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Wang H, Fan T, Lu Y, Que L, Zou B, Huang L, Chen F, Liang X, Shi Z, Hu Q, Yi T, Liang L, Hu K. Baseline audiometric assessment of newly diagnosed nasopharyngeal carcinoma patients: a multicentre cross-sectional study. Int J Cancer 2025; 157:239-250. [PMID: 39902938 DOI: 10.1002/ijc.35358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 01/20/2025] [Accepted: 01/22/2025] [Indexed: 02/06/2025]
Abstract
Hearing impairment is one of the most common chief complaints in newly diagnosed nasopharyngeal carcinoma (NPC) patients, but baseline audiometric assessments are seldom reported. This study aims to investigate the prevalence of hearing impairment in this population through comprehensive audiometric testing and analyse the associated factors. A cohort of 187 newly diagnosed NPC patients were recruited from three hospitals. Pre-treatment comprehensive audiometric assessments, including pure-tone audiometry, tympanometry, Eustachian tube function tests and distortion product otoacoustic emissions (DPOAE), were performed to evaluate hearing impairment. Patient characteristics and tumour invasion extent were also recorded. Binary logistic regression was employed to analyse factors associated with hearing impairment. Among the patients, 27.5% of ears showed conductive hearing loss (CHL), 13.6% had sensorineural hearing loss (SNHL), and 10.4% demonstrated mixed hearing loss. Additionally, 43.6% of ears exhibited abnormal tympanograms, 86.1% had Eustachian tube dysfunction, and 77.3% failed the DPOAE test. Multivariable analysis identified subjective hearing symptoms, mastoiditis, and invasion of the tensor veli palatini muscle and Eustachian tube as factors associated with CHL. T stage, mastoiditis, and invasion of the tensor veli palatini muscle and nasal cavity were linked to abnormal tympanograms. T stage, sinusitis, and invasion of the levator veli palatini muscle significantly affected Eustachian tube function, while age influenced both SNHL and DPOAE results. Hearing impairment is prevalent among newly diagnosed NPC patients, with over half exhibiting various forms. Comprehensive baseline audiometric assessment in this population is crucial for developing individualized treatment strategies and enabling early intervention to prevent further hearing deterioration.
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Affiliation(s)
- Housheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- State Key Laboratory of Targeting Oncology, Guangxi Medical University, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumour (Guangxi Medical University), Ministry of Education, Guangxi, China
| | - Ting Fan
- Department of Radiation Oncology, Guilin Hospital of Integrated Traditional Chinese and Western Medicine, Guilin, China
| | - Yushuang Lu
- Department of Oncology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Lilin Que
- Department of Oncology, The Sixth Affiliated Hospital of Guangxi Medical University/The First People's Hospital of Yulin, Yulin, China
| | - Bin Zou
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lulu Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fuli Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xian Liang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhiling Shi
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qianxin Hu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tingzhuang Yi
- Department of Oncology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Key Laboratory of Research on Prevention and Control of High Incidence Diseases in Western Guangxi, Baise, China
| | - Leifeng Liang
- Department of Oncology, The Sixth Affiliated Hospital of Guangxi Medical University/The First People's Hospital of Yulin, Yulin, China
| | - Kai Hu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- State Key Laboratory of Targeting Oncology, Guangxi Medical University, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumour (Guangxi Medical University), Ministry of Education, Guangxi, China
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Xie L, Martín RDS, Fink S, Singer W, Wolpert SM, Rüttiger L, Knipper M. Cochlear neural contributions to triple network changes in tinnitus, hyperacusis & misophonia? A perspective review. Hear Res 2025; 463:109305. [PMID: 40383086 DOI: 10.1016/j.heares.2025.109305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 04/11/2025] [Accepted: 05/09/2025] [Indexed: 05/20/2025]
Abstract
What do tinnitus, the perception of sounds without an internal or external source of noise, hyperacusis, the pathological hypersensitivity to noise, or misophonia, an intolerance to certain everyday noises, have in common, and what differentiates them? A large number of excellent studies focused in the last few decades on identifying the neural correlates of tinnitus, hyperacusis, or misophonia on the basis of central triple-network changes. In this perspective review we explicitly examine, possible differential and causal involvement of peripheral components as a presumptive trigger that may drive observed triple-network changes. Based on our results, we venture to hypothesize that: (i) tinnitus, hyperacusis, and misophonia can occur despite clinically normal hearing thresholds, and are likely causally independent of sex and age, (ii) tinnitus and hyperacusis, but possibly also misophonia are related to altered auditory processing that through desynchronized (tinnitus) or hyperactive (hyperacusis, misophonia) bottom-up ascending processing potentially explains the activity changes in, e.g., default or salient brain networks, as suggested in various studies of these different diseases. (iii) In misophonia a stress-induced top-down influence, as deep as the auditory nerve fibers, may be discussed as a contributor to generating misophonia-trigger sounds, a hypothesis that can be tested in future studies. We hope that the selective consideration of a possible interaction between peripheral and central components will help to minimize the greatest handicap of these pathologies to date towards successful therapy: the lack of clarification of the underlying causative mechanism of the diseases.
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Affiliation(s)
- Li Xie
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany; Department of Otolaryngology - Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Rodrigo Donoso-San Martín
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany; Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Stefan Fink
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Wibke Singer
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Stephan M Wolpert
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Lukas Rüttiger
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany
| | - Marlies Knipper
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, University of Tübingen, Tübingen, Germany.
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Wang Q, Zhao Y, Wang Y, Wu Y, Meng Z. Development of the West China Tinnitus Impact Inventory and Analysis of Its Reliability and Validity. Ear Hear 2025; 46:401-407. [PMID: 39252157 PMCID: PMC11825479 DOI: 10.1097/aud.0000000000001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 08/14/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVES Owing to differences in cultural background, education level, and lifestyle, certain items of existing tinnitus evaluation scales are difficult for Chinese patients to understand, despite being translated. However, few independently developed scales have been developed specifically for Chinese patients. Therefore, with this study, we aimed to construct a tinnitus scale, the West China Tinnitus Impact Inventory (WCTII), suitable for the accurate reflection of the impact and severity of the disease in this population. DESIGN Basic items were obtained through semistructured interviews with patients with tinnitus. We invited 23 domestic experts on tinnitus to form an expert group. The basic items were modified using the Delphi method. Cronbach's α values for the scale scores and correlation coefficients between the items and the scale scores were calculated. Items with correlation coefficients <0.5 were deleted. Exploratory factor analysis was conducted to determine the scale structure of the items remaining after item deletion. The intragroup correlation coefficient was used to assess the scale's test-retest reliability. The Pearson correlation coefficient between the scale scores and the scores for the Chinese-Mandarin version of the Tinnitus Handicap Inventory was used to evaluate concurrent validity. RESULTS After five rounds of expert correspondence and exploratory factor analysis, we determined the content and structure of the scale. The WCTII consists of 19 items in 4 subscales, namely, F1: the impact of tinnitus on emotion (items 1 to 9); F2: the impact of tinnitus on sleep (items 10 to 12); F3: patients' beliefs about their tinnitus (items 13 to 16, 19); and F4: the impact of tinnitus on auditory processing ability (items 17 to 18). The overall Cronbach's α was 0.934. The Cronbach's α values for F1 to F4 were 0.912, 0.843, 0.829, and 0.838, respectively. The intragroup correlation coefficient (95% confidence interval) of the total scale and F1 to F4 were 0.779 (0.549 to 0.886), 0.738 (0.496 to 0.860), 0.826 (0.713 to 0.897), 0.720 (0.536 to 0.836), and 0.715 (0.532 to 0.832), respectively. The correlation between the WCTII and Chinese-Mandarin version of the Tinnitus Handicap Inventory scores was 0.849 ( p < 0.001). CONCLUSIONS The WCTII yielded satisfactory reliability and validity, indicating that it can be used to assess the severity of tinnitus in Chinese patients.
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Affiliation(s)
- Qiang Wang
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Department of Audiology and Speech Language Pathology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yu Zhao
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Department of Audiology and Speech Language Pathology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yibo Wang
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Department of Audiology and Speech Language Pathology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yunyu Wu
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Department of Audiology and Speech Language Pathology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Zhaoli Meng
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Department of Audiology and Speech Language Pathology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Gross J, Knipper M, Mazurek B. Candidate Key Proteins in Tinnitus-A Bioinformatic Study of Synaptic Transmission in the Inferior Colliculus. Int J Mol Sci 2025; 26:1831. [PMID: 40076458 PMCID: PMC11899339 DOI: 10.3390/ijms26051831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 02/18/2025] [Accepted: 02/18/2025] [Indexed: 03/14/2025] Open
Abstract
Proteins involved in synaptic transmission in normal hearing, acoustic stimulation, and tinnitus were identified using protein-protein interaction (PPI) networks. The gene list for tinnitus was compiled from the GeneCards database using the keywords "synaptic transmission" AND "inferior colliculus" AND "tinnitus" (Tin). For comparison, two gene lists were built using the keywords "auditory perception" (AP) and "acoustic stimulation" (AS). The STRING and the Cytoscape data analyzer were used to identify the top two high-degree proteins (HDPs) and the corresponding high-score interaction proteins (HSIP). The top1 key proteins of the AP and AS processes are BDNF and the receptor NTRK2; the top2 key proteins in the AP process are PVALB, together with GAD1, CALB1, and CALB2, which are important for the balance of excitation and inhibition. In the AS process, the top2 key proteins are FOS, CREB1, EGR1, and MAPK1, reflecting an activated state. The top1 key proteins of the Tin process are BDNF, NTRK3, and NTF3; these proteins are associated with the proliferation and differentiation of neurons and indicate the remodeling of synaptic transmission in IC. The top2 key proteins are GFAP and S100B, indicating a role for astrocytes in the modulation of synaptic transmission.
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Affiliation(s)
- Johann Gross
- Tinnitus Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
- Leibniz Society of Science Berlin, 10117 Berlin, Germany;
| | - Marlies Knipper
- Leibniz Society of Science Berlin, 10117 Berlin, Germany;
- Department of Otolaryngology, Head and Neck Surgery, Tübingen Hearing Research Center (THRC), Molecular Physiology of Hearing, University of Tübingen, 72076 Tübingen, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
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Teggi R, Cangiano I, Familiari M, Gioffrè V, Nobile A, Gatti O. The Tinnitus Handicap Inventory Total Score: What Really Counts? Experience on a Sample of 1156 Patients. Audiol Res 2025; 15:4. [PMID: 39846557 PMCID: PMC11755440 DOI: 10.3390/audiolres15010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 01/08/2025] [Accepted: 01/14/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Tinnitus is a frequent symptom, and is present in 10-15% of people who suffer from chronic tinnitus, defined as heard every day for at least 6 months. Among these, 1-2% develop a strong emotive reaction, anxiety, and depression, leading to poor quality of life. OBJECTIVES to evaluate the comorbidities in tinnitus sufferers. METHODS In our retrospective study, we collected data on 1156 subjects with tinnitus present for at least 3 months, including age, audiometric exam, THI questionnaire, vascular disorders, fluctuations, causal factors, lifetime psychiatric disorders, and the presence of migraine. A linear regression model was used to assess the independent role of these variables on the THI total score representing tinnitus annoyance. A lifetime history of psychiatric disorders and migraine were predictive for the development of a disabling tinnitus. RESULTS Among comorbidities a history of previous psychiatric disorders was predictive for developing tinnitus. Moreover, no correlation has been found between hearing level and THI total score. CONCLUSIONS Our data are not inconsistent with the hypothesis that psychological disorders and a particular personality trait may be the main causal factors for tinnitus annoyance.
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Affiliation(s)
- Roberto Teggi
- ENT Division, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (I.C.); (A.N.); (O.G.)
| | - Iacopo Cangiano
- ENT Division, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (I.C.); (A.N.); (O.G.)
| | | | - Vittorio Gioffrè
- ENT Division, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (I.C.); (A.N.); (O.G.)
| | - Alessandro Nobile
- ENT Division, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (I.C.); (A.N.); (O.G.)
| | - Omar Gatti
- ENT Division, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (I.C.); (A.N.); (O.G.)
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Martins ML, Galdino MKC, Silva DSF, Valença ECD, Braz Dos Santos M, de Medeiros JF, Machado DGDS, da Rosa MRD. Standalone tDCS for tinnitus treatment: Is it a good choice? Neurophysiol Clin 2025; 55:103035. [PMID: 39709642 DOI: 10.1016/j.neucli.2024.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Accepted: 11/30/2024] [Indexed: 12/24/2024] Open
Affiliation(s)
- Mariana Lopes Martins
- Department of Speech-Language Pathology, Federal University of Paraiba - UFPB, João Pessoa, PB, 58051-900, Brazil.
| | | | - Daniel Soares Ferreira Silva
- Department of Speech-Language Pathology, University Center of João Pessoa - UNIPÊ, João Pessoa, PB, 58053-000, Brazil
| | | | - Mariana Braz Dos Santos
- Department of Speech-Language Pathology, Federal University of Paraiba - UFPB, João Pessoa, PB, 58051-900, Brazil
| | | | | | - Marine Raquel Diniz da Rosa
- Department of Speech-Language Pathology, Federal University of Paraiba - UFPB, João Pessoa, PB, 58051-900, Brazil
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Chen Z, Lu Y, Chen C, Lin S, Xie T, Luo X, Lin Y, Chen Y, Feng Y, Xiong G, Ma X, Zeng C, Lin C. Association between tinnitus and hearing impairment among older adults with age-related hearing loss: a multi-center cross-sectional study. Front Neurol 2024; 15:1501561. [PMID: 39741702 PMCID: PMC11686227 DOI: 10.3389/fneur.2024.1501561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 11/14/2024] [Indexed: 01/03/2025] Open
Abstract
Objective The relationship between tinnitus in the elderly with hearing loss remains elusive. This study aimed to reveal the association between tinnitus and hearing impairment among older adults with age-related hearing loss (ARHL). Methods This cross-sectional study was conducted among a population of outpatients diagnosed with ARHL at four medical centers in different regions of China, from June 2020 to June 2023. ARHL patients were divided into two groups based on their self-reported tinnitus: tinnitus and non-tinnitus. Multivariable linear regression models were used to assess the association between tinnitus and hearing impairment in ARHL patients. Subgroup analyses, stratified by gender and age, were performed to further evaluate the association. Results A total of 418 older adults with ARHL were included in the study. Compared to the non-tinnitus group, ARHL patients with tinnitus had lower hearing thresholds (β = -5.07; 95% confidence interval (CI) -9.32 to -0.81; p = 0.020). On subgroup analyses stratified by gender and age, the male ARHL patients with tinnitus still had lower hearing thresholds compared to those without tinnitus (β = -6.96; 95% CI -12.70 to 1.22; p = 0.018). In females, tinnitus was not associated with hearing thresholds (β = -3.69; 95% CI -10.11 to 2.74, p = 0.262). There was no association between tinnitus and hearing thresholds in both the age group of ≥70 years (β = -4.31; 95% CI -9.65 to 1.03; p = 0.116) and the age group of <70 years (β = -3.54; 95% CI -9.96 to 2.89; p = 0.282). Conclusion Based on this multi-center cross-sectional study, we reveal that there is no evidence for the assumption that tinnitus may exacerbate hearing loss in the elderly for the first time. On the contrary, tinnitus is associated with better hearing in the male elderly with ARHL. More extensive longitudinal studies are needed to give a comprehensive insight of the present findings and the underlying mechanisms.
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Affiliation(s)
- Zhifeng Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute of Otolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yan Lu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chenyu Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Hearing Medicine Research, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Shaolian Lin
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ting Xie
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaoyang Luo
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yanchun Lin
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yuqing Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yong Feng
- Department of Otorhinolaryngology, Xiangya Hospital Central South University, Changsha, China
| | - Guanxia Xiong
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiulan Ma
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chaojun Zeng
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otolaryngology, Affiliated Hospital of Putian University, Putian, China
- Putian Institute of Otolaryngology, Affiliated Hospital of Putian University, Putian, China
| | - Chang Lin
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute of Otolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Ding Y, Hou Z, Wang M, Xu L, Wang H. Mastoid approach for local drug delivery to the inner ear for treating hearing loss. J Control Release 2024; 376:488-501. [PMID: 39437965 DOI: 10.1016/j.jconrel.2024.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 10/14/2024] [Accepted: 10/18/2024] [Indexed: 10/25/2024]
Abstract
Hearing loss is a prevalent disability worldwide. Dexamethasone (Dex) is commonly used to treat hearing loss, administered either systemically or locally. However, targeted delivery of Dex to the inner ear remains challenging, which limits its therapeutic efficacy. This study aimed to develop new methods to improve Dex delivery to the inner ear and enhance its treatment effect. Mastoid, intraperitoneal, and intratympanic delivery routes for Dex were investigated in guinea pig cochlea. Liquid chromatography-mass spectrometry and immunohistochemistry were employed to compare the distribution of Dex in the perilymph and tissue uptake. Poly (lactic-co-glycolic acid) nanoparticles loaded with Dex (PLGA-NPs-Dex) were prepared, and their transport mechanism across the round window membrane (RWM) was explored. Among the three delivery routes, mastoid administration produced the highest Dex concentration in the perilymph. Compared to the control, PLGA-NPs-Dex provided significantly enhanced protection against lipopolysaccharide- and noise-induced hearing damage following mastoid administration. Mastoid delivery provides an accessible route for drug delivery to the inner ear and nanoparticle-based systems via this route represent a viable strategy for treating inner ear diseases. This approach caused less damage to the inner ear, making it a promising option for clinical use in treating hearing loss.
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Affiliation(s)
- Yanjiao Ding
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, China; Department of Pharmacy, Shandong Second Provincial General Hospital, Jinan, Shandong, China
| | - Zhiqiang Hou
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, China
| | - Mingming Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, China
| | - Lei Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, China.
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, Shandong, China.
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Vater J, Gröschel M, Szczepek AJ, Olze H. Electrical Ear Canal Stimulation as a Therapeutic Approach for Tinnitus-A Proof of Concept Study. J Clin Med 2024; 13:2663. [PMID: 38731192 PMCID: PMC11084225 DOI: 10.3390/jcm13092663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Tinnitus-the perception of sound despite the absence of an external source-can be a debilitating condition for which there are currently no pharmacological remedies. Our proof of concept study focused on the immediate effects of non-invasive electrical stimulation through the ear canal on loudness and tinnitus-induced distress. In addition, we aimed to identify variables that may affect the simulation outcomes. Methods: Sixty-six patients (29 women and 37 men, mean age 54.4 ± 10.4) with chronic tinnitus were recruited to the tertiary referral hospital between December 2019 and December 2021. They underwent 10 min of electrical stimulation through the ear canal for three consecutive days. Visual analog scales measured loudness and tinnitus-induced distress immediately before and after stimulation. Results: After three days of electrical stimulation, tinnitus loudness decreased in 47% of patients, 45.5% reported no change, and 7.6% reported worsening. Tinnitus severity decreased in 36.4% of cases, 59.1% of patients reported no change, and 4.5% reported worsening. Women responded positively to therapy earlier than men. In addition, tinnitus distress decreased in patients with compensated tinnitus but not in those with uncompensated tinnitus. Finally, patients with bilateral tinnitus improved earlier than those with unilateral tinnitus, and the age of the patients did not influence the stimulation results. Conclusions: Our proof of concept study confirms the potential of non-invasive electrical stimulation of the ear as a promising screening approach to identifying patients for more advanced electrostimulation treatment, such as an extracochlear anti-tinnitus implant. These findings have practical implications for tinnitus management, offering hope for improved patient care.
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Affiliation(s)
| | | | | | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität and Berlin Humboldt Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany; (J.V.); (M.G.); (A.J.S.)
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Zhu K, Wang T, Li S, Liu Z, Zhan Y, Zhang Q. NcRNA: key and potential in hearing loss. Front Neurosci 2024; 17:1333131. [PMID: 38298898 PMCID: PMC10827912 DOI: 10.3389/fnins.2023.1333131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024] Open
Abstract
Hearing loss has an extremely high prevalence worldwide and brings incredible economic and social burdens. Mechanisms such as epigenetics are profoundly involved in the initiation and progression of hearing loss and potentially yield definite strategies for hearing loss treatment. Non-coding genes occupy 97% of the human genome, and their transcripts, non-coding RNAs (ncRNAs), are widely participated in regulating various physiological and pathological situations. NcRNAs, mainly including micro-RNAs (miRNAs), long-stranded non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), are involved in the regulation of cell metabolism and cell death by modulating gene expression and protein-protein interactions, thus impacting the occurrence and prognosis of hearing loss. This review provides a detailed overview of ncRNAs, especially miRNAs and lncRNAs, in the pathogenesis of hearing loss. We also discuss the shortcomings and issues that need to be addressed in the study of hearing loss ncRNAs in the hope of providing viable therapeutic strategies for the precise treatment of hearing loss.
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Affiliation(s)
- Keyu Zhu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Wang
- Department of Medical Ultrasound, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Sicheng Li
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zeming Liu
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Zhan
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Zhang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Jain V, Policeni B, Juliano AF, Adunka O, Agarwal M, Dubey P, Friedman ER, Gule-Monroe MK, Hagiwara M, Hunt CH, Lo BM, Oh ES, Rath TJ, Roberts JK, Schultz D, Taheri MR, Zander D, Burns J. ACR Appropriateness Criteria® Tinnitus: 2023 Update. J Am Coll Radiol 2023; 20:S574-S591. [PMID: 38040471 DOI: 10.1016/j.jacr.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Tinnitus is abnormal perception of sound and has many subtypes. Clinical evaluation, audiometry, and otoscopy should be performed before ordering any imaging, as the choice of imaging will depend on various factors. Type of tinnitus (pulsatile or nonpulsatile) and otoscopy findings of a vascular retrotympanic lesion are key determinants to guide the choice of imaging studies. High-resolution CT temporal bone is an excellent tool to detect glomus tumors, abnormal course of vessels, and some other abnormalities when a vascular retrotympanic lesion is seen on otoscopy. CTA or a combination of MR and MRA/MRV are used to evaluate arterial or venous abnormalities like dural arteriovenous fistula, arteriovenous malformation, carotid stenosis, dural sinus stenosis, and bony abnormalities like sigmoid sinus wall abnormalities in cases of pulsatile tinnitus without a vascular retrotympanic lesion. MR of the brain is excellent in detecting mass lesions such as vestibular schwannomas in cases of unilateral nonpulsatile tinnitus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Oliver Adunka
- The Ohio State University Wexner Medical Center, Columbus, Ohio; American Academy of Otolaryngology-Head and Neck Surgery
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Mari Hagiwara
- New York University Langone Medical Center, New York, New York
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Esther S Oh
- Johns Hopkins University School of Medicine, Baltimore, Maryland; American Geriatrics Society
| | | | - J Kirk Roberts
- Columbia University Medical Center, New York, New York; American Academy of Neurology
| | - David Schultz
- Evansville Primary Care, Evansville, Indiana; American Academy of Family Physicians
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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12
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Cantuaria ML, Pedersen ER, Poulsen AH, Raaschou-Nielsen O, Hvidtfeldt UA, Levin G, Jensen SS, Schmidt JH, Sørensen M. Transportation Noise and Risk of Tinnitus: A Nationwide Cohort Study from Denmark. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:27001. [PMID: 36722980 PMCID: PMC9891135 DOI: 10.1289/ehp11248] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is a growing body of evidence linking residential exposure to transportation noise with several nonauditory health outcomes. However, auditory outcomes, such as tinnitus, are virtually unexplored. OBJECTIVES We aimed to investigate the association between residential transportation noise and risk of incident tinnitus. METHODS We conducted a nationwide cohort study including all residents in Denmark age ≥30y, of whom 40,692 were diagnosed with tinnitus. We modeled road traffic and railway noise at the most (Ldenmax) and least (Ldenmin) exposed façades of all Danish addresses from 1990 until 2017. For all participants, we calculated 1-, 5-, and 10-y time-weighted mean noise exposure and retrieved detailed information on individual- and area-level socioeconomic covariates. We conducted analyses using Cox proportional hazards models. RESULTS We found positive associations between exposure to road traffic noise and risk of tinnitus, with hazard ratios of 1.06 [95% confidence interval (CI): 1.04, 1.08] and 1.02 (95% CI: 1.01, 1.03) per 10-dB increase in 10-y Ldenmin and Ldenmax, respectively. Highest risk estimates were found for women, people without a hearing loss, people with high education and income, and people who had never been in a blue-collar job. The association with road Ldenmin followed a positive, monotonic exposure-response relationship. We found no association between railway noise and tinnitus. DISCUSSION To our knowledge, this is the first study to show that residential exposure to road traffic noise may increase risk of tinnitus, suggesting noise may negatively affect the auditory system. If confirmed, this finding adds to the growing evidence of road traffic noise as a harmful pollutant with a substantial health burden. https://doi.org/10.1289/EHP11248.
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Affiliation(s)
- Manuella Lech Cantuaria
- The Mærsk McKinney Møller Institute, University of Southern Denmark, Odense, Denmark
- Work, Environment and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ellen Raben Pedersen
- The Mærsk McKinney Møller Institute, University of Southern Denmark, Odense, Denmark
| | - Aslak Harbo Poulsen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Ulla Arthur Hvidtfeldt
- Work, Environment and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gregor Levin
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Jesper Hvass Schmidt
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit for ORL – Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Mette Sørensen
- Work, Environment and Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
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13
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Wang S, Cha X, Li F, Li T, Wang T, Wang W, Zhao Z, Ye X, Liang C, Deng Y, Liu H. Associations between sleep disorders and anxiety in patients with tinnitus: A cross-sectional study. Front Psychol 2022; 13:963148. [PMID: 35992459 PMCID: PMC9389284 DOI: 10.3389/fpsyg.2022.963148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the characteristics of sleep disorders and anxiety in patients with tinnitus, their influencing factors, and the role of sleep disorders as mediators.MethodsThe general conditions and disease characteristics of 393 patients with tinnitus presented to the Changzheng Hospital of the Naval Medical University from 2018 to 2021 were collected. All patients accepted questionnaires such as Tinnitus Handicap Inventory (THI), Pittsburgh Sleep Quality Index (PSQI) and Self-rating Anxiety Scale (SAS), and then the characteristics and the influencing factors of sleep disorders and anxiety were analyzed.ResultsAmong the 393 tinnitus patients, 213 cases (54.19%) were diagnosed with sleep disorders, and 78 cases (19.85%) were diagnosed with anxiety, including 25 men (32.1%) and 53 women (67.9%). Binary regression showed that gender, hearing loss, tinnitus severity, and sleep disorders severity were positively associated with anxiety. Multiple logistic regression analysis showed that female gender (OR = 2.526, P = 0.008), hearing loss (OR = 2.901, P = 0.003, tinnitus severity (OR = 1.863, P = 0.003) and sleep disorders (OR = 2.510, P = 0.001) were the independent risk factors of anxiety. The mediating effect of sleep disorders between tinnitus severity and anxiety accounted for 27.88% of the total effect size.ConclusionFemales patients with hearing loss, moderate to severe tinnitus, and sleep disorders were at greater risk for anxiety, with sleep disorders partially mediating the anxiety associated with tinnitus.
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Affiliation(s)
- Shenglei Wang
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xudong Cha
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Fengzhen Li
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Tengfei Li
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Tianyu Wang
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Wenwen Wang
- Department of Neurology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Zhengqing Zhao
- Department of Neurology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Caiquan Liang
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
- *Correspondence: Caiquan Liang
| | - Yue Deng
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
- Yue Deng
| | - Huanhai Liu
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
- Huanhai Liu
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14
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Kim KW, Hwang JS, Chang J, Shin YJ. Association of Dry Eye Diseases and Auditory Sensitivity. J Clin Med 2022; 11:jcm11144171. [PMID: 35887934 PMCID: PMC9318287 DOI: 10.3390/jcm11144171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/28/2022] [Accepted: 07/16/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the association between dry eye and inner ear diseases in a Korean population. Methods: Data from the Korean National Health and Nutrition Survey (KNHANES V, 2010−2012), a national cross-sectional health examination and survey, were collected by the Korea Centers for Disease Control and Prevention. The association between dry eye and inner ear disease was determined using the chi-square test and logistic regression analysis. The individuals were divided into two age groups (<60 and ≥60 years). Results: In total, 17,542 individuals (n = 11,932 in the <60 years group and n = 5610 in the ≥60 years group) were enrolled. After adjusting for confounding factors, the logistic regression model revealed that the associated factors were dizziness and loss of balance experience (OR, 1.315; 95% CI, 1.143−1.513), self-awareness of abnormal voice (OR, 1.372; 95% CI, 1.120−1.679), subjective hearing discomfort (OR, 1.278; CI, 1.084−1.506), and tinnitus (OR, 1.265; 95% CI, 1.101−1.453). The inversely associated factor for dry eye was bilateral hearing loss (OR, 0.497; 95% CI, 0.367−0.672). The hearing threshold was lower in the dry eye group than in the non-dry eye group (p < 0.05). Conclusions: Tinnitus was associated with dry eye and bilateral hearing loss was inversely associated with dry eye. These results suggest that hypersensitivity of the senses and nerves, which is neuropathic hyperesthesia, is one of the main mechanisms of dry eye. Treatment of neuropathy may help in treating dry eye associated with dizziness or tinnitus.
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Affiliation(s)
- Kyung Wook Kim
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul 07442, Korea; (K.W.K.); (J.S.H.)
- Hallym BioEyeTech Research Center, Hallym University College of Medicine, Seoul 07442, Korea;
| | - Jin Sun Hwang
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul 07442, Korea; (K.W.K.); (J.S.H.)
- Hallym BioEyeTech Research Center, Hallym University College of Medicine, Seoul 07442, Korea;
| | - Jiwon Chang
- Hallym BioEyeTech Research Center, Hallym University College of Medicine, Seoul 07442, Korea;
- Department of Otorhinolaryngology, Hallym University Medical Center, Hallym University College of Medicine, Seoul 07442, Korea
| | - Young Joo Shin
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul 07442, Korea; (K.W.K.); (J.S.H.)
- Hallym BioEyeTech Research Center, Hallym University College of Medicine, Seoul 07442, Korea;
- Correspondence: ; Tel.: +82-2-6960-1240
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15
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Manta O, Sarafidis M, Schlee W, Consoulas C, Kikidis D, Koutsouris D. Electrophysiological differences in distinct hearing threshold level individuals with and without tinnitus distress. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1630-1633. [PMID: 36085827 DOI: 10.1109/embc48229.2022.9871392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Tinnitus is the perception of sound when no actual external noise is present. Tinnitus is highly prevalent, with more than 1 in 7 adults in the EU having tinnitus, and it causes negative effects on quality of life for many individuals. However, there is currently no cure for tinnitus and its pathophysiology and genesis are unknown. Auditory evoked potentials (AEPs) provide a non-invasive means by which the electrical signals evoked by the brain can be recorded, and constitute a useful indicator for the evaluation of auditory disorders such as tinnitus and hearing loss. The present study analyzed a total of 98 auditory middle evoked potential (AMLR) waveforms, a subtype of AEPs, from 49 participants with subjective tinnitus, attempting to identify differences in AMLR parameters between sufferers with and without tinnitus distress. The waveforms were divided into three categories according to the ear's hearing level, and comparisons were made between sufferers in the same hearing level category. The results of the analysis indicated some statistically significant differences in AMLR latencies and amplitudes between the compared groups. Clinical Relevance- Identification of the electro-physiological profile of subjective tinnitus sufferers based on the distress manifested by tinnitus using AMLRs.
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