Hissing sound on left ear eclipse,stop tinnitus forever ebook 50,bony levy diamond hoop earrings - You Shoud Know

Author: admin, 07.01.2015. Category: Medicine For Tinnitus Over The Counter

How to cite this article Mahmoudian S, Lenarz M, Esser K, Salamat B, Alaeddini F, Dengler R, Farhadi M, et al.
INTRODUCTION: Residual inhibition (RI) is the temporary inhibition of tinnitus by use of masking stimuli when the device is turned off. OBJECTIVE: The main aim of this study was to evaluate the effects of RI induced by auditory electrical stimulation (AES) in the primary auditory pathways using early auditory-evoked potentials (AEPs) in subjective idiopathic tinnitus (SIT) subjects.
MATERIALS AND METHODS: A randomized placebo-controlled study was conducted on forty-four tinnitus subjects. CONCLUSION: The observed changes in AEP associated with RI suggested some peripheral and central auditory alterations. McFadden defined that "tinnitus is the conscious expression of a sound that originates in an involuntary manner in the head of its owner, or may appear to him to do so"1,2. Although the RI phenomenon is one of the few methods that may temporally relieve tinnitus, only few studies on RI have been published until now11.
Through the electrophysiological approaches, we may be able to determine the manner for abnormal brain electrical activity in the auditory pathway and provide quantitative information regarding tinnitus and RI phenomenon. Since the transmission time-interval is a presentation of the progress of neural excitation from the distal portion of auditory nerve to the inferior colliculus of the brainstem, this interval has been referred to as brainstem transmission time (BTT) (Figure 1). It is possible that the neural mechanisms involved in the RI phenomenon are similar to those that cause tinnitus10,35. This cross-sectional and randomized, placebo-controlled trial was conducted on 44 adults (32 males, 12 females) suffering from severe subjective idiopathic tinnitus (SIT) referred to the ENT and Head & Neck Research Center of Hazrate Rasoul Hospital for an evaluation and management of their tinnitus during 2010 and 2011. Additionally, the subjects were considered homogenous because of the constant and steady-state feature of their tinnitus. The screening tests included history taking, medical examinations, temporal bone imaging, an audiological evaluation (pure tone audiometry and tympanometry) and tinnitus psychoacoustic measurement (pitch and loudness matching) were performed for all tinnitus subjects. All studied subjects was initially received AES for three different durations of 60, 120 and 180 seconds delivered to the tinnitus ear. With respect to the responses to AES, the subjects were enrolled into one of two pre-defined groups, including subjects with RI and those with non-residual inhibition (NRI).
A few minutes following AES, the inhibitory effects on perceived tinnitus loudness (residual inhibition) were estimated using a visual analogue scale (VAS) and pitch-match and loudness balance tests.
The subjective criteria for evaluating tinnitus after AES using a psychoacoustic tinnitus assessment included diminishing or worsening of tinnitus loudness by at least 2 dB SL and reduction or increment in the pitch of tinnitus at least by 1000 Hz. We used a tinnitus evaluation device (TinnED®, designed in Research Center of Otolaryngology; Head and Neck of IUMS), which has 6 channels to reconstruct the most troublesome tinnitus (MTT) with a similar frequency and intensity. AES was applied by inserting an active surface tympanic membrane electrode through the external auditory canal into the posterior inferior of the tympanic membrane and placing silver surface electrode on the forehead and delivered by a stimulation system (promontory stimulator; cochlear company, Australia) used for evaluating cochlear implant (CI) candidates. An analysis of variance was used to analyses the differences between the RI, NRI and PES controls for auditory pure tone averages (PTA).
An ANOVA assessed the statistical significance between the RI, NRI and PES controls for the auditory pure tone averages (PTA). When rating the average pre-stimulation tinnitus loudness, the subjects rated their tinnitus as greater than 6 on a 10-point visual analogue scale. A repeated measures ANOVA was used to test for differences of PMT and LMT pre-and post-AES among the RI, NRI and PES control groups. The present study evaluated the alterations occurring in early auditory evoked potentials and brainstem transmission time associated with RI induced by AES in tinnitus subjects.
It appears that the neurophysiological mechanisms involved in RI could be related to both pre- and post-synaptic effects of AES followed by an increase of synchronized neural discharges and inhibition of the abnormal activity of the cochlear nerve. Tonndorf outlines the situation for most cochlear damage associated with tinnitus: the stronger inner hair cells (with large diameter nerve fibers) remain relatively undamaged, while the delicate outer hair cells (with small diameter nerve fibers) are destroyed. Using an ECochG test, the CAP amplitude indicated a significant increase associated with RI induced by AES. Since previous studies suggested neural alterations related to the AEPs properties in tinnitus subjects17,38, the current study used the measurement of BTT as a considerably more stable and invariant parameter in evaluate tinnitus RI phenomenon34. Many studies also stated that the majority of tinnitus forms result from a loss of inhibition in central auditory structures35. Also, a comparison of auditory nerve fiber discharges by AES in animal studies indicates that electrical stimulation causes discharge synchronizations in wide groups of nerves. Despite above mentioned facts, the possible mechanisms involved in causing tinnitus RI using electrical trigger have not been precisely recognized, and the origin of this phenomenon in the brain has not yet been obviously recognized. The current study conducted to examine the neural mechanisms of RI induced by AES in the first ten ms after stimulation include neurogenic responses arising from the auditory nerve to the inferior colliculus of the brainstem.
Iran National Science Foundation (INSF), Otolaryngology and Head & Neck Research Center, Iran University of Medical Sciences (IUMS). This study was financially and technically supported by the Iran National Science Foundation (INSF), ENT and Head & Neck Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran, and the Otorhinolaryngology Department of Hannover Medical University (MHH). Institution: Department of Otorhinolaryngology, Medical University of Hannover (MHH), Hannover, Germany ENT and Head & Neck Research Center, Iran University of Medical Sciences. Paper submitted to the ITJ-SGP (Publishing Management System) on April 9, 2014; and accepted on April 15, 2014. Alterations in early auditory evoked potentials and brainstem transmission time associated with tinnitus residual inhibition induced by auditory electrical stimulation. All enrolled subjects based on the responses to AES, were divided into two groups of RI and Non-RI (NRI). Synchronized discharges of the auditory nerve fibers and inhibition of the abnormal activity of the cochlear nerve by AES may play important roles associated with RI. It would be a critical step to define the factors that create these phantom sensations and develop rational treatments for this chronic and disabling disorder12. It has been shown that there is a relationship between the auditory evoked potentials (AEP) and the tinnitus phenomenon17. It has been shown that BTT is one of the most stable features in assess of neurotological conditions34.
Typical alterations in the AEP waveform associated with RI induced by auditory electrical stimulation.
Aberrant increase in function of neural networks or enhancement of stimulatory synapses function or decreased function of inhibitory synapses may be responsible for impairing pathways. The tinnitus subjects included in the research received electrical stimulation in the tinnitus ear. In the current study, all included tinnitus subjects were randomly allocated into two groups: those subjects who received AES and those who received placebo electrical stimulation (PES). This action was solely performed to ensure increased competence and effectiveness of the stimulation process to generate RI prior to electrophysiological procedures. The results of the ECochG and ABR recordings were determined and compared before and after the applying AES and PES.
Increased, unchanged or reduced less than 2 scores of VAS test were considered as NRI, 3 scales and more decrement were considered as RI. TinnED® measured four important parameters of tinnitus, including pitch-matching and loudness-matching of tinnitus (PMT and LMT), minimal masking level (MML) measured by narrow band noise to the affected ear until the tinnitus was fully covered and RI using a narrow band noise for 60 seconds when the intensity was 10 dB over MML.
Five subjects reported a complete inhibition (complete RI) of their tinnitus, and 19 subjects reported a significant attenuation of their tinnitus (partial RI).
A repeated measures ANOVA was used to test for the loudness rating differences using VAS between the groups pre-and post-AES. Observed changes in the visual analogue scale (VAS) scores for tinnitus loudness, the perceived frequency of tinnitus (pitch match of tinnitus) and perceived loudness of tinnitus (loudness match of tinnitus) pre-and post-AES among the three groups of subjects using repeated measures ANOVA. The mean difference in the inter-peak latency intervals of I-III, III-V and I-V pre- and post-AES were not significant in either group (Table 4). This study was performed in the first ten ms after stimulation to identify the effects of tinnitus and RI in neurogenic responses arising from the distal portion of acoustic nerve to the inferior colliculus of the brainstem.
This auditory deafferentation can cause an increase in spontaneous activity of auditory nerve fibers. When inhibitory deficits occur, synchronous neural activity, which is normally limited by feed-forward inhibition to acoustic features in the stimulus (normal auditory perception), may develop spontaneously among neuronal networks in the affected auditory cortical regions and generate the sensation of tinnitus25,46.
An electrical stimulus delivered to the round window sensory transduction47 and directly drives both outer hair cells (OHCs) somatic and hair-bundle motility48,49. Therefore, we could not conclude whether the RI produced by AES was induced by action on the entire nerve or on some restricted fibers related to tinnitus pitch.


Therefore, more comprehensive neuroscientific studies are required to better understand the mechanisms behind this phenomenon. Department of Otorhinolaryngology - Medical University of Hannover (MHH), Hannover, Germany and ENT and Head & Neck Research Center, Iran University of Medical Sciences - Hannover - AC - Germany.
Department of Otolaryngology - Charite - Universitatsmedizin Berlin, Berlin, Germany - Hannover - Germany.
Auditory Neuroethology & Neurobiology Lab, Institute of Zoology - University of Veterinary Medicine Hannover. Department and Research Center of ENT and Head & Neck Surgery - Iran University of Medical Sciences.
The results of the electrocochleography (ECochG), auditory brain stem response (ABR) and brain stem transmission time (BTT) were determined and compared pre- and post-AES in the studied groups. Further comprehensive studies are required to determine the mechanisms of RI more precisely. Feldman reported in his classic studies that many subjects with tinnitus experienced a brief elimination of their tinnitus following the application of a masking stimulus3. RI can also be contrasted with tinnitus inhibition produced by auditory electrical stimulation (AES)7,8,13,14.
Previous studies has made it clear that both tinnitus and residual inhibition phenomenon (RI) involved a number of regions of the auditory system18-21 and numerous electrophysiology and neuroimaging investigations have shown that tinnitus is associated with abnormal activity in the auditory system22-24.
These investigators have found that BTT to be significantly more stable and it is independent to intensity and frequency of stimulus. In order to compensate for the tinnitus signal, the processing of auditory stimuli in the presence of tinnitus-related activity may require an increase in firing rate of neurons, the use of more neural substrate, or a combination of both36. In the subjects with bilateral tinnitus, AES was administered in the ear with predominant or louder tinnitus. The subjects were examined by an ENT specialist for head and neck disorders, a neurologist for neurologic disorders, an internist for other medical diseases and a psychiatrist for psychological disorders.
In the current study, the subjects' RI group was (I) and another group was entitled NRI, which included (II) and (III). The accuracy of the calibrating equipment was sufficient to determine that the TinnED® was within the tolerances permitted by the American Standard Specification for Audiometers, S3.6-2004. The responses were recorded with a vertical montage of four-disk Ag-AgCl electrodes (noninverting on the vertex (Cz), grounded on the forehead, and inverting the electrodes on each mastoid).
The CAP amplitudes were calculated from baseline to N1, and the ABR I, III and V amplitude waves were calculated from baseline to their respective peaks. Bipolar burst of alternating current (square pulses) were applied in the tinnitus ear for 500 ms (a pulse rate of 1 Hz) and a frequency modulation of 50 Hz. Carry-over effects were estimated using the interaction between period, main and sequence effects.
The main goal of this study was to evaluate the RI induced by AES through the primary auditory pathways to better understand the neural mechanisms involved in RI.
Therefore, the RI induced by AES might be explained by interference with tinnitus generating circuits consisting of auditory nerve fibers, cochlear nucleus, inferior colliculus and whereby modification of cortical activity.
In the present study, the CAP amplitudes and latencies were measured at the identical intensity levels (CAP threshold + 20 dB SPL) before and after AES (Figure 1). AES reduced the level of tinnitus-related activity as it reduced the loudness of the tinnitus percept. AES reduces the spontaneous firing of the ipsilateral and contralateral cochlear nerves, probably owing to the reactivation of the efferent system. Electrical impulses directly stimulate the cochlear nerve with no effect bypasses on hair cells50. It appears that many factors could be responsible for RI and are involved in suppressing tinnitus. Suppression of tinnitus by electrical stimulation: a contribution to the history of medicine.
Repetitive transcranial magnetic stimulation in veterans with debilitating tinnitus: a pilot study. Residual inhibition functions overlap tinnitus spectra and the region of auditory threshold shift.
The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity. Electrocochleographic analysis of the suppression of tinnitus by electrical promontory stimulation. The analogy between tinnitus and pain: a suggestion for a physiological basis of chronic tinnitus. Auditory event related potentials in chronic tinnitus patients with noise induced hearing loss. Expanding the biological basis of tinnitus: crossmodal origins and the role of neuroplasticity. Final common pathway for tinnitus: theoretical and clinical implications of neuroanatomical substrates.
Cochlear-motor, transduction and signal-transfer tinnitus: models for three types of cochlear tinnitus. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. Lateralized tinnitus studied with functional magnetic resonance imaging: abnormal inferior colliculus activation. Auditory nerve and brain-stem evoked responses in normal, autistic, minimal brain dysfunction and psychomotor retarded children. Mathematical expression of relationship between auditory brainstem transmission time and age.
Noradrenergic and serotonergic projections to the superior olive: potential for modulation of olivocochlear neurons.
Electrical Stimulation-Tinnitus Inhibition: The Dynamic Range of Electrical Tinnitus Inhibition, a Predictable Test.
Mechanical responses of the organ of corti to acoustic and electrical stimulation in vitro. He also reported that Grapergiesser initially suppressed tinnitus by transcutaneous electrical stimulation using Volta's Platinum-Zinc cell4. In 1981, Vernon & Meikle15 speculated that the mechanism of RI may be related to mechanisms that suppress pain for a period of time after electrical stimulation.
Most hypotheses postulate that the generation of tinnitus is associated with cochlear or acoustic nerve or central auditory dysfunction and their interactions25-28. BTT is defined as the time interval between the initial earlobe-negative wave (the response of the auditory nerve - the 'input' to the brain stem) and earlobe-positive wave from the inferior colliculus region (the 'output' of the brain stem). The experiment reported in this paper was guided by the hypothesis that alterations in activity seen during residual inhibition can return the abnormal neural activity to normal levels. Thus, the responses among the subjects were divided into two groups, including those subjects who had tinnitus residual inhibition (RI) and those who had tinnitus non-residual inhibition (NRI). Each subject provided informed consent in accordance with the Declaration of Helsinki, Committee on Ethics at the ENT and Head & Neck Research Center of Iran University of Medical Sciences (IUMS) prior to participating in the study.
The identical procedure as AES was repeated, except that the electric current produced by the device was turned off.
We generated different pairs of pitch sounds at 11 frequencies (from 125 Hz to 12 kHz); we then decreased or increased the pitch (which was not similar to tinnitus), after which the subjects were asked to identify which pitch best matched the pitch of their tinnitus. Contact impedance indicators for the disk electrodes were less than 2 Kohms except for the inserted ECochG electrode, which was maintained at less than 5 Kohms.
The time-interval between the peaks wave I (auditory-nerve response) and the vertex negative wave following wave v (endpoint of wave V descending part) was measured as an auditory brainstem transmission time (BTT) (Figure 1). The AES intensity varied among the subjects with tinnitus according to their tolerance and satisfaction level. Making an analogy with a neural theory regarding chronic intractable pain, Tonndorf then suggests that, acoustic masking with its relatively short RI might mechanically re-activate the large diameter, inner-hair-cell fibers in largely the same manner as the large-diameter pain fibers are temporarily re-activated by scratching or by vibratory stimulation. Therefore, there was minimal chance that the increased CAP amplitude and thresholds reflected the recruitment phenomenon. It can be due to more neural synchronization process of the auditory pathway associated with RI induced by AES.


RI induced by AES can cause an increase in GABAergic shaping of the nerve activity when it reaches the inferior colliculus.
The effects on the cochlear nerve, the synchronization of auditory nerve fiber discharges, inhibition of the abnormal activity of the auditory nerve caused by modulated GABAergic shaping of the nerve activity in the inferior colliculus, serotonergic projections from the Raphe Nuclei and in the inferior colliculus, reactivation of the efferent system over time, revival of the neural coding pattern of auditory information in neural pathways can play important roles in generating RI.
In fact, one of the outstanding features of this phantom sound is that it can be inhibited by auditory external stimuli such as acoustical, electrical, and magnetic fields5-8. Previous works has assumed that the perception of tinnitus was associated with abnormally high ("tinnitus-related") neural activity in the central auditory pathways by means of AEPs measures and functional imaging.
The present study evaluated the changes occurring in BTT associated with tinnitus residual inhibition induced by auditory electrical stimulation in subjects with problem-tinnitus. According to this hypothesis, efforts to understand RI phenomenon should be guided by develop in our knowledge of the underlying mechanisms of tinnitus. All subjects had intractable permanent chronic moderate to severe SIT, which had been present for 4 to more than 180 months (Table 1).
Since the studied subjects has not been any experienced for electrical stimulation, prior to each study session were mentioned that they might or might not feel any sensations of AES.
The washout period for the crossover study was considered at least one week after the initial recording session. We performed the ECochG procedure to obtain the obvious compound action potentials (CAP) using the active surfacetympanic membraneelectrode (Tymptrode), which was inserted into the lower posterior-inferior region of the external auditory canal at the point closest to the tympanic membrane.
We re-measured the ECochG and ABR parameters within a few minutes after performing AES in the RI, NRI and PES control subjects.
Because of the differences in the intensity levels of electrical stimulation for generating RI among the subjects with tinnitus, we performed AES slightly above TSL at the MCL. According to gate control theory, the activity of the large diameter, inner-hair-cell fibers act to shut-off (for a time) the aberrant signaling from the small diameter, outer-hair-cell fibers.
Meanwhile the BTT is a demonstration of progress of excitation from the acoustic nerve to the inferior colliculus of the brainstem. GABA and the enzyme responsible for GABA synthesis, glutamic acid decarboxylase (GAD), and the genetic information necessary for the synthesis of GAD have been observed in the inferior colliculus of the central auditory pathway. It seems that early AEPs to be influenced by serotonin activity in an excitatory manner mainly. Mehrdad Salamat, MD, FAAP, FACC (Texas A & M University Health Science Center, USA) for their helpful comments on this manuscript. It is obvious that following the offset of appropriate masking stimuli, tinnitus may remain suppressed for a short period of time. He described the similarities between chronic pain and tinnitus RI by a gate control theory.
Such activity may occur in the subcortical and cortical portions of the central auditory system29-31. In the present study, primary parts of auditory pathways were evaluated using early evoked responses provided by electrocochleography (ECochG) and auditory brainstem response (ABR). Because the different subjects with tinnitus indicated various durations of RI following AES, a time interval was considered between the sessions.
VAS, LMT and PMT were administered pre-and post-AES during each session to assess tinnitus loudness changes. Finally, we administered an octave confusion test to more accurately determined tinnitus frequency. Initially, we used conductive gel on the tip of the Tymptrode before inserting it into the ear canal. RI could be produced by prolonged activity of the masking-induced released GABA because of masking stimuli.
We thank all ENT-doctors, audiologists and administrative personnel who helped us gather our data. This phenomenon is known as "residual inhibition" (RI) in the tinnitus literature, although the term of "post-masking effect"9 is more neutral with regard to its possible underlying mechanisms10.
A demonstration of such alterations was investigated in the occurrence of unusual increased or reduced waves in the AEPs.
The purpose of this study was to investigate alterations of BTT and other parameters of early AEPs in tinnitus subjects associated with RI induced by AES. The perceived sense of tinnitus varied among the subjects and included a single high-pitch tone or noise, cricket sound, hissing, whistling or ringing. The washout period for the crossover study was considered one week after the initial recording session. The tone pairs were adjusted to a loudness level equivalent to that of the tinnitus before each pair was presented.
Similarly, but more briefly, Vernon & Meikle15 in 1981 speculated that the mechanism of residual inhibition may be related to mechanisms that suppress pain for a period of time after electrical stimulation. Aminoxyacetic acid (AOAA), an inhibitor of GABA transaminase, has been shown in a controlled study to decrease tinnitus. These studies should contain a systematic database to evaluate procedures for optimizing RI to contrast it with AES and other intervention methods using specific measures. However, emphasis just in measurement of AEPs parameters (amplitude and latency) for assessment of tinnitus can be misleading.
When placed properly, the electrode rested gently on the eardrum, and the gel assisted in making contact with the eardrum. Afterwards the saline was removed from the external auditory canal prior reassessing ECochG and ABR. In addition, the inferior colliculus, the main generator of wave V, receives serotonergic input from the dorsal Raphe nucleus40. Because GABA transaminase is responsible for GABA degradation, the effect would be prolongation of the inhibitory activity of released GABA37. In 1971, Harald Feldmann3 proposed a theory that RI occurred in the brain rather than the ear.
Previous studies have reported using other alternatives measurement of time interval between certain waves32-34. The electrophysiological procedures consisting of ECochG and ABR were recorded before and immediately a few minutes after the applying of AES and PES.
Subsequently, the auditory threshold level at that specific frequency (A) was increased in 1-dB steps until the subject reported that the external tone equaled the loudness of the tinnitus (B). The acoustic stimuli were delivered monaurally by an insert phone (ER-3; Etymotic Research, Elk Grove Village, IL) to the tinnitus ear. Also serotonin often coexists with GABA in the inferior colliculus and both acting in the suppression of fearful and aversive behavior41. The visual analogue scale (VAS) for tinnitus loudness was measured pre- and post-AES and PES to monitor tinnitus loudness changes during the procedure (Figure 2). The sound level was then slightly raised by 1-dB increments to obtain a threshold, which was slightly louder than that of the tinnitus (C). Furthermore, descending serotonergic projections from Raphe nucleus may also modulate superior olive neurons42, the generators of ABR wave III43.
We used the mean level of loudness between points (B) and (C) as the representative loudness of the tinnitus. This author used electrical stimuli for tinnitus inhibition and concluded that the morphology and other specifications of ABR waves in tinnitus ears changed to the normal state. The AEPs amplitudes and latencies were administered to estimate the input-output functions.
According to changes in the AEP recordings associated with RI, it can be also speculated that the RI phenomenon might be caused by increasing synchronization of neural discharges in auditory fibers and distal portion of cranial nerve VIII following the applying of AES and modulating GABAergic activity in the inferior colliculus45. The threshold level of the auditory evoked potentials (AEP) was determined as the minimum sound pressure level in which the detectable and reproducible waveforms of the compound action potential (CAP) for ECochG and wave V for ABR. In this research, the changes in amplitude and latency of the CAP and ABR values (waves I, III, and V) were estimated at 20 dB over the AEP threshold level.



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