Objective Tinnitus Research Articles

Neural markers associated with improved tinnitus perception after tinnitus retraining therapy

Objective Tinnitus retraining therapy (TRT) has been widely used in tinnitus management. However, its efficacy is often assessed through subjective methods. Here, we aimed to assess potential neural changes following TRT using mismatch negativity (MMN). Design Chronic tinnitus (>6 months) patients participated in a six-month TRT program. We collected tinnitus psychoacoustic features and gathered the tinnitus handicap inventory (THI) before and after TRT. We also used a multi-featured paradigm, including frequency, intensity, duration, location and silent gap deviants, to elicit MMN response before and after TRT. Data were analyzed retrospectively. Study sample The study involved 26 chronic tinnitus patients. Results Post-TRT measurements showed that MMN amplitudes significantly increased for all deviant conditions (p ≤ .03). However, we did not find a significant difference in MMN latencies for all deviant conditions (p ≥ .13). The THI scores of the patients significantly decreased following the TRT program (p < 0.001). Our results reveal improved subjective tinnitus perception following the TRT program. Conclusion These findings indicate that TRT might be a viable alternative in tinnitus management. The greater MMN amplitudes and improved subjective tinnitus perception raise the possibility that MMN can be a useful tool in tinnitus research and tinnitus patient follow-up.

The Clinical Utility of Botulinum Toxin in the Field of Otolaryngology

Botulinum toxin, originally identified in relation to botulism, has evolved from being considered a perilous pathogen to an invaluable therapeutic agent. First utilized by Alan Scott in 1977 to treat strabismus under the commercial name, Oculinum, the toxin received Food and Drug Administration approval in 1989 and was subsequently rebranded as Botox. Its clinical applications have expanded notably, especially in the field of otolaryngology, proving effective in managing conditions such as spasmodic dysphonia, essential vocal tremor, and chronic salivary gland disorders. Moreover, botulinum toxin has shown promising results in treating persistent chronic rhinitis, objective tinnitus, and synkinesis following facial palsy, significantly improving involuntary facial movements. This paper details the diverse applications and methodologies of botulinum toxin across various ENT disorders, illustrating its growing scope and significance in medical practice.

Feasibility study on the use of peripheral blood differentially expressed genes for objective classification of chronic subjective tinnitus: a case study on high-frequency tinnitus

Objective: To explore the feasibility of constructing an objective tinnitus subtype model based on peripheral blood differentially expressed genes (DEGs) using a combination of Weighted Gene Co-expression Network Analysis (WGCNA) and Random Forest algorithm (RF). Methods: From October 2019 to June 2020, peripheral blood DEGs were obtained from 37 patients (from the Third Affiliated Hospital of Sun Yat-sen University)with chronic subjective high-frequency tinnitus (21 unbothersome type, 16 bothersome type) and 20 healthy volunteers through high-throughput sequencing. WGCNA was used to construct gene modules with different expression patterns and analyze their relationships with tinnitus characteristics. Subsequently, RF was employed to build subtype models, which were evaluated by the area under the receiver operating characteristic curve (AUC), accuracy, and F1-score. Results: A total of 12 351 intergroup DEGs were divided into 9 gene modules. Among them, MEblue, MEgreen, and MEbrown showed significant negative correlations with the healthy volunteer group, while MEpink showed a significant positive correlation with the tinnitus distress group. The "Tinnitus vs. Normal" and "Compensatory vs. Decompensatory" subtype models, based on MEblue and MEpink respectively, both had AUCs greater than 0.80, accuracies above 90%, and F1-scores above 0.90, indicating good performance. Conclusions: Peripheral blood DEGs are potential biological indicators for objective classification of subjective tinnitus. The combined application of WGCNA and the Random Forest algorithm should be a viable approach to constructing an objective tinnitus subtype model. However, further exploration and refinement are needed to validate the model's generalizability, cross-dataset performance, and algorithm optimization.

Efficacy and safety of transcutaneous auricular vagus nerve stimulation (ta-VNS) in the treatment of tinnitus: protocol for an updated systematic review and meta-analysis

IntroductionWith an increasing incidence and significant effects on patients, tinnitus has become a major disease burden. There is a dearth of therapies with established efficacy for tinnitus. Transcutaneous auricular vagus...

Surgical Treatment of Tinnitus

Tinnitus is the perception of sound in the absence of an external sound and often results in a disorder of the somatosensory system or the auditory system. Tinnitus is a common clinical symptom that can be debilitating. The risk factors for tinnitus include hearing loss, ototoxicity, head trauma, and depression. Tinnitus is only a symptom that might be the result of different underlying pathologies. The exact treatment of tinnitus has often several options because of its etiological heterogeneity. Although much progress has been made, tinnitus is still considered a scientific and clinical enigma. The search for effective tinnitus treatment faces considerable challenges. Despite numerous trials, no drugs have been approved by the Food and Drug Administration for the treatment of tinnitus. There are different types of treatment for tinnitus that have been tested in properly controlled trials. These treatment options include pharmacological, acoustic-physical, psychological, and surgical. In clinical practice, no pharmacological agent has been shown to have a lasting effect on the presence or severity of tinnitus. Surgery has a small but definite role in the treatment of tinnitus. Surgical intervention is often helpful in relieving most of the objective tinnitus. This review article discusses the epidemiology, indications, and different surgical approaches for tinnitus.

A Study of Muscular Objective Tinnitus Caused by Eustachian Tube Dysfunction (2nd Report)

A Study of Muscular Objective Tinnitus Caused by Eustachian Tube Dysfunction (2nd Report)

Critical Analysis of Karnakshweda with its Modern Aspect

Shalakyatantra, one of the eight branches of Ayurveda deals with diseases above the level of the clavicle, i.e., Urdhwajatru. In that, there are twenty-eight Karnarogas as described by Acharya Sushruta, Yogratnakara, and Bhavprakasha. Karnaksweda is one of the Karnaroga that resembles Karnanada, but there is vitiation of Pittadi doshas with a predominance of Vata in the channels of Karna, leading to the generation of Venughoshavata, i.e., flute-like sound, because of different etiological factors like Dhatu Kshayaa, Ruksha Bhojana, etc.&#x0D; In modern science, tinnitus is described as an unwanted auditory perception of internal origin, usually localised, and rarely heard by others. It can be subjective, when experience is of the individual alone, or, less commonly, objective. It, moreover, acts as a symptom rather than a disease with multifactorial etiology. Karnakshweda can be specifically correlated with cochlear synaptic tinnitus, i.e., tinnitus due to inner ear causes. The majority of cases of tinnitus are subjective; objective tinnitus is far less common. Treatment for Karnaksweda is described as the same as for Karnanada, which includes Vatahar Chikitsa, Snehana, Dhoomapana, Karnapoorana, etc., but there is no specific treatment for Tinnitus in modern science because of idiopathic etiopathogenesis. Ayurveda is a more effective science for the management of diseases like tinnitus.

Current and Emerging Therapies for Chronic Subjective Tinnitus.

Chronic subjective tinnitus, the perception of sound without an external source for longer than six months, may be a greatly debilitating condition for some people, and is associated with psychiatric comorbidities and high healthcare costs. Current treatments are not beneficial for all patients and there is a large need for new therapies for tinnitus. Unlike rarer cases of objective tinnitus, chronic subjective tinnitus often has no obvious etiology and a diverse pathophysiology. In the absence of objective testing, diagnosis is heavily based on clinical assessment. Management strategies include hearing aids, sound masking, tinnitus retraining therapy, cognitive behavioral therapy, and emerging therapies including transcranial magnetic stimulation and electrical stimulation. Although current treatments are limited, emerging diagnostics and treatments provide promising avenues for the management of tinnitus symptoms.

Non-pharmacological therapy for tinnitus

Background: Tinnitus is often difficult to treat because it is closely related to hearing loss, central nervous system disorders, and emotional problems. Although various drug treatments have been attempted for patients with tinnitus, there is no drug that has been clearly proven to be effective. On the other hand, there are some studies showing the effectiveness of various non-pharmacological treatments for tinnitus.Current Concepts: Tinnitus is classified into subjective and objective tinnitus. Representative non-pharmacological treatments for chronic subjective tinnitus include sound therapy, hearing aids or implantable hearing rehabilitation devices, tinnitus retraining therapy, neuropsychiatric therapy, and neuromodulatory treatment. When objective tinnitus does not improve with conservative treatment, surgical treatment can be selected depending on the cause. Acupuncture treatment for tinnitus is not recommended due to lack of evidence on its effectiveness and safety.Discussion and Conclusion: Despite many studies, the mechanisms of tinnitus remain unknown. Thus, it is difficult to cure the cause of tinnitus. Because subjective responses to tinnitus vary according to the patient’s psychological state, a variety of approaches would be needed for the treatment of tinnitus.

Objective Tinnitus of Nasopharyngeal Origin.

We report a rare case of objective tinnitus induced by nasopharyngeal muscle constriction. A 49-year-old female patient presented at the clinic with unintentional sounds coming from the nasal cavity while talking or swallowing, which were similar to the lip-smacking sound. Physical examination revealed a hypertrophic posterior nasopharyngeal wall and torus tubarius at rest. With voluntary effort, the posterior pharyngeal wall protruded prominently and collided with the torus tubarius on either side, generating a sound when they were separated. Botox injection was recommended but the patient refused. The diagnosis and treatment of objective tinnitus are well established, but in some cases, it may occur under unexpected conditions. We report a novel type of objective tinnitus. A thorough physical examination for tinnitus could reveal the cause.

Transcanal Endoscopic Stapedial and Tensor Tympani Tenotomy for Middle Ear Myoclonus: A Retrospective Case Series of Surgical Outcomes.

To describe and analyze the surgical outcomes of transcanal endoscopic resection of the stapedial tendon (ST) and tensor tympani tendon (TT) in the management of middle ear myoclonus (MEM). A retrospective case series. Tertiary academic center. Seven consecutive patients (seven ears) with tinnitus were diagnosed with MEM. Transcanal endoscopic resection of both the ST and TT using either microinstruments or a laser. The symptom of tinnitus, based on visual analog scale and Tinnitus Handicap Inventory scores, was analyzed preoperatively and postoperatively for each patient. The intraoperative findings and postoperative complications were also evaluated. Amelioration of objective tinnitus with significant improvement in visual analog scale and Tinnitus Handicap Inventory scores was noted in all seven patients. The ST and TT were easily identified in the same endoscopic field, with minimal or no removal of the scutum. There was no need to perform an anterior tympanotomy to expose the TT. Resection of both the ST and TT and creating a gap between the cut edges were achieved by using either microinstruments or a laser under an endoscopic field. Conversion to or conjunction with the microscopic approach was unnecessary for any of the seven patients. No hearing loss or hyperacusis occurred postoperatively. Transcanal endoscopic resection of the ST and TT successfully ameliorated the symptom of tinnitus in patients with MEM. A transcanal endoscopic approach provides an alternative method to manage MEM, providing excellent visualization and minimal invasiveness.

Tinnitus Related to Forceful Eyelid Closure: A Case Report.

Tinnitus is a common complaint in the clinical setting and can be classified into sensorineural and objective tinnitus. The sources of objective tinnitus may either come from para-auditory structures, such as myogenic or vascular structures, or the middle ear muscles. One type of objective tinnitus of muscular origin is known as forceful eyelid closure syndrome (FECS). We present an additional case of a 22-year-old woman with unilateral FECS. The auricles and external auditory canals were normal bilaterally; we examined her tympanic membrane under an endoscope, the left tympanic membrane was retracted simultaneously with the closure of her eyelids. Both tympanograms were of type A. However, small cut trace associated with tympanic membrane movement were obtained during blinking. The patient was managed by behavioral therapy and medication treatment conservatively, and the condition became well-controlled. Here, we present this rare case and review the literature.

Gap pre-pulse inhibition of the cortical auditory evoked potentials as a possible objective tinnitus assessment tool.

The objective assessment tests overcome the variability of subjective methods. Cortical recordings with gap pre-pulse inhibition of the acoustic startle reflex stimulus have been used as objective tinnitus assessments in humans. This study aims to investigate this possible objective tinnitus test and compare gap-induced inhibition in different stimulus parameters and brain regions. Twenty People (18-50 years old) without hearing loss and tinnitus were included. The sound stimuli consisted of continuous background noise with a loud startle tone preceded by a silent gap (20 and 40 ms duration, 120 and 150 ms distance from the startle). The N1-P2 complex amplitude and topoplot maps were extracted in 27-channel cortical response recording after signal processing. Four brain regions of interest (ROI) of anterior-frontal, centro-frontal, right, and left temporal were investigated. The results showed that the maximum inhibition occurred in a 40 ms gap duration and 150 ms distance in all 4 ROIs. In comparing ROIs, the centro-frontal and left temporal regions revealed the most inhibition (p<0.05). The decrease in the amplitude of the N1 and P2 in that region could also be traced in the 100 and 200 ms topoplots. Gap-induced inhibition was observed in all gap-embedded stimuli and all ROIs. However, the 40-150 mode and centro-frontal and left temporal regions had maximum inhibition in normal subjects. It provides a promising tool for objectively assessing tinnitus in humans with particular implications in children.

耳管が由来と考えられた筋性他覚的耳鳴例の検討

Objective tinnitus that originates in muscles can be heard by others as well as by the patient. Although there have many reports of objective tinnitus, each report has been limited to a small number of cases that have varied from one another, with some being accompanied by such findings as voluntary and/or involuntary movement of the soft palate and eardrum as well as by blinking, and the etiology has remained unclear.

Middle ear myoclonus as a cause of objective tinnitus

Middle ear myoclonus as a cause of objective tinnitus

Performance of an Automated Detection Algorithm to Assess Objective Pulsatile Tinnitus.

In this paper we describe an automated detection algorithm that objectively detects pulsatile tinnitus (PT) and investigate its performance. Sound measurements were made with a sensitive microphone placed in the outer ear canal in 36 PT-patients referred to our tertiary clinic, along with a registration of the heart rate. A novel algorithm expressed the coherence between the recorded sound and heart rate as a pulsatility index. This index was determined for 6 octave bands of the recorded sound. We assessed the performance of the detection algorithm by comparing it with the judgement of 3 blinded observers. The algorithm showed good agreement compared with the majority judgement of the blinded observers (ROC AUC 0.83). Interobserver reliability for detecting PT in sound recordings by the three blinded observers was substantial (Fleiss's κ=0.64). The algorithm may be a reliable alternative to subjective assessments of in-canal sound measurements in PT-patients, thus providing clinicians with an objective measure to differentiate between subjective and objective pulsatile tinnitus.

Effects of Combination Therapy in Reduction of Tinnitus Functional Index Score for Tinnitus Patients in a Tertiary Hospital in Malaysia

Background: This trial aimed to study the effect of combination therapy and compare it with tinnitus counseling alone in the reduction of tinnitus functional index (TFI) score. Materials and Methods: This work is a two-arm pilot-controlled trial where Muslims aged more than 18 years and with primary chronic bothersome tinnitus and a TFI score of more than 24 were recruited. The exclusion criteria were subjects with pulsatile or objective tinnitus or those with poor cognitive functions and Meniere's disease. They were randomized into two groups by using block randomization. The first treatment group received a combination of Al Quran sound therapy and tinnitus counseling, and the second treatment group received tinnitus counseling only. The results of the TFI score before intervention and 1-month postintervention were recorded and analyzed. Results: A total of 25 patients were recruited and randomized. Among them, 10 received combination therapy and 15 received counseling treatment. Overall, 68% of the patients (17/25) had reduced global TFI scores. The mean decline in total TFI score in the combination group was higher (12.4, standard deviation [SD]: 18.5) than that in the counseling group (4.9, SD: 18.8). Clinically relevant improvement was also higher in the combination group (40%) than in the counseling group (26.7%). Both comparisons were not statistically significant. Among the TFI subscales, the mean scores of intrusiveness, sense of control, and emotion decreased significantly after the intervention within the combination group, with values of P = 0.036, 0.026, and 0.036, respectively. Conclusion: This study was unable to determine if combination therapy is better than counseling due to the small sample size. However, combination therapy improved the emotion, sense of control, and degree of intrusiveness of tinnitus.

Middle ear myoclonus

Myoclonus is an involuntary, sudden jerking of a muscle or group of muscles. Middle ear myoclonus (MEM) is an idiopathic clinical entity attributed to causing abnormal repetitive contractions of the tensor tympani and/or stapedius muscles. MEM is an uncommon disorder produced by repetitive contractions of the middle ear muscles. In MEM, the objective tinnitus is produced by synchronous repetitive contraction of the tensor tympani and/or stapedius muscle. The exact etiology of MEM remains unclear. The diagnosis of MEM is often based on the history of rhythmic and involuntary clicking or buzzing tinnitus which is invariably unilateral. The important differential diagnosis of the MEM is palatal myoclonus while other local otological diseases must be excluded with careful clinical examination. Transcanal microscopic/endoscopic middle ear exploration with the injection of botulinum toxin into the tensor tympani and stapedius muscles is helpful to relieve the symptoms of MEM. This approach is both helpful as a diagnostic and therapeutic tool that allows temporary paralysis of the middle ear muscles before providing definitive surgical treatment. The surgical section of the middle ear muscles through tympanotomy is an excellent treatment option for MEM. There are not adequate research articles available concerning MEM and mainly case reports and few case series are available during the literature search. Proper methods for diagnosis and treatment of MEM are helpful to early resolution of the symptoms and enhance the quality of life. Here, this review article is attempting to discuss the etiopathology, clinical manifestations, diagnosis, and medical and surgical treatment of MEM. Literature search for MEM was done from the database of PubMed, MEDLINE, Scopus, and Google Scholar search with the use of the words MEM, middle ear muscles contractions, symptoms of MEM, diagnosis of MEM, and treatment of MEM.

Palatal Tic Disorder Causing Objective Clicking Tinnitus in an 8 Years Old

Palatal tremors including myoclonus are well-known causes of objective tinnitus. Essential palatal tremors and tic disorders are recognized but rarer causes of objective pulsatile tinnitus. An 8-year-old boy presented with a chief complaint of clicking sounds in both the ears for 1 month, intermittent, occurs frequently in episodes, wherein intraoral examination revealed bilateral rhythmic, low frequency, symmetrical contractions of the soft palate muscles accompanied by clicking sounds audible to physician as well (objective tinnitus). The child's mother stated that the clicking sounds were not present when he was asleep. When the child was distracted by tuning fork sound, the palatal movements stopped. CNS examination, developmental history, birth, and growth history were all normal. Magnetic resonance imaging study with contrast enhancement was normal. The child was started on clonazepam and clonidine and follow-up was done after 1st and 2nd months. The tinnitus reduced but did not resolve completely. Clinical features of a patient with palatal tremor should be carefully assessed with prior knowledge of possible etiopathologies to guide the investigations and management. We highlight a case of palatal tic disorder to bring the possibilities quickly to the reader's mind.

Geriatrik hastalarda objektif tinnitus

OBJECTIVE: This study aimed to investigate the distribution and possible causes of objective tinnitus in geriatric patients. METHODS: A total of 242 patients (101 males, 141 females; mean age: 71.5±13.3 years) over 65 years who were admitted to our outpatient clinic with the complaint of tinnitus between March 2021 and October 2021 were included in the retrospective study. The clinical history and the etiology of tinnitus were investigated. The pure tone audiometry tests were evaluated to determine whether there was a loss in any frequency. The associations between the presence of objective tinnitus, age, sex, hearing loss, and comorbid diseases were analyzed. RESULTS: The prevalence of objective tinnitus was 13.6% in geriatric patients. The relation between objective tinnitus with the male sex and lower age was statistically significant (p&lt;0.001 and p&lt;0.001, respectively). No association was found between objective tinnitus and hearing loss or other comorbid diseases (p=0.727 and p=0.658, respectively). CONCLUSION: Objective tinnitus may be less common than subjective tinnitus; however, a detailed medical history and physical examination is recommended, particularly in males and younger patients. The most common cause of objective tinnitus was vascular diseases.