Temporomandibular Joint Disorder Complaints in Tinnitus: Further Hints for a Putative Tinnitus Subtype

OBJECTIVE: Tinnitus is considered to be highly heterogeneous with respect to its etiology, its comorbidities and the response to specific interventions. Subtyping is recommended, but it remains to be determined which criteria are useful, since it has not yet been clearly demonstrated whether and to which extent etiologic factors, comorbid states and interventional response are related to each other and are thus applicable for subtyping tinnitus. Analyzing the Tinnitus Research Initiative Database we differentiated patients according to presence or absence of comorbid temporomandibular joint (TMJ) disorder complaints and compared the two groups with respect to etiologic factors. METHODS: 1204 Tinnitus patients from the Tinnitus Research Initiative (TRI) Database with and without subjective TMJ complaints were compared with respect to demographic, tinnitus and audiological characteristics, questionnaires, and numeric ratings. Data were analysed according to a predefined statistical analysis plan. RESULTS: Tinnitus patients with TMJ complaints (22% of the whole group) were significantly younger, had a lower age at tinnitus onset, and were more frequently female. They could modulate or mask their tinnitus more frequently by somatic maneuvers and by music or sound stimulation. Groups did not significantly differ for tinnitus duration, type of onset (gradual/abrupt), onset related events (whiplash etc.), character (pulsatile or not), hyperacusis, hearing impairment, tinnitus distress, depression, quality of life and subjective ratings (loudness etc.). CONCLUSION: Replicating previous work in tinnitus patients with TMJ complaints, classical risk factors for tinnitus like older age and male gender are less relevant in tinnitus patients with TMJ complaints. By demonstrating group differences for modulation of tinnitus by movements and sounds our data further support the notion that tinnitus with TMJ complaints represents a subgroup of tinnitus with clinical features that are highly relevant for specific therapeutic management

Tinnitus with Temporomandibular Joint Disorders: A Specific Entity of Tinnitus Patients?

Objective. Tinnitus is frequently associated with temporomandibular joint (TMJ) dysfunction. However, the nature of the relationship is not fully understood. Here the authors compared 30 patients with a confirmed diagnosis of temporomandibular joint dysfunction and tinnitus to a group of 61 patients with tinnitus but without any subjective complaints of TMJ dysfunction with respect to clinical and demographic characteristics. Study Design. Case-control study. Setting. Tertiary referral center. Subjects. Tinnitus patients with and without TMJ dysfunction presenting at the Department of Prosthetic Dentistry and the Tinnitus Clinic at the University of Regensburg. Results. Tinnitus patients with TMJ disorder had better hearing function (P < .0005), lower age (P = .001), and lower age at tinnitus onset (P = .002) and were more frequently female (P = .003). Their subjectively perceived tinnitus loudness was lower (P = .01), and more of them could modulate their tinnitus by jaw or neck movements (P = .001). Conclusion. Classical risk factors for tinnitus (age, male gender, hearing loss) are less relevant in tinnitus patients with TMJ disorder, suggesting a causal role of TMJ pathology in the generation and maintenance of tinnitus. Based on this finding, treatment of TMJ disorder may represent a causally oriented treatment strategy for tinnitus

Age-dependent effects of the onset of a conductive hearing loss on the volume of the cochlear nucleus subdivisions and the expression of c-fos in the mongolian gerbil (Meriones unguiculatus)

A monaural conductive hearing loss was induced by interrupting the chain of the middle ear ossicles on the right side in gerbils of four different age groups (P12-14, P20-21, P42 and P84). The volumes of the cochlear nucleus subdivisions and the number of cells that expressed immunoreactivity for c-fos after noise stimulation were determined on the left and right side in the deprived animals, and in undeprived control animals when they reached the age of 6 months. The anteroventral cochlear nucleus on the deprived side was reduced in volume when the deprivation started before the age of 3 months. The other cochlear nucleus subdivisions showed no systematic age-dependent reductions. The expression of c-fos in the dorsal cochlear nucleus appeared more resistant to a hearing loss, with deprivation being more effective in younger animals. c-fos expression was also dramatically reduced in the ventral cochlear nucleus, regardless of age at the onset of hearing loss

Age dependent changes in the medial nucleus of the trapezoid body in gerbils

The results of a quantitative light microscopic analysis of serial glycine immunoreacted sections through the medial nucleus of the trapezoid body (MNTB) of young and old gerbils are presented. Spongiform lesions were prominent in the MNTB of gerbils that were 3 years and older, but were virtually absent in animals below 1 year of age. In old animals the prevalence and density of spongiform lesions were most pronounced in the caudal MNTB and decreased towards the rostral MNTB. Total MNTB volume and rostro-caudal extent were independent of age and the cross-sectional area of MNTB varied in an identical fashion along the MNTB in young and old gerbils. Mean MNTB soma size (cross-sectional area) varied with the age of the animal. In young gerbils soma size increased between 1 and 6 months of age reaching a maximum near 160 microm(2). In old gerbils mean soma size was significantly reduced to 130 microm(2). At all three rostro-caudal positions analyzed along MNTB, soma size varied systematically being largest in the ventro-lateral and smallest in the dorso-medial part of MNTB. The reduction of soma size in old animals appeared uniform across MNTB

Schädigung von mikrochirurgischen Instrumenten durch Aufbereitung in einer Zentralsterilisation

Hospital facilities issue numerous risk announcements on corrosion, deformation or premature wearout of medical devices every year. As there is yet little data on the impact of reprocessing on the quality and durability of microsurgical instruments, this paper aims at evaluating the effects of the reprocessing on microsurgical instruments. Material and Methods 22 brand new microsurgical instruments for stapes surgery were being reprocessed 30 times without being used for surgery or other purposes in the interim time. After each reprocessing the instruments were examined macroscopicly and microscopicly. The results were portrayed in a photo documentation and analysed on that basis. Results Almost all devices showed mechanical damage caused by the reprocessing procedure. The increasing deterioration was often associated with missing protective caps. Furthermore contaminations and stains were apparent in several cases. Conclusions The findings illustrate that careful handling of delicate surgical devices during reprocessing is vital. They also highlight problems of protective caps. As an alternative going forward it should be considered to store microsurgical instruments statically in special racks

The effect of gabapentin on gap detection and forward masking in young and old gerbils.

OBJECTIVES: Auditory temporal processing frequently appears more affected in old subjects than would be predicted by the degree of peripheral hearing loss, pointing to an age-dependent central processing deficit. In parallel, an age-dependent decline of inhibitory function has been demonstrated in the auditory pathway, suggesting a causal relationship between temporal processing and inhibition. Gabapentin has been specifically synthesized as a potential gamma-amino-butyric-acid (GABA) mimetic with the capability to cross the blood-brain barrier. Gabapentin treatment ameliorated tinnitus in a rat model and improved tinnitus annoyance in humans with acoustic trauma. Consequently, the present study evaluated the effect of gabapentin on auditory temporal processing in the gerbil model. DESIGN: Psychometric functions were collected for different test paradigms. (A) "Gap detection": The detection of a gap in the middle of a 800 msec broadband noise pulse was determined either at 15 or at 30 dB SL. (B) "Forward masking": The detection of a 20 msec probe stimulus following 2.5 msec after a 400 msec 40 dB SPL masker was determined with masker and probe frequency at 2.85 kHz. The effect of gabapentin was evaluated by collecting gap detection and forward masking functions before, during, and after treating gerbils with gabapentin doses of 115 or 350 mg/kg/day administered via drinking water. Data under different experimental conditions were collected for groups of 3 to 5 young (2 years) gerbils. Two-way analyses of variance for the factors age groups and treatment groups with subsequent pairwise comparisons for significant effects were used for the statistical evaluation of the data. RESULTS: For gap detection, mean thresholds were significantly increased in the group of old as compared with the young gerbils at 30 dB SL (young 2.0 msec; old 3.2 msec) and at 15 dB SL (young 2.9 msec; old 9.1 msec). Gabapentin had no significant effect on gap detection, and there was no significant interaction between age group and gabapentin treatment. Mean thresholds in the forward masking paradigm were significantly elevated in old (45.5 dB SPL) as compared with young (35.0 dB SPL) gerbils. Overall, gabapentin had no significant effect on masked thresholds; however, there was a significant interaction between treatment and age. Subsequent pairwise comparisons revealed no significant effect on masked thresholds in old gerbils but showed significantly elevated thresholds of young gerbils during 350 mg/kg gabapentin (38.3 dB SPL) compared with thresholds obtained in young gerbils before (32.3 dB SPL) and after (33.5 dB SPL) treatment. CONCLUSIONS: Gabapentin did not exert a therapeutic effect on impaired gap detection and forward masking in old gerbils. The lack of an effect of gabapentin on impaired auditory temporal processing in old gerbils and the finding of elevated masked thresholds in young gerbils can be reconciled with reports of only moderate GABAergic effects compared with other drugs (e.g., comparing elevation of GABA levels in the brain by gabapentin and vigabatrin) and effects due to binding of gabapentin to alpha-2-delta units of voltage-gated calcium channels

Sound induced expression of c-Fos in GABA positive neurones of the gerbil cochlear nucleus

To characterize c-Fos-expressing neurones in more detail, a double labelling technique was developed to simultaneously demonstrate the presence of GABA-like and c-Fos-like immunoreactivity in cryostat sections of the gerbil cochlear nucleus. The animals were exposed to a wide-band noise stimulus for the induction of c-Fos expression. The distribution of c-Fos-positive cells and GABA-positive somata was consistent with previous reports. Our double labelling approach revealed the presence of GABA-positive cells that showed c-Fos expression after noise stimulation. One interpretation of this finding is that a prolonged acoustic exposure induces long term changes in inhibitory interneurones to adjust the output of the cochlear nucleus

The postnatal growth of cochlear nucleus subdivisions and neuronal somata of the anteroventral cochlear nucleus in the Mongolian gerbil (Meriones unguiculatus)

We have analysed the postnatal volume increase of the cochlear nucleus subdivisions from birth to senescence in the Mongolian gerbil. All subdivisions showed the most prominent growth in the 2nd week of life before the onset of hearing on day 12. After the onset of hearing, the dorsal and the postero-ventral portion of the cochlear nucleus showed only a moderate degree of further growth. The antero-ventral cochlear nucleus, however, almost doubled in volume after the onset of hearing, reaching a maximum in 4-month-old animals. In ageing gerbils, we observed a small but systematic reduction of the cochlear nucleus volume. To further assess which elements contribute to the growth of the antero-ventral cochlear nucleus after the onset of hearing, we analysed the somal size of the neurones. Before the onset of hearing, somal and volume growth were highly correlated. However, somata had reached an adult size by the onset of hearing. We conclude that the growth of the antero-ventral cochlear nucleus after the onset of hearing is due to changes in the neuropil