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The aim of our study was to outline the prevalence of hyperlipidemia in patients who had high-frequency hearing loss and tinnitus due to noise exposure. Cochlear hair cells and neural and central auditory pathways are involved in the generation of subjective tinnitus [1].
Decrease in internal diameter of the vascular bed resulting from hyperlipidemia compromises the oxygen transportation capability of the blood to the cochlea, and chronic hypoxia is likely to occur by the reduction in oxygen supply of the inner ear, which in turn would lead to insufficient adjustment of the cochlear metabolism. This may result in the overproduction and accumulation of free radicals, which disturb the microcirculation of the cochlea and play an important role in ischemiainduced cochlear injury [7]. The reasons for the susceptibility to noise-induced hearing loss of patients who have been exposed to a noisy environment have been the subject of various studies. Previous data indicate that the cochlea and the central auditory system age faster and earlier in patients with hyperlipidemia and that the risk of noise-induced hearing loss is much higher [5,11].
The aim of this study was to outline the prevalence of hyperlipidemia in patients who had high-frequency hearing loss and tinnitus due to chronic noise exposure and to evaluate the risk of developing sensory hearing loss in those patients as compared to risk in control subjects. We conducted this prospective study in 120 consecutive patients with complaints of chronic subjective tinnitus of varying degrees of severity and hearing loss due to noise exposure. The patients were examined otoscopically and were reviewed by an audiometric test battery including puretone audiometer (AC-30, IAC, Copenhagen, Denmark), stapes reflex, and tympanometry (Amplaid 775, Milan, Italy).
Antilipid treatment with statin derivatives was planned once-daily oral dosing for up to 1-2 years (minimum, 12.4 months).
We then compared tinnitus scores and hearing levels in patients with no response to antihyperlipidemic therapy and in patients who had a normal blood cholesterol level after the treatment. The duration of tinnitus in patients with noise exposure varied from 2 months to 12 years (mean, 5.5 years). Of 22 patients in the unresponsive group, 6 had high cholesterol and triglyceride, 9 had high triglyceride, and 7 had high cholesterol only before the antilipidemic therapy. Of 20 patients in the responsive group, 7 had high cholesterol or triglyceride, 10 had high triglyceride, and 3 had high cholesterol only before the antilipidemic therapy. The difference between the pitch-match frequencies before and after therapy was not significant. Epidemiological investigations emphasizing the relationship between hearing loss and the risk factors for coronary artery disease date back to the 1960s [18]. Spencer [19] found that 42.3% of 300 patients with different symptoms of inner-ear pathology had clearly defined hyperlipoproteinemia. The effect of hyperlipidemia on auditory perception has been studied clinically and experimentally.
The exact pathological mechanism for the hyperlipidemia-induced hearing loss remains obscure. In his study of 64 rats, Pillsbury [37] exposed half to loud noise and fed half of each subgroup a fat diet and found elevated auditory brainstem response thresholds in the hyperlipidemic animals.
Studies investigating the restorative possibility of a low-cholesterol diet and antihyperlipidemic therapy on hearing loss and tinnitus are very few. LDL apheresis has been reported to be much more effective as compared with standard prednisolone, dextran, and pentoxifylline therapy in patients with sudden hearing loss [9].
In our study, changes in tinnitus scores before and after therapy in the responsive group were significant as compared with those in the unresponsive group. Tinnitus and hearing loss are frequently encountered after an acute acoustic and blast trauma or chronic noise exposure. We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. The editor and reviewers' affiliations are the latest provided on their Loop research profiles and may not reflect their situation at time of review. Tinnitus, a phantom ringing, buzzing, or hissing sensation with potentially debilitating consequences, is thought to arise from aberrant spontaneous neural activity at one or more sites within the central nervous system; however, the location and specific features of these oscillations are poorly understood with respect to specific tinnitus features.
Chronic subjective tinnitus is a common hearing disorder often described as a buzzing, sizzling or ringing sensation that occurs in the absence of an objective sound. Most studies to date have demonstrated disrupted functional connectivity in tinnitus using resting-state fMRI (Husain and Schmidt, 2014).
To address this issue, we compared the changes of LFO amplitudes in chronic tinnitus patients using two resting-state fMRI metrics: ALFF and fractional ALFF (fALFF).
All subjects provided written informed consent before their participation in the study protocol, which was approved by the Research Ethics Committee of the Affiliated Zhongda Hospital of Southeast University. Magnetic resonance imaging data were acquired at the Radiology Department of Zhongda Hospital using a 3.0 T MRI scanner (Siemens MAGENETOM Trio, Erlangen, Germany). Functional data analyses were conducted using Data Processing Assistant for Resting-State fMRI (DPARSF) programs (Chao-Gan and Yu-Feng, 2010), based on statistical parametric mapping (SPM81) and resting-state fMRI data analysis toolkits (REST2). To exclude the effect of structural damage on ALFF measurements, we performed a voxel-based morphometry (VBM) approach to compute the GM volume of each subject using DPARSF software. Table 2 presents the comparisons of the whole-brain volumes (GM volume, WM volume, and brain parenchyma volume) between the tinnitus patients and the healthy controls.
We auditorily stimulated patients affected by subjective tinnitus with broadband noise containing a notch around their tinnitus frequency. We recruited tinnitus sufferers from among patients attending the Oto-Rhino-Laryngology II Clinic of the University of Parma, Italy, in the period 2004-2006.
We determined hearing sensitivity using tonal stimuli presented in octave steps, from 125 Hz to 8,000 Hz, and 1-dB increments. The experimental pitch-matching test was performed shortly after the patient had performed the loudnessmatching test using pure tones as comparison stimuli. Conversely, in our study, an essential prerequisite for the correct application of the experimental acoustic therapy (notched broadband noise; see later) was the reliability (and repeatability) of the measurement of the tinnitus pitch. Our method was based on the classic pure tone-matching paradigm and consisted of two phases. During both the upward and downward sweeps, we stopped tone presentation every time the subject reported a match between the tone and the pitch of the tinnitus. The second phase (termed sequential binary choice) resembled the traditional 2AFC procedure. During this phase, a number of patients reported more than one tone as matching their tinnitus pitch. We should note that any procedure of tinnitus pitch assessment is subject to many errors owing to, for example, differences in the ability of subjects to compare and discriminate among tones, the uniqueness of the tinnitus sensation, or the presence of different types of tinnitus. The experimental design consisted of randomly assigning to each patient either the experimental sound therapy (WWN)* or one of the two control sound therapies (WN or Wa) following a double-blind procedure.
We examined variation of the tinnitus parameters (F t , dB t ) over time for each patient by repeating measurements, ideally after 1, 3, and 6 months from the start of the therapy, following the same procedures of the first visit. In addition, when the subject's tinnitus pitch was reassessed during a control visit, usually the observed value of F t was not exactly the same as the one measured in the previous visit. Therefore, the following compromise criterion was adopted: A new, updated WWN acoustic sequence was constructed only when the re-measured value of F t fell outside the noise window previously determined. The temporal variation of tinnitus loudness in the three groups of patients was examined by computing the values of Δ dB t using the patient's values of dB t measured during subsequent control visits. Table 1 summarizes the characteristics of patients of each treatment group together with the clinical measurements of their tinnitus at their first visit. The average time elapsed from the beginning of the acoustic therapy and the last tinnitus measurement was similar in the three groups of patients: 148 dd (+ 20), 145 dd (+ 25), and 127 dd (+ 16), respectively, for the WN, Wa, and WWN groups. Figure 4 shows the variation of tinnitus loudness with time elapsed from the start of therapy for three patients taken as an example (one for each type of therapy) and for one subject initially receiving the Wa therapy and later re-treated with the WWN therapy (see further discussion later). The mean decibel attenuation between 3 and 6 months of therapy was less than 1 dB in patients of the Wa group and 4-5 dB in those in the WN and WWN groups. In the four patients re-treated with the WWN therapy, the value of dBt measured at the last control visit was compared to that measured at the control visit preceding the change of therapy. Our method for the treatment of subjective tinnitus differs substantially from previous methods (but see Goldstein et el.
Indeed, the most striking result of our study was the marked decrease of tinnitus loudness observed in patients after approximately 4-5 months of daily listening to the WWN sound stimulation but not seen in those listening to either the WN or the Wa sound stimulations for an equivalent amount of time.
The presence of subjects without residual tinnitus in the WWN group but not in the two control groups further strengthens this conclusion. Apart from the beneficial effects on tinnitus loudness perception, another remarkable aspect of this study was the development of a novel tinnitus pitch-matching procedure using binary comparison of tones selected by the patient in a previous test on the basis of their resemblance to tinnitus.
A potential methodological criticism that should be addressed in this study is the lack of control by experimenters over the patients' motivation or willingness to carefully follow the procedures established by the therapeutic listening program. First, both the Wa and WN therapies were equally ineffective in reducing tinnitus loudness, despite the greater tolerability and pleasantness of the first therapy according to the patients' judgment. The key element of the WST was the auditory stimulation of tinnitus sufferers with masking noise presumably not comprising the tinnitus frequencies, often suggested to be responsible for the exacerbation of the symptom.
An alternative explanation for the decreased tinnitus loudness in patients treated with WST might involve a change in the neural reorganization in the tinnitus region induced by stimulation with noise around, but not inside, the tinnitus pitch region. Tinnitus is associated with the most important symptoms in neurootology besides vertigo, nausea, and hearing loss. Since about 1985, via vestibular evoked potentials (VestEP) and brain electrical activity mapping (BEAM), the Wurzburg Neurootology Group of Claussen et al. For this study, we randomly selected a sample of 757 patients suffering from an endogenous tinnitus according to the tetrad of tinnitus differentiation described. We followed with a thorough audiometric investigation to obtain measurements of the hearing threshold, the acoustic discomfort threshold, the calculation of the acoustic dynamics, tinnitus masking, impedanciometry, and stapedial muscle reflexes.
In assessing the vestibulospinal pathways, we regularly applied craniocorpography (CCG) in the form of ultrasonographic computed craniocorpography (UCCCG).
The test results from our analyses helped us to demonstrate that these 757 patients were suffering from an endogenous tinnitus. At the Neurootological Research Institute at Bad Kissingen, we recorded statistics from our 757 patients suffering from an endogenous tinnitus. After exploring the vertigo mechanisms, we analyzed the different sensations in hearing distortion in our patient sample (Fig.
Figure 20 shows our analysis of trigeminal nerve complaints: Although no patient reported trigeminal nerve disorders, the medical investigators found such disorders by direct inspection relative to patients' obtained medical history. The special set of questions regarding our patients' history dealt with specific neurological disorders (Fig. Very well known is that after head and neck trauma, many patients complain of various types of tinnitus. Cardiovascular diseases were very important background disorders for our neurootological patients. We also questioned our patients about diabetes mellitus and categorized these cases with respect to their therapy. For this study, we randomly selected 757 tinnitus patients who reported that they felt better in a noisy environment. The question underlying this study is whether tinnitus is a monosymptomatic disease or is bound into a complex spectrum of complaints within a multisensory disorder. We saw a very varied picture in the subjective descriptions of the quality of tinnitus sensations. Of background disorders, various cardiovascular diseases showed a high occurrence rate (Fig.
All in all, we must conclude that our evaluations in studying our 757 cases demonstrate that the spectrum of subjective complaints is very complex and individually mingled. Overall, our evaluation of 757 patients with endogenous tinnitus posits that the most important accompanying general diseases are cardiovascular. From all these patterns of interactive complaints, we also must conclude that endogenous tinnitus points to a "cybernetopathia" deriving from dysfunctions at various points of the statoacoustic and interrelated supportive neurosensory pathways. Unfortunately, some people do not benefit from the phenomenon of habituation and come to consider their tinnitus as an inconvenience of nature that undermines their quality of life.
Whatever the case may be, the most efficient overall treatment are those that consist in perceptiona€“type therapies, whose aim is to transform the conscious perception of a€?phantom soundsa€? into an unconscious one. The experiment revealed that there are indeed differences, which corroborates the data of studies carried out in accordance with other protocols (in particular, with positron emission tomography and with electroencephalography) in other centers.
There are many things that can cause damage to the auditory system, but the most common is noise damage.
Please visit the NIH’s Interactive sound ruler for examples of various types of sounds and their hazard levels.
Musicians work in a high decibel environment in which hearing loss, tinnitus, hyper-sensitivity to sound and sound distortion can result.  Traditional earplugs are not a good choice for the professional musician, as they reduce sound by muffling low-to-mid-range frequencies, which change the frequency spectrum of what they are hearing. Hunting requires the ability to hear very soft sounds, while still having a need for protecting the ear from the peak noise levels of a gun blast. Low-Cholesterol Diet and Antilipid Therapy in Managing Tinnitus and Hearing Loss in Patients with Noise-Induced Hearing Loss and Hyperlipidemia.
We investigated the role of a low-cholesterol diet and antihyperlipidemic therapy to alleviate the severity of tinnitus and possibly promote hearing gain after therapy in patients with acoustic trauma. Analysis of the epidemiological data indicates that exposure to noise is widespread and is one of the most common causes of tinnitus, which leads to various somatic and psychological disorders and interferes with the quality of life [2]. Auditory perception in such cochleas is very sensitive to reduction of the oxygenation in the inner ear [6].
Platelet aggregation and blood viscosity due to high lipid levels will intensify inner-ear damage owing to slowing of microcirculation and will contribute to the development of both progressive and sudden hearing loss [8,9].
Gratton and Wright [10] demonstrated the accumulation of lipid in the stria vascularis and outer hair cells in chinchillas after experimentally induced hypercholesterolemia, which might intensify the detrimental effect of ototoxic drugs or noise. We instituted a low-cholesterol diet and antihyperlipidemic therapy to investigate whether any benefit accrued in terms of hearing gain and tinnitus relief.
The project was approved by the local medical research ethical committee, and we obtained informed consent from each patient. Audiometric tests included air- and boneconduction thresholds for pure tones of 125-8,000 Hz, tests of speech reception and speech discrimination, contralateral and ipsilateral reflex measurements, and tympanometry. Measurement of loudness of the tinnitus was based on subjective assessment by the patients. Daily dosage ranged from 10 to 40 mg for simvastatin (Zocor) and from 10 to 80 mg for atorvastatin calcium (Lipitor). Average ages of patients in the unresponsive and the responsive groups were 39 and 42 years, respectively. Wilcoxon and Mann-Whitney U tests were used to compare the pretreatment data with the posttreatment results and to compare the results of responders and nonresponders.
None of these patients demonstrated any drop to normal ranges in cholesterol or triglyceride values after the treatment.
When those patients were asked to qualify the severity of their tinnitus, seven rated their tinnitus as the same (35%), two rated it as increased (10%), seven rated it as decreased (35%), and four had no tinnitus (20%). The correlation between serum lipids and auditory dysfunction has been investigated before, and it has been reported that sensorineural hearing loss is more prominent in those with high levels of cholesterol, triglyceride, and lowLDL and in patients with low HDL concentration [18-23]. Increased blood viscosity and atherosclerosis of the cochlear vessels reduce the blood perfusion of the cochlea and promote hearing impairment [6,8,19,20,23,24]. When patients were required to qualify the severity of their tinnitus, 35% of the patients in the responsive group rated their tinnitus as decreased, and 20% of patients reported no tinnitus.
Even though other factors making the patients susceptible to noise-induced hearing loss should be considered, on the basis of present results it can be concluded that the incidence of hyperlipidemia is high among patients with noise-induced hearing loss and that significant improvement in lowered intensity of tinnitus and in average hearing thresholds at higher frequencies can be achieved after lowering patients' serum lipid level [43].
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Recent resting-state functional magnetic resonance imaging (fMRI) studies suggest that aberrant fluctuations in spontaneous low-frequency oscillations (LFO) of the blood oxygen level-dependent (BOLD) signal may be an important factor in chronic tinnitus; however, the role that frequency-specific components of LFO play in subjective tinnitus remains unclear. The oscillations occurring in neural networks extending over large area of the brain are thought to play critical roles in perception, attention, memory and cognition and disruptions in these oscillatory patterns have been linked to neurological disorders such as epilepsy, autism, and tinnitus (Buzsáki and Draguhn, 2004). Functional connectivity describes the temporal synchrony or interregional cooperation between two or more spatially separate regions.
A total of 82 subjects including 41 chronic tinnitus patients and 41 healthy controls were recruited through community health screenings and newspaper advertisements. A total of 240 volumes were scanned, and the first 10 volumes were discarded to allow for signal equilibrium of the initial magnetic resonance signals and adaptation of the subjects to the circumstances.
Briefly, cerebral tissues were segmented into GM, WM, and cerebrospinal fluid and were then normalized to the MNI space using a unified segmentation algorithm (Ashburner and Friston, 2005).
The results showed that there were no significant changes in GM and WM volumes between the two groups (p > 0.05). The Windowed Sound Therapy: A New Empirical Approach for an Effective Personalized Treatment of Tinnitus. We assessed the long-term effects on tinnitus perception in patients listening to notched noise stimuli (referred to as windowed sound therapy [WST]) by measuring the variation of subjects' tinnitus loudness over a period of 2-12 months.
Epidemiological surveys indicate that the sensation caused by the tinnitus is present in 5-15% of the human population. All subjects of the study were patients reporting a ringing or hissing sound in one or both ears (Table 1) and willing to take part voluntarily in the experiment and to scrupulously follow the assigned therapy. With a few exceptions, we noted that all patients had, in one or both ears, a more or less pronounced hearing loss at frequencies above 3-4 kHz, an important predisposing factor for the occurrence of tinnitus [9]. We stopped the procedure when a patient reported that the pitch of the comparison stimulus was similar to the tinnitus pitch. The difference between the two measurements was the estimated loudness of the patient's tinnitus (dB t [decibels SL]). Pure tones were generated with a function generator (Kenwood model FG-273; Kenwood Corporation, Taiwan) connected to a custom portable electronic switchboard (left, right, binaural), and the output signal was sent to a pair of Sennheiser HD 202 (Sennheiser Sales, Dublin, Ireland) closed-cup headphones.
Pure tones are commonly used for measuring the pitch of both noise-like and tonal tinnitus [10]. In such cases, the frequency value of the matching tone was noted, and the tone sweep was resumed, starting from the frequency at which it had been interrupted.
We asked subjects which of the previously identified tones were more similar to the pitch of their tinnitus.
This could happen for several reasons: presence of different kinds of tinnitus, such as a ringing associated to hissing tinnitus, presence of multiple tinnitus spectral peaks [13], or octave confusion.
WWN was constructed from a 10-minute sequence of white noise generated by the white noise generation function of a suitable software for sound analysis (AVISOFT; Avisoft Bioacoustics, Berlin, Germany).
For these reasons, the width of the erased band of WWN was set prudently to a value double the width of the critical band of the tinnitus frequency.
Spectral characterization of the three sound therapies with decibel values in relative units.
This was expected, as any procedure of pitch assessment is inherently imprecise for reasons already discussed. In this case, the patient was asked to return the old disk and listen to a new disk that contained the usual 8-minute sequence of equalized broadband noise recorded after a notch centered at the new tinnitus frequency or frequencies was created following the method explained earlier. Conversely, the presence of two control treatments allowed the effectiveness of the WWN therapy to be established regardless of the type of comparison stimuli used for the measurement of tinnitus loudness. The number of control visits (and re-measurements of dB t ) varied from one to seven per patient. When subsequent visits of the patient fell within the same temporal class, only the value of dBt measured during the last visit within the class was considered for analysis.
If the difference among means was statistically significant, we used the multiple-comparisons procedure of the Kruskal- Wallis test to test the difference of mean value between pairs of treatments.
Patients of the three groups did not differ significantly regarding gender ratio, mean age, mean hearing loss, and mean value of tinnitus parameters.
In the WWN-treated patient, tinnitus intensity decreased by 12 dB after only 1 month of therapy and by 15 dB at the end of the observation period (after 7 months). Variation of tinnitus loudness over time in four patients (indicated with a different symbol) taken as an example.
The mean attenuation between 7 and 12 months was less than 1 dB in patients of both the WN and Wa groups and 3 dB in those of the WWN group.
Results showed a remarkable reduction of tinnitus loudness in the three patients who were initially given the Wa therapy (one of them recovered from tinnitus; see Fig.


Furthermore, about two-thirds of the differences were below 1 kHz, and approximately one-half of the differences were below 0.6 kHz. These acoustic stimulations are standard for each subject; they are not personalized in relation to the tinnitus frequency that characterizes the subjective tinnitus. Furthermore, patient's estimation of tinnitus loudness showed a clear negative relationship with the time of WST application; loudness decreased by approximately 1 dB per month of application of the therapy (see Fig. This procedure yielded pitch estimates characterized by low between-session variability (mean absolute difference of 1.1 kHz between the tinnitus pitch measured at the initial visit and at the first control visit after 1-2 months). This could weaken the conclusions of our study if the patient's "at-home" listening behavior had been affected by the type of acoustic therapy they received. Second, tinnitus loudness did not decrease significantly with months of application of the sound therapy by patients of the two control groups.
This discrepancy, however, may be easily explained by considering the rough clinical procedure used in our study for finding pitch matches suitable for the loudnessmatching test. In our study, the pitchmatching test conducted during audiological evaluation was aimed solely at obtaining a matching tone only approximately resembling the tinnitus frequency, the tinnitus pitch being accurately measured in a separate experimental test (see under Methods). Jastreboff and Jastreboff [21] stressed the importance of ensuring that the sound-enriched environment provided with the TRT should not contain sounds causing annoyance and exacerbation of the tinnitus sensation.
The auditory stimulation of patients with waterfall noise recorded underwater (Wa therapy) did not contain significant energy in the frequency range above 3-4 kHz (where hearing loss usually occurs and most tinnitus sensations pitch) and, furthermore, appeared to be better tolerated as compared to the stimulation with white noise (WN sound therapy).
For instance, it has been hypothesized the overrepresentation of the edge frequencies before the hearing loss region is responsible for the tinnitus sensation [1]. Often, we find multisensory syndromes combined with tinnitus, hearing impairment, vertigo, and nausea.
Low-tone tinnitus is more frequently found in Meniere's disease and some other cochleo-apical disorders. In the high-tone range, most frequently tinnitus is matched and related to such conditions as noise trauma, whiplash, head and skull trauma, cardiovascular failures, stress, and toxic events, including pharmaceutical use, nicotine or drug abuse, and acoustic neuromas. Owing to the size of the workload, we limited ours efforts to constructing a sample from those 757 patients randomly selected from a major group of neurootological patients (we process more than 10,000 files of neurootological patients, many of whom suffer from one or another type of tinnitus). We then conducted objective and quantitative electrophysiological measurements of the acoustic pathways via otoacoustic emissions, acoustic brainstem-evoked potentials, and acoustic late or cortical evoked potentials.
We performed vestibulospinal recording of the CCG with the Romberg standing test and the Unterberger-Fukuda stepping test using USCCG and the human space trail. However, for this study, we present the broad spectrum of subjective complaints as reported by the patients with a broad variety of findings.
This is shown for instance, in Figures 6 and 7, wherein the typical tinnitus phenomena are matched on different hearing zones in the audiograms of the right and left sides. Therefore, we prepared a specific, detailed analysis of the background of head and neck trauma (Fig. Our search presented us with a great amount of data (more than 500 parameters per case), which we transferred into a digital version of the databank to preserve the anonymity of this sample of patients. The other identification indicators (weight, height, body mass index, and average systolic and diastolic blood pressure) lie within the expected range of this sample taken for Germany.
For vegetative symptoms, such as the occurrence of nausea in perhaps one of four patients, see Figure 9. Acoustic, vestibular, and behavioral and psychosomatic symptoms are intertwined and seemingly interact with one another. In a subsequent publication, we will deal with the outcome of the objective and quantitative measurements in audiology, equilibriometry, and the like in our group of 757 cases of endogenous tinnitus. This sensation of hearing a buzzing, ringing, swishing or clicking noise in one or both of the ears although no other sound is emanating from the immediate environment has recently been studied by a team of researchers from the Cyclotron Research Centre of the University of LiA?ge and the ENT department of the University Hospital of LiA?ge. If it is subjective, its etiology is difficult to establish because it is not linked to a loss of hearing. Thus, Tinnitus Retraining Therapy (TRT) draws on, among other things, a noise generator suggesting an auditory prosthesis and giving off a noise close to the tinnitus. In addition, these differences in connectivity concern the cortical and sub-cortical regions and include the attentional, emotional and memory systems.
Custom musicians earplugs are available that can protect the musician’s ears from loud sounds without distorting what they hear.
Loud, sudden noises (gunfire, industrial noises, woodworking, motorcycles, loud music, motorized lawn equipment, noisy hobbies and other noises louder than 90 db) are more damaging to hearing than regular and extended exposure to loud sounds over a period of time. Fortytwo hyperlipidemic patients with subjective tinnitus and hearing loss due to noise exposure were enrolled for the study. It has been reported that high-plasma cholesterol and triglyceride levels are one of the major risk factors for the development of occupational hearing loss [3-5]. It seems that noise and other metabolic disturbances have a synergistic effect on the development of tinnitus and hearing loss [5].
A diagnosis of acoustic trauma was verified by an ear, nose, and throat physician according to a clinical history of chronic noise exposure in patients who sought medical help for complaints of tinnitus and high-frequency hearing loss. Patients who had chronic otitis media or middle-ear effusion, those with an abnormal ear drum (perforation, retraction, etc.) or auditory canal, and those who had abnormal tympanometry (other than type A) were excluded.
In the study, from 120 patients we chose 42 male patients (35%) with elevated cholesterol or triglyceride or both (age range, 19-60 years; mean age, 45 years). The patients were separated into two groups: the "unresponsive" group, made up of 22 patients who had no response to either of the therapies and still had hyperlipidemia, and the "responsive" group, consisting of 20 patients who had lower cholesterol or triglyceride levels.
The results of the blood lipid profiles were withheld from the individual to prevent a placebo effect with the tinnitus therapy. The significance of the difference in patient's comments on their tinnitus after the treatment ("same," "decreased," "increased," and "disappeared") was analyzed using McNemar and chi-square tests.
However, the incidence of hyperlipidemia among a selected group of patients with neurosensory hearing loss varies. They selected a group of subjects aged between 20 and 50 years and compared auditory thresholds at high frequencies and serum lipid levels.
Noise and metabolic disturbances have a synergistic effect on the development of tinnitus and hearing loss. Effects of experimental cochlear thrombosis on oxygenation: Auditory function of the inner ear. Direct effects of intraperilymphatic reactive oxygen species generation on cochlear function.
Clinical utility of LDL-apheresis in the treatment of sudden hearing loss: A prospective, randomized study. The relation of hearing in the elderly to the presence of cardiovascular disease and cardiovascular risk factors.
Appearance of free radicals in the guinea pig inner ear after noise-induced acoustic trauma. Progressive sensorineural hearing loss, subjective tinnitus and vertigo caused by elevated blood lipids.
A comparison of auditory brainstem evoked potentials in hyperlipidemic and normolipidemic subjects. Exploration of the early auditory effects of hyperlipoproteinemia and diabetes mellitus using otoacoustic emissions.
Hypertension, hyperlipoproteinemia, chronic noise exposure: Is there a synergism in cochlear pathology?
Effects of noise exposure and hypercholesterolemia on auditory function in the New Zealand white rabbit. Hearing improvement after therapy for hyperlipidemia in patients with chronic-phase sudden deafness. A prospective case-controlled study of 197 men, 50-60 years old, selected at random from a population at risk from hyperlipidemia to examine the relationship between hyperlipidemia and sensorineural hearing loss.
A total of 39 chronic tinnitus patients and 41 well-matched healthy controls participated in the resting-state fMRI scans.
We hypothesized that (1) aberrant LFO amplitudes in tinnitus may depend on the specific frequency bands, especially the slow-4 and slow-5 bands that were mainly associated with neuronal oscillations, and that (2) these frequency specific abnormalities would be correlated with unique tinnitus characteristics such as tinnitus duration or distress. The tinnitus patients and healthy subjects were group-matched in terms of age, sex, and education. The earplugs (Hearos Ultimate Softness Series, USA) were used to attenuate scanner noise by approximately 32 dB. Briefly, time courses were first converted to the frequency domain using a Fast Fourier Transform. T1 images were normalized to the MNI template using affine linear registration followed by Gaussian smoothing (FWHM = 6 mm). We tested the effectiveness of WST using non-notched broadband noise and noise of water as control sound therapies. Tinnitus is thought to consist of an abnormal neural activity of the auditory pathways [1]. In addition, though Jastreboff and Jastreboff [7] claimed that all types of tinnitus and intolerance to sounds can be beneficially treated with TRT, intolerances toward the wearable acoustic prostheses delivering the masking auditory stimuli (noise generators) have been reported, presumably owing to the annoyance caused by stimulation of the patient with frequencies similar to that of the tinnitus [8].
All participants were provided with informed consent, previously approved by the Ethics Committee of the School of Medicine of the University of Parma, before starting the therapy.
Some patients (~25%) experienced difficulty in performing reliable comparisons because of the markedly different perceptual quality of pure tones as compared to that of their tinnitus.
Comparison tones (or NBN segments) were presented consecutively for a few seconds at the interstimulus interval of about 1 second. In a subject reporting the tinnitus only, or predominantly, in one ear, the comparison tone was presented contralaterally, whereas if the intensity of the subject's tinnitus sensation was similar in both ears, the tone to be matched was presented bilaterally. In our case, the use of pure tones facilitated the comparison of tinnitus pitch among subjects receiving different acoustic therapies and the tracking of its variation across time (see later).
During each tone sweep, the subject was asked to manually adjust the amplitude knob of the switchboard so as to keep the tone loudness approximately similar to the loudness of the tinnitus. Usually subjects reported more than one tone as matching the pitch of their tinnitus during both the upward and downward sweeps. In the latter case, subjects were asked to choose which one between the two tones (one having double the frequency of the other) best matched their tinnitus pitch.
The noise sequence was band-passed from 50 Hz to 15 kHz and equalized to compensate for the low-frequency bias of the frequency response of the earphones used for sound stimulation (see later). The acoustic stimulation of the WN sound therapy was white noise in the frequency range 0.05-15 kHz equalized as shown in the figure to compensate for the poor low-frequency response of the earphones (see Methods section for details).
These procedures aimed at obtaining a balanced design with an approximately equal number of subjects treated with the experimental therapy and with the control therapies (WN or Wa) and, at the same time, avoiding any possible bias in the process of data collection owing to, for example, the differential treatment of patients by the experimenters because of the type of therapy assigned.
These noncompliant patients were not counted in the analysis, thereby reducing the sample to 49 patients. For each visit, we noted the number of days (dd) elapsed from the date of the start of therapy (usually within 1 week from the first visit) and the date of the control visit. This was necessary to ensure that each patient contributed only one measurement value (if available) to the class mean value. Of the 49 patients who started acoustic therapy, 2 in the WWN group, 3 in the WN group, and 1 in the Wa group withdrew before the first control visit.
However, in the WWN group, the decrease was large (about -12 dB, corresponding to approximately a 75% decrease), whereas in the two other groups, the decrease was negligible (around -2 dB, corresponding to approximately a 10% decrease).
By contrast, in two patients receiving the control therapies, tinnitus intensity was initially increased by about 5 dB, showing only minor fluctuations during subsequent control visits.
Decibel units on the y-axis are mean values (+1 SE) of ∆dBt computed for three subsequent temporal classes using dBt measurements in subsequent control visits of the same patient. 4 for an example) and no change of tinnitus loudness in the subject who was initially assigned to the WN therapy.
Thus, our sound therapy (WST) was tailored to the frequency characteristics of patients' tinnitus. Indeed, analysis of the percentage of those withdrawing from each treatment group indicates that the WN therapy is the least tolerated, whereas the WWN therapy is the best tolerated by patients. Third, in a few patients reporting subjective beneficial effects by the Wa therapy, the measure of the tinnitus loudness did not vary appreciably over the study period. The purpose of TRT is the reduction of the alarm reaction associated with the tinnitus sensation by altering the connections between the limbic and autonomic nervous systems (responsible for the alarm reaction) and the auditory system [5]. Conversely, tinnitus pitch is often located inside the hearing loss region toward the audiogram's edge frequencies, a phenomenon having strong analogy with the one described for the occurrence of the Zwicker tone using notched noise [22]. A comparison of variability among measurements of subjective tinnitus and objective stimuli.
Psychoacoustic characterization of the tinnitus spectrum: Implications for the underlying mechanisms of tinnitus. Acoustic communication in two freshwater gobies: Ambient noise and short-range propagation in shallow streams. From more than 10,000 cases, we evaluated 757 randomly selected neurootological patients suffering from endogenous tinnitus. However, what could be proved by various authors since 1985 is that endogenous tinnitus is significantly related to dysfunctions in the human temporal lobe (Brodmann area 41). We administered a full spectrum of neurootometric testing to all 757 patients; the investigation protocol for thorough data analysis (more than 500 parameters) included five procedures. After all the files of the patients were transferred into digital lists and nets of digital data, we could select the various groups of complaints to derive a representative statistic. The most frequent quality of tinnitus distortion reported was a whizzing sound in either ear or in both (54.02%).
Figure 21 demonstrates a specific differentiation with respect to facial nerve paralysis cases.
We easily designated a group of patients who demonstrate a genuine objective sound in the head as experiencing bruits. In future, this must be taken into consideration in developing a spectrum of therapeutic procedures not only in the field of pharmacotherapy but in psychotherapy and physiotherapy and in applying such physical measures as magnetotherapy. We found diabetes mellitus more frequently in the group with the exogenous or unmaskable tinnitus, whereas hyperlipidemia was reported twice as often in the group with endogenous or maskable tinnitus as in those with the unmaskable type.
On the functional state of central vestibular structures in monaural symptomatic tinnitus patients. About the Strength of the Neck in Linking the Head to the Trunk as Measured by the US-CCG . Interdisciplinary clinical vertigo studies in whiplash lesions to the ligamenta alaria by means of dynamic MRI-findings in combination with ultrasound cranio-corpo-graphy (USCCG). Medical classification of tinnitus between bruits exogenous and endogenous tinnitus and other types of tinnitus. Die Differenzierung zwischen endogenem und exogenem Tinnitus [The differentiation between endogenous and exogenous tinnitus].
The study looks at the problem from the perspective of functional magnetic resonance imaging and has been published in PLoS ONE.Among those who suffer from tinnitus (around 15% of the population), only 10 to 20 percent suffer from it to the point that it alters their quality of life. Installed by a specially trained audio prosthetist, it must generally be worn for a period of 12 to 18 months. There are also a variety of in ear monitors that will enhance the music experience whether you are a serious musician or just a music aficionado. Not only can they choose from custom or over-the-counter earplugs or earmuffs, they can also choose protection devices that provide amplification while reducing the sounds of gunfire down to a safe level.
All patients who were required to complete the questionnaire and who were subjected to clinical examination were military personnel. A pure-tone signal was presented continuously at 50-Hz intervals at between 10- and 20-dB levels. We placed all these patients on a low-cholesterol diet or antihyperlipidemic therapy (Table 2). When patients were asked to qualify the severity of their tinnitus, 10 rated their tinnitus as the same (47%), 9 rated it as increased (42%), 2 rated it as decreased (9%), and 1 patient had no tinnitus (2%). Lowry and Isaacson [12] reported 20% hyperlipoproteinemia among 100 patients with bilateral hearing loss. Lipidosis of the inner ear has been postulated by Nguyen and Brownell [33] as an alternate mechanism.
Insufficient perfusion of the cochlea due to increased blood viscosity and microthrombosis related to hyperlipidemia has been claimed to cause susceptibility to noiseinduced hearing loss [35]. We found in our study that the incidence of hyperlipidemia among patients with noiseinduced tinnitus and hearing loss was 35%. Characteristics of tinnitus and etiology of associated hearing loss: A study of 123 patients. Since the phantom sound is often perceived in the impaired ear, tinnitus was originally believed to originate in the cochlea from aberrant hyperactivity in the auditory nerve. Nonetheless, these findings are based on investigations of LFO from the perspective of temporal synchrony or interregional cooperation, but fail to consider the amplitude of alternations in local or regional neuronal activity. Two tinnitus patients were subsequently excluded because of they exceeded the limits of head motion during MR scanning. Subjects were instructed to lie quietly with their eyes closed without falling asleep, not think of anything in particular, and avoid any head motion during the scan.
The square root of the power spectrum was computed and then averaged across a predefined frequency interval. Given the large age range of the subjects in the current study, we performed a multiple regression in SPM8 software to investigate the potentially altered brain regions accompanied with increased age in each group. We found a significant long-term reduction of tinnitus loudness in subjects treated with notched noise but not in those treated with control stimulations. However, the physiological mechanisms and persistence of the sensation of the tinnitus have still not been fully clarified. Indeed, anecdotal clinical evidence suggests that the exacerbation of the tinnitus sensation by exposure to sounds comprising the tinnitus frequency is a common complaint from patients suffering from tinnitus. Initially (first visit), each participant subject received an audiogram and tinnitus loudness and pitch-matching tests. In such cases, we instead used narrow-band noise (NBN) of one-third of an octave, having a pitch similar to the tinnitus frequency (according to patient judgment) of tones.
It must be stressed, however, that during the loudness-matching test, no effort was made to obtain the best match to tinnitus pitch, this being determined in a separate, experimental test (see later). Of course, the perceptual quality of a tone stimulus seldom corresponds to subjects' tinnitus sensation. The frequency values identified by the subject in the two sweep tests were grouped and ordered from the lowest to the highest.
It might happen that the patient was undecided about the two alternatives when these were of similar frequency.
Wa stimulation was an 8-minute sequence of stream noise recorded underwater with a hydrophone placed close to a stream cascade [16] (see Fig.
Patients were also asked to regulate the listening volume to a level approximately matching the loudness of their tinnitus.
In such cases, the patient usually informed the experimenters about the change that occurred.
Six subjects felt annoyed by the therapy and refused to continue before the first control visit (see Results). If these subjects are included in the total count of patients treated, the number voluntarily withdrawing from the therapy in the WWN, WN, and Wa groups amounted to three, four, and seven, respectively, the highest percentage being in the WN group (about 30% of subjects) and the lowest being in the WWN group (about 15% of subjects; Fig. Figure 5 reports the variation of the mean value of ΔdBt, with time elapsed from the start of the therapy, for the three groups of patients. Decibel units on the y-axis are values of ∆dBt computed using dBt measurements in subsequent control visits of the same subject (date on the x-axis). We tested the effectiveness of the therapy using two types of control sound treatments: nonnotched noise (WN) or waterfall noise recorded underwater (Wa). However, the WWN group had the lowest percentage of those who withdrew (around 15% of subjects compared to 28% in the WN group and 23% in the Wa group) among the three treatment groups, suggesting that WST was the sound therapy best tolerated by patients (presumably owing to the lack of annoyance caused by the stimulation of the patient with frequencies similar to that of the tinnitus). Thus, WST determined an objective and significant reduction of patient's tinnitus loudness and, hence, it appeared to be an effective sound therapy for the treatment of tinnitus.
Therefore, to the extent that these differences might correspond to a different listening behavior by patients in relation to the sound therapy they received, the decrease of tinnitus severity observed among the group of patients receiving the WWN therapy could partly be explained by their (supposed) higher tolerance and stamina in motivation to listen to the therapy as compared to patients receiving the control therapies.


Likewise, other patients treated with the WWN and reporting no subjective improvement of their tinnitus sensation showed in fact a decrease of tinnitus loudness measured over time. Therefore, the observed effectiveness of the WST in reducing tinnitus loudness appears consistent with the neurophysiological model of tinnitus underlying TRT [5]. One possibility is that Wa stimulation had poor masking effects on tinnitus in most patients, implying that the alarm reactions induced by tinnitus persisted in Wa-treated subjects.
Thus, a conceivable hypothesis is that a stimulation of the edge frequencies, but not the tinnitus region, by the noise frequencies just below the notched region has occurred during the listening of the WWN sound treatment.
First, we classified the 10,000 patients into those suffering from the basic tetrad of tinnitus forms: bruits, endogenous (maskable) tinnitus, exogenous (nonmaskable) tinnitus, and other syndromes such as the slow brainstem syndrome. Patients with a maskable or endogenous tinnitus prefer covering up their tinnitus by external sounds.
We found typical shortenings in the latencies of the vestibular evoked quantitative electroencephalography (QEEG), an enlarged DC shift of the vestibular evoked QEEG, and typical cortical electrical burst expansion in three phases on the brain surface as shown by BEAM.
First we recorded a thorough neurootological history with a systematic preprinted history scheme of Neurootologisches Anamneseschema Claussen (Neurootological History Scheme). As the sum of all the tinnitus spots being masked amounts to 141.74%, we were able to derive that nearly one-half of the sample suffered from a bilateral maskable tinnitus. The majority of patients (consistent through all age groups) reported so-called whiplash-related tinnitus problems after a car accident.
The frequently reported sensation of a roaring in the right or the left ear occurred in only 0.13% (left ear) in our sample. In Vertigo, Nausea, Tinnitus and Hearing Loss in Central and Peripheral Vestibular Diseases .
In JM Aran, R Dauman (eds), Proceedings of the Fourth International Tinnitus Seminar, Bordeaux, 1991 . In this case, tinnitus can leave a comorbidity in its wake in the form of irritability, (and therefore tiredness), concentration problems and depression. Surgical sections of the auditory nerve have been attempted, but without worthwhile results.
It is hoped that the patient will become used to the new noise and, indirectly, the noise of the tinnitus which is at a neighboring frequency. As for the regions involved in memory, such as the parahippocampal region, we think that they a€?decidea€™, after comparison with the other sounds picked up as usual, if a perceived noise a€“in this case the tinnitus- must be a€?stifleda€™ or dealt with more deeply because it represents a dangera€? explains Audrey Maudoux.Evidently, if the results recorded by the researchers at the CRC and the ENT department of the University of LiA?ge seem a€?logicala€™, the fact remains that the a€?set of influencesa€? remain hazy. Hearing protectors not properly fitted to the wearer’s ears do not effectively prevent damaging noises from penetrating the ear canal.
We excluded on the basis of their response to the questionnaire or clinical examination subjects who had a history of familial hearing loss, head trauma, collagen disease, neurological or hormonal disturbance, addiction to alcohol, or ototoxic drug therapy. The main criteria for response to the antihyperlipidemic therapy was defined as a return to normal cholesterol or triglyceride levels after therapy or at least a 40% drop from either of the initial blood cholesterol or triglyceride levels if the values were slightly above the normal limits.
The latter authors showed that the lateral wall of outer hair cells from guinea pig cochlea incorporates water-soluble cholesterol. Axelsson and Lindgren [34] matched 78 men at age 50 years with high serum cholesterol levels to 75 randomly selected 50-year-old men and found significant correlation between noise exposure and high cholesterol level. Sixteen patients reported a predominantly left-sided tinnitus, 13 a predominantly right-sided tinnitus, and 10 patients described their tinnitus as bilateral or originating within the head. This averaged square root was termed ALFF at a given voxel, and was further divided by the individual global mean ALFF value to reduce the global effects of variability across participants. These results point to the importance of the personalized sound treatment of tinnitus sufferers for the development of an effective tinnitus sound therapy. This observation has been the foundation of our approach to the treatment of tinnitus and the key element for the development of an effective personalized sound therapy.
This may partly explain the high betweensession variability of pitch-matching measurements often reported in the literature [11-13]. Therefore, before testing the patients for the first time, they were instructed in how to use the apparatus and make the tinnitus pitch-tone comparisons. This occurred frequently, as many subjects identified matching tones of similar frequency during the upward and downward sweeps.
We note that the distinction made here between single- and multi-pitched tinnitus was intended solely for the development of an appropriate tinnitus therapy; it may or may not have a relationship with the internal spectrum of the tinnitus.
Therefore, the noise energy between the two broken lines is missing in the WWN sound therapy.
In case of marked hearing loss in one ear, subjects were advised to regulate the listening volume using the ear of best hearing.
Conversely, the key feature of the WWN therapy is the construction of a noise window around the tinnitus pitch, implying that the window features should track any observed change (real or supposed) of the value of F t . Thus, sound stimulation of patients of the two control groups was not personalized on the basis of frequency characteristics of patient's tinnitus. Possible sources of between-session variability of pitch matches are, for example, the multipitched nature of many tinnitus percepts [13], the change of tinnitus pitch with time after application of the sound therapy [10] (Lugli et al., unpublished data), or judgment errors by patients. However, the observation that many of these subjects experienced tinnitus relief by listening to the water noise soundtrack (Lugli et al., unpublished data) does not support this interpretation. In addition, activation of the mechanism underlying the Zwicker tone must have occurred in patients listening to the WWN treatment, although none of them reported such an aftereffect, presumably because of the pitch similarity between the Zwicker tone and the tinnitus percepts. Next, we examined all the patients otologically, including bilateral microscopical inspection of the outer ear, ear canal, and tympanic membrane.
They also reported posttraumatic complaints of whiplash injury (also consistent through all the age groups but especially frequent in the age group 30-40 years). Significantly different from the group identified as having endogenous tinnitus are the behavior and the sensation of those with exogenous tinnitus or nonmaskable tinnitus, who find relief in a completely silent environment.
The majority of our patients described their tinnitus as lasting from one to several years (as seen in Fig.
We found that 3.70% of patients complained about a reduced acuity in their taste (hypogeusia). Initially, it was actually believed that tinnitus resulted exclusively from a problem localized in the ear, even though everything indicates today that the problem is essentially a neuronal one.Chronic tinnitus is difficult to treat, all the more so because its etiology is often uncertain.
Indeed, the studies carried out do not make it possible to define the initial meaning of dialogue between the cerebral areas. The difference between tinnitus scores in the unresponsive and responsive groups and the change in tinnitus scores before and after therapy in the responsive group were significant.
None of the patients had cerebrovascular disease, hypertension, electrolyte imbalance, cranial nerve deficit, or clinical signs of peripheral neuropathy.
Then, the pitch-match frequency threshold of the tinnitus was measured as the tinnitus loudness match of the pure-tone stimulus presented with a 1-dB increase of tinnitus frequency.
Morizono and Paparella [30], using cholesterolfed rabbits, showed increased auditory dysfunction with time at all frequencies. This uptake of cholesterol is accompanied by an increased stiffness of the cells, which may impair the cells' electromotile response. Enhancement of cochlear action potentials and auditory brainstem responses has been demonstrated after limited intake of cholesterol. However, patients were at the chronic phase, more than 1 month from the onset of the hearing loss.
Importantly, our patients had normal hearing thresholds up to the extended high frequencies and no evidence of hyperacusis (Chen et al., 2014).
In addition, no treatment can be considered efficacious in providing longterm relief from tinnitus in comparison to placebo [2]. In such cases, the operator continuously varied the knob of the tone generator within the narrow band delimited by the two frequency values to allow the subject to identify the tone best matching the tinnitus pitch. Hence, our results cannot be compared with those of studies trying to assess the form of the tinnitus spectrum [13]. As compared to the waterfall noise recorded in air, the waterfall noise recorded underwater is characterized by greater energy content at lower frequencies and larger amplitude and frequency modulation [16].
In the Wa sound therapy, most energy is concentrated in the lower part of the spectrum (bottom spectrum = mean spectrum of the 8-minute sequence of waterfall noise; see Methods). Thus, ideally, patients subjected to the WWN therapy should receive a new windowed noise sequence almost each time at every control visit. Thus, the overall number of subjects available for the comparative analysis of data was of 43 patients, of whom 20 were treated with WWN, 11 were treated with WN, and 12 were treated with Wa. We did not attempt the chi-squared analysis of the proportion of those who withdrew in the three groups owing to the low number of those who withdrew, expected in each group under the null hypothesis. Though the reliability of the method of pitch assessment proposed here awaits further testing before being asserted, our findings nonetheless point to the type of pitch-matching procedure adopted as a major factor responsible for the unreliability of pitch estimates documented in the tinnitus literature [18]. These facts do not support a supposed presence of marked differences in the at-home use of the therapy by patients of different treatment groups.
One or both of these phenomena might have determined a reorganization of the neural activity of the edge frequencies resulting in the observed longterm reduction of the tinnitus percept in such patients.
We also thank all personnel in the audiological laboratory of the University of Parma for their invaluable contribution to the collection of clinical data. Car accidents and whiplash occur more frequently in the younger age groups, whereas reports of cerebral concussions are more frequent in the old-age group (> 70 years). Finally, via our complex neurootometric tests, we demonstrated slowing deregulations in the statoacoustic pathways. We heard no complaints about trigeminal disorders; however, we found both peripheral and central facial nerve paresis, though in a small number (see Fig. 28) played a minor role in our sample, as was evident for the major hormonal diseases (Fig. However, much more exceptionally, these noises can be equivalent to about 70 or 80 decibels a€“ a normal conversation is at about 55 decibels. Also, from a therapeutic point of view, ita€™s as if we treated apples pears and bananas in the same waya€?, explains Philippe LefA?bvre.There is no objective parameter which makes it possible to measure the intensity of tinnitus. When it is accompanied by loss of hearing, the wearing of a hearing aid can improve the situation substantially from both viewpoints.
If emotional force is a major factor in the intolerance of the tinnitus given its inextinguishable permanent character, the patient knows in this case that he can a€?switch offa€? the sound at any time by disconnecting the noise generator.
Is it the auditory region that influences the activity of the attentional, emotional and memory areas or is it the latter that initiates the exchange of information? It seems that the order of destruction and the high-frequency nature of the auditory dysfunction are correlated not only with the frequency and severity of the noise exposure but with the presence of the secondary pathology, as the formation of vasoactive lipid peroxidation products after intense noise is similar to the condition seen in metabolic damage to the organ of Corti [7,14-17]. In a survey of 44 patients with cochlear-type hearing loss, Booth [26] found hyperlipidemia in 28% of the men and 10% of the women.
These authors observed hearing improvement of more than 10 dB in 9 of the 12 patients after antihyperlipidemic therapy.
We also observed significant interaction between frequency bands and patient groups in the orbitofrontal gyrus.
Hence, the width of the band-stop filter amounts to 1,377 Hz, being 5,462 Hz and 6,838 Hz, respectively, the lower and upper frequency extremes of the band, with the center frequency at 6,150 Hz. This is admittedly tedious and perhaps of little therapeutic significance when the re-measured value of F t is similar to the last one determined in the previous session.
To explore the efficacy of the WWN therapy further, three Wa subjects and one WN subject were chosen among the group of patients reporting no relief from the therapy and were asked to abandon the assigned therapy and to start with the WWN therapy. Finally, 7 of the 20 patients treated with WWN were given one (n = 5) or two (n = 2) updated WWN treatments during the study period (see Methods for details). Hence, the lack of direct control by the experimenters over the patient's at-home listening behavior was unlikely to be a factor potentially affecting the main conclusion of this study about the effectiveness of the WST therapy in the treatment of tinnitus. The statistical results demonstrate that tinnitus is interconnected to a multifactorial disease background with a broad spectrum of individual complaints. Only 0.13% of our patients described a subjective roaring sound in the left ear, whereas none attributed it to right ear.
In such cases, the visual acuity problems were corrected most frequently by use of eye glasses (74.50%). In those who do not feel handicapped by their tinnitus a phenomenon called habituation comes into play: the brain filters the parasitical information to the extent that the a€?phantom noisesa€?A are banished to the subconscious. Therefore the doctor has no other choice than to rely on the subjective assessment of the tinnitus sufferer. This question is highly significant, as it is at the center of questions relative to the etiology of the problem and the way to treat it. In this manner, preventive measures may provide restorative support to the injured cochlea. We required all patients to rate their tinnitus from 1 to 10, with 10 being loudest (Table 1). Furthermore, tinnitus distress was positively correlated with the magnitude of ALFF in right SFG and the magnitude of fALFF slow-4 band in left SFG, whereas tinnitus duration was positively correlated with the magnitude of ALFF in right SFG and the magnitude of fALFF slow-5 band in left SFG.
Further correlation of ALFF with tinnitus features indicated that abnormal ALFF patterns in tinnitus were linked to the duration and severity of tinnitus. Therefore, these researches suggest that the inherent brain functional activity is sensitive to specific frequency bands. The procedure was repeated until the tone identified up to that point was compared with the highest tone (F n) of the sequence.
Cursory examination of pitch match position in relation to the patient's audiogram showed that the matches were frequencies above that at the beginning of the region of hearing loss on the audiogram.
The control-toexperimental therapy shift occurred after 3-7 months from the beginning of the experiment. Finally, the topodiagnostics of the functional neurootometric analysis shows that this type of endogenous tinnitus constitutes decidedly more central than peripheral statoacoustic pathology. Astonishingly, even the number of occurrences of basic neurological disorders (paralysis, paresthesias, apoplexies, epilepsia, Parkinson's disease, and brain tumors) was very low (as shown in Fig.
As Professor Lefebvre points out, it is the same mechanism which prevents us from focusing our attention on the ticking of a clock or the rubbing of our clothes against the body.Subjective evaluationA A  In fact there are two types of tinnitus.
Philippe LefA?bvre adds that a broad approach must be adopted when treating the tinnitus patient.Another technique which is very popular is self-hypnosis which aims to allow the patient to adjust his sensations, to control them and therefore to push the tinnitus into his unconscious mind. Each level was defined by short explanations to simplify the patients' grading of their tinnitus.
Resting-state fMRI provides an unbiased method for identifying aberrant spontaneous LFO occurring throughout the central nervous system.
The goal is the reduction of subjects' tinnitus perception by providing competing auditory stimuli masking the tinnitus.
This observation agrees with results by earlier and recent studies on the relationship between tinnitus pitch and hearing loss [9].
The high-frequency tinnitus often develops close to the C5 dip and can be masked below the hearing threshold (see Fig. Clearly, a typical interrelation of tinnitus with a single major disease group is highly unlikely. These are practically the only medicines that have proved to be efficient with regard to tinnitus in the acute phase. Cognitive behavioral therapies are regularly used to combat chronic tinnitus and are also a valued method. Chronic tinnitus patients have widespread abnormalities in ALFF and fALFF slow-4 and slow-5 band which are correlated with tinnitus distress and duration.
In addition, it has been demonstrated that its frequency (low-pitched or high-pitched) does not have an impact on whether or not the patient is bothered or not by its presence. Several other medicinal approaches are offered in the context of chronic tinnitus, but with limited success: magnesium, Ginkgo biloba, vasodilators, anticonvulsants or even anxiolytics or anti-depressants.
In an entirely different approach, transcranial magnetic stimulation is used in experimental treatments.
These results provide new insights on the neuropathophysiology of chronic tinnitus; therapies capable of reversing these aberrant patterns may reduce tinnitus distress. There were no significant differences in auditory thresholds between the tinnitus and control groups.
However, no firm experimental evidence supports the effectiveness of these methods in the long term: an objective reduction of the loudness of the tinnitus or the complete recovery from tinnitus.
They are generally the result of a vascular deformation (for example, a blowing noise can be heard around the carotid) and for this reason are of the pulsatile kind as they are synchronized with the beating of the heart, or call to mind the idea of swishing, (blood flow).
As underlined by Professor Lefebvre, it would be necessary to identify sub-groups of patients in order to hope to obtain more conclusive results. One thing is certain: silence is one of the main enemies of the individual suffering from tinnitus.
In addition, treatment by laser has been added to the list but the efficiency of this method has not been proved by any placebo-controlled scientific study.A  Another technique which is invasive and reserved for rigorously selected cases, involves the implantation of electrodes in the brain.
This should be avoided (in isolation, with the help of background music for example), in order to prevent the individual from focusing on parasitical noises.
However, with a sample of only 13 tinnitus patients, we have only been able to show a trend. Linked to a malfunctioning of the auditory pathway, they are only experienced by the individual suffering from them. Tinnitus can also have other medical causes that we can expect to resolve: for example, hypertension, a neurinoma or a cerebral vascular problem. Practised in Belgium by Professor Dirk De Riddera€™s group, from the University of Antwerp, this approach has resulted in positive results in two-thirds of patients treated.
Paying attention to these noises all the time only has the effect of increasing the discomfort caused by them. We are going to try to refine and reinforce the results of our different work by analyzing a group of around one hundred patientsa€?, says Audrey Maudoux.The results published in PLoS ONE are the results of a group study. The characteristics of the chronic tinnitus patients and healthy subjects are summarized in Table 1. Often, however, the etiology of tinnitus remains poorly defined and treatments during the acute phase have not been crowned with success. A Several networksAs we have pointed out, the underlying physiopathological mechanism of tinnitus remains little-known. The first includes tinnitus caused by an increase in the frequency of potential action discharges in the cochlea (ciliated cells, neurons).
When the brain no longer receives some sensitive information from the periphery (this is called deafferentation?), a functional reorganization is produced (principally hyperactivity) in the cerebral areas that, in this case, process sound information. Recently, researchers at the Cyclotron Research Centre of the University of LiA?ge and the ENT department of the University Hospital of LiA?ge set about recording the cerebral activity of 28 subjects, 13 of whom suffer from unilateral or bilateral tinnitus.
Future work based on a larger sample will perhaps enable us to distinguish several types of tinnitus and to define their individual characteristics. Soddu, Connectivity graph analysis of the auditory resting state network in tinnitus, Brain Res. Put another way, the ear starts to send signals which do not respond to any external stimulus.
In addition, longitudinal a€?resting-state FMRIa€? monitoring would be of great interest because it would make it possible to determine the variations in the cerebral activity of a subject according to whether his tinnitus remained stable, disappeared, is better tolerated or becomes intolerable. The second category consists of tinnitus whose primary cause is a deterioration of hearing acuity, particularly with age. The tinnitus may disappear one day for an unknown reason, stay with the individual for life and vary in terms of its intensity or form.
The deterioration in the function of the auditory pathway is accompanied by a reduction of inhibitions in the cerebral cortex. Once they are reassured as to the benign nature of their tinnitus, which is the most common situation, most individuals are no longer disturbed by the phantom noises that characterize it- the brain succeeds in confining the problem to the unconscious. This suggests that the brain attempts to compensate for the loss of hearing by increasing its activity and this generates a€?phantom soundsa€?.



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