Exploring the reasons why melatonin can improve tinnitus.
From: Med Hypotheses. 2010 Mar 6. [Epub ahead of print]
Melatonin has been proposed as a treatment for tinnitus, especially on the basis of its favourable effects on sleep and its vasoactive and antioxidant properties. However, to the authors knowledge no attempts of interpretation have been advanced through a detailed analysis of the various specific properties of melatonin possibly cooperating in a coincidental way to relieve tinnitus: among these, its modulatory effect on central nervous system resulting in a protective mechanism against an exaggerated sympathetic drive; its capacity to induce a more steady hemodynamic condition, through a multifactorial and multi-organ activity, resulting in a more regular labyrinthine perfusion; a possible action on the skeletal muscle tending to a reduction of the muscular tone, which could relieve tinnitus of muscular origin deriving from tensor tympani tonic contractions; its possible reported antidepressive effect, which could indirectly act on tinnitus; a direct regulation of inner ear immunity as proposed in literature when melatonin was reported to be present in the inner ear.
All these observations seem to indicate melatonin as a tool deserving a greater attention than other antioxidants in the attempt of relieving tinnitus, justifying its application from a more precise rationale based on a series of physio-pathological aspects.
Tinnitus and psychological comorbidities
From: HNO. 2010 Mar 4. [Epub ahead of print] [Article in German]
Comorbidity is the presence of one or more disorders in addition to the main disorder. Comorbidities negatively influence the development of the main disease. For patients with tinnitus a comorbidity is an additional component complicating the habituation of ear noise and patients with decompensated tinnitus often have psychological comorbidities, e.g. affective, somatoform or anxiety disorders. At the time of first presentation and also during further follow-up, it is essential to pay particular attention to the presence of potential comorbid mental disorders. This is of special importance for patients with decompensated ear noise (severity grades 3 and 4). For ENT specialists it is important that the mental discomfort of patients must be taken seriously and should be identified through a targeted diagnosis. Effective treatment of the co-symptoms using cognitive behavior therapy (CBT) in conjunction with medication often reduces the severity of tinnitus perception and discomfort.
Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct current stimulation: a preliminary clinical study.
From: Exp Brain Res. 2010 Feb 26. [Epub ahead of print]
Tinnitus is considered as an auditory phantom percept. Preliminary evidence indicates that transcranial direct current stimulation of the temporo-parietal area might reduce tinnitus. Transcranial direct current stimulation studies of the prefrontal cortex have been successful in reducing depression, impulsiveness and pain. Recently, it was shown that the prefrontal cortex is important for the integration of sensory and emotional aspects of tinnitus. As such, frontal transcranial direct current stimulation might suppress tinnitus as well. In an open label study, a total of 478 tinnitus patients received bilateral transcranial direct current stimulation on dorsolateral prefrontal cortex (448 patients anode right, cathode left and 30 anode left, cathode right) for 20 min. Treatment effects were assessed with visual analogue scale for tinnitus intensity and distress.
No tinnitus suppressing effect was found for transcranial direct current stimulation with left anode and right cathode. Analyses show that transcranial direct current stimulation with right anode and left cathode modulates tinnitus perception in 29.9% of the tinnitus patients. For these responders a significant reduction was found for both tinnitus related distress and tinnitus intensity. In addition, the amount of suppression for tinnitus related distress is moderated by an interaction between tinnitus type and tinnitus laterality. This was, however, not the case for tinnitus intensity. This study supports the involvement of the prefrontal cortex in the pathophysiology of tinnitus.
Related: Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density There was a relationship between the dorsolateral prefrontal cortex and perceived pain. The authors suggested that the pattern of brain atrophy is directly related to the perceptual and behavioral properties of chronic back pain. Gray matter density was reduced in bilateral dorsolateral prefrontal cortex and right thalamus and was strongly related to pain characteristics in a pattern distinct for neuropathic and non-neuropathic chronic back pain.
Is there a relationship between chronic pain and tinnitus?
The distressed (Type D) personality is independently associated with tinnitus: a case-control study.
From: Psychosomatics. 2010 Jan;51(1):29-38.
Tinnitus is a common and disturbing condition, reported by 10% to 20% of the general population. The authors sought to determine personality characteristics associated with tinnitus patients versus a control group of ear-nose-throat (ENT) patients without tinnitus. Adult chronic tinnitus sufferers (N=265) and ENT patients without tinnitus (N=265) participated in a cross-sectional study. The authors evaluated personality characteristics with tests for distressed personality (Type D), neuroticism, extraversion, and emotional stability.
As compared with control subjects, tinnitus patients had statistically significant and clinically relevant higher levels of neuroticism, negative affectivity, and social inhibition, on one hand, and lower levels of extraversion and emotional stability on the other hand. Also, tinnitus patients were more likely to have a type D personality.
Neuroticism, reduced extraversion, and reduced emotional stability were associated with tinnitus, but the level of prediction of the model improved with the addition of type D personality to the single traits. This might indicate that personality characteristics, and type D personality, in particular, are associated with having tinnitus and might contribute to its perceived severity.
Related:
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The effectiveness of bibliotherapy in alleviating tinnitus related distress.
From: J Psychosom Res. 2010 Mar;68(3):245-251. Epub 2009 Nov 3
The present study examined the efficacy of bibliotherapy in assisting individuals experiencing distress related to tinnitus. One hundred sixty-two tinnitus sufferers from Australia participated in a study designed to examine the effectiveness of a cognitive-behaviorally based self-help book in reducing distress. To maximize the ecological validity of the findings, the authors excluded no individuals interested in treatment for tinnitus related distress.
The experimental condition lost 35% of participants at postassessment, compared to 10% in the control group. In an analysis of participants who completed postintervention assessment, those assigned to the intervention condition, who received a tinnitus self-help book, showed significantly less tinnitus related distress and general distress 2 months later compared to those assigned to the waiting list control condition. The intervention group’s reduction in tinnitus related distress and general distress from preintervention to postintervention 2 months later was significant, and these participants maintained a significant reduction in distress on follow-up 4 months after they received the tinnitus self-help book. A long-term follow-up of all participants, who at that time had received the book at least a year previously, showed a significant reduction in tinnitus distress.
Although these group differences and pre-post changes were significant, effect sizes were small. Intention-to-treat analyses showed no significant effect for between-groups analyses, but did show a significant effect for the 1-year follow-up pre-post analysis.
Information on the effectiveness of using a self-help book, without therapist assistance, in alleviating distress is important, as bibliotherapy can provide inexpensive treatment that is not bound by time or place.
More on this study: Self Help Books for Tinnitus
Resource: Tinnitus: A Self-Management Guide for the Ringing in Your Ears, by Jane L. Henry, Ph.D., and Peter H. Wilson, Ph.D. (2001)
Association between cervical curvature and cervical sympathetic symptoms
From: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2009 Jun;31(3):381-2
To investigate the association between cervical curvature and cervical sympathetic symptoms, the clinical data of 318 patients with cervical spondylosis who underwent surgical treatment in our department between July 2003 and December 2007 were retrospectively analyzed. All patients were divided into group without sympathetic symptoms (n = 284) and group with sympathetic symptoms (n = 34). The curvatures of both groups on cervical lateral radiographs were measured using Borden method and statistical analysis was performed.
The incidence of abnormal cervical curvature in group with cervical sympathetic symptoms were 67.6% (23/34), which was significantly higher than that in group without cervical sympathetic symptoms (50.7%, 144/284). Cervical curvature abnormality may be an independent factor that affects the cervical sympathetic symptoms.
In Zhonghua Wai Ke Za Zhi. 2008 Sep 15;46(18):1424-7, Treatment and mechanism of cervical spondylosis with sympathetic symptoms concluded: The sympathetic nerve fibers distributed in the cervical posterior longitudinal ligament maybe another one significant factor causing sympathetic symptom of cervical spondylosis.
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Association of tinnitus and electromagnetic hypersensitivity: hints for a shared pathophysiology?
From: PLoS ONE. 2009;4(3):e5026. Epub 2009 Mar 27
Tinnitus is a frequent condition with high morbidity and impairment in quality of life. The pathophysiology is still incompletely understood. Electromagnetic fields are discussed to be involved in the multi-factorial pathogenesis of tinnitus, but data proofing this relationship are very limited. Potential health hazards of electromagnetic fields have been under discussion for long. Especially, individuals claiming themselves to be electromagnetic hypersensitive suffer from a variety of unspecific symptoms, which they attribute to electromagnetic fields exposure. The aim of the study was to elucidate the relationship between electromagnetic field exposure, electromagnetic hypersensitivity and tinnitus using a case-control design.
Tinnitus, the perception of sound in the absence of an external sound, is a frequent disorder of auditory perception, which is very difficult to treat. Tinnitus as a phantom perception of a meaningless sound has to be differentiated from auditory hallucinations which mainly occur in the context of psychiatric diseases and are characterized by e.g. the perception of voices. About 10–20% of the adult population experiences some degree of tinnitus. Many learn to ignore the sounds and experience no major effects, but for about 1 in 100 adults, the noise interferes significantly with daily life. In those patients, tinnitus is frequently associated with neuropsychiatric co-morbidity such as depression, anxiety or sleep disorders, which underlines the clinical and socio-economic importance.
Even if the pathophysiology of tinnitus remains incompletely understood, there is growing evidence that dysfunctional neuroplastic processes in the brain are involved. In particular, it is assumed that tinnitus might be the correlate of maladaptive neuroplastic changes due to distorted sensory input. Accordingly functional imaging studies demonstrated neuroplastic alterations in the central auditory system. However tinnitus related alterations of neural functioning are not limited to the central auditory system, but also encompass non-auditory regions such as frontal and limbic areas.
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Abnormal resting-state cortical coupling in chronic tinnitus
From: BMC Neurosci. 2009 Feb 19;10(1):11. [Epub ahead of print]
Patients that suffer from chronic tinnitus complain of an ongoing perception of a phantom sound in the absence of any physical source for it. About 5-15 % of the population in western societies experience a phantom tinnitus sound and 1-3% of the population suffer from severe tinnitus that affects their daily life and is accompanied in 50 % of the cases by depression, in 40 % of the cases by insomnia and about 20% of the patients complain of an important decrease in their quality of life. Unfortunately, the underlying mechanisms responsible for the tinnitus perception is currently not known. Tinnitus therapies typically concentrate on coping with the tinnitus but there is no therapy that reliably reduces the perception of tinnitus.
Tinnitus is often accompanied by damage to the peripheral hearing system and a series of plastic changes in the central auditory system are observed in parallel to that. It is thought that a deafferentation of the hearing system triggers a series of reorganization processes at all levels of the auditory system. Indeed, abnormal neuronal activity in tinnitus has been demonstrated for the auditory nerve fibers, the dorsal cochlear nucleus, the inferior colliculus, the primary and the secondary auditory cortex. Furthermore, it has been found that a dissection of the auditory nerve in tinnitus patients does not lead to relief in tinnitus and most of the patients still experience tinnitus after surgery. Thus, there is an agreement that the tinnitus phantom sound is generated in the central nervous system – most likely as a result of the reorganization that is going on in the auditory system after hearing loss.
However, there are also studies that demonstrated tinnitus-related cortical abnormalities outside the auditory system. Using methods as different as Positron Emission Tomography (PET), Voxel Based Morphometry (VBM) and Magnetoencephalography (MEG) differences in cortical activity have been shown for the frontal cortex, the parietal lobe, mesial posterior regions and the subcollosal region including the nucleus accumbens. As hypothesized earlier by Jastreboff it might be that tinnitus is generated within the auditory system while non-auditory regions are involved in encoding the conscious percept well as the emotional evaluation of it. This idea also fits with a recently established model of the global neuronal workspace by Deheane and colleagues. This group suggests the existence of workspace neurons that are located mainly in the parietal lobe, the frontal, the cingulate cortex and the sensory systems. In order to form a conscious percept of a stimulus, two conditions are required: First, neuronal activity of the sensory cortex of the respective modality. Second, an entry into the global neuronal workspace and thus long-range coupling between the widely distributed workspace neurons. According to this model, coupling within this frontoparietal-cingulate network is needed for conscious perception (i.e. awareness of the stimulus). Activity of the sensory areas without this coupling would remain preconscious.
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Cost effectiveness of multidisciplinary management of Tinnitus at a specialized Tinnitus centre
From: BMC Health Serv Res. 2009 Feb 11;9(1):29. [Epub ahead of print]
Subjective tinnitus is the involuntary perception of the concept of a sound without the presence of an external source. It is a chronic condition that is highly prevalent, especially among hearing impaired individuals. Studies show a prevalence of 10% to 20% in the general population and among hearing impaired individuals prevalence has been estimated at 75% to 80%. Of the Dutch population at least 2 million individuals suffer from some form of tinnitus, 340,000 individuals indicate to hear the tinnitus continuously and 60,000 individuals claim to be severely impaired in their daily activities. Among severe sufferers it causes disability associated with severe affective problems, major declines in concentration, sleeping difficulties, hypersensitivity to sounds and problems in re-directing attention. The combination of these complaints makes them feel exhausted and frustrated resulting in diminished quality of life. Tinnitus is known to occur as a concomitant of almost all the dysfunctions that involve the human auditory system and it is postulated that the aetiology of tinnitus is diverse and that different activation circumstances can be present. Little is known about the pathophysiology and there is no known drug or curative therapy at present though considerable research effort has been expended in this regard.
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Simplified form of tinnitus retraining therapy in adults: a retrospective study
From: BMC Ear Nose Throat Disord. 2008 Nov 3;8(1):7 [Epub ahead of print]
Tinnitus retraining therapy is aimed at removing negative associations of the tinnitus signal to enable the natural habituation process to occur. The goal is to achieve this through retraining counseling and sound therapy. Retraining counseling is a crucial part of tinnitus retraining therapy; it teaches patients the components of the neurophysiological model of tinnitus and encourages them to reclassify their tinnitus as a neutral signal. Sound therapy is assumed to facilitate tinnitus habituation by decreasing the strength of tinnitus signal. The tinnitus retraining therapy protocol requires that the patient adheres to the regimen for 12-24 months (typically attending for seven sessions over that time), except for patients experiencing weak tinnitus, which hearing aids little impact on everyday life.
Since the first description of tinnitus retraining therapy in the 1990s, clinicians have modified and customised the method of tinnitus retraining therapy to suit their practice and their patients. A simplified form of tinnitus retraining therapy hearing aids been used at Ealing Primary Care Trust (PCT) Audiology Department since 2005. This is different from tinnitus retraining therapy in the type and (shorter) duration of retraining counseling. Although the counseling used in simplified tinnitus retraining therapy also aims to get the patient to reclassify tinnitus as a neutral stimulus, it is different from the counseling used in tinnitus retraining therapy in the following ways: (1) there is no teaching about basic functions of the auditory system; (2) there is no presentation of the basics of brain function and the interactions of various systems of the brain; (3) there is no explanation of the theoretical basis of habituation based on the Jastreboff neurophysiological model; and (4) the duration of the initial counseling of simplified tinnitus retraining therapy is 30 minutes in comparison to 90 minutes for the initial tinnitus retraining therapy counseling.
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