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Author: admin | 10.05.2014 | Category: Tinnitus Causes And Treatments

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Cutaneous digital blood flow (CDBF) during electrical promontory stimulation was measured by laser Doppler flowmetry in 46 tinnitus patients.
Our results suggest that relief of tinnitus was closely related to increased parasympathetic nerve tone. Our objective is to show that our electrical treatment for tinnitus could cause increased parasympathetic tone in tinnitus patients with tinnitus suppression.
We used LDF to assess the effects of treatment in 46 patients with tinnitus (46 ears) who received electrical stimulation treatment at least three times between September 1994 and March of 1995. The stimulation array was placed on the promontory through a small incision made in the ear drum after local anesthesia with iontophoresis. Laser Doppler Flowmetry (LDF) was used to monitor blood flow of the tip of the second finger of the right hand using a laser Doppler flowmetry monitor (Laserflow, BPM 403, TSI Corp.). Figure 2 shows a representative LDF pattern observed in patients with no relief of tinnitus. Electrical stimulation is sometimes associated with an acoustic effect that is similar to the effect produced by a tinnitus-masking device) In the present study, however, tinnitus was relieved without perception of sounds although higher frequency (up to 20 kHz) electrical stimulation evoked cochlear nerve activity even if lower frequency electrical stimulation caused stronger response of cochlear nerve activity.8 In addition, there has been no report that tinnitus suppression produced increased parasympathetic nerve tone.
In addition to tinnitus suppression, we reported that some patients with implanted electrical tinnitus suppressor fell asleep on a bed during stimulation,12 suggesting that ES using a 10 kHz sinusoidal wave induced sleep. Increased Parasympathetic Nerve Tone in Tinnitus Patients Following Electrical Promontory Stimulation.
The study group included 26 men (26 ears) and 20 women (20 ears) ages 42-79 years (mean: 61 years). A representative laser flowmetry pattern in a patient who experienced complete relief of tinnitus. Mean CBFR did not differ significantly (p>0.4) between patients with sudden deafness and patients with deafness of unknown origin. Percentage ratio of cutaneous digital blood flow as a function of change in tinnitus suppression.
Therefore, the mechanism of relief following electrical stimulation was not the same as that associated with a tinnitus-masking device.
Falling asleep may be the supreme relaxation, suggesting that our method for ES may be a kind of relaxation therapy in addition to masking by improvement of hearing loss which was shown by our preliminary report.9,10 Our method of using the electrode through the hole on the ear drum was so stressful that some patients actually seemed to feel comfortable after the cessation of the stimulation. However, electrical stimulation did not affect cutaneous digital blood flow in guinea pig, suggesting that increased CBF in this study is probably not caused by the same mechanism causing increased blood flow to the cochlea. However, the discrepancy between subjective findings and LDF assessment in five patients, who reported complete tinnitus suppression and did not feel comfortable, was observed. One of our goals for tinnitus suppression by ES is to extend the duration of residual inhibition.
Hazell JWP, Meerton LJ, Conway MJ: Electrical tinnitus suppression (ETS) with a single channel cochlear implant. Graham JM, Hazell JWP: Electrical stimulation of the human cochlea using a transtympanic electrode.
Matsushima J, Fujimura H, Sakai N, Suganuma T, Hayashi M, Ifukube T, Hirata Y, Miyoshi S: A study of electrical promontory stimulation in tinnitus patients.
Shepherd RK, Matsushima J, Millard RE, Clark GM: Cochlear pathology following chronic electrical stimulation using non charge-balanced stimuli.

Matsushima J, Harada C, Sakai N, Ifukube T: Neural responses to electrical stimulation of the cochlea in guinea pigs.
Matsushima J, Fujimura Y, Hayashi M, Nagahashi T, Sakai N, Inuyama Y, Ifukube T:Auditory evoked magnetic field response for tinnitus patients -A comparison study of the promontory electrical stimulation treatment-.
Matsushima J, Sakai N, Miyoshi S, Uemi N, Ifukube T: Improvement in hearing acuity in tinnitus patient following electrical promontory stimulation.
Matsushima M, Sakai N, Takeichi N, Miyoshi S, Sakajiri M, Uemi N, Ifukube T: Implanted electrical tinnitus suppressor. Miller JM, Bredberg G, Grenman R, Suonpaa J, Lindsrom B, Didier A: Measurement of human cochlear blood flow. In contrast, patients in whom treatment did not suppress tinnitus experienced no change in digital blood flow. Sympathetic stimulation constricts cutaneous blood vessels but increased parasympathetic tone dilates cutaneous vessels.6 Laser Doppler flowmetry (LDF) is a conventional method for measuring cutaneous blood flow. The wire was connected to a stainless steel lead wire that was attached to an electromagnetic coupling system. The symbol "o" represents the mean value of the cutaneous digital blood flow at the onset of stimulation and the symbol "+" represents the mean value at the end of stimulation. The number of patients in each etiologic group was too limited to permit a comparison between responsive and unresponsive ears.
Open circles showed values of ratio of cutaneous digital blood flow in 14 patients who felt comfortable and filled circles in 32 patients who did not feel comfortable. In patients with slight tinnitus suppression, only the three patients with larger CBFR felt comfortable.
Our previous report9 showed that response of auditory-evoked magnetic field response was augmented following ES in tinnitus patients with relief of tinnitus.
However, we did not let patients know the time of stimulation so that the expectancy of cessation of stimulation and pulling the electrode out could not make the parasympathetic nerve tone increased. Increased cholinergic nerve tone dilates the cutaneous vessels, suggesting that parasympathetic tone in tinnitus patients who experienced increased CBF may be augmented by ES. The CBFR in these five patients was similar to that detected in patients who reported little or no relief, suggesting a placebo effect.
We found that there was a close correlation between effectiveness and increased parasympathetic nerve tone.
Preliminary report from articulation test of grammatically correct but non-sense Japanese 4-segment sentences.
The cutaneous digital blood flow of patients who experienced slight relief did not differ significantly from patients who experienced no relief. Therefore, changes in the blood flow of the skin during ES could be easily detected by LDF. In the 20 patients with bilateral tinnitus, ears with louder tinnitus were chosen to be assessed. A plate electrode for recording the electrocardiogram was attached to the post-auricular skin. The difference in the mean hearing level between responsive and unresponsive ears was not significant (p>0.1). A dotted line shows the summated value of the mean ratio of cutaneous digital blood flow and the two standard deviations (113.8%) in patients without tinnitus suppression.

We also showed10 that word recognition was improved following ES in tinnitus patients with relief of tinnitus. The gradual increased cutaneous digital blood flow following the start of stimulation, as shown in Figure 1, suggested that ES actually acted on the parasympathetic nerve.
The mean CBFR in the group that was only slightly suppressed did not differ significantly from the group with no relief.
Therefore, we should focus more on the relationship between the autonomic nervous system and tinnitus relief to understand the mechanism of the residual inhibition. The ratio of CDBF before and after treatment did not correlate with patient age, audiogram pattern.
Stimulation was initiated at 50 μA for 60 seconds, about 30 seconds after the stimulator was switched on. Measurement was not done at the first stimulation trial because insertion of the electrode through the tympanic membrane was so stressful.
The most common audiogram pattern was slightly sloped and consistent with that for a high-frequency sensorineural hearing loss (n=17).
These findings are related to Shulman's comment" that tinnitus may be masked secondary to the improvement of hearing.
The next most common audiogram illustrated a sharply sloping, high-frequency sensorineural loss pattern (n=9). Therefore, these findings may suggest that tinnitus suppression by ES may be caused by a kind of central masking mechanism. This suggests that tinnitus suppression was not sufficient to increase CBF in patients with slight response or, alternatively, placebo responses are most likely in this group. Recording LDF was performed at the second or third tri al to decrease effects of stress (for example: etectrlcal stimulation and insertion of electrode through the ear drum) on the autonomic nervous system.
However, no previous report about ES showed the relationships between tinnitus suppression and increased parasympathetic nerve tone.
Blood flow started to increase with a stimulation intensity of 50 μA and continued to increase gradually as the intensity of stimulation increased.
Patients with the sharply sloping pattern showed a greater increase in CBFR compared with patients with the slightly sloping pattern. The Tatio of CDBF at the cessation of stimulation to that at the initiation of stimulation (CBFR) was calculated.
The value of cutaneous digital blood flow (CDBF) at the initiation of stimulation was defined as the mean value between the maximum and minimum of the blood flow at the point of the initiation on the recording paper. The number of patients with other types of audiogram patterns was too small to permit comparison of treatment efficacy.
Mean CBFR in patients with highpitched (3000 to 8000Hz) pre-stimulation tinnitus (n=16) did not differ significantly (p>0.6) from that of patients whose pre-stimulation tinnitus was classified as a noise (white and band noise, n=13). There was no significant difference (p>0.4) in mean CBRF between patients with high-pitched tinnitus and patients with low-pitched tinnitus.

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