
Iowa, USA.
PURPOSE OF REVIEW: Recently, more patients with single-sided deafness (SSD) have been undergoing
cochlear implantation. We review recent studies and case reports to provide an overview of the efficacy of
cochlear implants to rehabilitate patients with SSD with regards to sound localization, speech discrimination,
and tinnitus suppression. RECENT FINDINGS: There are a growing number of studies evaluating the
effect of cochlear implantation for rehabilitation of the deficits associated with SSD over the past several
years as more centers offer this treatment modality to patients with SSD. Although individual studies
have few patients and are underpowered, the vast majority report improvement in sound localization,
speech understanding in quiet and noise, and tinnitus. In some cases, the outcomes with cochlear implant
appear superior to those achieved with other devices, including contralateral routing of sound devices and
osseointegrated implants. SUMMARY: Although cochlear implant is not a Food and Drug Administrationapproved treatment for SSD, several recent studies show improvements in speech understanding, sound
localization, and tinnitus. Because of the low number of cases, it is difficult to conclusively compare
outcomes achieved with cochlear implants and those provided by other devices. However, on the basis of
encouraging early results and the unique ability to restore binaural sound processing, a growing number
of centers offer cochlear implants as treatment for SSD. Forthcoming studies will help define outcome
expectations in different populations.
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Amplitude Modulated "S-Tones" can be superior to Noise for Tinnitus Reduction.
Am J Audiol. 2014 Jul 14. doi: 10.1044/2014_AJA-14-0009. [Epub ahead of print]
Tyler R, Stocking C, Secor C, Slattery WH 3rd.
Purpose: Recent evidence has suggested that amplitude modulated tones might have some advantages
over broadband noise. Method: 56 subjects were required to listen to 'S-Tones' at a carrier frequency
matched at the tinnitus pitch (amplitude modulation rate of 40 Hz) and to broadband noise. Subjects
rated their tinnitus loudness before, during and after a 120 second duration masker. Results: The results
suggested the S-Tones were generally more effective at reducing tinnitus loudness than noise. In about
1/3 (21/56) of the subjects, there was no significant effect from any masker. In other subjects, 54.3%
(19/35) showed a greater reduction for the S-Tones, 20% (7/35) showed a greater reduction with the noise,
and 25.7% (9/35) showed similar performance between the two stimuli. The S-Tones showed a statistically
significant benefit (p < 0.01) vs noise at reducing the patient's tinnitus perception. Using low-level stimuli
that were rated much softer than the subjects' baseline tinnitus, the S-Tones reduced the tinnitus loudness
by 1.9× the amount that noise did (about 28% on average, whereas the noise reduced the tinnitus by about
15%). Conclusion: We conclude that S-Tones at the tinnitus pitch-match frequency are more likely to be
effective than broadband noise at reducing tinnitus loudness.
Effect of different sounds on the treatment outcome of tinnitus retraining therapy.
Clin Exp Otorhinolaryngol. 2014 Jun;7(2):87-93. doi: 10.3342/ceo.2014.7.2.87. Epub 2014 May 21.
Kim BJ1, Chung SW2, Jung JY2, Suh MW3.
1
Department of Otolaryngology-Head & Neck Surgery, Dankook University College of Medicine,
Cheonan, Korea.; Department of Otorhinolaryngology, Seoul National University Hospital, Seoul
National University College of Medicine, Seoul, Korea.
OBJECTIVES: The purpose of this study was to evaluate the therapeutic effect of three different types
of sounds on tinnitus patients undergoing tinnitus retraining therapy (TRT). METHODS: This is a singleinstitution retrospective study, performed in one tertiary otological referral center. Thirty-eight adults with
subjective idiopathic tinnitus who were followed for at least 9 weeks were enrolled. Sound therapy was
delivered in 3 different ways: narrowband noise TRT (nTRT); mixed band noise TRT (mTRT); broadband
noise TRT (bTRT). Treatment response was measured through validated psychometric questionnaires:
Tinnitus Handicap Inventory (THI), visual analog scale (VAS) on annoyance, and numerical description of
hours of tinnitus perception (awareness hours). RESULTS: A total of 38 patients were followed for at least
9 weeks. In nTRT group, all outcome measures including THI, VAS, and the awareness hours, decreased
over 9 weeks with no statistical significance. In mTRT group, all outcome measures except for awareness
hours significantly improved 9 weeks after the beginning of the treatment. In bTRT group, all outcome
measures decreased significantly in 9 weeks. When therapeutic success is defined as improvement in
THI 7 or more, bTRT group (77.8%) showed a higher success rate than other groups for 38 patients with
the minimum follow-up of 9 weeks. CONCLUSION: All three sounds can provide relief in patients with
annoying tinnitus after TRT. However, there is difference in the therapeutic effect according to sound types.
Broadband sound seems to be better than narrowband sound or mixed sound in relieving the patients from
tinnitus. Therefore, sound therapy with broadband noise may be more appropriate during TRT, but further
evidence is needed for precise conclusion. Free PMC Article.
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The effect of the NMDA channel blocker memantine on salicylate-induced tinnitus in rats.
Acta Otorhinolaryngol Ital. 2014 Jun;34(3):198-204. Review.
Ralli M1, Troiani D2, Podda MV2, Paciello F1, Eramo SL2, DE Corso E1, Salvi R3, Paludetti G1, Fetoni
AR1.
1
Institute of Otolaryngology, Università Cattolica del Sacro Cuore, Roma, Italy;
Short-term tinnitus develops shortly after the administration of a high dose of salicylate. Since salicylate
selectively potentiates N-methyl- D-aspartate (NMDA) currents in spiral ganglion neurons, it may play
a vital role in tinnitus by amplifying NMDA-mediated neurotransmission. The aim of this study was to
determine whether systemic treatment with a NMDA channel blocker, memantine, could prevent salicylateinduced tinnitus in animals. Additional experiments were performed to evaluate the effect of memantine
on the auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAE) to
test for changes in hearing function. Thirty-six rats were divided into 3 groups and treated daily for four
consecutive days. One group (n = 12) was injected with salicylate (300 mg/kg/d, IP), the second (n =
12) was treated with memantine (5 mg/kg/d, IP) and the third group (n = 12) was injected with salicylate
and memantine. All rats were tested for tinnitus and hearing loss at 2, 24, 48 and 72 h after the first drug
administration and 24 h post treatment; tinnituslike behaviour was assessed with gap prepulse inhibition of
acoustic startle (GPIAS), and hearing function was measured with DPOAE, ABR and noise burst prepulse
inhibition of acoustic startle (NBPIAS). Rats in the salicylate group showed impaired GPIAS indicative
of transient tinnitus-like behaviour near 16 kHz that recovered 24 h after the last salicylate treatment.
Memantine did not cause a significant change in GPIAS. Combined injection of salicylate and memantine
significantly attenuated GPIAS tinnitus-like behaviour at 48 hours after the first injection. None of the
treatments induced permanent threshold shifts in the ABR and DPOAE, which recovered completely within
one day post treatment. Animals treated with salicylate plus memantine showed results comparable to
animals treated with salicylate alone, confirming that there is no effect of memantine on DPOAE which
reflects OHC function. The present study confirms the role of cochlear NMDA receptors in the induction of
salicylate-induced tinnitus. Free PMC Article.
Cochlear implant complications in 403 patients: Comparative study of adults and children and
review of the literature.
Eur Ann Otorhinolaryngol Head Neck Dis. 2014 May 30. pii: S1879-7296(14)00009-X. doi: 10.1016/j.
anorl.2013.05.005. Epub 2014 Jun 2.
Farinetti A1, Ben Gharbia D2, Mancini J3, Roman S2, Nicollas R2, Triglia JM2.
1
Service ORL et Chirurgie Cervico-Faciale Pédiatrique, Hôpital de la Timone Enfants, Assistance
Publique-Hôpitaux de Marseille, Aix-Marseille Université, 264, rue Saint-Pierre, 13385 Marseille cedex
5, France. Electronic address: [email protected].
OBJECTIVES: The purpose of this study was to assess the postoperative complications related to cochlear
implants and to discuss the differences observed between adult and paediatric populations. Cochlear
implant complications were defined as any pathological events observed during the postoperative period,
whether or not they were directly related to the surgical technique. We therefore recorded all complications,
in the broad sense of the term, ranging from acute otitis media to cochlear explantation. STUDY
DESIGN: Retrospective analysis of cochlear implant patients. MATERIAL AND METHODS: All surgical
procedures (unilateral or bilateral cochlear implantation, revision surgery) performed in our institution
between March 1993 and January 2013 were reviewed. This population comprised 168 adults (median
age at the time of implantation: 51.9years), and 235 children (median age at the time of implantation:
4.5years). All postoperative complications were classified as either major (requiring surgical revision or
hospital management) or minor (requiring conservative management). RESULTS: The global complication
rate was 19.9% (80/403 cases), comprising 5% of major complications (20 cases) and 14.9% of minor
complications (60 cases). This complication rate was significantly higher in the adult population (P=0.004).
CONCLUSION: Cochlear implantation is a safe hearing rehabilitation surgical technique associated
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with a low complication rate. However, surgeons must be familiar with these complications in order to
ensure optimal prevention. Minor complications were mainly infectious in children (acute otitis media) and
cochleovestibular in adults (tinnitus and vertigo). Major complications were mostly reimplantation following
revision surgery or device failure. Only the minor complication rate was significantly higher in the adult
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population. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Playing and listening to tailor-made notched music: cortical plasticity induced by unimodal and
multimodal training in tinnitus patients.
Neural Plast. 2014;2014:516163. doi: 10.1155/2014/516163. Epub 2014 May 8.
Pape J1, Paraskevopoulos E1, Bruchmann M1, Wollbrink A1, Rudack C2, Pantev C1.
1
Institute for Biomagnetism and Biosignalanalysis, University of Münster, Malmedyweg 15, 48149
Münster, Germany.
Background. The generation and maintenance of tinnitus are assumed to be based on maladaptive
functional cortical reorganization. Listening to modified music, which contains no energy in the range of
the individual tinnitus frequency, can inhibit the corresponding neuronal activity in the auditory cortex.
Music making has been shown to be a powerful stimulator for brain plasticity, inducing changes in multiple
sensory systems. Using magnetoencephalographic (MEG) and behavioral measurements we evaluated
the cortical plasticity effects of two months of (a) active listening to (unisensory) versus (b) learning to
play (multisensory) tailor-made notched music in nonmusician tinnitus patients. Taking into account the
fact that uni- and multisensory trainings induce different patterns of cortical plasticity we hypothesized
that these two protocols will have different affects. Results. Only the active listening (unisensory) group
showed significant reduction of tinnitus related activity of the middle temporal cortex and an increase in
the activity of a tinnitus-coping related posterior parietal area. Conclusions. These findings indicate that
active listening to tailor-made notched music induces greater neuroplastic changes in the maladaptively
reorganized cortical network of tinnitus patients while additional integration of other sensory modalities
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during training reduces these neuroplastic effects. Free PMC Article.
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VII
Brain Stimulation
Methodology for studying the transient effects of Transcranial Direct Current Stimulation
combined with Auditory Residual Inhibition on Tinnitus.
J Neurosci Methods. 2014 Oct 3. pii: S0165-0270(14)00350-1. doi: 10.1016/j.jneumeth.2014.09.025.
[Epub ahead of print]
Shekhawat GS1, Kobayashi K2, Searchfield GD3.
1
Section of Audiology, University of Auckland, New Zealand; Centre for Brain Research, University of
Auckland, New Zealand. Electronic address: [email protected].
BACKGROUND: Transcranial direct current stimulation (tDCS) and auditory Residual Inhibition (RI)
are short lasting non-invasive techniques that can suppress tinnitus in some people. A pilot study was
undertaken to evaluate methods to measure a potential additive effect of these treatments. NEW METHOD:
Ten participants (mean age 59 years) with chronic tinnitus underwent four sessions of anodal tDCS of the
left temporoparietal area combined with 1minute of auditory stimulation (broadband noise presented at
tinnitus minimum masking level [MML]+10dB), either before, during or immediately after tDCS and in a
sham controlled session. Participants continuously monitored and recorded their MML on custom software
prior to stimulation, during 20minutes of tDCS, and 30minutes following tDCS. A tinnitus loudness rating
was undertaken before and after completion of testing RESULTS: Nine out of ten participants completed the
study, one participant dropped out after two sessions due to self-reported worsening in tinnitus symptoms.
Seven out of nine participants reported transient tinnitus suppression when sound stimulation was
presented along with tDCS. No reliable change in MML was observed. COMPARISON WITH EXISTING
METHOD: This is the first study to examine the feasibility of continuously measuring MML while providing
a combination of auditory and noninvasive brain stimulation simultaneously. CONCLUSIONS: We propose
modifications in the protocol used, to find ways to increase the duration of auditory RI and investigate
its underlying mechanisms. Recommendations for further research are discussed. Copyright © 2014.
Published by Elsevier B.V.
Suppression of putative tinnitus-related activity by extra-cochlear electrical stimulation.
J Neurophysiol. 2014 Oct 8. pii: jn.00580.2014. [Epub ahead of print]
Norena AJ1, Mulders WH2, Robertson D2.
1
CNRS [email protected].
Studies on animals have shown that noise-induced hearing loss is followed by an increase of spontaneous
firing at several stages of the central auditory system. This central hyperactivity has been suggested to
underpin the perception of tinnitus. It was shown that decreasing cochlear activity can abolish the noiseinduced central hyperactivity. This latter result further suggests that an approach consisting of reducing
cochlear activity may provide a therapeutic avenue for tinnitus. In this context, extra-cochlear electric
stimulation (ECES) may be a good candidate to modulate cochlear activity and suppress tinnitus. Indeed,
it has been shown that a positive current applied at the round window reduces cochlear nerve activity
and can suppress tinnitus reliably in tinnitus subjects. The present study investigates whether ECES with
a positive current can abolish the noise-induced central hyperactivity, i.e. the putative tinnitus-related
activity. Spontaneous and stimulus-evoked neural activity before, during and after ECES was assessed
from single-unit recordings in the inferior colliculus of anesthetized guinea pigs. We found that ECES with
positive current significantly decreases the spontaneous firing rate of neurons with high characteristic
frequencies (CF) whereas negative current produces the opposite effect. The effects of the ECES are
absent or even reversed for neurons with low CFs. Importantly, ECES with positive current had only a
marginal effect on thresholds and tone-induced activity of collicular neurons, suggesting that the main
action of positive current is to modulate the spontaneous firing. Overall, cochlear electrical stimulation may
be a viable approach for suppressing some forms of (peripheral-dependent) tinnitus. Copyright © 2013,
Journal of Neurophysiology.
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Suppression and facilitation of auditory neurons through coordinated acoustic and midbrain
stimulation: investigating a deep brain stimulator for tinnitus.
J Neural Eng. 2014 Oct 13;11(6):066001. [Epub ahead of print]
Offutt SJ1, Ryan KJ, Konop AE, Lim HH.
1
Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA.
Objective. The inferior colliculus (IC) is the primary processing center of auditory information in the midbrain
and is one site of tinnitus-related activity. One potential option for suppressing the tinnitus percept is
through deep brain stimulation via the auditory midbrain implant (AMI), which is designed for hearing
restoration and is already being implanted in deaf patients who also have tinnitus. However, to assess the
feasibility of AMI stimulation for tinnitus treatment we first need to characterize the functional connectivity
within the IC. Previous studies have suggested modulatory projections from the dorsal cortex of the IC
(ICD) to the central nucleus of the IC (ICC), though the functional properties of these projections need to
be determined. Approach. In this study, we investigated the effects of electrical stimulation of the ICD on
acoustic-driven activity within the ICC in ketamine-anesthetized guinea pigs. Main Results. We observed
ICD stimulation induces both suppressive and facilitatory changes across ICC that can occur immediately
during stimulation and remain after stimulation. Additionally, ICD stimulation paired with broadband noise
stimulation at a specific delay can induce greater suppressive than facilitatory effects, especially when
stimulating in more rostral and medial ICD locations. Significance. These findings demonstrate that ICD
stimulation can induce specific types of plastic changes in ICC activity, which may be relevant for treating
tinnitus. By using the AMI with electrode sites positioned with the ICD and the ICC, the modulatory effects
of ICD stimulation can be tested directly in tinnitus patients.
Non-invasive Vagus Nerve Stimulation in Healthy Humans Reduces Sympathetic Nerve Activity.
Brain Stimul. 2014 Jul 16. pii: S1935-861X(14)00260-5. doi: 10.1016/j.brs.2014.07.031. [Epub ahead of
print]
Clancy JA1, Mary DA1, Witte KK1, Greenwood JP1, Deuchars SA2, Deuchars J3.
1
School of Medicine, University of Leeds, Leeds LS2 9JT, UK.
BACKGROUND: Vagus nerve stimulation (VNS) is currently used to treat refractory epilepsy and is being
investigated as a potential therapy for a range of conditions, including heart failure, tinnitus, obesity and
Alzheimer's disease. However, the invasive nature and expense limits the use of VNS in patient populations
and hinders the exploration of the mechanisms involved. OBJECTIVE: We investigated a non-invasive
method of VNS through electrical stimulation of the auricular branch of the vagus nerve distributed to the
skin of the ear - transcutaneous VNS (tVNS) and measured the autonomic effects. METHODS: The effects
of tVNS parameters on autonomic function in 48 healthy participants were investigated using heart rate
variability (HRV) and microneurography. tVNS was performed using a transcutaneous electrical nerve
stimulation (TENS) machine and modified surface electrodes. Participants visited the laboratory once
and received either active (200 μs, 30 Hz; n = 34) or sham (n = 14) stimulation. RESULTS: Active tVNS
significantly increased HRV in healthy participants (P = 0.026) indicating a shift in cardiac autonomic
function toward parasympathetic predominance. Microneurographic recordings revealed a significant
decrease in frequency (P = 0.0001) and incidence (P = 0.0002) of muscle sympathetic nerve activity
during tVNS. CONCLUSION: tVNS can increase HRV and reduce sympathetic nerve outflow, which is
desirable in conditions characterized by enhanced sympathetic nerve activity, such as heart failure. tVNS
can therefore influence human physiology and provide a simple and inexpensive alternative to invasive
VNS. Copyright © 2014 Elsevier Inc. All rights reserved.
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Targeting the Parahippocampal Area by Auditory Cortex Stimulation in Tinnitus.
Brain Stimul. 2014 Apr 18. pii: S1935-861X(14)00163-6. doi: 10.1016/j.brs.2014.04.004. [Epub ahead of
print]
De Ridder D1, Vanneste S2.
1
Brai²n, Sint Augustinus Hospital, Antwerp, Belgium; Department of Surgical Sciences, Section of
Neurosurgery, Dunedin School of Medicine, University of Otago, New Zealand. Electronic address:
[email protected].
BACKGROUND: The final common pathway in tinnitus generation is considered to be synchronized
auditory oscillatory hyperactivity. Intracranial auditory cortex stimulation (iACS) via implanted electrodes
has been developed to treat severe cases of intractable tinnitus targeting this final common pathway, in
the hope of being a panacea for tinnitus. However, not everybody responds to this treatment. Objective:
The electrical brain activity and functional connectivity at rest might determine who is going to respond
or not to iACS and might shed light on the pathophysiology of auditory phantom sound generation.
METHOD: The resting state electrical brain activity of 5 patients who responded and 5 patients who
did not respond to auditory cortex implantation are compared using source localized spectral activity
(Z-score of log transformed current density) and lagged phase synchronization. RESULTS: sLORETA
source localization reveals significant differences between responders vs non-responders for beta3 in
left posterior parahippocampal, hippocampal and amygdala area extending into left insula. Gamma band
differences exist in the posterior parahippocampal areas and BA10. Functional connectivity between the
auditory cortex and the hippocampal area is increased for beta2, delta and theta2 in responders, as well
as between the parahippocampal area and auditory cortex for beta3. CONCLUSION: The resting state
functional connectivity and activity between the auditory cortex and parahippocampus might determine
whether a tinnitus patient will respond to a cortical implant. The auditory cortex may only be a functional
entrance into a larger parahippocampal based tinnitus network.
Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation
(rTMS).
Clin Neurophysiol. 2014 Jun 5. pii: S1388-2457(14)00296-X. doi: 10.1016/j.clinph.2014.05.021. [Epub
ahead of print] Review.
Lefaucheur JP1, André-Obadia N2, Antal A3, Ayache SS4, Baeken C5, Benninger DH6, Cantello RM7,
Cincotta M8, de Carvalho M9, De Ridder D10, Devanne H11, Di Lazzaro V12, Filipović SR13, Hummel
FC14, Jääskeläinen SK15, Kimiskidis VK16, Koch G17, Langguth B18, Nyffeler T19, Oliviero A20,
Padberg F21, Poulet E22, Rossi S23, Rossini PM24, Rothwell JC25, Schönfeldt-Lecuona C26, Siebner
HR27, Slotema CW28, Stagg CJ29, Valls-Sole J30, Ziemann U31, Paulus W3, Garcia-Larrea L32.
1
Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, Créteil,
France; EA 4391, Nerve Excitability and Therapeutic Team, Faculty of Medicine, Paris Est Créteil
University, Créteil, France. Electronic address: [email protected].
A group of European experts was commissioned to establish guidelines on the therapeutic use of repetitive
transcranial magnetic stimulation (rTMS) from evidence published up until March 2014, regarding pain,
movement disorders, stroke, amyotrophic lateral sclerosis, multiple sclerosis, epilepsy, consciousness
disorders, tinnitus, depression, anxiety disorders, obsessive-compulsive disorder, schizophrenia, craving/
addiction, and conversion. Despite unavoidable inhomogeneities, there is a sufficient body of evidence
to accept with level A (definite efficacy) the analgesic effect of high-frequency (HF) rTMS of the primary
motor cortex (M1) contralateral to the pain and the antidepressant effect of HF-rTMS of the left dorsolateral
prefrontal cortex (DLPFC). A Level B recommendation (probable efficacy) is proposed for the antidepressant
effect of low-frequency (LF) rTMS of the right DLPFC, HF-rTMS of the left DLPFC for the negative
symptoms of schizophrenia, and LF-rTMS of contralesional M1 in chronic motor stroke. The effects of rTMS
in a number of indications reach level C (possible efficacy), including LF-rTMS of the left temporoparietal
cortex in tinnitus and auditory hallucinations. It remains to determine how to optimize rTMS protocols and
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techniques to give them relevance in routine clinical practice. In addition, professionals carrying out rTMS
protocols should undergo rigorous training to ensure the quality of the technical realization, guarantee the
proper care of patients, and maximize the chances of success. Under these conditions, the therapeutic
use of rTMS should be able to develop in the coming years. Copyright © 2014 International Federation of
Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
Combined Central and Peripheral Stimulation for Treatment of Chronic Tinnitus: A Randomized
Pilot Study.
Neurorehabil Neural Repair. 2014 Jul 15. pii: 1545968314542616. [Epub ahead of print]
Mohamed N T1, Fouad N2, Shahat B3, Youssif M3.
1
Sohag University Hospital, Sohag, Egypt. [email protected].
Background. Tinnitus is a common untreatable condition that originates from central maladaptive plasticity
initiated by peripheral injury. Repetitive transcranial magnetic stimulation (rTMS), direct cochlear low-level
laser therapy (LLLT), and acupuncture were tried for tinnitus treatment, but the results of these methods
were clinically unsatisfactory. Objective. This study aimed to test the combined effect of the 3 methods
targeting both peripheral and central auditory areas as a new therapeutic strategy for tinnitus. Methods.
For this, 30 patients were randomized to 3 equal groups receiving 3 different interventions: inhibitory
rTMS to the left auditory cortex, LLLT (which includes a combination of direct cochlear LLLT and laser
acupuncture) to the affected ear(s), and finally, a combination of rTMS and LLLT. The Tinnitus Handicap
Inventory (THI) and Visual Analogue Scale (VAS) were assessed before, immediately after, and at 2 weeks
and 4 weeks after 10 consecutive every-other-day sessions for each intervention type. Results. We found
that combined stimulation was effective in tinnitus treatment. This effect remained for 4 weeks after the end
of the treatment. However, each of rTMS and LLLT alone had no significant effect. Repeated-measures
ANOVA showed a significant effect of Time and Time × Intervention interaction for THI and VAS scores. The
post hoc t test for different time points per intervention revealed a significant difference between baseline
and all postintervention measurements of both THI and VAS for the combination intervention. Conclusion.
Combined central rTMS and peripheral LLLT is more beneficial as a new method for management of
tinnitus rather than these two used separately. © The Author(s) 2014.
The Changeability and Predictive Value of Dysfunctional Cognitions in Cognitive Behavior
Therapy for Chronic Tinnitus.
Int J Behav Med. 2014 Jul 17. [Epub ahead of print]
Conrad I1, Kleinstäuber M, Jasper K, Hiller W, Andersson G, Weise C.
1
Department of Clinical Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany.
BACKGROUND: Multidimensional tinnitus models describe dysfunctional cognitions as a complicating
factor in the process of tinnitus habituation. However, this concept has rarely been investigated in previous
research. PURPOSE: The present study investigated the effects of two cognitive-behavioral treatments
on dysfunctional tinnitus-related cognitions in patients with chronic tinnitus. Furthermore, dysfunctional
cognitions were examined as possible predictors of the therapeutic effect on tinnitus distress. METHOD:
A total of 128 patients with chronic tinnitus were randomly assigned to either an Internet-delivered guided
self-help treatment (Internet-based cognitive-behavioral therapy, ICBT), a conventional face-to-face group
therapy (cognitive-behavioral group therapy, GCBT), or an active control group in the form of a web-based
discussion forum (DF). To assess tinnitus-related dysfunctional thoughts, the Tinnitus Cognitions Scale
(T-Cog) was used at pre- and post-assessment, as well as at the 6- and 12-month follow-up. RESULTS:
Multivariate ANOVAs with post hoc tests revealed significant and comparable reductions of dysfunctional
tinnitus-related cognitions for both treatments (GCBT and ICBT), which remained stable over a 6- and
12-month period. Negative correlations were found between the catastrophic subscale of the T-Cog and
therapy outcome for ICBT, but not for GCBT. This means a higher degree of catastrophic thinking at
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baseline was associated with lower benefit from ICBT directly after the treatment. Hierarchical regression
analysis confirmed catastrophizing as a predictor of poorer therapy outcome regarding emotional tinnitus
distress in ICBT. No associations were detected in the follow-up assessments. CONCLUSION: Both forms
of CBT are successful in reducing dysfunctional tinnitus-related cognitions. Catastrophizing significantly
predicted a less favorable outcome regarding emotional tinnitus distress in ICBT. Clinical implications of
these results are described. Dysfunctional cognitions could be targeted more intensively in therapy and in
future research on tinnitus.
Alterations in early auditory evoked potentials and brainstem transmission time associated with
tinnitus residual inhibition induced by auditory electrical stimulation.
Int Tinnitus J. 2013;18(1):63-74. doi: 10.5935/0946-5448.20130009.
Mahmoudian S, Lenarz M, Esser KH, Salamat B, Alaeddini F, Dengler R, Farhadi M, Lenarz T.
INTRODUCTION: Residual inhibition (RI) is the temporary inhibition of tinnitus by use of masking stimuli
when the device is turned off. OBJECTIVE: The main aim of this study was to evaluate the effects of RI
induced by auditory electrical stimulation (AES) in the primary auditory pathways using early auditoryevoked potentials (AEPs) in subjective idiopathic tinnitus (SIT) subjects. MATERIALS AND METHODS: A
randomized placebo-controlled study was conducted on forty-four tinnitus subjects. All enrolled subjects
based on the responses to AES, were divided into two groups of RI and Non-RI (NRI). The results of the
electrocochleography (ECochG), auditory brain stem response (ABR) and brain stem transmission time
(BTT) were determined and compared pre- and post-AES in the studied groups. RESULTS: The mean
differences in the compound action potential (CAP) amplitudes and III/V and I/V amplitude ratios were
significantly different between the RI, NRI and PES controls. BTT was significantly decreased associated
with RI. CONCLUSION: The observed changes in AEP associated with RI suggested some peripheral
and central auditory alterations. Synchronized discharges of the auditory nerve fibers and inhibition of
the abnormal activity of the cochlear nerve by AES may play important roles associated with RI. Further
comprehensive studies are required to determine the mechanisms of RI more precisely.
Structural Brain Changes Following Left Temporal Low-Frequency rTMS in Patients with
Subjective Tinnitus.
Neural Plast. 2014;2014:132058. doi: 10.1155/2014/132058. Epub 2014 Jun 3.
Lehner A1, Langguth B1, Poeppl TB1, Rupprecht R2, Hajak G3, Landgrebe M4, Schecklmann M1.
1
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße
84, 93053 Regensburg, Germany ; Interdisciplinary Tinnitus Center, University of Regensburg,
Universitaetsstraße 84, 93053 Regensburg, Germany.
Repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex has been used to treat patients
with subjective tinnitus. While rTMS is known to induce morphological changes in healthy subjects, no
study has investigated yet whether rTMS treatment induces grey matter (GM) changes in tinnitus patients
as well, whether these changes are correlated with treatment success, and whether GM at baseline is
a useful predictor for treatment outcome. Therefore, we examined magnetic resonance images of 77
tinnitus patients who were treated with rTMS of the left temporal cortex (10 days, 2000 stimuli/day, 1 Hz). At
baseline and after the last treatment session high-resolution structural images of the brain were acquired
and tinnitus severity was assessed. For a subgroup of 41 patients, additional brain scans were done after a
follow-up period of 90 days. GM changes were analysed by means of voxel based morphometry. Transient
GM decreases were detectable in several brain regions, especially in the insula and the inferior frontal
cortex. These changes were not related to treatment outcome though. Baseline images correlated with
change in tinnitus severity in the frontal cortex and the lingual gyrus, suggesting that GM at baseline might
hold potential as a possible predictor for treatment outcome. Free PMC Article.
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65
Feasibility, Safety and Efficacy of Transcutaneous Vagus Nerve Stimulation in Chronic Tinnitus:
An Open Pilot Study.
Brain Stimul. 2014 Jun 4. pii: S1935-861X(14)00173-9. doi: 10.1016/j.brs.2014.05.003. [Epub ahead of
print]
Kreuzer PM1, Landgrebe M2, Resch M3, Husser O3, Schecklmann M4, Geisreiter F4, Poeppl TB4,
Prasser SJ4, Hajak G5, Rupprecht R4, Langguth B4.
1
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstr. 84, 93053
Regensburg, Germany. Electronic address: [email protected].
OBJECTIVES: Vagus nerve stimulation represents an established treatment strategy for epilepsy and
affective disorders. Recently, positive effects were also shown in animals and humans with tinnitus. Here
we report the results of an open pilot study exploring feasibility, safety and efficacy of tVNS in the treatment
of chronic tinnitus. STUDY DESIGN: Fifty patients with chronic tinnitus underwent tVNS in an open
single-armed pilot study which was conducted in two phases applying two different stimulating devices
(Cerbomed CM02 and NEMOS). Clinical assessment was based on Tinnitus Questionnaire (TQ), Tinnitus
Handicap Inventory (THI), Beck Depression Inventory (BDI), WHO Quality of Life, and various numeric
rating scales. Primary outcome was defined as change in TQ (baseline vs. final visit in week 24). The
study has been registered with clinicaltrials.gov (NCT01176734). RESULTS: Primary analysis indicated
mean TQ reductions of 3.7 points (phase 1) and 2.8 points (phase 2) significant for the first study phase.
Secondary analyses indicated a significant BDI reduction for phase 1 (uncorrected for multiple testing), but
no further systematic or significant effects. Adverse events included twitching and pressure at electrode
placement site. The occurrence of one hospitalization because of palpations and the development of
a left bundle branch block were considered as unrelated to the intervention. Cognitive testing revealed
no significant changes. CONCLUSION: Our data demonstrate the feasibility of tVNS over a period of 6
months. There was no clinically relevant improvement of tinnitus complaints. Our data suggest tVNS to be
considered safe in patients without a history of cardiac disease. Copyright © 2014 Elsevier Inc. All rights
reserved.
Effect of Chronic Cortical Stimulation on Chronic Severe Tinnitus: A Prospective Randomized
Double-blind Cross-over Trial and Long-term Follow Up.
Brain Stimul. 2014 Jun 4. pii: S1935-861X(14)00178-8. doi: 10.1016/j.brs.2014.05.008. [Epub ahead of
print]
Engelhardt J1, Dauman R2, Arné P3, Allard M4, Dauman N5, Branchard O1, Perez P6, Germain C6,
Caire F7, Bonnard D2, Cuny E8.
1
CHU Bordeaux, Service de Neurochirurgie, France.
BACKGROUND: Chronic severe tinnitus can be greatly detrimental to quality of life. Some authors have
reported benefit of repetitive transcranial magnetic stimulation, others of electrical cortical stimulation
by stimulating the Heschl's gyrus or secondary auditory areas. OBJECTIVE: To evaluate the efficacy of
chronic electrical epidural stimulation of the auditory cortex on severe and disabling tinnitus. METHOD:
In this double-blind randomized cross-over, patients with chronic (at least 2 years), severe (Strukturierte
Tinnitus-Interview, STI score > 19), unilateral or strongly lateralized tinnitus were included. After openphase stimulation for 4 months, patients were randomized into 2 groups for double-blind stimulation with
cross-over between significant and non-significant phases and wash-out in between. Each of the 3 phases
was 2 weeks in duration. Patients were chronically stimulated and followed if not explanted. A decrease
of STI score >35% was considered as clinically significant. RESULTS: None of the 9 patients included
achieved significant improvement during the double-blind phase. Four were explanted, 2 owing to lack of
effect, one for breast cancer under the stimulator, and another for psychiatric decompensation. Five are
still stimulated. Three felt slight to great subjective effectiveness, the remaining 2 reported benefits and still
requested stimulation. CONCLUSIONS: This study did not find an objective efficiency of chronic cortical
stimulation for severe and resistant tinnitus. The discordance between the results in double-blind and
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66
open evaluations could be related to a placebo effect of surgery, but may also be explained by a poorly
defined target, a too short randomized phase, or inappropriate outcome measures. Clinical trial reference:
NCT00486577. Copyright © 2014 Elsevier Inc. All rights reserved.
Effectiveness of transcranial magnetic stimulation application in treatment of tinnitus.
J Craniofac Surg. 2014 Jul;25(4):1315-8. doi: 10.1097/SCS.0000000000000782.
Yilmaz M1, Yener MH, Turgut NF, Aydin F, Altug T.
1
Department of Otorhinolaryngology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.
OBJECTIVE: Pathophysiology of tinnitus known to accompany nearly all disorders in hearing system has
not been fully understood, and therefore, there are some difficulties in evaluation and treatment thereof. The
objective of the current study is to research the effectiveness of transcranial magnetic stimulation (TMS)
application in treatment of tinnitus. MATERIALS AND METHODS: Sixty patients aged between 15 and 70
years who applied to a polyclinic of Ear-Nose-Throat Department, Cerrahpasa Medical Faculty, Istanbul
University, because of the complaint of tinnitus between January 2009 and July 2009 were selected using
simple random sampling method. The treatment group and the placebo group were separated randomly
as to include 30 patients. The tinnitus loudness, tinnitus frequency, tinnitus subjective score, and tinnitus
handicap inventory results were compared before application of TMS and after 1 month. FINDINGS: It was
found that the difference of tinnitus handicap inventory score within the TMS group (before the treatment:
mean, 52.76; SD, 15.8; after the treatment: mean, 44.4; SD, 13.57) was statistically significant (P < 0.0001)
and the difference of tinnitus handicap inventory score within the placebo group (before the treatment:
mean, 51.46; SD, 15.41; after the treatment: mean, 51.13; SD, 16.86) was significantly insignificant (P
= 0.848). When tinnitus severities determined at the beginning and end of the treatment were evaluated
within each group, it was found that the difference of loudness within the group subjected to TMS was
statistically significant (P < 0.0001) but the difference of loudness within the placebo group was statistically
insignificant (P = 0.490). When tinnitus subjective scores were evaluated within each group before and
after the treatment, the difference of subjective score within the group subjected to transcranial magnetic
stimulation was statistically significant (P < 0.0001), and the difference of subjective score within the
placebo group was statistically significant (P = 0.168). CONCLUSIONS: The studies showed that lowfrequency repeating TMS is useful in the treatment of chronic tinnitus. In the current study performed
on the patients with chronic tinnitus, it was shown that low-frequency repeating TMS has a statistically
significant success when compared with the placebo group.
Use of Cortical Stimulation in Neuropathic Pain, Tinnitus, Depression, and Movement Disorders.
Neurotherapeutics. 2014 Jun 3. [Epub ahead of print]
Panov F1, Kopell BH.
1
Department of Neurosurgery, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY,
10029, USA.
Medical treatment must strike a balance between benefit and risk. As the field of neuromodulation develops,
decreased invasiveness, in combination with maintenance of efficacy, has become a goal. We provide a
review of the history of cortical stimulation from its origins to the current state. The first part discusses
neuropathic pain and the nonpharmacological treatment options used. The second part covers transitions
to tinnitus, believed by many to be another deafferentation disorder, its classification, and treatment. The
third part focuses on major depression. The fourth section concludes with the discussion of the use of
cortical stimulation in movement disorders. Each part discusses the development of the field, describes
the current care protocols, and suggests future avenues for research needed to advance neuromodulation.
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67
Neuroanatomical abnormalities in chronic tinnitus in the human brain.
Neurosci Biobehav Rev. 2014 Jun 2. pii: S0149-7634(14)00138-9. doi: 10.1016/j.neubiorev.2014.05.013.
[Epub ahead of print] Review.
Adjamian P1, Hall DA2, Palmer AR3, Allan T3, Langers DR2.
1
MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, United Kingdom.
Electronic address: [email protected].
In this paper, we review studies that have investigated brain morphology in chronic tinnitus in order to
better understand the underlying pathophysiology of the disorder. Current consensus is that tinnitus is
a disorder involving a distributed network of peripheral and central pathways in the nervous system.
However, the precise mechanism remains elusive and it is unclear which structures are involved. Given
that brain structure and function are highly related, identification of anatomical differences may shed light
upon the mechanism of tinnitus generation and maintenance. We discuss anatomical changes in the
auditory cortex, the limbic system, and prefrontal cortex, among others. Specifically, we discuss the gating
mechanism of tinnitus and evaluate the evidence in support of the model from studies of brain anatomy.
Although individual studies claim significant effects related to tinnitus, outcomes are divergent and even
contradictory across studies. Moreover, results are often confounded by the presence of hearing loss. We
conclude that, at present, the overall evidence for structural abnormalities specifically related to tinnitus is
poor. As this area of research is expanding, we identify some key considerations for research design and
propose strategies for future research. Copyright © 2014. Published by Elsevier Ltd.
Changes in motor cortex excitability associated with temporal repetitive transcranial magnetic
stimulation in tinnitus: hints for cross-modal plasticity?
BMC Neurosci. 2014 Jun 4;15(1):71. [Epub ahead of print]
Schecklmann M, Landgrebe M, Kleinjung T, Frank E, Sand PG, Rupprecht R, Eichhammer P, Hajak
G, Langguth B.
BACKGROUND: Motor cortex excitability was found to be changed after repetitive transcranial magnetic
stimulation (rTMS) of the temporal cortex highlighting the occurrence of cross-modal plasticity in noninvasive brain stimulation. Here, we investigated the effects of temporal low-frequency rTMS on motor
cortex plasticity in a large sample of tinnitus patients. In 116 patients with chronic tinnitus different
parameters of cortical excitability were assessed before and after ten rTMS treatment sessions. Patients
received one of three different protocols all including 1 Hz rTMS over the left temporal cortex. Treatment
response was defined as improvement by at least five points in the tinnitus questionnaire (TQ). Variables
of interest were resting motor threshold (RMT), short-interval intra-cortical inhibition (SICI), intracortical
facilitation (ICF), and cortical silent period (CSP). RESULTS: After rTMS treatment RMT was decreased
by about 1% of stimulator output near-significantly in the whole group of patients. SICI was associated
with significant changes with respect to treatment response. The group of treatment responders showed
a decrease of SICI over the course of treatment, the group of non-responders the reverse pattern.
CONCLUSIONS: Minor RMT changes during rTMS treatment do not necessarily suggest the need for
systematic re-examination of the RMT for safety and efficacy issues. Treatment response to rTMS was
shown to be related to changes in SICI that might reflect modulation of GABAergic mechanisms directly or
indirectly related to rTMS treatment effects. Free Article.
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68
VIII Behavioral Therapy
The effectiveness of neuro-music therapy according to the Heidelberg model compared to a
single session of educational counseling as treatment for tinnitus: A controlled trial.
J Psychosom Res. 2014 Sep 3. pii: S0022-3999(14)00314-6. doi: 10.1016/j.jpsychores.2014.08.012.
[Epub ahead of print]
Argstatter H1, Grapp M2, Hutter E2, Plinkert PK3, Bolay HV4.
1
Deutsches Zentrum für Musiktherapieforschung (German Center for Music Therapy Research) (Viktor
Dulger Institute), Heidelberg, Germany. Electronic address: [email protected].
OBJECTIVES: Tinnitus is a very common symptom, yet the quest for an effective treatment is challenging.
Results from several clinical trials support the notion that neuro-music therapy is an effective means to
reduce tinnitus distress with short duration and long lasting effect. However, until now, the effectiveness
has not been tested in a controlled trial against an active comparator. METHODS: The trial was designed
as two-center, parallel intervention group controlled study with two intervention groups: Counseling
(50minute individualized personal instruction) or neuro-music therapy (counseling plus eight 50-minute
sessions of individualized music therapy). Data of n=290 patients suffering from chronic tinnitus were
analyzed. Outcome measure was the change in Tinnitus Questionnaire Total Scores (TQ) from baseline
(admission) to end of treatment. RESULTS: Both treatment groups achieved a statistically relevant
reduction in TQ scores, though 66% of patients in the music therapy group attained a clinically meaningful
improvement compared to 33% in the counseling group. A binary logistic regression revealed two variables
significantly influencing therapy outcome: initial tinnitus score and type of therapy with an OR for the music
therapy compared to the counseling of 4.34 (CI 2.33-8.09). CONCLUSIONS: Counseling is an appropriate
treatment option with well above chance of improvement. The neuro-music therapy outperformed the
counseling. This treatment targets the tinnitus sound itself, is short in duration, intrinsically motivating and
easy to operate and thus presents a possible complement to the therapeutic spectrum in chronic tinnitus.
The trial was registered at the ClinicalTrials.gov registry (ID: NCT01845155). Copyright © 2014 Elsevier
back to Highlights
Inc. All rights reserved.
[Chronic complex tinnitus : Does day care unit-based short-term psychotherapy help?]
[Article in German]
HNO. 2014 Oct 2. [Epub ahead of print] German.
Klug G1, Henrich G.
1
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar,
Technische Universität München, München, Deutschland, [email protected].
BACKGROUND: Results of empirical research on the effectiveness of psychotherapeutic treatment of
chronic complex tinnitus are still unclear and require further studies for clarification. OBJECTIVE: The
objective of this study is to investigate the effectiveness of multimodal treatment of patients with chronic
complex tinnitus in a day care unit setting. PATIENTS AND METHODS: In this prospective study, the
effectiveness of an intense 5-day multimodal treatment delivered to 93 patients was assessed using a
pre-post design. Tinnitus-specific effects were captured by the Mini-TQ-12 measurement instrument and
psychiatric comorbidity assessed using the Brief Symptom Inventory (BSI). In statistical analyses, t-tests,
χ2 tests and Wilcoxon signed ranks tests were performed to determine statistical significance; effect sizes
(ES) were calculated according to Cohen's d. RESULTS: The pre-post difference in Mini-TQ-12 was highly
significant in t-test (p < 0.001); the ES was small (ES = 0.45). In BSI, the pre-post difference in the Global
Severity Index (GSI) as a global measure was also highly significant in t-test (p < 0.001); ES was small
(ES = 0.40). Nonparametric tests (Wilcoxon test) confirmed these results. CONCLUSION: This study
demonstrates the statistically significant effectiveness of a multimodal therapeutic approach. Moreover,
the results indicate that patients could benefit from more intensive therapeutic interventions.
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69
Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic
disorders: a systematic review and meta-analysis.
World Psychiatry. 2014 Oct;13(3):288-95. doi: 10.1002/wps.20151.
Andersson G1, Cuijpers P, Carlbring P, Riper H, Hedman E.
1
Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research,
University of Linköping, Linköping, Sweden; Department of Clinical Neuroscience, Division of
Psychiatry, Karolinska Institutet, Stockholm, Sweden.
Internet-delivered cognitive behavior therapy (ICBT) has been tested in many research trials, but to a
lesser extent directly compared to face-to-face delivered cognitive behavior therapy (CBT). We conducted
a systematic review and meta-analysis of trials in which guided ICBT was directly compared to face-toface CBT. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in
13 studies (total N=1053) that met all criteria and were included in the review. There were three studies on
social anxiety disorder, three on panic disorder, two on depressive symptoms, two on body dissatisfaction,
one on tinnitus, one on male sexual dysfunction, and one on spider phobia. Face-to-face CBT was either in
the individual format (n=6) or in the group format (n=7). We also assessed quality and risk of bias. Results
showed a pooled effect size (Hedges' g) at post-treatment of -0.01 (95% CI: -0.13 to 0.12), indicating that
guided ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect
outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric
and somatic condition and many conditions for which guided ICBT has not been compared to face-to-face
treatment. Thus, more research is needed to establish equivalence of the two treatment formats. Copyright
© 2014 World Psychiatric Association. Free Article.
Internet-Based Guided Self-Help versus Group Cognitive Behavioral Therapy for Chronic
Tinnitus: A Randomized Controlled Trial.
Psychother Psychosom. 2014;83(4):234-46. doi: 10.1159/000360705. Epub 2014 Jun 19.
Jasper K1, Weise C, Conrad I, Andersson G, Hiller W, Kleinstäuber M.
1
Department of Clinical Psychology and Psychotherapy, Johannes Gutenberg University of Mainz,
Mainz, Germany.
Background: The aim of this randomized controlled trial was to investigate the effects of conventional faceto-face group cognitive behavioral therapy (GCBT) and an Internet-delivered guided self-help treatment
(Internet-based CBT, ICBT) on tinnitus distress. Methods: A total of 128 adults with at least mild levels
of chronic tinnitus distress were randomly assigned to GCBT (n = 43), ICBT (n = 41), or a web-based
discussion forum (DF) that served as a control condition (n = 44). Standardized self-report measures
[the Tinnitus Handicap Inventory (THI), Mini-Tinnitus Questionnaire (Mini-TQ), Hospital Anxiety and
Depression Scale, Insomnia Severity Index and Tinnitus Acceptance Questionnaire] were completed at the
pre- and post-assessments and at the 6-month follow-up. Results: Repeated-measures ANOVAs revealed
significant time × group interaction effects on the primary outcomes (THI and Mini-TQ scores) in favor of
both CBT interventions compared with the DF at post-assessment (0.56 ≤ g ≤ 0.93; all p ≤ 0.001). There
were no significant differences between GCBT and ICBT (all p > 0.05) and the treatment effects remained
stable at the 6-month follow-up. Conclusions: This study provides evidence that ICBT might be an equally
effective alternative to conventional CBT in the management of chronic tinnitus. Despite encouraging
results, further research is necessary to determine the actual potential of ICBT as a viable alternative to
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CBT, and under which circumstances it is effective. © 2014 S. Karger AG, Basel.
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70
IX
Somatic Tinnitus
Incidence of otolaryngological symptoms in patients with temporomandibular joint dysfunctions.
Biomed Res Int. 2014;2014:824684. doi: 10.1155/2014/824684. Epub 2014 Jun 24.
Ferendiuk E1, Zajdel K2, Pihut M1.
epartment of Dental Prosthetics, Consulting Room of Functional Disorders of Masticatory Organ,
D
Jagiellonian University Medical College, 4 Montelupich Street, 31-155 Cracow, Poland.
1
The functional disorders of the masticatory organ are the third stomatological disease to be considered
a populational disease due to its chronicity and widespread prevalence. Otolaryngological symptoms
are a less common group of dysfunction symptoms, including sudden hearing impairment or loss, ear
plugging sensation and earache, sore and burning throat, difficulties in swallowing, tinnitus, and vertigo.
The diagnostic and therapeutic problems encountered in patients with the functional disorders of the
masticatory organ triggered our interest in conducting retrospective studies with the objective of assessing
the incidence of otolaryngological symptoms in patients subjected to prosthetic treatment of the functional
disorders of masticatory organ on the basis of the analysis of medical documentation containing data
collected in medical interviews. Material and Methods. Retrospective study was conducted by analyzing the
results of medical interviews of 1208 patients, who had reported for prosthetic treatment at the Functional
Disorders Clinic of the Department of Dental Prosthetics of Jagiellonian University Medical College in
Cracow between 2008 and March 14, 2014. Results. Otolaryngological symptoms were observed in 141
patients. The most common symptoms in the study group were earache and sudden hearing impairment;
no cases of sudden hearing loss were experienced. Free PMC Article.
X
Surgical Treatment
Cerebellopontine Angle and Intracanalicular Masses Mimicking Vestibular Schwannomas.
Otol Neurotol. 2014 Sep 15. [Epub ahead of print]
Calzada AP1, Go JL, Tschirhart DL, Brackmann DE, Schwartz MS.
1
*House Ear Clinic, †Department of Radiology, University of Southern California; ‡Department of
Pathology, St. Vincent Medical Center; and §House Clinic, Neurosurgery, Los Angeles, California,
U.S.A.
OBJECTIVE: To describe the clinical and radiographic characteristics in a series of patients with nonvestibular schwannoma cerebellopontine angle (CPA) and intracanalicular (IAC) masses, who underwent
microsurgery for presumed vestibular schwannoma (VS). STUDY DESIGN: Retrospective case series.
SETTING: Tertiary neurotologic referral center. PATIENTS: One thousand five hundred ninety-three
patients underwent microsurgery for apparent VS from 2002 to 2013. Of these, 53 patients (3%) were
discovered to have a diagnosis other than VS. INTERVENTIONS: Middle fossa, translabyrinthine, and
retrosigmoid craniotomy. MAIN OUTCOME MEASURES: Clinical presentation, radiologic analysis,
and histopathology examination. RESULTS: There were 17 facial schwannomas, 15 meningiomas, 9
hemangiomas, 6 lipochoristomas, 3 inflammatory reactions, and one each of lymphoma, glial heterotopia,
solitary fibrous tumor, ependymoma, and a non-diagnostic mass. Excluding facial schwannomas, 23
cases were misdiagnosed as VS in the first half of the study period, compared to only 15 cases in the
latter half (p = 0.09). Ninety-six percent of patients presented with some combination of sensorineural
hearing loss, balance disturbance, and tinnitus. In the subset of patients with available preoperative MRI
scans for retrospective review, only 4 of 28 patients had radiologic findings suggestive of pathology other
than VS. The most common missed radiologic diagnoses were facial schwannoma, lipochoristoma, and
meningioma. CONCLUSION: A subgroup of patients with CPA and IAC masses who present with radiologic
findings diagnostic of VS will have an alternative histopathologic diagnosis. Optimal radiologic imaging and
experienced interpretation can improve diagnostic accuracy. The most common tumors that mimic VS
despite ideal radiologic imaging are facial schwannomas, meningiomas, and hemangiomas. back to content 71
Subtotal Resection for Management of Large Jugular Paragangliomas with Functional Lower
Cranial Nerves.
Otolaryngol Head Neck Surg. 2014 Sep 26. pii: 0194599814552060. [Epub ahead of print]
Wanna GB1, Sweeney AD2, Carlson ML2, Latuska RF2, Rivas A2, Bennett ML2, Netterville JL2,
Haynes DS2.
1
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center,
Nashville, Tennessee, USA [email protected].
OBJECTIVES: To evaluate tumor control following subtotal resection of advanced jugular paragangliomas
in patients with functional lower cranial nerves and to investigate the utility of salvage radiotherapy
for residual progressive disease. STUDY DESIGN: Case series with planned chart review. SETTING:
Tertiary academic referral center. SUBJECTS AND METHODS: Patients who presented with advanced
jugular paragangliomas and functional lower cranial nerves were analyzed. Primary outcome measures
included extent of resection, long-term tumor control, need for additional treatment, and postoperative
lower cranial nerve function. RESULTS: Twelve patients (mean age, 46.2 years; 7 women, 58.3%) who
met inclusion criteria were evaluated between 1999 and 2013. The mean postoperative residual tumor
volume was 27.7% (range, 3.5%-75.0%) of the preoperative volume. When the residual tumor volume was
less than 20% of the preoperative volume, no tumor growth occurred over an average of 44.6 months of
follow-up (P < .01). Four tumors (33.3%) demonstrated serial growth at a mean of 23.5 months following
resection, 2 of which were treated with salvage stereotactic radiotherapy providing control through the
last recorded follow-up. No patient experienced permanent postoperative lower cranial neuropathy as a
result of surgery. CONCLUSION: Subtotal resection of jugular paragangliomas with preservation of the
lower cranial nerves is a viable management strategy. If more than 80% of the preoperative tumor volume
is resected, the residual tumor seems less likely to grow. © American Academy of Otolaryngology—Head
and Neck Surgery Foundation 2014.
Endoscopic endonasal surgical management of chondrosarcomas with cerebellopontine angle
extension.
Neurosurg Focus. 2014 Oct;37(4):E13. doi: 10.3171/2014.7.FOCUS14349.
Mesquita Filho PM1, Ditzel Filho LF, Prevedello DM, Martinez CA, Fiore ME, M D, Dolci RL, Otto
BA, Carrau RL.
1
Department of Neurosurgery-Head & Neck Surgery, Wexner Medical Center at The Ohio State
University, Columbus, Ohio.
Object Skull base chondrosarcomas are slow-growing, locally invasive tumors that arise from the petroclival
synchondrosis. These characteristics allow them to erode the clivus and petrous bone and slowly compress
the contents of the posterior fossa progressively until the patient becomes symptomatic, typically from
cranial neuropathies. Given the site of their genesis, surrounded by the petrous apex and the clival recess,
these tumors can project to the middle fossa, cervical area, and posteriorly, toward the cerebellopontine
angle (CPA). Expanded endoscopic endonasal approaches are versatile techniques that grant access
to the petroclival synchondrosis, the core of these lesions. The ability to access multiple compartments,
remove infiltrated bone, and achieve tumor resection without the need for neural retraction makes these
techniques particularly appealing in the management of these complex lesions. Methods Analysis of the
authors' database yielded 19 cases of skull base chondrosarcomas; among these were 5 cases with
predominant CPA involvement. The electronic medical records of the 5 patients were retrospectively
reviewed for age, sex, presentation, pre- and postoperative imaging, surgical technique, pathology, and
follow-up. These cases were used to illustrate the surgical nuances involved in the endonasal resection
of CPA chondrosarcomas. Results The male/female ratio was 1:4, and the patients' mean age was 55.2
±11.2 years. All cases involved petrous bone and apex, with variable extensions to the posterior fossa and
parapharyngeal space. The main clinical scenario was cranial nerve (CN) palsy, evidenced by diplopia
(20%), ptosis (20%), CN VI palsy (20%), dysphagia (40%), impaired phonation (40%), hearing loss (20%),
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72
tinnitus (20%), and vertigo/dizziness (40%). Gross-total resection of the CPA component of the tumor
was achieved in 4 cases (80%); near-total resection of the CPA component was performed in 1 case
(20%). Two patients (40%) harbored high-grade chondrosarcomas. No patient experienced worsening
neurological symptoms postoperatively. In 2 cases (40%), the symptoms were completely normalized
after surgery. Conclusions Expanded endoscopic endonasal approaches appear to be safe and effective
in the resection of select skull base chondrosarcomas; those with predominant CPA involvement seem
particularly amenable to resection through this technique. Further studies with larger cohorts are necessary
to test these preliminary impressions and to compare their effectiveness with the results obtained with
open approaches.
A Nonrandomized Comparison of the Thulium Laser and the CO2 Laser in Primary Stapedotomy
for Otosclerosis.
Otol Neurotol. 2014 Oct 8. [Epub ahead of print]
Kamalski DM1, Vincent R, Wegner I, Bittermann AJ, Grolman W.
1
*Department of Otorhinolaryngology-Head and Neck Surgery, and †Brain Center Rudolf Magnus,
University Medical Center Utrecht, Utrecht, The Netherlands; and ‡Jean Causse Ear Clinic, Traverse
de Béziers, Colombiers, France.
OBJECTIVE: Comparing hearing results in patients with otosclerosis treated with laser-assisted stapedotomy
using the 2-μm thulium laser or the CO2 laser. STUDY DESIGN: Prospective nonrandomized clinical
study. SETTING: In a tertiary referral center in France (Jean Causse Ear Clinic, Béziers), 208 primary
stapedotomies were performed in 204 patients between March 2008 and November 2009. Sufficient
follow-up data were available for 194 procedures. METHODS: The fenestration in the footplate was made
with the thulium laser in 98 procedures and with a flexible CO2 laser in 96 procedures. Preoperative and
postoperative audiometric results were compared. Side effects, such as vertigo and tinnitus, were scored.
RESULTS: Patients treated with the CO2 laser had better hearing outcome compared with those treated
with the thulium laser at both 3 and 12 months of follow-up. At 3 months, the success of the surgery, defined
as closure of the air-bone gap to within 10 dB, was 90.0% in the thulium group compared with 96.8% in
the CO2 group. Bone conduction shift showed an overall deterioration of 1.6 dB (standard deviation, 6.9
dB) in the thulium group compared with an improvement of 1.3 dB (standard deviation, 4 dB) in the CO2
group. In the thulium group, there were four patients with sensorineural hearing loss (4.4%) and three with
tinnitus (3.1%) compared with none in the CO2 group. CONCLUSION: Stapedotomy surgery performed
with a fiber-delivered thulium laser resulted in a higher chance of inner ear damage measured by bone
conduction shift compared with the use of a fiber-delivered CO2 laser. We advise not to use the thulium
laser for stapedotomy.
Analysis of 101 patients with severe to profound sudden unilateral hearing loss treated with
explorative tympanotomy and sealing of the round window membrane.
Eur Arch Otorhinolaryngol. 2014 Aug;271(8):2145-52. doi: 10.1007/s00405-013-2703-x. Epub 2013 Sep
22.
Kampfner D1, Anagiotos A, Luers JC, Hüttenbrink KB, Preuss SF.
1
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, Cologne,
Germany, [email protected].
The aim of this retrospective study was to evaluate the effect of sealing of the round window membrane in
patients with severe to profound unilateral sudden sensorineural hearing loss (SSNHL). 101 Patients with
unilateral SSNHL were treated with tympanotomy and sealing of the round window membrane if hearing
did not improve after conservative treatment. Preoperative and postoperative pure tone audiograms after
removal of the ear packing were evaluated. A 4-PTA (pure tone audiometry) was used as reference value.
The improvement of 4-PTA was analysed; in addition, recovery was evaluated using Siegel's criteria. Mean
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73
initial hearing threshold was 101.1 dB. Eighty-one patients had a hearing threshold of 80 dB or more.
The average improvement at the time of ear packing was 21.7 dB and a further average recovery of 13.4
dB was recorded in the follow-up. Patients who underwent rapid tympanotomy within 5 days showed a
significantly better hearing improvement than patients with delayed tympanotomy (26.9 vs. 14.0 dB, p <
0.02). Age was significantly correlated with the degree of hearing improvement. There was no significant
difference of recovery between patients with detected lesions of the round window membrane and those
without. Concomitant vertigo and tinnitus showed no significant effect on recovery. Tympanotomy and
sealing of the round window membrane is effective in the treatment of severe to profound SSNHL. There
is evidence that early surgery performed within 5 days is more effective than later surgery. The existence
of a detectable lesion of the round window membrane has no significant influence on recovery.
[Vestibular schwannoma: active treatment or follow-up?].
[Article in Finnish]
Duodecim. 2014;130(14):1413-20.
Blomstedt G, Ramsay H.
Vestibular schwannoma is a rare benign tumor of a cranial nerve. The symptom picture is usually a varying
one, centering on otogenic symptoms, such as hearing loss, tinnitus and dizziness. The diagnosis is
often made only after the patient has already had symptoms for a longer time. The number of tumors
found yearly in Finland is estimated to be approximately 50 to 100. Even very small tumors are detected
by contrast-enhanced magnetic resonance imaging. Since a significant proportion of the tumors remain
unchanged in size over a follow-up observation period of several years, follow-up instead of surgical
treatment is considered adequate for some of the patients.
Paragangliomas: Presentation and management by radiotherapy at the Prince of Wales Hospital.
J Med Imaging Radiat Oncol. 2014 Aug 22. doi: 10.1111/1754-9485.12226. [Epub ahead of print]
Smee RI1, Jayasekara J, Williams JR, Hanna C.
1
Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales,
Australia; University of New South Wales Clinical Teaching School, Prince of Wales Hospital, Sydney,
New South Wales, Australia; Department of Radiation Oncology, Tamworth Base Hospital, Tamworth,
New South Wales, Australia.
INTRODUCTION: Paragangliomas are commonly treated with surgery, while radiotherapy is reserved for
those that are inoperable or have relapsed. However, this retrospective study aims to determine whether
radiotherapy is a viable initial treatment for paragangliomas. METHODS: Of 73 tumours researched, 44
were diagnosed and treated from January 1967 to December 2012 at the Radiation Oncology Department
at the Prince of Wales Hospital and thus were eligible for analysis. Median follow-up time was 3.5 years
with a range of 1 to 40 years. Thirty-four tumours were treated with radiotherapy only, and 10 tumours were
treated with both surgical resection and radiotherapy. Local control and cause-specific survival were the
primary end points measured. RESULTS: Five-year local control rate for the population of 44 lesions was
89%; it was 100% in the group treated by radiotherapy alone, but only 50% in the group treated by surgery
followed by radiotherapy, with radiation used for salvage. The difference in control rates between these
two subset groups was found to be statistically significant (P < 0.001). Cause-specific survival rates for this
eligible population at 5 and 10 years were 98% and 90%, respectively. After initial radiotherapy, 4 patients
had improved cranial nerve function, there was clinical improvement in tinnitus, and one new cranial nerve
deficit developed where a high dose was used. CONCLUSIONS: Radiotherapy has high local control rates
and few complications. The local control and complication rates compare favourably to surgery. © 2014
The Royal Australian and New Zealand College of Radiologists.
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74
Cavernous Hemangiomas of the Internal Auditory Canal and Cerebellopontine Angle.
Otol Neurotol. 2014 Aug 7. [Epub ahead of print]
Oldenburg MS1, Carlson ML, Van Abel KM, Giannini C, Jacob J, Rivas A, Driscoll CL, Link MJ.
1
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester,
Minnesota, U.S.A.
OBJECTIVE: To review the clinical presentation, differential diagnosis, management strategy, and outcomes
after microsurgical resection of cavernous hemangiomas (CHs) arising primarily within the internal auditory
canal (IAC) and cerebellopontine angle (CPA). PATIENTS: Twelve patients (10 men; aged 18-66 yr) were
included from 1982 to 2012 from one of two tertiary academic referral centers. INTERVENTION(S): All
patients underwent preoperative imaging evaluation and subsequent microsurgical resection. MAIN
OUTCOME MEASURE(S): American Academy of Otolaryngology-Head and Neck Surgery hearing
class, facial nerve function, and tumor control. RESULTS: The most common presenting symptoms were
ipsilateral sensorineural hearing loss, nonpulsatile tinnitus, and vertigo. Three presented with facial paresis,
10 had lost serviceable hearing preoperatively. All lesions demonstrated heterogeneous enhancement
with gadolinium and hyperintense signal on T2-weighted imaging. The median tumor diameter was 8
mm; eight CHs were confined to the IAC, whereas four involved the CPA. Tumors were accessed via a
translabyrinthine approach in eight cases, retrosigmoid craniotomy in three cases, and a middle cranial
fossa approach in one case. Ten patients received gross total resection, whereas two underwent subtotal
removal. Neither patient with serviceable preoperative hearing retained useful hearing after resection. Eight
of the nine patients with normal preoperative facial nerve function retained House-Brackmann grade 1
function after surgery. One patient had residual tumor treated with postoperative stereotactic radiosurgery.
CONCLUSIONS: Primary CHs of the IAC and CPA are rare and present clinically and radiographically
similar to vestibular schwannoma. Microsurgical resection provides excellent facial nerve outcomes and
tumor control for most patients; however, the majority of individuals will acquire non-serviceable hearing
either from disease or as a result of treatment.
Radiation exposure of normal temporal bone structures during stereotactically guided gamma
knife surgery for vestibular schwannomas.
J Neurosurg. 2013 Dec;119 Suppl:800-6.
Linskey ME, Johnstone PA, O'Leary M, Goetsch S.
OBJECT: The dosimetry of radiation exposure of healthy inner, middle, and external ear structures that
leads to hearing loss, tinnitus, facial weakness, dizziness, vertigo, and imbalance after gamma knife
surgery (GKS) for vestibular schwannomas (VSs) is unknown. The authors quantified the dose of radiation
received by these structures after GKS for VS to assess the likelihood that these doses contributed to
postradiosurgery complications. METHODS: A retrospective study was performed using a prospectively
acquired database of a consecutive series of 54 patients with VS who were treated with GKS during a 3.5year period at an "open unit" gamma knife center. Point doses were measured for 18 healthy temporal bone
structures in each patient, with the anatomical position of each sampling point confirmed by a fellowshiptrained neurootologist. These values were compared against single-dose equivalents for the 5-year
tolerance dose for a 5% risk of complications and the 5-year tolerance dose for a 50% risk of complications,
which were calculated using known 2-Gy/fraction thresholds for chronic otitis, chondromalacia, and
osseous necrosis, as well as the tumor margin dose and typical tumor margin prescription doses for
patients in whom hearing preservation was attempted. External and middle ear doses were uniformly low.
The intratemporal facial nerve is susceptible to unintentionally high radiation exposure at the fundus of
the internal auditory canal, with higher than tumor margin doses detected in 26% of cases. In the cochlea,
the basal turn near the modiolus and its inferior portion are most susceptible, with doses greater than 12
Gy detected in 10.8 and 14.8% of cases. In the vestibular labyrinth, the ampulated ends of the lateral and
posterior semicircular canals are most susceptible, with doses greater than 12 Gy detected in 7.4 and
5.1% of cases. CONCLUSIONS: Doses delivered to middle and external ear structures are unlikely to
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75
contribute to post-GKS complications, but unexpectedly high doses may be delivered to sensitive areas of
the intratemporal facial nerve and inner ear. Unintentional delivery of high doses to the stria vascularis, the
sensory neuroepithelium of the inner ear organs and/or their ganglia, may play a role in the development
of post-GKS tinnitus, hearing loss, dizziness, vertigo, and imbalance. Minimizing treatment complications
post-GKS for VS requires precise dose planning conformality with the three-dimensional surface of the
tumor.
Non-audiofacial morbidity after Gamma Knife surgery for vestibular schwannoma.
J Neurosurg. 2013 Dec;119 Suppl:E4.
Sughrue ME, Yang I, Han SJ, Aranda D, Kane AJ, Amoils M, Smith ZA, Parsa AT.
OBJECT: While many studies have been published outlining morbidity following radiosurgical treatment
of vestibular schwannomas, significant interpractitioner and institutional variability still exists. For this
reason, the authors conducted a systematic review of the literature for non-audiofacial-related morbidity
after the treatment of vestibular schwannoma with radiosurgery. METHODS: The authors performed a
comprehensive search of the English-language literature to identify studies that published outcome data of
patients undergoing radiosurgery treatment for vestibular schwannomas. In total, 254 articles were found
that described more than 50,000 patients and were analyzed for satisfying the authors' inclusion criteria.
Patients from these studies were then separated into 2 cohorts based on the marginal dose of radiation:
≤ 13 Gy and > 13 Gy. All tumors included in this study were < 25 mm in their largest diameter. RESULTS:
A total of 63 articles met the criteria of the established search protocol, which combined for a total of 5631
patients. Patients receiving > 13 Gy were significantly more likely to develop trigeminal nerve neuropathy
than those receiving < 13 Gy (p < 0.001). While we found no relationship between radiation dose and
the rate of developing hydrocephalus (0.6% for both cohorts), patients with hydrocephalus who received
doses > 13 Gy appeared to have a higher rate of symptomatic hydrocephalus requiring shunt treatment
(96% [> 13 Gy] vs 56% [≤ 13 Gy], p < 0.001). The rates of vertigo or balance disturbance (1.1% [> 13 Gy]
vs 1.8% [≤ 13 Gy], p = 0.001) and tinnitus (0.1% [> 13 Gy] vs 0.7% [≤ 13 Gy], p = 0.001) were significantly
higher in the lower dose cohort than those in the higher dose cohort. CONCLUSIONS: The results of our
review of the literature provide a systematic summary of the published rates of nonaudiofacial morbidity
following radiosurgery for vestibular schwannoma.
Jugulotympanic paragangliomas treated with Gamma Knife radiosurgery: a single-center review
of 58 cases.
J Neurosurg. 2014 Jun 13:1-8. [Epub ahead of print]
Gandía-González ML1, Kusak ME, Moreno NM, Sárraga JG, Rey G, Alvarez RM.
1
Department of Neurosurgery, Hospital Universitario La Paz, Madrid; and.
Object Jugulotympanic paragangliomas (JTPs) are rare benign tumors whose surgical treatment is usually
associated with partial resection of the lesion, high morbidity, and even death. Gamma Knife radiosurgery
(GKRS) has been reported as a useful treatment option. The goal of this retrospective study is to analyze
the role of GKRS in tumor volume control and clinical outcomes of these patients. Methods A total of
75 patients with JTPs were treated with GKRS at the authors' center from 1995 to 2012. The authors
analyzed those treated during this period to allow for a minimal observation time of 2 years. The MR
images and clinical reports of these patients were reviewed to assess clinical and volumetric outcomes of
the tumors. The radiological and clinical assessments, along with a group of prognostic factors measured,
were analyzed using descriptive methods. The time to volumetric and clinical progression was analyzed
using the Kaplan-Meier method. Prognostic factors were identified using log-rank statistics and multivariate
Cox regression models. Results The mean follow-up was 86.4 months. The authors observed volumetric
tumor control in 94.8% of cases. In 67.2% of cases, tumor volume decreased by a mean of 40.1% from
the original size. Of patients with previous tinnitus, 54% reported complete recovery. Improvement of
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76
other symptoms was observed in 34.5% of cases. Overall, clinical control was achieved in 91.4% of
cases. Previous embolization and familial history of paraganglioma were selected as significant prognostic
factors for volumetric response to GKRS treatment in the univariate analysis. In multivariate analysis, no
factors were significantly correlated with progression-free survival. No patient died of side effects related to
GKRS treatment or tumor progression. Conclusions Gamma Knife radiosurgery is an effective, safe, and
efficient therapeutic option for the treatment of these tumors as a first-line treatment or in conjunction with
traditional surgery, endovascular treatment, or conventional fractionated radiotherapy.
XIHolistic
The enigma of the tinnitus-free dream state in a bayesian world.
Neural Plast. 2014;2014:612147. doi: 10.1155/2014/612147. Epub 2014 Jul 6.
De Ridder D1, Joos K2, Vanneste S3.
1
Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, P.O. Box 56,
Dunedin 9054, New Zealand ; BRAI²N & TRI, Sint Augustinus Hospital, Antwerp, Belgium.
There are pathophysiological, clinical, and treatment analogies between phantom limb pain and phantom
sound (i.e., tinnitus). Phantom limb pain commonly is absent in dreams, and the question arises whether
this is also the case for tinnitus. A questionnaire was given to 78 consecutive tinnitus patients seen at a
specialized tinnitus clinic. Seventy-six patients remembered their dreams and of these 74 claim not to
perceive tinnitus during their dreams (97%). This can be most easily explained by a predictive Bayesian
brain model. That is, during the awake state the brain constantly makes predictions about the environment.
Tinnitus is hypothesized to be the result of a prediction error due to deafferentation, and missing input is
filled in by the brain. The heuristic explanation then is that in the dream state there is no interaction with
the environment and therefore no updating of the prediction error, resulting in the absence of tinnitus. Free
Article.
From tones in tinnitus to sensed social interaction in schizophrenia: how understanding cortical
organization can inform the study of hallucinations and psychosis.
Schizophr Bull. 2014 Jul;40 Suppl 4:S305-16. doi: 10.1093/schbul/sbu041.
Ffytche DH1, Wible CG2.
1
Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, De Crespigny Park,
London, UK;
The content, modality, and perceptual attributes of hallucinations and other psychotic symptoms may be
related to neural representation at a single cell and population level in the cerebral cortex. A brief survey
of some principles and examples of cortical representation and organization will be presented together
with evidence for a correspondence between the neurobiology of brain areas activated at the time of a
hallucination and the content of the corresponding hallucinatory and psychotic experiences. Contrasting
the hallucinations of schizophrenia with other conditions, we highlight phenomenological aspects of
hallucinations that are ignored in clinical practice but carry potentially important information about the
brain regions and dysfunctions underlying them. Knowledge of cortical representation and organization
are being used to develop animal models of hallucination and to test treatments that are now beginning to
translate to the clinical domain. © The Author 2014. Published by Oxford University Press on behalf of the
Maryland Psychiatric Research Center. Free full text.
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77
Insult-induced adaptive plasticity of the auditory system.
Front Neurosci. 2014 May 23;8:110. eCollection 2014. Review.
Gold JR, Bajo VM.
Department of Physiology, Anatomy and Genetics, University of Oxford Oxford, UK.
The brain displays a remarkable capacity for both widespread and region-specific modifications in response
to environmental challenges, with adaptive processes bringing about the reweighing of connections in
neural networks putatively required for optimizing performance and behavior. As an avenue for investigation,
studies centered around changes in the mammalian auditory system, extending from the brainstem to the
cortex, have revealed a plethora of mechanisms that operate in the context of sensory disruption after insult,
be it lesion-, noise trauma, drug-, or age-related. Of particular interest in recent work are those aspects
of auditory processing which, after sensory disruption, change at multiple-if not all-levels of the auditory
hierarchy. These include changes in excitatory, inhibitory and neuromodulatory networks, consistent with
theories of homeostatic plasticity; functional alterations in gene expression and in protein levels; as well
as broader network processing effects with cognitive and behavioral implications. Nevertheless, there
abounds substantial debate regarding which of these processes may only be sequelae of the original insult,
and which may, in fact, be maladaptively compelling further degradation of the organism's competence to
cope with its disrupted sensory context. In this review, we aim to examine how the mammalian auditory
system responds in the wake of particular insults, and to disambiguate how the changes that develop might
underlie a correlated class of phantom disorders, including tinnitus and hyperacusis, which putatively are
brought about through maladaptive neuroplastic disruptions to auditory networks governing the spatial and
temporal processing of acoustic sensory information. Free PMC Article.
XIIReview
Tinnitus and arterial hypertension: a systematic review.
Eur Arch Otorhinolaryngol. 2014 Sep 5. [Epub ahead of print]
Figueiredo RR1, de Azevedo AA, Penido ND.
1
Federal University of São Paulo, Rua dos Otonis, 700, Vila Clementino, São Paulo, RJ, 04025-002,
Brazil, [email protected].
Tinnitus is considered a multi-factorial symptom. Arterial hypertension has been cited as a tinnitus etiological
factor. To assess the scientific evidence on the associations between arterial hypertension and tinnitus. A
systematic review was performed using PubMed, ISI Web, Lilacs and SciELO scientific databases. This
review included articles published in Portuguese, Spanish, French and English correlating tinnitus with
hypertension. Letters to editors and case reports were excluded. A total of 424 articles were identified, of
which only 20 met the inclusion criteria. Studies that analyzed the incidence of hypertension in tinnitus
patients tended to show an association, while those that evaluated the incidence of tinnitus in hypertensive
patients did not. There is evidence of an association between tinnitus and hypertension, although a cause
and effect relationship is uncertain. Changes in the cochlear microcirculation, resulting in hearing loss,
may be an adjuvant factor in tinnitus pathophysiology.
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78
The efficacy of Acceptance and Commitment Therapy: An updated systematic review and metaanalysis.
Behav Res Ther. 2014 Aug 19. pii: S0005-7967(14)00121-1. doi: 10.1016/j.brat.2014.07.018. [Epub
ahead of print]
Ost LG.
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, SE-171 77
Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden. Electronic
address: [email protected].
Acceptance and Commitment therapy (ACT) has attracted a lot of interest during the last 10-15 years with
a strong increase of the number of randomized controlled trials (RCTs). The present review and metaanalysis includes 60 RCTs (4234 participants) on psychiatric disorders, somatic disorders, and stress at
work. The mean effect size across all comparisons was small (0.42). Compared to the Öst (2008) metaanalysis there was no significant improvement in methodological quality and deterioration in effect size
(from 0.68). When ACT was compared to various forms of cognitive or behavioral treatments a small
and non-significant effect size of 0.16 was obtained. An evidence-base evaluation showed that ACT is
not yet well-established for any disorder. It is probably efficacious for chronic pain and tinnitus, possibly
efficacious for depression, psychotic symptoms, OCD, mixed anxiety, drug abuse, and stress at work, and
experimental for the remaining disorders. Copyright © 2014 Elsevier Ltd. All rights reserved.
Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic
disorders: a systematic review and meta-analysis.
World Psychiatry. 2014 Oct;13(3):288-95. doi: 10.1002/wps.20151.
Andersson G1, Cuijpers P, Carlbring P, Riper H, Hedman E.
1
Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research,
University of Linköping, Linköping, Sweden; Department of Clinical Neuroscience, Division of
Psychiatry, Karolinska Institutet, Stockholm, Sweden.
Internet-delivered cognitive behavior therapy (ICBT) has been tested in many research trials, but to a
lesser extent directly compared to face-to-face delivered cognitive behavior therapy (CBT). We conducted
a systematic review and meta-analysis of trials in which guided ICBT was directly compared to face-toface CBT. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in
13 studies (total N=1053) that met all criteria and were included in the review. There were three studies on
social anxiety disorder, three on panic disorder, two on depressive symptoms, two on body dissatisfaction,
one on tinnitus, one on male sexual dysfunction, and one on spider phobia. Face-to-face CBT was either in
the individual format (n=6) or in the group format (n=7). We also assessed quality and risk of bias. Results
showed a pooled effect size (Hedges' g) at post-treatment of -0.01 (95% CI: -0.13 to 0.12), indicating that
guided ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect
outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric
and somatic condition and many conditions for which guided ICBT has not been compared to face-to-face
treatment. Thus, more research is needed to establish equivalence of the two treatment formats. Copyright
© 2014 World Psychiatric Association. Free Article.
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Clinical practice guideline: tinnitus.
Otolaryngol Head Neck Surg. 2014 Oct;151(2 Suppl):S1-S40. doi: 10.1177/0194599814545325.
Tunkel DE1, Bauer CA2, Sun GH3, Rosenfeld RM4, Chandrasekhar SS5, Cunningham ER Jr6, Archer
SM7, Blakley BW8, Carter JM9, Granieri EC10, Henry JA11, Hollingsworth D12, Khan FA13, Mitchell
S14, Monfared A15, Newman CW16, Omole FS17, Phillips CD18, Robinson SK19, Taw MB20, Tyler RS21,
Waguespack R22, Whamond EJ23.
1
Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA
[email protected].
OBJECTIVE: Tinnitus is the perception of sound without an external source. More than 50 million people
in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10%
to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality
of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with
management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6
months or longer), which often negatively affects the patient's quality of life. The target audience for the
guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target
patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and
bothersome. PURPOSE: The purpose of this guideline is to provide evidence-based recommendations
for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework
to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It
will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and
specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation
and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation
and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve
symptoms and quality of life for tinnitus sufferers.
The development group made a strong recommendation that clinicians distinguish patients with bothersome
tinnitus from patients with nonbothersome tinnitus. The development group made a strong recommendation
against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus
that does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurologic abnormalities or an
asymmetric hearing loss. The panel made the following recommendations: Clinicians should (a) perform a
targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus
to identify conditions that if promptly identified and managed may relieve tinnitus; (b) obtain a prompt,
comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥ 6 months),
or associated with hearing difficulties; (c) distinguish patients with bothersome tinnitus of recent onset from
those with persistent symptoms (≥ 6 months) to prioritize intervention and facilitate discussions about natural
history and follow-up care; (d) educate patients with persistent, bothersome tinnitus about management
strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome tinnitus
associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with
persistent, bothersome tinnitus. The panel recommended against (a) antidepressants, anticonvulsants,
anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome
tinnitus; (b) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent,
bothersome tinnitus; and (c) transcranial magnetic stimulation for the routine treatment of patients with
persistent, bothersome tinnitus. The development group provided the following options: Clinicians may (a)
obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless
of laterality, duration, or perceived hearing status); and (b) recommend sound therapy to patients with
persistent, bothersome tinnitus. The development group provided no recommendation regarding the effect
of acupuncture in patients with persistent, bothersome tinnitus. © American Academy of Otolaryngology—
Head and Neck Surgery Foundation 2014.
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Clinical practice guideline: tinnitus executive summary.
Otolaryngol Head Neck Surg. 2014 Oct;151(4):533-41. doi: 10.1177/0194599814547475.
Tunkel DE1, Bauer CA2, Sun GH3, Rosenfeld RM4, Chandrasekhar SS5, Cunningham ER Jr6, Archer
SM7, Blakley BW8, Carter JM9, Granieri EC10, Henry JA11, Hollingsworth D12, Khan FA13, Mitchell
S14, Monfared A15, Newman CW16, Omole FS17, Phillips CD18, Robinson SK19, Taw MB20, Tyler RS21,
Waguespack R22, Whamond EJ23.
1
Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA
[email protected].
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has
published a supplement to this issue featuring the new Clinical Practice Guideline: Tinnitus. To assist in
implementing the guideline recommendations, this article summarizes the rationale, purpose, and key
action statements. The 13 recommendations developed address the evaluation of patients with tinnitus,
including selection and timing of diagnostic testing and specialty referral to identify potential underlying
treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary
tinnitus, with recommendations to guide the evaluation and measurement of the impact of tinnitus and to
determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers.
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Positive experiences associated with acquired hearing loss, Ménière's disease, and tinnitus: A
review.
Int J Audiol. 2014 Oct 9:1-10. [Epub ahead of print]
Manchaiah V1, Baguley DM, Pyykkö I, Kentala E, Levo H.
1
*Department of Vision and Hearing Sciences, Anglia Ruskin University , Cambridge , UK.
Objective: It is common to study and understand how various illness and disorders result in negative
consequences. However, positive experiences have been reported in a range of disabling conditions
including multiple sclerosis, heart disease, physical and sensory disabilities. This paper presents a
literature review of studies that have explored positive experiences associated with acquired hearing loss,
Ménière's disease, and tinnitus. Design: A review of the peer reviewed scientific literature. Study sample:
A comprehensive search strategy identified 15 articles after applying inclusion criteria. Results: A range
of positive experiences have been reported by patients with hearing and balance disorders and by their
significant others. Associations between demographic variables (e.g. age, gender), audiological variables
(e.g. severity of the condition, duration) and the reported positive experiences are low. In Ménière's disease,
self-reported positive experiences can predict the impact of the condition. However, this phenomenon has
not yet been demonstrated in relation to hearing loss and tinnitus. Conclusions: Positive experiences
associated with audio-vestibular disorders have been demonstrated. Further research is needed on the
long-term benefits of the encouragement of such experiences and positive attitudes in persons with hearing
loss, tinnitus, and imbalance.
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81
Systematic review of evidence on the association between personality and tinnitus.
Braz J Otorhinolaryngol. 2014 September - October;80(5):441-447. doi: 10.1016/j.bjorl.2014.05.031.
Epub 2014 Jul 4.
Mucci S1, Geocze L2, Abranches DC2, Antúnez AE3, de Oliveira Penido N4.
1
Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo
(UNIFESP-EPM), São Paulo, SP, Brazil. Electronic address: [email protected].
INTRODUCTION: The scientific literature demonstrates that personality traits are associated with the
individual's adaptation to chronic diseases, and can be an important factor in the etiology and prognosis
of physical illness. Some studies indicate that personality characteristics may influence the perception of
tinnitus. OBJECTIVE: To assess the scientific evidence of the association between tinnitus and personality.
METHODS: A systematic review of the following databases: PubMed, SciELO, LILACS, and Web of
Knowledge. Only studies of patients older than 18 years published in English, Portuguese, or Spanish
that established an association between tinnitus and personality were selected. RESULTS: Seventeen
of the 77 articles found were selected: 13 cross-sectional studies, two longitudinal studies, one validation
study, and one birth cohort study. The samples ranged from 27 to 970 patients. CONCLUSION: Some
personality traits, especially neuroticism, psychasthenia, and schizoid aspects, may be associated with
tinnitus perception and with the annoyance due to this symptom. Copyright © 2014 Associação Brasileira
de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.
Free full text.
Non-audiofacial morbidity after Gamma Knife surgery for vestibular schwannoma.
J Neurosurg. 2013 Dec;119 Suppl:E4.
Sughrue ME, Yang I, Han SJ, Aranda D, Kane AJ, Amoils M, Smith ZA, Parsa AT.
OBJECT: While many studies have been published outlining morbidity following radiosurgical treatment
of vestibular schwannomas, significant interpractitioner and institutional variability still exists. For this
reason, the authors conducted a systematic review of the literature for non-audiofacial-related morbidity
after the treatment of vestibular schwannoma with radiosurgery. METHODS: The authors performed a
comprehensive search of the English-language literature to identify studies that published outcome data of
patients undergoing radiosurgery treatment for vestibular schwannomas. In total, 254 articles were found
that described more than 50,000 patients and were analyzed for satisfying the authors' inclusion criteria.
Patients from these studies were then separated into 2 cohorts based on the marginal dose of radiation:
≤ 13 Gy and > 13 Gy. All tumors included in this study were < 25 mm in their largest diameter. RESULTS:
A total of 63 articles met the criteria of the established search protocol, which combined for a total of 5631
patients. Patients receiving > 13 Gy were significantly more likely to develop trigeminal nerve neuropathy
than those receiving < 13 Gy (p < 0.001). While we found no relationship between radiation dose and
the rate of developing hydrocephalus (0.6% for both cohorts), patients with hydrocephalus who received
doses > 13 Gy appeared to have a higher rate of symptomatic hydrocephalus requiring shunt treatment
(96% [> 13 Gy] vs 56% [≤ 13 Gy], p < 0.001). The rates of vertigo or balance disturbance (1.1% [> 13 Gy]
vs 1.8% [≤ 13 Gy], p = 0.001) and tinnitus (0.1% [> 13 Gy] vs 0.7% [≤ 13 Gy], p = 0.001) were significantly
higher in the lower dose cohort than those in the higher dose cohort. CONCLUSIONS: The results of our
review of the literature provide a systematic summary of the published rates of nonaudiofacial morbidity
following radiosurgery for vestibular schwannoma.
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Management of vestibular schwannoma: focus on vertigo.
CNS Oncol. 2013 Jan;2(1):99-104. doi: 10.2217/cns.12.30.
Dayal M1, Perez-Andujar A, Chuang C, Parsa AT, Barani IJ.
1
Department of Radiation Oncology, University of California at San Francisco, 505 Parnassus Avenue,
Room L-08 (Box 0226), San Francisco, CA 94143-0226, USA.
SUMMARY This article reviews published literature on vertigo and a 'sense of imbalance' affecting patients
who are treated with radiosurgery (RS) for vestibular schwannoma. This is a relatively understudied
complaint, along with tinnitus, in this patient population, despite its significant impact on quality of life. It is
also a symptom that is most inconsistently impacted by either RS or surgery. This article aims to highlight
the importance of this symptom in patients managed for vestibular schwannoma primarily with RS to
encourage a more systematic study of vertigo as an outcome measure and to help elucidate its potential
etiology.
Tinnitus: Facts, Theories, and Treatments.
National Research Council (US) Committee on Hearing, Bioacoustics, and Biomechanics.
Washington (DC): National Academies Press (US); 19823.
Excerpt
In this report, then, the term tinnitus is used to describe the conscious experience of a sound that originates
in the head, either acoustically or physiologically. For inclusion in the definition, no criterion of severity,
loudness, annoyance, or other characteristic of the tinnitus need be met. A distinction not made by this
definition, but which will eventually have to be drawn, is between the elementary sensory experiences of
the tinnitus sufferer and the organized perceptual experiences of the hallucinating mental patient. Copyright
© National Academy of Sciences.
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Working Group 89
Committee on Hearing, Bioacoustics, and Biomechanics
Foreword
Preface
1. Introduction
2. Facts, Theories, and Issues
3. Measurement Procedures
4. Treatments
5. Standardizing Procedures
References and Bibliography
Free full text.
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Tinnitus and its association with psychiatric disorders: systematic review.
J Laryngol Otol. 2014 Jul 17:1-5. [Epub ahead of print]
Pinto PC1, Marcelos CM1, Mezzasalma MA1, Osterne FJ1, de Melo Tavares de Lima MA2, Nardi AE1.
1
Laboratory of Panic and Respiration (Institute of Psychiatry),Brazil.
Objectives: To systematically review the literature on the occurrence of psychiatric diagnoses in a tinnitusaffected population, and correlate the presence of psychiatric disorders with tinnitus-related annoyance
and severity. Method: A systematic review of the literature published between January 2000 and December
2012 was performed using PubMed, ISI Web of Science and SciELO databases. Original articles in English
and Portuguese that focused on the diagnosis of mental disorders associated with tinnitus, especially
anxiety and depression, were identified. Results: A total of 153 articles were found and 16 were selected.
Fifteen articles showed a high prevalence of psychiatric disorders in tinnitus-affected patients, and nine
showed a high correlation between the presence of a psychiatric disorder and tinnitus-related annoyance
and severity. Conclusion: The prevalence of psychiatric disorders, especially anxiety and depression, is
high in tinnitus patients, and the presence of these disorders correlates with tinnitus-related annoyance
and severity.
Myofascial trigger point pain.
Alpha Omegan. 2013 Spring-Summer;106(1-2):14-22. Review.
Jaeger B.
Myofascial trigger point pain is an extremely prevalent cause of persistent pain disorders in all parts of
the body, not just the head, neck, and face. Features include deep aching pain in any structure, referred
from focally tender points in taut bands of skeletal muscle (the trigger points). Diagnosis depends on
accurate palpation with 2-4 kg/cm2 of pressure for 10 to 20 seconds over the suspected trigger point to
allow the referred pain pattern to develop. In the head and neck region, cervical muscle trigger points (key
trigger points) often incite and perpetuate trigger points (satellite trigger points) and referred pain from
masticatory muscles. Management requires identification and control of as many perpetuating factors as
possible (posture, body mechanics, psychological stress or depression, poor sleep or nutrition). Trigger
point therapies such as spray and stretch or trigger point injections are best used as adjunctive therapy.
Electrical stimulation and tinnitus: neuroplasticity, neuromodulation, neuroprotection.
Int Tinnitus J. 2013;18(1):75-95. doi: 10.5935/0946-5448.20130010.
Abraham S, Barbara G, Arnold S.
Neuroplasticity (NPL), neuromodulation (NM), and neuroprotection (NPT) are ongoing biophysiological
processes that are linked together in sensory systems, the goal being the maintenance of a homeostasis
of normal sensory function in the central nervous system. It is hypothesized that when the balance between
excitatory - inhibitory action is broken in sensory systems, predominantly due to neuromodulatory activity
with reduced induced inhibition and excitation predominates, sensory circuits become plastic with adaptation
at synaptic levels to environmental inputs(1). Tinnitus an aberrant auditory sensation, for all clinical types,
is clinically considered to reflect a failure of NPL, NM, and NPT to maintain normal auditory function at
synaptic levels in sensory cortex and projected to downstream levels in the central auditory system in
brain and sensorineural elements in ear. Clinically, the tinnitus sensation becomes behaviorally manifest
with varying degrees of annoyance, reflecting a principle of sensory physiology that each sensation has
components, i.e. sensory, affect/behavior, psychomotor and memory. Modalities of tinnitus therapies, eg
instrumentation, pharmacology, surgery, target a particular component of tinnitus, with resultant activation
of neuromodulators at multiple neuromodulatory centers in brain and ear. Effective neuromodulation at
sensory neuronal synaptic levels results in NPL in sensory cortex, NPT and tinnitus relief. Functional
brain imaging, metabolic (PET brain) and electrophysiology quantitative electroencephalography (QEEG)
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data in a cochlear implant soft failure patient demonstrates what is clinically considered to reflect NPL,
NM, NPT. The reader is provided with a rationale for tinnitus diagnosis and treatment, with a focus on ES,
reflecting the biology underlying NPL, NM, NPT.
A Brain Centred View of Psychiatric Comorbidity in Tinnitus: From Otology to Hodology.
Neural Plast. 2014;2014:817852. Epub 2014 Jun 11. Review.
Salviati M1, Bersani FS2, Valeriani G2, Minichino A2, Panico R2, Romano GF2, Mazzei F3, Testugini
V3, Altissimi G3, Cianfrone G3.
1
Department of Sensory Organs, Sapienza University of Rome, Rome, Italy ; Department of Neurology
and Psychiatry, Sapienza University of Rome, Rome, Italy.
Introduction. Comorbid psychiatric disorders are frequent among patients affected by tinnitus. There are
mutual clinical influences between tinnitus and psychiatric disorders, as well as neurobiological relations
based on partially overlapping hodological and neuroplastic phenomena. The aim of the present paper is
to review the evidence of alterations in brain networks underlying tinnitus physiopathology and to discuss
them in light of the current knowledge of the neurobiology of psychiatric disorders. Methods. Relevant
literature was identified through a search on Medline and PubMed; search terms included tinnitus,
brain, plasticity, cortex, network, and pathways. Results. Tinnitus phenomenon results from systemicneurootological triggers followed by neuronal remapping within several auditory and nonauditory pathways.
Plastic reorganization and white matter alterations within limbic system, arcuate fasciculus, insula, salience
network, dorsolateral prefrontal cortex, auditory pathways, ffrontocortical, and thalamocortical networks
are discussed. Discussion. Several overlapping brain network alterations do exist between tinnitus
and psychiatric disorders. Tinnitus, initially related to a clinicoanatomical approach based on a cortical
localizationism, could be better explained by an holistic or associationist approach considering psychic
functions and tinnitus as emergent properties of partially overlapping large-scale neural networks. Free
PMC Article.
Intracranial hypotension and hypertension in children and adolescents.
Curr Pain Headache Rep. 2014 Jul;18(7):430. doi: 10.1007/s11916-014-0430-7.
Ozge A1, Bolay H.
1
Department of Neurology, Mersin University School of Medicine, 33079, Mersin, Turkey, aynurozge@
gmail.com.
The specific aim of this review is to report the features of intracranial pressure changes [spontaneous
intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH)] in children and adolescents,
with emphasis on the presentation, diagnosis, and treatment modalities. Headache associated with
intracranial pressure changes are relatively rare and less known in children and adolescents. SIH
is a specific syndrome involving reduced intracranial pressure with orthostatic headache, frequently
encountered connective tissue disorders, and a good prognosis with medical management, initial epidural
blood patching, and sometimes further interventions may be required. IIH is an uncommon condition in
children and different from the disease in adults, not only with respect to clinical features (likely to present
with strabismus and stiff neck rather than headache or pulsatile tinnitus) but also different in outcome.
Consequently, specific ICP changes of pediatric ages required specific attention both of exact diagnosis
and entire management.
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XIIIOthers
Development of a progressive audiologic tinnitus management program for Veterans with
tinnitus.
J Rehabil Res Dev. 2014 Jul;51(4):609-22. doi: 10.1682/JRRD.2013.08.0189.
Myers PJ1, Griest S, Kaelin C, Legro MW, Schmidt CJ, Zaugg TL, Henry JA.
1
James A. Haley Veterans' Hospital, Audiology Clinic, 14020 N 46th St, Tampa, FL 33613. paula.
[email protected].
Tinnitus is the most prevalent service-connected disability awarded to Veterans. However, clinical protocols
for management of tinnitus have been inconsistent across Department of Veterans Affairs (VA) medical
centers. A study was funded to develop and pilot test a protocol to provide tinnitus services consistently
across VA audiology clinics. Drawing on a series of prior VA and external research projects, a clinical model
was formulated, supporting materials in multimedia were developed, and a pilot study was conducted. Five
hierarchical levels of care were defined and labeled the Progressive Audiologic Tinnitus Management
(PATM) model. The model facilitates access to medical services for tinnitus and includes detailed protocols
for evaluation, education, and counseling of patients. Patients at each level of care have the option to
"progress" to the next level of PATM if further services are required. Clinical procedures were defined for
each level and materials were produced for audiologists and patients. The PATM model was then piloted
with clinical patients at the James A. Haley Veterans' Hospital (JAHVH) in Tampa, Florida. Throughout the
pilot study, feedback from patients and clinicians was carefully noted. Training materials for audiologists,
incorporation of the protocol into clinic activities, and patient outcomes were evaluated. The model was
implemented within the JAHVH Audiology Clinic and to assist Veterans with tinnitus management. The
most notable finding was how little tinnitus-specific intervention was required for the majority of patients.
This finding supports a clinical model that offers stepped-care ("progressive") levels of care until tinnitus
management is achieved by the patient. Free Article.
Hyperbaric oxygen therapy for carbon monoxide poisoning.
Undersea Hyperb Med. 2014 Jul-Aug;41(4):339-54.
Weaver LK.
Despite established exposure limits and safety standards, and the availability of carbon monoxide (CO)
alarms, each year 50,000 people in the United States visit emergency departments for CO poisoning.
Carbon monoxide poisoning can occur from brief exposures to high levels of CO, or from longer exposures
to lower levels. Common symptoms include headaches, nausea and vomiting, dizziness, general malaise,
and altered mental status. Some patients may have chest pain, shortness of breath and myocardial
ischemia, and may require mechanical ventilation and treatment of shock. Individuals poisoned by CO
often go on to develop neurological problems, including cognitive sequelae, anxiety and depression,
persistent headaches, dizziness, sleep problems, motor weakness, vestibular and balance problems,
gaze abnormalities, peripheral neuropathies, hearing loss, tinnitus and Parkinsonian-like syndrome. While
breathing oxygen hastens the removal of carboxyhemoglobin (COHb), hyperbaric oxygen (HBO2) hastens
COHb elimination and favorably modulates inflammatory processes instigated by CO poisoning, an effect
not observed with breathing normobaric oxygen. Hyperbaric oxygen improves mitochondrial function,
inhibits lipid peroxidation transiently, impairs leukocyte adhesion to injured microvasculature, and reduces
brain inflammation caused by the CO-induced adduct formation of myelin basic protein. Based upon three
supportive randomized clinical trials in humans and considerable evidence from animal studies, HBO2
should be considered for all cases of acute symptomatic CO poisoning. Hyperbaric oxygen is indicated for
CO poisoning complicated by cyanide poisoning, often concomitantly with smoke inhalation.
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86
A United Kingdom Survey of Concerns, Needs, and Priorities Reported by Patients Diagnosed
With Acoustic Neuroma.
Otol Neurotol. 2014 Aug 12. [Epub ahead of print]
Leong SC1, Lesser TH.
1
The Skull Base Unit, Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital
Aintree, Liverpool, United Kingdom.
INTRODUCTION: The Patient Concerns Inventory-Acoustic Neuroma (PCI-AN) was developed to explore
specifically the concerns that patients would like to discuss during their clinic consultation. The PCI covers a
range of issues including hearing, intimacy, fatigue, financial/benefits, relationships, regret, and support for
family. It also lists multidisciplinary team (MDT) members that patients would like to see or be referred on to.
METHOD: The PCI-AN was emailed to members of the British Acoustic Neuroma Association. RESULTS:
A total of 465 complete (54.5%) responses were received. There were 284 female and 181 male subjects.
Overall, the most common treatment modality was surgical excision (47%). A quarter of the study cohort
had stereotactic radiosurgery, whereas 23% were conservatively managed with interval MRI scanning.
The remaining 5% had both surgery and stereotactic radiosurgery. From the 55-item PCI-AN, the most
commonly selected issues that patients wanted to talk about were related to the physical and functional
well-being and treatment received. Tinnitus was the most frequently selected issue (46%), followed by
fatigue/tiredness (43%), dizziness (33%), further investigation (39%), acoustic neuroma treatment (38%),
and energy levels (32%). More than a quarter of the respondents had fears of their acoustic neuroma
recurring (29%), had concerns about their facial appearance/ palsy (29%), or suffered pain in the head
and neck region (26%). The 3 health-care professionals patients most wanted to talk with either in clinic
or by referral were as follows: ENT/neurosurgeon (39%), vestibular (balance) physiotherapist (39%), and
audiologist (39%). Although it was unknown how many respondents had facial palsy, 21% wanted to see
a facial palsy physiotherapist, and another 10% sought referral to a plastic surgeon. CONCLUSION: The
PCI-AN has shed light on an interesting array of issues, which may be overlooked by clinicians in busy
skull base clinic. The PCI-AN allows for patient-directed consultation and ultimately empowers them to be
actively involved in the management of their health.
E-021 de novo, progressive, multiple, and recurrent intracranial dural arteriovenous fistulas:
characteristics and outcomes.
J Neurointerv Surg. 2014 Jul;6 Suppl 1:A47. doi: 10.1136/neurintsurg-2014-011343.88.
Hetts S1, Tsai T2, Cooke D1, Amans M1, Narvid J1, Dowd C1, Higashida R1, Halbach V1.
1
Radiology, UCSF, San Francisco, CA, USA.
PURPOSE: Although many intracranial dural arteriovenous fistulas (DAVFs) are straightforward to treat,
de novo and rapidly progressive ("runaway" or "malignant") DAVFs are more complex, often requiring
multiple treatment sessions with suboptimal results. As these are rare entities, we sought to review our
experience in the treatment of de novo and progressive DAVFs in order to better understand predictors
of disease progression. MATERIALS AND METHODS: Under an IRB-approved protocol, 29 patients with
multiple, recurrent, de novo, or progressive DAVFs were identified from our hospital's neurointerventional
radiology database of 578 patients treated for intracranial DAVFs between 1986 and 2012. One patient
with acute traumatic carotid cavernous fistulas was excluded. Patient demographics, clinical presentation,
lesion angioarchitecture, treatment approaches, and clinical outcomes were categorized and assessed.
Categorical variables were analyzed with odds ratios and 2-sided Fisher's exact tests. RESULTS: We
compared 28 patients with multiple, recurrent, de novo, or progressive DAVFs to 550 DAVF patients
without such features. Whereas 18/28 (64%) of patients with multiple, recurrent, de novo, or progressive
DAVFs were female, 283/550 (51%) without such features were female (OR 1.7, 95% CI: 0.73-4.2, p =
0.24). Mean age at presentation in the multiple, recurrent, de novo, or progressive DAVF group was 42 ±
23 years (range 2 months to 77 years) compared to 52 ± 20 years (range 1 day to 87 years) for the entire
DAVF cohort. The most common presenting signs and symptoms the 28 patients treated for multiple,
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recurrent, de novo, or progressive DAVFs were headache (50%), cranial neuropathy (46%), tinnitus
(36%), visual changes (32%), and intracranial haemorrhage (29%). 59 DAVFs were identified in these
28 patients. Location of fistulas included transverse/sigmoid sinus in 18 (64%), superior sagittal sinus in
8 (29%), torcula in 6 (21%), cavernous sinus in 5 (18%), marginal sinus in 5 (18%), and petrosal sinus
in 2 patients (7%). Eight patients had DAVFs in other intracranial locations. Number of interventions per
patient ranged from 2 to 19 (mean 5.5, median 4.5). All 28 patients were treated endovascularly; 15 (54%)
were also treated with surgery. Embolic agents included coils in 25 patients (89%), ethanol in 23 (82%),
polyvinyl alcohol in 21 (75%), N-butyl cyanoacrylate in 10 (36%), and Onyx in 5 (18%). 153 transarterial,
transvenous, and surgical interventions were performed. The time between diagnosis of DAVF and last
imaging ranged from 10 days to 21 years. At last follow up, 10 patients (36%) had no symptoms or residual
DAVFs, 15 patients (54%) had neurological symptoms and/or residual DAVFs, and 3 patients (11%) had
died due to intracranial haemorrhage or refractory elevations in intracranial pressure related to intracranial
venous hypertension. A total of 19/28 patients had de novo or rapidly progressive DAVFs (68%) with all
3 deaths occurring in that group. No deaths were recorded in the other 9 patients with only recurrent or
multiple DAVFs. CONCLUSION: De novo or rapidly progressive DAVFs constituted 3% of all intracranial
DAVF cases treated at our institution. Among these patients, despite aggressive endovascular and surgical
care, a minority followed a malignant clinical course. DISCLOSURES: S. Hetts: 1; C; NIH-NIBIB, NIH-NCI,
Siemens, Covidien. 2; C; Stryker, Penumbra, Medina Medical, Silk Road Medical. 4; C; Medina Medical,
ChemoFilter, DriftCoast. T. Tsai: None. D. Cooke: 1; C; Siemens. 4; C; Viket. M. Amans: None. J. Narvid:
None. C. Dowd: None. R. Higashida: None. V. Halbach: None. © 2014, Published by the BMJ Publishing
Group Limited. For permission to use (where not already granted under a licence) please go to http://
group.bmj.com/group/rights-licensing/permissions.
Physical therapy treatment in patients suffering from cervicogenic somatic tinnitus: study
protocol for a randomized controlled trial.
Trials. 2014 Jul 22;15(1):297. [Epub ahead of print]
Michiels S, De Hertogh W, Truijen S, Van de Heyning P.
BACKGROUND: Tinnitus occurs in a large part of the general population with prevalences ranging from
10% to 15% in an adult population. One subtype is cervicogenic somatic tinnitus, arising from cervical
spine dysfunctions, justifying cervical spine assessment and treatment. This study aims to investigate the
effect of a standardized physical therapy treatment, directed to the cervical spine, on tinnitus. Additionally,
a second aim is to identify a subgroup within the tinnitus population that benefits from physical therapy
treatment.Methods and design: This study is designed as a randomized controlled trial with delayed
treatment design. Patients with severe subjective tinnitus (Tinnitus Functional Index (TFI) between 25 and
90 points), in combination with neck complaints (Neck Bournemouth Questionnaire (NBQ) >14 points) will
be recruited from the University Hospital of Antwerp.Patients suffering from tinnitus with clear otological
etiologies, severe depression, traumatic cervical spine injury, tumors, cervical spine surgery, or conditions
in which physical therapy is contra-indicated, will be excluded.After screening for eligibility, baseline data
such as TFI, NBQ, and a set of cervical biomechanical and sensorimotor tests will be collected.Patients
are randomized in an immediate therapy group and in a group with a delayed start of therapy by 6 weeks.
Patients will receive physical therapy with a maximum of 12 sessions of 30 min for a 6-week program. Data
from the TFI and NBQ will be collected at baseline (week 0), at the start of therapy (weeks 0 or 6), at the
end of therapy (weeks 6 or 12), 6 weeks after therapy (weeks 12 or 18), and 3 months after therapy (weeks
18 or 24). Secondary outcome measures will be collected at baseline and 6 weeks after the therapy
(weeks 12 or 18), as the maximal therapy effect on the cervical spine dysfunctions is expected at that
moment. DISCUSSION: This study is the first to investigate the effect of a standardized physical therapy
treatment protocol on somatic tinnitus with a prospective comparative delayed design and with blinded
evaluator for baseline, end of therapy, and 6 and 12 weeks after therapy.Trial registration: 12 September
2013, ClinicalTrials.gov: NCT02016313. Free full text.
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XIV Case Reports
Long-term follow up of sudden sensorineural hearing loss patients treated with intratympanic
steroids: audiological and quality of life evaluation.
J Laryngol Otol. 2014 Aug;128(8):669-73. doi: 10.1017/S0022215114001595.
Dallan I1, Fortunato S1, Casani AP1, Bernardini E1, Sellari-Franceschini S1, Berrettini S2, Nacci A2.
1
First ENT Unit,University of Pisa,Italy.
OBJECTIVE: To evaluate the long-term stability of intratympanic steroids and investigate the 'real' impact of
sudden sensorineural hearing loss on patients. METHOD: A total of 14 patients treated with intratympanic
steroids were evaluated by audiometric and vestibular examinations. The modified Glasgow Benefit
Inventory was used to evaluate quality of life changes after intratympanic steroid treatment. RESULTS:
There was no significant difference between pure tone average post-intratympanic steroids and at follow
up. The general Glasgow Benefit Inventory score was not significantly associated with the presence of
tinnitus or dizziness, or with patient age. The change in pure tone average after intratympanic steroid
treatment did not correlate with social or physical scores, but correlated strongly with the general Glasgow
Benefit Inventory score (p = 0.0023). Intratympanic steroid administration led to a stable improvement in
hearing. Quality of life assessment showed that patients can feel satisfaction regardless of the hearing
outcome. Patients who regained a social hearing level expressed greater satisfaction than patients
without serviceable hearing. Overall, quality of life improvement was not related to hearing improvement.
CONCLUSION: Sudden sensorineural hearing loss is devastating. Considering the audiological effects
alone ignores the 'human' perspective. Audiological success can correlate with poor quality of life outcome.
Persistent stapedial artery with stapes ankylosis.
Auris Nasus Larynx. 2014 Sep 3. pii: S0385-8146(14)00114-X. doi: 10.1016/j.anl.2014.05.024. [Epub
ahead of print]
Sugimoto H1, Ito M2, Hatano M1, Yoshizaki T1.
1
Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of
Medical Science, Kanazawa, Japan.
The persistent stapedial artery (PSA) is a very rare, congenital, vascular anomaly. It presents as a pulsatile
middle ear mass and sometimes causes conductive hearing loss. The diagnosis of the presence of a PSA
is always accidental, because it is so rare and difficult to predict. CT findings include the absence of the
foramen spinosum and a soft-tissue prominence in the region of the tympanic segment of the facial nerve.
The risks of surgery include facial palsy, hemiplegia caused by coagulation of the PSA, and bleeding
due to injury of the carotid artery during surgery in cases of aberrant internal carotid. In this article we
report a case of PSA with stapes ankylosis for which we performed malleus-stapedotomy using a Teflon
wire piston. We did not coagulate the PSA. Nevertheless the PSA attached to the prosthesis, the patient
presented significant improvement in hearing level and had no complaint of pulsating tinnitus. Thus, we
have shown that attachment of the prosthesis to the PSA does not necessarily disturb improvement of
hearing level after malleus-stapedotomy for otosclerosis with PSA. Based on our experience, many cases
can be treated by stapedotomy using a prosthesis and without coagulating the PSA. Copyright © 2014
Elsevier Ireland Ltd. All rights reserved.
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89
Audio-vestibular signs and symptoms in Chiari malformation type i. Case series and literature
review.
Acta Otorrinolaringol Esp. 2014 Sep 4. pii: S0001-6519(14)00129-0. doi: 10.1016/j.otorri.2014.05.002.
[Epub ahead of print] English, Spanish.
Guerra Jiménez G1, Mazón Gutiérrez A2, Marco de Lucas E3, Valle San Román N3, Martín Laez R4,
Morales Angulo C2.
1
Servicio de ORL, Complejo Hospitalario Insular Materno Infantil, Las Palmas, Gran Canaria, España.
Electronic address: [email protected].
INTRODUCTION: Chiari malformation is an alteration of the base of the skull with herniation through the
foramen magnum of the brain stem and cerebellum. Although the most common presentation is occipital
headache, the association of audio-vestibular symptoms is not rare. The aim of our study was to describe
audio-vestibular signs and symptoms in Chiari malformation type i (CM-I). MATERIALS AND METHODS:
We performed a retrospective observational study of patients referred to our unit during the last 5 years.
We also carried out a literature review of audio-vestibular signs and symptoms in this disease. RESULTS:
There were 9 patients (2 males and 7 females), with an average age of 42.8 years. Five patients presented
a Ménière-like syndrome; 2 cases, a recurrent vertigo with peripheral features; one patient showed a
sudden hearing loss; and one case suffered a sensorineural hearing loss with early childhood onset. The
most common audio-vestibular symptom indicated in the literature in patients with CM-I is unsteadiness
(49%), followed by dizziness (18%), nystagmus (15%) and hearing loss (15%). Nystagmus is frequently
horizontal (74%) or down-beating (18%). Other audio-vestibular signs and symptoms are tinnitus (11%),
aural fullness (10%) and hyperacusis (1%). Occipital headache that increases with Valsalva manoeuvres
and hand paresthesias are very suggestive symptoms. CONCLUSIONS: The appearance of audiovestibular manifestations in CM-I makes it common to refer these patients to neurotologists. Unsteadiness,
vertiginous syndromes and sensorineural hearing loss are frequent. Nystagmus, especially horizontal and
down-beating, is not rare. It is important for neurotologists to familiarise themselves with CM-I symptoms
to be able to consider it in differential diagnosis. Copyright © 2014 Elsevier España, S.L.U. y Sociedad
Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved. Free full text.
Paraganglioma of the facial canal: A report of 2 cases and literature review.
Am J Otolaryngol. 2014 Aug 20. pii: S0196-0709(14)00190-2. doi: 10.1016/j.amjoto.2014.08.006. [Epub
ahead of print] Review.
Frisch CD1, Driscoll CL2, Neff BA3.
1
The Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, MN. Electronic address:
[email protected].
PURPOSE: METHODS: Retrospective chart review at single tertiary academic referral center. Literature
review using the PubMed electronic database. RESULTS: There are 12 cases of histologically-proven
paraganglioma of the facial canal published in the English literature. We present two additional cases that
were encountered at our institution. We also include three additional cases from a separate institution that
have been accepted for publication in a different journal. We found that patients most commonly present
with slowly progressive facial paralysis; though paralysis can be acute. The second most common symptom
was pulsatile tinnitus, which was the only symptom in one patient. Radiographically, tumor location was in
the descending segment in all but one case. The mass was often centered directly over the stylomastoid
foramen, mimicking a parotid mass. We found circumferential widening of the proximal fallopian canal,
and a "moth-eaten" bony destruction distally on CT imaging in several patients. In patients with poor facial
nerve function (HB IV-VI), complete tumor removal with nerve sacrifice followed by great auricular or sural
nerve grafting was performed with acceptable facial function results. CONCLUSIONS: Paraganglioma of
the facial canal remains a rare etiology of progressive facial paralysis. The lesions are found in the distal
descending segment, or centered over the stylomastoid foramen 94% of the time. In patients with poor
facial function, surgical removal with nerve sacrifice, followed by great auricular or sural nerve grafting,
90
yields an acceptable functional result. Published by Elsevier Inc.
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Single-unit hyperactivity and bursting in the auditory thalamus of awake rats directly correlates
with behavioral evidence of tinnitus.
J Physiol. 2014 Sep 12. [Epub ahead of print]
Kalappa BI1, Brozoski TJ2, Turner JG3, Caspary DM4.
1
Department of Pharmacology, Southern Illinois University School of Medicine, Springfield, IL, USA.
Tinnitus is an auditory percept without an environmental acoustic correlate. Contemporary tinnitus models
hypothesize tinnitus to be a consequence of maladaptive plasticity-induced disturbance of excitationinhibition homeostasis, possibly convergent on medial geniculate body (MGB, auditory thalamus) and
related neuronal networks. The MGB is an obligate acoustic relay in a unique position to gate auditory
signals to higher-order auditory and limbic centers. Tinnitus-related maladaptive plastic changes of MGBrelated neuronal networks may affect the gating function of MGB and enhance gain in central auditory
and non-auditory neuronal networks resulting in tinnitus. The present study examined the discharge
properties of MGB neurons in the sound-exposure gap inhibition animal model of tinnitus. MGB single-unit
responses were obtained from awake unexposed controls and sound-exposed adult rats with behavioral
evidence of tinnitus. MGB units in animals with tinnitus exhibited enhanced spontaneous firing, altered
burst properties and increased rate-level function slope when driven by broadband noise and tones at
the unit's characteristic frequency. Elevated patterns of neuronal activity and altered bursting showed
a significant positive correlation with animals' tinnitus scores. Altered activity of MGB neurons revealed
additional features of auditory system plasticity associated with tinnitus, which may provide a testable
assay for future therapeutic and diagnostic development. This article is protected by copyright. All rights
reserved.
First report on ototoxicity of meglumine antimoniate.
Rev Inst Med Trop Sao Paulo. 2014 Sep;56(5):439-42.
Valete-Rosalino CM1, Araujo-Melo MH1, Bezerra DC2, Barcelos RO2, Melo-Ferreira Vd1, Torraca TS1,
Martins AC1, Moreira JS1, Vargas MC1, Braga FP1, Salgueiro Mde M1, Saheki MN1, Schubach AO1.
1
Fundação Oswaldo Cruz (IPEC-FIOCRUZ), Rio de Janeiro, RJ, Brazil.
INTRODUCTION: Pentavalent antimonials are the first drug of choice in the treatment of tegumentary
leishmaniasis. Data on ototoxicity related with such drugs is scarcely available in literature, leading us to
develop a study on cochleovestibular functions. CASE REPORT: A case of a tegumentary leishmaniasis
patient, a 78-year-old man who presented a substantial increase in auditory threshold with tinnitus and
severe rotatory dizziness during the treatment with meglumine antimoniate, is reported. These symptoms
worsened in two weeks after treatment was interrupted. CONCLUSION: Dizziness and tinnitus had already
been related to meglumine antimoniate. However, this is the first well documented case of cochlearvestibular toxicity related to meglumine antimoniate. Free full text.
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Acupuncture in treating sudden sensorineural hearing loss: a report of 2 cases.
Forsch Komplementmed. 2014;21(4):246-9. doi: 10.1159/000365982. Epub 2014 Aug 15.
Huang N1, Li C.
1
Department of Acupuncture, Beijing Shijitan Hospital, Yang Fang Dian, Haidian District, Beijing, China.
Background: Two cases of sudden sensorineural hearing loss (SSHL) in left ear diagnosed by an ear,
nose, and throat specialist are presented. CASE REPORT: The first patient was a 22-year-old male college
student with moderately severe hearing loss, tinnitus, and a feeling of fullness in the ear for 5 days. The
other patient was a 48-year-old male pilot with severe hearing loss, tinnitus, and fullness in the ear for 7
days. Both patients did not respond to medical treatment, and the hearing loss became even worse. The
patients were then treated with acupuncture 5 and 7 days, respectively, after hearing loss had developed.
Electroacupuncture was applied to ear and neck once per day for both patients. Results : Fullness in
ear disappeared during the first treatment in both cases, and the first patient also felt great improvement
in hearing during the first treatment. After 10 treatments, the first patient had recovered. In the other
patient, hearing had greatly improved after 19 treatments. Conclusion : Acupuncture may be worth trying
in patients with SSHL who do not respond to routine medical treatment. © 2014 S. Karger GmbH, Freiburg.
Unusual presentation of glomus tympanicum tumour: New bone formation in the middle ear.
World J Clin Cases. 2014 Sep 16;2(9):463-5. doi: 10.12998/wjcc.v2.i9.463.
Kumar G, Andreou Z, Virk JS, Owa A.
Gaurav Kumar, Zenon Andreou, Jagdeep Singh Virk, Anthony Owa, ENT Department, Queen's Hospital,
Romford, Essex RM7 0AG, United Kingdom.
The objective of this study is to increase awareness of the rare presentation, diagnostic difficulties
and management of glomus tympanicum of the middle ear. A 49 years old male, with a background of
hypertension and epilepsy, presented with a two month history of left sided conductive hearing loss,
pulsatile tinnitus and headache. Clinically and radiologically a diagnosis of glomus tympanicum was made.
Intraoperatively, extensive osteogenesis of the middle ear resulting in ossicular fixation and erosion was
found. This patient required a two stage operation for full clearance of disease. A stapedectomy drill was
used to drill off the bony overgrowth surrounding the ossicles resulting in improved hearing thresholds and
full clearance of the disease at two year follow up. Glomus tympanicum can result in new bone formation in
the middle ear with resultant ossicular fixation and conductive hearing loss. This can be effectively treated
surgically with restoration of hearing. Free PMC Article.
Headache as an initial manifestation of Vogt-Koyanagi-Harada disease.
Saudi J Ophthalmol. 2014 Jul;28(3):239-42. doi: 10.1016/j.sjopt.2013.10.003. Epub 2013 Oct 14.
Khairallah AS.
Department of Ophthalmology, King Fahad Hospital of the University, P.O. Box 40194, Alkhobar 31952,
Saudi Arabia.
A 29 year-old healthy Saudi female presented with a 1 week history of headache followed by decreased
vision in both eyes. Biomicroscopy revealed anterior uveitis without hypopyon, posterior synechia or
keratic precipitate. Fundus examinations were remarkable for serous retinal detachment and hyperemic
discs. Fundus fluorescein angiogram showed a hot disc with multiple pinpoint leakage in both eyes. CT
scan and MRI were normal, all uveitis workups were negative. Five months later, the patient presented
with complete criteria of Vogt-Koyanagi-Harada disease including a 2 weeks history of tinnitus, alopecia,
poliosis and vitiligo. Headache alone followed by decreased vision before the onset of neurological and
auditory symptoms can be an initial presentation of VKH disease. VKH should be considered in the
differential diagnosis of atypical presentation of symptoms. Free PMC Article.
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Streptococcus suis Meningoencephalitis with Seizure from Raw Pork Ingestion: A Case Report.
Hawaii J Med Public Health. 2014 Sep;73(9 Suppl 1):13-4.
Wongjittraporn S, Teerasukjinda O, Yee M, Chung HH.
John A. Burns School of Medicine, Univeristy of Hawai'i, Honolulu, HI.
BACKGROUND: Streptococcus suis meningoencephalitis is a rare but increasingly important condition.
Good history taking will give clues to the diagnosis. This is the fourth case report in the United States. CASE:
A 52-year-old Filipino man who recently returned from a trip to the Philippines was admitted with classic
symptoms of bacterial meningitis. His cerebrospinal fluid culture grew Streptococcus suis. His clinical
course was complicated by seizures, hearing loss, and permanent tinnitus. CONCLUSION: Clinicians
should be aware of this emerging disease especially in patients with recent travel history to endemic areas.
Early recognition and appropriate management could potentially prevent complications. Free PMC Article.
Red ear syndrome precipitated by a dietary trigger: a case report.
J Med Case Rep. 2014 Oct 10;8(1):338. [Epub ahead of print]
Chan CC, Ghosh S.
INTRODUCTION: Red ear syndrome is a rare condition characterized by episodic attacks of erythema
of the ear accompanied by burning ear pain. Symptoms are brought on by touch, exertion, heat or cold,
stress, neck movements and washing or brushing of hair. Diagnosis and treatment of this condition are
challenging. The case we report here involves a woman whose symptoms were brought on by a dietary
trigger: orange juice as well as stress, causing significant physical and psychological morbidity. Avoidance
of triggers resulted in symptomatic improvement. CASE PRESENTATION: A 22-year-old Caucasian
woman who was a student presented twice to our department with evolving symptoms, the first time with
hyperacusis (abnormal sound sensitivity arising from within the auditory system to sounds of moderate
volume), intermittent right tinnitus and subjective hearing difficulties. She presented five years later with
highly distressing episodes of erythematous ears, which were associated with burning pain around the ear
and temporal areas, and intolerance to noise. After keeping a symptom diary, she identified orange juice
and stress as triggers of her symptoms. No local head and neck pathology was present. Investigations
and imaging were negative. Avoidance of triggers led to great symptomatic improvement. To the best of
our knowledge, dietary triggers have not previously been reported as a trigger for this syndrome. This
case shows a direct temporal link to a dietary trigger and supports a primary pathogenesis. Recognition
and management of primary headache disorder and simple dietary and lifestyle changes brought about
symptomatic relief. CONCLUSION: Red ear syndrome is a little-known clinical syndrome of unknown
etiology and management. To the best of our knowledge, our present case report is the first to describe
primary red ear syndrome triggered by orange juice. Clinical benefit derived from avoidance of this trigger,
which is already known to precipitate migraines, gives some insight into the pathogenesis of red ear
syndrome. Free Article.
Investigating Long-Term Effects of Cochlear Implantation in Single-Sided Deafness: A Best
Practice Model for Longitudinal Assessment of Spatial Hearing Abilities and Tinnitus Handicap.
Otol Neurotol. 2014 Aug 25. [Epub ahead of print]
Gartrell BC1, Jones HG, Kan A, Buhr-Lawler M, Gubbels SP, Litovsky RY.
1
*Division of Otolaryngology, Department of Surgery; †Waisman Center and ‡Department of
Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin,
U.S.A.
OBJECTIVES: To evaluate methods for measuring long-term benefits of cochlear implantation in a patient
with single-sided deafness (SSD) with respect to spatial hearing and to document improved quality of life
because of reduced tinnitus. PATIENT: A single adult male with profound right-sided sensorineural hearing
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loss and normal hearing in the left ear who underwent right-sided cochlear implantation. METHODS: The
subject was evaluated at 6, 9, 12, and 18 months after implantation on speech intelligibility with specific
target-masker configurations, sound localization accuracy, audiologic performance, and tinnitus handicap.
Testing conditions involved the acoustic (NH) ear only, the cochlear implant (CI) ear (acoustic ear plugged),
and the bilateral condition (CI+NH). Measures of spatial hearing included speech intelligibility improvement
because of spatial release from masking (SRM) and sound localization. In addition, traditional measures
known as "head shadow," "binaural squelch," and "binaural summation" were evaluated. RESULTS: The
best indicator for improved speech intelligibility was SRM, in which both ears are activated, but the relative
locations of target and masker(s) are manipulated. Measures that compare performance with a single ear
to performance using bilateral auditory input indicated evidence of the ability to integrate inputs across the
ears, possibly reflecting early binaural processing, with 12 months of bilateral input. Sound localization
accuracy improved with addition of the implant, and a large improvement with respect to tinnitus handicap
was observed. CONCLUSION: Cochlear implantation resulted in improved sound localization accuracy
when compared with performance using only the NH ear, and reduced tinnitus handicap was observed
with use of the implant. The use of SRM addresses some of the current limitations of traditional measures
of spatial and binaural hearing, as spatial cues related to target and maskers are manipulated, rather than
the ear(s) tested. Sound testing methods and calculations described here are therefore recommended for
assessing performance of a larger sample size of individuals with SSD who receive a CI.
An unusual cause of peroneal neuropathy.
Semin Pediatr Neurol. 2014 Jun;21(2):77-81. doi: 10.1016/j.spen.2014.04.006. Epub 2014 Apr 13.
Ananth AL1, Yang Y2, Lalani SR2, Lotze TB3.
1
Department of Neurology, Baylor College of Medicine, Houston, TX. Electronic address: ananth@bcm.
edu.
We discuss the case of a teenage girl who presented with neurologic symptoms suggestive of a peripheral
neuropathy, before the development of a central arteriovenous fistula. Electromyography and nerve
conduction studies indicated peroneal motor neuropathy, but her comprehensive genetic study results were
negative for common Charcot-Marie-Tooth mutations. After 2 years of stable symptoms, she presented
with unilateral throbbing headache and tinnitus. Magnetic resonance angiography revealed a carotid
cavernous fistula, which was confirmed with conventional angiography. A successful coil embolization of
the fistula was performed. Whole exome sequencing demonstrated a de novo heterozygous c.3158G>A
(p.G1056D) mutation in the COL31A gene, consistent with Ehlers-Danlos type IV. To our knowledge, this
is the first reported case of isolated peroneal motor neuropathy in a patient with Ehlers-Danlos type IV.
This case highlights the utility of whole exome sequencing in the diagnosis of patients with neurologic
symptoms that do not fit a clear phenotype. Copyright © 2014 Elsevier Inc. All rights reserved.
A Lightning Strike Causing a Cholesteatoma: A Unique Form of Otologic Blast Injury.
Otol Neurotol. 2014 Aug 8. [Epub ahead of print]
Scalzitti NJ1, Pfannenstiel TJ.
1
*Otolaryngology, and †Otology and Neurotology, Brooke Army Medical Center, San Antonio, Texas,
U.S.A.
OBJECTIVE: We present a case of a middle-aged male struck by lightning while walking in a parking lot.
Assessment of the patient's injuries demonstrated common sequelae of an otologic blast injury. Review
of this case should prepare the otolaryngologist to identify and manage otologic blast injuries regardless
of their etiology. METHODS: Case study and literature review CASE REPORT: The patient presented to a
level 1 trauma and burn center with a ruptured tympanic membrane, otalgia, mixed hearing loss, dizziness,
and tinnitus. After 3 months of observation, the patient's tympanic membrane perforation demonstrated
little spontaneous closure. Additionally, he was noted to have formation of a posttraumatic cholesteatoma
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94
in the posterior-superior mesotympanum. Over-under tympanoplasty with excision of the cholesteatoma
was successful, and the ossicular chain remained intact. The patient underwent vestibular therapy for an
ipsilateral uncompensated vestibular weakness. His dizzinloudness modulationess resolved, allowing him
to return to full employment. The patient's final audiogram demonstrated normal hearing thresholds sloping
to a mild mixed hearing loss in the high frequencies, and the tinnitus reduced significantly in intensity but
did not resolve. CONCLUSION: The patient's injury pattern clearly resulted from the damaging effects of
the shock wave generated by the lightning bolt, which impacted the patient's thorax. Management of his
otologic care was conducted after practices developed for otologic blast injury and resulted in his being
able to return to his primary occupation.
Catecholamine-secreting carotid body paraganglioma: successful preoperative control of
hypertension and clinical symptoms using high-dose long-acting octreotide.
Endocrinol Diabetes Metab Case Rep. 2014;2014:140051. doi: 10.1530/EDM-14-0051. Epub 2014 Jul 1.
Elshafie O1, Al Badaai Y2, Alwahaibi K2, Qureshi A3, Hussein S4, Al Azzri F4, Almamari A1,
Woodhouse N1.
1
Department of Medicine, Sultan Qaboos University Hospital , Muscat , Sultanate of Oman.
A 48-year-old hypertensive and diabetic patient presented with a 10-year history of progressive right facial
pain, tinnitus, hearing loss, sweating, and palpitations. Investigations revealed a 5.6 cm vascular tumor
at the carotid bifurcation. Her blood pressure (BP) was 170/110, on lisinopril 20 mg od and amlodipine
10 mg od and 100 U of insulin daily. A catecholamine-secreting carotid body paraganglioma (CSCBP)
was suspected; the diagnosis was confirmed biochemically by determining plasma norepinephrine (NE)
level, 89 000 pmol/l, and chromogranin A (CgA) level, 279 μg/l. Meta-iodobenzylguanidine and octreotide
scanning confirmed a single tumor in the neck. A week after giving the patient a trial of octreotide 100 μg
8 h, the NE level dropped progressively from 50 000 to 25 000 pmol/l and CgA from 279 to 25 μg/l. Treatment
was therefore continued with labetalol 200 mg twice daily (bid) and long-acting octreotide-LA initially using
40 mg/month and later increasing to 80 mg/month. On this dose and with a reduced labetalol intake of
100 mg bid, BP was maintained at 130/70 and her symptoms resolved completely. CgA levels returned
to normal in the first week and these were maintained throughout the 3 month treatment period. During
tumor resection, there were minimal BP fluctuations during the 10 h procedure. We conclude that shortterm high-dose octreotide-LA might prove valuable in the preoperative management of catecholaminesecreting tumors. To the best of our knowledge, this is the first report on the successful use of octreotide
in a CSCBP. LEARNING POINTS: The value of octreotide scanning in the localization of extra-adrenal
pheochromocytoma.Control of catecholamine secretion using high-dose octreotide.This is a report of a
rare cause of secondary diabetes and hypertension.
Simple core-needle biopsy for thyroid nodule, complicated tinnitus.
Eur Thyroid J. 2014 Jun;3(2):130-3. doi: 10.1159/000360985. Epub 2014 Jun 7.
Bergeron M1, Beaudoin D2.
1
Department of Otolaryngology - Head and Neck Surgery, Laval University, Quebec, Que., Canada.
BACKGROUND: Fine-needle aspiration is the procedure of choice for evaluating thyroid nodules. Coreneedle biopsy (CNB) is not included in the American Thyroid Association recommendations for evaluating
such nodules. CNB complications are classically bleeding and hematomas. To our knowledge, no case of
arteriovenous fistula (AVF) secondary to a CNB has been reported, nor has any case of tinnitus secondary
to a post-CNB AVF. OBJECTIVES: To make the clinician aware of possible vascular complications caused
by CNB and the possibility of difficult pathology reading caused by previous CNB. METHODS: A 44-yearold female is described who was referred to our tertiary care center for left-sided pulsatile tinnitus. She
did report having had a CNB right before the tinnitus appeared. Conventional angiography demonstrated
a focal AVF originating from the left vertebral artery, with reflux to the left vertebral venous plexus. A
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95
6-mm stent was placed over the site of the fistula via an endovascular approach, which solved both the
radiological and clinical documented problems. Moreover, CNB greatly complicated pathology reading
once total thyroidectomy was later performed. The suspected area of invasion was an artifact due to the
previous biopsies. CONCLUSION: Although many authors recommend a CNB as an alternative modality
in cases of inconclusive cytology with fine-needle aspiration, it is not in the American Thyroid Association
recommendations. In cases of iatrogenic AVFs caused by a CNB, angiography is recommended both as
a diagnostic and therapeutic modality. Stenting the fistula with an endoprosthesis can correct the problem
immediately.
Bilateral hearing loss heralding sporadic creutzfeldt-jakob disease: a case report and literature
review.
Otol Neurotol. 2014 Sep;35(8):1327-9. doi: 10.1097/MAO.0000000000000485.
Salazar R1, Cerghet M, Ramachandran V.
1
*Department of Neurology, Parkview Neurology Services, Rocky Vista University, Parker, Colorado,
U.S.A.;
OBJECTIVE: To report a case of sporadic Creutzfeldt-Jakob disease (CJD) with bilateral hearing loss at
onset and literature review of the scarce cases of CJD with similar audiologic manifestations at presentation.
CASE REPORT: A 67-yr-old man presented to the hospital for evaluation of rapid progression of behavioral
decline, unsteady gait, and bilateral hearing loss. Three months before admission, he abruptly developed
bilateral hypoacusis without associated tinnitus or vertigo. Shortly after, his family noted an ataxic gait and
behavioral changes, for example, paranoid delusions. Initial workup, including a complete autoimmune
panel and heavy metals, infectious, toxicology, and paraneoplastic panel (e.g., anti-Hu, anti-VGKC), was
conducted. Electroencephalography revealed diffuse generalized slowing without periodic complexes.
The presence of distortion product otoacoustic emissions bilaterally was consistent with normal cochlear
function, suggesting a retrocochlear origin for symptoms of hearing loss. In the meantime, the patient
developed startle myoclonus. The brain magnetic resonance imaging demonstrated asymmetric cortical
ribbon along with T2 FLAIR signal hyperintensities of bilateral basal ganglia. Later on, the protein 14-3-3
in the cerebrospinal fluid came back positive, which supported the diagnosis of CJD. Only three cases of
CJD with deafness at onset have been published: one sporadic, associated with symptoms suggestive
of polyneuropathy; and the other two familial, with the E200K mutation. One presented with symptoms of
polyneuropathy and the other with typical features. CONCLUSION: This case illustrates the phenotypic
variability of presentation of CJD in a patient with hearing loss as the initial manifestation. In patients with
subacute bilateral hypoacusis and signs of dementia, the differential diagnosis of CJD must be taken into
consideration.
Acute neurological complications following gamma knife surgery for vestibular schwannoma:
case report.
J Neurosurg. 2013 Dec;119 Suppl:546-51.
Pollack AG, Marymont MH, Kalapurakal JA, Kepka A, Sathiaseelan V, Chandler JP.
The authors describe an acute facial and acoustic neuropathy following gamma knife surgery (GKS) for
vestibular schwannoma (VS). This 39-year-old woman presenting with tinnitus underwent GKS for a small
right-sided intracanalicular VS, receiving a maximal dose of 26 Gy and a tumor margin dose of 13 Gy to
the 50% isodose line. Thirty-six hours following treatment she presented with nausea, vomiting, vertigo,
diminished hearing, and a House-Brackmann Grade III facial palsy. She was started on intravenous
glucocorticosteroid agents, and over the course of 2 weeks her facial function returned to House-Brackmann
Grade I. Unfortunately, her hearing loss persisted. A magnetic resonance (MR) image obtained at the
time of initial deterioration demonstrated a significant decrease in tumor enhancement but no change in
tumor size or peritumoral edema. Subsequently, the patient experienced severe hemifacial spasms, which
persisted for a period of 3 weeks and then progressed to a House-Brackmann Grade V facial palsy. During
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96
the next 3 months, the patient was treated with steroids and in time her facial function and hearing returned
to baseline levels. Results of MR imaging revealed transient enlargement (3 mm) of the tumor, which
subsequently returned to its baseline size. This change corresponded to the tumor volume increase from
270 to 336 mm3. The patient remains radiologically and neurologically stable at 10 months posttreatment.
This is the first detailed report of acute facial and vestibulocochlear neurotoxicity following GKS for VS that
improved with time. In addition, MR imaging findings were indicative of early neurotoxic changes. A review
of possible risk factors and explanations of causative mechanisms is provided.
Immediate neurological deterioration after gamma knife radiosurgery for acoustic neuroma: case
report.
J Neurosurg. 2013 Dec;119 Suppl:78-81.
Tago M, Terahara A, Nakagawa K, Aoki Y, Ohtomo K, Shin M, Kurita H.
The authors describe acute deterioration in facial and acoustic neuropathies following radiosurgery for
acoustic neuromas. In May 1995, a 26-year-old man, who had no evidence of neurofibromatosis Type
2, was treated with gamma knife radiosurgery (GKS; maximum dose 20 Gy and margin dose 14 Gy)
for a right-sided intracanalicular acoustic tumor. Two days after the treatment, he developed headache,
vomiting, right-sided facial weakness, tinnitus, and right hearing loss. There was a deterioration of facial
nerve function and hearing function from pretreatment values. The facial function worsened from HouseBrackmann Grade 1 to 3. Hearing deteriorated from Grade 1 to 5. Magnetic resonance (MR) images,
obtained at the same time revealed an obvious decrease in contrast enhancement of the tumor without
any change in tumor size or peritumoral edema. Facial nerve function improved gradually and increased
to House-Brackmann Grade 2 by 8 months post-GKS. The tumor has been unchanged in size for 5 years,
and facial nerve function has also been maintained at Grade 2 with unchanged deafness. This is the first
detailed report of immediate facial neuropathy after GKS for acoustic neuroma and MR imaging revealing
early possibly toxic changes. Potential explanations for this phenomenon are presented.
Unique presentation of cerebellopontine angle choroid plexus papillomas: case report and review
of the literature.
J Neurol Surg Rep. 2014 Aug;75(1):e27-32. doi: 10.1055/s-0033-1358378. Epub 2013 Dec 12.
Anderson M1, Babington P2, Taheri R3, Diolombi M4, Sherman JH2.
1
School of Medicine, The George Washington University School of Medicine, Washington, District of
Columbia, United States.
Objectives We present the case of a choroid plexus papilloma (CPP) in the cerebellopontine angle
(CPA), describe the different appearances of CPPs with a variety of imaging techniques, and discuss the
differential diagnosis of CPA tumors. Participant and Design We report the case of a 52-year-old woman
with headache, tinnitus, and unilateral hearing impairment whose preoperative magnetic resonance
imaging revealed a heterogeneously enhancing CPA mass that extended into the internal auditory canal.
Main Outcome Measures, Results, and Conclusion The preoperative imaging appearance of the lesion
was most consistent with that of a schwannoma. Postoperative histopathologic examination found the
tumor to be a CPP with cuboidal epithelial cells overlying fibrovascular stroma. CPPs are rare benign
central nervous system neoplasms arising from choroid plexus epithelium. The most common site of
presentation is in the fourth ventricle in adults and the lateral ventricles in children. CPPs rarely occur in
the CPA, and when they do, clinical-radiologic diagnosis is difficult due to both the rarity of this presentation
and to nonspecific radiological features. Free PMC Article.
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Disabling vertigo and tinnitus caused by intrameatal compression of the anterior inferior
cerebellar artery on the vestibulocochlear nerve: a case report, surgical considerations, and
review of the literature.
J Neurol Surg Rep. 2014 Aug;75(1):e47-51. doi: 10.1055/s-0033-1359299. Epub 2013 Dec 12.
Borghei-Razavi H, Darvish O, Schick U.
Department of Neurosurgery, Clemens Hospital, Münster, Germany.
Microvascular compression of the vestibulocochlear nerve is known as a cause of tinnitus and vertigo
in the literature, but our review of the literature shows that the compression is usually located in the
cerebellopontine angle and not intrameatal. We present a case of intrameatal compression of the anterior
inferior cerebellar artery (AICA) on the vestibulocochlear nerve of a 40-year-old woman with symptoms
of disabling vertigo and intermittent high-frequency tinnitus on the left side without any hearing loss for ∼
4 years. Magnetic resonance imaging of the brain did not show any abnormality, but magnetic resonance
angiography showed a left intrameatal AICA loop as a possible cause of the disabling symptoms. After
the exclusion of other possible reasons for disabling vertigo, surgery was indicated. The intraoperative
findings proved the radiologic findings. The large AICA loop was found extending into the internal auditory
canal and compressing the vestibulocochlear nerve. The AICA loop was mobilized and separated from the
vestibulocochlear nerve. The patient's symptoms resolved immediately after surgery, and no symptoms
were noted during 2 years of follow-up in our clinic. Her hearing was not affected by the surgery. In addition
to other common reasons, such as acoustic neuroma, disabling vertigo and tinnitus can occur from an
intrameatal arterial loop compression of the vestibulocochlear nerve and may be treated successfully by
drilling the internal acoustic meatus and separating the arterial conflict from the vestibulocochlear nerve.
Free PMC Article.
Temporomandibular Joint Disorder and Inner Ear Pruritus: Resolution by Eminectomy.
J Craniofac Surg. 2014 Jul 28. [Epub ahead of print]
Pentyala S1, Mysore P, Moller D, Pentyala S, Kardovich R, Martino A, Proothi M.
1
From the *Department of Anesthesiology, Stony Brook Medical Center, Stony Brook;
Recurrent dislocation of the temporomandibular joint (TMJ) disk is caused by many factors. Dislocation can
result in an acute or chronic closed lock condition. Temporomandibular joint dysfunction is often presented
with otalgia symptoms. Other aural symptoms such as deafness, tinnitus, pressure/blockage, and vertigo
are also commonly presented together with TMJ dysfunction (Clin Otolaryngol Allied Sci. 1980;5:23-36).
However, pruritus associated with TMJ dysfunction in the inner ear has never been reported in the literature.
We report a case history of TMJ dysfunction and associated inner ear pruritus, which are both resolved by
eminectomy.
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CT and MR Imaging Characteristics of Intravestibular and Cerebellopontine Angle Lipoma.
Iran J Radiol. 2014 May;11(2):e11320. doi: 10.5812/iranjradiol.11320. Epub 2014 May 15.
P Buyukkaya R1, Buyukkaya A2, Ozturk B1, Yaman H3, Belada A3.
1
Department of Radiology, School of Medicine, Duzce University, Duzce, Turkey.
Intracranial lipoma is an uncommon entity. A rare type of tumor in the internal auditory canal (IAC) and the
cerebellopontine angle (CPA) is lipoma. There are a few case reports in the literature related to intravestibular
lipoma. Herein, we report a case of lipomas within the cerebellopontine angle and vestibule of the inner
ear in a patient with tinnitus and dizziness. The patient was evaluated with a 1.5 T magnetic resonance
imaging (MRI) system. MRI and CT showed the masses in the left CPA and the left IAC. These lesions
were hyperintense on both T1- and T2 weighted images and showed no enhancement after gadolinium
administration. Conservative management was suggested. Histopathological diagnosis is rarely necessary
with the widespread use of magnetic resonance imaging. Considering significant morbidity during resection,
conservative follow-up is the best approach for CPA and IAC lipoma. Free PMC Article.
Venous pulsatile tinnitus due to pseudotumor cerebri syndrome in a young morbid obese female.
Hippokratia. 2013 Oct;17(4):383. No abstract available.
Kastanioudakis I1, Konitsiotis S2, Asproudis I3, Ziavra N4.
1
Department of Otorhinolaryngology, University of Ioannina, Ioannina, Greece.
No abstryct available.
[Ten cases report of vascular compressive syndrome caused by the facial, acoustic nerves].
[Article in Chinese]
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Apr;28(7):440-2. Chinese.
Zhao Y, Cai Q, Weng W, Wang D.
OBJECTIVE: To search the features and the treatment of vascular compressive syndrome caused by the
facial, acoustic nerves. METHOD: Ten cases of vascular compressive syndrome caused by the facial,
acoustic nerves were included in the group,which were treated by microvascular decompression(MVD).
Besides, the microanatomic relationship between the nerve and their adjacent vessel at the root exit zone
(REZ) were observed under microscope or nasoendoscopy in MVD. RESULT: Tinnitus, vertigo and facial
spasm disappeared after MVD in 7 cases (70%), improved in 2 cases (20%), and relapse in 1 case (10%).
All cases were found out vessels compressing at the root zone of the facial nerve and the auditory nerve.
CONCLUSION: The Clinical features of vascular compressive syndrome caused by the facial, acoustic
nerves are facial spasm, tinnitus, and vertigo, for which microvascular decompression has a positive
therapeutic effect as long as the diagnosis is correct.
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99
Recurrent Vogt–Koyanagi–Harada disease with sensorineural hearing loss and choroidal
thickening.
Int Ophthalmol. 2014 Jun;34(3):679-84.
Ishibazawa A, Kinouchi R, Minami Y, Katada A, Yoshida A.
We report a case of Vogt–Koyanagi–Harada (VKH) disease that recurred with sensorineural hearing loss
and choroidal thickening. We measured the choroidal thickness using enhanced-depth imaging optical
coherence tomography (EDI-OCT) in a patient with VKH during corticosteroid-tapering therapy. A71-yearold male presented with fever, headache, and anorthopia associated with wavy choroidal folds and aserous
retinal detachment (SRD). The EDI-OCT images showed choroidal thickening ([600 l m at the subfovea),
and he was diagnosed with VKH disease. After treatment with pulsed intravenous methylprednisolone,
the choroidal folds and SRD resolved and the choroidal thickness decreased. About 6 months after
subsequent treatment with an oral corticosteroid started, headache, tinnitus, and sensorineural hearing
loss developed, and increased choroidal thickness was observed without other evidence of increased
ocular inflammation. A high-dose corticosteroid was injected and tapered, and the sensorineural hearing
loss improved immediately and the choroidal thickness decreased. In the current case, sensorineural
hearing loss occurred with recurrent VKH disease;however, there were no ocular inflammatory signs
except for rebound choroidal thickening. Measuring the choroidal thickness using EDI-OCT can sensitively
identify recurrent VKH disease.
Traumatic pseudoaneurysm of the middle meningeal artery with an arteriovenous fistula on a
non-fractured site.
Interv Neuroradiol. 2014 Jun 30;20(3):352-6. doi: 10.15274/NRJ-2014-10025. Epub 2014 Jun 17.
Ko JH1, Kim YJ2.
1
Department of Neurosurgery, Dankook University College of Medicine; Cheonan, Korea - kimyj@
dankook.ac.kr.
We describe a rare case of a combined traumatic pseudoaneurysm and arteriovenous fistula (AVF) of the
middle meningeal artery (MMA) on a non-fractured site. A 24-year-old man was admitted to our hospital
with head trauma. He underwent a craniotomy and removal of an epidural hematoma on the right side.
Twenty-five days later, he complained of pulsatile tinnitus on the left non-fractured side. Angiography
revealed a markedly dilated proximal MMA with flow shunting to the pterygoid plexus. We performed
proximal occlusion on the proximal MMA for the traumatic pseudoaneurysm and the AVF of the MMA using
coils. Although immediate angiography showed retrograde contrast filling from the collateral vessels into
the distal part of the pseudoaneurysm, follow-up angiography revealed that the lesion had successfully
disappeared.
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100
Large capillary hemangioma of the temporal bone with a dural tail sign: A case report.
Oncol Lett. 2014 Jul;8(1):183-186. Epub 2014 May13.
Yang G1, Li C1, Chen X1, Liu Y1, Han D1, Gao X2, Kawamoto K3, Zhao S1.
1
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin,
Heilongjiang, P.R. China ; Institute of Brain Science, Harbin Medical University, Harbin, Heilongjiang,
P.R. China.
The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural
tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a tenyear history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right
petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this
tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified
pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma.
Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone.
Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most
often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in
other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical
excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present
study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal
hemangioma to be reported in the literature to date. Free PMC Article.
An endolymphatic sac tumor with imaging features of aneurysmal bone cysts: differential
diagnostic considerations.
Childs Nerv Syst. 2014 Jun 1. [Epub ahead of print]
Alkonyi B1, Günthner-Lengsfeld T, Rak K, Nowak J, Solymosi L, Hagen R.
1
Department of Neuroradiology, Universitätsklinikum Würzburg, Josef-Schneider-Strasse 11, 97080,
Würzburg, Germany, [email protected].
BACKGROUND: Endolymphatic sac tumors (ELSTs) are rare, slow-growing tumors of the petrous bone.
Despite the typical localisation, their radiological diagnosis can be challenging due to the variety of
other tumors potentially showing similar features. CASE REPORT: We present a 16-year-old child with
progressive hearing loss, vertigo, and tinnitus who had a large petrous bone lesion showing imaging features
of both ELSTs and aneurysmal bone cysts (ABCs). The patient underwent preoperative embolization of
the tumor-supplying vessels and subsequently a subtotal resection. Histological examination revealed an
ELST. CONCLUSION: Despite the rarity of petrous bone ABCs, they should be considered as a differential
diagnostic alternative of ELSTs due to their similar imaging appearance.
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101
Exacerbation of audiovestibular symptoms in a patient with Ménière's disease and choroidal
melanoma.
Am J Otolaryngol. 2014 May 4. pii: S0196-0709(14)00101-X. doi: 10.1016/j.amjoto.2014.04.007. [Epub
ahead of print]
Barozzi S1, Ginocchio D2, Cesarani A2.
1
Audiology Unit Department of Clinical Sciences, Community Health Università degli Studi di Milano,
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Pace 9, Milan, Italy. Electronic
address: [email protected].
We report the case of a man affected by a unilateral Ménière's disease who, after being free from
vertigo spells and tinnitus for more than ten years, manifested an exacerbation of symptoms just
before the diagnosis of a choroidal melanoma. Melanoma is an aggressive form of cancer derived from
neuroectodermal melanocytes. Melanocytes are present in the inner ear where they contribute to the
production of endolymphatic potentials and to the maintenance of normal volumes of the inner ear fluids. A
possible autoimmune connection between the exacerbation of audiovestibular symptoms and melanoma
is discussed. Copyright © 2014 Elsevier Inc. All rights reserved.
Idiopathic Oculostapedial Synkinesis Without History of Facial Nerve Palsy.
Otol Neurotol. 2014 Jun 2. [Epub ahead of print]
Fujiwara K1, Furuta Y, Fukuda S.
1
*Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Hokkaido
University; and †Department of Otolaryngology, Head and Neck Surgery, Teine-Keijinkai Hospital,
Sapporo, Hokkaido, Japan.
OBJECTIVE: To report a case of idiopathic oculostapedial synkinesis without facial nerve disorder.
PATIENT: A 30-year-old woman with tinnitus synchronous with eye closure is presented. The patient had
no history of facial nerve disorder. RESULT: An impedance audiometer, in the absence of an auditory
stimulus, was used to record tympanic membrane compliance without sound stimulation, revealing
decreased compliance in the concomitant with eye blinking. Her symptoms disappeared spontaneously,
so no intervention was undertaken. CONCLUSION: Although oculostapedial synkinesis is often observed
as one of the sequelae of facial nerve palsy, idiopathic oculostapedial synkinesis is very rare. The use of
an impedance audiometer in the absence of an auditory stimulus is very useful for demonstrating objective
changes in the compliance of the tympanic membrane. It is assumed that the cause of the synkinesis in
our case was abnormal transmission of signals for orbicularis oculi muscle to the stapedial and orbicularis
oris muscles rather than misdirected regenerating fibers. Resection of the stapedial muscle tendon should
be considered if her symptoms recur.
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102
XV Specific Forms of Tinnitus
Clinical signs and symptoms of tinnitus in temporomandibular joint disorders: a pilot study
comparing patients and non-patients.
S Afr J Commun Disord. 2013 Dec;60:16-20.
Kanji A, Khoza-Shangase K.
BACKGROUND: Tinnitus is one of the otologic symptoms commonly reported to be associated with
temporomandibular disorder (TMD), and questions regarding its nature and cause continue to plague the
clinical and research community. OBJECTIVES: The current pilot study aimed to investigate the clinical
signs and symptoms of presenting tinnitus in a group of individuals with TMD (group A), and compare them
with a group with tinnitus but without TMD (group B). Twenty participants were included in the study, 10
from each group. METHODS: All participants underwent basic audiological as well as ear, nose and throat
(ENT) evaluations to establish group A and group B. For tinnitus assessment, all participants completed
a tinnitus survey questionnaire, and their tinnitus was evaluated using tinnitus matching procedures.
RESULTS: Findings revealed clinically relevant differences in attributes of tinnitus in patients with and
without TMD. Most of the participants in group A matched their tinnitus to a 6 000 Hz tone or noise, at
lower intensity levels than participants in group B, although these results were not statistically significant.
Participants in group A associated their tinnitus with a single sound whereas some participants in group B
associated it with more than one sound. More participants in group B reported the duration of their tinnitus
as constant. CONCLUSIONS: Tinnitus may occur in patients with TMD, and be of high frequency. This
highlights the importance of thorough assessment for patients with tinnitus as this might have implications
for diagnosis and management.
XVI Animal Models
A synaptic and circuit basis for corollary discharge in the auditory cortex.
Nature. 2014 Aug 27. doi: 10.1038/nature13724. [Epub ahead of print]
Schneider DM1, Nelson A1, Mooney R2.
1 Department of Neurobiology, Duke University School of Medicine, Durham, North Carolina 27710, USA
[2].
Sensory regions of the brain integrate environmental cues with copies of motor-related signals important
for imminent and ongoing movements. In mammals, signals propagating from the motor cortex to the
auditory cortex are thought to have a critical role in normal hearing and behaviour, yet the synaptic and
circuit mechanisms by which these motor-related signals influence auditory cortical activity remain poorly
understood. Using in vivo intracellular recordings in behaving mice, we find that excitatory neurons in
the auditory cortex are suppressed before and during movement, owing in part to increased activity of
local parvalbumin-positive interneurons. Electrophysiology and optogenetic gain- and loss-of-function
experiments reveal that motor-related changes in auditory cortical dynamics are driven by a subset of
neurons in the secondary motor cortex that innervate the auditory cortex and are active during movement.
These findings provide a synaptic and circuit basis for the motor-related corollary discharge hypothesized
to facilitate hearing and auditory-guided behaviours.
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103
Changes in the Numbers of Ribbon Synapses and Expression of RIBEYE in Salicylate-Induced
Tinnitus.
Cell Physiol Biochem. 2014 Aug 19;34(3):753-767. [Epub ahead of print]
Zhang FY1, Xue YX, Liu WJ, Yao YL, Ma J, Chen L, Shang XL.
1
Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, People's
Republic of China.
Background: This study was performed to explore the mechanism underlying tinnitus by investigating the
changes in the synaptic ribbons and RIBEYE expression in cochlear inner hair cells in salicylate-induced
tinnitus. Methods: C57BL/6J mice were injected with salicylate (350 mg/kg) for 10 days and grouped.
Behavioral procedures were performed to assess whether the animals experienced tinnitus. The specific
presynaptic RIBEYE protein and non-specific postsynaptic glutamate receptor 2&3 protein in basilar
membrane samples were examined by immunofluorescent labeling. RT-PCR and Western blot assays
were used to examine RIBEYE expression. Serial sections were used to build three-dimensional models
using 3ds MAX software to evaluate the changes in the synaptic ribbons. Results: The administration of
salicylate increased false positives in the behavioral procedure from 3 d to 10 d. The membrane profiles
of inner hair cells in all mice were intact. The number of synaptic ribbons in the salicylate group increased
on the 7th d and decreased on the 9th and 10th d. mRNA and protein expression of RIBEYE were initially
up-regulated and later down-regulated by injecting salicylate for 10 consecutive days. Conclusion: This
change in the ribbon synapses of cochlear inner hair cells in salicylate-induced mice might serve as a
compensatory mechanism in the early stages of ototoxicity and contribute to tinnitus later. The alteration
of RIBEYE expression could be responsible for the changes in the morphology of ribbon synapses and for
salicylate-induced tinnitus. © 2014 S. Karger AG, Basel.
Effects of Unilateral Acoustic Trauma on Tinnitus-Related Spontaneous Activity in the Inferior
Colliculus.
J Assoc Res Otolaryngol. 2014 Sep 26. [Epub ahead of print]
Ropp TJ1, Tiedemann KL, Young ED, May BJ.
1
Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD,
21205, USA.
This study describes the long-term effects of sound-induced cochlear trauma on spontaneous discharge
rates in the central nucleus of the inferior colliculus (ICC). As in previous studies, single-unit recordings in
Sprague-Dawley rats revealed pervasive increases in spontaneous discharge rates. Based on differences
in their sources of input, it was hypothesized that physiologically defined neural populations of the auditory
midbrain would reveal the brainstem sources that dictate ICC hyperactivity. Abnormal spontaneous activity
was restricted to target neurons of the ventral cochlear nucleus. Nearly identical patterns of hyperactivity
were observed in the contralateral and ipsilateral ICC. The elevation in spontaneous activity extended to
frequencies well below and above the region of maximum threshold shift. This lack of frequency organization
suggests that ICC hyperactivity may be influenced by regions of the brainstem that are not tonotopically
organized. Sound-induced hyperactivity is often observed in animals with behavioral signs of tinnitus. Prior
to electrophysiological recording, rats were screened for tinnitus by measuring gap pre-pulse inhibition
of the acoustic startle reflex (GPIASR). Rats with positive phenotypes did not exhibit unique patterns of
ICC hyperactivity. This ambiguity raises concerns regarding animal behavioral models of tinnitus. If our
screening procedures were valid, ICC hyperactivity is observed in animals without behavioral indications
of the disorder. Alternatively, if the perception of tinnitus is strictly linked to ongoing ICC hyperactivity, our
current behavioral approach failed to provide a reliable assessment of tinnitus state.
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104
Tinnitus: animal models and findings in humans.
Cell Tissue Res. 2014 Sep 30. [Epub ahead of print]
Eggermont JJ1, Roberts LE.
1
Department of Physiology and Pharmacology, Hotchkiss Brain Institute, and Department of
Psychology, University of Calgary, 2500 University Drive N.W, Calgary, AB, Canada, eggermon@
ucalgary.ca.
Chronic tinnitus (ringing of the ears) is a medically untreatable condition that reduces quality of life for
millions of individuals worldwide. Most cases are associated with hearing loss that may be detected by
the audiogram or by more sensitive measures. Converging evidence from animal models and studies
of human tinnitus sufferers indicates that, while cochlear damage is a trigger, most cases of tinnitus are
not generated by irritative processes persisting in the cochlea but by changes that take place in central
auditory pathways when auditory neurons lose their input from the ear. Forms of neural plasticity underlie
these neural changes, which include increased spontaneous activity and neural gain in deafferented
central auditory structures, increased synchronous activity in these structures, alterations in the tonotopic
organization of auditory cortex, and changes in network behavior in nonauditory brain regions detected by
functional imaging of individuals with tinnitus and corroborated by animal investigations. Research on the
molecular mechanisms that underlie neural changes in tinnitus is in its infancy and represents a frontier
for investigation.
Both Central and Peripheral Auditory Systems Are Involved in Salicylate-Induced Tinnitus in
Rats: A Behavioral Study.
PLoS One. 2014 Sep 30;9(9):e108659. doi: 10.1371/journal.pone.0108659. eCollection 2014.
Chen G1, Feng L2, Liu Z1, Sun Y1, Chang H3, Cui P1.
1
Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, the Fourth Military Medical
University, Xi'an, China.
OBJECTIVE: This study was designed to establish a low dose salicylate-induced tinnitus rat model and to
investigate whether central or peripheral auditory system is involved in tinnitus. METHODS: Lick suppression
ratio (R), lick count and lick latency of conditioned rats in salicylate group (120 mg/kg, intraperitoneally)
and saline group were first compared. Bilateral auditory nerves were ablated in unconditioned rats and
lick count and lick latency were compared before and after ablation. The ablation was then performed in
conditioned rats and lick count and lick latency were compared between salicylate group and saline group
and between ablated and unablated salicylate groups. RESULTS: Both the R value and the lick count in
salicylate group were significantly higher than those in saline group and lick latency in salicylate group
was significantly shorter than that in saline group. No significant changes were observed in lick count and
lick latency before and after ablation. After ablation, lick count and lick latency in salicylate group were
significantly higher and shorter respectively than those in saline group, but they were significantly lower
and longer respectively than those in unablated salicylate group. CONCLUSION: A low dose of salicylate
(120 mg/kg) can induce tinnitus in rats and both central and peripheral auditory systems participate in the
generation of salicylate-induced tinnitus. Free PMC Article.
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105
Behavioral models of tinnitus and hyperacusis in animals.
Front Neurol. 2014 Sep 17;5:179. doi: 10.3389/fneur.2014.00179. eCollection 2014. Review.
Hayes SH1, Radziwon KE1, Stolzberg DJ2, Salvi RJ1.
1
Center for Hearing and Deafness, Department of Communicative Disorders and Sciences, University
at Buffalo, The State University of New York , Buffalo, NY , USA.
The phantom perception of tinnitus and reduced sound-level tolerance associated with hyperacusis have
a high comorbidity and can be debilitating conditions for which there are no widely accepted treatments.
One factor limiting the development of treatments for tinnitus and hyperacusis is the lack of reliable animal
behavioral models of these disorders. Therefore, the purpose of this review is to highlight the current animal
models of tinnitus and hyperacusis, and to detail the advantages and disadvantages of each paradigm. To
date, this is the first review to include models of both tinnitus and hyperacusis. Free PMC Article.
Age effects on tinnitus and hearing loss in CBA/CaJ mice following sound exposure.
Springerplus. 2014 Sep 20;3:542. doi: 10.1186/2193-1801-3-542. eCollection 2014.
Longenecker RJ1, Chonko KT2, Maricich SM3, Galazyuk AV4.
1
Department of Anatomy and Neurobiology, Northeast Ohio Medical University, 4209 State Route 44,
Rootstown, OH 44272 USA ; Kent State University, Kent, OH 44240 USA.
Tinnitus is a maladaptive neuropathic condition that develops in humans and laboratory animals following
auditory insult. In our previous study we demonstrated that sound exposure leads to development of
behavioral evidence of tinnitus in a sample of exposed mice. However, this tinnitus mouse model did
not account for long-term maladaptive plasticity or aging, factors that are commonly linked to the human
tinnitus population. Therefore the same group of mice was monitored for tinnitus for 360 days post
exposure. Tinnitus was assessed behaviorally by measuring gap-induced pre-pulse suppression of the
acoustic startle (GPIAS). Cochlear histology was performed on both control (unexposed) and experimental
mice to determine whether sound exposure caused any evident cochlear damage. We found that 360 days
after exposure the vast majority of exposed mice exhibited similar gap detection deficits as detected at
84 days post exposure. These mice did not demonstrate significant loss of inner/outer hair cells or spiral
ganglion neurons compared to the control sample. Lastly, we demonstrated that GPIAS deficits observed
in exposed animals were unlikely exclusively caused by cochlear damage, but could be a result of central
auditory maladaptive plasticity. We conclude that CBA/CaJ mice can be considered a good animal model
to study the possible contribution of age effects on tinnitus development following auditory insult. Free
PMC Article.
Suppression and facilitation of auditory neurons through coordinated acoustic and midbrain
stimulation: investigating a deep brain stimulator for tinnitus.
J Neural Eng. 2014 Oct 13;11(6):066001. [Epub ahead of print]
Offutt SJ1, Ryan KJ, Konop AE, Lim HH.
1
Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA.
Objective. The inferior colliculus (IC) is the primary processing center of auditory information in the midbrain
and is one site of tinnitus-related activity. One potential option for suppressing the tinnitus percept is
through deep brain stimulation via the auditory midbrain implant (AMI), which is designed for hearing
restoration and is already being implanted in deaf patients who also have tinnitus. However, to assess the
feasibility of AMI stimulation for tinnitus treatment we first need to characterize the functional connectivity
within the IC. Previous studies have suggested modulatory projections from the dorsal cortex of the IC
(ICD) to the central nucleus of the IC (ICC), though the functional properties of these projections need to
be determined. Approach. In this study, we investigated the effects of electrical stimulation of the ICD on
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106
acoustic-driven activity within the ICC in ketamine-anesthetized guinea pigs. Main Results. We observed
ICD stimulation induces both suppressive and facilitatory changes across ICC that can occur immediately
during stimulation and remain after stimulation. Additionally, ICD stimulation paired with broadband noise
stimulation at a specific delay can induce greater suppressive than facilitatory effects, especially when
stimulating in more rostral and medial ICD locations. Significance. These findings demonstrate that ICD
stimulation can induce specific types of plastic changes in ICC activity, which may be relevant for treating
tinnitus. By using the AMI with electrode sites positioned with the ICD and the ICC, the modulatory effects
of ICD stimulation can be tested directly in tinnitus patients.
A synaptic and circuit basis for corollary discharge in the auditory cortex.
Nature. 2014 Aug 27. doi: 10.1038/nature13724. [Epub ahead of print]
Schneider DM1, Nelson A1, Mooney R2.
1
Department of Neurobiology, Duke University School of Medicine, Durham, North Carolina 27710, USA.
Sensory regions of the brain integrate environmental cues with copies of motor-related signals important
for imminent and ongoing movements. In mammals, signals propagating from the motor cortex to the
auditory cortex are thought to have a critical role in normal hearing and behaviour, yet the synaptic and
circuit mechanisms by which these motor-related signals influence auditory cortical activity remain poorly
understood. Using in vivo intracellular recordings in behaving mice, we find that excitatory neurons in
the auditory cortex are suppressed before and during movement, owing in part to increased activity of
local parvalbumin-positive interneurons. Electrophysiology and optogenetic gain- and loss-of-function
experiments reveal that motor-related changes in auditory cortical dynamics are driven by a subset of
neurons in the secondary motor cortex that innervate the auditory cortex and are active during movement.
These findings provide a synaptic and circuit basis for the motor-related corollary discharge hypothesized
to facilitate hearing and auditory-guided behaviours.
The Effects of Acute Stress-Induced Sleep Disturbance on Acoustic Trauma-Induced Tinnitus in
Rats.
Biomed Res Int. 2014;2014:724195. Epub 2014 Aug 3.
Zheng Y, Stiles L, Chien YT, Darlington CL, Smith PF.
Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago, P.O. Box
913, Dunedin 9016, New Zealand ; Brain Health Research Centre, University of Otago, Dunedin 9016,
New Zealand.
Chronic tinnitus is a debilitating condition and often accompanied by anxiety, depression, and sleep
disturbance. It has been suggested that sleep disturbance, such as insomnia, may be a risk factor/predictor
for tinnitus-related distress and the two conditions may share common neurobiological mechanisms. This
study investigated whether acute stress-induced sleep disturbance could increase the susceptibility to
acoustic trauma-induced tinnitus in rats. The animals were exposed to unilateral acoustic trauma 24 h before
sleep disturbance being induced using the cage exchange method. Tinnitus perception was assessed
behaviourally using a conditioned lick suppression paradigm 3 weeks after the acoustic trauma. Changes
in the orexin system in the hypothalamus, which plays an important role in maintaining long-lasting arousal,
were also examined using immunohistochemistry. Cage exchange resulted in a significant reduction in the
number of sleep episodes and acoustic trauma-induced tinnitus with acoustic features similar to a 32 kHz
tone at 100 dB. However, sleep disturbance did not exacerbate the perception of tinnitus in rats. Neither
tinnitus alone nor tinnitus plus sleep disturbance altered the number of orexin-expressing neurons. The
results suggest that acute sleep disturbance does not cause long-term changes in the number of orexin
neurons and does not change the perception of tinnitus induced by acoustic trauma in rats.
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107
Effects of chronic furosemide on central neural hyperactivity and cochlear thresholds after
cochlear trauma in Guinea pig.
Front Neurol. 2014 Aug 8;5:146. doi: 10.3389/fneur.2014.00146. eCollection 2014.
Mulders WH, McMahen C, Robertson D.
The Auditory Laboratory, School of Anatomy, Physiology and Human Biology, The University of Western
Australia , Crawley, WA , Australia.
Increased neuronal spontaneous firing rates have been observed throughout the central auditory system
after trauma to the cochlea and this hyperactivity is believed to be associated with the phantom perception
of tinnitus. Previously, we have shown in an animal model of hearing loss, that an acute injection with
furosemide can significantly decrease hyperactivity after cochlear trauma and eliminate behavioral
evidence of tinnitus of early onset. However, furosemide also has the potential to affect cochlear thresholds.
In this paper, we measured the effects of a chronic (daily injections for 7 days) furosemide treatment on
the spontaneous firing rate of inferior colliculus neurons and on cochlear thresholds in order to establish
whether a beneficial effect on hyperactivity can be obtained without causing additional hearing loss.
Guinea pigs were exposed to a 10-kHz, 124 dB, 2 h acoustic trauma, and after 5 days of recovery, were
given daily i.p. injections of 80 mg/kg furosemide or an equivalent amount of saline. The activity of single IC
neurons was recorded 24 h following the last injection. The furosemide treatment had no effect on cochlear
thresholds compared to saline injections but did result in significant reductions in spontaneous firing rates
recorded in inferior colliculus. These results that suggest a long-term beneficial effect of furosemide on
hyperactivity after cochlear trauma may be achievable without detrimental effects on hearing, which is
important when considering therapeutic potential.
Laminar and Neurochemical Organization of the Dorsal Cochlear Nucleus of the Human, Monkey,
Cat, and Rodents.
Anat Rec (Hoboken). 2014 Aug 18. doi: 10.1002/ar.23000. [Epub ahead of print]
Baizer JS1, Wong KM, Paolone NA, Weinstock N, Salvi RJ, Manohar S, Witelson SF, Baker JF,
Sherwood CC, Hof PR.
1
Department of Physiology and Biophysics, University at Buffalo, Buffalo, New York.
The dorsal cochlear nucleus (DCN) is a brainstem structure that receives input from the auditory
nerve. Many studies in a diversity of species have shown that the DCN has a laminar organization and
identifiable neuron types with predictable synaptic relations to each other. In contrast, studies on the
human DCN have found a less distinct laminar organization and fewer cell types, although there has
been disagreement among studies in how to characterize laminar organization and which of the cell types
identified in other animals are also present in humans. We have reexamined DCN organization in the
human using immunohistochemistry to analyze the expression of several proteins that have been useful in
delineating the neurochemical organization of other brainstem structures in humans: nonphosphorylated
neurofilament protein (NPNFP), nitric oxide synthase (nNOS), and three calcium-binding proteins. The
results for humans suggest a laminar organization with only two layers, and the presence of large projection
neurons that are enriched in NPNFP. We did not observe evidence in humans of the inhibitory interneurons
that have been described in the cat and rodent DCN. To compare humans and other animals directly we
used immunohistochemistry to examine the DCN in the macaque monkey, the cat, and three rodents. We
found similarities between macaque monkey and human in the expression of NPNFP and nNOS, and
unexpected differences among species in the patterns of expression of the calcium-binding proteins. Anat
Rec, 2014. © 2014 Wiley Periodicals, Inc. Copyright © 2014 Wiley Periodicals, Inc.
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Protective Effects of Ginkgo biloba Extract EGb 761 against Noise Trauma-Induced Hearing Loss
and Tinnitus Development.
Neural Plast. 2014;2014:427298. doi: 10.1155/2014/427298. Epub 2014 Jun 17.
Tziridis K, Korn S, Ahlf S, Schulze H.
Experimental Otolaryngology, University of Erlangen-Nuremberg, Waldstraße 1, 91054 Erlangen,
Germany.
Noise-induced hearing loss (NIHL) and resulting comorbidities like subjective tinnitus are common diseases
in modern societies. A substance shown to be effective against NIHL in an animal model is the Ginkgo biloba
extract EGb 761. Further effects of the extract on the cellular and systemic levels of the nervous system
make it a promising candidate not only for protection against NIHL but also for its secondary comorbidities
like tinnitus. Following an earlier study we here tested the potential effectiveness of prophylactic EGb 761
treatment against NIHL and tinnitus development in the Mongolian gerbil. We monitored the effects of
EGb 761 and noise trauma-induced changes on signal processing within the auditory system by means
of behavioral and electrophysiological approaches. We found significantly reduced NIHL and tinnitus
development upon EGb 761 application, compared to vehicle treated animals. These protective effects of
EGb 761 were correlated with changes in auditory processing, both at peripheral and central levels. We
propose a model with two main effects of EGb 761 on auditory processing, first, an increase of auditory
brainstem activity leading to an increased thalamic input to the primary auditory cortex (AI) and second, an
asymmetric effect on lateral inhibition in AI.
Blast-Induced tinnitus and spontaneous firing changes in the rat dorsal cochlear nucleus.
J Neurosci Res. 2014 Jun 17. doi: 10.1002/jnr.23424. [Epub ahead of print]
Luo H1, Pace E, Zhang X, Zhang J.
1
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine,
Detroit, Michigan.
Exposure to high-pressure blast shock waves is known to cause tinnitus. Although the underlying
mechanisms may involve damage to structures in the ear and/or direct brain impact, which triggers a
cascade of neuroplastic changes in both auditory and nonauditory centers, it remains unclear how the
induced neuroplasticity manifests neurophysiologically. This study investigates the influence of blast
exposure on spontaneous firing rates (SFRs) in the dorsal cochlear nucleus (DCN) and its time course in
rats with blast-induced tinnitus. Each rat was exposed to a single blast at 22 psi. Behavioral evidence of
tinnitus was measured by using a gap-detection acoustic startle-reflex paradigm. SFRs were measured
1 day, 1 month, and 3 months after blast exposure. The results showed that nine rats with blast-induced
tinnitus and hearing loss developed hyperactivity immediately and that the induced hyperactivity persisted
in six rats with tinnitus at 1 month after blast exposure. At 3 months after blast exposure, however, the
induced hyperactivity of four rats with tinnitus transitioned to hypoactivity. In addition, the 20-30-kHz, and
>30-kHz regions in the DCN of rats with and without blast-induced tinnitus were more affected than other
frequency regions at different recovery time points after blast exposure. These results demonstrate that
the neural mechanisms underlying blast-induced tinnitus are substantially different from those underlying
noise-induced tinnitus. © 2014 Wiley Periodicals, Inc. Copyright © 2014 Wiley Periodicals, Inc.
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109
Time course of cochlear injury discharge (excitotoxicity) determined by ABR monitoring of
contralateral cochlear events.
Hear Res. 2014 Jun 26;315C:34-39. doi: 10.1016/j.heares.2014.06.002. [Epub ahead of print]
Negandhi J1, Harrison AL1, Allemang C1, Harrison RV2.
1
Auditory Science Laboratory, Neuroscience and Mental Health Program, The Hospital for Sick
Children, 555 University Ave., Toronto, M5G 1X8 Canada.
The dynamics of cochlear excitotoxicity can be monitored from effects on the contralateral ear. After
unilateral mechanical ablation of the cochlea (in a mouse model) we observed immediate elevations
in auditory brainstem evoked response (ABR) thresholds in the contralateral ear. Threshold elevations
peaked at 2-3 h post ablation, and returned to baseline levels after 5-6 h. These contralateral effects are
initiated by cochlear afferent injury discharges most likely activating the olivocochlear efferent system. Six
hours after cochlear injury, ABR thresholds were fully returned to pre-lesion baseline levels and remained
normal for up to 10 days of monitoring. We have confirmed that our cochlear ablation procedure increases
short-term activity levels in the auditory brainstem and midbrain using c-fos labelling. The study provides
insight into the dynamics of glutamate excitotoxicity, a pathological process directly related to acute tinnitus
after acoustic trauma, and more generally implicated in many types of brain injury and neuro-degenerative
disease. Copyright © 2014. Published by Elsevier B.V.
Functional mapping of the auditory tract in rodent tinnitus model using manganese-enhanced
magnetic resonance imaging.
Neuroimage. 2014 Jun 28. pii: S1053-8119(14)00532-1. doi: 10.1016/j.neuroimage.2014.06.055. [Epub
ahead of print]
Jung DJ1, Han M2, Jin SU2, Lee SH3, Park I4, Cho HJ5, Kwon TJ5, Lee HJ6, Cho JH7, Lee KY8, Chang
Y9.
1
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National
University Hospital, Daegu, Republic of Korea.
Animal models of salicylate-induced tinnitus have demonstrated that salicylate modulates neuronal activity
in several brain structures leading to neuronal hyperactivity in auditory and non-auditory brain areas. In
addition, these animal tinnitus models indicate that tinnitus can be a perceptual consequence of altered
spontaneous neural activity along the auditory pathway. Peripheral and/or central effects of salicylate can
account for neuronal activity changes in salicylate-induced tinnitus. Because of this ambiguity, an in vivo
imaging study would be able to address the peripheral and/or central involvement of salicylate-induced
tinnitus. Therefore, in the present study, we developed a novel manganese-enhanced magnetic resonance
imaging (MEMRI) method to map the in vivo functional auditory tract in a salicylate-induced tinnitus
animal model by administrating manganese through the round window. We found that acute salicylateinduced tinnitus resulted in higher manganese uptake in the cochlea and in the central auditory structures.
Furthermore, serial MRI scans demonstrated that the manganese signal increased in an anterograde
fashion from the cochlea to the cochlear nucleus. Therefore, our in vivo MEMRI data suggest that acute
salicylate-induced tinnitus is associated with higher spontaneous neural activity both in peripheral and
central auditory pathways. Copyright © 2014 Elsevier Inc. All rights reserved.
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110
Loudness perception affected by high doses of salicylate-A behavioral model of hyperacusis.
Behav Brain Res. 2014 May 29. pii: S0166-4328(14)00348-9. doi: 10.1016/j.bbr.2014.05.045. [Epub
ahead of print]
Zhang C1, Flowers E2, Li JX3, Wang Q4, Sun W5.
1
Department of Otolaryngology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, PR
China; Center for Hearing & Deafness, Department of Communicative Disorders and Sciences, State
University of New York at Buffalo, 3435 Main Street, Buffalo, NY 14214, United States.
The major side-effects of high doses of salicylate include sensorial hearing loss and tinnitus. Although
salicylate decreases cochlear output, it enhances the evoked potentials recorded from the central auditory
system (CAS), suggesting an increase to sound sensitivity. However, the loudness change after salicylate
administration has not yet been directly measured. In this study, we established an operant conditioning
based behavioral task in rats and measured their loudness perception changes before and after high
doses of salicylate injection (250mg/kg, i.p.). We found that high doses of salicylate induced a significant
increase to loudness response in 40% of the rats (out of 20 rats), suggesting a hyperacusis behavior. In
another 40% of rats, a rapid increase of loudness response was detected, suggesting loudness recruitment.
The reaction time of the rats was also measured during the loudness tests before and after salicylate
exposure. The reaction time level functions are highly correlated to the loudness response functions. Our
studies confirmed that increased sound sensitivity, which is commonly seen in patients with tinnitus and
hyperacusis, can be induced by high doses of salicylate. This loudness change induced by salicylate may
be related with hypersensitivity in the CAS. Copyright © 2014. Published by Elsevier B.V.
Salicylate-induced auditory perceptual disorders and plastic changes in nonclassical auditory
centers in rats.
Neural Plast. 2014;2014:658741. doi: 10.1155/2014/658741. Epub 2014 May 7.
Chen GD, Radziwon KE, Kashanian N, Manohar S, Salvi R.
Center for Hearing and Deafness, State University of New York at Buffalo, 137 Cary Hall, 3435 Main
Street, Buffalo, NY 14214, USA.
Previous studies have shown that sodium salicylate (SS) activates not only central auditory structures, but
also nonauditory regions associated with emotion and memory. To identify electrophysiological changes in
the nonauditory regions, we recorded sound-evoked local field potentials and multiunit discharges from the
striatum, amygdala, hippocampus, and cingulate cortex after SS-treatment. The SS-treatment produced
behavioral evidence of tinnitus and hyperacusis. Physiologically, the treatment significantly enhanced
sound-evoked neural activity in the striatum, amygdala, and hippocampus, but not in the cingulate. The
enhanced sound evoked response could be linked to the hyperacusis-like behavior. Further analysis
showed that the enhancement of sound-evoked activity occurred predominantly at the midfrequencies,
likely reflecting shifts of neurons towards the midfrequency range after SS-treatment as observed in our
previous studies in the auditory cortex and amygdala. The increased number of midfrequency neurons
would lead to a relative higher number of total spontaneous discharges in the midfrequency region, even
though the mean discharge rate of each neuron may not increase. The tonotopical overactivity in the
midfrequency region in quiet may potentially lead to tonal sensation of midfrequency (the tinnitus). The
neural changes in the amygdala and hippocampus may also contribute to the negative effect that patients
associate with their tinnitus. Free PMC Article.
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XVII Psychological Factors
Tinnitus-related distress and the personality characteristic resilience.
Neural Plast. 2014;2014:370307. doi: 10.1155/2014/370307. Epub 2014 Jul 8.
Wallhäusser-Franke E1, Delb W2, Balkenhol T1, Hiller W3, Hörmann K4.
1
Medical Faculty Mannheim, Heidelberg University, ENT-Department, Unit of Phoniatrics and Audiology,
Ludolf-Krehl-Straße 13-17, 68167 Mannheim, Germany.
It has been suggested that personality traits may be prognostic for the severity of suffering from tinnitus.
Resilience as measured with the Wagnild and Young resilience scale represents a positive personality
characteristic that promotes adaptation to adverse life conditions including chronic health conditions. Aim
of the study was to explore the relation between resilience and tinnitus severity. In a cross-sectional study
with a self-report questionnaire, information on tinnitus-related distress and subjective tinnitus loudness
was recorded together with the personality characteristic resilience and emotional health, a measure
generated from depression, anxiety, and somatic symptom severity scales. Data from 4705 individuals
with tinnitus indicate that tinnitus-related distress and to a lesser extent the experienced loudness of the
tinnitus show an inverse correlation with resilience. A mediation analysis revealed that the relationship
between resilience and tinnitus-related distress is mediated by emotional health. This indirect effect
indicates that high resilience is associated with better emotional health or less depression, anxiety, and
somatic symptom severity, which in turn is associated with a less distressing tinnitus. Validity of resilience
as a predictor for tinnitus-related distress is supported but needs to be explored further in longitudinal
studies including acute tinnitus patients. Free PMC Article.
Tinnitus and its association with psychiatric disorders: systematic review.
J Laryngol Otol. 2014 Jul 17:1-5. [Epub ahead of print]
Pinto PC1, Marcelos CM1, Mezzasalma MA1, Osterne FJ1, de Melo Tavares de Lima MA2, Nardi AE1.
1
Laboratory of Panic and Respiration (Institute of Psychiatry), Brazil.
Objectives: To systematically review the literature on the occurrence of psychiatric diagnoses in a tinnitusaffected population, and correlate the presence of psychiatric disorders with tinnitus-related annoyance
and severity. Method: A systematic review of the literature published between January 2000 and December
2012 was performed using PubMed, ISI Web of Science and SciELO databases. Original articles in English
and Portuguese that focused on the diagnosis of mental disorders associated with tinnitus, especially
anxiety and depression, were identified. Results: A total of 153 articles were found and 16 were selected.
Fifteen articles showed a high prevalence of psychiatric disorders in tinnitus-affected patients, and nine
showed a high correlation between the presence of a psychiatric disorder and tinnitus-related annoyance
and severity. Conclusion: The prevalence of psychiatric disorders, especially anxiety and depression, is
high in tinnitus patients, and the presence of these disorders correlates with tinnitus-related annoyance
and severity.
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The relationship of perceived severity of tinnitus with depression, anxiety, hearing status, age
and gender in individuals with tinnitus.
Int Tinnitus J. 2013;18(1):29-34. doi: 10.5935/0946-5448.20130005.
Udupi VA, Uppunda AK, Mohan KM, Alex J, Mahendra MH.
INTRODUCTION: The present study investigated the relationship between the perceived tinnitus severity,
depressive and anxiety symptoms in individuals with tinnitus. An attempt was also made to see if any
relationship exists between the perceived tinnitus severity and the age, gender or hearing status of the
sufferer. MATERIALS AND METHODS: Fifty individuals (31 males, 19 females) with tinnitus (age range 19
to 60 years) were enrolled in the study. After the routine pure tone audiometry, each participant completed
the Tinnitus Handicap Inventory, the State-Trait Anxiety Inventory and the Inventory of Depressive
Symptomatology-Self Report-30. RESULTS: A significant correlation (r = 0.585, p pp < 0.01 respectively).
Furthermore, age, gender and hearing status did not significantly influence the perceived severity of
tinnitus. CONCLUSION: The results support the view that there is a strong relation between tinnitus and
anxiety-depressive symptoms. Further, perceived severity of tinnitus is not influenced by age, gender and
hearing status of the individual.
Modulation of Electrocortical Brain Activity by Attention in Individuals with and without Tinnitus.
Neural Plast. 2014;2014:127824. doi: 10.1155/2014/127824. Epub 2014 Jun 12.
Paul BT1, Bruce IC2, Bosnyak DJ3, Thompson DC1, Roberts LE3.
1
Department of Psychology, Neuroscience & Behaviour, McMaster University, 1280 Main Street West,
Hamilton, ON, Canada L8S 4K1.
Age and hearing-level matched tinnitus and control groups were presented with a 40 Hz AM sound using
a carrier frequency of either 5 kHz (in the tinnitus frequency region of the tinnitus subjects) or 500 Hz
(below this region). On attended blocks subjects pressed a button after each sound indicating whether a
single 40 Hz AM pulse of variable increased amplitude (target, probability 0.67) had or had not occurred.
On passive blocks subjects rested and ignored the sounds. The amplitude of the 40 Hz auditory steadystate response (ASSR) localizing to primary auditory cortex (A1) increased with attention in control groups
probed at 500 Hz and 5 kHz and in the tinnitus group probed at 500 Hz, but not in the tinnitus group probed
at 5 kHz (128 channel EEG). N1 amplitude (this response localizing to nonprimary cortex, A2) increased
with attention at both sound frequencies in controls but at neither frequency in tinnitus. We suggest that
tinnitus-related neural activity occurring in the 5 kHz but not the 500 Hz region of tonotopic A1 disrupted
attentional modulation of the 5 kHz ASSR in tinnitus subjects, while tinnitus-related activity in A1 distributing
nontonotopically in A2 impaired modulation of N1 at both sound frequencies. Free PMC Article.
XVIIIHyperacusis
No publications this time.
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113
Controlled Clinical Trials
Sources: www.clinicaltrials.gov, www.controlled-trials.com (Oct. 2014)
Effectiveness of Neuronavigated Continuous Theta Burst Stimulation of the Left Heschl's Gyrus in
Chronic Tinnitus
This study is completed.
ClinicalTrials.gov Identifier: NCT02199106
Sponsor: University of Regensburg, Germany
Information provided by (Responsible Party): Berthold Langguth, MD, Ph.D., University of Regensburg
Study start: January 2009
First received: July 22, 2014
Tinnitus is the phantom auditory perception of sound in the absence of an external or internal acoustic
stimulus. It is a frequent problem which can interfere significantly with the ability to lead a normal life.
One significant modulator of tinnitus is stress. Tinnitus has been shown to be generated in the brain, as a
result of functional reorganization of auditory neural pathways and the central auditory system. Repetitive
transcranial magnetic stimulation (rTMS) is also effective in treatment of tinnitus with moderate effect
size. Pilot data were positive for low-frequency rTMS applied to the temporal and temporoparietal areas.
Continuous theta burst stimulation (cTBS) is a new protocol of rTMS with a possible superior effect in
contrast to low-frequency rTMS. Also anatomical neuronavigation might increase the efficacy of rTMS due
to exact targeting of the primary auditory cortex. Thus, the aim of this study is the evaluation of the clinical
efficacy of neuronavigated left-sided cTBS in chronic tinnitus in a randomised sham-controlled two-arm
design.
Treating Tinnitus Using Eutectic Mixture of Local Anesthetics (EMLA) 5% Cream
This study is not yet open for participant recruitment.
ClinicalTrials.gov Identifier: NCT02266160
Sponsor: HaEmek Medical Center, Israel
Information provided by (Responsible Party): HaEmek Medical Center, Israel
Study start: November 2014
First received: September 22, 2014
The investigators like to learn whether EMLA cream 5% helps tinnitus patients. so far it is known that
lidocaine I.V do helps tinnitus but until now it is not clear if topical anaesthetics (e.g EMLA cream) helps
tinnitus.
The investigators are going to compare 4 days of treatment of EMLA 5% cream Versus (VS.) cetomacrogol
cream (water- based lotion cream) in treating tinnitus patients.
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EMA-Defined Tinnitus Subgroups
This study is currently recruiting participants.
ClinicalTrials.gov Identifier: NCT02191592
Sponsor: Washington University School of Medicine
Information provided by (Responsible Party): Jay F. Piccirillo, MD, Washington University School of
Medicine
Study start: July 2014
First received: July 14, 2014
The purpose of this research study is to test a new way of measuring the severity of tinnitus using a tool
called Ecological Momentary Assessmehesnt (EMA) of Tinnitus. We will compare the relationship with this
tool with another widely used questionnaire. Previous studies we have done suggest there are different
patterns of tinnitus bother; we plan to explore how often these patterns occur, and how many patterns of
tinnitus bother there are. And lastly we want to test how reliable this type of testing is for measuring the
amount of bother people experience from their tinnitus.
Hypothesis 1: We will be able to identify 6 or more distinctive patterns of tinnitus.
Hypothesis 2: EMA will provide a reliable method for more accurately capturing the amount of bother
individuals have from tinnitus.
A Feasibility Study Assessing the Effectiveness of rTMS in Tinnitus
This study is currently recruiting participants.
ClinicalTrials.gov Identifier: NCT02269839
Sponsor: Sheffield Teaching Hospitals NHS Foundation Trust
Information provided by (Responsible Party): Sheffield Teaching Hospitals NHS Foundation Trust
Study start: September 2014
First received: June 27, 2014
Tinnitus is a common problem which can have a severe impact on quality of life and for which there is no
truly successful treatment available.
Repetitive transcranial magnetic stimulation (rTMS) is a method of stimulating the brain through the
application of a magnetic field in a series of rapid pulses and may be a valuable treatment for patients with
tinnitus.
The overall aim of this research is to see if patients with tinnitus benefit from treatment with rTMS, and in
particular whether one type (continuous theta burst) is more effective than other variations of rTMS. Prior
to developing a definitive study to address this area a feasibility study needs to be performed.
The proposed feasibility study aims to determine outcomes necessary to enable development of a definitive
study in the future.
40 patients suffering with idiopathic tinnitus will be randomised into 2 groups, a control group receiving a
sham treatment, and an active treatment group receiving theta-burst rTMS on 5 consecutive days.
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115
Cochlear Implantation in Single Sided Deafness and Asymmetrical Hearing Loss: a Cost/Utility
Study. (CISSD)
This study is not yet open for participant recruitment.
ClinicalTrials.gov Identifier: NCT02204618
Sponsor: University Hospital, Toulouse
Information provided by (Responsible Party): University Hospital, Toulouse
Study start: September 2014
First received: July 28, 2014
The investigators assume that cochlear implants in this indication are not only effective but also costeffective. The investigators' experimental protocol relies on real life therapeutic strategy, where a cochlear
implant may be proposed once CROS and bone conductions systems have failed. Thus, all subjects
enrolled in our study will try CROS and bone conduction devices. If these trials are ineffective, the
remaining subjects will be randomized between two arms (cochlear implantation vs 6 months abstention
followed by cochlear implantation). A comparative cost-utility analysis between the two arms, of medical
consequences measured in terms of quality of life will identify a preference for a strategy. Specific binaural
hearing measurements with respect to each treatment option (abstention, CROS, bone conduction device,
cochlear implant) will also be collected.
Cochlear Implants for Adults With Single-sided Deafness
This study is ongoing, but not recruiting participants..
ClinicalTrials.gov Identifier: NCT02259192
Sponsor: Rober Shannon
Information provided by (Responsible Party): Rober Shannon, University of Southern California
Study start: September 2014
First received: September 26, 2014
The purpose of this investigation is to determine the safety and preliminary efficacy of implanting a cochlear
implant (CI) in the profoundly deaf ear of an adult with one normal hearing (NH) ear (termed "single-sided
deaf" person, or SSD). The potential subjects will have been deafened post-lingually, thus, at one point the
now deafened ear did conduct sound from the periphery. The MED-EL Maestro CI system will be implanted
in ten (10) SSD patients.The long-term goal of this research program is to determine whether the CI, in
combination with the NH ear, may provide improved localization ability and better speech understanding
in noise, relative to performance before cochlear implantation (i.e., with the NH ear alone). A secondary
long-term goal is to determine whether CI stimulation may reduce tinnitus severity, compared to tinnitus
experienced prior to cochlear implantation or when the CI is turned off, after implantation.
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Can an early, tailored return to work management intervention focused on support to cancer
patients undergoing treatment and their workplaces enhance the readiness for return to work and
the return to work rate?
Status of Trial: Ongoing.
ISRCTN Identifier: ISRCTN50753764
DOI 10.1186/ISRCTN50753764
Sponsor: Public Health and Quality Improvement, Central Denmark Region (Denmark)
Study start: December 2013
Date assigned: August 23, 2014
We hypothesise that an early, tailored occupational rehabilitation intervention conducted by a municipal
job consultant parallel to cancer treatment at the oncology ward will increase the chance of an early
return to work among cancer survivors from two municipalities compared with other cancer survivors not
receiving this intervention but treated at the same hospital and receiving the standard municipal sick leave
management.
Furthermore, we hypothesise that cancer survivors with low socioeconomic status and co-morbidity will
benefit more from the intervention, i.e. increased chance of an early return to work, than cancer survivors
having high socioeconomic status and not suffering from co-morbidity.
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