63 research outputs found
Ototoxicity: Old and New Foes
Drug-induced ototoxicity has been known for centuries. Already in the seventeenth century, hearing loss was described to be a side effect of quinine. The post- World War II pharmaceutical industry boomed with the production of aminoglycoside antibiotics followed by diuretics and cytostatic drugs. Wide-spread and long-term usage of these medications brought the knowledge about their unwanted ototoxic effects. In the last decades, several new drugs appeared on the shelves of pharmacies and the hearing loss or tinnitus have been among the side effects of many of them. However, the awareness of community about new ototoxic medications is still not sufficient. New ototoxic drugs may belong to the class of phosphodiesterase-5 (PDE5) inhibitors, used to improve microcirculation and to treat erectile dysfunction. Moreover, interferons used for the therapy of hepatitis B and C, common painkiller paracetamol and hydrocodone, synthetic opioid methadone and the inhibitors of reverse transcriptase were demonstrated to induce adverse effects on hearing. Lastly, hearing loss linked to immunosuppressive drugs was documented in patients undergoing organ transplantation. Making the patients aware of adverse drug reactions and offering them audiological monitoring and intervention should be considered by respective therapists
Neurotological consequences of long COVID
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Stress and tinnitusâfrom bedside to bench and back
The aim of this review is to focus the attention of clinicians and basic researchers on the association between psycho-social stress and tinnitus. Although tinnitus is an auditory symptom, its onset and progression often associates with emotional strain. Recent epidemiological studies have provided evidence for a direct relationship between the emotional status of subjects and tinnitus. In addition, studies of function, morphology, and gene and protein expression in the auditory system of animals exposed to stress support the notion that the emotional status can influence the auditory system. The data provided by clinical and basic research with use of animal stress models offers valuable clues for an improvement in diagnosis and more effective treatment of tinnitus
Geldanamycin induces production of heat shock protein 70 and partially attenuates ototoxicity caused by gentamicin in the organ of Corti explants
<p>Abstract</p> <p>Background</p> <p>Heat shock protein 70 (HSP70) protects inner ear cells from damage and death induced by e.g. heat or toxins. Benzoquinone ansamycin antibiotic geldanamycin (GA) was demonstrated to induce the expression of HSP70 in various animal cell types. The aim of our study was to investigate whether GA induces HSP70 in the organ of Corti (OC), which contains the auditory sensory cells, and whether GA can protect these cells from toxicity caused by a common aminoglycoside antibiotic gentamicin.</p> <p>Methods</p> <p>To address these questions, we used the OC explants isolated from p3-p5 rats. As a read-out, we used RT-PCR, ELISA and immunofluorescence.</p> <p>Results</p> <p>We found that GA at the concentration of 2 ÎŒM efficiently induced HSP70 expression on mRNA and protein level in the OC explants. Confocal microscopy revealed that HSP70 induced by GA is expressed by hair cells and interdental cells of spiral limbus. Preincubation of explants with 2 ÎŒM GA prior to adding gentamicin (500 ÎŒM) significantly reduced the loss of outer but not inner hair cells, suggesting different mechanisms of otoprotection needed for these two cell types.</p> <p>Conclusion</p> <p>GA induced HSP70 in the auditory sensory cells and partially protected them from toxicity of gentamicin. Understanding the molecular mechanisms of GA otoprotection may provide insights for preventative therapy of the hearing loss caused by aminoglycoside antibiotics.</p
protocol for a systematic review
Introduction In Europe alone, over 70 million people experience tinnitus.
Despite its considerable socioeconomic relevance, progress in developing
successful treatments has been limited. Clinical effectiveness is judged
according to change in primary outcome measures, but because tinnitus is a
subjective condition, the definition of outcomes is challenging and it remains
unclear which distinct aspects of tinnitus (ie, âdomainsâ) are most relevant
for assessment. The development of a minimum outcome reporting standard would
go a long way towards addressing these problems. In 2006, a consensus meeting
recommended using 1 of 4 questionnaires for tinnitus severity as an outcome in
clinical trials, in part because of availability in different language
translations. Our initiative takes an approach motivated by clinimetrics,
first by determining what to measure before seeking to determine how to
measure it. Agreeing on the domains that contribute to tinnitus severity (ie,
âwhatâ) is the first step towards achieving a minimum outcome reporting
standard for tinnitus that has been reached via a methodologically rigorous
and transparent process. Methods and analysis Deciding what should be the core
set of outcomes requires a great deal of discussion and so lends itself well
to international effort. This protocol lays out the first-step methodology in
defining a Core Domain Set for clinical trials of tinnitus by establishing
existing knowledge and practice with respect to which outcome domains have
been measured and which instruments used in recent registered and published
clinical trials. Ethics and dissemination No ethical issues are foreseen.
Findings will be reported at national and international ear, nose and throat
(ENT) and audiology conferences and in a peer-reviewed journal, using PRISMA
(Preferred Reporting Items for Systematic reviews and Meta-analysis)
guidelines. Trial registration number The systematic review protocol is
registered on PROSPERO (International Prospective Register of Systematic
Reviews): CRD42015017525
Cochlear Implantation of Bilaterally Deafened Patients with Tinnitus Induces Sustained Decrease of Tinnitus-Related Distress
Objective: Tinnitus is a common symptom of hearing impairment. Patients who
are bilaterally hard of hearing are often affected by tinnitus. However, they
cannot undergo any of the standard tinnitus therapies, since they rely on
hearing. Cochlear implantation (CI) used to treat severe hearing disabilities,
such as bilateral hearing loss, was also shown to reduce tinnitus. Our goal
was to determine if CI induces sustained reduction of tinnitus. We performed
prospective, longitudinal analyses of tinnitus-related distress in a uniform
group of bilaterally deafened patients after CI. Patients and Methods: The
homogenous sample consisted of 41 patients who met the inclusion criteria and
were consecutively included in this study. The impact of unilateral CI on
tinnitus-related distress, health-related quality of life (HRQoL), and hearing
abilities was studied with validated instruments. The follow-up appointments
were scheduled at 6, 12, and 24 months after CI surgery. During the
appointments, hearing abilities were estimated with monosyllabic Freiburg
test, whereas the tinnitus-related distress, the HRQoL, and the subjective
hearing were measured with standard questionnaires [Tinnitus Questionnaire
(TQ), Nijmegen Cochlear Implantation Questionnaire, and Oldenburg Inventory,
respectively]. Results: Tinnitus-related distress decreased significantly from
the mean TQ score of 35.0 (SD = 19.6) prior to surgery to the mean TQ = 27.54
(SD = 20.0) 6 months after surgery and remained sustained low until the end of
follow-up period. In addition, CI significantly improved the hearing abilities
and the HRQoL of all patients. Conclusion: The results from our prospective
study suggest that in a homogenous sample of bilaterally deafened, implanted
patients who report having tinnitus prior to surgery, CI alone not only
improves the hearing abilities but also significantly reduces the tinnitus-
related distress and improves the HRQoL in a sustained way
Comorbid symptoms occurring during acute low-tone hearing loss (AHLH) as potential predictors of Meniere's disease
Acute low-tone sensorineural hearing loss (ALHL) is a type of idiopathic sudden sensorineural hearing loss. ALHL is rarely a solitary condition but rather co-occurs with vertigo and tinnitus, being an element of contemporary diagnostic criteria for Meniere's disease (MD). The goal of our present study was to determine the value of ALHL for the early diagnosis of MD in patients presenting in the emergency room with AWL as a main complaint. The files of 106 patients with ALHL who were admitted to the emergency room over the period of 7 years and 104 patients with acute high- tone sensorineural hearing loss (AHHL) from the same period were included in this retrospective study. Forty ALHL patients presented with recurrent episode of hearing loss and 66 remaining patients presented with ALHL for the first time. Of the latter group, 25 patients gave consent for the follow-up. First, we analyzed the difference in the occurrence of tinnitus and vertigo between the ALHL and AHHL groups. In patients with ALHL, the incidence of vertigo with tinnitus and the number of recurrent episodes were statistically higher than in patients with AHHL. Next, we focused on the ALHL follow-up group (25 patients). In that group, two patients had all MD symptoms at presentation, 18 had ALHL and tinnitus and five ALHL only. Of 18 patients with ALHL and tinnitus at admission, five developed vertigo and thus the triad of Meniere's disease. None of the five patients with AHLH as a sole symptom developed MD during the follow-up time but four of them have developed tinnitus. Patients with recurrent ALHL had significantly higher incidence of MD than the patients with first episode. We conclude that some patients who present with ALHL and concomitant tinnitus or have recurrent episodes of ALHL are more likely to develop Meniere's disease than these patients, who present with ALHL as a sole symptom. Nonetheless, we recommend otological follow-up for all patients presenting with ALHL
Impact of Multiple Factors on the Degree of Tinnitus Distress
Objective: The primary cause of subjective tinnitus is a dysfunction of the
auditory system; however, the degree of distress tinnitus causes depends
largely on the psychological status of the patient. Our goal was to attempt to
associate the grade of tinnitus-related distress with the psychological
distress, physical, or psychological discomfort patients experienced, as well
as potentially relevant social parameters, through a simultaneous analysis of
these factors. Methods: We determined the level of tinnitus-related distress
in 531 tinnitus patients using the German version of the tinnitus
questionnaire (TQ). In addition, we used the Perceived Stress Questionnaire
(PSQ); General Depression Scale Allgemeine Depression Skala (ADS), Berlin Mood
Questionnaire (BSF); somatic symptoms inventory (BI), and SF-8 health survey
as well as general information collected through a medical history. Results:
The TQ score significantly correlated with a score obtained using PSQ, ADS,
BSF, BI, and SF-8 alongside psychosocial factors such as age, gender, and
marital status. The level of hearing loss and the auditory properties of the
specific tinnitus combined with perceived stress and the degree of depressive
mood and somatic discomfort of a patient were identified as medium-strong
predictors of chronic tinnitus. Social factors such as gender, age, or marital
status also had an impact on the degree of tinnitus distress. The results that
were obtained were implemented in a specific cortical distress network model.
Conclusions: Using a large representative sample of patients with chronic
tinnitus permitted a simultaneous statistical measurement of psychometric and
audiological parameters in predicting tinnitus distress. We demonstrate that
single factors can be distinguished in a manner that explains their causative
association and influence on the induction of tinnitus-related distress
In Patients Undergoing Cochlear Implantation, Psychological Burden Affects Tinnitus and the Overall Outcome of Auditory Rehabilitation
Cochlear implantation (CI) is increasingly being used in the auditory
rehabilitation of deaf patients. Here, we investigated whether the auditory
rehabilitation can be influenced by the psychological burden caused by mental
conditions. Our sample included 47 patients who underwent implantation. All
patients were monitored before and 6 months after CI. Auditory performance was
assessed using the Oldenburg Inventory (OI) and Freiburg monosyllable (FB MS)
speech discrimination test. The health-related quality of life was measured
with Nijmegen Cochlear implantation Questionnaire (NCIQ) whereas tinnitus-
related distress was measured with the German version of Tinnitus
Questionnaire (TQ). We additionally assessed the general perceived quality of
life, the perceived stress, coping abilities, anxiety levels and the
depressive symptoms. Finally, a structured interview to detect mental
conditions (CIDI) was performed before and after surgery. We found that CI led
to an overall improvement in auditory performance as well as the anxiety and
depression, quality of life, tinnitus distress and coping strategies. CIDI
revealed that 81% of patients in our sample had affective, anxiety, and/or
somatoform disorders before or after CI. The affective disorders included
dysthymia and depression, while anxiety disorders included agoraphobias and
unspecified phobias. We also diagnosed cases of somatoform pain disorders and
unrecognizable figure somatoform disorders. We found a positive correlation
between the auditory performance and the decrease of anxiety and depression,
tinnitus-related distress and perceived stress. There was no association
between the presence of a mental condition itself and the outcome of auditory
rehabilitation. We conclude that the CI candidates exhibit high rates of
psychological disorders, and there is a particularly strong association
between somatoform disorders and tinnitus. The presence of mental disorders
remained unaffected by CI but the degree of psychological burden decreased
significantly post-CI. The implants benefitted patients in a number of
psychosocial areas, improving the symptoms of depression and anxiety,
tinnitus, and their quality of life and coping strategies. The prevalence of
mental disorders in patients who are candidates for CI suggests the need for a
comprehensive psychological and psychosomatic management of their treatment
Biomarkers of Presbycusis and Tinnitus in a Portuguese Older Population
Introduction: Presbycusis or age-related hearing loss (ARHL) is a ubiquitous
health problem. It is estimated that it will affect up to 1.5 billion people
by 2025. In addition, tinnitus occurs in a large majority of cases with
presbycusis. Glutamate metabotropic receptor 7 (GRM7) and N-acetyltransferase
2 (NAT2) are some of the genetic markers for presbycusis. Objectives: To
explore patterns of hearing loss and the role of GRM7 and NAT2 as possible
markers of presbycusis and tinnitus in a Portuguese population sample.
Materials and Methods: Tonal and speech audiometry, tinnitus assessment,
clinical interview, and DNA samples were obtained from patients aged from 55
to 75 with or without tinnitus. GRM7 analysis was performed by qPCR.
Genotyping of single nucleotide polymorphisms (SNPs) in NAT2 was performed by
PCR amplification followed by Sanger sequencing or by qPCR. Results: We
screened samples from 78 individuals (33 men and 45 women). T allele at GRM7
gene was the most observed (60.3% T/T and 33.3% A/T). Individuals with a T/T
genotype have a higher risk for ARHL and 33% lower risk for tinnitus, compared
to individuals with A/A and A/T genotype, respectively. Being a slow
acetylator (53%) was the most common NAT2 phenotype, more common in men
(55.8%). Intermediate acetylator was the second most common phenotype (35.9%)
also more frequent in men (82.6%). Noise exposed individuals and individuals
with âhigh frequencyâ hearing loss seem to have a higher risk for tinnitus.
Our data suggests that allele AT of GRM7 can have a statistically significant
influence toward the severity of tinnitus. Conclusion: For each increasing
year of age the chance of HL increases by 9%. The risk for ARHL was not
significantly associated with GRM7 neither NAT2. However, we cannot conclude
from our data whether the presence of T allele at GRM7 increases the odds for
ARHL or whether the A allele has a protective effect. Genotype A/T at GRM7
could potentially be considered a biomarker of tinnitus severity. This is the
first study evaluating the effect of GRM7 and NAT2 gene in tinnitus
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