Abstract
ObjectiveAlthough vascular pulsatile tinnitus (VPT) has been classified as “objective”, VPT is not easily recognizable or documentable in most cases. In response to this, we have developed transcanal sound recording (TSR) and spectro-temporal analysis (STA) for the objective diagnosis of VPT. By refining our initial method, we were able to apply TSR/STA to post-treatment outcome evaluation, as well as pre-treatment objective diagnosis.MethodsTSR was performed on seven VPT patients and five normal controls before and after surgical or interventional treatment. VPT was recorded using an inserted microphone with the subjects placed in both upright and supine positions with 1) a neutral head position, 2) head rotated to the tinnitus side, 3) head rotated to the non-tinnitus side, and 4) a neutral position with ipsi-lesional manual cervical compression. The recorded signals were analyzed in both time and time-frequency domains by performing a short-time Fourier transformation.ResultsThe pre-treatment ear canal signals of all VPT patients demonstrated pulse-synchronous periodic structures and acoustic characteristics that were representative of their presumptive vascular pathologies, whereas those the controls exhibited smaller peaks and weak periodicities. Compared with the pre-treatment signals, the post-treatment signals exhibited significantly reduced peak- and root mean square amplitudes upon time domain analysis. Additionally, further sub-band analysis confirmed that the pulse-synchronous signal of all subjects was not identifiable after treatment and, in particular, that the signal decrement was statistically significant at low frequencies. Moreover, the post-treatment signals of the VPT subjects revealed no significant differences when compared to those of the control group.ConclusionWe reconfirmed that the TSR/STA method is an effective modality to objectify VPT. In addition, the potential role of the TSR/STA method in the objective evaluation of treatment outcomes in patients with VPT was proven. Further studies incorporating a larger sample size and more refined recording techniques are warranted.
Highlights
Tinnitus can be classified as either non-pulsatile subjective or pulsatile
The pre-treatment ear canal signals of all Vascular pulsatile tinnitus (VPT) patients demonstrated pulse-synchronous periodic structures and acoustic characteristics that were representative of their presumptive vascular pathologies, whereas those the controls exhibited smaller peaks and weak periodicities
We recently developed a novel method of transcanal sound recording (TSR) and spectro-temporal analysis (STA) for the objective and differential diagnosis of VPT
Summary
Tinnitus can be classified as either non-pulsatile subjective or pulsatile. Non-pulsatile subjective tinnitus originates from the inner ear, ascending auditory pathway, or cortical regions [1,2,3,4,5,6], whereas pulsatile tinnitus (PT) is defined as tinnitus with heartbeat-synchronous and periodic nature [7,8]. Vascular pulsatile tinnitus (VPT) is produced from turbulent blood flow, which is transmitted directly to the inner ear [9], whereas nonvascular PT arises from abnormal muscle contraction [10]. Considering that only 20% of all PT cases are objectively detected by clinicians [11], most cases of PT remain subjective. The pre-treatment evaluation of PT and the post-treatment assessment of outcomes usually rely on the subjective accounts of patients. When a patient complains of PT but the PT is inaudible by auscultation and the imaging findings are equivocal, surgeons may encounter difficulty in choosing the appropriate management options
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