The effectiveness of acupuncture as a treatment for tinnitus: a randomized controlled trial using (99m)Tc-ECD SPECT.

OBJECTIVE: Investigate the effect of acupuncture on brain perfusion using ethyl cysteinate dimer single-photon emission computed tomography ((99m)Tc-ECD SPECT) in patients with tinnitus. METHODS: This randomized, single-blind, sham-control study examined patients (18-60 years old) with normal hearing and chronic, idiopathic, continuous tinnitus. Fifty-seven subjects were randomly assigned to true (n = 30) or sham (n = 27) acupuncture (ACP); (99m)Tc-ECD SPECT examinations were performed before and after 12 twice-weekly ACP sessions. Secondary outcomes included changes in the Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), Hamilton Anxiety Scale (HAS) and Beck Depression Inventory (BDI). Imaging data were analysed using Statistical Parametric Mapping (SPM8) software. Regression models were used to examine secondary outcomes via two paradigms: intention-to-treat (ITT; where multiple imputations were conducted because of study attrition) and complete cases. RESULTS: No between-group brain perfusion differences were observed. However, a significant improvement in THI scores was observed at the end of true ACP treatment for all domains (all p values < 0.01) except the catastrophic scale. CONCLUSIONS: ACP might reduce the effects of tinnitus on daily life; however, additional studies should be conducted to verify the effects of ACP on the neural architecture and brain function of tinnitus patients. KEY POINTS: • Efficacy of acupuncture on brain perfusion and symptoms of tinnitus patients. • Acupuncture improved the Tinnitus Handicap Inventory scores in tinnitus patients. • No significant changes in brain perfusion were observed after 12 twice-weekly sessions. • Perfusion changes would reflect changes in neuronal function.

Memory networks in tinnitus: a functional brain image study.

UNLABELLED: Tinnitus is characterized by the perception of sound in the absence of an external auditory stimulus. The network connectivity of auditory and non-auditory brain structures associated with emotion, memory and attention are functionally altered in debilitating tinnitus. Current studies suggest that tinnitus results from neuroplastic changes in the frontal and limbic temporal regions. The objective of this study was to use Single-Photon Emission Computed Tomography (SPECT) to evaluate changes in the cerebral blood flow in tinnitus patients with normal hearing compared with healthy controls. METHODS: Twenty tinnitus patients with normal hearing and 17 healthy controls, matched for sex, age and years of education, were subjected to Single Photon Emission Computed Tomography using the radiotracer ethylenedicysteine diethyl ester, labeled with Technetium 99 m (99 mTc-ECD SPECT). The severity of tinnitus was assessed using the "Tinnitus Handicap Inventory" (THI). The images were processed and analyzed using "Statistical Parametric Mapping" (SPM8). RESULTS: A significant increase in cerebral perfusion in the left parahippocampal gyrus (pFWE <0.05) was observed in patients with tinnitus compared with healthy controls. The average total THI score was 50.8+18.24, classified as moderate tinnitus. CONCLUSION: It was possible to identify significant changes in the limbic system of the brain perfusion in tinnitus patients with normal hearing, suggesting that central mechanisms, not specific to the auditory pathway, are involved in the pathophysiology of symptoms, even in the absence of clinically diagnosed peripheral changes.

Vestibular evoked myogenic potential in unilateral vestibular hypofunction.

CONCLUSION: The patients with unilateral chronic vestibular hypofunction detected by caloric test demonstrated at least some sort of altered vestibular evoked myogenic potential (VEMP) in 63.63% of the cases. The VEMP altered side was the same as the unilateral vestibular hypofunction side in 54.54% of the cases and was the opposite side in 24.24%. The VEMP test improved functional vestibular assessment in patients with unilateral caloric hypofunction. OBJECTIVES: To analyze VEMP in patients with chronic dizziness and unilateral vestibular hypofunction and verify findings according to the side and structures involved. METHODS: This was an observational study. In all, 66 subjects were evaluated by VEMP (tone bursts/1000 Hz/100 dBnHL/bandpass filtered 10-1500 Hz/4.3 Hz rate), 33 with unilateral vestibular hypofunction, detected by caloric test and clinical data, and 33 control subjects, matched by gender and age. Amplitude of the p13-n23, asymmetry index of the amplitude, p13 and n23 latencies, p13 and n23 interaural difference and threshold were analyzed. Simple descriptive analysis was carried out using the t test, Shapiro-Wilks test, and Mann-Whitney test, p < 0.05. RESULTS: VEMP was altered in patients with unilateral vestibular hypofunction in 63.63% of cases. Thirteen of them were ipsilateral to the vestibular hypofunction and three were contralateral to the vestibular hypofunction. In five cases, VEMP were bilaterally altered.