ACUFENOS-Seccíon Tecnicas de diagnostico

DPOAE in estimation of the function of the cochlea 

in tinnitus patients with normal hearing

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Aleksandra Sztuka^a, Lucyna Pospiech^a, Wojciech Gawron^{, a,} and Krzysztof Dudek^a

^a Wroclaw Medical University, ENT Department, Borowska 213, Wroclaw, Poland

Available online 26 June 2009.

Abstract

Objective

The most probable place generating tinnitus in the auditory pathway is the outer hair cells (OHCs) inside the cochlea.
Otoacoustic emissions are used to assess their activity.
The objective of the investigation was to measure the features of distortion product otoacoustic emissions (DPOAE) in a group of tinnitus patients without hearing loss, estimate the diagnostic value of the parameters for the analysis of cochlear function in the patients, emphasizing those most useful in localizing tinnitus generators, and determine the hypothetical influence of hyperacusis and misophony on DPOAE parameters in tinnitus patients.

Patients and methods

The material consisted of 44 patients with tinnitus and without hearing loss.
In the control group were 33 patients without tinnitus with the same state of hearing.
The tinnitus patients were divided into three subgroups: those with hyperacusis, those with misophonia, and those with neither.
After collecting medical history and performing clinical examination of all the patients, tonal and impedance audiometry, ABR, and discomfort level were evaluated.
Then DPOAE were measured using three procedures.
First the amplitudes of two points per octave were assessed, second the “fine structure” method with 16–20 points per octave (f2/f1 = 1.22, L1 = L2 = 70 dB), and the third procedure included recording the growth function in three series for input tones of f2 = 2002, 4004, and 6006 Hz (f2/f1 = 1.22) and L1 = L2 levels increasing by increments of 5 dB in each series.

Results and conclusions

Hyperacusis was found in 63% and misophonia in 10% of the tinnitus patients with no hearing loss.
DPOAE amplitudes in recordings with two points per octave and the fine structure method are very valuable parameters for estimating cochlear function in tinnitus patients with normal hearing.

Function growth rate cannot be the only parameter in measuring DPOAE in tinnitus patients, including subjects with hyperacusis and misophonia.

The markedly higher DPOAE amplitudes in the group of tinnitus patients without hearing loss suggest that tinnitus may be caused by increased motility of the OHCs induced by decreasing efferent fiber activity, and not by OHC failure.

Hyperacusis significantly increases the amplitude of DPOAE in tinnitus patients with no hearing loss.

Keywords: Tinnitus; Hyperacusis; Misophonia; DPOAE

Corresponding author at: ul. Krzycka 32, 53-020 Wroclaw, Poland. Tel.: +48 603672132.

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Fuente: Auris Nasus Larynx Volume 37, Issue 1, February 2010, Pages 55-60

ACUFENOS-Seccíon Tecnicas de tratamiento

Transcranial magnetic stimulation for the treatment of tinnitus: 4-year follow-up in treatment responders—a retrospective analysis

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Julia Burger¹, Elmar Frank¹, Peter Kreuzer¹, Tobias Kleinjung², Veronika Vielsmeier², Michael Landgrebe¹, Goeran Hajak¹ and Berthold Langguth^{1, ,}

¹ Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
² Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany

Received 29 September 2010; 

revised 8 November 2010; 

accepted 26 November 2010. 

Available online 28 December 2010.

Background

Repetitive transcranial magnetic stimulation (rTMS) over the temporal cortex has been proposed as a new approach for the treatment of tinnitus. Even if most studies have shown beneficial effects, there is only limited knowledge about clinical predictors for treatment response and about the duration of treatment effects.

Objective

In this study, we compared clinical characteristics of rTMS responders and nonresponders and assessed long-term outcome in the responder group.

Method

Results from 235 patients, who were treated with rTMS because of chronic tinnitus were analysed.
Patients received either a standard protocol of low-frequency rTMS (n = 188; 110% motor threshold, 1 Hz, 2000 stimuli/day) over the left temporal cortex or combined frontal and temporal rTMS (n = 47; 110% motor threshold, 1000 stimuli at 20 Hz, left dorsolateral prefrontal cortex plus 1000 stimuli at 1 Hz left temporal cortex).

Response criterion was defined as an improvement of at least 10 points in the tinnitus questionnaire (TQ) score between baseline and the follow-up assessment 90 days after treatment.

Results

For the entire study group there was a highly significant effect of treatment on the TQ score.

Fifty patients (21.3%) were responders according to the above mentioned definition.
The response criterion was fulfilled by 19.7% of the patients receiving left temporal rTMS and by 26% of the patients receiving combined rTMS.

The only significant difference between responders and nonresponders was a higher baseline score of the TQ in the responder group. 

There were no significant differences in all other assessed patient parameters (gender, age, tinnitus duration, tinnitus laterality, motor threshold, handedness).

Ninety days after treatment the average TQ reduction in the responder group was 18.2 points as compared with baseline. At the two long-term follow-up assessments (2.12 ± 1.17 years and 3.9 ± 1.17 years after treatment) the improvement in the responder group was still 14.2, respective 14.4 points.

Conclusions

These data underscore the clinical relevance of rTMS in the treatment of tinnitus. 

A potential explanation for the observed long-lasting clinical effects is that rTMS interferes with tinnitus related neuronal activity and thus facilitates the intrinsic ability of the brain to restore normal function.

Keywords: chronic tinnitus; predictor; repetitive transcranial magnetic stimulation; treatment outcome; long-term effects

Correspondence to: Berthold Langguth, MD, Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany.

fuente: Science Direct

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B8JBG-51TGKJR-1&_user=10&_coverDate=12%2F28%2F2010&_alid=1592786709&_rdoc=1&_fmt=high&_orig=search&_origin=search&_zone=rslt_list_item&_cdi=43558&_sort=r&_st=13&_docanchor=&view=c&_ct=1241&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a78e44a58d767cc26d87c4148d607235&searchtype=a