Beyond silence: evolving ultrasound strategies in the battle against cardiovascular thrombotic challenges.

Cardiovascular thrombotic events have long been a perplexing factor in clinical settings, influencing patient prognoses significantly. Ultrasound-mediated acoustic therapy, an innovative thrombolytic treatment method known for its high efficiency, non-invasiveness, safety, and convenience, has demonstrated promising potential for clinical applications and has gradually become a focal point in cardiovascular thrombotic disease research. The current challenge lies in the technical complexities of preparing ultrasound-responsive carriers with thrombus-targeting capabilities and high thrombolytic efficiency. Additionally, optimizing the corresponding acoustic treatment mode is crucial to markedly enhance the thrombolytic effectiveness of ultrasound-mediated acoustic therapy. In light of the current status, this article provides a comprehensive review of the research progress in innovative ultrasound-mediated acoustic therapy for cardiovascular thrombotic diseases. It explores the impact of technical methods, therapeutic mechanisms, and influencing factors on the thrombolytic efficiency and clinical potential of ultrasound-mediated acoustic therapy. The review places particular emphasis on identifying solutions and key considerations in addressing the challenges associated with this cutting-edge therapeutic approach.

The influence of tinnitus frequency on patients experiencing subjective tinnitus and the efficacy and prognosis of acoustic therapy.

OBJECTIVE: This study examines the therapeutic impact and prognosis of acoustic therapy in patients with chronic subjective tinnitus across different tinnitus frequencies. METHODS: A total of 135 patients with subjective tinnitus were selected and categorized based on their primary tone frequency into three groups: high frequency (43 patients, 4-8 kHz), mid frequency (40 patients, 1-3 kHz), and low frequency (42 patients, < 1 kHz). All patients received acoustic therapy customized to their specific frequency and loudness levels, along with tinnitus cognitive behavioral therapy. Changes in tinnitus loudness and efficacy rates before and after treatment in the different groups, as well as before and after tinnitus cognitive behavioral therapy were evaluated and assessed. RESULTS: The low frequency group showed a statistical improvement in tinnitus loudness compared to the mid and high frequency groups (P < 0.05). The efficacy rate was 93.55 % in the low frequency group, 82.88 % in the mid frequency group, and 58.82 % in the high frequency group. The efficacy rate in the low frequency group was significantly higher than in the high frequency group, but there was no statistical difference when compared to the mid frequency group. CONCLUSION: The frequency of tinnitus in patients with chronic subjective tinnitus might be a key factor affecting treatment effectiveness and could account for the differences in treatment outcomes among patients.

Binaural sound therapy for tinnitus treatment: A psychometric and neurophysiological evaluation.

INTRODUCTION: Tinnitus is an annoying buzz that manifests itself in many ways. In addition, it can provoke anxiety, stress, depression, and fatigue. The acoustic therapies have become the most commonly applied treatment for tinnitus, either self-administered or clinically prescribed. Binaural Sound Therapy (BST) and Music Therapy (MT) aim to reverse the neuroplasticity phenomenon related to tinnitus by adequately stimulating the auditory path-way. The goal of this research is to evaluate the feasibility of applying BST for tinnitus treatment by comparing its effect with MT effect. MATERIALS AND METHODS: 34 patients with tinnitus from 29 to 60 years were informed about the experimental procedure and consented their participation. Patients were divided into two groups: 1) MT and 2) BST. They applied their sound-based treatment for one hour every day along eight weeks. Each treatment was adjusted to Hearing Loss (HL) and tinnitus characteristics of each participant. To record EEG data, a bio-signal amplifier with sixteen EEG channels was used. The system recorded data at a sampling frequency of 256 Hz within a bandwidth between 0.1 and 100 Hz. RESULTS: The questionnaire-monitoring reported that MT increased tinnitus perception in 30% of the patients, and increased anxiety and stress in 8% of them. Regarding EEG-monitoring, major neural synchronicity over the frontal lobe was found after the treatment. In the case of BST reduced stress in 23% of patients. Additionally, BST reduced tinnitus perception similar to MT (15% of patients). With respect to EEG-monitoring, slightly major neural synchronicity over the right frontal lobe was found after the treatment. CONCLUSIONS: MT should be applied with caution since it could be worsening the tinnitus sufferer condition. On the other hand, BST is recommended for tinnitus sufferers who have side effects concerning stress but no anxiety.

Efficacy of tinnitus retraining therapy in the treatment of tinnitus: A meta-analysis and systematic review.

PURPOSE: To evaluate the efficacy of Tinnitus Retraining Therapy (TRT) in the treatment of tinnitus. MATERIALS AND METHOD: Computer retrieval of PubMed, Embase, The Cochrane Library, Web of Science, China National Knowledge Internet (CNKI), Wanfang data, etc., were conducted. According to the inclusion and exclusion criteria, the literature's quality was evaluated, and useful data was extracted. All statistical analyses were performed by RevMan5.3 software. RESULTS: 13 eligible RCTs with a total of 1345 patients were included in this meta-analysis. The meta-analysis results showed that the 1-month response rate, 3-month response rate, 6-month response rate, and overall response rate of TRT with drugs for tinnitus were higher than that of drugs only (P < 0.05). The results demonstrated that the THI scale after the treatment period of TRT with medications for tinnitus was lower than that of drugs only (P < 0.05). CONCLUSIONS: Analysis of limited studies low-quality evidence with a high risk of bias showed that the TRT was an effective treatment for tinnitus, which could improve the response rate of tinnitus and reduce the THI scale. However, more multicenter RCTs with a large sample number and high quality should verify the conclusion mentioned above.

Electroencephalographic evaluation of acoustic therapies for the treatment of chronic and refractory tinnitus.

BACKGROUND: To date, a large number of acoustic therapies have been applied to treat tinnitus. The effect that produces those auditory stimuli is, however, not well understood yet. Furthermore, the conventional clinical protocol is based on a trial-error procedure, and there is not a formal and adequate treatment follow-up. At present, the only way to evaluate acoustic therapies is by means of subjective methods such as analog visual scale and ad-hoc questionnaires. METHODS: This protocol seeks to establish an objective methodology to treat tinnitus with acoustic therapies based on electroencephalographic (EEG) activity evaluation. On the hypothesis that acoustic therapies should produce perceptual and cognitive changes at a cortical level, it is proposed to examine neural electrical activity of patients suffering from refractory and chronic tinnitus in four different stages: at the beginning of the experiment, at one week of treatment, at five weeks of treatment, and at eight weeks of treatment. Four of the most efficient acoustic therapies found at the moment are considered: retraining, auditory discrimination, enriched acoustic environment, and binaural. DISCUSSION: EEG has become a standard brain imaging tool to quantify and qualify neural oscillations, which are basically spatial, temporal, and spectral patterns associated with particular perceptual, cognitive, motor and emotional processes. Neural oscillations have been traditionally studied on the basis of event-related experiments, where time-locked and phase-locked responses (i.e., event-related potentials) along with time-locked but not necessary phase-locked responses (i.e., event-related (de) synchronization) have been essentially estimated. Both potentials and levels of synchronization related to auditory stimuli are herein proposed to assess the effect of acoustic therapies. TRIAL REGISTRATION: Registration Number: ISRCTN14553550. ISRCTN Registry: BioMed Central. Date of Registration: October 31st, 2017.

The clinical effects of modified tinnitus relieving sound (MTRS) for chronic tinnitus: protocol for a randomized controlled trial.

INTRODUCTION: Chronic subjective tinnitus has become an increasingly serious hazard that affects the health-related quality of life for millions of people. Due to the lack of curative treatment strategies, this study aims to introduce a novel acoustic therapy named the modified tinnitus relieving sound (MTRS) for tinnitus and to evaluate the efficacy of MTRS in comparison with unmodified music (UM) which served as a control. METHODS AND ANALYSIS: A randomized, double-blinded, controlled, clinical trial will be carried out. Sixty-eight patients with subjective tinnitus will be recruited and randomly allocated into two groups in 1:1 ratio. The primary outcome is Tinnitus Handicapped Inventory (THI); the secondary outcomes are the Hospital Anxiety and Distress Scale (HADS; HADS subscales for Anxiety (HADS-A) and Depression (HADS-D)), Athens Insomnia Scale (AIS), the visual analog scale (VAS) for tinnitus, and tinnitus loudness matched by sensation level (SL). Assessment will be performed at baseline and at 1, 3, 9, and 12 months post-randomization. The sound stimulus will be persistent until 9 months after randomization, and be interdictory in the last three months. Data collected during the intervention process will be analyzed and compared to baseline. ETHICS AND DISSEMINATION: This trial received ethical approval from the Institutional Review Board (IRB) of Eye & ENT Hospital of Fudan University (No. 2017048). The study results will be disseminated via academic journals and conferences. FUNDING: This study is supported by the Shanghai Shenkang Development Program (SHDC12019119), the Excellent Doctors-Excellent Clinical Researchers Program (SYB202008), the Shanghai Rising-Star Program (23QC1401200), the Shanghai Rising Stars of Medical Talent Youth Development Program (2021-99), the National Natural Science Foundation of China (81800912), and the National Natural Science Foundation of Shanghai (21ZR1411800). TRIAL REGISTRATION: ClinicalTrials.gov NCT04026932. Registered on 18 July 2019.

Comparative analysis of acoustic therapies for tinnitus treatment based on auditory event-related potentials.

Introduction: So far, Auditory Event-Related Potential (AERP) features have been used to characterize neural activity of patients with tinnitus. However, these EEG patterns could be used to evaluate tinnitus evolution as well. The aim of the present study is to propose a methodology based on AERPs to evaluate the effectiveness of four acoustic therapies for tinnitus treatment. Methods: The acoustic therapies were: (1) Tinnitus Retraining Therapy (TRT), (2) Auditory Discrimination Therapy (ADT), (3) Therapy for Enriched Acoustic Environment (TEAE), and (4) Binaural Beats Therapy (BBT). In addition, relaxing music was included as a placebo for both: tinnitus sufferers and healthy individuals. To meet this aim, 103 participants were recruited, 53% were females and 47% were males. All the participants were treated for 8 weeks with one of these five sounds, which were moreover tuned in accordance with the acoustic features of their tinnitus (if applied) and hearing loss. They were electroencephalographically monitored before and after their acoustic therapy, and wherefrom AERPs were estimated. The sound effect of acoustic therapies was evaluated by examining the area under the curve of those AERPs. Two parameters were obtained: (1) amplitude and (2) topographical distribution. Results: The findings of the investigation showed that after an 8-week treatment, TRT and ADT, respectively achieved significant neurophysiological changes over somatosensory and occipital regions. On one hand, TRT increased the tinnitus perception. On the other hand, ADT redirected the tinnitus attention, what in turn diminished the tinnitus perception. Tinnitus handicapped inventory outcomes verified these neurophysiological findings, revealing that 31% of patients in each group reported that TRT increased tinnitus perception, but ADT diminished it. Discussion: Tinnitus has been identified as a multifactorial condition highly associated with hearing loss, age, sex, marital status, education, and even, employment. However, no conclusive evidence has been found yet. In this study, a significant (but low) correlation was found between tinnitus intensity and right ear hearing loss, left ear hearing loss, heart rate, area under the curve of AERPs, and acoustic therapy. This study raises the possibility to assign acoustic therapies by neurophysiological response of patient.

Cortical Activation Patterns of Different Masking Noises and Correlation With Their Masking Efficacy, Determined by Functional Near-Infrared Spectroscopy.

Acoustic therapy in tinnitus treatment is poorly characterized, and efficacy assessment depends on subjective descriptions. Narrow-band noise, notched sound, and white noise have positive therapeutic effects on monotonous tinnitus. Considering the tonotopic characteristics of the auditory system and the spectral characteristics of these three masking sounds, the activation pattern of the auditory cortex and the mechanism of inhibiting tinnitus may be different. This study aimed to compare the activation patterns of three spectrally different masking noises and study the correlation between the masking effects and variational amplitude of oxygenated hemoglobin (HbO) in the corresponding cortical regions. We also assessed near-infrared spectroscopy brain function imaging (NIRS) as an objective assessment tool in acoustic therapy. Patients with persistent non-pulsatile tinnitus and control volunteers without tinnitus were enrolled in this study. The subjects were seated in a sound-proof room, with two optode arrays covering the bilateral temporal lobe. Auditory stimuli were presented; stimulation sequences followed the block design: different noises appeared randomly and repeated in five cycles. Tinnitus match and residual inhibition were performed in the tinnitus group. The data analyses were conducted using the NIRS_SPM toolbox. The group analysis results showed that the narrow-band noise caused a marginally significant decrease in HbO signal in the Brodmann 21 region (BA21), while white noise caused a significant increase in HbO signal in BA21. Notched sound did not cause significant changes in the HbO signal in the temporal cortex. And none of the three masking noises caused significant changes in the HbR signal in the temporal cortex. The depth of residual inhibition induced by the narrow-band noise and white noise significantly correlated with ΔHbO in the region of interest (ROI). However, neither the depth nor duration of the residual inhibition induced by notched sound correlated with the ΔHbO. Thus, NIRS showed three cortical activation patterns induced by three different masking noises, and correlations between residual inhibition effects and change of HbO amplitude were found. NIRS could therefore be applied in objective assessment of acoustic therapy.

An Overview of Acoustic-Based Interventions to Improve Motor Symptoms in Parkinson's Disease.

Parkinson's disease (PD) is characterized by motor and cognitive deficits that negatively impact on activities of daily living. While dopaminergic medications are used to attenuate motor symptoms, adjuvant therapies such as acoustic-based non-pharmacological interventions are used as a complement to standard drug treatments. At present, preliminary studies of acoustic-based interventions such as rhythmic-auditory stimulation (RAS) and vibroacoustic therapy (VAT) suggest two competing hypotheses: (1) RAS may recruit alternative motor networks that may bypass faulty spatiotemporal motor networks of movement in PD; or (2) the use of RAS enhances BG function through entrainment of beta oscillatory activities. In this mini review article, we discuss the mechanisms underlying the role of acoustic-based interventions and how it may serve to improve motor deficits such as gait impairments and tremors. We further provide suggestions for future work that may use a combination of RAS, VAT, and physical therapy to improve motor function in PD.

In-ear medical devices for acoustic therapies in tinnitus treatments, state of the art.

Cochrane reviews indicate there is very limited support for all forms of sound therapy and cognitive behavioral therapy has the strongest support. American Academy of Otolaryngology (AAO) recently published some guidelines which recommends Cognitive Behavioral Therapy (CBT) for tinnitus intervention, and only indicates that sound therapy should be considered an "option" for intervention. Nevertheless, acoustic therapy could lead to cause changes in the tinnitus perception and has been appreciated by the affected people for years. In the last decades, the use of sound or sound enrichment has become a central part of many tinnitus management programs used by audiologists, whether the intention was to mask tinnitus, suppress tinnitus, or interrupt the tinnitus generating neural activity. Several acoustic therapies have been developed and implemented in the last 40 years, but how can we determine which one is the most effective? We can determine the effects based on the results reported in many research studies, but in those studies are many factors that differ from one study to another, like in-ear medical devices used to apply acoustic therapy for tinnitus treatment. In this article, we review and analyze the different types of in-ear medical devices used in the most recently acoustic therapies in treatments against tinnitus, allowing us to identify the pros and cons. By our analysis, an optimal medical device could be characterized to enhance the application of acoustic therapies and in consequence the global results of the sound therapies that already exist. In this review, it was considered acoustic therapies, the technology implemented in medical devices and the clinical needs.