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Dirk De Ridder - One of the best experts on this subject based on the ideXlab platform.
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pathology of Tinnitus and hyperacusis clinical implications
BioMed Research International, 2015Co-Authors: Aage R Moller, Richard Salvi, Dirk De Ridder, Tobias Kleinjung, Sven VannesteAbstract:Not long ago, Tinnitus and hyperacusis were considered intractable symptoms and the lack of interest and shortage of research in diseases with these symptoms would have made publishing a special issue on Tinnitus and hyperacusis nearly impossible. During the past two decades, there has been an explosion of research on Tinnitus and incremental growth on hyperacusis, a condition associated with hearing loss, autism, migraine, closed head injuries, Williams syndrome, fibromyalgia, and other sensory hypersensitivity disorders. Prior to 1980, a search of PubMed turned up fewer than 25 publications with Tinnitus in the title (Figure 1); the situation for hyperacusis was even more dismal with less than 5 publications in 1980 and only 19 in 2014. Figure 1 A search of PubMed shows an exponential increase of publications related to Tinnitus over the last 20 years, while research related to hyperacusis has been mainly overlooked. This increase in publications reflects a large increase in research made possible by new hypotheses about the pathology of these diseases, advances in neuroscience in general, and new technological approaches. The increase in research funding by private philanthropic organizations such as the American Tinnitus Association, the Tinnitus Research Consortium, the Tinnitus Research Initiative, and Action on Hearing Loss has been essential for the progress in understanding of Tinnitus and hyperacusis and the treatment of these disorders. Research grants from governmental agencies have also contributed to these advances in research regarding Tinnitus and hyperacusis. The incentive for this special issue was the tremendous personal, social, and financial costs associated with Tinnitus and hyperacusis. For those suffering from severe or debilitating Tinnitus or hyperacusis, the psychosocial and emotional costs can be enormous. While Tinnitus and hyperacusis can affect anyone, young or old, those serving in the military are at a higher risk than nonmilitary people. Roughly 50% of combat personnel in the Gulf War developed Tinnitus where exposure to intense noise and stress were likely the major contributing factors. Tinnitus ranks as the #1 service-connected disabilities in the Veterans Health Care System with compensation costs $1.2 billion for the year 2012, projected to reach $3 billion for the year 2017. The completion of this special issue is a testament to the tremendous efforts by research groups around the world to develop a better understanding of the neural mechanisms underlying Tinnitus and hyperacusis and to develop better and more effective therapies. This special issue combines association studies (Tinnitus and sleep, Tinnitus and headaches, Tinnitus and interoceptive awareness, mastoid pneumatization, and pulsatile Tinnitus), diagnostic studies (how to measure hyperacusis, the relevance of high-frequency hearing loss in Tinnitus), and treatment studies (coordinated reset acoustic stimulation, repeated rTMS sessions). A few highlights from the accepted papers in this special issue are discussed below. Hearing loss, which reduces the neural input to the central auditory system, is thought to be one of the major triggers for inducing Tinnitus and aberrant neural activity within the brain; however, many people with Tinnitus have normal hearing thresholds within the conventional audiometric range (0.25–8 kHz). The work of V. Vielsmeier et al. shows that many people with Tinnitus who have what is regarded to be normal hearing have elevated hearing thresholds above 8 kHz, which are strongly correlated with the laterality of the Tinnitus. The take home message is that high-frequency audiometry should be an integral part of a comprehensive Tinnitus assessment. Some evidence suggests that the air spaces within the temporal bone (pneumatization) may contribute to the severity of pulsatile Tinnitus. Using imaging techniques to quantify pneumatization, W. Liu et al., however, found little correlation between the severity of Tinnitus and the degree of pneumatization. While many people with Tinnitus have hearing loss, not everybody who has hearing loss has Tinnitus, a result that supports other findings that show that Tinnitus is a multifactorial disease. The article by B. Langguth et al. present evidence that Tinnitus and headache may be pathologically linked, consistent with earlier research linking Tinnitus and hyperacusis to migraine. Sleep disturbances are common in people with Tinnitus but the relationship between sleep disturbance and the severity of a person's Tinnitus has been unclear. M. Schecklmann et al. report that Tinnitus distress is highly correlated with sleep disturbances. Over the past decade, many new and promising therapeutic approaches for treating Tinnitus have emerged. Many different sound therapies designed to modify neural activity in the brain have been developed and remain to be validated. The exciting paper by C. Hauptmann et al. suggests that acoustic coordinated reset neuromodulation could become a therapeutic strategy for treating patients with chronic tonal Tinnitus. Even though the lack of a control group does not permit showing real efficacy, the promising results of this open label study demonstrate that further controlled studies are warranted. Another approach to treating people with Tinnitus is repetitive transcranial magnetic stimulation (rTMS). One of the main problems with published studies of the use of rTMS to treat people with Tinnitus is the small effect size and the fact that the effect of rTMS in Tinnitus is limited in time. In a paper in this issue A. Lehner et al. demonstrate that repeating the rTMS sessions seems to be beneficial when the Tinnitus distress worsens after waning of the rTMS effect. The Hyperacusis Questionnaire is a tool used by clinicians to evaluate hyperacusis symptoms in Tinnitus patients. Factor analysis of data obtained by K. Fackrell et al. suggests that only 10 items and two factors (attentional and social) in the Hyperacusis Questionnaire may be a more appropriate approach for assessing hyperacusis instead of the current 12 items and 3 factors (emotional, attentional, and social). Furthermore, it was shown by M. Schecklmann et al. that using only 2 questions can give a good hint at whether hyperacusis is present: (1) Do you have a problem tolerating sounds because they often seem much too loud? (2) Do sounds cause you pain or physical discomfort? P. Lau et al. demonstrate that Tinnitus is unrelated to interoceptive awareness but that people with Tinnitus tend to overestimate physical changes in comparison to people who do not have Tinnitus. In summary, special issues like this, covering clinical, diagnostic, and treatment aspects of Tinnitus and hyperacusis, remain highly needed to continue the quest for finding better and more effective ways to treat these elusive symptoms. Only a better understanding of the causes of both Tinnitus and hyperacusis and their pathology can pave the way to reaching this goal. Aage R. Moller Richard Salvi Dirk De Ridder Tobias Kleinjung Sven Vanneste
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treatment of Tinnitus with cyclobenzaprine an open label study
Principles and Practice of Constraint Programming, 2012Co-Authors: Sven Vanneste, Ricardo Rodrigues Figueiredo, Dirk De RidderAbstract:Objective Tinnitus is defined as an intrinsic sound sensation that cannot be attributed to an external sound source. Currently there are no standardized drug therapies for the treatment of Tinnitus. Based on the analogy between pain and Tinnitus it is suggested that among all antidepressant families that have been used for Tinnitus, particular interest should be paid to the tricyclic group of drugs as they have an analgesic effect. The aim of the present study was to investigate the effect of a tricyclic pharmacological agent, namely cyclobenzaprine for the relief of Tinnitus complaints. Subjects and methods 65 patients, who received the drug treatment, were compared to 30 patients on a waiting list, who received no treatment. Results Analysis shows that cyclobenzaprine offers some benefit to patients with Tinnitus on both Tinnitus intensity and Tinnitus distress, while a waiting list control group does not demonstrate any improvement: 24% of the Tinnitus patients showed a clear response to cyclobenzaprine with a reduction of 53% on Tinnitus intensity and 25% had a clear response to cyclobenzaprine with a reduction of 55% on Tinnitus distress. It was further demonstrated that particular subgroups, namely pure tone Tinnitus patients and unilateral Tinnitus patients, respond better to cyclobenzaprine. Conclusion Our results indicate that cyclobenzaprine is a promising drug to treat Tinnitus particularly in certain subgroups. As there is a good risk-benefit ratio and there are currently no well-established, specific treatments for Tinnitus, cyclobenzaprine might be worthwhile to further investigate.
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repetitive transcranial magnetic stimulation frequency dependent Tinnitus improvement by double cone coil prefrontal stimulation
Journal of Neurology Neurosurgery and Psychiatry, 2011Co-Authors: Sven Vanneste, Paul Van De Heyning, Mark Plazier, Dirk De RidderAbstract:Background A double cone coil (DCC) with large angled windings has been developed to modulate deeper brain areas such as the dorsal and subcallosal anterior cingulate cortex. Methods Seventy-eight Tinnitus patients received transcranial magnetic stimulation (TMS) using a DCC placed over the dorsal frontal cortex. Treatment effects were assessed with visual analogue scale for intensity and distress. Results The results showed that 1 and 3 Hz of DCC frontal TMS can improve both Tinnitus intensity and Tinnitus distress, 5 Hz is equal to sham and 20 Hz is significantly worse than sham. Of the 78 Tinnitus patients, 52 had no control response. Of these 52 placebo negative participants, 21 showed no suppressive response to stimulation and 31 patients were TMS responders. For this latter group, mean transient Tinnitus suppression was obtained in 34.38% for Tinnitus intensity and in 26% for Tinnitus related distress. Conclusion Frontal TMS using a DCC is capable of suppressing Tinnitus transiently dependent on the repetitive TMS frequency used. These data further support the idea that non-auditory areas are involved in Tinnitus intensity and Tinnitus distress modulation.
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bilateral dorsolateral prefrontal cortex modulation for Tinnitus by transcranial direct current stimulation a preliminary clinical study
Experimental Brain Research, 2010Co-Authors: Sven Vanneste, Paul Van De Heyning, Mark Plazier, Jan Ost, Elsa Van Der Loo, Dirk De RidderAbstract:Tinnitus is considered as an auditory phantom percept. Preliminary evidence indicates that transcranial direct current stimulation (tDCS) of the temporo-parietal area might reduce Tinnitus. tDCS studies of the prefrontal cortex have been successful in reducing depression, impulsiveness and pain. Recently, it was shown that the prefrontal cortex is important for the integration of sensory and emotional aspects of Tinnitus. As such, frontal tDCS might suppress Tinnitus as well. In an open label study, a total of 478 Tinnitus patients received bilateral tDCS on dorsolateral prefrontal cortex (448 patients anode right, cathode left and 30 anode left, cathode right) for 20 min. Treatment effects were assessed with visual analogue scale for Tinnitus intensity and distress. No Tinnitus-suppressing effect was found for tDCS with left anode and right cathode. Analyses show that tDCS with right anode and left cathode modulates Tinnitus perception in 29.9% of the Tinnitus patients. For these responders a significant reduction was found for both Tinnitus-related distress and Tinnitus intensity. In addition, the amount of suppression for Tinnitus-related distress is moderated by an interaction between Tinnitus type and Tinnitus laterality. This was, however, not the case for Tinnitus intensity. Our study supports the involvement of the prefrontal cortex in the pathophysiology of Tinnitus.
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incapacitating unilateral Tinnitus in single sided deafness treated by cochlear implantation
Annals of Otology Rhinology and Laryngology, 2008Co-Authors: Paul H Van De Heyning, Katrien Vermeire, Martina Diebl, Peter Nopp, Ilona Anderson, Dirk De RidderAbstract:Objectives:Tinnitus is a well-known, difficult-to-treat symptom of hearing loss. Users of cochlear implants (CIs) have reported a reduction in Tinnitus following implantation for bilateral severe-to-profound deafness. This study assessed the effect of electrical stimulation via a CI on Tinnitus in subjects with unilateral deafness and ipsilateral Tinnitus who underwent implantation in an attempt to treat Tinnitus with the CI.Methods:Twenty-one subjects who complained of severe intractable Tinnitus that was unresponsive to treatment received a CI. Tinnitus loudness was measured with a Visual Analog Scale; loudness percepts were recorded with the device activated and deactivated. Tinnitus distress was measured with the Tinnitus Questionnaire before and after implantation.Results:Electrical stimulation via a CI resulted in a significant reduction in Tinnitus loudness (mean ± SD; 1 year after implantation, 2.4 ± 1.8; 2 years after implantation, 2.5 ± 1.9; before implantation, 8.5 ± 1.3). With the device deact...
Carol A Bauer - One of the best experts on this subject based on the ideXlab platform.
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clinical practice guideline Tinnitus
Otolaryngology-Head and Neck Surgery, 2014Co-Authors: David E Tunkel, Carol A Bauer, Gordon H Sun, Richard M Rosenfeld, Sujana S Chandrasekhar, Eugene R Cunningham, Sanford M Archer, Brian W Blakley, John M Carter, Evelyn C GranieriAbstract:Objective. Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing Tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of Tinnitus and its potential significant effect on quality of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on Tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient’s quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with Tinnitus. The target patient population is limited to adults (18 years and older) with primary Tinnitus that is persistent and bothersome. Purpose. The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with Tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome Tinnitus. It will discuss the evaluation of patients with Tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary Tinnitus, with recommendations to guide the evaluation and measurement of the effect of Tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for Tinnitus sufferers. Action Statements. The development group made a strong recommendation that clinicians distinguish patients with bothersome Tinnitus from patients with nonbothersome Tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with Tinnitus, specifically to evaluate Tinnitus that does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurologic abnormalities or an asymmetric hearing loss. The panel made the following recommendations: Clinicians should (a) perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary Tinnitus to identify conditions that if promptly identified and managed may relieve Tinnitus; (b) obtain a prompt, comprehensive audiologic examination in patients with Tinnitus that is unilateral, persistent (≥ 6 months), or associated with hearing difficulties; (c) distinguish patients with bothersome Tinnitus of recent onset from those with persistent symptoms (≥ 6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care; (d) educate patients with persistent, bothersome Tinnitus about management strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome Tinnitus associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with persistent, bothersome Tinnitus. The panel recommended against (a) antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome Tinnitus; (b) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome Tinnitus; and (c) transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome Tinnitus. The development group provided the following options: Clinicians may (a) obtain an initial comprehensive audiologic examination in patients who present with Tinnitus (regardless of laterality, duration, or perceived hearing status); 545325
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effect of Tinnitus retraining therapy on the loudness and annoyance of Tinnitus a controlled trial
Ear and Hearing, 2011Co-Authors: Carol A Bauer, Thomas J BrozoskiAbstract:Objectives Subjective Tinnitus is the sensation of hearing a sound in the absence of an external stimulus. Although an estimated 30 million Americans experience chronic Tinnitus, only a small percentage are significantly bothered by the sensation. However, this population is currently in need of effective therapy that reduces the impact of Tinnitus. Tinnitus retraining therapy has been promoted as an effective intervention for treating chronic bothersome Tinnitus from any etiology. The aim of this study was to compare the effect of Tinnitus retraining therapy on the loudness and annoyance of Tinnitus with a control group. Design Subjects with subjective, stable, bothersome, chronic Tinnitus, and normal to near-normal hearing in the speech frequencies (average pure-tone thresholds for 0.5, 1, 2, and 4 kHz ≤ 30 dB HL) were recruited to participate in a study for the effect of Tinnitus retraining therapy (TRT) on the loudness and annoyance of their Tinnitus. Participants were assigned to either the TRT arm or a control arm, with assignment balanced between groups by Tinnitus severity. After baseline evaluation, participants received acoustic stimulation devices and 3 mos of individual counseling. An integrated computerized test battery of questionnaires and psychophysical procedures were used to evaluate participants at 6, 12, and 18 mos after enrollment. The primary outcome measure was the change in total score on the Tinnitus handicap inventory. Secondary outcome measures were change in global Tinnitus impact on a Tinnitus experience questionnaire, subjective Tinnitus loudness rating, and Tinnitus loudness objectively measured using a psychophysical matching procedure. Results Both TRT and general counseling without additional sound therapy are effective in reducing the annoyance and impact of Tinnitus. The largest effect on overall Tinnitus handicap was observed in the TRT participants, with an effect size of 1.13. However, a clinically significant effect was also observed in the control group, with an effect size of 0.78. Conclusions Individuals with moderate to severe Tinnitus, without hearing loss in the speech frequency range, benefit from treatment with either TRT or general counseling. The global improvement in Tinnitus handicap with TRT accrues over an 18-mo period and seems to be a robust and clinically significant effect.
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The effect of dorsal cochlear nucleus ablation on Tinnitus in rats.
Hearing research, 2005Co-Authors: Thomas J Brozoski, Carol A BauerAbstract:A growing body of evidence implies that the dorsal cochlear nucleus (DCN) plays an important role in Tinnitus. To test the hypothesis that the rostral output of the DCN is necessary for the experience of chronic Tinnitus, the dorsal DCN and the dorsal acoustic stria of rats with psychophysical evidence of Tinnitus was ablated. If the DCN plays a necessary role in the generation of chronic Tinnitus, ablating the DCN should decrease the evidence of Tinnitus in subjects previously shown to have Tinnitus. Contrary to prediction, bilateral dorsal DCN ablation did not significantly (n=11, p=0.707) affect the psychophysical evidence of Tinnitus, and ipsilateral dorsal DCN ablation appeared to increase the evidence of Tinnitus (n=9, p=0.018) compared to pre-ablation performance. It was concluded that the DCN does not act as a simple feed-forward source of chronic Tinnitus. Alternative hypotheses were considered, among them that elevated DCN activity following acoustic trauma triggers persistent pathological changes distributed across more than one level of the auditory system. In addition to serving as a trigger, the DCN may also modify the experience of Tinnitus, since the evidence of Tinnitus was enhanced by ipsilateral DCN ablation.
Thomas J Brozoski - One of the best experts on this subject based on the ideXlab platform.
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effect of Tinnitus retraining therapy on the loudness and annoyance of Tinnitus a controlled trial
Ear and Hearing, 2011Co-Authors: Carol A Bauer, Thomas J BrozoskiAbstract:Objectives Subjective Tinnitus is the sensation of hearing a sound in the absence of an external stimulus. Although an estimated 30 million Americans experience chronic Tinnitus, only a small percentage are significantly bothered by the sensation. However, this population is currently in need of effective therapy that reduces the impact of Tinnitus. Tinnitus retraining therapy has been promoted as an effective intervention for treating chronic bothersome Tinnitus from any etiology. The aim of this study was to compare the effect of Tinnitus retraining therapy on the loudness and annoyance of Tinnitus with a control group. Design Subjects with subjective, stable, bothersome, chronic Tinnitus, and normal to near-normal hearing in the speech frequencies (average pure-tone thresholds for 0.5, 1, 2, and 4 kHz ≤ 30 dB HL) were recruited to participate in a study for the effect of Tinnitus retraining therapy (TRT) on the loudness and annoyance of their Tinnitus. Participants were assigned to either the TRT arm or a control arm, with assignment balanced between groups by Tinnitus severity. After baseline evaluation, participants received acoustic stimulation devices and 3 mos of individual counseling. An integrated computerized test battery of questionnaires and psychophysical procedures were used to evaluate participants at 6, 12, and 18 mos after enrollment. The primary outcome measure was the change in total score on the Tinnitus handicap inventory. Secondary outcome measures were change in global Tinnitus impact on a Tinnitus experience questionnaire, subjective Tinnitus loudness rating, and Tinnitus loudness objectively measured using a psychophysical matching procedure. Results Both TRT and general counseling without additional sound therapy are effective in reducing the annoyance and impact of Tinnitus. The largest effect on overall Tinnitus handicap was observed in the TRT participants, with an effect size of 1.13. However, a clinically significant effect was also observed in the control group, with an effect size of 0.78. Conclusions Individuals with moderate to severe Tinnitus, without hearing loss in the speech frequency range, benefit from treatment with either TRT or general counseling. The global improvement in Tinnitus handicap with TRT accrues over an 18-mo period and seems to be a robust and clinically significant effect.
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The effect of dorsal cochlear nucleus ablation on Tinnitus in rats.
Hearing research, 2005Co-Authors: Thomas J Brozoski, Carol A BauerAbstract:A growing body of evidence implies that the dorsal cochlear nucleus (DCN) plays an important role in Tinnitus. To test the hypothesis that the rostral output of the DCN is necessary for the experience of chronic Tinnitus, the dorsal DCN and the dorsal acoustic stria of rats with psychophysical evidence of Tinnitus was ablated. If the DCN plays a necessary role in the generation of chronic Tinnitus, ablating the DCN should decrease the evidence of Tinnitus in subjects previously shown to have Tinnitus. Contrary to prediction, bilateral dorsal DCN ablation did not significantly (n=11, p=0.707) affect the psychophysical evidence of Tinnitus, and ipsilateral dorsal DCN ablation appeared to increase the evidence of Tinnitus (n=9, p=0.018) compared to pre-ablation performance. It was concluded that the DCN does not act as a simple feed-forward source of chronic Tinnitus. Alternative hypotheses were considered, among them that elevated DCN activity following acoustic trauma triggers persistent pathological changes distributed across more than one level of the auditory system. In addition to serving as a trigger, the DCN may also modify the experience of Tinnitus, since the evidence of Tinnitus was enhanced by ipsilateral DCN ablation.
Wolfgang Delb - One of the best experts on this subject based on the ideXlab platform.
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Tinnitus related distress and the personality characteristic resilience
Neural Plasticity, 2014Co-Authors: Elisabeth Wallhausserfranke, Wolfgang Delb, Tobias Balkenhol, Wolfgang Hiller, Karl HormannAbstract:It has been suggested that personality traits may be prognostic for the severity of suffering from Tinnitus. Resilience as measured with the Wagnild and Young resilience scale represents a positive personality characteristic that promotes adaptation to adverse life conditions including chronic health conditions. Aim of the study was to explore the relation between resilience and Tinnitus severity. In a cross-sectional study with a self-report questionnaire, information on Tinnitus-related distress and subjective Tinnitus loudness was recorded together with the personality characteristic resilience and emotional health, a measure generated from depression, anxiety, and somatic symptom severity scales. Data from 4705 individuals with Tinnitus indicate that Tinnitus-related distress and to a lesser extent the experienced loudness of the Tinnitus show an inverse correlation with resilience. A mediation analysis revealed that the relationship between resilience and Tinnitus-related distress is mediated by emotional health. This indirect effect indicates that high resilience is associated with better emotional health or less depression, anxiety, and somatic symptom severity, which in turn is associated with a less distressing Tinnitus. Validity of resilience as a predictor for Tinnitus-related distress is supported but needs to be explored further in longitudinal studies including acute Tinnitus patients.
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Tinnitus: Distinguishing between Subjectively Perceived Loudness and Tinnitus-Related Distress
2013Co-Authors: Elisabeth Wallhäusser-franke, Joachim Brade, Tobias Balkenhol, Andrea Seegmuller, Wolfgang DelbAbstract:Objectives: Overall success of current Tinnitus therapies is low, which may be due to the heterogeneity of Tinnitus patients. Therefore, subclassification of Tinnitus patients is expected to improve therapeutic allocation, which, in turn, is hoped to improve therapeutic success for the individual patient. The present study aims to define factors that differentially influence subjectively perceived Tinnitus loudness and Tinnitus-related distress. Methods: In a questionnaire-based cross-sectional survey, the data of 4705 individuals with Tinnitus were analyzed. The selfreport questionnaire contained items about subjective Tinnitus loudness, type of onset, awareness and localization of the Tinnitus, hearing impairment, chronic comorbidities, sleep quality, and psychometrically validated questionnaires addressing Tinnitus-related distress, depressivity, anxiety, and somatic symptom severity. In a binary step-wise logistic regression model, we tested the predictive power of these variables on subjective Tinnitus loudness and Tinnitus-related distress. Results: The present data contribute to the distinction between subjective Tinnitus loudness and Tinnitus-related distress. Whereas subjective loudness was associated with permanent awareness and binaural localization of the Tinnitus, Tinnitusrelated distress was associated with depressivity, anxiety, and somatic symptom severity. Conclusions: Subjective Tinnitus loudness and the potential presence of severe depressivity, anxiety, and somatic symptom severity should be assessed separately from Tinnitus-related distress. If loud Tinnitus is the major complaint together wit
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Tinnitus distinguishing between subjectively perceived loudness and Tinnitus related distress
PLOS ONE, 2012Co-Authors: Elisabeth Wallhausserfranke, Tobias Balkenhol, Joachim Brade, Roberto Damelio, Andrea Seegmuller, Wolfgang DelbAbstract:Objectives: Overall success of current Tinnitus therapies is low, which may be due to the heterogeneity of Tinnitus patients. Therefore, subclassification of Tinnitus patients is expected to improve therapeutic allocation, which, in turn, is hoped to improve therapeutic success for the individual patient. The present study aims to define factors that differentially influence subjectively perceived Tinnitus loudness and Tinnitus-related distress. Methods: In a questionnaire-based cross-sectional survey, the data of 4705 individuals with Tinnitus were analyzed. The selfreport questionnaire contained items about subjective Tinnitus loudness, type of onset, awareness and localization of the Tinnitus, hearing impairment, chronic comorbidities, sleep quality, and psychometrically validated questionnaires addressing Tinnitus-related distress, depressivity, anxiety, and somatic symptom severity. In a binary step-wise logistic regression model, we tested the predictive power of these variables on subjective Tinnitus loudness and Tinnitus-related distress. Results: The present data contribute to the distinction between subjective Tinnitus loudness and Tinnitus-related distress. Whereas subjective loudness was associated with permanent awareness and binaural localization of the Tinnitus, Tinnitusrelated distress was associated with depressivity, anxiety, and somatic symptom severity. Conclusions: Subjective Tinnitus loudness and the potential presence of severe depressivity, anxiety, and somatic symptom severity should be assessed separately from Tinnitus-related distress. If loud Tinnitus is the major complaint together with mild or moderate Tinnitus-related distress, therapies should focus on auditory perception. If levels of depressivity, anxiety or somatic symptom severity are severe, therapies and further diagnosis should focus on these symptoms at first.
Sven Vanneste - One of the best experts on this subject based on the ideXlab platform.
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pathology of Tinnitus and hyperacusis clinical implications
BioMed Research International, 2015Co-Authors: Aage R Moller, Richard Salvi, Dirk De Ridder, Tobias Kleinjung, Sven VannesteAbstract:Not long ago, Tinnitus and hyperacusis were considered intractable symptoms and the lack of interest and shortage of research in diseases with these symptoms would have made publishing a special issue on Tinnitus and hyperacusis nearly impossible. During the past two decades, there has been an explosion of research on Tinnitus and incremental growth on hyperacusis, a condition associated with hearing loss, autism, migraine, closed head injuries, Williams syndrome, fibromyalgia, and other sensory hypersensitivity disorders. Prior to 1980, a search of PubMed turned up fewer than 25 publications with Tinnitus in the title (Figure 1); the situation for hyperacusis was even more dismal with less than 5 publications in 1980 and only 19 in 2014. Figure 1 A search of PubMed shows an exponential increase of publications related to Tinnitus over the last 20 years, while research related to hyperacusis has been mainly overlooked. This increase in publications reflects a large increase in research made possible by new hypotheses about the pathology of these diseases, advances in neuroscience in general, and new technological approaches. The increase in research funding by private philanthropic organizations such as the American Tinnitus Association, the Tinnitus Research Consortium, the Tinnitus Research Initiative, and Action on Hearing Loss has been essential for the progress in understanding of Tinnitus and hyperacusis and the treatment of these disorders. Research grants from governmental agencies have also contributed to these advances in research regarding Tinnitus and hyperacusis. The incentive for this special issue was the tremendous personal, social, and financial costs associated with Tinnitus and hyperacusis. For those suffering from severe or debilitating Tinnitus or hyperacusis, the psychosocial and emotional costs can be enormous. While Tinnitus and hyperacusis can affect anyone, young or old, those serving in the military are at a higher risk than nonmilitary people. Roughly 50% of combat personnel in the Gulf War developed Tinnitus where exposure to intense noise and stress were likely the major contributing factors. Tinnitus ranks as the #1 service-connected disabilities in the Veterans Health Care System with compensation costs $1.2 billion for the year 2012, projected to reach $3 billion for the year 2017. The completion of this special issue is a testament to the tremendous efforts by research groups around the world to develop a better understanding of the neural mechanisms underlying Tinnitus and hyperacusis and to develop better and more effective therapies. This special issue combines association studies (Tinnitus and sleep, Tinnitus and headaches, Tinnitus and interoceptive awareness, mastoid pneumatization, and pulsatile Tinnitus), diagnostic studies (how to measure hyperacusis, the relevance of high-frequency hearing loss in Tinnitus), and treatment studies (coordinated reset acoustic stimulation, repeated rTMS sessions). A few highlights from the accepted papers in this special issue are discussed below. Hearing loss, which reduces the neural input to the central auditory system, is thought to be one of the major triggers for inducing Tinnitus and aberrant neural activity within the brain; however, many people with Tinnitus have normal hearing thresholds within the conventional audiometric range (0.25–8 kHz). The work of V. Vielsmeier et al. shows that many people with Tinnitus who have what is regarded to be normal hearing have elevated hearing thresholds above 8 kHz, which are strongly correlated with the laterality of the Tinnitus. The take home message is that high-frequency audiometry should be an integral part of a comprehensive Tinnitus assessment. Some evidence suggests that the air spaces within the temporal bone (pneumatization) may contribute to the severity of pulsatile Tinnitus. Using imaging techniques to quantify pneumatization, W. Liu et al., however, found little correlation between the severity of Tinnitus and the degree of pneumatization. While many people with Tinnitus have hearing loss, not everybody who has hearing loss has Tinnitus, a result that supports other findings that show that Tinnitus is a multifactorial disease. The article by B. Langguth et al. present evidence that Tinnitus and headache may be pathologically linked, consistent with earlier research linking Tinnitus and hyperacusis to migraine. Sleep disturbances are common in people with Tinnitus but the relationship between sleep disturbance and the severity of a person's Tinnitus has been unclear. M. Schecklmann et al. report that Tinnitus distress is highly correlated with sleep disturbances. Over the past decade, many new and promising therapeutic approaches for treating Tinnitus have emerged. Many different sound therapies designed to modify neural activity in the brain have been developed and remain to be validated. The exciting paper by C. Hauptmann et al. suggests that acoustic coordinated reset neuromodulation could become a therapeutic strategy for treating patients with chronic tonal Tinnitus. Even though the lack of a control group does not permit showing real efficacy, the promising results of this open label study demonstrate that further controlled studies are warranted. Another approach to treating people with Tinnitus is repetitive transcranial magnetic stimulation (rTMS). One of the main problems with published studies of the use of rTMS to treat people with Tinnitus is the small effect size and the fact that the effect of rTMS in Tinnitus is limited in time. In a paper in this issue A. Lehner et al. demonstrate that repeating the rTMS sessions seems to be beneficial when the Tinnitus distress worsens after waning of the rTMS effect. The Hyperacusis Questionnaire is a tool used by clinicians to evaluate hyperacusis symptoms in Tinnitus patients. Factor analysis of data obtained by K. Fackrell et al. suggests that only 10 items and two factors (attentional and social) in the Hyperacusis Questionnaire may be a more appropriate approach for assessing hyperacusis instead of the current 12 items and 3 factors (emotional, attentional, and social). Furthermore, it was shown by M. Schecklmann et al. that using only 2 questions can give a good hint at whether hyperacusis is present: (1) Do you have a problem tolerating sounds because they often seem much too loud? (2) Do sounds cause you pain or physical discomfort? P. Lau et al. demonstrate that Tinnitus is unrelated to interoceptive awareness but that people with Tinnitus tend to overestimate physical changes in comparison to people who do not have Tinnitus. In summary, special issues like this, covering clinical, diagnostic, and treatment aspects of Tinnitus and hyperacusis, remain highly needed to continue the quest for finding better and more effective ways to treat these elusive symptoms. Only a better understanding of the causes of both Tinnitus and hyperacusis and their pathology can pave the way to reaching this goal. Aage R. Moller Richard Salvi Dirk De Ridder Tobias Kleinjung Sven Vanneste
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treatment of Tinnitus with cyclobenzaprine an open label study
Principles and Practice of Constraint Programming, 2012Co-Authors: Sven Vanneste, Ricardo Rodrigues Figueiredo, Dirk De RidderAbstract:Objective Tinnitus is defined as an intrinsic sound sensation that cannot be attributed to an external sound source. Currently there are no standardized drug therapies for the treatment of Tinnitus. Based on the analogy between pain and Tinnitus it is suggested that among all antidepressant families that have been used for Tinnitus, particular interest should be paid to the tricyclic group of drugs as they have an analgesic effect. The aim of the present study was to investigate the effect of a tricyclic pharmacological agent, namely cyclobenzaprine for the relief of Tinnitus complaints. Subjects and methods 65 patients, who received the drug treatment, were compared to 30 patients on a waiting list, who received no treatment. Results Analysis shows that cyclobenzaprine offers some benefit to patients with Tinnitus on both Tinnitus intensity and Tinnitus distress, while a waiting list control group does not demonstrate any improvement: 24% of the Tinnitus patients showed a clear response to cyclobenzaprine with a reduction of 53% on Tinnitus intensity and 25% had a clear response to cyclobenzaprine with a reduction of 55% on Tinnitus distress. It was further demonstrated that particular subgroups, namely pure tone Tinnitus patients and unilateral Tinnitus patients, respond better to cyclobenzaprine. Conclusion Our results indicate that cyclobenzaprine is a promising drug to treat Tinnitus particularly in certain subgroups. As there is a good risk-benefit ratio and there are currently no well-established, specific treatments for Tinnitus, cyclobenzaprine might be worthwhile to further investigate.
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repetitive transcranial magnetic stimulation frequency dependent Tinnitus improvement by double cone coil prefrontal stimulation
Journal of Neurology Neurosurgery and Psychiatry, 2011Co-Authors: Sven Vanneste, Paul Van De Heyning, Mark Plazier, Dirk De RidderAbstract:Background A double cone coil (DCC) with large angled windings has been developed to modulate deeper brain areas such as the dorsal and subcallosal anterior cingulate cortex. Methods Seventy-eight Tinnitus patients received transcranial magnetic stimulation (TMS) using a DCC placed over the dorsal frontal cortex. Treatment effects were assessed with visual analogue scale for intensity and distress. Results The results showed that 1 and 3 Hz of DCC frontal TMS can improve both Tinnitus intensity and Tinnitus distress, 5 Hz is equal to sham and 20 Hz is significantly worse than sham. Of the 78 Tinnitus patients, 52 had no control response. Of these 52 placebo negative participants, 21 showed no suppressive response to stimulation and 31 patients were TMS responders. For this latter group, mean transient Tinnitus suppression was obtained in 34.38% for Tinnitus intensity and in 26% for Tinnitus related distress. Conclusion Frontal TMS using a DCC is capable of suppressing Tinnitus transiently dependent on the repetitive TMS frequency used. These data further support the idea that non-auditory areas are involved in Tinnitus intensity and Tinnitus distress modulation.
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bilateral dorsolateral prefrontal cortex modulation for Tinnitus by transcranial direct current stimulation a preliminary clinical study
Experimental Brain Research, 2010Co-Authors: Sven Vanneste, Paul Van De Heyning, Mark Plazier, Jan Ost, Elsa Van Der Loo, Dirk De RidderAbstract:Tinnitus is considered as an auditory phantom percept. Preliminary evidence indicates that transcranial direct current stimulation (tDCS) of the temporo-parietal area might reduce Tinnitus. tDCS studies of the prefrontal cortex have been successful in reducing depression, impulsiveness and pain. Recently, it was shown that the prefrontal cortex is important for the integration of sensory and emotional aspects of Tinnitus. As such, frontal tDCS might suppress Tinnitus as well. In an open label study, a total of 478 Tinnitus patients received bilateral tDCS on dorsolateral prefrontal cortex (448 patients anode right, cathode left and 30 anode left, cathode right) for 20 min. Treatment effects were assessed with visual analogue scale for Tinnitus intensity and distress. No Tinnitus-suppressing effect was found for tDCS with left anode and right cathode. Analyses show that tDCS with right anode and left cathode modulates Tinnitus perception in 29.9% of the Tinnitus patients. For these responders a significant reduction was found for both Tinnitus-related distress and Tinnitus intensity. In addition, the amount of suppression for Tinnitus-related distress is moderated by an interaction between Tinnitus type and Tinnitus laterality. This was, however, not the case for Tinnitus intensity. Our study supports the involvement of the prefrontal cortex in the pathophysiology of Tinnitus.
