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1.
Rev Prat ; 73(7): 724-726, 2023 Sep.
Artigo em Francês | MEDLINE | ID: mdl-37796256

RESUMO

NOISE POLLUTION: WHAT ARE THE HEALTH IMPACTS? Noise pollution resulting from human activities is more and more present and important. It can have deleterious consequences for hearing and health in general, but also for the quality of life. Its economic and societal cost is significant. Active strategies to reduce noise pollution are essential, particularly in urban areas, to prevent the risks of hearing and non-hearing disorders at the source.


POLLUTION SONORE: QUELS IMPACTS SUR LA SANTÉ ? La pollution sonore résultant des activités humaines est de plus en plus présente et importante. Elle peut engendrer des conséquences délétères tant pour l'audition que pour la santé en général, mais aussi pour la qualité de vie. Son coût économique et sociétal est significatif. Des stratégies actives de réduction de la pollution sonore sont indispensables, en particulier en milieu urbain, pour prévenir, à la source, les risques de troubles auditifs et extra-auditifs.


Assuntos
Ruído , Qualidade de Vida , Humanos , Ruído/efeitos adversos
2.
Brain Sci ; 13(4)2023 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-37190537

RESUMO

The understanding of tinnitus has always been elusive and is largely prevented by its intrinsic heterogeneity. To address this issue, scientific research has aimed at defining stable and easily identifiable subphenotypes of tinnitus. This would allow better disentangling the multiple underlying pathophysiological mechanisms of tinnitus. In this study, three-dimensionality reduction techniques and two clustering methods were benchmarked on a database of 2772 tinnitus patients in order to obtain a reliable segmentation of subphenotypes. In this database, tinnitus patients' endotypes (i.e., parts of a population with a condition with distinct underlying mechanisms) are reported when diagnosed by an ENT expert in tinnitus management. This partial labeling of the dataset enabled the design of an original semi-supervised framework. The objective was to perform a benchmark of different clustering methods to get as close as possible to the initial ENT expert endotypes. To do so, two metrics were used: a primary one, the quality of the separation of the endotypes already identified in the database, as well as a secondary one, the stability of the obtained clusterings. The relevance of the results was finally reviewed by two ENT experts in tinnitus management. A 20-cluster clustering was selected as the best-performing, the most-clinically relevant, and the most-stable through bootstrapping. This clustering used a T-SNE method as the dimensionality reduction technique and a k-means algorithm as the clustering method. The characteristics of this clustering are presented in this article.

3.
Artigo em Inglês | MEDLINE | ID: mdl-37107791

RESUMO

(1) Background: Poor sleep and fragmented sleep are associated with several chronic conditions. Tinnitus is an auditory symptom that often negatively combines with poor sleep and has been associated with sleep impairment and sleep apnea. The relationship between tinnitus psychoacoustic characteristics and sleep is still poorly explored, notably for a particular subgroup of patients, for whom the perceived loudness of their tinnitus is highly modulated by sleep. (2) Methods: For this observational prospective study, 30 subjects with tinnitus were recruited, including 15 "sleep intermittent tinnitus" subjects, who had reported significant modulations of tinnitus loudness related to night sleep and naps, and a control group of 15 subjects displaying constant non-sleep-modulated tinnitus. The control group had matching age, gender, self-reported hearing loss grade and tinnitus impact on quality of life with the study group. All patients underwent a polysomnography (PSG) assessment for one complete night and then were asked to fill in a case report form, as well as a report of tinnitus loudness before and after the PSG. (3) Results: "Sleep Intermittent tinnitus" subjects had less Stage 3 sleep (p < 0.01), less Rapid-Eye Movement (REM) Sleep (p < 0.05) and more Stage 2 sleep (p < 0.05) in proportion and duration than subjects from the control group. In addition, in the "sleep Intermittent tinnitus" sample, a correlation was found between REM sleep duration and tinnitus overnight modulation (p < 0.05), as well as tinnitus impact on quality of life (p < 0.05). These correlations were not present in the control group. (4) Conclusions: This study suggests that among the tinnitus population, patients displaying sleep-modulated tinnitus have deteriorated sleep quality. Furthermore, REM sleep characteristics may play a role in overnight tinnitus modulation. Potential pathophysiological explanations accounting for this observation are hypothesized and discussed.


Assuntos
Sono REM , Zumbido , Humanos , Sono REM/fisiologia , Qualidade de Vida , Zumbido/etiologia , Estudos Prospectivos , Sono
4.
Rev Prat ; 73(9): 935-938, 2023 Nov.
Artigo em Francês | MEDLINE | ID: mdl-38294437

RESUMO

MANAGEMENT OF SUBJECTIVE TINNITUS. Subjective tinnitus, which is the perception of a sound in the absence of any actual external or internal acoustic stimulation, is a common symptom affecting about 15% of the population. It should be distinguished from objective tinnitus, which is the perception of a sound produced inside the human body (vascular pulsation or muscular contraction). In this article, we will only focus on the therapeutic management of subjective tinnitus, which is the most frequent case. Tinnitus may be a severe symptom that strongly impairs the patient's quality of life. Etiological treatments aimed at silencing tinnitus are rarely available. One should then consider alternative palliative interventions such as pharmacological treatments (off-market authorization), sound therapies, neuromodulation techniques or cognitive-behavioral psychotherapeutic interventions.


PRISE EN CHARGE DES ACOUPHÈNES SUBJECTIFS. L'acouphène subjectif, c'est-à-dire la perception d'un son en l'absence de toute stimulation sonore externe ou interne à l'organisme, est un symptôme fréquent qui affecte environ 15 % de la population générale. Il est à distinguer de l'acouphène dit objectif qui correspond à la perception d'un son produit à l'intérieur du corps humain (pulsation vasculaire ou contraction musculaire). Dans cet article, seule la prise en charge thérapeutique de l'acouphène subjectif, cas le plus fréquent, est abordée. L'acouphène peut parfois être un symptôme sévère altérant fortement la qualité de vie du patient. Disposant rarement de traitements étiologiques visant à éradiquer l'acouphène, des traitements palliatifs sont utilisés, tels que certains médicaments (hors AMM), les thérapies sonores, les techniques de neuromodulation ou les prises en charge psychothérapeutiques d'inspiration cognitivo- comportementale.


Assuntos
Terapia Cognitivo-Comportamental , Zumbido , Humanos , Zumbido/diagnóstico , Zumbido/etiologia , Zumbido/terapia , Qualidade de Vida
5.
Am J Audiol ; 31(3S): 993-1002, 2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-35130042

RESUMO

BACKGROUND: This study was aimed at identifying key topics in online discussions about tinnitus by examining a large data set extracted from Reddit social media using a natural language processing technique. METHOD: A corpus of 113,215 posts about tinnitus was extracted from Reddit's application programming interface. After cleaning the data for duplications and posts without any text information, the sample was reduced to 101,905 posts, which was subjected to cluster analysis using the open-source IRaMuTeQ software to identify main topics based on the co-occurrence of texts. These clusters were named by a panel of tinnitus experts (n = 9) by reading typical text segments within each cluster. RESULTS: The cluster analysis identified 16 unique clusters that belong to two topics, which were named "tinnitus causes and consequences" and "tinnitus management and coping." Based on their characteristics, the clusters were named: tinnitus timeline (10%), tinnitus perception (9.7%), medical triggers and modulators (8.8%), hearing research (8.8%), attention and silence (8.6%), social media posts about tinnitus (7.4%), hearing protection (7.3%), interaction with hearing health care providers (6.7%), mental health and coping (5.8%), music listening (5.7%), hope for a cure (5.6%), interactions with people without tinnitus (5.4%), dietary supplements and alternative therapies (3.2%), sleep (3.9%), dietary effects (1.7%), and writing about tinnitus and being thankful to online community (1.4%). CONCLUSIONS: Despite some limitations, tinnitus posts on Reddit provide rich real-world data to identify various issues and complaints that tinnitus patients and their significant others discuss in online communities. Some of the clusters identified here are novel (e.g., tinnitus timeline, interactions with people without tinnitus) and have not been much discussed in the tinnitus literature. The results suggest that individuals with tinnitus relay on social media for support and highlight the service delivery needs in providing social support through other means (e.g., support groups).


Assuntos
Mídias Sociais , Zumbido , Humanos , Processamento de Linguagem Natural , Grupos de Autoajuda , Apoio Social
6.
Prog Brain Res ; 260: 167-185, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33637216

RESUMO

BACKGROUND: Several clinical studies have shown that neurofeedback (NFB) has the potential to significantly improve the quality of life of patients complaining of chronic subjective tinnitus. Yet the clinical applicability of such a therapeutic approach in the everyday practice has not been tested so far. OBJECTIVE: This study aims at investigating the feasibility and efficacy of a semi-automated NFB intervention by means of a portable device that eventually could be used by the patients at home on an everyday basis. The duration of setup procedures is minimized through the use of a dry electrodes electroencephalography (EEG) headset and an automated user-interface. METHODS: We conducted a pilot clinical study (non-controlled, single arm, NCT03773926). According to a predetermined power calculation, a homogeneous population of 33 subjects with strict inclusion criteria was enrolled. After inclusion, all patients underwent 10 NFB sessions lasting 50min each, over a period of 5 weeks and a 3-month follow-up period. According to previous studies, the NFB training aimed at increasing the alpha-band power (8-12Hz) in the EEG power spectrum on the averaged signal of leads FC1, FC2, F3 and F4. Tinnitus handicap inventory (THI) was used as a primary outcome measure. Secondary outcome measures were the visual analog scales (VAS) and the change of the alpha-band power within sessions and across training. Time points of assessment were before intervention (T1), after intervention (T2) and at the 3-month follow-up (T3). RESULTS: Patient exhibited a clinically significant decrease of the THI score, with a 23% decrease (N=28) on average between T1 and T2 and a 31% decrease (N=25) between T1 and T3. A significant increase of the alpha-band power within sessions was observed. No significant increase of the alpha-band power across sessions was observed. For the 19 subjects where sufficient data were exploitable, a significant correlation was found between the evolution of the alpha-band training across sessions and the evolution of the THI between T1 and T2. The sessions were well tolerated and no adverse effect was reported. CONCLUSION: This study suggests that neurofeedback has potential to suit everyday clinical practice with the goal to significantly reduce tinnitus intrusiveness. The merits and limitations of this NFB procedure are discussed, especially with respect to the choice of EEG electrodes to ensure a good signal quality.


Assuntos
Neurorretroalimentação , Zumbido , Eletroencefalografia , Estudos de Viabilidade , Humanos , Projetos Piloto , Qualidade de Vida , Zumbido/terapia , Resultado do Tratamento
7.
Prog Brain Res ; 260: 1-25, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33637213

RESUMO

As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: "Tinnitus" for the former and "Tinnitus Disorder" for the latter. The proposed definition then becomes "Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder "when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.". In other words "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder.


Assuntos
Zumbido , Nível de Alerta , Estado de Consciência , Humanos , Zumbido/complicações
9.
Audiol Neurootol ; 25(4): 174-189, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32062654

RESUMO

INTRODUCTION: Subjective tinnitus (ST) and hyperacusis (HA) are common auditory symptoms that may become incapacitating in a subgroup of patients who thereby seek medical advice. Both conditions can result from many different mechanisms, and as a consequence, patients may report a vast repertoire of associated symptoms and comorbidities that can reduce dramatically the quality of life and even lead to suicide attempts in the most severe cases. The present exploratory study is aimed at investigating patients' symptoms and complaints using an in-depth statistical analysis of patients' natural narratives in a real-life environment in which, thanks to the anonymization of contributions and the peer-to-peer interaction, it is supposed that the wording used is totally free of any self-limitation and self-censorship. METHODS: We applied a purely statistical, non-supervised machine learning approach to the analysis of patients' verbatim exchanged on an Internet forum. After automated data extraction, the dataset has been preprocessed in order to make it suitable for statistical analysis. We used a variant of the Latent Dirichlet Allocation (LDA) algorithm to reveal clusters of symptoms and complaints of HA patients (topics). The probability of distribution of words within a topic uniquely characterizes it. The convergence of the log-likelihood of the LDA-model has been reached after 2,000 iterations. Several statistical parameters have been tested for topic modeling and word relevance factor within each topic. RESULTS: Despite a rather small dataset, this exploratory study demonstrates that patients' free speeches available on the Internet constitute a valuable material for machine learning and statistical analysis aimed at categorizing ST/HA complaints. The LDA model with K = 15 topics seems to be the most relevant in terms of relative weights and correlations with the capability to individualizing subgroups of patients displaying specific characteristics. The study of the relevance factor may be useful to unveil weak but important signals that are present in patients' narratives. DISCUSSION/CONCLUSION: We claim that the LDA non-supervised approach would permit to gain knowledge on the patterns of ST- and HA-related complaints and on patients' centered domains of interest. The merits and limitations of the LDA algorithms are compared with other natural language processing methods and with more conventional methods of qualitative analysis of patients' output. Future directions and research topics emerging from this innovative algorithmic analysis are proposed.


Assuntos
Hiperacusia/fisiopatologia , Processamento de Linguagem Natural , Zumbido/fisiopatologia , Aprendizado de Máquina não Supervisionado , Mineração de Dados , Humanos , Internet , Aprendizado de Máquina , Qualidade de Vida , Estatística como Assunto
10.
Clin Neurophysiol ; 131(2): 474-528, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31901449

RESUMO

A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance.


Assuntos
Transtornos Mentais/terapia , Doenças do Sistema Nervoso/terapia , Guias de Prática Clínica como Assunto , Estimulação Magnética Transcraniana/métodos , Medicina Baseada em Evidências/normas , Humanos , Estimulação Magnética Transcraniana/efeitos adversos , Estimulação Magnética Transcraniana/normas
11.
Hear Res ; 377: 353-359, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30871820

RESUMO

BACKGROUND: The heterogeneity of tinnitus is substantial. Its numerous pathophysiological mechanisms and clinical manifestations have hampered fundamental and treatment research significantly. A decade ago, the Tinnitus Research Initiative introduced the Tinnitus Sample Case History Questionnaire, a case history instrument for standardised collection of information about the characteristics of the tinnitus patient. Since then, a number of studies have been published which characterise individuals and groups using data collected with this questionnaire. However, its use has been restricted to a clinical setting and to the evaluation of people with tinnitus only. In addition, it is limited in the ability to capture relevant comorbidities and evaluate their temporal relationship with tinnitus. METHOD: Here we present a new case history instrument which is comprehensive in scope and can be answered by people with and without tinnitus alike. This 'European School for Interdisciplinary Tinnitus Research Screening Questionnaire' (ESIT-SQ) was developed with specific attention to questions about potential risk factors for tinnitus (including demographics, lifestyle, general medical and otological histories), and tinnitus characteristics (including perceptual characteristics, modulating factors, and associations with co-existing conditions). It was first developed in English, then translated into Dutch, German, Italian, Polish, Spanish, and Swedish, thus having broad applicability and supporting international collaboration. CONCLUSIONS: With respect to better understanding tinnitus profiles, we anticipate the ESIT-SQ to be a starting point for comprehensive multi-variate analyses of tinnitus. Data collected with the ESIT-SQ can allow establishment of patterns that distinguish tinnitus from non-tinnitus, and definition of common sets of tinnitus characteristics which might be indicated by the presence of otological or comorbid systemic diseases for which tinnitus is a known symptom.


Assuntos
Audição , Inquéritos e Questionários/normas , Zumbido/diagnóstico , Europa (Continente)/epidemiologia , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Risco , Zumbido/epidemiologia , Zumbido/fisiopatologia , Tradução
12.
Trends Hear ; 23: 2331216518824827, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30803389

RESUMO

Good practice in clinical trials advocates common standards for assessing and reporting condition-specific complaints ("outcome domains"). For tinnitus, there is no common standard. The Core Outcome Measures in Tinnitus International Delphi (COMiT'ID) study created recommendations that are relevant to the most common intervention approaches for chronic subjective tinnitus in adults using consensus methods. Here, the objectives were to examine why it is important to tailor outcome domain selection to the tinnitus intervention that is being evaluated in the clinical trial and to demonstrate that the COMiT'ID recommendations are robust. The COMiT'ID study used an online three-round Delphi method with three separate surveys for sound-, psychology-, and pharmacology-based interventions. Survey data were analyzed to assess quality and confidence in the consensus achieved across surveys and stakeholder groups and between survey rounds. Results found participants were highly discriminatory in their decision-making. Of the 34 outcome domains reaching the prespecified consensus definition in the final round, 17 (50%) were unique to one intervention, while only 12 (35%) were common to all three. Robustness was demonstrated by an acceptable level of agreement across and within stakeholder groups, across survey rounds, across medical specialties (for the health-care practitioners), and across health-care users with varying tinnitus duration. There were few dissenting voices, and results showed no attrition bias. In conclusion, there is compelling evidence that one set of outcomes does not fit all therapeutic aims. Our analyses evidence robust decisions by the electronic Delphi process, leading to recommendations for three unique intervention-specific outcome domain sets. This provides an important starting point for standardization.


Assuntos
Zumbido/terapia , Adulto , Doença Crônica , Ensaios Clínicos como Assunto , Terapia Combinada , Consenso , Técnica Delphi , Humanos , Inquéritos e Questionários , Zumbido/tratamento farmacológico , Resultado do Tratamento
13.
Trends Hear ; 22: 2331216518814384, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30488765

RESUMO

Subjective tinnitus is a chronic heterogeneous condition that is typically managed using intervention approaches based on sound devices, psychologically informed therapies, or pharmaceutical products. For clinical trials, there are currently no common standards for assessing or reporting intervention efficacy. This article reports on the first of two steps to establish a common standard, which identifies what specific tinnitus-related complaints ("outcome domains") are critical and important to assess in all clinical trials to determine whether an intervention has worked. Using purposive sampling, 719 international health-care users with tinnitus, health-care professionals, clinical researchers, commercial representatives, and funders were recruited. Eligibility was primarily determined by experience of one of the three interventions of interest. Following recommended procedures for gaining consensus, three intervention-specific, three-round, Delphi surveys were delivered online. Each Delphi survey was followed by an in-person consensus meeting. Viewpoints and votes involved all stakeholder groups, with approximately a 1:1 ratio of health-care users to professionals. "Tinnitus intrusiveness" was voted in for all three interventions. For sound-based interventions, the minimum set included "ability to ignore," "concentration," "quality of sleep," and "sense of control." For psychology-based interventions, the minimum set included "acceptance of tinnitus," "mood," "negative thoughts and beliefs," and "sense of control." For pharmacology-based interventions, "tinnitus loudness" was the only additional core outcome domain. The second step will next identify how those outcome domains should best be measured. The uptake of these intervention-specific standards in clinical trials will improve research quality, enhance clinical decision-making, and facilitate meta-analysis in systematic reviews.


Assuntos
Ensaios Clínicos como Assunto/normas , Determinação de Ponto Final/normas , Projetos de Pesquisa/normas , Zumbido/terapia , Consenso , Técnica Delphi , Humanos , Medidas de Resultados Relatados pelo Paciente , Participação dos Interessados , Zumbido/diagnóstico , Zumbido/fisiopatologia , Zumbido/psicologia , Resultado do Tratamento
14.
Trends Hear ; 22: 2331216518801725, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30249168

RESUMO

Acoustic shocks and traumas sometimes result in a cluster of debilitating symptoms, including tinnitus, hyperacusis, ear fullness and tension, dizziness, and pain in and outside the ear. The mechanisms underlying this large variety of symptoms remain elusive. In this article, we elaborate on the hypothesis that the tensor tympani muscle (TTM), the trigeminal nerve (TGN), and the trigeminal cervical complex (TCC) play a central role in generating these symptoms. We argue that TTM overuse (due to the acoustic shock), TTM overload (due to muscle tension), and ultimately, TTM injury (due to hypoxia and "energy crisis") lead to inflammation, thereby activating the TGN, TCC, and cortex. The TCC is a crossroad structure integrating sensory inputs coming from the head-neck complex (including the middle ear) and projecting back to it. The multimodal integration of the TCC may then account for referred pain outside the ear when the middle ear is inflamed and activates the TGN. We believe that our model proposes a synthetic and explanatory framework to explain the phenomena occurring postacoustic shock and potentially also after other nonauditory causes. Indeed, due to the bidirectional properties of the TCC, musculoskeletal disorders in the region of the head-neck complex, including neck injury due to whiplash or temporomandibular disorders, may impact the middle ear, thereby leading to otic symptoms. This previously unavailable model type is experimentally testable and must be taken as a starting point for identifying the mechanisms responsible for this particular subtype of tinnitus and its associated symptoms.


Assuntos
Orelha Média/lesões , Hiperacusia/fisiopatologia , Transtornos da Articulação Temporomandibular/complicações , Zumbido/fisiopatologia , Análise por Conglomerados , Dor de Orelha/etiologia , Dor de Orelha/fisiopatologia , Feminino , Humanos , Hiperacusia/etiologia , Masculino , Choque/complicações , Transtornos da Articulação Temporomandibular/diagnóstico , Tensor de Tímpano/fisiopatologia , Zumbido/etiologia , Nervo Trigêmeo/fisiopatologia
15.
Trends Hear ; 22: 2331216518769996, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29708062

RESUMO

Tinnitus masking and residual inhibition (RI) are two well-known psychoacoustic measures of tinnitus. While it has long been suggested that they may provide diagnostic and prognostic information, these measures are still rarely performed in clinics, as they are too time consuming. Given this issue, the main goal of the present study was to validate a new method for assessing these measures. An acoustic sequence made of pulsed stimuli, which included a fixed stimulus duration and interstimulus interval, was applied to 68 tinnitus patients at two testing sites. First, the minimum masking level (MML) was measured by raising the stimulus intensity until the tinnitus was unheard during the stimulus presentation. Second, the level of the stimulus was further increased until the tinnitus was suppressed during the silence interval between the acoustic pulses. This level was called the minimum residual inhibition level (MRIL). The sequential measurement of MML and MRIL from the same stimulus condition offers several advantages such as time efficiency and the ability to compare results between the MRIL and MML. Our study confirms that, from this new approach, MML and MRIL can be easily and quickly obtained from a wide variety of patients displaying either normal hearing or different hearing loss configurations. Indeed, MML was obtained in all patients except one (98.5%), and some level of MRIL was found on 59 patients (86.7%). More so, this approach allows the categorization of tinnitus patients into different subgroups based on the properties of their MRIL.


Assuntos
Mascaramento Perceptivo , Psicoacústica , Zumbido , Adolescente , Adulto , Idoso , Audiometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Zumbido/diagnóstico , Adulto Jovem
16.
Front Neurol ; 8: 420, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28861040

RESUMO

This study reports the case of an acoustic shock injury (ASI), which did not result in a significant hearing loss, but was followed by manifold chronic symptoms both within (tinnitus, otalgia, tingling in the ear, tension in the ear, and red tympanum) and outside the ears (blocked nose, pain in the neck/temporal region). We suggest that these symptoms may result from a loop involving injury to middle ear muscles, peripheral inflammatory processes, activation and sensitization of the trigeminal nerve, the autonomic nervous system, and central feedbacks. The pathophysiology of this ASI is reminiscent of that observed in post-traumatic trigeminal-autonomic cephalalgia. This framework opens new and promising perspectives on the understanding and medical management of ASI.

17.
Trials ; 18(1): 388, 2017 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-28835261

RESUMO

BACKGROUND: The reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is, therefore to, develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes. METHODS: The 'Core Outcome Measures in Tinnitus: International Delphi' (COMIT'ID) study will use a mixed-methods approach that incorporates input from health care users at the pre-Delphi stage, a modified three-round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following Core Outcome Set publication. DISCUSSION: The COMIT'ID study aims to develop a Core Outcome Domain Set that is agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the Core Outcome Set in the long term. TRIAL REGISTRATION: This project has been registered (November 2014) in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative.


Assuntos
Acústica , Percepção Auditiva/efeitos dos fármacos , Técnica Delphi , Audição/efeitos dos fármacos , Psicoterapia/métodos , Projetos de Pesquisa , Zumbido/terapia , Doença Crônica , Consenso , Determinação de Ponto Final , Humanos , Seleção de Pacientes , Participação dos Interessados , Zumbido/diagnóstico , Zumbido/fisiopatologia , Zumbido/psicologia , Resultado do Tratamento
19.
Trials ; 17(1): 270, 2016 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-27250987

RESUMO

BACKGROUND: There is no evidence-based guidance to facilitate design decisions for confirmatory trials or systematic reviews investigating treatment efficacy for adults with tinnitus. This systematic review therefore seeks to ascertain the current status of trial designs by identifying and evaluating the reporting of outcome domains and instruments in the treatment of adults with tinnitus. METHODS: Records were identified by searching PubMed, EMBASE CINAHL, EBSCO, and CENTRAL clinical trial registries (ClinicalTrials.gov, ISRCTN, ICTRP) and the Cochrane Database of Systematic Reviews. Eligible records were those published from 1 July 2006 to 12 March 2015. Included studies were those reporting adults aged 18 years or older who reported tinnitus as a primary complaint, and who were enrolled into a randomised controlled trial, a before and after study, a non-randomised controlled trial, a case-controlled study or a cohort study, and written in English. Studies with fewer than 20 participants were excluded. RESULTS: Two hundred and twenty-eight studies were included. Thirty-five different primary outcome domains were identified spanning seven categories (tinnitus percept, impact of tinnitus, co-occurring complaints, quality of life, body structures and function, treatment-related outcomes and unclear or not specified). Over half the studies (55 %) did not clearly define the complaint of interest. Tinnitus loudness was the domain most often reported (14 %), followed by tinnitus distress (7 %). Seventy-eight different primary outcome instruments were identified. Instruments assessing multiple attributes of the impact of tinnitus were most common (34 %). Overall, 24 different patient-reported tools were used, predominantly the Tinnitus Handicap Inventory (15 %). Loudness was measured in diverse ways including a numerical rating scale (8 %), loudness matching (4 %), minimum masking level (1 %) and loudness discomfort level (1 %). Ten percent of studies did not clearly report the instrument used. CONCLUSIONS: Our findings indicate poor appreciation of the basic principles of good trial design, particularly the importance of specifying what aspect of therapeutic benefit is the main outcome. No single outcome was reported in all studies and there was a broad diversity of outcome instruments. PROSPERO REGISTRATION: The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): CRD42015017525 . Registered on 12 March 2015 revised on 15 March 2016.


Assuntos
Ensaios Clínicos como Assunto , Zumbido/terapia , Adulto , Humanos , Projetos de Pesquisa , Resultado do Tratamento
20.
Neurosci Biobehav Rev ; 44: 16-32, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23597755

RESUMO

Tinnitus is a considered to be an auditory phantom phenomenon, a persistent conscious percept of a salient memory trace, externally attributed, in the absence of a sound source. It is perceived as a phenomenological unified coherent percept, binding multiple separable clinical characteristics, such as its loudness, the sidedness, the type (pure tone, noise), the associated distress and so on. A theoretical pathophysiological framework capable of explaining all these aspects in one model is highly needed. The model must incorporate both the deafferentation based neurophysiological models and the dysfunctional noise canceling model, and propose a 'tinnitus core' subnetwork. The tinnitus core can be defined as the minimal set of brain areas that needs to be jointly activated (=subnetwork) for tinnitus to be consciously perceived, devoid of its affective components. The brain areas involved in the other separable characteristics of tinnitus can be retrieved by studies on spontaneous resting state magnetic and electrical activity in people with tinnitus, evaluated for the specific aspect investigated and controlled for other factors. By combining these functional imaging studies with neuromodulation techniques some of the correlations are turned into causal relationships. Thereof, a heuristic pathophysiological framework is constructed, integrating the tinnitus perceptual core with the other tinnitus related aspects. This phenomenological unified percept of tinnitus can be considered an emergent property of multiple, parallel, dynamically changing and partially overlapping subnetworks, each with a specific spontaneous oscillatory pattern and functional connectivity signature. Communication between these different subnetworks is proposed to occur at hubs, brain areas that are involved in multiple subnetworks simultaneously. These hubs can take part in each separable subnetwork at different frequencies. Communication between the subnetworks is proposed to occur at discrete oscillatory frequencies. As such, the brain uses multiple nonspecific networks in parallel, each with their own oscillatory signature, that adapt to the context to construct a unified percept possibly by synchronized activation integrated at hubs at discrete oscillatory frequencies.


Assuntos
Percepção Auditiva/fisiologia , Modelos Neurológicos , Membro Fantasma/psicologia , Zumbido/patologia , Zumbido/fisiopatologia , Encéfalo , Eletrofisiologia , Humanos
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