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Denys S, Cima RFF, Fuller TE, Ceresa AS, Blockmans L, Vlaeyen JWS, Verhaert N. Fear influences phantom sound percepts in an anechoic room. Front Psychol 2022; 13:974718. [PMID: 36225679 PMCID: PMC9549870 DOI: 10.3389/fpsyg.2022.974718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Aims and hypotheses In an environment of absolute silence, researchers have found many of their participants to perceive phantom sounds (tinnitus). With this between-subject experiment, we aimed to elaborate on these research findings, and specifically investigated whether–in line with the fear-avoidance model of tinnitus perception and reactivity–fear or level of perceived threat influences the incidence and perceptual qualities of phantom sound percepts in an anechoic room. We investigated the potential role of individual differences in anxiety, negative affect, noise sensitivity and subclinical hearing loss. We hypothesized that participants who experience a higher level of threat would direct their attention more to the auditory system, leading to the perception of tinnitus-like sounds, which would otherwise be subaudible, and that under conditions of increased threat, narrowing of attention would lead to perceptual distortions. Methods In total, N = 78 normal-hearing volunteers participated in this study. In general, the study sample consisted of young, mostly female, university students. Their hearing was evaluated using gold-standard pure tone audiometry and a speech-in-noise self-test (Digit Triplet Test), which is a sensitive screening test to identify subclinical hearing loss. Prior to a four-minute stay in an anechoic room, we randomized participants block design-wise in a threat (N = 37) and no-threat condition (N = 41). Participants in the threat condition were deceived about their hearing and were led to believe that staying in the room would potentially harm their hearing temporarily. Participants were asked whether they perceived sounds during their stay in the room and rated the perceptual qualities of sound percepts (loudness and unpleasantness). They were also asked to fill-out standardized questionnaires measuring anxiety (State–Trait Anxiety Inventory), affect (Positive and Negative Affect Schedule) and noise sensitivity (Weinstein Noise Sensitivity Scale). The internal consistency of the questionnaires used was verified in our study sample and ranged between α = 0.61 and α = 0.90. Results In line with incidence rates reported in the literature, 74% of our participants reported having heard tinnitus-like sounds in the anechoic room. Speech-in-noise identification ability was comparable for both groups of participants. The experimental manipulation of threat was proven to be effective, as indicated by significantly higher scores on a Threat Manipulation Checklist among participants in the threat condition as compared to those in the no-threat condition (p < 0.01). Nevertheless, participants in the threat condition were as likely to report tinnitus percepts as participants in the no-threat condition (p = 1), and tinnitus percepts were not rated as being louder (p = 0.76) or more unpleasant (p = 0.64) as a function of level of threat. For participants who did experience tinnitus percepts, a higher level of threat was associated with a higher degree of experienced unpleasantness (p < 0.01). These associations were absent in those who did not experience tinnitus. Higher negative affect was only slightly associated with higher ratings of tinnitus unpleasantness (p < 0.01). Conclusion Whereas our threat manipulation was successful in elevating the level of fear, it did not contribute to a higher percentage of participants perceiving tinnitus-like sounds in the threat condition. However, higher levels of perceived threat were related to a higher degree of perceived tinnitus unpleasantness. The findings of our study are drawn from a rather homogenous participant pool in terms of age, gender, and educational background, challenging conclusions that are applicable for the general population. Participants generally obtained normophoric scores on independent variables of interest: they were low anxious, low noise-sensitive, and there was little evidence for the presence of subclinical hearing loss. Possibly, there was insufficient variation in scores to find effects.
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Affiliation(s)
- Sam Denys
- Research Group Experimental Otorhinolaryngology (ExpORL), Department of Neurosciences, University of Leuven, Leuven, Belgium
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospitals of Leuven, Leuven, Belgium
- Multidisciplinary University Center for Speech-Language Pathology and Audiology, University Hospitals of Leuven, Leuven, Belgium
- *Correspondence: Sam Denys,
| | - Rilana F. F. Cima
- Research Group Health Psychology, Department of Behavior, Health and Psychopathology, University of Leuven, Leuven, Belgium
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Thomas E. Fuller
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
- Medtronic, Maastricht, Netherlands
| | | | - Lauren Blockmans
- Research Group Experimental Otorhinolaryngology (ExpORL), Department of Neurosciences, University of Leuven, Leuven, Belgium
| | - Johan W. S. Vlaeyen
- Research Group Health Psychology, Department of Behavior, Health and Psychopathology, University of Leuven, Leuven, Belgium
| | - Nicolas Verhaert
- Research Group Experimental Otorhinolaryngology (ExpORL), Department of Neurosciences, University of Leuven, Leuven, Belgium
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospitals of Leuven, Leuven, Belgium
- Multidisciplinary University Center for Speech-Language Pathology and Audiology, University Hospitals of Leuven, Leuven, Belgium
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2
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Isler B, von Burg N, Kleinjung T, Meyer M, Stämpfli P, Zölch N, Neff P. Lower glutamate and GABA levels in auditory cortex of tinnitus patients: a 2D-JPRESS MR spectroscopy study. Sci Rep 2022; 12:4068. [PMID: 35260698 PMCID: PMC8904839 DOI: 10.1038/s41598-022-07835-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/14/2022] Open
Abstract
We performed magnetic resonance spectroscopy (MRS) on healthy individuals with tinnitus and no hearing loss (n = 16) vs. a matched control group (n = 17) to further elucidate the role of excitatory and inhibitory neurotransmitters in tinnitus. Two-dimensional J-resolved spectroscopy (2D-JPRESS) was applied to disentangle Glutamate (Glu) from Glutamine and to estimate GABA levels in two bilateral voxels in the primary auditory cortex. Results indicated a lower Glu concentration (large effect) in right auditory cortex and lower GABA concentration (medium effect) in the left auditory cortex of the tinnitus group. Within the tinnitus group, Glu levels positively correlated with tinnitus loudness measures. While the GABA difference between groups is in line with former findings and theories about a dysfunctional auditory inhibition system in tinnitus, the novel finding of reduced Glu levels came as a surprise and is discussed in the context of a putative framework of inhibitory mechanisms related to Glu throughout the auditory pathway. Longitudinal or interventional studies could shed more light on interactions and causality of Glu and GABA in tinnitus neurochemistry.
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Affiliation(s)
- B Isler
- Department of Otorhinolaryngology, University Hospital Zurich, (USZ), University of Zurich (UZH), Zurich, Switzerland. .,Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland.
| | - N von Burg
- Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland
| | - T Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, (USZ), University of Zurich (UZH), Zurich, Switzerland.,Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland
| | - M Meyer
- Division of Neuropsychology, University of Zurich (UZH), Zurich, Switzerland.,University Research Priority Program 'Dynamics of Healthy Aging', University of Zurich (UZH), Zurich, Switzerland
| | - P Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
| | - N Zölch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland.,Institute of Forensic Medicine, University of Zurich (UZH), Zurich, Switzerland
| | - P Neff
- Department of Psychology, Center for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.,Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland.,Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
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3
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Ukaegbe OC, Tucker DA. The Role of Eye Color in the Emergence of Tinnitus in Silence. Int Arch Otorhinolaryngol 2021; 26:e407-e413. [PMID: 35846819 PMCID: PMC9282950 DOI: 10.1055/s-0041-1726039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction
Previous research suggests that African Americans are less likely than Caucasians to perceive tinnitus in sustained silence.
Objective
To evaluate the association between non-cutaneous melanin as indicated by eye color and the emergence of temporary tinnitus during a brief period of silence.
Methods
A cross-section of adults grouped according to their eye color were exposed to silence. A total of 62 adults, aged 18 to 35 years (10 males, 52 females) were required to sit in silence for 10 minutes, after which they filled out a questionnaire to report their eye color and any perception of sounds in the ears or head.
Results
In total, 63% of the participants perceived tinnitus while sitting in silence, and, of these 95% perceived the tinnitus sounds within 5 minutes of sitting in silence. Though African Americans were less likely to perceive tinnitus in silence, this difference was not significant (
p
= 0.6). After a period of silence, 69% of the subjects with light-colored eyes and 58% of the dark-eyed subjects perceived tinnitus. This difference was not statistically significant (χ
2
(1) = 0.77;
p
= 0.38).
Conclusion
When exposed to reduced auditory stimulation, 3 out of 5 normal-hearing people are likely to experience tinnitus. However, there was no relationship between eye color and the perception of tinnitus in silence. Although melanin has been shown to play a role in the protection of the ear against noise trauma and the effects of age-related hearing loss, its role in the emergence of tinnitus needs further investigation.
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Affiliation(s)
- Onyinyechi C. Ukaegbe
- Communication Sciences and Disorders Department, School of Health and Human Sciences, University of North Carolina, Greensboro
- Otorhinolaryngology Department, Faculty of Medical Sciences, University of Nigeria, Enugu
| | - Denise A. Tucker
- Communication Sciences and Disorders Department, School of Health and Human Sciences, University of North Carolina, Greensboro
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4
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Zenke JK, Rahman S, Guo Q, Leung AWS, Gomaa NA. Central Processing in Tinnitus: fMRI Study Outlining Patterns of Activation Using an Auditory Discrimination Task in Normal Versus Tinnitus Patients. Otol Neurotol 2021; 42:e1170-e1180. [PMID: 34086638 DOI: 10.1097/mao.0000000000003194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Elucidate brain activity differences between patients with tinnitus and controls. STUDY DESIGN Cross-sectional cohort study. SETTING Outpatient Otolaryngology clinic. PATIENTS Three cohorts; 8 controls, 12 with subjective idiopathic tinnitus (tinnitus without hearing loss), and 12 with both tinnitus and hearing loss. INTERVENTION An auditory oddball identification task was performed in fMRI scanner. MAIN OUTCOME MEASURES Task performance and Tinnitus Handicap Inventory (THI) scores were recorded. Brain activation maps were generated comparing deviant and standard tones as well as at rest. One-way and two-way T-contrasts were generated in addition to multiple regression modeling which identified significant brain regions predicting tinnitus, disease severity, duration, and task performance. RESULTS Task performance worsened in tinnitus patients with increased auditory workload, in terms of additional hearing loss. THI score and grade correlated with false alarms. The limbic system, heschel's gyrus, angular gyrus and cerebellum have a significant effect on both brain behavior in patients with tinnitus, and predictability of tinnitus and its behavioral implications. CONCLUSION Increased auditory workload resulted in poorer task performance. Moreover, it is possible to predict auditory task performance in patients with tinnitus by looking at the activity of specific regions of interest. Heschl's gyrus, angular gyrus, cerebellar, and limbic system activity are important contributors to neurological activity associated with tinnitus. Finally, predictive modeling may influence further research surrounding tinnitus treatment.
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Affiliation(s)
- Julianna K Zenke
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery
| | | | - Qi Guo
- Faculty of Medicine and Dentistry
| | - Ada W S Leung
- Neuroscience and Mental Health Institute
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nahla A Gomaa
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery
- Faculty of Medicine and Dentistry
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5
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Ma X, Li JJ, Lai JT, Yu LS. An Integrated Physical Regulation Theory and Classification of Acute Tinnitus. Curr Med Sci 2021; 41:84-86. [PMID: 33582910 DOI: 10.1007/s11596-021-2322-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/28/2020] [Indexed: 10/22/2022]
Abstract
Tinnitus, acute or chronic, is one of the most common and refractory disorders. Acute tinnitus is a symptom that is a warning sign when compared with chronic tinnitus. Although hearing loss initiates acute tinnitus, the relationship between hearing loss and tinnitus is far from straightforward. Other factors beyond the auditory system may play important roles in the occurrence of acute tinnitus. To address this issue, we propose an integrated regulation theory of the possible physical causes of acute tinnitus, and summarize a classification system for acute tinnitus based on this regulation theory to help guide clinical treatment.
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Affiliation(s)
- Xin Ma
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, 100044, China
| | - Jing-Jing Li
- Department of Otorhinolaryngology, Distinct Clinic, Chengdu, 610041, China
| | - Jen-Tsung Lai
- Department of Otorhinolaryngology, Taiwan Kuang-Tien General Hospital, and Taiwan Tinnitus Association, Taichung, 433, China.
| | - Li-Sheng Yu
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, 100044, China.
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6
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McFerran DJ, Stockdale D, Holme R, Large CH, Baguley DM. Why Is There No Cure for Tinnitus? Front Neurosci 2019; 13:802. [PMID: 31447630 PMCID: PMC6691100 DOI: 10.3389/fnins.2019.00802] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
Tinnitus is unusual for such a common symptom in that there are few treatment options and those that are available are aimed at reducing the impact rather than specifically addressing the tinnitus percept. In particular, there is no drug recommended specifically for the management of tinnitus. Whilst some of the currently available interventions are effective at improving quality of life and reducing tinnitus-associated psychological distress, most show little if any effect on the primary symptom of subjective tinnitus loudness. Studies of the delivery of tinnitus services have demonstrated considerable end-user dissatisfaction and a marked disconnect between the aims of healthcare providers and those of tinnitus patients: patients want their tinnitus loudness reduced and would prefer a pharmacological solution over other modalities. Several studies have shown that tinnitus confers a significant financial burden on healthcare systems and an even greater economic impact on society as a whole. Market research has demonstrated a strong commercial opportunity for an effective pharmacological treatment for tinnitus, but the amount of tinnitus research and financial investment is small compared to other chronic health conditions. There is no single reason for this situation, but rather a series of impediments: tinnitus prevalence is unclear with published figures varying from 5.1 to 42.7%; there is a lack of a clear tinnitus definition and there are multiple subtypes of tinnitus, potentially requiring different treatments; there is a dearth of biomarkers and objective measures for tinnitus; treatment research is associated with a very large placebo effect; the pathophysiology of tinnitus is unclear; animal models are available but research in animals frequently fails to correlate with human studies; there is no clear definition of what constitutes meaningful change or “cure”; the pharmaceutical industry cannot see a clear pathway to distribute their products as many tinnitus clinicians are non-prescribing audiologists. To try and clarify this situation, highlight important areas for research and prevent wasteful duplication of effort, the British Tinnitus Association (BTA) has developed a Map of Tinnitus. This is a repository of evidence-based tinnitus knowledge, designed to be free to access, intuitive, easy to use, adaptable and expandable.
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Affiliation(s)
- Don J McFerran
- Colchester General Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom.,British Tinnitus Association, Sheffield, United Kingdom
| | | | - Ralph Holme
- Action on Hearing Loss, London, United Kingdom
| | - Charles H Large
- Autifony Therapeutics Limited, Stevenage Bioscience Catalyst, Stevenage, United Kingdom
| | - David M Baguley
- British Tinnitus Association, Sheffield, United Kingdom.,National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom.,Hearing Sciences, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Nottingham Audiology Services, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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7
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8
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Pienkowski M. Rationale and Efficacy of Sound Therapies for Tinnitus and Hyperacusis. Neuroscience 2019; 407:120-134. [DOI: 10.1016/j.neuroscience.2018.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/20/2022]
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9
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Prediction and perception: Insights for (and from) tinnitus. Neurosci Biobehav Rev 2019; 102:1-12. [PMID: 30998951 DOI: 10.1016/j.neubiorev.2019.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/14/2019] [Indexed: 12/20/2022]
Abstract
More than 150 years have passed since Helmholtz first described perception as a process of unconscious inference about the causes of sensations. His ideas have since inspired a wealth of literature investigating the mechanisms underlying these inferences. In recent years, much of this work has converged on the notion that the brain is a hierarchical generative model of its environment that predicts sensations and updates itself based on prediction errors. Here, we build a case for modeling tinnitus from this perspective, i.e. predictive coding. We emphasize two key claims: (1) acute tinnitus reflects an increase in sensory precision in related frequency channels and (2) chronic tinnitus reflects a change in the brain's default prediction. We further discuss specific neural biomarkers that would constitute evidence for or against these claims. Finally, we explore the implications of our model for clinical intervention strategies. We conclude that predictive coding offers the basis for a unifying theory of cognitive neuroscience, which we demonstrate with several examples linking tinnitus to other lines of brain research.
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10
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Noda K, Kitahara T, Doi K. Sound Change Integration Error: An Explanatory Model of Tinnitus. Front Neurosci 2018; 12:831. [PMID: 30538615 PMCID: PMC6277469 DOI: 10.3389/fnins.2018.00831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/24/2018] [Indexed: 11/23/2022] Open
Abstract
A growing body of research is focused on identifying and understanding the neurophysiological mechanisms that underlie tinnitus. Unfortunately, however, most current models cannot adequately explain the majority of tinnitus features. For instance, although tinnitus generally appears within minutes after entering a silent environment, most models postulate that tinnitus emerges over a much larger timescale (days). Similarly, there is a limited understanding of how the severity of tinnitus can differ in patients with a similar degree of hearing loss. To address this critical knowledge gap, we have formulated a novel explanatory model of tinnitus, the perception-update (PU) model, which rests on a theory of information processing and can explain several key characteristics of tinnitus onset. The PU model posits that the brain continuously updates the information received from the inner ear by comparing it to the received information immediately before. That is, the auditory system processes the relative change in sensory input, as opposed to the absolute value of the auditory input. This is analogous to the functioning of data compression technology used for music and images called differential pulse code modulation (differential PCM). The PU model proposes that the inner ear transmits sound change to the auditory cortex via an auditory N1 response, an event-related potential component that constitutes is a prime signaler of auditory input change. In cases of hearing impairment, the PU model posits that the auditory system finds itself in a state of uncertainty where perception has to be predicted based on previous stimulation parameters, which can lead to the emergence of tinnitus.
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Affiliation(s)
| | - Tadashi Kitahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Katsumi Doi
- Department of Otolaryngology, Faculty of Medicine, Kindai University, Osakasayama, Japan
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11
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Fernandes S. Tinnitus: still 'A Ghost in the Machine' or a Darwinian survival phenomenon? Int J Neurosci 2017; 128:175-181. [PMID: 28858532 DOI: 10.1080/00207454.2017.1374958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The causation of tinnitus continues to intrigue. Despite the plethora of publications there is no definitive path available to concentrate our efforts, in alleviating the symptom. Several mechanical theories are available in standard tinnitus literature with varying empiricism. Purpose/aim of the study: To investigate a possible way forward. MATERIALS AND METHODS Employing a forensic methodology ("crime scene analysis" technique) and utilizing available evidence from the related sciences, inductive and abstract reasoning, a pragmatic model incorporating the known features of tinnitus is available. RESULTS A plausible evolutionary explanation of the origins and functions for the causation of tinnitus is offered with a possible link to its evasive nature, in our search for a cause. CONCLUSION The functional value of tinnitus may be provided by our evolutionary history. It is possible that tinnitus was a protective adaptive phenomenon in earlier forms but in our current environment merely contributes to nuisance value.
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Affiliation(s)
- Sylvester Fernandes
- a Department of Health Sciences , Newcastle University , Newcastle , Australia
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12
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Song JJ, Kim K, Sunwoo W, Mertens G, Van de Heyning P, De Ridder D, Vanneste S, Lee SY, Park KJ, Choi H, Choi JW. A Quantitative Electroencephalography Study on Cochlear Implant-Induced Cortical Changes in Single-Sided Deafness with Tinnitus. Front Hum Neurosci 2017; 11:210. [PMID: 28572760 PMCID: PMC5435818 DOI: 10.3389/fnhum.2017.00210] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
The mechanism of tinnitus suppression after cochlear implantation (CI) in single-sided deafness (SSD) is not fully understood. In this regard, by comparing pre- and post-CI quantitative electroencephalography (qEEG), we explored cortical changes relevant to tinnitus improvement. In SSD patients who underwent CI, qEEG data were collected: (1) before CI, (2) 6 months post-operatively with CI-on, and (3) 30 min after CI-off and source-localized cortical activity/functional connectivity analyses were performed. Compared to the pre-operative baseline, the CI-on condition demonstrated significantly decreased activity in the right auditory- and orbitofrontal cortices (OFC) for the delta frequency band as well as decreased connectivity between the auditory cortex/posterior cingulate cortex for the delta/beta2 bands. Meanwhile, compared to the CI-off condition, the CI-on condition displayed decreased activity in the right auditory cortices/OFC for the delta band, and in bilateral auditory cortices, left inferior frontal cortex/OFC for the gamma band. However, qEEG analyses showed no significant differences between the CI-off and baseline conditions. CI induced overall decreased cortical activity and functional connectivity. However, judging from no differences between the CI-off and baseline conditions, CI-induced cortical activity and functional connectivity changes are not by cortical plastic changes, but by dynamic peripheral reafferentation.
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Affiliation(s)
- Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University HospitalSeoul, South Korea
| | - Kyungsoo Kim
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and TechnologyDaegu, South Korea
| | - Woongsang Sunwoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University HospitalSeoul, South Korea
| | - Griet Mertens
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital AntwerpEdegem, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital AntwerpEdegem, Belgium
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of OtagoDunedin, New Zealand
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas at Dallas, RichardsonTX, USA
| | - Sang-Youp Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University HospitalSeoul, South Korea
| | - Kyung-Joon Park
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and TechnologyDaegu, South Korea
| | - Hongsoo Choi
- Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and TechnologyDaegu, South Korea
| | - Ji-Woong Choi
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and TechnologyDaegu, South Korea
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13
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Trevis KJ, McLachlan NM, Wilson SJ. Psychological mediators of chronic tinnitus: The critical role of depression. J Affect Disord 2016; 204:234-40. [PMID: 27391257 DOI: 10.1016/j.jad.2016.06.055] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Maintenance of chronic tinnitus has been proposed to result from a vicious cycle of hypervigilance occurring when a phantom sound is associated with anxiety and limbic system overactivity. Depression, obsessive-compulsiveness, illness attitudes and coping strategies are known to impact tinnitus, but their relationship with the vicious cycle is unknown. As such, we aimed to identify psychological mediators of the vicious cycle. We also examined the relationship between coping strategies and any identified mediators to facilitate the translation of our research to treatment settings. METHODS We comprehensively assessed a heterogeneous community sample of 81 people with chronic tinnitus who completed measures assessing their tinnitus and psychological wellbeing. Specifically, we examined the mediating role of depressive symptoms, illness attitudes, and obsessive-compulsiveness in the vicious cycle. RESULTS While the predicted relationship between tinnitus handicap and anxiety was observed, this was fully mediated by depressive symptoms. In addition, we identified avoidant behaviours and self-blame as maladaptive coping strategies in people with chronic tinnitus and depressive symptoms, identifying potential new treatment targets. LIMITATIONS This work requires replication in a clinical cohort of people with chronic tinnitus, and further investigations of the role of coping strategies. CONCLUSIONS These results extend our understanding of the complex role of psychology in the experience of tinnitus, highlighting the importance of depressive symptoms that may be underpinned by functional disruption of specific neurocognitive networks. We have also identified depressive symptoms and maladaptive coping strategies as new treatment targets to improve the health wellbeing of people with chronic tinnitus.
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Affiliation(s)
- Krysta J Trevis
- Psychological Sciences, The University of Melbourne, Victoria, Australia.
| | - Neil M McLachlan
- Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Sarah J Wilson
- Psychological Sciences, The University of Melbourne, Victoria, Australia
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14
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Hesse LL, Bakay W, Ong HC, Anderson L, Ashmore J, McAlpine D, Linden J, Schaette R. Non-Monotonic Relation between Noise Exposure Severity and Neuronal Hyperactivity in the Auditory Midbrain. Front Neurol 2016; 7:133. [PMID: 27625631 PMCID: PMC5004570 DOI: 10.3389/fneur.2016.00133] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/02/2016] [Indexed: 12/13/2022] Open
Abstract
The occurrence of tinnitus can be linked to hearing loss in the majority of cases, but there is nevertheless a large degree of unexplained heterogeneity in the relation between hearing loss and tinnitus. Part of the problem might be that hearing loss is usually quantified in terms of increased hearing thresholds, which only provides limited information about the underlying cochlear damage. Moreover, noise exposure that does not cause hearing threshold loss can still lead to “hidden hearing loss” (HHL), i.e., functional deafferentation of auditory nerve fibers (ANFs) through loss of synaptic ribbons in inner hair cells. While it is known that increased hearing thresholds can trigger increases in spontaneous neural activity in the central auditory system, i.e., a putative neural correlate of tinnitus, the central effects of HHL have not yet been investigated. Here, we exposed mice to octave-band noise at 100 and 105 dB SPL to generate HHL and permanent increases of hearing thresholds, respectively. Deafferentation of ANFs was confirmed through measurement of auditory brainstem responses and cochlear immunohistochemistry. Acute extracellular recordings from the auditory midbrain (inferior colliculus) demonstrated increases in spontaneous neuronal activity (a putative neural correlate of tinnitus) in both groups. Surprisingly, the increase in spontaneous activity was most pronounced in the mice with HHL, suggesting that the relation between hearing loss and neuronal hyperactivity might be more complex than currently understood. Our computational model indicated that these differences in neuronal hyperactivity could arise from different degrees of deafferentation of low-threshold ANFs in the two exposure groups. Our results demonstrate that HHL is sufficient to induce changes in central auditory processing, and they also indicate a non-monotonic relationship between cochlear damage and neuronal hyperactivity, suggesting an explanation for why tinnitus might occur without obvious hearing loss and conversely why hearing loss does not always lead to tinnitus.
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Affiliation(s)
- Lara Li Hesse
- UCL Ear Institute, London, UK; Klinik für HNO, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | | | | | | | - Jonathan Ashmore
- UCL Ear Institute, London, UK; Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
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Ismi O, Erdogan O, Yesilova M, Ozcan C, Ovla D, Gorur K. Does stapes surgery improve tinnitus in patients with otosclerosis? Braz J Otorhinolaryngol 2016; 83:568-573. [PMID: 27553985 PMCID: PMC9444730 DOI: 10.1016/j.bjorl.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/30/2016] [Accepted: 07/11/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Otosclerosis (OS) is the primary disease of the human temporal bone characterized by conductive hearing loss and tinnitus. The exact pathogenesis of tinnitus in otosclerosis patients is not known and factors affecting the tinnitus outcome in otosclerosis patients are still controversial. Objectives To find the effect of stapedotomy on tinnitus for otosclerosis patients. Methods Fifty-six otosclerosis patients with preoperative tinnitus were enrolled to the study. Pure tone average Air-Bone Gap values, preoperative tinnitus pitch, Air-Bone Gap closure at tinnitus frequencies were evaluated for their effect on the postoperative outcome. Results Low pitch tinnitus had more favorable outcome compared to high pitch tinnitus (p = 0.002). Postoperative average pure tone thresholds Air-Bone Gap values were not related to the postoperative tinnitus (p = 0.213). There was no statistically significant difference between postoperative Air-Bone Gap closure at tinnitus frequency and improvement of high pitch tinnitus (p = 0.427). There was a statistically significant difference between Air-Bone Gap improvement in tinnitus frequency and low pitch tinnitus recovery (p = 0.026). Conclusion Low pitch tinnitus is more likely to be resolved after stapedotomy for patients with otosclerosis. High pitch tinnitus may not resolve even after closure of the Air-Bone Gap at tinnitus frequencies.
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Affiliation(s)
- Onur Ismi
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey.
| | - Osman Erdogan
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Mesut Yesilova
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Cengiz Ozcan
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
| | - Didem Ovla
- University of Mersin, Faculty of Medicine, Department of Biostatistics, Mersin, Turkey
| | - Kemal Gorur
- University of Mersin, Faculty of Medicine, Department of Otorhinolaryngology, Mersin, Turkey
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16
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Parallels between phantom pain and tinnitus. Med Hypotheses 2016; 91:95-97. [PMID: 27142154 DOI: 10.1016/j.mehy.2016.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/13/2016] [Indexed: 01/23/2023]
Abstract
Phantom pain and tinnitus are diseases that cause patients great discomfort. Both are phantom sensations that have many connections with cerebral structures, but their underlying mechanisms are not fully understood. Several therapies have been suggested for these conditions over the years, but there is still no consensus on how to treat either one. Comparison of these two phenomena reveals many similarities, including what is known about their underlying mechanisms, associated brain areas, and responses to therapeutic agents and methods. These similarities need to be evaluated in greater depth, as this could improve our understanding of tinnitus and phantom pain, and thereby improve management strategies for these conditions.
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Subjective tinnitus assessment and treatment in clinical practice. Curr Opin Otolaryngol Head Neck Surg 2015; 23:369-75. [DOI: 10.1097/moo.0000000000000183] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Eggermont JJ, Roberts LE. Tinnitus: animal models and findings in humans. Cell Tissue Res 2015; 361:311-36. [PMID: 25266340 PMCID: PMC4487353 DOI: 10.1007/s00441-014-1992-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/14/2014] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Jos J Eggermont
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, and Department of Psychology, University of Calgary, 2500 University Drive N.W, Calgary, AB, Canada,
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Song JJ, Vanneste S, De Ridder D. Dysfunctional noise cancelling of the rostral anterior cingulate cortex in tinnitus patients. PLoS One 2015; 10:e0123538. [PMID: 25875099 PMCID: PMC4395158 DOI: 10.1371/journal.pone.0123538] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/05/2015] [Indexed: 12/31/2022] Open
Abstract
Background Peripheral auditory deafferentation and central compensation have been regarded as the main culprits of tinnitus generation. However, patient-to-patient discrepancy in the range of the percentage of daytime in which tinnitus is perceived (tinnitus awareness percentage, 0 – 100%), is not fully explicable only by peripheral deafferentation, considering that the deafferentation is a stable persisting phenomenon but tinnitus is intermittently perceived in most patients. Consequently, the involvement of a dysfunctional noise cancellation mechanism has recently been suggested with regard to the individual differences in reported tinnitus awareness. By correlating the tinnitus awareness percentage with resting-state source-localized electroencephalography findings, we may be able to retrieve the cortical area that is negatively correlated with tinnitus awareness percentage, and then the area may be regarded as the core of the noise cancelling system that is defective in patients with tinnitus. Methods and Findings Using resting-state cortical oscillation, we investigated 80 tinnitus patients by correlating the tinnitus awareness percentage with their source-localized cortical oscillatory activity and functional connectivity. The activity of bilateral rostral anterior cingulate cortices (ACCs), left dorsal- and pregenual ACCs for the delta band, bilateral rostral/pregenual/subgenual ACCs for the theta band, and left rostral/pregenual ACC for the beta 1 band displayed significantly negative correlations with tinnitus awareness percentage. Also, the connectivity between the left primary auditory cortex (A1) and the rostral ACC, as well as between the left A1 and the subgenual ACC for the beta 1 band, were negatively correlated with tinnitus awareness percentage. Conclusions These results may designate the role of the rostral ACC as the core of the descending noise cancellation system, and thus dysfunction of the rostral ACC may result in perception of tinnitus. The present study also opens a possibility of tinnitus modulation by neuromodulatory approaches targeting the rostral ACC.
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Affiliation(s)
- Jae Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Sven Vanneste
- Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Edegem, Belgium
- Lab for Auditory and Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, United States of America
| | - Dirk De Ridder
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- BRAIN, Sint Augustinus Hospital, Antwerp, Belgium
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20
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Abstract
Tinnitus, the perception of sound in the absence of an external sound, usually results from a disorder of: (1) the auditory system (usually peripheral, rarely central); (2) the somatosensory system (head and neck); or (3) a combination of the two. Its cause can be determined through its characteristics. The history must include the tinnitus': (1) quality (including whether it can ever be pulsatile or have a clicking component); (2) location; (3) variability; (4) predominant pitch (low or high); and (5) whether the patient can do something to modulate the percept. In addition to the standard neuro-otologic examination, the exam should include inspection of the teeth for evidence of wear, listening around the ear and neck for sounds similar to the tinnitus, palpation of the craniocervical musculature for trigger points, and probing whether the tinnitus percept can be modulated with "somatic testing." All subjects should have a recent audiogram. Presently the most compelling tinnitus theory is the dorsal cochlear nucleus (DCN) hypothesis: both the auditory and somatosensory systems converge upon and interact within the DCN. If the activity of the DCN's somatosensory-interacting fusiform cells exceeds an individual's tinnitus threshold, then tinnitus results.
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Affiliation(s)
- Robert A Levine
- Department of Ear, Nose and Throat and Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Yahav Oron
- Department of Otolaryngology, Head and Neck Surgery, E. Wolfson Medical Centre, Holon, Israel
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Pienkowski M, Tyler RS, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Coelho CB, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BCJ. A review of hyperacusis and future directions: part II. Measurement, mechanisms, and treatment. Am J Audiol 2014; 23:420-36. [PMID: 25478787 DOI: 10.1044/2014_aja-13-0037] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 02/21/2014] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Hyperacusis can be extremely debilitating, and at present, there is no cure. In this detailed review of the field, we consolidate present knowledge in the hope of facilitating future research. METHOD We review and reference the literature on hyperacusis and related areas. This is the 2nd of a 2-part review. RESULTS Hyperacusis encompasses a wide range of reactions to sounds, which can be grouped into the categories of excessive loudness, annoyance, fear, and pain. Reasonable approaches to assessing the different forms of hyperacusis are emerging, including brain-imaging studies. Researchers are only beginning to understand the many mechanisms at play, and valid animal models are still evolving. There are many counseling and sound-therapy approaches that some patients find helpful, but well-controlled studies are needed to measure their long-term efficacy and to test new approaches. CONCLUSIONS Hyperacusis can make life difficult in this increasingly noisy world, forcing sufferers to dramatically alter their work and social habits. We believe this is an opportune time to explore approaches to better understand and treat hyperacusis.
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Affiliation(s)
| | | | | | | | - Tom Brozoski
- Southern Illinois University School of Medicine, Springfield
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Fournier P, Schönwiesner M, Hébert S. Loudness modulation after transient and permanent hearing loss: implications for tinnitus and hyperacusis. Neuroscience 2014; 283:64-77. [PMID: 25135356 DOI: 10.1016/j.neuroscience.2014.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022]
Abstract
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 hearing-impaired 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.
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Affiliation(s)
- P Fournier
- 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
| | - M Schönwiesner
- International Laboratory for Research on Brain, Music, and Sound (BRAMS), Université de Montréal, Montréal, Québec, Canada; Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - S Hébert
- 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.
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The enigma of the tinnitus-free dream state in a Bayesian world. Neural Plast 2014; 2014:612147. [PMID: 25097788 PMCID: PMC4109081 DOI: 10.1155/2014/612147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/16/2014] [Indexed: 11/22/2022] Open
Abstract
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.
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De Ridder D, Vanneste S, Weisz N, Londero A, Schlee W, Elgoyhen AB, Langguth B. An integrative model of auditory phantom perception: Tinnitus as a unified percept of interacting separable subnetworks. Neurosci Biobehav Rev 2014; 44:16-32. [PMID: 23597755 DOI: 10.1016/j.neubiorev.2013.03.021] [Citation(s) in RCA: 253] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/19/2013] [Accepted: 03/27/2013] [Indexed: 01/30/2023]
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Joos K, Gilles A, Van de Heyning P, De Ridder D, Vanneste S. From sensation to percept: The neural signature of auditory event-related potentials. Neurosci Biobehav Rev 2014; 42:148-56. [DOI: 10.1016/j.neubiorev.2014.02.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 02/17/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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Can an auditory illusion trick the brain into turning down tinnitus? Med Hypotheses 2014; 83:119-21. [PMID: 24767808 DOI: 10.1016/j.mehy.2014.03.029] [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: 03/08/2014] [Accepted: 03/24/2014] [Indexed: 11/23/2022]
Abstract
Tinnitus, the phantom perception of sound with no external source, affects an estimated 10-15% of the adult population. Current treatments for this oftentimes distressing condition are of limited effectiveness. The "central gain" model proposes that tinnitus arises from an increase in the responsiveness, or gain, of neurons in central auditory pathways, triggered by damage to the auditory periphery. It has been suggested that tinnitus might be treated by compensating for the peripheral damage, thereby restoring normal levels of input to the central pathways, and hence reducing central gain. Unfortunately, when tinnitus originates with permanent damage to the auditory periphery, it may be impossible to compensate for this damage directly. However, we hypothesize that tinnitus may be treated by tricking the brain into believing that it temporarily receives normal levels of input at frequencies where peripheral damage has occurred. We identify an auditory illusion that seems capable, in principle, of achieving this objective. If effective, this approach would offer a safe, accessible, and non-invasive treatment for tinnitus.
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Tinnitus in men, mice (as well as other rodents), and machines. Hear Res 2013; 311:63-71. [PMID: 24374091 DOI: 10.1016/j.heares.2013.12.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/13/2013] [Accepted: 12/17/2013] [Indexed: 11/20/2022]
Abstract
The phantom auditory sensation of tinnitus is now studied in humans, animals, and computer models, and our understanding of how tinnitus is triggered and which neural mechanisms give rise to the phantom sensation in the brain has increased considerably. In most cases, tinnitus is associated with hearing loss, and even tinnitus patients with normal hearing thresholds might have cochlear damage that is not detected through conventional audiometry, as has been recently shown through auditory brainstem response measurements. Animals show behavioural signs of tinnitus after induction of hearing loss, indicating a causal relation. Moreover, surgical reduction of hearing loss in otosclerosis can reduce or even abolish tinnitus. However, hearing loss does not always lead to tinnitus. Psychophysical measurements have indicated that certain types of cochlear damage might be more closely linked to tinnitus than others. Recent animal studies have used behavioural testing to distinguish between animals with and without tinnitus after noise exposure. Comparisons between these groups of animals have helped identify neural correlates of tinnitus as well as factors that could represent a predisposition for tinnitus. Human neuroimaging studies have also begun to separate the neural signature of tinnitus from other consequences of hearing loss. The functional mechanisms that could underlie tinnitus development tinnitus have been analysed in computational modelling studies, which indicate that tinnitus could be a side-effect of the brain's attempt to compensate for hearing loss. Even though causal treatments for tinnitus are currently not available, hearing aids can provide considerable benefit when used in conjunction with counselling, tinnitus retraining therapy or cognitive behavioural therapy. Finally, animal studies demonstrate that the development of chronic noise-induced tinnitus might be prevented through timely interventions after noise exposure. This article is part of a Special Issue entitled <Annual Reviews 2014>.
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Neural substrates predicting improvement of tinnitus after cochlear implantation in patients with single-sided deafness. Hear Res 2013; 299:1-9. [PMID: 23415916 DOI: 10.1016/j.heares.2013.02.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/15/2013] [Accepted: 02/02/2013] [Indexed: 11/20/2022]
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Noreña AJ, Farley BJ. Tinnitus-related neural activity: Theories of generation, propagation, and centralization. Hear Res 2013; 295:161-71. [DOI: 10.1016/j.heares.2012.09.010] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/23/2012] [Accepted: 09/26/2012] [Indexed: 01/03/2023]
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Peltier E, Peltier C, Tahar S, Alliot-Lugaz E, Cazals Y. Long-term tinnitus suppression with linear octave frequency transposition hearing AIDS. PLoS One 2012; 7:e51915. [PMID: 23284815 PMCID: PMC3527381 DOI: 10.1371/journal.pone.0051915] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/07/2012] [Indexed: 12/04/2022] Open
Abstract
Over the last three years of hearing aid dispensing, it was observed that among 74 subjects fitted with a linear octave frequency transposition (LOFT) hearing aid, 60 reported partial or complete tinnitus suppression during day and night, an effect still lasting after several months or years of daily use. We report in more details on 38 subjects from whom we obtained quantified measures of tinnitus suppression through visual analog scaling and several additional psychoacoustic and audiometric measures. The long-term suppression seems independent of subject age, and of duration and subjective localization of tinnitus. A small but significant correlation was found with audiogram losses but not with high frequency loss slope. Long-term tinnitus suppression was observed for different etiologies, but with a low success rate for sudden deafness. It should be noted that a majority of subjects (23) had a history of noise exposure. Tinnitus suppression started after a few days of LOFT hearing aid use and reached a maximum after a few weeks of daily use. For nine subjects different amounts of frequency shifting were tried and found more or less successful for long-term tinnitus suppression, no correlation was found with tinnitus pitch. When the use of the LOFT hearing aid was stopped tinnitus reappeared within a day, and after re-using the LOFT aid it disappeared again within a day. For about one third of the 38 subjects a classical amplification or a non linear frequency compression aid was also tried, and no such tinnitus suppression was observed. Besides improvements in audiometric sensitivity to high frequencies and in speech discrimination scores, LOFT can be considered as a remarkable opportunity to suppress tinnitus over a long time scale. From a pathophysiological viewpoint these observations seem to fit with a possible re-attribution of activity to previously deprived cerebral areas corresponding to high frequency coding.
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Affiliation(s)
| | | | | | | | - Yves Cazals
- Laboratoire de Neurosciences Intégratives et Adaptatives, Aix-Marseille Université, CNRS UMR 7260, Féderation de Recherche 3C (Cerveau, Comportement, Cognition), Marseille, France
- * E-mail:
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Abstract
BACKGROUND This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2006 and previously updated in 2009.Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. It has been compared with chronic pain, and may be associated with depression or depressive symptoms which can affect quality of life and the ability to work. Antidepressant drugs have been used to treat tinnitus in patients with and without depressive symptoms. OBJECTIVES To assess the effectiveness of antidepressants in the treatment of tinnitus and to ascertain whether any benefit is due to a direct tinnitus effect or a secondary effect due to treatment of concomitant depressive states. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; PsycINFO; CINAHL; Web of Science; BIOSIS; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 5 January 2012. SELECTION CRITERIA Randomised controlled clinical studies of antidepressant drugs versus placebo in patients with tinnitus. DATA COLLECTION AND ANALYSIS Two authors critically appraised the retrieved studies and extracted data independently. Where necessary we contacted study authors for further information. MAIN RESULTS Six trials involving 610 patients were included. Trial quality was generally low. Four of the trials looked at the effect of tricyclic antidepressants on tinnitus, investigating 405 patients. One trial investigated the effect of a selective serotonin reuptake inhibitor (SSRI) in a group of 120 patients. One study investigated trazodone, an atypical antidepressant, versus placebo. Only the trial using the SSRI drug reached the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop-out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. In the trial investigating trazodone, the results showed an improvement in tinnitus intensity and in quality of life after treatment, but in neither case reached statistical significance. Reports of side effects including sedation, sexual dysfunction and dry mouth were common. AUTHORS' CONCLUSIONS There is as yet insufficient evidence to say that antidepressant drug therapy improves tinnitus.
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Affiliation(s)
- Paolo Baldo
- Pharmacy Unit, Drug Information Centre, CRO Aviano - Centro di RiferimentoOncologico IRCCS, Aviano (PN), Italy. .
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Schaette R, Turtle C, Munro KJ. Reversible induction of phantom auditory sensations through simulated unilateral hearing loss. PLoS One 2012; 7:e35238. [PMID: 22675466 PMCID: PMC3366980 DOI: 10.1371/journal.pone.0035238] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 03/14/2012] [Indexed: 11/24/2022] Open
Abstract
Tinnitus, a phantom auditory sensation, is associated with hearing loss in most cases, but it is unclear if hearing loss causes tinnitus. Phantom auditory sensations can be induced in normal hearing listeners when they experience severe auditory deprivation such as confinement in an anechoic chamber, which can be regarded as somewhat analogous to a profound bilateral hearing loss. As this condition is relatively uncommon among tinnitus patients, induction of phantom sounds by a lesser degree of auditory deprivation could advance our understanding of the mechanisms of tinnitus. In this study, we therefore investigated the reporting of phantom sounds after continuous use of an earplug. 18 healthy volunteers with normal hearing wore a silicone earplug continuously in one ear for 7 days. The attenuation provided by the earplugs simulated a mild high-frequency hearing loss, mean attenuation increased from <10 dB at 0.25 kHz to >30 dB at 3 and 4 kHz. 14 out of 18 participants reported phantom sounds during earplug use. 11 participants presented with stable phantom sounds on day 7 and underwent tinnitus spectrum characterization with the earplug still in place. The spectra showed that the phantom sounds were perceived predominantly as high-pitched, corresponding to the frequency range most affected by the earplug. In all cases, the auditory phantom disappeared when the earplug was removed, indicating a causal relation between auditory deprivation and phantom sounds. This relation matches the predictions of our computational model of tinnitus development, which proposes a possible mechanism by which a stabilization of neuronal activity through homeostatic plasticity in the central auditory system could lead to the development of a neuronal correlate of tinnitus when auditory nerve activity is reduced due to the earplug.
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Affiliation(s)
- Roland Schaette
- Ear Institute, University College London, London, United Kingdom.
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Noreña AJ. Stimulating the Auditory System to Treat Tinnitus: From Alleviating the Symptoms to Addressing the Causes. SPRINGER HANDBOOK OF AUDITORY RESEARCH 2012. [DOI: 10.1007/978-1-4614-3728-4_10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Phantom percepts: tinnitus and pain as persisting aversive memory networks. Proc Natl Acad Sci U S A 2011; 108:8075-80. [PMID: 21502503 DOI: 10.1073/pnas.1018466108] [Citation(s) in RCA: 447] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Phantom perception refers to the conscious awareness of a percept in the absence of an external stimulus. On the basis of basic neuroscience on perception and clinical research in phantom pain and phantom sound, we propose a working model for their origin. Sensory deafferentation results in high-frequency, gamma band, synchronized neuronal activity in the sensory cortex. This activity becomes a conscious percept only if it is connected to larger coactivated "(self-)awareness" and "salience" brain networks. Through the involvement of learning mechanisms, the phantom percept becomes associated to distress, which in turn is reflected by a simultaneously coactivated nonspecific distress network consisting of the anterior cingulate cortex, anterior insula, and amygdala. Memory mechanisms play a role in the persistence of the awareness of the phantom percept, as well as in the reinforcement of the associated distress. Thus, different dynamic overlapping brain networks should be considered as targets for the treatment of this disorder.
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Noreña AJ. An integrative model of tinnitus based on a central gain controlling neural sensitivity. Neurosci Biobehav Rev 2011; 35:1089-109. [PMID: 21094182 DOI: 10.1016/j.neubiorev.2010.11.003] [Citation(s) in RCA: 277] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/20/2010] [Accepted: 11/12/2010] [Indexed: 02/03/2023]
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Abstract
Tinnitus is a phantom sound (ringing of the ears) that affects quality of life for millions around the world and is associated in most cases with hearing impairment. This symposium will consider evidence that deafferentation of tonotopically organized central auditory structures leads to increased neuron spontaneous firing rates and neural synchrony in the hearing loss region. This region covers the frequency spectrum of tinnitus sounds, which are optimally suppressed following exposure to band-limited noise covering the same frequencies. Cross-modal compensations in subcortical structures may contribute to tinnitus and its modulation by jaw-clenching and eye movements. Yet many older individuals with impaired hearing do not have tinnitus, possibly because age-related changes in inhibitory circuits are better preserved. A brain network involving limbic and other nonauditory regions is active in tinnitus and may be driven when spectrotemporal information conveyed by the damaged ear does not match that predicted by central auditory processing.
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Abstract
Tinnitus, the perception of sound in the absence of an auditory stimulus, is perceived by about 1 in 10 adults, and for at least 1 in 100, tinnitus severely affects their quality of life. Because tinnitus is frequently associated with irritability, agitation, stress, insomnia, anxiety and depression, the social and economic burdens of tinnitus can be enormous. No curative treatments are available. However, tinnitus symptoms can be alleviated to some extent. The most widespread management therapies consist of auditory stimulation and cognitive behavioral treatment, aiming at improving habituation and coping strategies. Available clinical trials vary in methodological rigor and have been performed for a considerable number of different drugs. None of the investigated drugs have demonstrated providing replicable long-term reduction of tinnitus impact in the majority of patients in excess of placebo effects. Accordingly, there are no FDA or European Medicines Agency approved drugs for the treatment of tinnitus. However, in spite of the lack of evidence, a large variety of different compounds are prescribed off-label. Therefore, more effective pharmacotherapies for this huge and still growing market are desperately needed and even a drug that produces only a small but significant effect would have an enormous therapeutic impact. This review describes current and emerging pharmacotherapies with current difficulties and limitations. In addition, it provides an estimate of the tinnitus market. Finally, it describes recent advances in the tinnitus field which may help overcome obstacles faced in the pharmacological treatment of tinnitus. These include incomplete knowledge of tinnitus pathophysiology, lack of well-established animal models, heterogeneity of different forms of tinnitus, difficulties in tinnitus assessment and outcome measurement and variability in clinical trial methodology.
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Affiliation(s)
- Berthold Langguth
- University of Regensburg, Interdisciplinary Tinnitus Clinic, Department of Psychiatry and Psychotherapy, Universitaetsstrabetae 84, 93053 Regensburg, Germany.
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Abstract
BACKGROUND Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. It has been compared with chronic pain, and may be associated with depression or depressive symptoms which can affect quality of life and the ability to work. Antidepressant drugs have been used to treat tinnitus in patients with and without depressive symptoms. OBJECTIVES To assess the effectiveness of antidepressants in the treatment of tinnitus and to ascertain whether any benefit was due to a direct tinnitus effect or a secondary effect due to treatment of concomitant depressive states. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library Issue 1, 2006); MEDLINE (January 1951 to 2006); EMBASE (1974 to 2006), CINAHL (to 2006), PSYCINFO (to 2006), LILACS (to 2006), and Cambridge Scientific Abstracts. The date of the most recent search was March 2006. SELECTION CRITERIA Randomised controlled clinical studies of antidepressant drugs versus placebo in patients with tinnitus. DATA COLLECTION AND ANALYSIS The studies retrieved were critically appraised and data extracted independently by two authors. Where necessary study authors were contacted for further information. MAIN RESULTS Five trials involving 525 patients were included. Four of these trials looked at the effect of tricyclic antidepressants on tinnitus, investigating 405 patients. One trial investigated the effect of a selective serotonin reuptake inhibitor (SSRI) in a group of 120 patients. No trials involving other antidepressant agents met the inclusion criteria. Only the trial using the SSRI drug met the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. Reports of side effects including sedation, sexual dysfunction and dry mouth were common. AUTHORS' CONCLUSIONS There is insufficient evidence to say that antidepressant drug therapy improves tinnitus.
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Affiliation(s)
- P Baldo
- Centro di Riferimento Oncologico--CRO Aviano (PN) Italy, Hospital Pharmacy, Via Pedemontana Occidentale, 12, Aviano (PN), Friuli-Venezia-Giulia, Italy.
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