Neurofeedback for tinnitus treatment: an innovative method with promising potential

This scientific commentary refers to 'Does it matter what is trained? A randomized controlled trial evaluating the specificity of alpha/delta ratio neurofeedback in reducing tinnitus symptoms 'by Jensen et al. (https://doi.org/10.1093/braincomms/fcad185)

Deep resequencing of the voltage-gated potassium channel subunit KCNE3 gene in chronic tinnitus

Membrane-stabilizing drugs have long been used for the treatment of chronic tinnitus, suggesting an underlying disturbance of sensory excitability due to changes in ion conductance. The present study addresses the potassium channel subunit gene KCNE3 as a potential candidate for tinnitus susceptibility. 288 Caucasian outpatients with a diagnosis of chronic tinnitus were systematically screened for mutations in the KCNE3 open reading frame and in the adjacent region by direct sequencing. Allele frequencies were determined for 11 known variants of which two (F66F and R83H) were polymorphic but were not associated with the disorder. No novel variants were identified and only three carriers of R83H were noted. However, owing to a lack of power, our study can neither rule out effects of KCNE3 on the risk for developing chronic tinnitus, nor can it exclude a role in predicting the severity of tinnitus. More extensive investigations are invited, including tests for possible effects of variation in this ion channel protein on the response to treatment

Curing tinnitus with a Cochlear Implant in a patient with unilateral sudden deafness: a case report

Cochlear implantation is a routine procedure for patients with bilateral profound sensorineural hearing loss. Some reports demonstrated a suppression of tinnitus as a side-effect after implantation. We describe the case of a 55-year-old man suffering from severe right-sided tinnitus in consequence of sudden right-sided deafness. Multiple therapeutic efforts including intravenous steroids and tympanoscopy with grafting of the round window remained unsuccessful. One year after onset of symptoms right-sided cochlear implantation was performed, which resulted in a complete abolishment of tinnitus after activating the implant. Severe unilateral tinnitus after sudden deafness might represent a new indication for cochlear implantation

Tinnitus and Coxsackie B infections: A case series

Tinnitus is a frequent and often debilitating condition. There is consensus in the scientific community that there exist various forms of tinnitus, which differ in their pathogenesis. Here we report a series of five cases where the onset of tinnitus was associated with viral infections. In all five patients elevated antibodies against Coxsackie B have been detected. This observation suggests that Coxsackie B Virus infections might be involved in the development of some cases of tinnitus and indicate that further systematic investigations are warranted.Fil: Langguth, Berthold. Universitat Regensburg; AlemaniaFil: Stadtlaender, Hans. An der Zuckerfabrik 2; AlemaniaFil: Landgrebe, Michael. Universitat Regensburg; AlemaniaFil: Elgoyhen, Ana Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; ArgentinaFil: Coors, Hermann. Gaußstr 10; AlemaniaFil: Vielsmeier, Veronika. Universitat Regensburg; AlemaniaFil: Kleinjung, Tobias. Universitat Regensburg; Alemani

Accounting for Heterogeneity: Mixed-Effects Models in Resting-State EEG Data in a Sample of Tinnitus Sufferers

In neuroscience, neural oscillations and other features of brain activity recorded by electroencephalography (EEG) are typically statistically assessed on the basis of the study's population mean to identify possible blueprints for healthy subjects, or subjects with diagnosable neurological or psychiatric disorders. Despite some inter-individual similarities, there is reason to believe that a discernible portion of the individual brain activity is subject-specific. In order to encompass the potential individual source of variance in EEG data and psychometric parameters, we introduce an innovative application of linear mixed-effects models (LMM) as an alternative procedure for the analysis of resting-state EEG data. Using LMM, individual differences can be modelled through the assumptions of idiosyncrasy of all responses and dependency among data points (e.g., from the same subject within and across units of time) via random effects parameters. This report provides an example of how LMM can be used for the statistical analysis of resting-state EEG data in a heterogeneous group of subjects; namely, people who suffer from tinnitus (ringing in the ear/s). Results from 49 participants (38 male, mean age of 46.69 ± 12.65 years) revealed that EEG signals were not only associated with specific recording sites, but exhibited regional specific oscillations in conjunction to symptom severity. Tinnitus distress targeted the frequency bands beta3 (23.5-35 Hz) and gamma (35.5-45 Hz) in right frontal regions, whereas delta (0.5-4 Hz) exhibited significant changes in temporal-parietal sources. Further, 57.8% of the total variance in EEG power was subject-specific and acknowledged by the LMM framework and its prediction. Thus, a deeper understanding of both the underlying statistical and physiological patterns of EEG data was gained

Recovering Hidden Responder Groups in Individuals Receiving Neurofeedback for Tinnitus

The widespread understanding that chronic tinnitus is a heterogeneous phenomenon with various neural oscillatory profiles has spurred investigations into individualized approaches in its treatment. Neurofeedback, as a non-invasive tool for altering neural activity, has become increasingly popular in the personalized treatment of a wide range of neuropsychological disorders. Despite the success of neurofeedback on the group level, the variability in the treatment efficacy on the individual level is high, and evidence from recent studies shows that only a small number of people can effectively modulate the desired aspects of neural activity. To reveal who may be more suitable, and hence benefit most from neurofeedback treatment, we classified individuals into unobserved subgroups with similar oscillatory trajectories during the treatment and investigated how subgroup membership was predicted by a series of characteristics. Growth mixture modeling was used to identify distinct latent subgroups with similar oscillatory trajectories among 50 individuals suffering from chronic subjective tinnitus (38 male, 12 female, mean age = 47.1 ± 12.84) across 15 neurofeedback training sessions. Further, the impact of characteristics and how they predicted the affiliation in the identified subgroups was evaluated by including measures of demographics, tinnitus-specific (Tinnitus Handicap Inventory) and depression variables, as well as subjective quality of life subscales (World Health Organization—Quality of Life Questionnaire), and health-related quality of life subscales (Short Form-36) in a logistic regression analysis. A latent class model could be fitted to the longitudinal data with a high probability of correctly classifying distinct oscillatory patterns into 3 different groups: non-responder (80%), responder (16%), and decliner (4%). Further, our results show that the health-related wellbeing subscale of the Short Form-36 questionnaire was differentially associated with the groups. However, due to the small sample size in the Responder group, we are not able to provide sufficient evidence for a distinct responder profile. Nevertheless, the identification of oscillatory change-rate differences across distinct groups of individuals provides the groundwork from which to tease apart the complex and heterogeneous oscillatory processes underlying tinnitus and the attempts to modify these through neurofeedback. While more research is needed, our results and the analytical approach presented may bring clarity to contradictory past findings in the field of tinnitus research, and eventually influence clinical practice

Möglichkeiten der funktionellen Bildgebung bei Tinnitus

Hintergrund Die Pathophysiologie des Tinnitus ist nach wie vor nicht ausreichend verstanden. Verschiedene Bildgebungsmethoden helfen beim besseren Verständnis der komplexen Zusammenhänge, die zur Wahrnehmung von Tinnitus führen. Ziel der Arbeit Es erfolgt die Vorstellung von verschiedenen funktionellen Bildgebungsmethoden, die in der Erforschung von Tinnitus eingesetzt werden können. Material und Methoden Unter Einbezug der aktuellen Fachliteratur zum Thema gehen die Autoren auf die relevanten Bildgebungsmethoden der Tinnitusforschung ein. Ergebnisse und Schlussfolgerung Die funktionelle Bildgebung kann Korrelate von Tinnitus aufzeigen. Aufgrund der noch eingeschränkten zeitlichen und räumlichen Auflösung der aktuellen Bildgebungsmodalitäten lässt eine abschließende Erklärung von Tinnitus auf sich warten. Mit der weiteren Verbreitung der funktionellen Bildgebung lassen sich in Zukunft zusätzliche wichtige Erkenntnisse zur Aufklärung von Tinnitus gewinnen

Tinnitus Guidelines and Their Evidence Base

Evidence-based medicine (EBM) is generally accepted as the gold standard for high-quality medicine and, thus, for managing patients with tinnitus. EBM integrates the best available scientific information with clinical experience and patient values to guide decision-making about clinical management. To help health care providers and clinicians, the available evidence is commonly translated into medical or clinical guidelines based on a consensus. These involve a systematic review of the literature and meta-analytic aggregation of research findings followed by the formulation of clinical recommendations. However, this approach also has limitations, which include a lack of consideration of individual patient characteristics, the susceptibility of guideline recommendations to material and immaterial conflicts of interest of guideline authors and long latencies till new knowledge is implemented in guidelines. A further important aspect in interpreting the existing literature is that the absence of evidence is not evidence of absence. These circumstances could result in the decoupling of recommendations and their supporting evidence, which becomes evident when guidelines from different countries differ in their recommendations. This opinion paper will discuss how these weaknesses can be addressed in tinnitus

Speech-in-Noise Performance and Executive Functioning in Individuals with Chronic Subjective Tinnitus

Background: Many individuals with chronic subjective tinnitus report significant problems in comprehending speech in adverse listening situations. A large body of studies has provided evidence to support the notion that deficits in speech-in-noise (SIN) are prevalent in the tinnitus population, while some studies have challenged these results. Notably, elemental auditory perception is usually only minimally or not impaired. In addition, deficits in cognitive functions, particularly executive functions, have also been observed in individuals with tinnitus.Methods: In order to investigate differences in SIN performance and executive functioning, 25 participants with tinnitus and 25 control participants, between 23 and 58 years of age, were examined. A large audiometric battery was used, including tests of peripheral and central hearing, ranging from threhold and supra-threshold tasks to complex speech tasks. Additionally, four cognitive tests were performed, primarily covering the area of executive functions. Tinnitometry and tinnitus-related questionnaires were assessed to complement sample description and allow for secondary analyses. The groups were case-matched for age, sex, education, and hearing loss. We hypothesized, that tinnitus participants score lower in SIN and executive function tasks compared to healthy controls, while no group differences in elementary audio tasks were expected.Results: Hypothesized considerable differences in speech perception under adverse listening conditions were found in the SIN task and also in the gated speech task, while there were no differences in the basic speech recognition threshold task. Other elementary auditory perception tasks did not differ between the two groups. The cognitive tests revealed clear deficits in interference susceptibility in the Stroop task, but not in the Flanker task. There were no differences in inhibition or working memory tasks.Conclusion: Our results clearly delineate differences between the tinnitus and the control group in two tests of speech intelligibility under complex listening conditions. Further, the poorer performance in a task of interference control in individuals with tinnitus points towards a reduced central executive control in tinnitus. Taken together, these novel corroborating evidence supports the view of a deficient central inhibiton system in healthy individuals with tinnitus. Hence, we present important contributions to the ongoing debate about the effects of tinnitus on comprehension in adverse listening situations

The correlation between tinnitus-specific and quality of life questionnaires to assess the impact on the quality of life in tinnitus patients

IntroductionSubjective tinnitus is often associated with a reduction in health-related quality of life (HRQoL). The HRQoL represents the impact of tinnitus on an individual's life by addressing the physical, social, and psychological domains of 1. A limited amount of studies has investigated the association between tinnitus and HRQoL questionnaires. The aim of this study was to examine the correlation between tinnitus-specific and HRQoL questionnaires in order to shorten fulfilling questionnaires, as it is often time-consuming.Material and methodEighty-five patients with tinnitus as primary complaint completed five questionnaires, including one general, two tinnitus-specific, and two generic HRQoL questionnaires: Tinnitus Sample Case History Questionnaire (TSCHQ), Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), short version of World Health Organization Quality of Life (WHOQOL-BREF), and the eight-item Short-Form (SF-8). Four simple linear regression models were used to analyze the relationship between the THI and TFI and the WHOQOL-BREF and SF-8.ResultsA negative and strong correlation was found between the tinnitus questionnaires and the SF-8. More than half of the variability in the SF-8 scores could be explained by the TFI and THI, respectively 50.6 and 54.4% (all p < 0.001). A strong negative regression was also found between the WHOQOL-BREF and the THI and TFI with a decrease in the determination coefficient of approximately 10% compared with the SF-8. The weakest correlation (regression coefficient of 0.628, p < 0.001) was observed between the WHOQOL-BREF and the TFI, indicating that the WHOQOL-BREF mean score explained 39.4% of the TFI. When looking at the subdomain scores, a strong correlation was observed between the QoL subdomain of the TFI and a combination of the physical and psychological subdomain of the WHOQOL-BREF (r = −0.627, p < 0.001).ConclusionThe QoL subdomain of the TFI gives good information about the physical and psychological health. Thus, the TFI is suitable to assess both tinnitus severity and the HRQoL. The coefficients of determination of the WHOQOL-BREF were significantly lower compared to the SF-8, suggesting that the WHOQOL-BREF provides more specific information about HRQoL. If more specific information on HRQoL, such as “environment” and “social relationships”, is required, it is recommended to use the WHOQOL-BREF