Tinnitus Handicap Inventory Scores Research Articles

Novel, braided, self-expandable stent designed for the treatment of pulsatile tinnitus caused by intracranial venous stenosis: first-in-human experience and long-term outcomes

BackgroundPulsatile tinnitus (PT) can be a disabling clinical condition, which may be caused by a sigmoid/transverse sinus stenosis (STSS). Intracranial venous stenting with off-label carotid or peripheral venous stents has...

Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss.

In previous animal studies, sound enhancement reduced tinnitus perception in cases associated with hearing loss. The aim of this study was to investigate the efficacy of sound enrichment therapy in tinnitus treatment by developing a protocol that includes criteria for psychoacoustic characteristics of tinnitus to determine whether the etiology is related to hearing loss. A total of 96 patients with chronic tinnitus were included in the study. Fifty-two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment. There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p<.01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p<.01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p<.05) and at all months for VAS-1 (tinnitus severity) (p<.05) and VAS-2 (tinnitus discomfort) (p<.05). In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55dB HL in a relatively short period of 1 month.

Evaluation of Subjective Tinnitus Severity and Distortion Product Otoacoustic Emissions and Extended High-Frequency Audiometry.

Tinnitus is a multifactorial phenomenon with quality-of-life detriments for those affected by it. We aim to establish a relationship between subjective tinnitus severity with objective audiometric data in the extended high frequency (EHF) from 9 to 16 khz and with distortion product otoacoustic emissions (DPOAE). We hypothesize that severe subjective tinnitus as measured by the Tinnitus Handicap Inventory (THI) does not correlate with increased hearing thresholds in the EHF range. Prospective. Single Tertiary Care Center. Patients identified with tinnitus and normal hearing thresholds within standard frequency range (250-8000 Hz) were consented for participation. Those with underlying otologic disease, trauma, radiotherapy, or ototoxic drug use were excluded. The THI questionnaire was given to eligible patients and audiometric test results were collected. THI scores were categorized by severity groups. An n = 20 to 30 was determined to have an effect size of 0.7 with a significance level of P = .05. THI and audiometric data were collected for 38 patients and categorized into mild (n = 18, 47.4%), moderate (n = 8, 21.1%), slight (n = 7, 18.4%), and severe (n = 5, 13.2%) tinnitus severity groups. Mean THI score was 32.3 ± 19.6 with a statistically significant difference in scores by assigned THI severity group (P < .01). There were no significant differences or linear relationship among hearing thresholds in EHF range or DPOAE stratified by subjective tinnitus group (P = .49, r2 = 0.10) CONCLUSION: Subjective tinnitus severity is not predictive of audiometric outcomes. This finding can be used as a counseling tool to help tinnitus patients manage symptoms, expectations, and overall treatment outcomes.

Investigating the effectiveness of music therapy combined with binaural beats on chronic tinnitus: A randomized controlled trial

BackgroundBinaural beat stimulation (BBS) involve presenting two sinusoidal waves with specific frequency differences to induce neural changes in the brain, often used for mental state induction and symptom reduction. However, there are limited studies on its effectiveness for tinnitus. This study aimed to assess the effectiveness of combining binaural beats with music containing nature sounds for chronic tinnitus. MethodsA total of 30 men, aged 45.87 on average (SD = 8.09), who had chronic tinnitus and symmetrical mild to moderate hearing loss, were included in this study. The participants were randomly assigned to two groups: MT group (Music therapy; n = 15), which received relaxing music containing the sound of sea waves, and MT + BBS group (Music therapy plus binaural beats; n = 15), which received the same music combined with alpha frequency (8 Hz) binaural beats. The therapy sessions were conducted twice a day for 15 min, over a period of 4 weeks. Outcome measures, including the Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI), Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS) and the pitch and loudness of tinnitus were administered before, immediately after, and during the three-month follow-up period. ResultsThe findings revealed improvements in loudness and annoyance VAS, as well as THI total and all subscale scores in both groups (p < 0.001). Additionally, TFI total score showed improvement in both groups (MT: p = 0.001; MT + BBS: p < 0.001) except for the sense of control subscale in both groups and the cognitive subscale in the MT group after the treatment and during the three-month follow-up period. Furthermore, both groups exhibited a decrease in scores for both subscales of HADS. However, there were no significant differences between the two groups in any of the measurement outcomes (p > 0.05), except for the emotional subscale scores of TFI (p = 0.049) and the functional subscale scores of THI (p = 0.034). In other words, during the follow-up period, the MT + BBS group exhibited lower scores in these two subscales compared to the MT group. ConclusionAlthough our study failed to demonstrate the superiority of combining binaural beats with music, both groups experienced significant improvements. This suggest that there are potential benefits to be gained from these types of stimuli. Given the sustained effect of both methods and the even greater improvements in follow-up observed in the binaural beats group for some scales, it seems that the changes in neural response and brain waves caused by our stimulations are persistent. This necessitates further research involving brain mapping, especially with longer follow-up durations.

Repeated Bilateral Transcranial Direct Current Stimulation over Auditory Cortex for Tinnitus Treatment: A Double-Blinded Randomized Controlled Clinical Trial.

Transcranial direct current stimulation (tDCS) is a non-invasive and painless technique of brain neuromodulation that applies a low-intensity galvanic current to the scalp with the aim of stimulating specific areas of the brain. Preliminary investigations have indicated the potential therapeutic efficacy of multisession tDCS applied to the auditory cortex (AC) in the treatment of chronic tinnitus. The aim of this study was to explore the therapeutic effects of repeated sessions of bilateral tDCS targeting the AC on chronic tinnitus. A double-blinded randomized placebo-controlled trial was conducted on patients (n = 48) with chronic intractable tinnitus (>2 years duration). Participants were randomly allocated to two groups: one receiving tDCS (n = 26), with the anode/cathode placed over the left/right AC, and the other receiving a placebo treatment (n = 22). A 20 min daily session of 2 mA current was administered for five consecutive days per week over two consecutive weeks, employing 35 cm2 electrodes. Tinnitus handicap inventory (THI) scores, tinnitus loudness, and tinnitus distress were measured using a visual analogue scale (VAS), and were assessed before intervention, immediately after, and at one-month follow-up. Anodal tDCS significantly reduced THI from 72.93 ± 10.11 score to 46.40 ± 15.36 after the last session and 49.68 ± 14.49 at one-month follow-up in 18 out of 25 participants (p < 0.001). The risk ratio (RR) of presenting an improvement of ≥20 points in the THI after the last session was 10.8 in patients treated with tDCS. Statistically significant reductions were observed in distress VAS and loudness VAS (p < 0.001). No statistically significant differences in the control group were observed. Variables such as age, gender, duration of tinnitus, laterality of tinnitus, baseline THI scores, and baseline distress and loudness VAS scores did not demonstrate significant correlations with treatment response. Repeated sessions of bilateral AC tDCS may potentially serve as a therapeutic modality for chronic tinnitus.

Modulations of resting-static functional connectivity on insular by electroacupuncture in subjective tinnitus.

To explore the modulations of electroacupuncture in subjective tinnitus (ST) by comparing the difference of functional connectivity (FC) in ST patients and healthy volunteers between the insular (INS) and the whole brain region. A total of 34 ST patients were selected into electroacupuncture group (EG) and 34 age- and sex-matched normal subjects were recruited into control group (CG). The EG received acupuncture at SI19 (Tinggong), GB11 (Touqiaoyin), TE17 (Yifeng), GV20 (Baihui), GV15 (Yamen), GV14 (Dazhui), SJ13 (Zhongzhu), among which the points of SI19 and GB11 were connected to the electroacupuncture instrument with the density wave of 2/50 Hz, and 3 treatments per week for 10 sessions in total. The severity of tinnitus was evaluated by Tinnitus Handicap Inventory (THI), the hearing status was recorded using pure tone audiometry, and resting-state functional magnetic resonance imaging (rs-fMRI) was performed on the brain before and after treatment, the CG received no intervention yet only rs-fMRI data were collected. With the electroacupuncture treatment, the total THI score, average air conduction threshold of patients of EG were significantly lower than before (p < 0.01), and the total effective rate was 88.24%. Compared with CG, FC of ST patients between INS and left superior temporal gyrus and right hippocampal significantly decreased before treatment, while FC of ST patients between INS and right superior frontal gyrus, left middle frontal gyrus and right anterior cuneus significantly decreased after treatment (voxel p < 0.001, cluster p < 0.05, corrected with GRF). FC of ST patients between the INS and right middle frontal gyrus, left superior frontal gyrus and right paracentral lobule showed a significant decrease after treatment (voxel p < 0.001, cluster p < 0.05, corrected with GRF). In addition, THI score in EG was negatively correlated with the reduction of FC value in INS-left superior frontal gyrus before treatment (r = -0.41, p = 0.017). Therefore, this study suggests that abnormal FC of INS may be one of the significant central mechanisms of ST patients and can be modulated by electroacupuncture. Electroacupuncture treatment can effectively reduce or eliminate tinnitus symptoms in ST patients and improve the hearing by decreasing FC between the INS and the frontal and temporal brain regions.

Phenotypic spectrum of tinnitus patients bearing rare ANK2 gene variants.

To describe the clinical, audiological, and psychometric features observed in patients with chronic tinnitus and rare variants in the ANK2 gene. We report a case series of 12 patients with chronic tinnitus and heterozygous variants in the ANK2 gene. Tinnitus phenotyping included audiological (standard and high-frequency audiometry, Auditory Brainstem Responses (ABR) and Auditory Middle Latency Responses (AMLR)), psychoacoustic and psychometric assessment by a Visual Analog Scale (VAS) for tinnitus annoyance, the Tinnitus Handicap Inventory (THI), the test on Hypersensitivity to Sound (THS-GÜF), the Patient Health Questionnaire (PHQ-9), the Hospital Anxiety and Depression Scale (HADS) and the Montreal Cognitive Assessment (MoCA). All patients reported a persistent, unilateral noise-type tinnitus, mainly described as white noise or narrowband noise. Seven patients (58%) were considered to have extreme phenotype (THI score > 76), and all patients reported some degree of hyperacusis (THS-GÜF score > 18 in 75% of patients). Seven patients scored MoCA < 26, regardless of the age reported, suggesting a mild cognitive disorder. ABR showed no significant differences in latencies and amplitudes between ears with or without tinnitus. Similarly, the latencies of Pa, Pb waves, and NaPa complex in the AMLR did not differ based on the presence of tinnitus. However, there were statistical differences in the amplitudes of Pa waves in AMLR, with significantly greater amplitudes observed in ears with tinnitus. Patients with ANK2 variants and severe tinnitus exhibit an endophenotype featuring hyperacusis, persistent noise-like tinnitus, high-frequency hearing loss, and decreased amplitudes in AMLR. However, anxiety, depression, and cognitive symptoms vary among individuals.

Therapy effect of cochleural alternating acoustic beam therapy versus traditional sound therapy for managing chronic idiopathic tinnitus patients

Idiopathic tinnitus is a common and complex disorder with no established cure. The CAABT (Cochleural Alternating Acoustic Beam Therapy CAABT), is a personalized sound therapy designed to target specific tinnitus frequencies and effectively intervene in tinnitus according to clinical tinnitus assessment. This study aimed to compare the effectiveness of the CAABT and Traditional Sound Therapy (TST) in managing chronic idiopathic tinnitus. This was a randomized, double-blind, parallel-group, single-center prospective study. Sixty adult patients with tinnitus were recruited and randomly assigned to the CAABT or TST group in a 1:1 ratio using a computer-generated randomization. The treatment lasted for 12 weeks, and participants underwent assessments using the tinnitus handicap inventory (THI), visual analog scale (VAS), tinnitus loudness measurements, and resting-state functional magnetic resonance imaging (rs-fMRI). Both groups showed significant reductions in THI scores, VAS scores, and tinnitus loudness after treatment. However, CAABT showed superiority to TST in THI Functional (p = 0.018), THI Emotional (p = 0.015), THI Catastrophic (p = 0.022), THI total score (p = 0.005) as well as VAS score (p = 0.022). More interesting, CAABT showed superiority to TST in the changes of THI scores, and VAS scores from baseline. The rs-fMRI results showed significant changes in the precuneus before and after treatment in both groups. Moreover, the CAABT group showed more changes in brain regions compared to the TST. No side effects were observed. These findings suggest that CAABT may be a promising treatment option for chronic idiopathic tinnitus, providing significant improvements in tinnitus-related symptoms and brain activity.Trial registration: ClinicalTrials.gov:NCT02774122.

The Placebo Effect on Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To quantify the placebo effect in randomized clinical trials treating tinnitus with oral or intratympanic placebo treatment. CINAHL, PubMed, and Scopus were searched for articles from conception to October 2022. MESH and key terms such as "tinnitus," "placebo," and "medication" were used to find randomized, placebo-controlled trials. The search was limited to articles in English. Randomized controlled trials with adult subjects evaluating tinnitus pretreatment and posttreatment with an oral or intratympanic medication versus a placebo arm were included. Crossover studies, studies involving middle/inner ear operations or devices, and studies that exclusively included nonidiopathic etiologies of tinnitus were excluded. Mean tinnitus symptom survey scores for the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index, Tinnitus Functional Index, Tinnitus Handicap Questionnaire, and Visual Analog Scales for tinnitus Intensity/Loudness (VAS-L), Annoyance (VAS-An), and Awareness (VAS-Aw) were extracted for both placebo and experimental groups. 953 studies were screened with 23 studies being included in the final analysis. Meta-analysis of mean difference (MD) was calculated using RevMan 5.4. MD between pretreatment and posttreatment THI scores of the placebo arms was 5.6 (95% confidence interval, 3.3-8.0; p < 0.001). MD between pretreatment and posttreatment VAS scores of the placebo groups for Loudness, Annoyance, and Awareness were 0.8 (0.0 to 1.6, p = 0.05), 0.2 (-0.2 to 0.5, p = 0.34), and 0.3 (-0.0 to 0.7, p = 0.08), respectively. Placebo treatment has shown effectiveness in improving patient-reported evaluations of tinnitus when using some standardized metrics such as THI and VAS-L; however, the improvement is not as substantial as nonplacebo treatment.

Neuromodulation for Treatment of Tinnitus: A Systematic Review and Meta-Analysis.

To evaluate the treatment efficacy of neuromodulation versus sham for the treatment of tinnitus. Cochrane Library, CINAHL, PubMed, Scopus. The Cochrane Library, CINAHL, PubMed, and Scopus were searched from inception through May 2023 for English language articles documenting "neuromodulation" and "tinnitus" stratified by sham-controlled randomized control trials with 40 or more patients. Data collected included Beck Anxiety Inventory, Beck Depression Inventory (BDI), Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire, and Visual Analog Scale. A Meta-analysis of continuous measures (mean) and proportions (%) were conducted. A total of 19 randomized control trials (N = 1186) were included. The mean age was 48.4 ± 5.3 (range: 19-74), mean duration of tinnitus was 3.8 ± 3.4 years, 61% [56.2-65.7] male, and 55.7% [46-65] with unilateral tinnitus. The short-term effect of transcutaneous electrical nerve stimulation and transcranial direct current stimulation on THI score is -16.2 [-23.1 to -9.3] and -19 [-30.1 to -7.8], respectively. The long-term effect of repetitive transcranial magnetic stimulation on THI score is -8.6 [-11.5 to -5.7]. Transcranial direct current stimulation decreases BDI score by -11.8 [-13.3 to -10.3]. As measured by the Tinnitus Handicap Index, our findings suggest the effects of transcutaneous electrical nerve stimulation and transcranial direct current stimulation reach significant benefit in the short term, whereas repetitive transcranial magnetic stimulation reaches significant benefit in the long term. Based on the BDI, transcranial direct current stimulation significantly reduces comorbid depression in patients with tinnitus.

Effect of the COVID-19 Pandemic on Resting-State Brain Activity in Individuals with Tinnitus.

This study looked at the possible effect of the COVID-19 pandemic on individuals who came to our clinic seeking relief from tinnitus. The performance of the subjects during the COVID-19 pandemic was compared with similar individuals who came to our clinic before the pandemic began. The study involved 50 adults with chronic tinnitus, made up of a study group (24 subjects tested during the COVID-19 pandemic of 2020-2021) and a control group before the pandemic began (26 subjects tested from 2013 to 2017). None of the 24 reported having contracted COVID-19. Data collection involved the Tinnitus Handicap Inventory (THI) questionnaire, audiological tests, and quantitative electroencephalography (qEEG). In terms of THI scores, there were no statistically significant differences between the two groups. However, with regard to qEEG, some changes were observed, with significant decreases in alpha and beta band activity in the study group compared to the control group, particularly over the auditory cortex. We conclude that COVID-19 did not have a discernible impact on the general well-being of individuals with tinnitus. However, it did appear to alter brain activity, specifically in the alpha and beta bands over the auditory cortex, and these reults warrant further investigation.

Abnormal quantitative sudomotor axon reflex test results in patients with tinnitus as a possible indicator of small fiber neuropathy.

A few cases of small fiber neuropathy (SFN) and tinnitus (TN) associated with coronavirus disease 2019 have been reported. However, the relationship between SFN and TN has not been studied. This study investigated a possible relationship between SFN and patients with TN (PwTNs) using autonomic function tests (AFTs) including quantitative sudomotor axon reflex tests (QSART). We performed QSARTs and other AFTs such as the Sympathetic skin response (SSR), Valsalva ratio (VR), and heart rate variability (HRV). The QSART results, obtained at seven hospitals using same protocols, were compared between PwTNs and healthy controls. We confirmed the abnormalities in SSR, VR, and HRV in PwTNs, although those parasympathetic AFTs were not performed in healthy controls. Additionally, we checked Tinnitus handicap inventory (THI) scores for PwTNs and ~50% of PwTNs had low-grade disability, whereas 9.3% had high-grade disability. Data from 57 PwTNs and 122 healthy controls were analyzed. The sweat volumes of QSART in the older age group tended to be higher in the PwTNs than in age-matched healthy controls, and significant differences between the PwTN and control groups were observed in the feet in both sexes (p < 0.001) and in the arms in women (p = 0.013). In the younger age group, the sweat volumes in the feet of men were higher in PwTNs than in healthy controls (p = 0.017). No association was observed between THI and QSART scores. In this study, the sweat volumes in QSARTs were higher in PwTNs than in healthy controls. However, abnormal SSR, HRV, and VR results were not commonly observed in PwTNs. Although the results should be interpreted with caution because of limitations in study, PwTNs might also have SFN apart from dysautonomia. This is the first study to perform QSART with other parasympathetic AFTs in PwTNs. However, larger and more rigorously controlled studies will be needed to reveal the relationship between SFN and TN in the future.

Sensory Gating Networks in Normal-Hearing Adults With Minimal Tinnitus.

The goal of this study was to observe sensory gating-related networks underlying cortical auditory evoked potential (CAEP) peak components in individuals with and without minimal tinnitus, as measured using the Tinnitus Handicap Inventory (THI). This analysis was performed on previously published sensory gating responses in normal-hearing adults with and without minimal tinnitus. Independent component analysis was performed for each individual CAEP gating component (Pa, P50, N1, and P2). Significant components were retained for source localization analyses within the following groups: no tinnitus, tinnitus with a THI score ≤ 6, and tinnitus with a THI score > 6. Brain source localization was performed on the gating difference wave for each component using standardized low-resolution brain electromagnetic tomography. Gating-related networks were identified within each group. Different regional sources were observed between groups, with parietal sources underlying the Pa and P50 components as tinnitus severity increased. A larger prefrontal regional activation was also shown for the N1 gating component as tinnitus severity increased. These results expand upon the functional gating responses via CAEP waveforms in a previously published study. The auditory gating response, as measured via CAEPs, has previously been shown to significantly correlate with an increase in tinnitus severity in adults with normal hearing. The corresponding changes in the gating response appear to be supported by different cortical regions in those without tinnitus, those with a THI score ≤ 6, and those with a THI score > 6. Next, functional differences between localized cortical regions should be tested.

Enriched Acoustic Environment as a customized treatment for tinnitus: A non-controlled longitudinal study

Tinnitus is a heterogeneous hearing disorder with no cure at present, but some treatments, such as a combination of counselling and sound therapy, can alleviate the discomfort it causes. The sound therapy efficiency depends on both the type of sound stimulus and the time of exposure. This study describes the fundamentals of a personalized sound therapy that stimulates the auditory system with either continuous or sequential sounds whose spectra are adjusted to the hearing levels of the participants. This sound therapy is called Enriched Acoustic Environment and is assessed in a sample of 137 participants with tinnitus. Tinnitus-related distress relief was clinically relevant and statistically significant for 90% of these patients. This was quantified as a mean decrease of 24.3 points on the Tinnitus Handicap Inventory. 31% of participants were treated with sequential stimuli and achieved greater relief of distress (29.4 points on their Tinnitus Handicap Inventory score) compared to those treated with continuous sound (69%). According to these results, sequential sound seems to be optimal compared to continuous sound.

Rare Deletions or Large Duplications Contribute to Genetic Variation in Patients with Severe Tinnitus and Meniere Disease.

Meniere disease (MD) is a debilitating disorder of the inner ear defined by sensorineural hearing loss (SNHL) associated with episodes of vertigo and tinnitus. Severe tinnitus, which occurs in around 1% of patients, is a multiallelic disorder associated with a burden of rare missense single nucleotide variants in synaptic genes. Rare structural variants (SVs) may also contribute to MD and severe tinnitus. In this study, we analyzed exome sequencing data from 310 MD Spanish patients and selected 75 patients with severe tinnitus based on a Tinnitus Handicap Inventory (THI) score > 68. Three rare deletions were identified in two unrelated individuals overlapping the ERBB3 gene in the positions: NC_000012.12:g.56100028_56100172del, NC_000012.12:g.56100243_56101058del, and NC_000012.12:g.56101359_56101526del. Moreover, an ultra-rare large duplication was found covering the AP4M1, COPS6, MCM7, TAF6, MIR106B, MIR25, and MIR93 genes in another two patients in the NC_000007.14:g.100089053_100112257dup region. All the coding genes exhibited expression in brain and inner ear tissues. These results confirm the contribution of large SVs to severe tinnitus in MD and pinpoint new candidate genes to get a better molecular understanding of the disease.

Clinical Features of Non-Lateralized Tinnitus.

We aimed to analyze and confirm the clinical features of patients with non-lateralized tinnitus and to identify clues that can be used in their management. Data from 469 patients who visited a university hospital complaining of tinnitus between March 2020 and December 2021 were reviewed. The patients' medical histories, Tinnitus Handicap Inventory, Beck Depression Inventory, and numerical rating scale scores on tinnitus awareness, annoyance, loudness, and effect on life, audiological profiles, and quantitative electroencephalography findings were documented. Forty-nine (10.4%) patients had non-lateralized tinnitus. They were older and had a shorter duration of symptoms (13.91 ± 34.16 months) than patients with bilateral tinnitus (duration: 39.15 ± 80.82 months) (P -lt; .05). The accompanying symptoms, Tinnitus Handicap Inventory scores, and numerical rating scale scores were not significantly different between the 2 groups (P -gt; .05). Patients with non-lateralized tinnitus had worse hearing at 12 kHz on the left side than those with unilateral tinnitus. Hearing asymmetry was least common in non-lateralized tinnitus (n=11/49, 10.4%), followed by bilateral tinnitus (n=54/198, 42.2%) and unilateral tinnitus (n=97/222, 47.3%) (P-lt; .001). Regarding quantitative electroencephalography, there were significant differences in the absolute power of the theta, alpha, beta, gamma, and total frequency bands based on tinnitus lateralization (P -lt; .001). Non-lateralized tinnitus can be perceived in elderly patients with symmetric and extended high-frequency hearing loss before habituation is achieved at an early stage of tinnitus. However, there was no difference in the questionnaire scores and accompanying symptoms; therefore, it may not be worth managing non-lateralized tinnitus separately from tinnitus in the ear.

Changes in audiovestibular handicap following treatment of vestibular schwannomas.

This study aimed to assess degree of audiovestibular handicap in patients with vestibular schwannoma. Audiovestibular handicap was assessed using the Hearing Handicap Inventory, Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Patients completed questionnaires at presentation and at least one year following treatment with microsurgery, stereotactic radiosurgery or observation. Changes in audiovestibular handicap and factors affecting audiovestibular handicap were assessed. All handicap scores increased at follow up, but not significantly. The Tinnitus Handicap Inventory and Dizziness Handicap Inventory scores predicted tinnitus and dizziness respectively. The Hearing Handicap Inventory was not predictive of hearing loss. Age predicted Tinnitus Handicap Inventory score and microsurgery was associated with a deterioration in Dizziness Handicap Inventory score. Audiovestibular handicap is common in patients with vestibular schwannoma, with 75 per cent having some degree of handicap in at least one inventory. The overall burden of handicap was, however, low. The increased audiovestibular handicap over time was not statistically significant, irrespective of treatment modality.

Exploring functional connectivity alterations in sudden sensorineural hearing loss: A multilevel analysis

Sudden sensorineural hearing loss (SSNHL) constitutes an urgent otologic emergency, marked by a rapid decline of at least 30 dB across three consecutive frequencies within 72 h. While previous studies have noted brain region alterations encompassing both auditory and non-auditory areas, this research examines functional connectivity changes across integrity, network, and edge levels in SSNHL. The cohort included 184 participants: 107 SSNHL patients and 77 age- and sex-matched healthy controls. Our investigation comprises: (1) characterization of overall functional connectivity degree across 55 nodes in nine networks (p < 0.05, corrected for false discovery rate), exposing integrity level changes; (2) identification of reduced intranetwork connectivity strength within sensory and attention networks (somatomotor network, auditory network, ventral attention network, dorsal attention network) in SSNHL individuals (p < 0.05, Bonferroni corrected), and reduced internetwork connectivity across twelve distinct subnetwork pairs (p < 0.05, FDR corrected); (3) revelation of increased internetwork connectivity in SSNHL patients, primarily spanning dorsal attention network, fronto parietal network, default mode network, and limbic network, alongside widespread reductions in connectivity patterns among the nine distinct resting-state brain networks. The study further uncovers negative correlations between SSNHL duration and intranetwork connectivity of the auditory network (p < 0.001, R = −0.474), and between Tinnitus Handicap Inventory (THI) scores and internetwork connections linking auditory network and dorsal attention network (p < 0.001, R = −0.331). These observed alterations provide crucial insights into the neural mechanisms underpinning SSNHL and extend our comprehension of the brain's network-level responses to sensory loss. By unveiling the intricate interplay between sensory deprivation, adaptation, and cognitive processes, this study lays the groundwork for future research targeting enhanced diagnosis, treatment, and rehabilitation approaches for individuals afflicted by SSNHL.

Personalized Neuromodulation: A Novel Strategy for Improving Tinnitus Treatment.

This study evaluated the efficacy of personalized neuromodulation, where treatment modalities are chosen based on the patient's responses in a pilot trial. A total of 71 patients with tinnitus were divided into two groups: a personalized group and a randomized neuromodulation group. In the personalized group (n = 35), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) were assessed in a pilot trial, and responsive modalities were administered to 16 patients, while the non-responders (n = 19) were randomly assigned to rTMS, tDCS, or combined modalities. Patients in the randomized group (n = 36) were randomly allocated to rTMS, tDCS, or combined modalities. The Tinnitus Handicap Inventory (THI) score improvement after 10 sessions of each neuromodulation was significantly greater in the personalized group than in the randomized group (p = 0.043), with no significant differences in tinnitus loudness, distress, or awareness. The treatment success rate was highest in the personalized responder subgroup (92.3%), and significantly greater than that in the non-responder subgroup (53.0%; p = 0.042) and the randomized group (56.7%; p = 0.033). Personalized neuromodulation, where the treatment modality is chosen based on the patient's responses in a pilot trial, is an advantageous strategy for treating tinnitus.

Abstract 095: Pulsatile Tinnitus from An Enlarged Mastoid Emissary Vein: Successful Management with Endovascular Embolization

Introduction Tinnitus is a prevalent condition, affecting approximately 10% of the population. It can be categorized into vascular (pulsatile) and nonvascular (non‐pulsatile) based on its rhythmic quality in sync with the heartbeat (1). Recent literature identifies venous etiologies as the most common cause of pulsatile tinnitus, including venous sinus stenosis, venous diverticula, and the less common enlarged mastoid emissary vein (MEV). Emissary veins are residual connections between the extracranial venous system of the head and the intracranial venous system. Although rare, pathologically enlarged MEVs have been recognized as a cause of pulsatile tinnitus. Endovascular treatment is a novel approach for these patients, offering a safe and quicker recovery compared to traditional open surgical options (2). Here, we present a case of a young woman with debilitating pulsatile tinnitus due to an enlarged MEV, with technically successful treatment via endovascular embolization. Methods A 42‐year‐old female presented with left pulsatile tinnitus, imbalance, and headaches following a motor vehicle collision two years prior. Her symptoms included a persistent “whooshing” sound at rest, exacerbated by strenuous physical activity. A tinnitus handicap inventory score of Grade 4‐5 (severe to catastrophic) confirmed the severity of her condition. After ruling out other malignant causes through extensive imaging, a CT scan revealed an enlarged 4.4mm left mastoid emissary vein. Diagnostic suspicions were confirmed by physical examination with superficial compression of the vein along the mastoid region, effectively eliminating the tinnitus. A cerebral angiogram subsequently confirmed an enlarged 5.2mm left MEV, while excluding other malignant arterial or arteriovenous etiologies. After discussing surgical options with neurosurgery and ENT specialists, the patient chose to pursue endovascular intervention. Using a transvenous approach, a coaxial construct of a guide catheter with microcatheter was navigated into the emissary vein, with technically successful coil embolization/sacrifice of the MEV. Post embolization angiogram demonstrated complete occlusion of the MEV with preserved arterial, parenchymal, and venous phases on cerebral angiogram. No procedural complications were reported. Results Following the procedure, the patient reported complete resolution of her symptoms. At one‐month follow‐up, she experienced an occasional pulsatile sensation in the left ear, lasting less than one hour per day. The post‐procedural tinnitus handicap inventory scoring was 1, indicating significant improvement in her quality of life, and she resumed an essentially normal daily routine. Conclusion This case highlights the successful management of pulsatile tinnitus caused by an enlarged MEV through endovascular intervention, offering a new and safe alternative to traditional surgical treatments. Although emissary veins have been implicated as a venous cause of pulsatile tinnitus, reports of this specific etiology (mastoid emissary vein) and endovascular treatment remain limited (3),(4). The considerable improvement in the patient’s quality of life, rapid post‐procedural recovery, and minimally invasive nature of the procedure makes this approach a promising alternative for the management of pathologically enlarged MEVs as a cause of pulsatile tinnitus.