Eye movement abnormalities in somatic tinnitus:
Fixation, smooth pursuit and optokinetic nystagmus
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Z. Kapoulaa, 1, 
, 
, Q. Yanga, 1, , , M. Verneta, P. Bonfilsb and A. Londerob
a Laboratoire IRIS, CNRS, FRE 3154, Service d’Ophtalmologie-ORL-Stomatologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris, France
b Service d’ORL et de Chirurgie cervico-Faciale, Hôpital Européen Georges Pompidou, Faculté de médecine Paris-Descartes, Université Paris V et Laboratoire CNRS UMR 7060, 20 rue Leblanc, Paris, France
Received 12 May 2009;
accepted 16 October 2009.
Available online 17 November 2009.
Abstract
Objective
Smooth pursuit (SP), optokinetic nystagmus (OKN) and fixation were investigated in five subjects with somatic
tinnitus modulated by eye movements, jaw or neck.
Methods
Eye movements were recorded with the EyeLink II video system.
Results
(1) Fixation was characterized by high frequency and amplitude of saccade intrusions;
(2) SP had low gain particularly in the vertical direction, and it was characterized by high frequency of catch-up saccades with high amplitude, including predictive saccades;
(3) OKN also had low gain particularly in the vertical direction.
Each subject showed abnormality for more than one type of eye movement, and for specific directions.
Conclusions and significance
The results suggest mild dysfunction of cortical–subcortical and cerebellar structures involved in the control of these eye movements.
Particularly deficits for vertical pursuit eye movements and fixation instability in line with cerebellar signs. Further studies of more patients with or without modulated
tinnitus are in progress.
Keywords: Tinnitus; Fixation; Smooth pursuit; Optokinetic nystagmus; Abnormality
Fig. 3. Individual trials of fixation at center, at 10° to left, at 10° to right, at 10° to up or at 10° to down for subject NT (no tinnitus) and five patients with tinnitus. The values of SI (saccade intrusions) amplitude and frequency were presented in each figure. The abnormal values for each parameter are in bold characters. The horizontal lines show the target position. The letter in parentheses indicates the direction of increased tinnitus for each subject, L for left and R for right.
Fig. 4. Individual trials of smooth pursuit to left, to right, to up or to down for subject NT (no tinnitus) and five patients with tinnitus. The values of CUS (catch-up saccades) frequency and amplitude, and pursuit gain were presented in each figure. The abnormal values for each parameter were in bold characters. The letter in parentheses indicates the direction of increased tinnitus for each subject, L for left and R for right.
Fig. 5. Individual trials of optokinetic nystagmus (OKN) to left, to right, to up or to down for subject NT (no tinnitus) and five patients with tinnitus. The values of OKN gain were presented in each figure. The abnormal values for OKN gain were in bold characters. The letter in parentheses indicates the direction of increased tinnitus for each subject, L for left and R for right.
Table 1. Epidemiological data. 
Note: SNHL: sensory neural hearing loss; WN: white noise; L: left; R: right.
Table 2. Tinnitus consciousness and modulation.
Note: Severity: Subjective Tinnitus Severity Scale (STSS Halford et al., 1991
[24]; French version, Meric and Chery-Croze S, 1996
[25]); Score > 8 show moderate tinnitus; Score > 12 show severe tinnitus; Distress: Tinnitus Reaction Questionnaire (Wilson et al., 1991
[26], French version, Meric, 1997
[27]); Scores > 30 < 60 show moderate distress; Scores > 60 show marked distress.
Corresponding authors. Tel.: +33 1 56 09 50 66; fax: +33 1 56 09 50 66.
1 Z. Kapoula and Q. Yang co-first author.
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