Tinnitus Score Research Articles

Cochlear implant usage in single sided deafness and factors affecting usage

Objectives The primary objective was to examine duration of daily cochlear implant (CI) usage at 12 and 24 months post-operatively in single sided deafness (SSD). The secondary objective was to examine factors that could affect CI usage. Methods Retrospective cohort of patients with SSD who received CI from January 2015 to March 2020. CI usage was evaluated at 12 and 24 months. Hearing loss duration, tinnitus scores and signal-to-noise ratio (SNR) were correlated with CI usage at 12 months. Results Usage data was available for 54 patients at 12 months and 38 patients at 24 months. The mean usage was 8.2 h/day (SD 4.2) at 12 months, 7.0 h/day (SD 5.1) at 24 months. 5 out of 54 (9.3%) and 7 out of 38 patients (18.4%) were non-users at 12 and 24 months post-operatively. An improved mean SNR score from pre-operative 4.4 dB (SD 2.8) to – 0.70 dB (SD 4.2) at 12 months post-operative was positively correlated with CI usage at 12 and 24 months. Hearing loss duration and tinnitus scores were not associated with CI usage. Conclusions 18.4% of our patients were non-users at 24 months. Mean usage at 24 months was 7.0 h/day. Improved hearing in noise at 12 months was correlated with better usage.

Photobiomodulation with near-infrared laser for tinnitus management: preliminary animal experiments and randomized clinical trials.

This study investigates the effectiveness of photobiomodulation therapy (PBMT) in treating chronic high-frequency tinnitus with the TINI device, a near-infrared (830nm) laser. The study includes preliminary animal experiments with 28 mice and a randomized controlled trial with 56 participants to examine the functional and molecular changes in the auditory system that PBMT may cause. The animal model used sodium salicylate to induce tinnitus, followed by PBMT, which showed promising reductions in the behavioral evidence of tinnitus and a reversal of tinnitus-associated upregulation of vesicular glutamate transporters 2 expression in the ipsilateral dorsal cochlear nucleus (p < 0.05). In the clinical trial, participants with chronic high-frequency tinnitus received trans-tympanic application of the TINI device. The results did not show a significant difference in tinnitus score at the final time point when compared to the sham group. However, questionnaires revealed significant improvements in tinnitus symptoms and psychological outcomes following treatment with the TINI device compared to before treatment (p < 0.05). These findings suggest that while PBMT has potential benefits, its clinical effectiveness may be unclear due to its complex nature and interaction with other conditions. Further research is required to optimize treatment parameters and gain a complete understanding of the therapeutic potential of PBMT in managing tinnitus.

The effect of cochlear implantation on tinnitus in patients with post lingual bilateral profound hearing loss.

In this study we investigated the effect of cochlear implantation on tinnitus in patients with post lingual bilateral profound hearing loss. In this retrospective study, 66 post-lingual deaf patients over 18 years old who referred for cochlear implantation and complained of tinnitus were included. Patients were divided into two groups with residual hearing (in frequency 250-500Hz) and without residual hearing. All data including age, gender, type of implants, type of surgery, cause of the disease, and information on the THI score before cochlear implantation, one month after cochlear implantation and one year after cochlear implantation was recorded and analyzed. Nine patients had residual hearing, while 57 patients did not. After one month and one year, in both groups, the mean THI score has decreased significantly (p-value = 0.001), but there was no significant difference in the mean THI score before surgery and one month and one year after surgery between two groups with and without residual hearing. There was no significant difference in tinnitus severity according to THI-grade between two groups. Also there was no significant difference in THI score and the cause of the hearing loss, type and insertion method of implantation, one month and one year after the surgery between two groups. According to our results, the was no significant correlation between residual hearing and tinnitus score before surgery, one month and one year after the surgery.

Tinnitus-related increases in single-unit activity in awake rat auditory cortex correlate with tinnitus behavior

Tinnitus is known to affect 10–15 % of the population, severely impacting 1–2 % of those afflicted. Canonically, tinnitus is generally a consequence of peripheral auditory damage resulting in maladaptive plastic changes in excitatory/inhibitory homeostasis at multiple levels of the central auditory pathway as well as changes in diverse nonauditory structures. Animal studies of primary auditory cortex (A1) generally find tinnitus-related changes in excitability across A1 layers and differences between inhibitory neuronal subtypes. Changes due to sound-exposure include changes in spontaneous activity, cross-columnar synchrony, bursting and tonotopic organization. Few studies in A1 directly correlate tinnitus-related changes in neural activity to an individual animal's behavioral evidence of tinnitus. The present study used an established condition-suppression sound-exposure model of chronic tinnitus and recorded spontaneous and driven single-unit responses from A1 layers 5 and 6 of awake Long-Evans rats. A1 units recorded from animals with behavioral evidence of tinnitus showed significant increases in spontaneous and sound-evoked activity which directly correlated to the animal's tinnitus score. Significant increases in the number of bursting units, the number of bursts/minute and burst duration were seen for A1 units recorded from animals with behavioral evidence of tinnitus. The present A1 findings support prior unit recording studies in auditory thalamus and recent in vitro findings in this same animal model. The present findings are consistent with sensory cortical studies showing tinnitus- and neuropathic pain-related down-regulation of inhibition and increased excitation based on plastic neurotransmitter and potassium channel changes. Reducing A1 deep-layer tinnitus-related hyperactivity is a potential target for tinnitus pharmacotherapy.

Effectiveness of Tinnitus Retraining Therapy Based on Mobile Devices for Tinnitus Patients

Background and Objectives Tinnitus retraining therapy (TRT) is a well-known effective method for tinnitus management by retraining the brain to achieve habituation of tinnitus. The mobile device based TRT can let both clinicians and patients be free from time and space limitations and secure cost-effectiveness. The study aimed to investigate whether the mobile-based TRT is inferior or not to the conventional TRT in treatment outcomes for chronic subjective tinnitus.Subjects and Method A prospective randomized controlled trial was conducted in a single tertiary hospital. Adult patients with chronic subjective tinnitus were enrolled. Pure tone audiometry, State-Trait Anxiety Inventory [(STAI), axis1 and axis2], Beck Depression Inventory, Pittsburgh Sleep Quality Index, and a survey for TRT were evaluated. Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) of tinnitus, and Tnnitogram were compared at the start, then at one month and three months of the treatment. The mobile group was subdivided into the treatment effective group and the refractory group. Demographics, baseline tinnitus severity, and therapy compliance were comparatively analyzed.Results A total of 19 patients for the mobile-based TRT and 21 patients for the conventional TRT were enrolled. THI scores and Tinnitus scores using VAS were significantly reduced in the mobile group after the treatment. Furthermore, THI and STAI were significantly more improved in the conventional group than in the mobile-based TRT at one and three months of the treatment. Also, the effective group of the mobile device based TRT was statistically younger than the refractory group and had a higher understanding of the treatment method.Conclusion The mobile-based TRT could improve THI and VAS scores of tinnitus at one and three months of treatment. However, the conventional TRT showed better outcome than the Mobile-based TRT with respect to THI scores. The mobile-based TRT can be one of different potential options that clinicians can apply to tinnitus patients who cannot follow the conventional TRT or limited candidate. Further improvement of the mobile device based TRT would be needed.

Increased pyramidal and VIP neuronal excitability in rat primary auditory cortex directly correlates with tinnitus behaviour.

Tinnitus affects roughly 15%-20% of the population while severely impacting 10% of those afflicted. Tinnitus pathology is multifactorial, generally initiated by damage to the auditory periphery, resulting in a cascade of maladaptive plastic changes at multiple levels of the central auditory neuraxis as well as limbic and non-auditory cortical centres. Using a well-established condition-suppression model of tinnitus, we measured tinnitus-related changes in the microcircuits of excitatory/inhibitory neurons onto layer 5 pyramidal neurons (PNs), as well as changes in the excitability of vasoactive intestinal peptide (VIP) neurons in primary auditory cortex (A1). Patch-clamp recordings from PNs in A1 slices showed tinnitus-related increases in spontaneous excitatory postsynaptic currents (sEPSCs) and decreases in spontaneous inhibitory postsynaptic currents (sIPSCs). Both measures could be correlated to the rat's behavioural evidence of tinnitus. Tinnitus-related changes in PN excitability were independent of changes in A1 excitatory or inhibitory cell numbers. VIP neurons, part of an A1 local circuit that can control the excitation of layer 5 PNs via disinhibitory mechanisms, showed significant tinnitus-related increases in excitability that directly correlated with the rat's behavioural tinnitus score. That PN and VIP changes directly correlated to tinnitus behaviour suggests an important role in A1 tinnitus pathology. Tinnitus-related A1 changes were similar to findings in studies of neuropathic pain in somatosensory cortex suggesting a common pathology of these troublesome perceptual impairments. Improved understanding between excitatory, inhibitory and disinhibitory sensory cortical circuits can serve as a model for testing therapeutic approaches to the treatment of tinnitus and chronic pain. KEY POINTS: We identified tinnitus-related changes in synaptic function of specific neuronal subtypes in a reliable animal model of tinnitus. The findings show direct and indirect tinnitus-related losses of normal inhibitory function at A1 layer 5 pyramidal cells, and increased VIP excitability. The findings are similar to what has been shown for neuropathic pain suggesting that restoring normal inhibitory function at synaptic inputs onto A1 pyramidal neurons (PNs) could conceptually reduce tinnitus discomfort.

Warming-needle moxibustion with different lengths of moxa stick for asthenospermia with kidney deficiency and liver depression: a randomized controlled trial

To explore the clinical effect of warming-needle moxibustion with different lengths of moxa stick for asthenospermia with kidney deficiency and liver depression. A total of 240 patients with asthenospermia of kidney deficiency and liver depression were randomly divided into a 4-cm group (moxibustion with 4-cm moxa stick, 60 cases, 3 cases dropped off), a 3-cm group (moxibustion with 3-cm moxa stick, 60 cases, 4 cases dropped off), a 2-cm group (moxibustion with 2-cm moxa stick, 60 cases, 2 cases dropped off) and an acupuncture group (60 cases, 3 cases dropped off). All patients were treated with warming-needle moxibustion with different lengths of moxa stick or conventicnal acupuncture at Zhongwan (CV 12), Guanyuan (CV 4), Zhongji (CV 3), Guilai (ST 29), Yaoyangguan (GV 3), Guanyuanshu (BL 26), etc., once a day, five times a week; 4-week treatment was taken as one course, a total of two courses of treatment were given. The semen routine indexes, seminal plasma biochemical indexes, sex hormone levels and TCM syndrome score were compared before and after treatment among the 4 groups. After treatment, the sperm density, sperm viability, ratio of grade A sperm, ratio of grade A and B sperm, seminal plasma fructose and neutral α-glucosidase were higher than those before treatment (P<0.05, P<0.01), and the sperm deformity rates were lower than those before treatment in the 4-cm group and the 3-cm group (P<0.01, P<0.05). The ratio of grade A sperm, ratio of grade A and B sperm, seminal plasma fructose and neutral α-glucosidase in the 4-cm group were higher than the other three groups (P<0.05, P<0.01), and the sperm deformity rate was lower than the other three groups (P<0.05). After treatment, except for dizziness and tinnitus score, each-domain score and total scores of TCM syndrome scale in the 4-cm group and the 3-cm group were lower than those before treatment (P<0.01, P<0.05). The each-domain score of depression, weak waist and knees, low sexual function and total score in the 4-cm group were lower than those in the other three groups (P<0.05, P<0.01). The total effective rate was 87.7% (50/57) in the 4-cm group, which was higher than 78.6% (44/56) in the 3-cm group, 77.6% (45/58) in the 2-cm group and 70.2% (40/57) in the acupuncture group (P<0.05, P<0.01). The warming-needle moxibustion with 4-cm moxa stick could effectively improve quality and motility of sperm and clinical symptoms in patients with asthenospermia of kidney deficiency and liver depression, which is superior to moxibustion with 3-cm, 2-cm moxa sticks and conventional acupuncture.

Association of hearing loss and tinnitus symptoms with health-related quality of life among long-term oropharyngeal cancer survivors.

This study investigated the association of hearing loss and tinnitus with overall health-related quality of life (HRQoL) among long-term oropharyngeal cancer (OPC) survivors. This study included OPC survivors treated between 2000 and 2013 and surveyed from September 2015 to July 2016. Hearing loss and tinnitus were measured by asking survivors to rate their "difficulty with hearing loss and/or ringing in the ears" from 0 (not present) to 10 (as bad as you can imagine). Hearing loss and tinnitus scores were categorized as follows: 0 for none, 1-4 for mild, and 5-10 for moderate to severe. The primary outcome was the mean score of MD nderson Symptom Inventory Head & Neck module interference component as a HRQoL surrogate dichotomized as follows: 0 to 4 for none to mild and 5 to 10 for moderate to severe interference. Among 880 OPC survivors, 35.6% (314), reported none, 39.3% (347) reported mild, and 25.1% (221) reported moderate to severe hearing loss and tinnitus. On multivariable analysis, mild (OR, 5.83; 95% CI; 1.48-22.88; p=0.012) and moderate (OR, 30.01; 95% CI; 7.96-113.10; p < 0.001) hearing loss and tinnitus were associated with higher odds of reporting moderate to severe symptom interference scores in comparison to no hearing loss and tinnitus. This association of hearing dysfunction was consistent with all domains of HRQoL. Our findings provide preliminary evidence to support the need for continued audiological evaluations and surveillance to detect hearing dysfunction, to allow for early management and to alleviate the long-term impact on QoL.

Is There an Optimal Repetitive Transcranial Magnetic Stimulation Target to Treat Chronic Tinnitus?

Chronic tinnitus is a clinical symptom that affects 10% to 15% of the adult population. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment, but significant heterogeneity exists in the treatment outcomes and stimulation parameters. In this study, we perform a qualitative systematic review to determine if there is an optimal rTMS site to treat tinnitus. A literature search was performed by searching the MEDLINE, Embase, Web of Science, and Cochrane databases. Sham-controlled studies in adults were included that contained >10 patients with tinnitus for >3 months and utilized 10 to 20 electroencephalography coordinates. Study outcomes were considered positive if the treatment arm reported a significant reduction in the primary tinnitus score relative to sham. There were 1211 studies screened. Nineteen studies met the inclusion criteria, and 8 unique stimulation sites were reported. Studies had 53.7 ± 46.0 patients (mean ± SD). The mean duration of follow-up was 10.3 ± 9.6 weeks. Positive outcomes regarding tinnitus suppression were reported in 5 of 5 (100%) studies stimulating the temporoparietal junction midway between T3 and P3 or between T4 and P4. Tinnitus suppression at all other sites was less frequent with a combined success rate of only 8 of 14 (57.1%). Significant heterogeneity exists in the literature in regard to the optimal transcranial magnetic stimulation target. These preliminary findings suggest that the temporoparietal junction midway between T3 and P3 or T4 and P4 is a promising nonauditory rTMS target in the setting of chronic tinnitus. Future research should elucidate the effectiveness of this site for tinnitus suppression.

Effectiveness of Intratympanic Dexamethasone with Lidocaine for Alleviation of Tinnitus

Objective: To determine the effectiveness of Intratympanic Dexamethasone with Lidocaine in control of idiopathic tinnitus.&#x0D; Study Design: Randomized control trial (Clinical Trials. gov Identifier: NCT04798391).&#x0D; Place and Duration of Study: ENT Department, PAF Hospital, Sargodha Pakistan, from Apr 2017 to Jul 2019.&#x0D; Methodology: 264 consenting patients with idiopathic unilateral tinnitus presenting at ENT Department PAF Hospital Sargodha were assessed for tinnitus severity using the modified tinnitus handicap inventory. The scores were recorded and subsequently administered intra-tympanicaly 2.0ml (milli-liter) of Dexamethasone and Lidocaine (1.5 ml Dexamethasone ± 0.5 ml 1% Lidocaine). The dose was repeated twice at weekly intervals. All the patients were reassessed on the modified tinnitus handicap inventory two weeks after the third Intra-tympanic administration, with patients divided into responsive and noresponsive groups depending on ten points or more improvement in tinnitus score.&#x0D; Results: Mean modified tinnitus handicap inventory score pre-therapy was 29.6 ± 5.68, and post-therapy was 17.1 ± 7.45. Independent-sample T-test applied showed a p-value of &lt;0.001.&#x0D; Conclusion: Intratympanic Dexamethasone with lidocaine has a definitively positive outcome on tinnitus improvement.

Cochlear Implantation in Adults With Single-Sided Deafness: A Systematic Review and Meta-analysis.

To determine the clinical outcomes of adult patients with single-sided deafness (SSD) undergoing ipsilateral cochlear implantation. An electronic search of Medline and Embase articles. A systematic review was performed with a search strategy developed by a licensed librarian to identify studies of adult patients with SSD who underwent ipsilateral cochlear implantation. Articles were managed in Covidence and evaluated by 2 independent reviewers. Risk of bias was assessed and data were extracted, including patient demographics, etiology of deafness, duration of deafness, and postoperative change in speech recognition, tinnitus, sound localization, and quality of life (QoL). A meta-analysis was performed, and pooled mean differences were calculated for each outcome of interest via random effects models by each outcome, as well as subgroup analyses by the individual clinical score used. Of 2309 studies identified, 185 full texts were evaluated, and 50 were ultimately included involving 674 patients. Speech perception scores in quiet and noise, tinnitus control, sound localization, and QoL all significantly improved after implantation. Pooled outcomes demonstrated score improvements in speech perception (standardized mean difference [SMD], 2.8 [95% CI, 2.16-3.43]), QoL (SMD, 0.68 [95% CI, 0.45-0.91]), sound localization (SMD, -1.13 [95% CI, -1.68 to -0.57]), and tinnitus score reduction (SMD, -1.32 [95% CI, -1.85 to -0.80]). Cochlear implantation in adults with SSD results in significant improvements in speech perception, tinnitus control, sound localization, and QoL.

Efficacy of Intratympanic Dexamethasone Injection in Subjective Idiopathic Tinnitus- An Interventional Study

Introduction: Tinnitus is a common and annoying symptom characterised by the perception of sound without any corresponding external stimulus. Subjective idiopathic tinnitus is a subjective form of tinnitus where the perceived sound originates from the auditory nervous system, without both aberrant aetiology and external stimuli. Intratympanic injection of steroid (Dexamethasone) is used for the treatment of subjective idiopathic tinnitus by introducing the drug through the tympanic membrane, resulting in reduced systemic toxicity and a higher perilymph steroid level. Aim: To evaluate the efficacy of intratympanic dexamethasone injection in the treatment of subjective idiopathic tinnitus. Materials and Methods: This prospective interventional study was carried out at Madurai Medical College, Madurai, Tamil Nadu, India, from March 2021 to March 2022. A total of 30 patients with subjective idiopathic tinnitus were subjected to intratympanic dexamethasone injection, once per week for three weeks. Improvement in the symptom of tinnitus was assessed by means of subjective evaluation with the help of Tinnitus Handicap Inventory (THI) before and after one week, one month and three months of last injection. Data were statistically analysed using Student’s paired t-test. Results: The results of this study shows that, 53.33% of the population belonged to the age group of 31-40 years. There was 16 females and 14 males. There was a significant reduction in the mean grade of THI at one month and three months after the treatment. The mean THI score was significantly reduced from 50.067 before treatment to 35.733 in one month and 26.933 in three months after the treatment. Conclusion: The intratympanic injection of dexamethasone was found to be effective in the treatment of subjective idiopathic tinnitus. Intratympanic treatment was demonstrated to improve tinnitus scores in the study population.

The DizzyQuest: relation between self-reported hearing loss, tinnitus and objective hearing thresholds in patients with Meniere’s disease

BackgroundCombining a mobile application-based vestibular diary called the DizzyQuest and an iPad-based hearing test enables evaluation of the relationship between experienced neuro-otological symptoms and hearing thresholds in daily life setting. The aim was to investigate the relationship between self-reported hearing symptoms and hearing thresholds in patients with Meniere’s disease (MD), using the DizzyQuest and the iPad-based hearing test simultaneously.MethodsThe DizzyQuest was administered for 3 weeks in 21 patients. Using the experience-sampling-method (ESM), it assessed hearing loss and tinnitus severity for both ears separately. Each day after the DizzyQuest, an iPad-based hearing test was used to measure hearing thresholds. A mixed model regression analysis was performed to investigate relationships between hearing thresholds and self-reported hearing loss and tinnitus severity.ResultsFifteen patients were included. Overall, pure-tone averages (PTAs) were not correlated with self-reported hearing loss severity and tinnitus. Individual differences in PTA results between both ears did not significantly influence the difference in self-reported hearing loss severity between both ears. Self-reported hearing loss and tinnitus scores were significantly higher in ears that corresponded with audiometric criteria of MD (p < 0.001). Self-reported tinnitus severity significantly increased with self-reported hearing loss severity in affected (p = 0.011) and unaffected ears (p < 0.001).ConclusionCombining the DizzyQuest and iPad-based hearing test, facilitated assessment of self-reported hearing loss and tinnitus severity and their relationship with hearing thresholds, in a daily life setting. This study illustrated the importance of investigating neuro-otological symptoms at an individual level, using multiple measurements. ESM strategies like the DizzyQuest should therefore be considered in neuro-otological research.

Evaluating the efficacy of hearing aids for tinnitus therapy – A Positron emission tomography study

Brain imaging studies have revealed neural changes in chronic tinnitus patients that are not restricted to auditory brain areas; rather, the engagement of limbic system structures, attention and memory networks are has been noted. Hearing aids (HA) provide compensation for comorbid hearing loss and may decrease tinnitus-related perception and annoyance. Using resting state positron emission tomography our goal was to analyze metabolic and functional brain changes after six months of effective HA use by patients with chronic tinnitus and associated sensorineural hearing loss. 33 age and hearing loss matched participants with mild/moderate hearing loss were enrolled in this study: 19 with tinnitus, and 14 without tinnitus. Participants with tinnitus of more than 6 months with moderate/severe Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores composed the tinnitus group. A full factorial 2X2 ANOVA was conducted for imaging analysis, with group (tinnitus and controls) and time point (pre-intervention and post-intervention) as factors. Six months after HA fitting, tinnitus scores reduced statistically and clinically. Analysis revealed increased glycolytic metabolism in the left orbitofrontal cortex, right temporal lobe and right hippocampus, and reduced glycolytic metabolism in the left cerebellum and inferior parietal lobe within the tinnitus group. The hearing loss control group showed no significant metabolic changes in the analysis. Parsing out the contribution of tinnitus independent of hearing loss, allowed us to identify areas implicated in declines in tinnitus handicap as a result of the intervention. Brain regions implicated in the present study may be part of chronic tinnitus-specific network.

Recent, Bioelectricity-Related Articles Selected by Ann M. Rajnicek, Media Editor of Bioelectricity.

Recent, Bioelectricity-Related Articles Selected by Ann M. Rajnicek, Media Editor of Bioelectricity.

Co-occurrence of Hyperacusis Accelerates With Tinnitus Burden Over Time and Requires Medical Care.

Although tinnitus represents a major global burden, no causal therapy has yet been established. Ongoing controversies about the neuronal pathophysiology of tinnitus hamper efforts in developing advanced therapies. Hypothesizing that the unnoticed co-occurrence of hyperacusis and differences in the duration of tinnitus may possibly differentially influence the neural correlate of tinnitus, we analyzed 33 tinnitus patients without (T-group) and 20 tinnitus patients with hyperacusis (TH-group). We found crucial differences between the T-group and the TH-group in the increase of annoyance, complaints, tinnitus loudness, and central neural gain as a function of tinnitus duration. Hearing thresholds did not differ between T-group and TH-group. In the TH-group, the tinnitus complaints (total tinnitus score) were significantly greater from early on and the tinnitus intensity distinctly increased over time from ca. 12 to 17 dB when tinnitus persisted more than 5 years, while annoyance responses to normal sound remained nearly constant. In contrast, in the T-group tinnitus complaints remained constant, although the tinnitus intensity declined over time from ca. 27 down to 15 dB beyond 5 years of tinnitus persistence. This was explained through a gradually increased annoyance to normal sound over time, shown by a hyperacusis questionnaire. Parallel a shift from a mainly unilateral (only 17% bilateral) to a completely bilateral (100%) tinnitus percept occurred in the T-group, while bilateral tinnitus dominated in the TH-group from the start (75%). Over time in the T-group, ABR wave V amplitudes (and V/I ratios) remained reduced and delayed. By contrast, in the TH-group especially the ABR wave III and V (and III/I ratio) continued to be enhanced and shortened in response to high-level sound stimuli. Interestingly, in line with signs of an increased co-occurrence of hyperacusis in the T-group over time, ABR wave III also slightly increased in the T-group. The findings disclose an undiagnosed co-occurrence of hyperacusis in tinnitus patients as a main cause of distress and the cause of complaints about tinnitus over time. To achieve urgently needed and personalized therapies, possibly using the objective tools offered here, a systematic sub-classification of tinnitus and the co-occurrence of hyperacusis is recommended.

Effects of two inhibitors of metabolic glutamate receptor 5 on expression of endogenous homer scaffold protein 1 in the auditory cortex of mice with tinnitus

ABSTRACT Tinnitus is deemed as the result of abnormal neural activities in the brain, and Homer proteins are expressed in the brain that convey nociception. The expression of Homer in tinnitus has not been studied. We hypothesized that expression of Homer in the auditory cortex was altered after tinnitus treatment. Mice were injected with sodium salicylate to induce tinnitus. Expression of Homer was detected by quantitative real-time polymerase chain reaction, western blotting, and immunohistochemistry assays. We found that Homer1 expression was upregulated in the auditory cortex of mice with tinnitus, while expression of Homer2 or Homer3 exhibited no significant alteration. Effects of two inhibitors of metabolic glutamate receptor 5 (mGluR5), noncompetitive 2-Methyl-6-(phenylethynyl)-pyridine (MPEP) and competitive α-methyl-4-carboxyphenylglycine (MCPG), on the tinnitus scores of the mice and on Homer1 expression were detected. MPEP significantly reduced tinnitus scores and suppressed Homer1 expression in a concentration dependent manner. MCPG had no significant effects on tinnitus scores or Homer1 expression. In conclusion, Homer1 expression was upregulated in the auditory cortex of mice after tinnitus, and was suppressed by noncompetitive mGluR5 inhibitor MPEP, but not competitive mGluR5 inhibitor MCPG.

On the relationship between tinnitus distress, cognitive performance and aging.

In this study we analyzed psychometric data of 107 individuals who suffer from chronic subjective tinnitus. In particular, we elucidated the relationship between tinnitus-related distress, psychological comorbidities, age, and hearing, and the performance in cognitive concentration and interference tests. Previous research has provided first evidence that individuals with tinnitus may have deficits in cognitive tasks. The present study aimed at extending former research by investigating the relationship between tinnitus distress and cognition. Statistical analyses comprised correlation and regression approaches. We observed a significant relationship between tinnitus distress (tinnitus score, TQ), age and hearing loss and the performance in tests on selective and sustained attention (d2 test) and cognitive interference (Stroop test). Tinnitus distress was identified as the most important predictor of cognitive performance (additionally age for cognitive interference). For other psychometric variables (perceived stress, PSQ; self-efficacy, optimism and pessimism, SWOP) and hearing loss we could not find any meaningful relationship with cognitive performance. The results clearly point to a (currently non-causal) relationship between cognitive skills and distress of tinnitus-related symptoms. Furthermore, the influence of age is noteworthy as this finding implies that with increasing age an appropriate coping with aversive tinnitus symptoms based on proper cognitive functions and age-related hearing dysfunctions, namely inhibition, may become more difficult. Hence, it is suggested to consider cognitive tests as a supplementary measurement in clinical assessment of tinnitus and to raise awareness for the impairing influence of tinnitus on cognition in daily life.

Evaluation of Outcomes Related to Hearing and Tinnitus After Ossicular Chain Reconstruction.

The aim of this study was to evaluate both audiological and tinnitus related results in patients with tinnitus undergoing ossicular chain reconstruction (OCR) for ossicular chain injury. Between January 2015 and January 2019, patients who underwent OCR due to ossicular chain pathology and developed tinnitus symptoms were included in the study group. Middle ear pathologies were standardized using the middle ear risk index (MERI) scoring system and the tinnitus handicap inventory (THI) was used to determine the severity of tinnitus. The surgical methods used for reconstruction were partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), depending on the patient's pathology. The study group consisted of 43 patients aged between 34 and 65 years. Mean MERI score of the patients was 6.42 ± 2.52. When assessed categorically, 18.6% of the study group was identified in the 'mild', 46.5% were in the 'moderate', and 34.5% were in the 'severe' MERI category. Patients in the TORP group and those who were undergoing second session OCR had higher MERI and preop THI scores. Post-operative tinnitus levels were higher in patients who had OCR in the second session and were in the severe risk group. The ABG and tinnitus scores of patients were found to improve with OCR. In patients who underwent TORP, both ABG and tinnitus scores decreased significantly. Whereas, in patients who underwent PORP, only ABG values decreased significantly. After OCR, both ABG value and tinnitus scores significantly decreased compared to pre-operative results. ABG recovery rate was 100% in the study group. It can be said that OCR positively changes both audiological parameters and tinnitus levels in ossicular chain pathologies.

Abnormal Spontaneous Neural Activity of the Central Auditory System Changes the Functional Connectivity in the Tinnitus Brain: A Resting-State Functional MRI Study.

ObjectiveAn abnormal state of the central auditory system (CAS) likely plays a large role in the occurrence of phantom sound of tinnitus. Various tinnitus studies using resting-state functional MRI (RS-fMRI) have reported aberrant spontaneous brain activity in the non-auditory system and altered functional connectivity between the CAS and non-auditory system. This study aimed to investigate abnormal functional connections between the aberrant spontaneous activity in the CAS and the whole brain in tinnitus patients, compared to healthy controls (HC) using RS-fMRI.Materials and MethodsRS-fMRI from 16 right-ear tinnitus patients with normal hearing (TNHs) and 15 HC individuals was collected, and the time series were extracted from different clusters of a CAS template, supplied by the Anatomy Toolbox of the Statistical Parametric Mapping software. These data were used to derive the smoothed mean amplitude of low-frequency fluctuation (smALFF) values and calculate the relationship between such values and the corresponding clinical data. In addition, clusters in the CAS identified by the smALFF maps were set as seed regions for calculating and comparing the brain-wide connectivity between TNH and HC.ResultsWe identified the different clusters located in the left higher auditory cortex (HAC) and the right inferior colliculus (IC) from the smALFF maps that contained increased (HAC) and decreased (IC) activity when the TNH group was compared to the HC group, respectively. The value of increased smALFF cluster in the HAC was positively correlated with the tinnitus score, but the decreased smALFF cluster in the IC was not correlated with any clinical characters of tinnitus. The TNH group displayed increased connectivity, compared to the HC group, in brain regions that encompassed the left IC, bilateral Heschl gyrus, bilateral supplementary motor area, right insula, bilateral superior temporal gyrus, right middle temporal gyrus, left hippocampus, left amygdala, and right supramarginal gyrus.ConclusionTinnitus may be linked to abnormal spontaneous activity in the HAC, which can arise from the neural plasticity induced from the increased functional connectivity between the auditory network, cerebellum, and limbic system.