Les effets de la neuromodulation non invasive sur les acouphènes

Les acouphènes touchent une grande proportion de Canadiens. Cette condition est associée à de nombreuses comorbidités et affecte de manière significative la qualité de vie des patients qui en souffrent. Malheureusement, les mécanismes de génération et de persistance des acouphènes sont méconnus et il demeure de nombreux questionnements dans la communauté scientifique. Notamment, aucun traitement curatif n’est disponible pour l’instant. Ce mémoire fait état des différents types d’acouphènes qui peuvent se manifester ainsi que des diverses thérapies étudiées pour le traitement des acouphènes. Les grands modèles neurobiologiques prédominants dans la littérature sont aussi présentés. De plus, ce mémoire étudie la neuromodulation non invasive comme nouvelle avenue de traitement pour les acouphènes. Nous avons réalisé une méta-analyse et une étude de modélisation afin d’évaluer l’efficacité de ce traitement pour les acouphènes ainsi que les impacts sur les substrats neurobiologiques des acouphènes. Les résultats de cette étude montrent que la neuromodulation non invasive magnétique (SMTr) diminue de manière statistiquement significative les scores d’évaluation de l’acouphène, et que ces effets sont plus marqués chez les femmes. Les résultats montrent aussi que la neuromodulation du cortex auditif est l’approche qui diminue le plus les acouphènes et qu’elle génère un champ électrique plus fort dans l’insula en comparaison à d’autres régions d’intérêt. Finalement, ce mémoire discute des principales méthodes d’évaluation des acouphènes ainsi que de l’effet placébo présent lors du traitement des acouphènes. Des parallèles avec la douleur chronique sont établis, afin d’orienter la recherche sur de prochains traitements. Le futur de la neuromodulation non invasive pour le traitement des acouphènes est aussi discuté en marge de perspectives et de limites du travail.Tinnitus impacts a large proportion of Canadians. It is linked to various comorbidities that significantly affect the quality of life of those who suffer from it. Unfortunately, generation and maintenance mechanisms are still unclear and numerous questions remain in the scientific community. Notably, no cure is available for tinnitus as of now. This dissertation reports the different types of tinnitus that can occur, besides the diverse therapies that have been reviewed for the treatment of tinnitus. The main neurobiological models of tinnitus prevailing in the literature are also presented. Furthermore, this dissertation investigates noninvasive neuromodulation as a new approach to treat tinnitus. A meta-analysis and modeling study have evaluated the efficacy of this treatment for tinnitus along with its impact on neurobiological substrates of tinnitus. The results of the study show that repetitive transcranial magnetic stimulation (rTMS) decreases statistically significantly tinnitus scores and that those effects are more marked in women. The results also show that noninvasive neuromodulation of the auditory cortex is the approach that decreases tinnitus the most and that this approach generates a stronger electric field in the insula among other regions of interest. Finally, this dissertation discusses the main methods to rate tinnitus and the placebo effect measured during tinnitus treatment. We also draw parallels with chronic pain, to orient prospective research. The future of noninvasive neuromodulation is also discussed in terms of treatment for tinnitus alongside perspectives and limits of the work

Impacts and Identification of Hearing Aid Refurbishing Programs for People with Hearing Loss: A Scoping Review

This article consists of a scoping review completed to describe the impacts of refurbished hearing aids (HAs) for people with hearing loss, and to identify existing HA refurbishing programs around the world. In this review, JBI methodological guidance for scoping reviews was followed. All types of sources of evidence were considered. Thirty-six sources of evidence were included, 11 articles and 25 web pages. Results suggest that refurbished HAs may improve communication and social participation for individuals with hearing loss and provide monetary savings to them and to governmental agencies. Twenty-five HA refurbishing programs were identified, all based in developed countries and distributing refurbished HAs mostly locally, but also in developing countries. Issues related to refurbished HAs were highlighted, such as potential cross-contamination, quick obsolescence, and repairing problems. Some facilitators for the success of this intervention are to offer accessible and affordable follow-up services, repairs, and batteries, and to ensure awareness and participation of hearing healthcare professionals and citizens with hearing loss. In conclusion, the use of refurbished HAs appears to be a valuable option for low-income people with hearing loss, but it should be included in a more global intervention program to ensure its sustainability