Unilateral Subjective Tinnitus Research Articles

A study on impact of tinnitus masking on psychophysical and tinnitus tuning curve in participants with hearing impairment suffering from severe tinnitus

Background: Tinnitus can be treated by using different pedagogies of management approaches in which tinnitus masking has been acclaimed most evidence-based approach. Psychophysical tuning curve and tinnitus tuning curve explored as least interested procedures in tinnitus research. This noteworthy but nonspecific psychophysical domain may throw a light on need of the present research. Aim of the study was to find out the effect of tinnitus masking on Psychophysical tuning curve and tinnitus tuning curve. Method: A total of 30 native Bengali speaking participants were included in this study, having mean age of 45.9 years and SD was 6.46. All the participants had unilateral subjective tinnitus with Mild to Moderately severe sensorineural hearing loss. Quasi-experimental research design was used. Dual channel audiometer (MAICO MA 53) with supra-aural TDH 39 headphone was used for psychoacoustic measurements of tinnitus (including pitch matching, loudness matching, minimum masking level etc.) and to provide tinnitus masking therapy. MATLAB version 9.5 was used to develop noise to assess PTC and TTC using Sennheiser HD 201 headphone routed through MAICO MA 53 audiometer via stereo jack and cable. Tinnitus masking therapy was carried out for 30 sessions by using regimen of MML +20 dB of masking level for 30 minutes duration for each session with matched pitch. PTC and TTC were measured before and 30 sessions-after tinnitus masking therapy. PTC was measured using 1000 Hz pure tone at 10 dBSLl as reference followed by four narrow band noise with centre frequency of 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz pertaining to 312 Hz band width as developed by MATLAB software. TTC was measured using the same noise with reference to matched tinnitus pitch. All the above-mentioned conditions forced choice procedure was carried out in dBHL frame work. Results: Wilcoxon sign rank test was used at 95% confidence level to check the influence of tinnitus masking therapy on PTC and TTC measures. Significant changes were portrayed at 1000 Hz and 4000 Hz respectively in PTC measure and at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz respectively in TTC measures. Conclusion: This study preliminarily provides information regarding influence on tinnitus pitch domains which has been psychoacoustically systematically measured as PTC and TTC. These two psychoacoustic signatures may be treated as prognostic biomarker of tinnitus management in future using replicable research using different methodology or using statistical basis of data mining. At that point conclusive remarks may not throw a clear indication based on the results found in this study.

Development and Validation of a Nomogram to Predict the Risk of Tinnitus Severity in Patients With Unilateral Subjective Tinnitus.

Purpose: To develop and validate a nomogram for predicting the risk of tinnitus severity in patients with unilateral subjective tinnitus. Methods: The objective of this study was to establish and validate a nomogram specifically designed for patients with unilateral subjective tinnitus. We collected data on unilateral subjective tinnitus from the Air Force Medical Center, including 146 participants between January 2021 and June 2022. Risk factors for unilateral subjective tinnitus severity were evaluated by least absolute shrinkage and selection operator (LASSO) and binary logistic regression analysis. Internal verification was used to evaluate the performance of the nomogram. The discriminative ability was measured by the consistency index (C-indices) and the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. Results: All included patients were randomized according to a 7:3 ratio into the training cohort (104 patients) and the validation cohort (42 patients). The LASSO regression model identified sex, tinnitus loudness, and hearing loss as candidate variables. Binary logistic regression analysis showed that gender (OR: 0.76; 95% CI: 0.6-0.95; P = 0.021) and tinnitus loudness (OR: 1.37; 95% CI: 1.09-1.72; P = 0.009) were significant predictors of unilateral subjective tinnitus severity, while age, tinnitus matching frequency, and tinnitus duration were not. The significant predictors were included in the nomogram. Hearing loss was included in the nomogram based on prior clinical experience and previous studies. The training and validation cohorts C-indexes were 0.707 (95% CI: 0.607-0.806) and 0.706 (95% CI: 0.548-0.863), respectively. The training and validation cohort's AUC of the ROC curves were 0.692 and 0.705, respectively. Conclusion: We have developed and validated a nomogram based on gender, hearing loss, and tinnitus loudness, which can effectively predict the risk of tinnitus severity in patients with unilateral subjective tinnitus. The nomogram provides personalized prediction results for patients with unilateral subjective tinnitus, which is beneficial for clinical decision-making and treatment plan development.

Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator.

Typewriter tinnitus refers to a special kind of staccato tinnitus, which is mostly described by patients as Morse code, popcorn, or machine-gun. It has been accepted that the mechanism of typewriter tinnitus is caused by the neurovascular compression of the cochleovestibular nerve. Patients who suffered from typewriter tinnitus have exhibited a good response to carbamazepine or oxcarbazepine, but there is a risk of recurrence after treatment cessation. The present study aims to determine the value of auditory brainstem response (ABR) in diagnosing typewriter tinnitus and predicting relapse after drug withdrawal. Patients who presented with typewriter tinnitus from March 2019 to March 2022 were included for the present retrospective study. The auditory and vestibular test results and drug treatment effects were collected and analyzed. Patients with idiopathic unilateral subjective tinnitus, who were matched by age to patients with typewriter tinnitus at a ratio of 2:1, were consecutively recruited for the control group. Eighteen patients with typewriter tinnitus and 38 controls were included. Ears with typewriter tinnitus had longer interpeak latency (IPL) I-III, and wave III and V latencies, and a higher ratio of IPL I-III ≥2.3 ms based on ABR, when compared to the unaffected side and controls ( p <0.05). Seventeen patients with typewriter tinnitus responded positively to medication. Among these patients, seven patients had a relapse after drug cessation, while 10 patients did not have a relapse. The relapse group had significantly longer IPL I-III and wave V latency, older age, and poorer hearing, when compared to the nonrelapse group ( p < 0.05). Furthermore, IPL I-III had the largest area under the receiver operating characteristic curve, and the optimal cutoff was 2.4 ms (sensitivity, 100.0%; specificity, 66.7%). There were no significant differences in other demography or other clinical test results between the relapse and nonrelapse groups ( p > 0.05). Ramsay Hunt syndrome and neuromyelitis optica spectrum disorders were identified in two cases. Prolonged IPL I-III based on ABR can help in the diagnosis of typewriter tinnitus and its prognosis after treatment cessation. Patients with IPL I-III greater than 2.4 ms, older age and poorer hearing are more likely to relapse. In addition to the neurovascular conflict of the cochleovestibular nerve, the etiologies of neuroinflammation and demyelinating diseases are also possible for typewriter tinnitus.

The Evaluation of the Cochlear Aqueduct and Internal Acoustic Canal in Patients with Unilateral Subjective Tinnitus and Normal Hearing

The Evaluation of the Cochlear Aqueduct and Internal Acoustic Canal in Patients with Unilateral Subjective Tinnitus and Normal Hearing

Auditory brainstem response test results in normal hearing adolescents with subjective tinnitus

ObjectivesThe objective of the study was to analyze the auditory brainstem response (ABR) test results of adolescents with normal hearing threshold who have subjective tinnitus in an effort to determine the probable site of origin of tinnitus. MethodsAmong the patients who visited the outpatient clinic of the Department of Otolaryngology at our tertiary hospital from January 2016 to December 2019, adolescents aged 13–18 years with the chief complaint of unilateral subjective tinnitus and pure tone audiometry (PTA) within 25 dB HL were enrolled and retrospectively reviewed. The ABR test parameters (amplitudes and latencies of waves I, III, and V and interpeak latencies [IPLs] of waves I–III, III–V, and I–V) were analyzed and compared between tinnitus ears and contralateral ears without tinnitus. Study participants were divided into the chronic tinnitus (tinnitus duration ≥6 months) and non-chronic tinnitus (tinnitus duration <6 months) groups, and the difference between the two groups was analyzed. ResultsTen adolescents were included in the study, and their ABR test results were reviewed. IPL III–V was significantly prolonged in tinnitus ears compared to non-tinnitus ears (p = 0.035). Although other parameters were found to be statistically non-significant, there was preponderance in ABR wave I amplitude; it was smaller in tinnitus ears of chronic tinnitus adolescents than in those of non-chronic tinnitus adolescents (p = 0.114). ConclusionThe probable site of origin of tinnitus in adolescents with normal hearing might be in the upper brainstem of the auditory pathway. Further analysis of ABR test results in adolescents with tinnitus and normal hearing can help clarify the pathophysiology of tinnitus in adolescents.

The results of high-frequency audiometry in tinnitus patients

Objective: To evaluate high-frequency (HF) audiometry in subjects with unilateral subjective tinnitus and normal pure tone thresholds (≤25 dB HL) at 0.25-8 kHz.Materials and methods: The study group; consisted of 20 patients with unilateral subjective tinnitus (12 women, 8 men) and normal hearing threshold levels. A control group was also selected as 20 subjects (11 women, 9 men) having normal pure tone thresholds below 25 dBHL at 0.25-8 kHz and not complaining of tinnitus. The HF audiometry testing was used. HF hearing threshold measurements were performed in a sound-treated booth using the clinic audiometer (Interacoustics AC 40, Danimarka) with Koss R80 HF headphone at 10, 12.5, 14 and 16 kHz.Results: The pure tone hearing thresholds showed difference between tinnitus ears of study group and control group at 10, 12.5, 14 and 16 kHz (p < .05). Similarly HF hearing thresholds showed difference between tinnitus ears and non-tinnitus ears in the study group at 10, 12.5, 14 and 16 kHz (p < .05).Conclusions: The routinely use of HF audiometry in tinnitus subjects with normal pure tone thresholds with conventional audiometry can provide useful information about the patients’ hearing status.

Intratympanic dexamethasone as an adjuvant to oral imipramine hydrochloride (Tofranil, a TCA) 25 mg twice daily in management of idiopathic unilateral subjective tinnitus

BackgroundIn this report, we summarize our clinical experience with intratympanic (IT) dexamethasone treatment for control of idiopathic unilateral tinnitus when used as an adjunct treatment with Tricyclic antidepressant (TCA) imipramine hydrochloride 25mg twice daily for 1 month.ObjectivesTo assess the clinical benefit of adding dexamethasone by IT route to the tricyclic antidepressant imipramine hydrochloride in the management of idiopathic unilateral subjective tinnitus.Study designA prospective randomized clinical trial was conducted.ResultsResults from this study showed significant subjective improvement of patients with unilateral subjective tinnitus when comparing the two arms of the study, both to pretreatment assessment and between the two arms, giving significant advantage to the group treated with combination of intratympanic dexamethasone with imipramine hydrochloride 25mg twice daily for 2 weeks using tinnitus handicap inventory questionnaire, subjective tinnitus loudness as measured by a visual analog scale, and tinnitus awareness score.ConclusionIntratympanic dexamethasone injection in combination with TCA imipramine maleate could be subjectively beneficial when compared with imipramine hydrochloride alone.

Auditory and visual 3D virtual reality therapy for chronic subjective tinnitus: theoretical framework

It is estimated that ~10% of the adult population in developed countries is affected by subjective tinnitus. Physiopathology of subjective tinnitus remains incompletely explained. Nevertheless, subjective tinnitus is thought to result from hyperactivity and neuroplastic reorganization of cortical and subcortical networks following acoustic deafferentation induced by cochlear or auditory nerve damage. Involvement of both auditory and non-auditory central nervous pathways explains the conscious perception of tinnitus and also the potentially incapacitating discomfort experienced by some patients (sound hypersensitivity, sleep disorders, attention deficit, anxiety or depression). These clinical patterns are similar to those observed in chronic pain following amputation where conditioning techniques using virtual reality have been shown both to be theoretically interesting and effectively useful. This analogy led us to develop an innovative setup with dedicated auditory and visual 3D virtual reality environments in which unilateral subjective tinnitus sufferers are given the possibility to voluntarily manipulate an auditory and visual image of their tinnitus (tinnitus avatar). By doing so, the patients will be able to transfer their subjective auditory perception to the tinnitus avatar and to gain agency on this multimodal virtual percept they hear, see and spatially control. Repeated sessions of such virtual reality immersions are then supposed to contribute to tinnitus treatment by promoting cerebral plasticity. This paper describes the theoretical framework and setup adjustments required by this very first attempt to adapt virtual reality techniques to subjective tinnitus treatment. Therapeutic usefulness will be validated by a further controlled clinical trial.

Functional imaging of unilateral tinnitus using fMRI

Conclusions. This article shows that the inferior colliculus plays a key role in unilateral subjective tinnitus. Objectives. The major aim of this study was to determine tinnitus-related neural activity in the central auditory system of unilateral tinnitus subjects and compare this to control subjects without tinnitus. Subjects and methods. Functional MRI (fMRI) was performed in 10 patients (5 males) with unilateral tinnitus (5 left-sided, 5 right-sided) and 12 healthy subjects (6 males); both groups had normal hearing or mild hearing loss. fMRI experiments were performed using a 3T Philips Intera Scanner. Auditory stimuli were presented left or right and consisted of dynamically rippled broadband noise with a sound pressure level of 40 or 70 dB SPL. The responses of the inferior colliculus and the auditory cortex to the stimuli were measured. Results. The response to sound in the inferior colliculus was elevated in tinnitus patients compared with controls without tinnitus.