Handbook

Sponsors

Sponsor of Keynote Speakers Prof Deborah Hall and Prof Pim van Dijk

Co-Sponsor of Prof Larry Roberts

Co-Sponsor of Prof Larry Roberts Podium Sessions Sponsor Wednesday

New Zealand PhD Scholarship Sponsor Coffee Cart Sponsor

Conference Dinner Entertainment Sponsor Satchel Sponsor

Student Guide Sponsor

NZ Tinnitus and

Hyperacusis Network

Major Sponsor

Link ReseaRch and GRants

1

Contents

Welcome 2

Programme 4–9

SocialProgramme 10

Exhibition 11

ExhibitorListing 12–13

GeneralInformation 15–17

Abstracts–Tuesday11March 19–93

PosterSession1/Tahi 94–95

PosterSession2/Rua 96–97

Abstracts–Wednesday12March 99–171

PosterSession3/Toru 172–174

PosterSession4/Wha 174–175

Abstracts–Thursday13March 177–257

PosterSession5/Rima 258–260

PosterSession6/Ono 260–262

Index 263

2

WelcomeOnbehalf of theTinnitusResearch Initiative it is agreatpleasure towelcomeyou to the8th

InternationalTinnitusResearchInitiativeConference“OvertheHorizon”.

TheorganizerswouldliketothankyouallfortravellingtoAuckland.Wehopethatyourvisitwill

bebotheducationalandenjoyable.Itiswonderfulthatsomanyprominenttinnitusresearchers

andclinicianshavetravelledtoNewZealandtosharetheirexpertise.Aucklandanditssurrounds

hasmuchtooffervisitors,fromthewildwestcoastbeachestotheserenityofWaihekevineyards

intheEast,fromthevibeofthecity’sbarsandrestaurantstothevistasoftheWaitakereranges

andourmagnificentharbours.

Thehostuniversity,theUniversityofAuckland,wasfoundedin1883andisNewZealand’slargest

universitywith38000students.TheCentreforBrainResearchattheUniversityofAucklandisa

partnershipbetweenscientists,cliniciansandthecommunity.Workingtogetherinthelaboratory,

clinic, and community, theCBRstrives to provide abrighter andbetter future for people and

families livingwithbraindiseaseand injury.Tinnitus isan important topic formultidisciplinary

research;successfulpartnershipsandinnovationbeginswithnetworking,thismeetingisaperfect

opportunityforresearchers,cliniciansandcommunityorganizationstolearnfromeachother,to

networkandforgecollaborationsthatwillprovidemeaningfulbenefitstotinnitussufferersacross

theglobe.Thepostersessionsareveryimportantforthispurposeandsohaveaprominentpart

toplayhere.Theposterswillbeupthroughoutthemeeting,pleaseattendthescheduledposter

sessionstohearthepresenters,theydeserveyourattention.

Thankyoutoallwhohavecontributedtoorganizingthismeeting.Weareverygratefulforthe

supportofoursponsorsandexhibitors.Pleasetakethetimetovisittheexhibitorsandenquire

abouttheirservicesandproducts.

Tocuretinnituswemust:embracenewmethodologies,challengeconvention,andlookoverthe

horizon.

Herangitamatawhaiti,herangitamatawhanui.

The person with a narrow vision sees a narrow horizon; the person with a wide vision sees a wide

horizon. Maori Proverb

Grant D Searchfield

Chair of Organising Committee

EngaiwioteaoHaeremai,haeremai,haeremai

TothepeoplesoftheworldWelcome,welcome,welcome

NF - Tinnitus TRI Conference.indd 1 7/02/14 8:49 AM

3

NF - Tinnitus TRI Conference.indd 1 7/02/14 8:49 AM

4

Tuesday 11 March0830–0900 Conference opening

0900–0945 Guest Speaker

BioengineeringandthePhysiomeProject

Prof Peter Hunter

0945–1015 Morningtea

1015–1050 Invited Speaker

Betterunderstandingtheheterogeneityoftinnitustoimproveanddevelopnew

treatments-TINNET

Dr Berthold Langguth

Podium Session 1 / Tahi

1050–1100 Characterisingthepsychosocialexperiencesofchronictinnitussufferers

Krysta Callander

1100–1110 Seasonalaffectivedisorderinpatientswithchronictinnitus

Prof Young Ho Kim

1110–1120 Therelationbetweentinnitusloudness,sleepdisordersandemotionaldistress

Narges Jangholi

1120–1130 Useofthesignificantothertogaugetinnitusseverity

Dr Tricia Sheehan

1130–1140 ValidationofthetinnitusfunctionalindexinaUKresearchpopulation

Dr Derek Hoare

Programme

Monday 10 March

0830–1710 Preconferenceworkshop

1710–1930 WelcomeReception

5

1140–1215 Lunch

1215–1345 Poster Session 1 / Tahi – refer to page 94

1345–1420 Guest Speaker

Metaplasticity:Brakeoracceleratorforplasticity?

Prof Cliff Abraham

Podium Session 2 / Rua

1420–1430 Responsivenesstothreateningsounds:Aselectiveattentionparadigm

Dr Rilana Cima

1430–1440 Noiseprotectionforhyperacusispatientswithstressonteachers

Acasepresentationofanewapproach

Gaby Lux-Wellenhof

1440–1450 Gentleskinstimulationmodulatesthebalancebetweenthesympatheticnerve

andthevagalnerveamongthenormaladult

Prof Masafumi Nakagawa

1450–1500 Ontheperceptualandneuronalvariabilityinchronictinnitus

Dr Winnifried Schlee

1500–1510 Elderlypatientsbenefitfromcochlearimplantationregardingauditory

rehabilitation,qualityoflife,tinnitusandpsychologicalcomorbidities

Prof Heidi Olze

1510–1540 Afternoontea

1540–1700 Poster Session 2 / Rua – refer to page 96

1700–1735 Invited Speaker

Multimodalityevaluationandtreatmentoftinnitus

Dr Shujiro Minami

1735–1810 Keynote Speaker

Aretreatmentsfortinnituseffective?

Prof Deborah Hall

Kindly sponsored by the Neurological Foundation of New Zealand

6

Wednesday 12 March

0830–0900 Invited Speaker

Plasticityofmultisensoryprocessinginthedorsalcochlearnucleus:It’srolein

tinnitusgenerationandsuppression

Prof Susan Shore

0900–0945 Keynote Speaker

Tinnitusandabnormalprocessinginthecentralauditorysystem

Prof Pim Van Dijk

Kindly sponsored by the Neurological Foundation of New Zealand

0945–1015 Morningtea

Podium Session 3 / Toru

Kindly sponsored by the Centre for Brain Research

1015–1025 Parahippocampal-auditorycortexcommunicationintinnitus

Prof Dirk De Ridder

1025–1035 Modulatingalphaandbetaoscillationswithinposteriorcingulatecortex

throughreal-timesourcelocalizedneurofeedbackanditseffectontinnitus

relateddistress

Prof Sven Vanneste

1035–1045 Changeinspontaneouscorticalactivityduringtinnitusremediation

Ankit Mathur

1045–1055 Tonotopicmapchangesduringtinnitusremediation

Ankit Mathur

1055–1105 Changesinresting-statefMRIactivityduringsalicylate-inducedtinnitusand

soundstimulation

Prof Richard Salvi

1105–1115 Auditory-limbicnetworkintinnitusrevealedbyresting-statefunctional

connectivityMRI

Prof Josef Rauschecker

1115–1145 Lunch

1145-1315 Poster Session 3 / Toru – refer to page 172

7

Podium Session 4 / WhaKindly sponsored by the Centre for Brain Research

1315–1325 InfusionofGABABreceptoragonistsintothecochlearnucleusontinnitus

developmentfollowingacoustictraumainrats

Dr Yiwen Zheng

1325–1335 Stress-associatedchangesofmitochondrialproteinsinauditorycortex

Dr Agnieszka Szczepek

1335–1345 Evidenceforneurogenesisinthecochlearnucleusfollowingacoustictraumainrats

Prof Paul Smith

1345–1355 Sound-triggeredsuppressionofneuronalfiringintheauditorycortex:

Implicationtotheresidualinhibitionoftinnitus

Alexander Galazyuk

1355–1405 Effectsofparaflocculusremovalonhyperactivityafteracoustictrauma

Darryl P Vogler

1405–1415 Hyperactivityintheinferiorcolliculusafternoisetraumaandit’smodulationby

extra-cochlearelectricstimulation

Dr Arnaud Norena

1415–1445 Afternoontea

1445-1615 Poster Session 4 / Wha – refer to page 174

1615–1650 Invited Speaker

Multidisciplinaryassociationforpsychedelicstudies

Rick Doblin

1650–1725 Invited Speaker

MDMA-assistedpsychotherapyfortinnitusandPTSD

Amy Emerson

1725–1810 Keynote Speaker

Neuralplasticityandattentioninnormalhearingandintinnitus

Prof Larry Roberts

Kindly co-sponsored by the Neurological Foundation of New Zealand and NZ

Tinnitus and Hyperacusis Network

1900– Conference Dinner

midnight

8

Thursday 13 March

0830–0915 Guest Speaker

Thebodyinmind-currentconceptsinthebraininpain

Prof Lorimer Moseley

0915–0950 Invited Speaker

Attentionandsubjectivetinnitus:Fromaclinicalpointofview

Dr Alain Londero

0950–1025 Invited Speaker

AnENTdoctor’sjourneytothebrain:Theauditoryandnon-auditorybrain

areasinvolvedintinnitusandtinnitus-relateddistress

Dr Jae-Jin Song

1025–1100 Morningtea

Podium Session 5 / Rima

1100–1110 PRISM(PictorialRepresentationofIllnessandSelfMeasure)asanew

assessmenttoolforsufferingintinnituspatients

Dr Tobias Kleinjung

1110–1120 Proportionanddiversificationofunderlyingcausesof242unilateralvenous

pulsatiletinnituscasesindual-phasecontrast-enhancedCT

Cheng Dong

1120–1130 Theduralsinuswalldehisciencepresentingwithpulsatiletinnitus:

EvaluationwithCTvenography

Dr Pengfai Zhao

1130–1140 Deepbrainstimulationoftheinferiorcolliculusfortreatingtinnitus

Sarah Offut

1140–1150 Impactofspectralnotchwidthontheclinicaleffectivenessofthetailor-made

notchedmusictraining

Robert Wunderlich

1150–1200 ComparisonofpositioningthecathodeintDCS

Sarah Rabau

9

1200–1230 Lunch

1230–1350 Poster Session 5 / Rima – refer to page 259

Podium Session 6 / Ono

1350–1400 Mindfulnessbasedtinnitusstressreduction:Anewtreatmentwithancient

roots

Dr Jennifer Gans

1400–1410 Consensusonhearing-aidcandidatureandfittingformildhearingloss,with

andwithouttinnitus:DELPHIreview

Prof Deborah Hall

Kindly sponsored by the Neurological Foundation of New Zealand

1410–1420 Frequenciescharacteristicsoftinnitusanditsimpactondifferentsound-

relatedtreatmentmethods

Prof Weijia Kong

1420–1430 Space:The3rddimensionoftinnitus

Dr Grant Searchfield

1430–1440 Totalorsignificantremissionoftinnituswhatcanwelearnfrompatientswho

havereachedthisstage?

Dr Tanit Sanchez

1440–1510 Afternoontea

1510–1630 Poster Session 6 / Ono – refer to page 261

1630–1705 Invited Speaker

Tinnitus:Whynotstopitbeforeitstarts?

Prof William Martin

1705-1730 Conference Close

Establishingnetworksfortinnituscliniciansandresearchers,TRI2015,and

farewells

Grant D Searchfield and Berthold Langguth

10

“come over to our place...”

SocialProgramme

Welcome Reception

When: Monday10March2014

Where: ExhibitionArea,ViaductEventsCentre

Time: 5.10pm–7.30pm

Dress: SmartCasual

Kickoffthesocialfestivitiesbycatchingupoverwineandcheese.TheWelcomeReceptionwill

giveyoutheopportunitytosamplesomeofthebestlocalwinesfromtheAucklandregion.The

winemakerswillalsobeonhandtoansweryourquestions!

Conference Dinner

When: Wednesday12March2014

Where: WaihekeRoom,Viaduct

EventsCentre

Time: 7.00pm–Midnight

Dress: SmartCasual

Joinyourcolleaguesandnewconferencefriendsfora

nightonAuckland’swaterfront.Asuperbvenuefrom

which towatch thecity transformfromday tonight,

this evening will play on the classic ‘kiwi barbeque’

withplentyofentertainmentandachancetocelebrate

afterabusyfewdays.

11

ExhibitionInformation

Exhi

bito

rs

Stan

d Nu

mbe

r

MED

-EL

Impl

antS

yste

ms

Aust

rala

sia

01

Unitr

on

02

Coch

lear

NZ

Lim

ited

04

SIEM

ENS

05

The

Natio

nalF

ound

atio

nfo

rthe

Dea

f06

Phon

akN

Zan

dAd

vanc

edB

ioni

cs

07,0

8

11

MAIN ENTRANCE

12

MED-EL Implant Systems Australasia 01

Suite2.07,90-96BourkeRoad

Alexandria

NSW2015

Australia

T. 1300744782

T. +61(0)296902455

E. office@medel.com.au

W.www.medel.com

MED-EL’sbroadportfolioofproductsensures

thatwecanprovideahearingimplantsolution

tofiteachcandidate’suniquehearingloss.We

will be there for you today, tomorrow and in

the future offering state−of−the−art hearing

implantsolutionsthatarecomfortabletowear

andeasytouse.

Unitron New Zealand 02

GroundFloor,159HurstmereRoad

Takapuna

Auckland0622

NewZealand

Contact:AlanMcKenna

T. 08008648766

E. alan.mckenna@unitron.co.nz

W. www.unitron.com/nz

At Unitron, hearing matters. We believe

everyoneshouldbeable toenjoy thesounds

of life.That’swhywedirectallourefforts to

pioneering innovation. It’s why we focus on

helpingpeoplehearandunderstandothers—

from a child’s question to a friend’s hello—

underthemostchallengingconditions.

For close to a half a century, Unitron has

designed and manufactured hearing

instruments to meet people’s needs. We

are backed by the resources of the Sonova

Group, the leadingglobal provider of hearing

healthcare solutions, we develop proprietary

technologiesontheworld’smostsophisticated

platform.

We care deeply about people with hearing

lossandtheprofessionalswhosupportthem.

Together, we pursue fresh and imaginative

ways to improve lives and make these

advancesavailabletoeveryone.Thispurpose-

driveninnovationisapriorityineverythingwe

do.Becausehearingmatters.

Cochlear NZ Limited 04

Level4,19ComoStreet

Takapuna0622

Auckland

NewZealand

Contact:SimonWilson

T. +6421675665

E. swilson@cochlear.com

W. www.cochlear.com/au

MorepeoplehearmorewithCochlear™

As the leading global expert in implantable

hearing solutions, Cochlear is dedicated to

bringing the gift of sound to people all over

theworld.Forover thirtyyears,Cochlearhas

pioneered this technology,helpingmore than

aquarterofamillionpeoplereconnecttotheir

familiesandfriends.

13

Along with the industry’s largest investment

inresearchanddevelopment,wecontinueto

partnerwith leading international researchers

and hearing professionals, ensuring that we

areattheforefrontofhearingscience.Forour

customers, that means access to our latest

technologies throughout their lives, and the

ongoingsupporttheyneed.Morepeopletrust

their hearing to Cochlear than all the other

hearingimplantcompaniescombined.

Formoreinformation,contactCochlear:

customerservice@cochlear.com

www.cochlear.com/au

Siemens Hearing Instruments 05

55HugoJohnstonDrive

Penrose

Auckland1061

NewZealand

Contact:BonytaWatson

T. 0800666671

E. bonyta.watson@siemens.com

W. www.siemens.co.nz/hearing

For over 130 years, Siemens has been

developing hearing instruments that are

technically state-of-the-art so that you can

offereachofyourcustomerstherighthearing

solution.Siemens’miconhearinginstruments

all come with best-in-class industry features

includingatinnitustherapyfeature.

The National Foundation for the Deaf Inc. 06

Level2,11YorkStreet

Parnell

Auckland

NewZealand

Contact:LouiseCarroll

T. +6493072922

E. enquiries@nfd.org.nz

W. www.nfd.org.nz

The National Foundation for the Deaf has

been operating in New Zealand since 1979.

Workingwithourninememberorganisations,

we support the rights of peoplewith hearing

impairment or deafness and promote safe

listeningpractices.

Phonak NZ and Advanced Bionics 07, 08

Level1,TakapunaFinanceCentre

159HurstmereRd

Takapuna0740

Auckland

NewZealand

Contact:DavidCrowhen

T. +6494861849

E. david.crowhen@phonak.com

W. www.phonak.co.nz

Phonak provide innovative hearing solutions

toimprovequalityoflifeforpeoplelivingwith

hearinglossandtinnitus.PhonakNZarealso

pleased to partner with Advanced Bionics

and introduce the Naída CI Q70 cochlear

implant system, a quantum leap forward in

performance and wireless connectivity. Visit

ourstandtofindoutmore.

14

Catering

Whenplanningthisconferencetheorganiserswerekeentosharewithyousomeofthefoods

thatareiconictoNewZealand.Throughoutthenextfewdaysyouwillgettosamplesomeof

ourfavourites.

Toallourconferenceguestswelcometo‘ourplace’andwehopeyouenjoy!

15

GeneralInformation

Registration and LocatedintheViaductEventsCentreFoyertheregistrationand

Information informationdeskwillbeopenatthefollowingtimes:

Monday10March 0730-2000

Tuesday11March 0730-1830

Wednesday12March 0730-1900

Thursday13March 0730-1800

Telephone Directory ViaductEventsCentre +6493075498

RegistrationandInformationDesk +6421918524

ConferenceInnovatorsafterhours(RachelCook) +6421918524

Hotels

SofitelAucklandViaductHarbour +6499099000

TheSebelSuitesAuckland +6499784000

CopthorneHotelAucklandHarbourCity +6493770349

Transport

CorporateCabs +6493770773

AucklandCoopTaxis +6493003000

BlueBubbleTaxis +6493026001

Accommodation Forthosedelegateswhohavereservedhotelaccommodationthrough

theconferencemanagers(ConferenceInnovators),pleaseensureyour

accountissettledinfullpriortoyourdeparture.

Airport Transfers AucklandInternationalandDomesticAirportis40minutesbycarfrom

theViaductEventsCentre(allow60minutesinrushhour).

Thereareanumberofcompaniesthatprovidetransporttotheairport.

Shouldyouwishtopre-book,wesuggesttheoperatorsbelow,orask

yourhotelreceptiontobookitforyou.

SuperShuttle +6495225100

AirbusExpress +6493666400

16

Attendance at the Pleasewearyournamebadgewhenattendingallconferencesessions,

Conference and cateringareasandsocialfunctions.

Social Functions

Banking and CentralcitybanksareopenMondaytoFridayfrom9:00amto4:30pm.

ATM Machines ThenearestATMislocatedattheASBbuildinginNorthWharf.

Catering CateringisavailablewithintheExhibitionarealocatedonlevel1ofthe

ViaductEventCentre.

Luggage Storage It is preferable for you to ask your hotel concierge to arrange for

luggagestorageas therearenostorage facilitiesat theconference

venue.

Medical and AucklandCityMedicalCentre,locatedat8AlbertStreetistheclosest

Pharmacy Assistance medicalcentretotheconferencevenue(a12minutewalk).Theycan

becontactedon+6493775525.

TheclosestpharmacyisRadiusPharmacy,locatedat7QueenStreet

(a10minutewalk).

Messages Shouldyouneedtosendamessagetoanotherdelegate,pleasevisit

theregistrationdesk.

Mobile Phones Please ensure mobile phones are switched off prior to the start of

conferencesessions.

Name Badges Pleasewearyourconferencenamebadgewhenattendingconference

sessionsandwithinthevenue.

Parking No parking is available at the conference venue, however street

parking is available nearby, as is car parking at Wynyard Quarter

Carpark,entranceoffBeaumontStreetandMaddenStreet.Thefirst

hour is freeand$2.00everyhour thereafter.Pleasenote ratesare

currentattimeofprinting.

17

Smoking Smokingisnotpermittedattheconferencevenue.

Speaker Preparation TheSpeakerPreparationRoomislocatedinKawauRoom2(level1).

If you are speaking at the conference, please ensure you visit the

SpeakerPreparationRoomatleasttwohoursbeforeyourpresentation

(ideallyallowasmuchtimeaspossible).Thetechnicianwillloadyour

presentationandaskyoutocheckitbeforeyoursession.

Speaker Preparation Room hours:

Monday10March 0800-1800

Tuesday11March 0800-1800

Wednesday12March 0800-1800

Thursday13March 0800-1730

Special Diets Forthosedelegateswhoprovidedspecificdetailsduringregistration,

special dietary meals/options will be available in the main catering

area.Venuestaffwillbeavailabletoassist.

Wi-Fi Complimentary wireless access is available to all conference

delegates.PleasevisittheregistrationdeskfortheWi-Ficode.

18

2428

3 r1

.0

The Only CI System* for SSD in Both Children and Adults

medel.com* The MED-EL CI System is approved for Single-Sided-Deafness

(SSD) by the TGA and in countries that recognise the CE-MARK.

19

TUESDAY 11 MA

RCH

BIOENGINEERING AND THE PHYSIOME PROJECT

Hunter,P.

Auckland Bioengineering Institute, University of Auckland, New Zealand

Multi-scalemodelsoforgansandorgansystems,basedonmodelencodingstandards,arebeing

developedundertheumbrellaoftheIUPSPhysiomeProjectandtheVirtualPhysiologicalHuman

(VPH)projectfundedbytheEuropeanCommission.Thesecomputationalphysiologymodelsdeal

withmultiplephysicalprocesses(coupledtissuemechanics,electricalactivity,fluidflow,etc)and

multiplespatialand temporalscales.Theyare intendedboth tohelpunderstandphysiological

functionand toprovideabasis fordiagnosingand treatingpathologies inaclinicalsetting.A

longtermgoaloftheprojectistousecomputationalmodellingtoanalyseintegrativebiological

functionintermsofunderlyingstructureandmolecularmechanisms.Web-accessibledatabases,

basedonthestandards(whichincludeSBML,CellMLandFieldML),havebeenestablishedfor

modelsandmodel-relateddataatthecell,tissue,organandorgansystemlevels.Thistalkwill

discussrecentdevelopmentsintheVPH/PhysiomeProjectandtheapplicationofthesemulti-scale

modellingapproachestoseveralphysiologicalsystemsincludingthecardiovascularsystem,the

respiratorysystem,themusculo-skeletalsystemandthedigestivesystem.

20

TUES

DAY

11 M

AR

CH

BETTER UNDERSTANDING THE HETEROGENEITY OF TINNITUS TO IMPROVE AND DEVELOP NEW TREATMENTS – TINNET

Langguth,B.

University Hospital Regensburg, Department of Psychiatry and Psychotherapy

Tinnitusistheperceptionofsoundintheabsenceofacorrespondingacousticstimulus.InEurope

over70millionpeopleexperience tinnitusand for7million it createsadebilitatingcondition.

Establishedtherapeuticapproachesarelimitedandbettertreatmentisurgentlyneeded.

Brain researchhasdemonstrated that tinnitus is theconsequenceofalteredneuralactivity in

specificbrainareas.Thishaspromptedthedevelopmentofnewtherapeuticapproachesbuttheir

furtherdevelopmentishamperedbytheheterogeneityoftinnitusandlimitedknowledgeabout

theneuronalcorrelatesofthedifferenttinnitussubtypes.

TheCOST-Actionwillfostertheestablishmentofapan-europeanmultidisciplinarynetworkwith

themajorgoalstoidentifyclinicallyrelevanttinnitussubtypes,theirneurobiologicalunderpinnings

and their relevance for response to treatment. This will substantially speed up the clinical

investigationofnewtreatmentsandtheirtranslationintomarketableproducts.

21

TUESDAY 11 MA

RCH

CHARACTERISING THE PSYCHOSOCIAL EXPERIENCES OF CHRONIC TINNITUS SUFFERERS

Callander, K.J.;McLachlan,N.M.;Wilson,S.J.

Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia

Chronictinnitusishighlysubjective,bothintermsofthesoundexperienced,andanindividual’s

reactionstothesound.Whilesomepeopleareableto”tuneout”theirtinnitus,othersreportthat

theirexperienceoftinnitushasasubstantialnegativeimpactontheirpsychosocialfunctioning.

Thiscommonlyincludesfeelingsoflowmood,highanxiety,anddecreasedengagementin,and

enjoymentof,dailyroutines.Assuch,animportantstepinunderstandingthetinnitusexperience,

and thus helping sufferers, is the characterisation of the factors contributing to the observed

declineinpsychosocialfunctioning.Thus,theaimofthisstudywastocharacterisethesefactors,

aswellasidentifythosethatpredictanindividual’sabilitytoadjusttothepresenceoftheirtinnitus

frombothapsychologicalanddailyfunctioningperspective.

Method

37tinnitussufferers(15male)wererecruitedforthisstudywitharangeoftinnitusexperiences

fromchronicnon-bothersometinnitus,tochronicbothersometinnitus.Participantswereasked

to complete a series of questionnaires assessing mood, thinking strategies, health attitudes

andcopingstyles tocapture theirbroaderpsychosocialexperiences. Inaddition,participants

wereassessed for the impact their tinnitushadon theiremotion regulationandgeneraldaily

functioning.

Results

Preliminaryanalysesindicateanimportantdistinctionbetweentinnitussuffererswhoexperience

asignificantfunctionalimpairmentandthosewhoexperiencesignificantemotionaldysregulation

in response to their tinnitus. Contributing factors to thesedistinctpsychosocialoutcomeswill

beexplored,inparticular,theroleofdifferentcopingstrategies,attitudestowardsillness,mood,

andsubjectivetinnitusvariables,tocharacterisethesegroupsanddeterminethepredictorsof

each.Theseresultswillformthebasisofamodeloutliningthepsychosocialfactorsinfluencing

differencesinthetinnitusexperiencetoinformmoretargetedtreatmentstrategiesandthusassist

inimprovingtheexperiencesandcopingabilitiesoftinnitussufferers,andultimatelyfacilitationof

theirabilityto“tuneout”theirtinnitus.

22

TUES

DAY

11 M

AR

CH

SEASONAL AFFECTIVE DISORDER IN PATIENTS WITH CHRONIC TINNITUS

Kim,Y.H.

Department of Otolaryngology, Seoul National University Boramae Medical Center, Seoul, Korea

ObjectiveSeasonal affective disorder (SAD) is one type of depressions presenting in area with a big

seasonaldifference,especiallyshowingrecurrentdepressivesymptominwinter.Theaimofthis

study isto investigate incidenceofSAD,degreesofanxiety/depression/sleepdisturbance,and

characteristicsoftinnitusinchronictinnitus.

MethodsFrom December 2012 to November 2013, seventy-five patients with chronic persistent or

intermittenttinnituswereenrolledinthisstudy.Exclusioncriteriawerepulsatiletinnitus,tinnitusby

temporalbonetraumaorearsurgery,historyoftinnitustreatmentmorethan3monthspreviously,

historyofneuropsychologicaldiseaseordepression,abusehistoryofalcoholordrug,cognitive

dysfunction(brainlesionorsurgery),andsevereillnessmakingregularfollow-upandtreatment

difficult. Audiometry, tinnitogram, and questionnaire for anxiety/depression/sleep disturbance/

SADwereperformedinallpatients.

ResultsAmongtotal75chronictinnituspatientsenrolledinthisstudy,maletofemaleratiowas42:33

andmeanagewas55.3years.NumberofpatientssuggestingSADandsubclinicalSAD(S-SAD)

was7(9.3%)and9(12.0%),respectively.Thefavoriteseasonwasautumninmostcasesand

mostpatientsdislikedwinter.Therewere7patientsshowingcatastrophicscoremorethanTHI

76andtheproportionwas2/7(28.6%)inSADgroup,2/9(22.2%)inS-SADgroup,and3/59

(5.1%)incontrolgroupsuggestingthesignificantcorrelationbetweenSADandTHI.Therewas

no significant difference among audiogram and tinnitogram results in three groups.Anxiety/

depression/sleepdisturbancetestsshowedmoreabnormalfindingsinSADandS-SADgroups.In

particular,thepossibilityofdepressioninSAD/S-SADgroupswassignificantlyhighercompared

tothatofcontrolgroup(BDI>16:7/16(43.8%)vs10/59(17.0%);BDI>30:3/16(18.8%)vs1/59

(1.7%),respectively).

ConclusionInthepresentstudy,SADandS-SADweresuspectedinabout20%ofchronictinnituspatients

andthisdiseaseentitymaybeconsideredtomanagetinnituseffectively.

23

TUESDAY 11 MA

RCH

THE RELATION BETWEEN TINNITUS LOUDNESS, SLEEP DISORDERS AND EMOTIONAL DISTRESS

Jangholi, N. 1;GhodratiToostani,I.2,3;MauriceErnaClaessens,P.1

1 Universidade Federal do ABC, Center of Mathematics, Computer and Cognition, São Paulo, Brazil2 Research and Development department of Fannavaran Gostaresh Salamat (FGSco), Tehran, Iran3 Research and Development department of Neurophoneme, LA, USA

Introduction

Subjectivetinnitusisacommonhearingdisorderinwhichpatientssufferfromringing,buzzing

and other perceived noises without external source, due to a number of different possible

peripheral and central causes. Tinnitus often leads to cognitive impairment and emotional

distress,and,amongothercomplaints,avarietyofsleepdisturbances.Amongstandardexams

applied to tinnituspatientsareanaudiometricexam toestimate the intensityof thephantom

sound–tinnitusloudnessmatching(LM)–andinternationallyvalidatedquestionnairestoassess

thelevelofpsychologicalsufferinginducedbytinnitus,suchastheTinnitusQuestionnaire(TQ)

andTinnitusHandicapInventory(THI).Sleepdisturbanceisoneofthefactordimensionsofthe

TQforwhichascorecanbedeterminedbasedonasubsetoftheitems.Theobjectiveofthis

studyistoinvestigatetherelationbetweentinnitusloudnessasmeasuredbytheLMprocedure,

sleepdisturbance,andmeasuresofothercognitive,emotional,perceptualandsomaticstress

symptoms.

Materials and Methods

Completedataweregatheredfrom134maleandfemaleadulttinnituspatientsobtainedfrom

testreportsofFGSandNeurophonemeR&Ddepartments.Associationsbetweenloudness,THI

andtotalandsubscalesoftheTQintheir IranianversionswerecalculatedusingPearsonand

SpearmanrankordercorrelationsandPearsonchi-squaredtests.

Results

OnlytheSpearmancorrelationresultswillbereproducedinthisabstract,withtwo-sidedp-values.

RankordercorrelationsbetweendifferentdimensionsofTQ,andTHIandTQ,are, ingeneral,

moderate to high (>0.2) and statically significant (=0.05), as expected. Sleep disturbance is

particularly correlatedwith emotional distress (ρ=0.28, p=0.001), but,more surprisingly, the

correlationwithsubjectiveloudnessisnegativeratherthanpositive,andslightlysignificant(ρ=

24

TUES

DAY

11 M

AR

CH

-0.18,p=0.036).SubjectiveloudnessasmeasuredthroughLMalsohardlyhasanycorrelation

withemotionalandcognitivesymptomsintinnituspatients.

Conclusion

These results indicate that, while there seems to be a positive association between sleep

disturbance and emotional distress, there is no direct relation with tinnitus loudness. The

dissociationbetweensleeplessnessanddistresson theonehand,and loudnesson theother,

goesagainstearlierstudies,andshowsthenecessityofcarefulstudyandmodelingofpotentially

relativelyindependentsystemsforsensoryexperienceandsufferingduetotinnitus.

25

TUESDAY 11 MA

RCH

USE OF THE SIGNIFICANT OTHER TO GAUGE TINNITUS SEVERITY

Sheehan, T. 1;Davis,P.1,2

1 University of Miami Ear Institute Tinnitus Clinic2 Scientific Advisor to Neuromonics

Aims / Objectives

Tinnitusreaction isnotoriouslydifficult toquantity,andsufferers lackany internalreferenceto

benchmarktheirtinnitusovertime.Itispossiblethatthepatient’sSignificantOther’s(SO’s)perspective

might be helpful in measuring it, given that tinnitus can also greatly impact the SO’s quality

of life. The Significant Others Tinnitus Questionnaire (SOTQ) was thus developed to assess

the severity of the patient’s tinnitus disturbance from the SO’s perspective and also to more

directlyinvolvetheSOinthecounselingandrehabilitationprocess.

Methods

TheSOTQincorporatesfivekeyareasoftinnitusdisturbancethatarealsoquantifiedbythepatient

ontheTinnitusReactionQuestionnaire(TRQ).Threequestionsthatarealsoimportanttotheeffect

on the SO were added in addition to two questions on how often the patient spontaneously

mentionedtheirtinnitusaswellashowoftenitappearedthatthepatientwasdisturbedbytheir

tinnitus.TherewerealsofivequestionsonwhethertheSOthemselvessufferedfromtinnitus.The

samefive-responseoptionsystem(0-4)fromtheTRQwasthusutilizedforallSOTQitems.

The SOTQ was presented to the SOs as part of routine tinnitus evaluation and counseling

sessions on twenty-eight concurrent patients at the University of Miami Tinnitus Clinic.

Concurrently,thepatientcompletedtheTRQ.

Results and Discussion

DataonthefivecommonquestionsfromtheTRQwaspairedwiththeSO’scorrespondingSOTQ

questions;resultswerethenpooledasgroupeddata.Two-tailedpairedt-testswerecalculatedon

eachdomain,aswellasthecompositescores.

Mean results indicated that the SOs rated the patient’s avoidance of social situations as a

significantlymorefrequentproblemthanthepatientsdid.Perhapsthisislikehearingloss,where

thesocialsituationavoidancemightaffecttheSO’smorethanthepatientsthemselves.

Therewasnosignificantdifferencebetweenthetwogroupsintermsoftinnitusinterferingwiththe

patient’srelaxationandsleep,withbothdomainsbeingratedasquitefrequentlydisturbed.This

mightbebecausetheSOscanreadilydeterminethatthepatienthasalotoftroublerelaxingor

26

TUES

DAY

11 M

AR

CH

sleeping.

TheSOratedthepatient’sabilitytoworkasafrequentproblemonaverage,whilethepatient

rateditasmoreminor.Thissignificantdifferencedoesn’tyethaveaclearexplanation.

PatientsratedconcentrationasasignificantlymorefrequentproblemthantheSOs.Perhapsthis

istheonedomainthattheSOcan’treadilygauge.

Overall,thecompositescoremeandifferencesindicatedatrendwheretheSOratedtinnitusas

moredisturbingthanthesuffererdid,althoughthisdifferencewasnotsignificant.AstheSOsand

thepatientseachratedvariousdomainsmorehighlythantheother,thecompositescoretended

toaverageoutthosedifferences.

Conclusion

ThisdataindicatedthattheSO’sperspectiveisusefulinquantifyingapatient’stinnitusdistress,

andtheymaysufferasaresultofthepatient’stinnitus.Itwasanexcellentcounselingresource

thatempoweredtheSOstohelpintherehabilitationprocess,particularlyinmaintainingrealistic

expectations.

27

TUESDAY 11 MA

RCH

VALIDATION OF THE TINNITUS FUNCTIONAL INDEX IN A UK RESEARCH POPULATION

Hoare, D. 1;Fackrell,K.1;Barry,J.2;Hall,D.1

1 NIHR Nottingham Hearing Biomedical Research Unit, University of Nottingham, UK2 MRC Institute of Hearing Research, University Park, Nottingham, UK

Background

Chronic tinnitus isacommonandsometimesdisablingconditionyet there isnostandardized

approachtomeasuringitsimpactineithertheclinicalsettingorresearch.Forclinicalassessment

of tinnitus thepreferredquestionnaire in theUK is theTinnitusHandicap Inventory1.Thiswas

developed as a diagnostic tool to measure tinnitus severity. Although it lacks sensitivity to

treatment-relatedchangesintinnitusitisalsooftenusedasanoutcomemeasuresinbothclinical

practiceandresearch.CurrentalternativestotheTHIequallyonlymeasureseverity,oraregood

measuresofchange,butnotboth.Incontrast,theTinnitusFunctionalIndex(TFI)2wasdeveloped

tobeusedasbothadiagnosticmeasureofseverityandtobeasensitivemeasureoftreatment-

relatedchange.WearecurrentlyvalidatingthisquestionnaireforuseintheUK.

Methods

The present study evaluates theTFI as a diagnostic tool for the assessment of tinnitus in a

researchpopulation.Questionnairedatawasobtainedfromamulti-siteclinicaltrial.Aspartof

theinitialscreening,294participantscompletedsixscreeningassessmentquestionnaires;the

TFI,theBeck’sDepressionInventory(BDI),theBeck’sAnxietyInventory(BAI),theWorldHealth

OrganisationQualityofLifeBref(WHOQOL-BREF)theTinnitusHandicapInventory(THI),andthe

TinnitusHandicapQuestionnaire(THQ).100tinnitusparticipantscompletedtheTFIatasecond

visitbeforetheresearchintervention.WeevaluateddiscriminantandconvergentvalidityoftheTFI

withthislargecohort(N=247)comparingthesixassessmentquestionnaires.Test-retestreliability

andagreement(N=94)oftheTFIwereevaluatedusingIntra-classcorrelationcoefficients(ICC).

ConfirmatoryfactoranalysisinprogressusestheeightsubscalesidentifiedbyMeikleetal.(2012)

duringTFIdevelopment.

Results

ConvergentanddiscriminantvalidityoftheTFIrevealedhighcorrelationswiththeTHI(r=0.82)

andTHQ(r=0.82)andmoderatetolowcorrelationswiththeBDI(r=0.56),BAI(r=0.38)and

WHOQOL(r=-0.48).Test-retestreliabilityfortheTFIglobalscorewasextremelyhigh,withthe

28

TUES

DAY

11 M

AR

CH

ICC(95%CI)showingstrongcorrelationsbetweentwoadministrations (ICC=0.86,p<.001,

95%CI=0.8-0.9).OngoingCFA to be presented is predicted to demonstrate theTFI has a

multidimensionalquestionnairestructure.

Conclusion

Wecanconfirmthat theTFI isa reliablemeasureof tinnitus foruse inevaluatinga research

population.TheTFIdemonstrateshighdiscriminantandconvergentvalidityandextremelyhigh

test-retest reliability. It is expected that confirmatory factor analysis will show eight separate

domains.

1. Newman CW, Jacobson GP, Spitzer JB. Arch Otolaryngol Head Neck Surg, 1996; 122:143-148.

2. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R et al. Ear Hear, 2012; 33(2):153-76.

29

TUESDAY 11 MA

RCH

TINNITUS PRECEDED DEPRESSIVE SYMPTOMS IN COMMUNITY-DWELLING OLDER JAPANSES: A PROSPECTIVE COHORT STUDY

Mizutari, K.1,2;Michikawa,T.3,4;Nishiwaki,Y.5;Saito,H.1;Ogawa,K.1

1 Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Keio University,

35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan2 Division of Otolaryngology, National Center for Child Health and Development, 2-10-1 Okura,

Setagaya-ku, Tokyo 157-8535, Japan3 Environmental Epidemiology Section, Center for Environmental Health Sciences, National Institute

for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan4 Department of Preventive Medicine and Public Health, School of Medicine, Keio University, 35

Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan5 Department of Environmental and Occupational Health, School of Medicine, Toho University,

5-21-16 Omorinishi, Ota-ku, Tokyo 143-8540, Japan

Objective

Depressionhasastrongnegativeimpactonwell-beinginolderadults,soprimarypreventionof

depressionisdesirablefromapublichealthpointofview.Giventheassociationoftinnituswith

depressionandtheavailabilityoftreatmentfortinnitus,itisimportanttoestablishwhetherthe

associationisacausalone,namelywhethertinnitusisariskfactorofdepression.However,most

studiesof theassociationbetweentinnitusanddepressionhavebeencross-sectional,making

itdifficulttodrawanyconclusionsaboutthedirectionalityoftheassociation.Thisstudyaimed

toclarifywhethertinnitusprecedesthedevelopmentofdepressivesymptomsinageneralolder

population.

Methods

Weperformedthisstudy inKurabuchi town,Gunmaprefecture,Japan(approximately100km

northofTokyo).Forthepresentstudy,weselectedonlythosewhohadnodepressivesymptoms

(GDS5≤ 1) at baseline.Weperformedhealth examinations of535 residents (239men;296

women)aged65yearsorolderwithoutdepressivesymptoms(year:2005-2006).Informationon

tinnituswasobtainedviaaquestionnaire“Haveyoueverhadanyringing,buzzing,orothersounds

(tinnitus)inyourearswithinthepastyear?”Theresponseoptionswere“Yes”or“No”.Depressive

symptomswereassessedaccordingtotheGeriatricDepressionScale15-itemversion(GDS15)

inface-to-facehomevisitinterviewscarriedoutoncein2007andoncein2008.Inthepresent

study,participantswithscoresof6ormoreineither2007or2008wereconsidereddepressed.

30

TUES

DAY

11 M

AR

CH

Results

Duringtheaveragefollow-upperiodof2.5years,atotalof27menand56womenwerenewly

identifiedashavingdepressivesymptoms(GDS15≥6),givinganoverallincidenceofdepressive

symptomsof11.3%inmenand18.9%inwomen.Amongthemen,theincidenceofdepressive

symptoms was higher in those with tinnitus than in those without (20.5% vs. 9.5%). In the

multi-adjustedmodel,tinnituswassignificantlyassociatedwithanincreasedriskofdepressive

symptoms (relative risk=2.07; 95% confidence interval=1.01-4.25). On the other hand, no

associationbetweentinnitusanddepressivesymptomswasobservedinthewomen.

Conclusion

In thepresentstudy,Weobservedasex-specificassociationbetween tinnitusanddepressive

symptoms: the men with tinnitus had approximately twice the risk of developing depressive

symptomscomparedwiththemenwithouttinnitus,butnoapparentassociationwasfoundinthe

women.Ourstudyisthefirsttopresentdataonthetemporalassociationbetweentinnitusand

depressivesymptomsinageneralolderpopulation.Webelieveprimarycareprovidersandpublic

healthstaffshouldrecognizedtinnitusasariskfactorfordepressivesymptoms.Becausetinnitus

isacommoncomplaint inolderadults,effectivescreeningandmanagementare, if tinnitus is

confirmedasariskfactorofdepression,expectedtobeimportantforpreventingdepression.

31

TUESDAY 11 MA

RCH

VALIDATION OF THE TINNITUS FUNCTIONAL INDEX IN NEW ZEALAND

Chandra,N.1;Lee,A.2;Searchfield, G.1, 3

1 School of Population Health, The University of Auckland2 Epidemiology and Biostatistics, The University of Auckland3 Centre for Brain Research, The University of Auckland

Aims and objectives

Thesubjectivenatureof tinnitusnecessitates theuseofself-reportquestionnaires inorder to

assess tinnitus severity and evaluate the outcomes of treatments. The limitations of existing

tinnitusquestionnaireshaveledtothedevelopmentofanewquestionnaire,theTinnitusFunctional

Index(TFI),intheUnitedStates.TheaimsofthisstudyweretodetermineiftheTFIisareliable

andvalidmeasureofthenegativeimpactsandseverityoftinnitusinNewZealand,andtofindout

whethertheTFIneedstobemodifiedforuseintheNewZealandcontext.

Methods

SecondarydatafromtwostudiesconductedattheUniversityofAucklandwereused.Principal

components factor analysis with varimax rotation to an eight-factor solution was undertaken

to investigate the internalstructureof theTFI. Internalconsistencyreliabilitywasexaminedby

computing theCronbachCoefficientAlpha for theTFIand itssubscales. IntraclassCorrelation

Coefficientswerecomputedtoassessthetest-retestreliabilityoftheTFIanditssubscales.To

evaluate convergent validity, Pearson correlations between theTFI scores and scores on the

Tinnitus Handicap Questionnaire (THQ) and Tinnitus Severity Numerical Scales (TSNS) were

computed.Pearson correlationsbetween theTFI scores and scores on theHearingHandicap

Inventory(HHI)werecomputedtoevaluatedivergentvalidity.

Results

The internalstructureof theTFI remainedunchangedfromtheUSA.TheCronbachAlphaand

IntraclassCorrelationCoefficientsweregreaterthan0.7fortheTFIoverallandforeachofthe

8subscales,indicatinghighinternalconsistencyreliability.Therewashightest-retestreliability.

StrongPearsoncorrelationswiththeTHQandTSNS,andamoderatecorrelationwiththeHHI,

indicatedstrongconvergentanddivergentvalidity.

Conclusions

Thesefindings indicate that thisnewquestionnaire isa reliableandvalidmeasureof tinnitus

32

TUES

DAY

11 M

AR

CH

severityinNewZealandandcanthereforebeusedforassessingtinnituspatientsintheclinical

context.TheunchangedfactorstructureindicatesthattheTFIdoesnotneedmodificationforuse

inNewZealand.Italsoindicatesthattheresultsofclinicaltrialsevaluatingtheeffectivenessof

treatmentinterventions,thatusetheTFIasanoutcomemeasure,canbecomparedbetweenthe

UnitedStatesandNewZealand,as thequestionnaire itemsmeasure thesamedimensionsof

tinnitusseverityinbothcountries.

33

TUESDAY 11 MA

RCH

ARE PEOPLE WITH TINNITUS SATISFIED WITH THEIR INTERACTION WITH THE HEALTHCARE SYSTEM?

Carmody,N.1,2;Eikelboom,R.H1,2

1 Ear Sciences Centre, School of Surgery, The University of Western Australia

2 Ear Sciences Institute Australia

Background

Thereislimitedresearchonpeoplewithtinnitusandtheirinteractionwiththehealthcaresystem.

Researchshowsthatpeoplewhoseekhealthcarefortinnitusreportlowsatisfactionwithdiagnosis

andtreatment(Redmond,2010).Thereismuchscopetoimprovediagnosticsandtreatmentfor

peoplewithtinnitus(Hoare&Hall,2011).

Aims

Toexaminewhetherpeoplewith tinnitusaresatisfiedwith the interactionwith thehealthcare

system,consideringfactorssuchasseverityoftinnitusandhealthstatus.

Methods

Twocohortswereused:(i)Cohort1:Volunteersfromthecommunity,presentingwithtinnitus,aged

18yearsandoverfromthemetropolitanareaofPerth,WesternAustraliaand(ii)Cohort2:Those

self-reportingtinnitusinanepidemiologicalstudyofpeoplebornbetween1946to1964fromthe

ShireofBusselton,WesternAustralia.Afivepartquestionnairewasadministered:TinnitusSample

CaseHistoryQuestionnaire–Adapted(TSCHQ),TinnitusReactionQuestionnaire(TRQ),Glasgow

HealthStatusInventory–allpurpose(GHSI),PatientSatisfactionwithCommunication(PSC)and

theFunctionalAssessmentofChronicIllnessTherapy-TreatmentSatisfaction-General(FACIT-

TS-G).

Results/Discussion

Ofthe332peoplewhoparticipated(Cohort1n=180andCohort2n=152),281completedthe

survey:Cohort1 (n=150;meanTRQscore:19.09,SD:17;meanage:58.94,SD:13.24)and

Cohort 2 (n=131; meanTRQ score: 11.83, SD:14.85; mean age: 59.74, SD:5.04).TRQ<17

indicatedsub-clinicaltinnitus.AnalysisshowedasignificantrelationshipbetweenTRQ>=17score

andCohort1,agecategory,andlowerhealthstatus(GHSItotalscore).Seekinghealthcarewas

significantlyassociatedwithTRQ>=17,Cohort1,self-reporthearingloss,thoseonmedication

andlowerhealthstatus.Forthosewhosoughthealthcare(Cohort1n=90andCohort2n=57)

34

TUES

DAY

11 M

AR

CH

fewwereofferedtreatment(Cohort1n=27andCohort2n=6).Meansatisfactionratingforinitial

diagnosishadnosignificantrelationshipswithcohort,gender,self-reportofhearinglossorage.

Themeansatisfactionratingforinitialtreatmentwassignificantlyrelatedwithgender,withmales

morelikelytobelesssatisfiedandmorelikelytohavetreatmentoffered.Meandiagnosisand

meantreatmentsatisfactionratingswerelow.Seekingmorethanonetreatmentwassignificantly

relatedtoCohort1andTRQ>=17,althoughthenumberofpeoplewhosoughtmorethanone

treatmentwaslow.

Conclusion

The study shows that those who sought healthcare tended to report dissatisfaction with the

healthcaretheyreceivedandthosewhoreportedgreatertinnitusinterferenceandlowerhealth

statusweremorelikelytoseekhealthcare.Moreresearchandimprovementsinhealthcarefor

tinnitusarerequired.

References

Hoare, D. J., & Hall, D. A. (2011). Clinical Guidelines and Practice A Commentary on the Complexity of Tinnitus

Management. Evaluation & the Health Professions, 34(4), 413-420.

Redmond, S. (2010) ‘What’s that Noise? A profile of personal and professional experience of tinnitus in NI,

RNID, London

35

TUESDAY 11 MA

RCH

TINNITUS IN NEW ZEALAND

Wu, B.1; Exeter, D.1; Searchfield, G.D.2,3

1 Epidemiology and Biostatistics, The University of Auckland2 Audiology Section, The University of Auckland3 Centre for Brain Research, The University of Auckland

Aims and objectives

ThereisthelackofpopulationdatafortinnitusinNewZealand.Itisoftenpresumedthattinnitus

prevalenceinNewZealandisthesameasNorthAmericaortheUnitedKingdom,howeverNew

ZealandhasalargeMaori,PacificandAsiancommunity.Theaimofthisstudywastodetermine

thecharacteristicsoftinnitusintheNewZealandpopulation.

Methods

AspartofahouseholdsurveyRoyMorganResearchquestionned69,976peopleacrossNew

ZealandbetweenAugust2007andJuly2013,ofwhom4,771(6.8%)responded‘yes’tohaving

tinnitus.Thedatawasexploredwithregardtogender,age,ethnicity,region,andincomealong

withotherhealthandlifestylefactors.

Results

The adjusted prevalence of tinnitus was 6.0% for the total population. The prevalence was

higheramongmen(6.5%)comparedtowomen(5.5%).Menare16%morelikelytohavetinnitus

comparedtowomen.Theprevalenceoftinnitusincreasedwithageaffecting13.5%ofpeopleage

≥65years;thisagegroupaccountsforoverone-thirdofallpeoplewithtinnitus.Theprevalence

of tinnituswashighest amongNZEuropean (7.1%), accounting for86%of all tinnitus in the

totalpopulation.Three-quartersofallcasesoftinnitusoccurredintheNorthIsland.Themean

prevalenceoftinnitusacrossallmajorcentreswas6.0%,althoughnearlyone-third(27.2%)of

alltinnituscasesoccurredinAuckland.Therewasnosignificantdifferenceintinnitusprevalence

betweenpeopleearning$50,000ormore,andpeopleearning$49,999orless.

Conclusions

ThissurveydataprovidessomeinsightintotinnitusinNewZealand.Furtheranalysiswillexplore

the relationship between tinnitus, other heath related factors, and technology use by people

experiencingtinnitus,soastoassistinthedevelopmentandplanningofnewtreatmentsolutions

fortinnitus.

36

TUES

DAY

11 M

AR

CH

CLINICAL CHARACTERISTICS OF PATIENTS WITH TINNITUS EVALUATED WITH TINNITUS SAMPLE CASE HISTORY QUESTIONNAIRE IN JAPAN

Kojima, T.;Kanzaki,S.;Oishi,N.;Watabe,T.;Inagaki,Y.;Wakabayashi,S.;Yamada,H.;Ogawa,K.

Department of Otolaryngology – Head & Neck Surgery, Keio University School of Medicine, Tokyo,

Japan

Background

At theTinnitusResearch Initiative inRegensburg,Germany in2006,anattemptwasmade to

gainaconsensus forpatientassessments.Throughworkshops,TinnitusSampleCaseHistory

Questionnaire (TSCHQ) was determined as a standardized questionnaire to obtain a patient’s

casehistoryand tocharacterizecandidates intosubgroups [1]. In this study,wedevelopeda

JapaneseversionofTSCHQforevaluatingclinicalcharacteristicofpatientswithtinnitusinJapan.

Thiswillbeavailableforcomparingamongtinnitusresearchcentersandevaluatingtreatments

fortinnitus.

Aims / Objectives

To evaluate clinical characteristic of patients with tinnitus in Japan using a newly-developed

JapaneseversionofTSCHQ.

Methods

The subjectswerepatientswith subjective tinnituswhowere examinedat the otolaryngology

departmentsof twouniversityhospitals,fivegeneralhospitalsandsixEar-Nose-Throatprivate

clinicsbetweenAugust2012andDecember2012 inJapan. In thisstudy,336patientswere

included:159malesand177females;andagerangingfrom18to91yearsold(meanage,61.2

years).Eighty-ninepatientsvisiteduniversityhospitals,177patientsvisitedgeneralhospitals,and

70patientsvisitedclinics.

Results

TheJapaneseversionofTSCHQshowedhighavailabilitytoobtainvariouspatients’information;

suchasbackground,tinnitushistory,influencesaffectingtinnitus,andaccompanyingconditions.

37

TUESDAY 11 MA

RCH

Discussion

Wecomparedourstatisticstodatafromothercountries,andfoundsomedifferenceinoursamples.

Forexample,anumberofpatientswithtinnitusgeneratedfromanacoustictraumawerefewer

thanreportedinwesterncountries.Oneofthepossiblereasonsisthatthereisnoconscription

systeminourcountry.Patientswithtinnituswhovisiteduniversityhospitalsdemonstratedmore

serious symptoms than patients who visited other institutions, although patients can directly

accessanymedicalcentersbecauseofuniversalcoveragehealthinsurancesysteminJapan.In

ordertostandardizesetofdataoftinnituspatientsovertheworld,weshouldbecareaboutsubtle

differencewhenTSCHQistranslatedtodifferentlanguagesespeciallyoutsidewesterncountries.

Conclusion

TheJapaneseversionofTSCHQisausefultooltoevaluatepatientswithtinnitusatanyinstitutions

in Japan. Results of this multicenter study reflect an attribute of patients with tinnitus who

requiremedicalcareinJapan.Ourdatacanbeabasisofaninternationalcomparisonoftinnitus

epidemiologyindifferentcentersandcountries.

References

1.Langguth B, Goodey R, et. al. Prog Brain Res. 2007;166:525-36

38

TUES

DAY

11 M

AR

CH

CLINICALLY RELEVANT CHANGES ON THE PRIMARY TINNITUS OUTCOME MEASURES; NORMS AND RELIABLE CHANGE ANALYSES

Cima, R.1, 2;Vlaeyen,J.2,3

1 Adelante, centre of expertise in rehabilitation and audiology2 Maastricht University, Clinical Psychological Science3 University of Leuven, Research group Health Psychology

Aims / Objectives

Tinnitusisasubjectiveexperienceandthereforedifficulttomeasureandquantify,andseveral

tinnitusmeasuresfortheassessmentoftheimpactoftinnitusoncognitive,emotional,physical,

andauditory functioning,havebeendevelopedover time.Themost frequentlyusedmeasures

for tinnitus distress are the tinnitus questionnaire (TQ) and the tinnitus handicap inventory

(THI).Althoughbothhave theirmerits, theyarealsoconceptuallyhybrid in that theyassessa

combinationofdifferentconstructsatthesametime.Avalidandreliablemeasuretoassessmore

generalfunctionaldisability,i.e.theinterferenceoftinnituswithperformanceonmajordailylife

activities, is theTinnitusDisability Index (TDI).Afirstpsychometricexaminationsupportedthat

theTinnitusDisability index(TDI), introducedasanovelunitarybrief index, isavalidmeasure

forassessingtinnitus-relateddisability indaily life.TheTDIwasfoundtobeabriefandeasily

administeredindex,withgoodtestretestreliability,capturingaunitaryconstruct,namelytinnitus

disability.GivenfortheTQandtheTHInonormsexistfordeterminingclinicallyrelevantchanges,

orforindicatingsub-groupsofpatients,andthatTDIisanewlydevelopedassessmentinstrument,

morework isneedednotonly inthereplicationof thesefirstfindings,butalso inestablishing

norms,suchthatforeachindividualameaningfullevelofdisabilitycanbeidentified.

Method

Arecentandpromisingmethodisbasedonregressionmodels.Thisapproachoffersatleast2

advantages.First,multiple regressionallowsdeterminationofpatient-variableswhichareand

whicharenot relevant to thenorming (validity). Second, byusing information from theentire

sample,multipleregressionleadstocontinuousandmorestablenormsforanysubgroupdefined

in terms of prognostic variables (reliability).These models will be used to determine patient-

variablesandprognosticvariablesinacross-sectionalsampleofN=600,aswellasonasample

ofa2-grouprandomized,repeatedmeasuresdesign(N=492)

39

TUESDAY 11 MA

RCH

Results

Analyseswillrevealrelevantnormsforinterpretingtherawscoresofpatients.Moreover,result

assist in outcome comparisons across scientific patient studies, as well as in clinical and

diagnosticdecision-making.

Conclusions

Normswillbeestablished,basedonthecomparisontothevaluesofscoresofarelevantreference

populationusingregressionmodelsofrawscoresondemographicandotherpatientvariables.

Comparedwithtraditionalnormingmethods,thisapproachoffersatleasttwoadvantages:first,

itallowsdeterminationofwhichpatientvariablesarerelevanttothenormingandwhicharenot

(validity).Second,byusinginformationfromtheentiresampleratherthansubgroupsbasedon

genderandage,multipleregressionleadstocontinuousandmorestablenormsforanysubgroup

thatisdefinedintermsofprognosticvariables(reliability).

40

TUES

DAY

11 M

AR

CH

ASSESSMENT OF HYPERACUSIS SEVERITY USING QUESTIONNAIRES AND ITS CLINICAL USEFULNESS

Sakashita, T.;Kato,S.;Yamane,H.

Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School

of Medicine, Osaka, Japan

Backgrounds

Hyperacusis, commonly described as hypersensitivity to sound, is a condition in which some

ordinary or well-tolerated sounds to most people are experienced as extremely loud or

uncomfortablewithdistress.Self-reportinstrumentsareusefultoassesstheseverityofsubjective

phenomenasuchashyperacusis.Therearetwomajorvalidatedquestionnairesfrequentlyused

forassessinghyperacusis:theHyperacusisQuestionnaire(HQ)devisedbyKhalfaetal.(2002)and

theGermanquestionnaireonhypersensitivitytosound(GÜF)developedbyNeltingetal.(2002).

However,thereisnoestablishedJapanesequestionnaireforhyperacusisclinicallyusedinJapan.

Aims

Weprepared Japanese-translated versions ofHQandGÜF.Thepurpose of this studywas to

examine the clinical usefulness of these two questionnaires by assessing the severity of

hyperacusisintheJapanesepatients.

Patients and Methods

Thirty-fourJapanesepatientsvisitingouruniversityhospitalwithacomplaintofhyperacusiswere

included.Theyunderwentthepsychoacousticmeasurementofhearingthresholdsbystandard

pure-tone audiometry and uncomfortable loudness levels (ULLs) and completed the following

questionnaires: the Japanese versions of HQ and GÜF, Self-rating Depression Scale (SDS),

and State-TraitAnxiety Inventory (STAI). Several months after the first examination, a second

administrationofHQandGÜFwasconductedin18patients.

Results

The total scores for HQ and GÜF ranged from 3 to 35 with an average of 18.0 (SD = 7.4)

and from 1 to 37 with an average of 16.0 (SD = 8.3), respectively. Both scores seemed to

demonstratenormaldistributionandweresignificantlycorrelated.NeithertotalHQnortotalGÜF

scoressignificantlycorrelatedwithULLandthedynamicrange,whichisthedifferencebetween

thehearing thresholdsandULLs.On theotherhand, statistically significant correlationswere

41

TUESDAY 11 MA

RCH

observedbetweenthetotalscoresforGÜFandthoseforSDSandSTAI.However,TheHQscores

demonstratednosignificantcorrelationswithSDSandSTAIscores.Onthesecondadministration

of HQ and GÜF, a change of nine points or more in total scores of both questionnaires was

observedinmostpatientswithsubjectivelyclearchange(markedlyimprovementorexacerbation)

inhyperacusis,whereasthischangewaslessthan8pointsinmostpatientswhosubjectivelyfelt

noclearchanges(slightornoimprovement)oftheirsymptom.

Conclusion

The Japanese versions of HQ and GÜF are considered useful for clinical assessment of

hyperacusis severity because of the normal distribution of their total scores and appropriate

changesinscoresforsubjectivechangesinhyperacusisseverity.Theresultsalsosuggestthat

theemotionalaspectsofGÜFaremoresatisfactorythanthoseofHQ.Large-scalestudiesshould

beconductedtoconfirmthevalidityandreliabilityofthesetwoquestionnaires.

42

TUES

DAY

11 M

AR

CH

EFFECT OF DRINKING ALCOHOL, BATHING, AND EXERCISING ON TINNITUS

Kato, S.;Sakashita,T.;Yamane,H.

Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School

of Medicine, Osaka, Japan

Background and aims

Tinnituspatientsoftencomplainthattheseverityoftheirtinnituschangesinsomesituationsin

theirdaily life.Thischange,althoughvariable,seemstohaveasomewhatcommontendency.

Theaimofthisstudywastoevaluatethechangesintinnituswhileperformingcommonactivities

ofdaily living (e.g.,drinkingalcohol,bathing,andexercising),and toexamine thecorrelations

amongthem.

Patients and Methods

Twohundredand fourteenpatients visitingouruniversityhospitalwithacomplaintof tinnitus

answered questions regarding how the severity of tinnitus changed in each of the following

situations:drinkingalcohol(moderately),bathing(relaxinginabathtub),andexercising.

Accordingtotheirresponsesforeachsituation,thepatientsweredividedinto3groups(improved,

unchanged,orworsened)andthecorrelationsamongthesewereexaminedusingPearson’s2

test.

Results

1. Drinking alcohol: Of the 214 cases, 93 were non-drinkers and were excluded. In the

remaining121cases,tinnitusimprovedin41(33.9%),remainedunchangedin63(52.1%),

andworsenedin17(14.0%).

2. Bathing:Tinnitusimprovedin89(41.6%),remainedunchangedin104(48.6%),worsenedin

19(8.9%),andwasobscurein2(1.0%)cases.

3. Exercising:Mostofthepatientswereseniorsandtheirexercisesvaried(e.g.,jogging,walking,

orplayingtennis,golf,orping-pong),but8didnotperformanyexercise.Intheremaining

206cases,tinnitusimprovedin110(53.4%),remainedunchangedin78(37.9%),worsened

in16(22.3%),andwasobscurein2(1.0%).

4. Correlationbetweendrinkingalcoholandbathing:Inthedrinking-improvedgroup(41cases),

tinnitus improved in23, remainedunchanged in13,andworsened in5onexercising. In

thedrinking-unchangedgroup(63cases),tinnitusimprovedin32,remainedunchangedin

30,andworsened in1onexercising. In thedrinking-worsenedgroup (17cases), tinnitus

43

TUESDAY 11 MA

RCH

improvedin9,remainedunchangedin7,anddidnotworseninanycaseonexercising;1

patientdidnotexercise.Thecorrelationwasnotsignificantbetweenthesetwosituations.

5. Correlationbetweendrinkingalcoholandbathing:Inthedrinking-improvedgroup(41cases),

tinnitusimprovedin24,remainedunchangedin13,worsenedin3,andwasobscurein1

onbathing.Inthedrinking-unchangedgroup(63cases),tinnitusimprovedin22,remained

unchangedin39,andworsenedin2onbathing.Thecorrelationwassignificant(p<0.05).

6. Correlationbetweenbathingandexercising:Intheexercising-improvedgroup(110cases),

tinnitusimprovedin68,remainedunchangedin34,andworsenedin8onbathing.Inthe

exercising-unchangedgroup(78cases),tinnitusimprovedin16,remainedunchangedin56,

worsenedin5,andwasobscurein1.Intheexercising-worsenedgroup(16cases),tinnitus

improvedin3,remainedunchangedin8,worsenedin4,andwasobscurein1.Nosignificant

correlationwasnotedbetweenthesetwosituations(p<0.01).

Conclusions

Thechangeintinnitusseverityvarieswhiledrinkingalcohol,bathing,andexercising.However,the

changesduringbathingandexercisingaswellasduringdrinkingandbathingweresomewhat

similar.

44

TUES

DAY

11 M

AR

CH

PROPOSAL OF THE CLASSIFICATION OF TINNITUS SEVERITY AND MANAGEMENT

Takahashi, M.1;Kabaya,K.1;Sekiya,Y.2;Murakami,S.1

1 Nagoya City University Medical school2 Sekiya ENT clinic

Objective

Tinnitusisasensationthatsometimescausessuffering.Generally,tinnitusevaluationhavebeen

usedbytinnitusquestionnaires.TinnitusHandicapInventory(THI)byNewmanetal.isthemajor

questionnaireintheworld.Wealsousethisfortinnitusevaluation.However,manyofthetinnitus

patienthavepsychologicalproblem,especiallydepressionandanxiety, it isdifficulttoevaluate

of tinnitusseveritybyTHIonly.Sincepurposeof treatment forchronic tinnitus is tohabituate

itself,TinnitusRetraingTherapy(TRT)consistsofdirectivecounselingandsoundtherapyhave

beenuseful,but inpractice,Wehavebeentreatedwithacombinationofantidepressantsand

psychotherapy for severe tinnitus patients. Therefore we make the classification of tinnitus

severity,andplantotreatmentalongtinnitusseverity.

Method(s)

We analyzed 113 cases of tinnitus patients that were treated byTRT over 6 months at the

Department of otolaryngology, Nagoya city university hospital and Kasugai city hospital.

Tinnitus severitywasevaluatedbyTHI, psychological scalewasevaluatedbyHospitalAnxiety

and Depression Scale (HADS), and four catastrophic items were answered.We classified the

tinnitus patients by THI scores, HADS and catastrophic items into four categories. To make

treatmentcourseofeachcategories,weinvestigatedthattinnituspatientshavebeentreatedof

psychotherapeuticdrugsandpsychotherapy.

Result(s)

Numbersofgrade1are38patients,andaverageofTHIscore is37.6±12.2points,average

ofHADSscore is10.9±4.5points,catastrophic itemare0point.Numbersofgrade2are24

patients,THIscoreis70.6±8.6points,HADSscoreis13.1±3.5points,catastrophicitemsare

0points.Numbers of grade3are38patients,THI score is 64.7±19.3points,HADS score is

20.9±8.1points,catastrophic itemsare0.87points.Numberofgrade4are13patients,THI

scoreis73.2±16.8,HADSscoreis22.4±3.5,catastrophicitemsare2.2points.

45

TUESDAY 11 MA

RCH

Wehavejustinvestigatedwhetherreceivedpsychotherapeuticdrugtreatmentforeachcategory,

2.6%ingradeI,4.2%ingradeII,44.7%ingradeIII,84.6%ingradeIV,themedicationenough

toseverestageswasusedincombination.Psychotherapyaswell,27.3%weretreatedatgrade

III,53.8%ingradeIV.

Conclusion(s)

BecauseitisdifficulttoevaluatefortinnitusseverityonlyTHI,wemadeaclassificationforit.We

suggestedthattinnitusshouldbetreatedalongseverityoftinnitus.

46

TUES

DAY

11 M

AR

CH

CHARACTERISING THE PSYCHOSOCIAL EXPERIENCES OF CHRONIC TINNITUS SUFFERERS

Callander, K.J.;McLachlan,N.M.;Wilson,S.J.

Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia

Chronictinnitusishighlysubjective,bothintermsofthesoundexperienced,andanindividual’s

reactionstothesound.Whilesomepeopleareableto”tuneout”theirtinnitus,othersreportthat

theirexperienceoftinnitushasasubstantialnegativeimpactontheirpsychosocialfunctioning.

Thiscommonlyincludesfeelingsoflowmood,highanxiety,anddecreasedengagementin,and

enjoymentof,dailyroutines.Assuch,animportantstepinunderstandingthetinnitusexperience,

and thus helping sufferers, is the characterisation of the factors contributing to the observed

declineinpsychosocialfunctioning.Thus,theaimofthisstudywastocharacterisethesefactors,

aswellasidentifythosethatpredictanindividual’sabilitytoadjusttothepresenceoftheirtinnitus

frombothapsychologicalanddailyfunctioningperspective.

Method

37tinnitussufferers(15male)wererecruitedforthisstudywitharangeoftinnitusexperiences

fromchronicnon-bothersometinnitus,tochronicbothersometinnitus.Participantswereasked

to complete a series of questionnaires assessing mood, thinking strategies, health attitudes

andcopingstyles tocapture theirbroaderpsychosocialexperiences. Inaddition,participants

wereassessed for the impact their tinnitushadon theiremotion regulationandgeneraldaily

functioning.

Results

Preliminaryanalysesindicateanimportantdistinctionbetweentinnitussuffererswhoexperience

asignificantfunctionalimpairmentandthosewhoexperiencesignificantemotionaldysregulation

in response to their tinnitus. Contributing factors to thesedistinctpsychosocialoutcomeswill

beexplored,inparticular,theroleofdifferentcopingstrategies,attitudestowardsillness,mood,

andsubjectivetinnitusvariables,tocharacterisethesegroupsanddeterminethepredictorsof

each.Theseresultswillformthebasisofamodeloutliningthepsychosocialfactorsinfluencing

differencesinthetinnitusexperiencetoinformmoretargetedtreatmentstrategiesandthusassist

inimprovingtheexperiencesandcopingabilitiesoftinnitussufferers,andultimatelyfacilitationof

theirabilityto“tuneout”theirtinnitus.

47

TUESDAY 11 MA

RCH

SEASONAL AFFECTIVE DISORDER IN PATIENTS WITH CHRONIC TINNITUS

Kim,Y.H.

Department of Otolaryngology, Seoul National University Boramae Medical Center, Seoul, Korea

ObjectiveSeasonal affective disorder (SAD) is one type of depressions presenting in area with a big

seasonaldifference,especiallyshowingrecurrentdepressivesymptominwinter.Theaimofthis

studyisto investigate incidenceofSAD,degreesofanxiety/depression/sleepdisturbance,and

characteristicsoftinnitusinchronictinnitus.

MethodsFrom December 2012 to November 2013, seventy-five patients with chronic persistent or

intermittenttinnituswereenrolledinthisstudy.Exclusioncriteriawerepulsatiletinnitus,tinnitusby

temporalbonetraumaorearsurgery,historyoftinnitustreatmentmorethan3monthspreviously,

historyofneuropsychologicaldiseaseordepression,abusehistoryofalcoholordrug,cognitive

dysfunction(brainlesionorsurgery),andsevereillnessmakingregularfollow-upandtreatment

difficult. Audiometry, tinnitogram, and questionnaire for anxiety/depression/sleep disturbance/

SADwereperformedinallpatients.

ResultsAmongtotal75chronictinnituspatientsenrolledinthisstudy,maletofemaleratiowas42:33

andmeanagewas55.3years.NumberofpatientssuggestingSADandsubclinicalSAD(S-SAD)

was7(9.3%)and9(12.0%),respectively.Thefavoriteseasonwasautumninmostcasesand

mostpatientsdislikedwinter.Therewere7patientsshowingcatastrophicscoremorethanTHI

76andtheproportionwas2/7(28.6%)inSADgroup,2/9(22.2%)inS-SADgroup,and3/59

(5.1%)incontrolgroupsuggestingthesignificantcorrelationbetweenSADandTHI.Therewas

no significant difference among audiogram and tinnitogram results in three groups.Anxiety/

depression/sleepdisturbancetestsshowedmoreabnormalfindingsinSADandS-SADgroups.In

particular,thepossibilityofdepressioninSAD/S-SADgroupswassignificantlyhighercompared

tothatofcontrolgroup(BDI>16:7/16(43.8%)vs10/59(17.0%);BDI>30:3/16(18.8%)vs1/59

(1.7%),respectively).

ConclusionInthepresentstudy,SADandS-SADweresuspectedinabout20%ofchronictinnituspatients

andthisdiseaseentitymaybeconsideredtomanagetinnituseffectively.

48

TUES

DAY

11 M

AR

CH

THE RELATION BETWEEN TINNITUS LOUDNESS, SLEEP DISORDERS AND EMOTIONAL DISTRESS

Jangholi, N.1;GhodratiToostani,I.2,3;MauriceErnaClaessens,P.1

1 Universidade Federal do ABC, Center of Mathematics, Computer and Cognition, São Paulo, Brazil2 Research and Development department of Fannavaran Gostaresh Salamat (FGSco), Tehran, Iran3 Research and Development department of Neurophoneme, LA, USA

Introduction

Subjectivetinnitusisacommonhearingdisorderinwhichpatientssufferfromringing,buzzing

and other perceived noises without external source, due to a number of different possible

peripheral and central causes. Tinnitus often leads to cognitive impairment and emotional

distress,and,amongothercomplaints,avarietyofsleepdisturbances.Amongstandardexams

applied to tinnituspatientsareanaudiometricexam toestimate the intensityof thephantom

sound–tinnitusloudnessmatching(LM)–andinternationallyvalidatedquestionnairestoassess

thelevelofpsychologicalsufferinginducedbytinnitus,suchastheTinnitusQuestionnaire(TQ)

andTinnitusHandicapInventory(THI).Sleepdisturbanceisoneofthefactordimensionsofthe

TQforwhichascorecanbedeterminedbasedonasubsetoftheitems.Theobjectiveofthis

studyistoinvestigatetherelationbetweentinnitusloudnessasmeasuredbytheLMprocedure,

sleepdisturbance,andmeasuresofothercognitive,emotional,perceptualandsomaticstress

symptoms.

Materials and Methods

Completedataweregatheredfrom134maleandfemaleadulttinnituspatientsobtainedfrom

testreportsofFGSandNeurophonemeR&Ddepartments.Associationsbetweenloudness,THI

andtotalandsubscalesoftheTQintheir IranianversionswerecalculatedusingPearsonand

SpearmanrankordercorrelationsandPearsonchi-squaredtests.

Results

OnlytheSpearmancorrelationresultswillbereproducedinthisabstract,withtwo-sidedp-values.

RankordercorrelationsbetweendifferentdimensionsofTQ,andTHIandTQ,are, ingeneral,

moderate to high (>0.2) and statically significant (=0.05), as expected. Sleep disturbance is

particularly correlatedwith emotional distress (ρ=0.28, p=0.001), but,more surprisingly, the

correlationwithsubjectiveloudnessisnegativeratherthanpositive,andslightlysignificant(ρ=

49

TUESDAY 11 MA

RCH

-0.18,p=0.036).SubjectiveloudnessasmeasuredthroughLMalsohardlyhasanycorrelation

withemotionalandcognitivesymptomsintinnituspatients.

Conclusion

These results indicate that, while there seems to be a positive association between sleep

disturbance and emotional distress, there is no direct relation with tinnitus loudness. The

dissociationbetweensleeplessnessanddistresson theonehand,and loudnesson theother,

goesagainstearlierstudies,andshowsthenecessityofcarefulstudyandmodelingofpotentially

relativelyindependentsystemsforsensoryexperienceandsufferingduetotinnitus.

50

TUES

DAY

11 M

AR

CH

USE OF THE SIGNIFICANT OTHER TO GAUGE TINNITUS SEVERITY

Sheehan, T.1;Davis,P.1,2

1 University of Miami Ear Institute Tinnitus Clinic2 Scientific Advisor to Neuromonics

Aims / Objectives

Tinnitusreaction isnotoriouslydifficult toquantity,andsufferers lackany internalreferenceto

benchmarktheirtinnitusovertime.Itispossiblethatthepatient’sSignificantOther’s(SO’s)perspective

might be helpful in measuring it, given that tinnitus can also greatly impact the SO’s quality

of life. The Significant Others Tinnitus Questionnaire (SOTQ) was thus developed to assess

the severity of the patient’s tinnitus disturbance from the SO’s perspective and also to more

directlyinvolvetheSOinthecounselingandrehabilitationprocess.

Methods

TheSOTQincorporatesfivekeyareasoftinnitusdisturbancethatarealsoquantifiedbythepatient

ontheTinnitusReactionQuestionnaire(TRQ).Threequestionsthatarealsoimportanttotheeffect

on the SO were added in addition to two questions on how often the patient spontaneously

mentionedtheirtinnitusaswellashowoftenitappearedthatthepatientwasdisturbedbytheir

tinnitus.TherewerealsofivequestionsonwhethertheSOthemselvessufferedfromtinnitus.The

samefive-responseoptionsystem(0-4)fromtheTRQwasthusutilizedforallSOTQitems.

The SOTQ was presented to the SOs as part of routine tinnitus evaluation and counseling

sessions on twenty-eight concurrent patients at the University of Miami Tinnitus Clinic.

Concurrently,thepatientcompletedtheTRQ.

Results and Discussion

DataonthefivecommonquestionsfromtheTRQwaspairedwiththeSO’scorrespondingSOTQ

questions;resultswerethenpooledasgroupeddata.Two-tailedpairedt-testswerecalculatedon

eachdomain,aswellasthecompositescores.

Mean results indicated that the SOs rated the patient’s avoidance of social situations as a

significantlymorefrequentproblemthanthepatientsdid.Perhapsthisislikehearingloss,where

thesocialsituationavoidancemightaffecttheSO’smorethanthepatientsthemselves.

Therewasnosignificantdifferencebetweenthetwogroupsintermsoftinnitusinterferingwiththe

patient’srelaxationandsleep,withbothdomainsbeingratedasquitefrequentlydisturbed.This

mightbebecausetheSOscanreadilydeterminethatthepatienthasalotoftroublerelaxingor

51

TUESDAY 11 MA

RCH

sleeping.

TheSOratedthepatient’sabilitytoworkasafrequentproblemonaverage,whilethepatient

rateditasmoreminor.Thissignificantdifferencedoesn’tyethaveaclearexplanation.

PatientsratedconcentrationasasignificantlymorefrequentproblemthantheSOs.Perhapsthis

istheonedomainthattheSOcan’treadilygauge.

Overall,thecompositescoremeandifferencesindicatedatrendwheretheSOratedtinnitusas

moredisturbingthanthesuffererdid,althoughthisdifferencewasnotsignificant.AstheSOsand

thepatientseachratedvariousdomainsmorehighlythantheother,thecompositescoretended

toaverageoutthosedifferences.

Conclusion

ThisdataindicatedthattheSO’sperspectiveisusefulinquantifyingapatient’stinnitusdistress,

andtheymaysufferasaresultofthepatient’stinnitus.Itwasanexcellentcounselingresource

thatempoweredtheSOstohelpintherehabilitationprocess,particularlyinmaintainingrealistic

expectations.

52

TUES

DAY

11 M

AR

CH

VALIDATION OF THE TINNITUS FUNCTIONAL INDEX IN A UK RESEARCH POPULATION

Hoare, D.1;Fackrell,K.1;Barry,J.2;Hall,D.1

1 NIHR Nottingham Hearing Biomedical Research Unit, University of Nottingham, UK2 MRC Institute of Hearing Research, University Park, Nottingham, UK

Background

Chronic tinnitus isacommonandsometimesdisablingconditionyet there isnostandardized

approachtomeasuringitsimpactineithertheclinicalsettingorresearch.Forclinicalassessment

of tinnitus thepreferredquestionnaire in theUK is theTinnitusHandicap Inventory1.Thiswas

developed as a diagnostic tool to measure tinnitus severity. Although it lacks sensitivity to

treatment-relatedchangesintinnitusitisalsooftenusedasanoutcomemeasuresinbothclinical

practiceandresearch.CurrentalternativestotheTHIequallyonlymeasureseverity,oraregood

measuresofchange,butnotboth.Incontrast,theTinnitusFunctionalIndex(TFI)2wasdeveloped

tobeusedasbothadiagnosticmeasureofseverityandtobeasensitivemeasureoftreatment-

relatedchange.WearecurrentlyvalidatingthisquestionnaireforuseintheUK.

Methods

The present study evaluates theTFI as a diagnostic tool for the assessment of tinnitus in a

researchpopulation.Questionnairedatawasobtainedfromamulti-siteclinicaltrial.Aspartof

theinitialscreening,294participantscompletedsixscreeningassessmentquestionnaires;the

TFI,theBeck’sDepressionInventory(BDI),theBeck’sAnxietyInventory(BAI),theWorldHealth

OrganisationQualityofLifeBref(WHOQOL-BREF)theTinnitusHandicapInventory(THI),andthe

TinnitusHandicapQuestionnaire(THQ).100tinnitusparticipantscompletedtheTFIatasecond

visitbeforetheresearchintervention.WeevaluateddiscriminantandconvergentvalidityoftheTFI

withthislargecohort(N=247)comparingthesixassessmentquestionnaires.Test-retestreliability

andagreement(N=94)oftheTFIwereevaluatedusingIntra-classcorrelationcoefficients(ICC).

ConfirmatoryfactoranalysisinprogressusestheeightsubscalesidentifiedbyMeikleetal.(2012)

duringTFIdevelopment.

Results

ConvergentanddiscriminantvalidityoftheTFIrevealedhighcorrelationswiththeTHI(r=0.82)

andTHQ(r=0.82)andmoderatetolowcorrelationswiththeBDI(r=0.56),BAI(r=0.38)and

WHOQOL(r=-0.48).Test-retestreliabilityfortheTFIglobalscorewasextremelyhigh,withthe

53

TUESDAY 11 MA

RCH

ICC(95%CI)showingstrongcorrelationsbetweentwoadministrations (ICC=0.86,p<.001,

95%CI=0.8-0.9).OngoingCFA to be presented is predicted to demonstrate theTFI has a

multidimensionalquestionnairestructure.

Conclusion

Wecanconfirmthat theTFI isa reliablemeasureof tinnitus foruse inevaluatinga research

population.TheTFIdemonstrateshighdiscriminantandconvergentvalidityandextremelyhigh

test-retest reliability. It is expected that confirmatory factor analysis will show eight separate

domains.

3. Newman CW, Jacobson GP, Spitzer JB. Arch Otolaryngol Head Neck Surg, 1996; 122:143-148.

4. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R et al. Ear Hear, 2012; 33(2):153-76.

54

TUES

DAY

11 M

AR

CH

DEVELOPMENT OF OBJECTIVE MEASUREMENT FOR TINNITUS

Kanzaki, S.1; Takayama, K.2; Mitsukura, Y.2; Oishi, N.1; Yamada, H1; Inagaki, Y.1;Wakabayashi,S.1;Kojima,T.1;Ogawa,K.1

1 Department of Otolaryngology- Head and Neck Surgery, Keio University School of Medicine,

Tokyo, Japan2 Department of Information and Computer Science, Keio University, Tokyo, Japan

Aims / Objectives

No objective test is available for most tinnitus cases, and diagnosis is made on the basis of

medicalhistory.Inthisstudy,wedevelopthenoveldevicetoobjectivelydetecttinnitus.

Methods

Wedevelopedtheportableelectroencephalography(EEG)deviceandmeasuredattheirleftsideof

FP1ofEEGalone.FP1islocatedonforeheadareaandisreflectedbyhighercognitiveprocesses

includingattentionandrelaxationalgorithms. Thepatientsgroupwithchronic tinnitusandno

tinnitus(healthyvolunteers)groupweretestedandanalyzedbyourdevice.IRBwasapprovedin

KeioUniversityHospital.

Results

There are three EEG patterns at FP1 we obtained; patternA (lower spectrum at higher EEG

frequencies),patternB-1(8-9HzatEEGpeak),B-2(10-11HzatEEGpeak),patternC(alphaand

betawavesatpeaks).Innotinnitusgroup(N=25),twentysubjectspresentedpatternB-2,four

forpatternB-1,oneforpatternA.Ontheotherhand, in tinnitusgroup (N=25),11people for

patternA,7forpatternB-1,4forB-2,3forpatternC.ThetypicalpatternintinnitusgroupisB-2

(peakfrequency10-11Hz).FivesubjectsofnotinnitusgrouppresentedB-2pattern,suggesting

falsepositive.

Conclusion

This study indicated that this measurement device of FP1 we developed can detect tinnitus

objectively(sensitivity;84%,specificity;80%).FP1mayreflectanxietyofpatientswithtinnitus.

Thefurtherstudyofanalyzingpathophysiologicalbackgroundwillbenecessary.

55

TUESDAY 11 MA

RCH

METAPLASTICITY: BRAKE OR ACCELERATOR FOR PLASTICITY?

Abraham,W.C.

Department of Psychology and Brain Health Research Centre, University of Otago

Synapticplasticity isa fundamentalmechanismof learning,and thuscritical forall cognition.

Toomuchortoolittleplasticity,however,canleadtoabnormallevelsofneuralactivityandthus

dysfunctionalnetworks.Mechanismsmustbepresentthereforethatcanhomeostaticallyregulate

plasticitycapabilitytohelpkeepneuralactivitywithinsafelimits.Ontheotherhand,thereare

times, for example during learning,whenplasticitymay need to be temporarily up-regulated.

Thegeneralabilityofpriorneuralactivitytoregulatefutureplasticityistermed“metaplasticity”.

Understanding of specific homeostatic and non-homeostatic metaplasticity mechanisms may

helpwithidentifyingmechanismsandpotentialtreatmentsofconditionswhereneuralactivityis

unusuallysustainedorreduced.

56

TUES

DAY

11 M

AR

CH

RESPONSIVENESS TO THREATENING SOUNDS: A SELECTIVE ATTENTION PARADIGM

Cima, R.1,3;Schrooten,M.5;Janssen,S.4;Vlaeyen,J.1,2

1 Maastricht University, Clinical psychological Science2 University of Leuven, research group health psychology3 Adelante, centre of expertise in rehabilitation and audiology4 University of Leuven, Research Group Experimental Oto-rhino-laryngology5 Örebro university, Center for Health and Medical Psychology

Aims / Objectives

The impact of tinnitus on cognitive resources has scarcely been studied experimentally. We

presentlyhypothesizethatresponsivenesstotinnitusisdeterminedbytheperceivedharmfulness

ofthetinnitus, i.e. thethreat-appraisalofthesound, leadingto lowertolerancetosoundand

depletion of cognitive resources.The influence of perceived threat value of neutral tones on

responsiveness was studied in a selective attention paradigm with healthy individuals. It was

hypothesisedthatperformanceonaprimarydecisiontaskisnegativelyinfluencedbyincreased

perceivedthreatofdistractingneutraltones.

Method

FirstandsecondyearpsychologyandspeechpathologystudentsoftheKULeuvenwererecruited

(N=70).Individualswithahearingloss(cut-offatapuretoneaverageon1,2and4kHzof35dB

hearinglevel),orchronictinnituscomplaints,wereexcluded.Participantswererandomlyassigned

tooneoftwothreatconditions,high-threat(HT)versuslow-threat(LT).Bothgroupswereexposed

tobothpuretones(4kHz,70dB)andwarbles(4kHz,70dB,modulatedby100Hz,moderation

frequencyof20Hz)whileperformingacognitivedecisiontask.Inthethreat-conditioneitherthe

puretoneorthewarblewasmanipulatedtoincreasethreat-valueofthetone(counterbalanced).

AmixedmodelANCOVAwith‘threat’ (highvs. low)as thebetweensubjects factorand‘Tone’

(warblevs.puretone)asthewithinsubjectsfactorwasconducted,withresponsetimesonthe

decisiontaskastheoutcomevariable.

Results

Theexpectedinteractionbetweenthreatandtone-typereachedsignificance,F(1,113)p=.03.

AnalysesshowedamaineffectofthreatF(6.04)p=.02,η²=.16andnottonetypeF(.38)

p>.05,η²=.01.

57

TUESDAY 11 MA

RCH

Conclusions

Exposuretoan(initiallyneutral)tone,whichismanipulatedtohaveincreasedthreat-value,will

depletecognitiveresources.Exposuretothreateningtoneshasdetrimentaleffectsoncognitive

taskperformanceinnormalsubjects.Theseresultsshedlightintothemechanismsunderlying

tinnitusanditsinterruptiveeffectsondailytasks.

58

TUES

DAY

11 M

AR

CH

NOISE PROTECTION FOR HYPERACUSIS PATIENTS WITH STRESS ON TEACHERS

A CASE PRESENTATION OF A NEW APPROACH

Specific aspects of noise protection for patients with hyperacusis with particular stress

on teachers.

Lux-Wellenhof,G.

Tinnitus und Hyperakusis Centre Frankfurt/Main, Kaiserhofstr. 10, 60313 Frankfurt/Main,

Germany

Aim

ItisachallengeforeveryacousticianandENT-doctortoprovidenoiseprotectionfortinnitus-and

hyperacusispatients.Theproblemisevenmoredifficultforteacherswhoworkinclassrooms

with backgroundnoise and reverberation andat the same time theirworknecessitates good

speechunderstanding.

Understandingofspeechinaclassroomcouldbedifficultevenforapersonwithnormalhearing,

butitisespeciallychallengingforthosewithhearingdisorders.Thesepeopleneedbetteracoustic

conditionsforunderstanding.

Wedevelopednoiseprotectionfordifferentprofessionalgroupsworking innoisysurroundings

withspecialemphasisonpersonswithtinnitusandhyperacusis.Apartfromimprovingthequality

oflifeforthesepatients,thesenewpossibilitiesofnoiseprotectionhelptopreventlossofworking

hours.

Outof110patientswetreatedsuccessfullyoverthelast3yearswepresentonecasewhichis

exemplaryasteachersinclassroomsareexposedtodisturbingnoisesfromthechildrenandon

theotherhandhavetounderstandthemclearly.

Method

Case:A36yearoldteacherwithsound-speechaudiogramsdifferingonbothsides,hyperacusis

approx.70–75dB,notabletocontinueherteachingjob.InJanuary2013wesuppliedherwitha

combinationofsoundgeneratorsandafrequencyamplifierwhichenhancessoundinthespeech

rangeand/orcompensatesforhearingloss.

Thechallenge inprovidingnoiseprotection forhyperacusispatients iskeeping thebalanceof

59

TUESDAY 11 MA

RCH

noiseprotection.Toomuchprotection is not helpful, because it increases thegainwithin the

auditorysystemconsequentlyincreasinghyperacusis.Toolittleprotectioncouldannoythepatient

andconsequently increasehyperacusis.Ourpatientwearsdynamicnoiseprotection,a“sound

brake”,whichproducesadefinednoiselevel,thesocalled“digitalsoundseparatingtechnology”.

Thismeansaninstrumentwithasoundmanagerfordisturbingnoises(soundcleaning)which

suppresses disturbing noises and enhances speech.We chose an instrument with automatic

directionalmicrophonesandwirelessfunctionsothatbothinstrumentscanbeadjustedatthe

sametime.

Result

Soundgenerator,frequencyamplifierand“soundbrake”arematchedandcanbeadaptedtothe

respectivesoundsituation.Symptomsofhyperacusisarerelieved,leadingtorelaxationofbody

andpsyche,decreaseofstresslevelandlastingimprovement.

OurpatientisteachingagainsinceAugust2013.

Conclusion

Thismethodprovesveryeffectiveinmanyofourpatients.Itisagoodwaytoreintegratepatients

intheirworkinglives,thusbeingbeneficialforthepatientsandforthecommunity.

60

TUES

DAY

11 M

AR

CH

GENTLE SKIN STIMULATION MODULATES THE BALANCE BETWEEN THE SYMPATHETIC NERVE AND THE VAGAL NERVE AMONG NORMAL ADULT

Nakagawa, M.1;Tanuma,F.2;Fukasawa,S.3;Mori,Y.4;Watanabe,S.5

1 International University for Health and Welfare Hospital, Tochigi, Japan2 International University for Health and Welfare Hospital, Tochigi, Japan3 The Graduate School for the Creation of New Photonics Industries, Shizuoka, Japan4 Salesian Polytechnic, Tokyo, Japan5 Shizuoka Sangyo University, Shizuoka, Japan

Background

Thereisasimplemethodformeasuringheartratevariabilitycalled“StandingUptest”thatisa

veryeasyexamination.Whenasubjectsitsonthechair,onehasalowrestingheartrate.Butafter

standingupone’sheartratewillbegreaterthantherestingstate.Whenoneishealthy,itwillget

intoflatsmoothly.Butsomeresearchersalarmthatitwillbesomepredictionforthemortality.

On theotherhand, theStandingUp testbasedheart ratevariability isanactualphysiological

phenomenon caused by the autonomic nervous system.This system consists of sympathetic

systemandCardiacvagalnervoussystem.Thispresentstudy,weevaluateswhether theskin

stimulation canmodulate thebalancebetween the sympatheticnerveand the vagal nerve in

humansubjectsusingMicroCone.Lux

About Micro Cone

Theadhesiveplastercalled“MicroCone” isproduces inJapanesemarketsasasubstituteof

painkillermedicinebyTotoResinInc.Itpossessesa376ofnano-sizedconeon1cmdiameterof

theplasticdiskwiththeplaster.TheefficacyoftheMicroConefortheneuropathicpaininhuman

wasreported.AstheresultsofthemodulationoftheneuraltransmissionofA-deltafiberand

Cfiber,thresholdofpainwillbereducedinthesamemanneroftheGateControlTheory.Inthe

anesthetizedanimalstudy, theneural transmissionwas restrained regardlessofattentionand

recognitionbysomaticsensationandtheusabilitytestofthecardiacsympatheticnervereflection

bymechanicalskinstimulation.ThesemeansthatMicroConeSkinStimulationhasthecapability

oftheinfluenceforasympatheticnerveandtheinteractionofthevagalnerve.

Subjects and Methods

21healthynormaladultsubjectsareemployedinthestudy.3typesoftheskinstimulationwere

takenforthestudy;Realplaster(SC-II),Sham-1plaster(plasteronly)andSham-2plaster(disc

61

TUESDAY 11 MA

RCH

withoutthemicro-cone).Whenthesubjectputtheplasterunderthedoubleblindcondition,one

performedaStandingUptestandwascheckedthepNN50duringthestandingstate.pNN50

wascalculatedwithRRintervalofone’splethysmogram(StressChecker2,AzumioInc).Subject

performsalltypesofplasteratrandom(NN50isthenumberofintervaldifferencesofsuccessive

NN(RR)intervalsofheartrategreaterthan50msec.pNN50istheproportionderivedbydividing

NN50bythetotalnumberofNNintervals).

Results

ThegrandaveragedscoreofpNN50issignificantlydifferentamongtheseplaster:44.9%(ave.)

inSham-1,41.0%inSham-2and26.4%inRealPlaster(SC-II).ThedifferencesamongtheGA

scorewereconfirmedwiththestatisticalmeaningofStudentt-test.

Conclusion

It isconfirmedthat theunder thresholdSkinStimulationmodulates theBalancebetweenthe

sympatheticnerveandthevagalnerveusingMicroCone.Asthesamemeaningofvagalnerve

stimulationorGalvanicSCMelectricalstimulation,thisskinstimulationtechnologycanbeapplied

forthetinnitustreatment.

62

TUES

DAY

11 M

AR

CH

ON THE PERCEPTUAL AND NEURONAL VARIABILITY IN CHRONIC TINNITUS

Schlee, W.;Herrmann,J.;Pryss,R.;Langguth,B.

Clinic and Policlinic for Psychiatry and Psychotherapy, University Hospital Regensburg, Germany

Institute for Databases and Information Systems, University of Ulm, Germany

Subjective tinnitus is defined as an auditory perception in the absence of any physically

identifiablesourceforit.About5-10%ofthepopulationreportanongoingandchronicperception

ofthetinnitussound–buthowchronicisthisperception?Isthetinnitusconstantly“on”,orare

therealsoperiodswere the tinnitus isperceived less? Indeed,more than60%of thechronic

tinnitussubjectsreportavariabilityofthetinnitusperceptionbetweendays,buttodatewedon’t

understandwherethisvariabilitycomesfromandifthisisanimportantindicatorforthetreatment

responseofthesubjects.Inordertomeasurethiswithin-personvariabilityoftinnitusperception,

wedevelopedanexperiencesamplingapplicationrunningonsmartphonesthatisabletotrack

theindividualtinnitusperceptionanddistressduringthedayunderrealworldconditions.Inthe

firstpartofthetalk,wewanttopresentpreliminaryresultsofthisstudy.

Withthesecondpartofthetalkwewanttoconcentrateonthevariabilityofneuronalactivityin

theauditorycortex.Chronictinnitusisusuallyassociatedwithadecreaseofthealphafrequency

oscillatorypowerintemporalareas.Hereweshow,thatalsothemoment-to-momentvariability

ofthealphaactivityislargelyreducedinchronictinnitus.Mostimportantly,itcanbeshownthat

thisneuronalvariability isassociatedwith the tinnitusduration.Subjectswitha longerhistory

of tinnitus show lessalpha variability inauditory regions.Whether thesechanges inneuronal

variabilityrelatetotheperceptualvariabilityremainstobeseen.

63

TUESDAY 11 MA

RCH

ELDERLY PATIENTS BENEFIT FROM COCHLEAR IMPLANTATION REGARDING AUDITORY REHABILITATION, QUALITY OF LIFE, TINNITUS AND PSYCHOLOGICAL COMORBIDITIES

Olze,H.1;Gräbel,S.1;Förster-Ruhrmann,U1;Mazurek,B.2

1 Department of Otorhinolaryngology, Charité- Universitätsmedizin Berlin, Germany2 Tinnitus Center, Charité- Universitätsmedizin Berlin, Germany

Aims / Objectives

Toevaluatetheeffectofcochlearimplantation(CI)onthehealthrelatedqualityoflife(HRQoL),

speechunderstanding,tinnitusimpairment,perceivedstressanddepressiveandanxietydisorders

inthe70+yearsold,postlinguallydeafenedpatientsandtocomparetheresultstotheseobtained

fromagroupofyoungerpatients.

Methods

Fifty-fivepostlinguallydeafenedadultsatleast6monthsafterCIwereincludedinthisstudy(20

patients≥70years/35patients<70years.Using5validatedquestionnaires,wehaveevaluated

the quality of life (NCIQ), tinnitus impairment (TQ), perceived stress (PSQ), depressive (ADSL)

and anxiety symptoms (GAD-7). In addition, speech perception in quiet and noise (Freiburg

monosyllables,HSMsentences,OldenburgInventory)wasdetermined.

Results

Cochlear implantation significantly increased theHRQoL inbothagegroups, asmeasuredby

theNCIQand itssixsubscales.ThespeechperceptionafterCIdidnotdiffer from thatof the

youngerpatients.Ofthe55patients,48(87%)reportedhavingchronictinnitusbeforeCI.Among

theolderpatients,tinnitus-induceddistresshadatendencytodecreasefollowingCI.Inpatients

whohadahighseverity leveloftinnitus,theTQscoredecreasedsignificantly intheolderand

youngergroup.Similarly,patientswithhighseverity levelofperceivedstress, thePSQscores

decreasedsignificantlyinbothagegroups.Nearly30%ofpatientshaddepressivedisordersprior

toCI.Numberof thesepatientsdecreasedto11%intheyoungerand1%intheoldergroup.

Furthermore,20%of the youngerand36%ofolderpatientshadsevereormoderateanxiety

disorder prior to CI. Older group of patients had no longer anxious symptoms after cochlear

implantation

64

TUES

DAY

11 M

AR

CH

Conclusion

The present study provides evidence that cochlear implantation represents a very successful

procedure of auditory rehabilitation, also for patients over 70. In addition, elderly patients

benefitfromCIwithincreasedqualityoflifeandareductionintinnitus,stressandpsychological

comorbidities.

65

TUESDAY 11 MA

RCH

TINNITUS: A SEMINAR IN THE LANCET

Hall, D.A.3;Baguley,D.1;McFerran,D.2

1 Cambridge University Hospitals NHS Foundation Trust, UK2 Colchester Hospital University NHS Foundation Trust, UK3 National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, UK

There has been significant progress in tinnitus research in recent times, which has led to a

deeperunderstandingofcauses,impacts,andeffectivetreatmentstrategies.Muchofthishas

beenpublishedinspecialistjournals,andnotreadilyavailabletothewiderclinicalandscientific

communities.We recently published a major review inThe Lancet - a journal that is hugely

wellrespected.Thesepeer-reviewed‘seminars’astheyareknownarecommissionedbyLancet

editors.Thepurposeofeachseminar is toprovideastate-of-the-art,broad-rangingoverview

ofadisease,coveringepidemiology,pathogenesis,diagnosis, treatment,andprevention,while

highlightingrelevantclinicalcontroversies.Theseminarsarerelevanttodoctorsandothermedical

professionalsanywhereintheworld,idealforexampreparation,andinvaluableasteachingtools

forclinicaltutorsworldwide.

Ourreviewsummarisespresentknowledgefromclinicalandauditoryneuroscienceperspectives

forallinterestedscientificandclinicalreaders.Whilstatreatmenttoabolishtinnituscompletely

continuestoeludeus,thisisanindicationofthetinnitusfieldcomingofage,andtroublesome

tinnitusbeingrecognisedasanissuethatrequiresurgentresearchandappropriateresources.

This poster summarises the main themes contained within our review and provides an ideal

opportunitytodisseminatetothewidertinnituscommunity.

Theviewsexpressedarethoseoftheauthor(s)andnotnecessarilythoseoftheNHS,theNIHRor

theDepartmentofHealth.

Reference

Baguley D, McFerran D, Hall DA. The Lancet, 2013; 382:9904:1600-7.

66

TUES

DAY

11 M

AR

CH

IS GENTLE SKIN STIMULATION MODULATING TINNITUS DISTRESS AMONG TINNITUS PATIENTS?

Tanuma,F.1;Nakagawa,M.2;Fukasawa,S.3;Mori,Y.4;Watanabe,S.5

1 Department of Ear Nose Throat, International University of Health and Welfare Shioya Hospital,

Tochigi, Japan2 Department of Ear Nose Throat, International University of Health and Welfare Hospital, Tochigi,

Japan3 The Graduate School for the Creation of New Photonics Industries, Shizuoka, Japan.4 Salesian Polytechnic, Tokyo, Japan5 Shizuoka Sangyo University, Shizuoka, Japan

Introduction

As the result of posture change (i.e., standup and standstill condition), it causes the pressor

reflex. This physiological change is based on the autonomic balance between sympathetic

nervoussystemandvagalnervesystem.Howeverthisresponsecanbemodulatedwithgentle

skinstimulation,thatDr.Nakagawadiscoveredandhavepresentedonthis8thTRImeeting.HRVis

dynamicallychangedwhenthegentleskinstimulationplaster(MicroCone,ToyoResinInc.)sticks

onthehallucalarea(ballofthethumb).

This technique might be applied for the neural modulation for the autonomic nervous system

insteadofotherinvasivemethods(i.e.,electricalvagalnervestimulation).

Inthepresentstudy,weevaluatewhethergentleskinstimulationmodulatestinnitusandrelated

distresswiththegentleskinstimulationastheresultsoftheneuralmodulationforthebalance

betweenthesympatheticnerveandthevagalnerveinhumansubjects.

Subject and Method

Fourteen severe and moderate tinnitus suffer participants were recruited among our out door

patients. Subjects undergo 3 months course of Micro Cone absorbed plaster treatment.Their

tinnitusseveritywasassessedwiththequestionnairesbeforethegentleskinstimulationtherapy

(GST)andafter3month.

Several questionnaires were taken as follows:Tinnitus Handicap Inventory-12 (THI-12), visual

analogscale(VAS)forTSSwandTRSwandetc.Thisstudyisdesignedwiththeshamcontrolled

doubleblindcondition.

67

TUESDAY 11 MA

RCH

Results

Therewasnostatisticalsignificantchangeamongallsubjectsbetweenbeforeandafter1month.

Finalresultsafter3monthsdatawillbepresentedonthesite.

Conclusion

Among total 14 patients with severe and moderate chronic tinnitus, some patients felt the

improvementofsymptomsafter1monthwithoutstatisticalconfirmation.GSTmighthavesome

potentialtobeconsideredmanagementmodalityfortinnitusevenwithdistressassevere.

68

TUES

DAY

11 M

AR

CH

MULTISENSORY CONTRIBUTORS TO TINNITUS: HEARING, PAIN, TASTE AND SMELL

Kerridge,M.1;Searchfield,G.1,2

1 Audiology Section, The University of Auckland2 Centre for Brain Research, The University of Auckland

Aims / objectives

Theliteraturedemonstratesthattinnituscanbemodulatedandelicitedthroughstimulationofthe

somatosensorysystem.Thisphenomenonisstillnotwellunderstood,andotheraspectsofthe

somatosensorysystemandtinnitushavenotbeenexplored.Theaimofthisstudyistoinvestigate

multisensorycontributorstotinnitusperceptionandtosubtypetinnitusintoauditory/nonauditory

contributors.Subtypingtinnitusiscrucialforbothresearchintotheunderlyingmechanismsand

thedevelopmentoftreatmentfortinnitus.

Methods

QuestionnairesweresenttoparticipantsfromtheUniversityofAucklandHearingClinicDatabase.

Analysis involved usingChi-squared and one-wayANOVA tests, and a cluster analysis, using

Ward’smethod, to subtype tinnitus into separategroupsof non-auditory sensory tinnitusand

auditorytinnitus.

Results

Statisticallysignificantrelationshipswerefoundbetweentinnitusseverityandspontaneoustaste

(p<0.001), spontaneoussmell (p<0.001),unexplainedpain (p=0.001),hearing impairment in

the leftear(p=0.028),hearing impairment intherightear(p=0.020),sensitivityto loudnoise

(p=0.004) and pain with tinnitus (p<0.001). The cluster analysis revealed three clusters of

participants with tinnitus; (1) participants who experience tinnitus rarely, (2) participants who

experiencetinnitusconstantly,(3)participantswhohavehearingimpairmentsandtinnitus.

Conclusions

Thesefindingssupportthehypothesisthatdifferentsensorysystemsmaycontributetotinnitus.

Thesefindingstakeresearchanotherstepclosertounderstandingtinnitusandthedevelopingof

moretargetedtreatment.

69

TUESDAY 11 MA

RCH

MULTISENSORY TRAINING FOR TINNITUS

Linford,T.;Spiegel,D.;Searchfield,G.D.

Audiology Section, The University of Auckland

Aims and objectives

This is a proof-of-principle study to investigate the viability of a home-based computerised

programmeinvolvingtinnitustrainingwithmultiplesensorymodalities.Twotrainingparadigms

weretrialled.Integrationtheorysuggestsiftinnitusispairedwithvisualandtactilefeaturesthat

fitwithgestaltprinciplesofgoodcontinuation,anobjectcanforminvolvingthetinnitusthatno

longerviolatesauditorysceneanalysis. Such integrationmayassist inadaptation to tinnitus.

Alternatively,attention-diversiontheorysuggestsifattentionistrainedawayfromthetinnitusside,

decreasesmaybeobservedintinnitusrelateddistress.Theaimsofthestudyweretodetermine

ifmultisensorytrainingwasapossibletreatmentfortinnitusbycombiningauditory,visualand

tactile stimuli and if the sensory-integration paradigm or attention-diversion paradigm was a

superiormethodforunilateraltinnitustreatment.

Methods

Arandomisedstudyincluded18participants,agedbetween41to75years,withpredominantly

unilateral tinnitus(11right,7 left).Psychophysicalandsubjectivemeasuresof tinnitusformed

theoutcomemeasures.Participantswererandomlyallocatedtooneoftwogroups,withauditory,

visualandtactilestimulipresentedineitherasensory-integrationorattention-diversiontraining

paradigmdevelopedspecificallyforthestudy.Participantswereprovidedwithlaptopcomputers

and trainedonahome-basedcomputerisedprogrammeover20consecutivedays for20-30

minutesperday.

Results

Themultisensorytrainingonaverageresultedinreducedtinnitusperceptionasevaluatedbythe

TFI (F2,32=5.254,p=0.011),withreducedscoresreflectingimprovements inthenegative

impactoftinnitusseverityandchangesthatoccurredduetotreatment.TheTSNSalsorevealed

improvements (F2,32=4.787,p=0.016)suggestiveofareduction inperceptionof tinnitus

loudness,discomfort,annoyance,ignorability,andunpleasantnessexperiencedbytheindividual.

TheTHIrevealedimprovementsbutwasnotstatisticallysignificant(F2,32=2.116,p=0.151).

Theresultsdidnotshowanyreliabledifferencebetweenthesensory-integrationandattention-

diversiongroups.Thepitchofparticipant’stinnitusdecreased(F1,16=11.209,p=0.004)over

thetrainingperiod.

70

TUES

DAY

11 M

AR

CH

Conclusions

This preliminary study revealed how a novel home-based computerised perceptual training

programme,involvingmultiplesensorymodalities,leadtoimprovementsintinnitus.Sometrends

butnostatisticallysignifantdifferenceswerefoundbetweentrainingtypes.Improvementsinboth

thesubjectiveimpactoftinnitusandthepsychophysicalcharacteristicswererecordedwhichmay

reflectplasticchangeswithinashorttimeframe.Furtherresearchisrequiredtoconfirmthese

findingsandmayinvolvetechniquestoenhanceplasticityandinvestigatetheneuralcorrelates

ofimprovementsobserved.

71

TUESDAY 11 MA

RCH

MULTISENSORY TINNITUS TREATMENT AND SACCADIC EYE MOVEMENTS

Spiegel,D.P.1,2;Thompson,B.2,3;Petoe,M.1,4;Kobayashi,K.1,2;Linford,T.1;Searchfield,G.D.1,2

1 Section of Audiology, School of Population Health, The University of Auckland, New Zealand2 Centre for Brain Research, The University of Auckland, New Zealand3 Department of Optometry and Vision Science, The University of Auckland, New Zealand4 The Bionics Institute of Australia, Melbourne, Australia

Aims / Objectives

Tinnitusistheconsciousawarenessofsoundwithoutanexternal,drivingsoundsource.Recent

evidence indicates thatcorticalandsubcortical regionsassociatedwithmemory,emotionand

attentionmaybeinvolvedintinnitus’pathophysiology.Inaddition,ithasbeenshownthatnumerous

interventions including attentional perceptual training and oculomotor and somatosensory

manipulations can modulate tinnitus perception. In the present study, we developed a novel

multisensorytreatmentfortinnitusrelyingonaudio,visual,andsomatosensorystimulation.Two

approacheswereadopted,wherebythestimuliwereusedtoeitherdivertattentionfromtinnitus

(attentiondiversion)ortointegratetinnituswithothersensorymodalities(integration).Saccadic

eyemovementswereanalyzedasaprobetomultisensoryinteractionsintinnitusandtoassess

theeffectsofthemultisensorytraining.

Methods

Eye tracking data were collected before and after multisensory treatment in a group of 16

participants(59.3years±10SD)withpredominantlyunilateraltinnitus.Participantsreceived20

daysofeitherintegration(N=9)orattentiondiversiontraining(N=7),wherebythegroupswere

matchedforageandTinnitusFunctionalIndex.Saccadeswereassessedintermsoftheirerror

rate,latency(thetimebetweenstimulusonsetandthebeginningofthesaccade),accuracy(the

endpointofthesaccadeinrespecttothetarget)andpeakvelocity.Saccadicdataforthetinnitus-

dominantandoppositesidewerecomparedbetweentheattentiondiversionandmultisensory

integrationgroups.

Results

No differences were found for saccadic measures between the two sides and groups before

thetraining.Themultisensorytrainingsignificantlyalteredtheerrorrateofthetrialsdirectedto

thetinnitussideby9.5%±2.8SEM(t8=3.409,p=0.009),wherebythiseffectwasspecific

72

TUES

DAY

11 M

AR

CH

onlytotheintegrationgroup(F1,14=6.662,p=0.022).Inaddition,thetreatmentresultedin

significantlyshorter latencies (F1,14=29.047,p<0.001),withcomparableeffectsonboth

sidesandgroups(F1,14=0.448,p=0.514).Noothermeasureswerereliablyaffectedbythe

training.

Conclusion

These preliminary results show that the novel multisensory treatment can affect oculomotor

function in tinnitus patients, as manifested by task-specific decrease of saccadic latency.

Specifically, the integrationmultisensorytrainingalteredthesaccadicerrorrate infavorofthe

non-tinnitus side. This finding suggests that multisensory interventions may be effective in

reducingtinnitussalienceandemergeasaviabletreatmentintervention.

73

TUESDAY 11 MA

RCH

A NONINVASIVE NEUROMODULATION APPROACH FOR TREATING TINNITUS UTILIZING MULTIMODAL ACTIVATION AND PLASTICITY

Markovitz,C.1;Smith,B.1;Gloeckner,C.1;Lim,H.1,2,3

1 University of Minnesota Department of Biomedical Engineering2 University of Minnesota Department of Otolaryngology3 University of Minnesota Institute for Translational Neuroscience

Objectives

Tinnitusaffectsapproximately250millionpeopleworldwideandhasbeen linked toabnormal

activityacrosstheauditorysystem.Weproposeanewnoninvasiveneuromodulationapproach

for treatingtinnituswhichwecallMultimodalStimulationTherapy(MST).Anunderappreciated

organization of the brain for treating neurological disorders is the dense and topographic

interconnectivity among sensory, motor, cognitive, and limbic centers.Through appropriately-

timed activation of different multimodal pathways, we hypothesize that MST can target and

modulateaberrantneuronalpopulationstosuppressthetinnituspercept.Weinitiallyinvestigated

theeffectsofcombinedauditoryandsomatosensorystimulationtoinduceauditoryplasticitythat

couldberelevantfortreatingtinnitus.

Methods

Wepositioned32-siteelectrodearraysthroughouttheinferiorcolliculus(IC)andprimaryauditory

cortex (A1) in ketamine-anesthetized guinea pigs and compared spontaneous and acoustic-

drivenactivityinbothregionsbeforeandafterMST.Subcutaneousneedleelectrodeswereused

toelectricallystimulatedifferentbodylocations,includingtheleftandrightlegs,back,leftand

rightshoulders,neck,leftandrightmastoids,andtongue.Eachbodyregionwaspairedwitha

broadbandnoiseorpuretonestimuluswithvaryingdelays.Wealsoperformedseveralcontrol

conditions,includingacousticstimulationalone,bodystimulationalone,andnostimulation.

Results

InICandA1,MSTinducedgreaterchangesinspontaneousandacoustic-drivenactivitycompared

to the control conditions. More significantly, the delay between somatosensory and acoustic

stimulation elicited differential neural effects. Body stimulation before acoustic stimulation

evokedvastinhibitionofICactivitywhilethereverseordercausedmorefacilitationofICactivity.

Similarly,therewasmorefacilitationofA1activityatonedelaythatwasnotthecaseforanother

delay.Thesechangesinactivationbasedontimingdifferencesareconsistentwithspike-timing

74

TUES

DAY

11 M

AR

CH

dependentplasticityresultsshownvia invasiveneuralstimulationprotocols.Furthermore,MST

couldcausedifferentialeffectsbyvaryingthe locationofbodystimulation.Stimulationofright

sidebodysitesinducedmoreinhibitionthanfacilitationintherightICandA1,whilethereverse

trendoccurredforstimulationofleftsidebodysites.Stimulationofupperbodysitesalsoinduced

more inhibitionthanfacilitation in IC,while thereversetrendoccurredforstimulationof lower

bodysites.ParticularlyforMSTwithpuretones,stimulationofleftbodysitescausedA1neurons

tobecomemoresensitivetothefrequencyofthepresentedpuretone.

Conculsion

MSTcaninducedifferentialchangesinfiringpatternsandsensitivitytoacousticstimuliacross

theauditorysystembyvaryingstimulationparameters.WestillneedtoinvestigateifMSTcan

systematicallyreverseneuralfeatureslinkedtotinnitus,suchashyperactivityandhypersynchrony,

aswellasbehaviorinatinnitusanimalmodel.SinceMSTisnoninvasive,wehavetheopportunity

totestMSTwithdifferentparametersandpathways(e.g.,auditory,somatosensory,visual,motor,

andlimbic)directlyintinnituspatientsthatareguidedbytheanimalfindings.

75

TUESDAY 11 MA

RCH

THE TEMPORAL CORTEX AND ITS ROLE IN A TINNITUS NETWORK. AN MEG-STUDY

Lau, P.;Pantev,C.

Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany

Aims / Objectives

Tinnitusisaphantomauditoryperceptwhichaffectsupto15%ofthepopulation.Itmostlikely

originates from maladaptive cortical reorganization and a hypersensitive, hyperactive auditory

cortex.Researchhasshownthatbrainoscillations–whicharethoughttoaccountforamajor

role in neural communication – differ between tinnitus patients and healthy controls (1).The

GlobalBrainModelofTinnitus(2)drawsabroaderframeworkforabrain-widebasisoftinnitus:it

proposesthatafronto-parieto-cingulatenetworkexertstop-downinfluenceonthelocalauditory

cortexinspecialfrequencyranges.

Methods

UsingfiveminutesrestingstateMEGdata,weexaminedseventeentinnituspatients(n=17)and

sixteenhealthycontrols(n=16)usingthematlabbasedFieldTripToolbox.DatawasICA-corrected

andartifactsremovedviathreshold(2.5pT).ConnectivitywasmeasuredthroughPartialDirected

Coherence(PDC).Toanalyzeinsourcespace,weusedabeamformerapproachandcreatedeight

“virtualchannels”representingareasaccordingtotheGlobalBrainModel.In-andoutflowwere

calculatedthroughnodedegrees,asummationofPDCvalues.

Results

Insensorspacewefoundanenhanceddeltaactivityinthetinnitusgroupcomparedtothehealthy

controlsintemporalareas.Theglobalpowershowedanalphareductioninthetinnitusgroup,yet

theeffectwasdrivenbyparietal,nottemporalareas.Preliminaryanalysisinsourcespacehints

toanalphareductioninthelefttemporalcortex.Furthermore,theinflowfromtheglobalnetwork

tolefttemporalareasseemstobereducedandtheinformationoutflowoutofthisareaenhanced

intinnituspatientscomparedtothecontrolgroup.

Conclusion

WewereabletoreplicateWeiszetal.findingsregardingtheenhanceddeltapowerintemporal

areasintinnituspatients.Yet,wecouldnotdemonstratethealpha-reductionintemporalareasin

sensorspace.Sourcespaceanalysisindicatesatemporallylocatedalphareduction,thoughonly

intheleftone.Theenhancedoutflowcouldrepresenttheauditoryhyperactivityandtheprominent

76

TUES

DAY

11 M

AR

CH

roleof theauditorycortex in the tinnitusnetwork, the lackof inflow thesimultaneous lackof

inhibitionexertedontheauditorycortexbyotherpartofthebrain,e.g.frontalareas.

1. Weisz, N, Moratti, S, Meinzer, M, Dohrmann, K, Elbert, T.; PLoS Med 2(6): e153

2. Schlee W, Lorenz I, Hartmann T, Müller N, Schulz H, Weisz N; In A.R. Møller, Kleinjung, T., Langguth, B., &

De Ridder, D. (Eds.), Textbook of Tinnitus: 161-169.

77

TUESDAY 11 MA

RCH

THE ROLE OF INDIVIDUAL PAIN TOLERANCE AND PAIN TRESHOLD IN BEARING TINNITUS

Aslan, S.1;Aksoy,S.1;YÄlmaz,T.2;Keser,I.3;Kirdi,N.4

1 Hacettepe University, Faculty of Health Sciences, Department of Audiology2 Turgut Özal University, School of Medicine, Department of ENT3 Gazi University, Faculty of Health Sciences, Department of Phsical Therapy4 Hacettepe University, Faculty of Health Sciences, Department of Phsical Therapy

Tinnitusisachronicanddisturbingsymptomthataffectsmillionsofpeopleworldwide.

Inthisstudy,thedifferences(andsimilarities)betweenshorttermandlongtermtinnitusandpain

isevaluated.Pain thresholdandpain toleranceofpatientswith tinnitusweremeasured three

timesandtheaveragewasrecorded.

Forty-fivepatientsattendingtheAudiologydepartmentofHacettepeUniversity(HU)Hospitalwere

evaluated.Patientsconsistedof19femaleand26male,withanagerangebetween24to79

years,anddurationoftinnitusofatleast3monthspriortotesting.Theresultswerecomparedto

acontrolgroupofhealthy(non-tinnitussufferers)individuals,20femalesand25males,withan

agerangebetween21and48years.

Painthresholdandpaintolerancemeasurementsofthepatientsandcontrolgrouphavebeen

recordedintheDepartmentofPhysicalTherapyandRehabilitationofHU.Thesemeasurements

weretakenusingelectricalstimulation.ForpainthresholdandtolerancemeasurementDimeq

MedModule5(Bosch)instrumentwasused.

Measurementsweremadeatroomtemperatureof22degreesCelsius,inasittingposition,90

degreesflexionoftheelbowandforearmpronationandSupination,whilerecordedbetweenthe

neutralpositions.Measurementsoftheradialsideoftheforearm,proximaltotherightpassive

electrode, theactiveelectrodewasplacedat thedistalendof theRadius. Thepatientswere

askedtorespondwhentheyfeelpainsensation.Painthresholdandpaintolerancemeasurements

were repeated for three times. The average of these three values obtained and recorded in

milliamp’s.Theresultsfromthepatientsgroupandthecontrolgroupwerestatisticallycompared

usingtheMann-WhitneyUtestandStudent’sT-Test.

78

TUES

DAY

11 M

AR

CH

Results

Therewasnostatisticallysignificantdifferenceinpainthresholdbetweenthestudyandcontrol

groups,thesamegoesforthepaintoleranceresults.

Conclusion

Itwaspossibletoendureshort-termpainandtinnitus.However,itwasnotpossibletoendurethe

painandtinnituswhenthedurationisincreased.

Tolerancetotinnituswasassociatedwithcorticalfamiliarization(habituation)orbrainplastisite

andcorticalprintmaking (suppression).Researchandstudies in thisdirectionareexpected to

givepositiveresults.

79

TUESDAY 11 MA

RCH

PREVALENCE AND FACTORS ASSOCIATED WITH NECK AND JAW MUSCLE MODULATION OF TINNITUS

Yoo,SY.;Park,HY.;Nam,EC.

Myoung Dong Yonsei Ear Clinic, Seoul, Korea / Ajou Medical University, Suwon, Korea / Kangwon

National School of Medicine, Chuncheon, Korea

Forcefulcontractionsofneckandjawmuscleshavebeenshowntomodulatetinnitusandcan

beusedtoscreenpatientwhoareresponsivetosomaticmodulation.

Toidentifythefactorsassociatedwithsomaticmodulationoftinnitus,163patientsunderwent19

neckandjawmaneuversafteraphysiologicalandaudiologicalprofilewascompiled.

Tinnituswasmodulatedin57.1%ofearstested.Neckmaneuversgenerallydecreasedtinnitus

loudness,whereasjawmaneuversincreasedloudness.Femalegenderandbuzzingtinnituswere

associatedwithahighprevalenceofmodulation.

Use of these characteristics to select optimal candidates for somatosensory based tinnitus

therapies.

80

TUES

DAY

11 M

AR

CH

NOISE PROTECTION FOR HYPERACUSIS PATIENTS WITH STRESS ON TEACHERS

A CASE PRESENTATION OF A NEW APPROACH

Specific aspects of noise protection for patients with hyperacusis with particular stress

on teachers.

Lux-Wellenhof,G.

Tinnitus und Hyperakusis Centre Frankfurt/Main, Kaiserhofstr. 10, 60313 Frankfurt/Main,

Germany

Aim

ItisachallengeforeveryacousticianandENT-doctortoprovidenoiseprotectionfortinnitus-and

hyperacusispatients.Theproblemisevenmoredifficultforteacherswhoworkinclassrooms

with backgroundnoise and reverberation andat the same time theirworknecessitates good

speechunderstanding.

Understandingofspeechinaclassroomcouldbedifficultevenforapersonwithnormalhearing,

butitisespeciallychallengingforthosewithhearingdisorders.Thesepeopleneedbetteracoustic

conditionsforunderstanding.

Wedevelopednoiseprotectionfordifferentprofessionalgroupsworking innoisysurroundings

withspecialemphasisonpersonswithtinnitusandhyperacusis.Apartfromimprovingthequality

oflifeforthesepatients,thesenewpossibilitiesofnoiseprotectionhelptopreventlossofworking

hours.

Outof110patientswetreatedsuccessfullyoverthelast3yearswepresentonecasewhichis

exemplaryasteachersinclassroomsareexposedtodisturbingnoisesfromthechildrenandon

theotherhandhavetounderstandthemclearly.

Method

Case:A36yearoldteacherwithsound-speechaudiogramsdifferingonbothsides,hyperacusis

approx.70–75dB,notabletocontinueherteachingjob.InJanuary2013wesuppliedherwitha

combinationofsoundgeneratorsandafrequencyamplifierwhichenhancessoundinthespeech

rangeand/orcompensatesforhearingloss.

81

TUESDAY 11 MA

RCH

Thechallenge inprovidingnoiseprotection forhyperacusispatients iskeeping thebalanceof

noiseprotection.Toomuchprotection is not helpful, because it increases thegainwithin the

auditorysystemconsequentlyincreasinghyperacusis.Toolittleprotectioncouldannoythepatient

andconsequently increasehyperacusis.Ourpatientwearsdynamicnoiseprotection,a“sound

brake”,whichproducesadefinednoiselevel,thesocalled“digitalsoundseparatingtechnology”.

Thismeansaninstrumentwithasoundmanagerfordisturbingnoises(soundcleaning)which

suppresses disturbing noises and enhances speech.We chose an instrument with automatic

directionalmicrophonesandwirelessfunctionsothatbothinstrumentscanbeadjustedatthe

sametime.

Result

Soundgenerator,frequencyamplifierand“soundbrake”arematchedandcanbeadaptedtothe

respectivesoundsituation.Symptomsofhyperacusisarerelieved,leadingtorelaxationofbody

andpsyche,decreaseofstresslevelandlastingimprovement.

OurpatientisteachingagainsinceAugust2013.

Conclusion

Thismethodprovesveryeffectiveinmanyofourpatients.Itisagoodwaytoreintegratepatients

intheirworkinglives,thusbeingbeneficialforthepatientsandforthecommunity.

82

TUES

DAY

11 M

AR

CH

GENTLE SKIN STIMULATION MODULATES THE BALANCE BETWEEN THE SYMPATHETIC NERVE AND THE VAGAL NERVE AMONG NORMAL ADULT

Nakagawa, M.1;Tanuma,F.2;Fukasawa,S.3;Mori,Y.4;Watanabe,S.5

1 International University for Health and Welfare Hospital, Tochigi, Japan2 International University for Health and Welfare Hospital, Tochigi, Japan3 The Graduate School for the Creation of New Photonics Industries, Shizuoka, Japan4 Salesian Polytechnic, Tokyo, Japan5 Shizuoka Sangyo University, Shizuoka, Japan

Background

Thereisasimplemethodformeasuringheartratevariabilitycalled“StandingUptest”thatisa

veryeasyexamination.Whenasubjectsitsonthechair,onehasalowrestingheartrate.Butafter

standingupone’sheartratewillbegreaterthantherestingstate.Whenoneishealthy,itwillget

intoflatsmoothly.Butsomeresearchersalarmthatitwillbesomepredictionforthemortality.

On theotherhand, theStandingUp testbasedheart ratevariability isanactualphysiological

phenomenon caused by the autonomic nervous system.This system consists of sympathetic

systemandCardiacvagalnervoussystem.Thispresentstudy,weevaluateswhether theskin

stimulation canmodulate thebalancebetween the sympatheticnerveand the vagal nerve in

humansubjectsusingMicroCone.

About Micro Cone

Theadhesiveplastercalled“MicroCone” isproduces inJapanesemarketsasasubstituteof

painkillermedicinebyTotoResinInc.Itpossessesa376ofnano-sizedconeon1cmdiameterof

theplasticdiskwiththeplaster.TheefficacyoftheMicroConefortheneuropathicpaininhuman

wasreported.AstheresultsofthemodulationoftheneuraltransmissionofA-deltafiberand

Cfiber,thresholdofpainwillbereducedinthesamemanneroftheGateControlTheory.Inthe

anesthetizedanimalstudy, theneural transmissionwas restrained regardlessofattentionand

recognitionbysomaticsensationandtheusabilitytestofthecardiacsympatheticnervereflection

bymechanicalskinstimulation.ThesemeansthatMicroConeSkinStimulationhasthecapability

oftheinfluenceforasympatheticnerveandtheinteractionofthevagalnerve.

83

TUESDAY 11 MA

RCH

Subjects and Methods

21healthynormaladultsubjectsareemployedinthestudy.3typesoftheskinstimulationwere

takenforthestudy;Realplaster(SC-II),Sham-1plaster(plasteronly)andSham-2plaster(disc

withoutthemicro-cone).Whenthesubjectputtheplasterunderthedoubleblindcondition,one

performedaStandingUptestandwascheckedthepNN50during thestandingstate.pNN50

wascalculatedwithRRintervalofone’splethysmogram(StressChecker2,AzumioInc).Subject

performsalltypesofplasteratrandom(NN50isthenumberofintervaldifferencesofsuccessive

NN(RR)intervalsofheartrategreaterthan50msec.pNN50istheproportionderivedbydividing

NN50bythetotalnumberofNNintervals).

Results

ThegrandaveragedscoreofpNN50issignificantlydifferentamongtheseplaster:44.9%(ave.)

inSham-1,41.0%inSham-2and26.4%inRealPlaster(SC-II).ThedifferencesamongtheGA

scorewereconfirmedwiththestatisticalmeaningofStudentt-test.

Conclusion

It isconfirmedthat theunder thresholdSkinStimulationmodulates the Balancebetweenthe

sympatheticnerveandthevagalnerveusingMicroCone.Asthesamemeaningofvagalnerve

stimulationorGalvanicSCMelectricalstimulation,thisskinstimulationtechnologycanbeapplied

forthetinnitustreatment.

84

TUES

DAY

11 M

AR

CH

ON THE PERCEPTUAL AND NEURONAL VARIABILITY IN CHRONIC TINNITUS

Schlee, W.;Herrmann,J.;Pryss,R.;Langguth,B.

Clinic and Policlinic for Psychiatry and Psychotherapy, University Hospital Regensburg, Germany

Institute for Databases and Information Systems, University of Ulm, Germany

Subjective tinnitus is defined as an auditory perception in the absence of any physically

identifiablesourceforit.About5-10%ofthepopulationreportanongoingandchronicperception

ofthetinnitussound–buthowchronicisthisperception?Isthetinnitusconstantly“on”,orare

therealsoperiodswere the tinnitus isperceived less? Indeed,more than60%of thechronic

tinnitussubjectsreportavariabilityofthetinnitusperceptionbetweendays,buttodatewedon’t

understandwherethisvariabilitycomesfromandifthisisanimportantindicatorforthetreatment

responseofthesubjects.Inordertomeasurethiswithin-personvariabilityoftinnitusperception,

wedevelopedanexperiencesamplingapplicationrunningonsmartphonesthatisabletotrack

theindividualtinnitusperceptionanddistressduringthedayunderrealworldconditions.Inthe

firstpartofthetalk,wewanttopresentpreliminaryresultsofthisstudy.

Withthesecondpartofthetalkwewanttoconcentrateonthevariabilityofneuronalactivityin

theauditorycortex.Chronictinnitusisusuallyassociatedwithadecreaseofthealphafrequency

oscillatorypowerintemporalareas.Hereweshow,thatalsothemoment-to-momentvariability

ofthealphaactivityislargelyreducedinchronictinnitus.Mostimportantly,itcanbeshownthat

thisneuronalvariability isassociatedwith the tinnitusduration.Subjectswitha longerhistory

of tinnitus show lessalpha variability inauditory regions.Whether thesechanges inneuronal

variabilityrelatetotheperceptualvariabilityremainstobeseen.

85

TUESDAY 11 MA

RCH

ELDERLY PATIENTS BENEFIT FROM COCHLEAR IMPLANTATION REGARDING AUDITORY REHABILITATION, QUALITY OF LIFE, TINNITUS AND PSYCHOLOGICAL COMORBIDITIES

Olze,H.1;Gräbel,S.1;Förster-Ruhrmann,U1;Mazurek,B.2

1 Department of Otorhinolaryngology, Charité- Universitätsmedizin Berlin, Germany2 Tinnitus Center, Charité- Universitätsmedizin Berlin, Germany

Aims / Objectives

Toevaluatetheeffectofcochlearimplantation(CI)onthehealthrelatedqualityoflife(HRQoL),

speechunderstanding,tinnitusimpairment,perceivedstressanddepressiveandanxietydisorders

inthe70+yearsold,postlinguallydeafenedpatientsandtocomparetheresultstotheseobtained

fromagroupofyoungerpatients.

Methods

Fifty-fivepostlinguallydeafenedadultsatleast6monthsafterCIwereincludedinthisstudy(20

patients≥70years/35patients<70years.Using5validatedquestionnaires,wehaveevaluated

the quality of life (NCIQ), tinnitus impairment (TQ), perceived stress (PSQ), depressive (ADSL)

and anxiety symptoms (GAD-7). In addition, speech perception in quiet and noise (Freiburg

monosyllables,HSMsentences,OldenburgInventory)wasdetermined.

Results

Cochlear implantation significantly increased theHRQoL inbothagegroups, asmeasuredby

theNCIQand itssixsubscales.ThespeechperceptionafterCIdidnotdiffer from thatof the

youngerpatients.Ofthe55patients,48(87%)reportedhavingchronictinnitusbeforeCI.Among

theolderpatients,tinnitus-induceddistresshadatendencytodecreasefollowingCI.Inpatients

whohadahighseverity leveloftinnitus,theTQscoredecreasedsignificantlyintheolderand

youngergroup.Similarly,patientswithhighseverity levelofperceivedstress, thePSQscores

decreasedsignificantlyinbothagegroups.Nearly30%ofpatientshaddepressivedisordersprior

toCI.Numberofthesepatientsdecreasedto11%intheyoungerand1%intheoldergroup.

Furthermore,20%of theyoungerand36%ofolderpatientshadsevereormoderateanxiety

disorder prior to CI. Older group of patients had no longer anxious symptoms after cochlear

implantation

86

TUES

DAY

11 M

AR

CH

Conclusion

The present study provides evidence that cochlear implantation represents a very successful

procedure of auditory rehabilitation, also for patients over 70. In addition, elderly patients

benefitfromCIwithincreasedqualityoflifeandareductionintinnitus,stressandpsychological

comorbidities.

87

TUESDAY 11 MA

RCH

RESPONSIVENESS TO THREATENING SOUNDS: A SELECTIVE ATTENTION PARADIGM

Cima, R. 1,3;Schrooten,M.5;Janssen,S.4;Vlaeyen,J.1,2

1 Maastricht University, Clinical psychological Science2 University of Leuven, research group health psychology3 Adelante, centre of expertise in rehabilitation and audiology4 University of Leuven, Research Group Experimental Oto-rhino-laryngology5 Örebro university,Center for Health and Medical Psychology

Aims / Objectives

The impact of tinnitus on cognitive resources has scarcely been studied experimentally. We

presentlyhypothesizethatresponsivenesstotinnitusisdeterminedbytheperceivedharmfulness

ofthetinnitus, i.e. thethreat-appraisalofthesound, leadingto lowertolerancetosoundand

depletion of cognitive resources.The influence of perceived threat value of neutral tones on

responsiveness was studied in a selective attention paradigm with healthy individuals. It was

hypothesisedthatperformanceonaprimarydecisiontaskisnegativelyinfluencedbyincreased

perceivedthreatofdistractingneutraltones.

Method

FirstandsecondyearpsychologyandspeechpathologystudentsoftheKULeuvenwererecruited

(N=70).Individualswithahearingloss(cut-offatapuretoneaverageon1,2and4kHzof35dB

hearinglevel),orchronictinnituscomplaints,wereexcluded.Participantswererandomlyassigned

tooneoftwothreatconditions,high-threat(HT)versuslow-threat(LT).Bothgroupswereexposed

tobothpuretones(4kHz,70dB)andwarbles(4kHz,70dB,modulatedby100Hz,moderation

frequencyof20Hz)whileperformingacognitivedecisiontask.Inthethreat-conditioneitherthe

puretoneorthewarblewasmanipulatedtoincreasethreat-valueofthetone(counterbalanced).

AmixedmodelANCOVAwith‘threat’ (highvs. low)as thebetweensubjects factorand‘Tone’

(warblevs.puretone)asthewithinsubjectsfactorwasconducted,withresponsetimesonthe

decisiontaskastheoutcomevariable.

88

TUES

DAY

11 M

AR

CH Results

Theexpectedinteractionbetweenthreatandtone-typereachedsignificance,F(1,113)p=.03.

AnalysesshowedamaineffectofthreatF(6.04)p=.02,η²=.16andnottonetypeF(.38)p

>.05,η²=.01.

Conclusions

Exposuretoan(initiallyneutral)tone,whichismanipulatedtohaveincreasedthreat-value,will

depletecognitiveresources.Exposuretothreateningtoneshasdetrimentaleffectsoncognitive

taskperformanceinnormalsubjects.Theseresultsshedlightintothemechanismsunderlying

tinnitusanditsinterruptiveeffectsondailytasks.

89

TUESDAY 11 MA

RCH

THE RELATIONSHIP BETWEEN TINNITUS AND CRANIOCERVICAL MUSCULOSKELETAL DYSFUNCTION

Stinear,J.W.;Shekhawat,G.S.;Backhouse,D.P.;Searchfield,G.D.

Sports and Exercise Science/Section of Audiology, University of Auckland, New Zealand

Background / Aim

Acausalconnectionbetweentinnitusandsignsandsymptomsofcraniomandibulardisorderin

sometinnituspatientshasbeenproposed.Tinnitussufferershaveshownhigherprevalenceof

fatigue/tendernessinjawmuscles,painonpalpationofmasticatorymuscles,impairedmandibular

mobility,signsofparafunctions,andpainuponmouthopeninginepidemiologicsamples1,2.A

modeltoexplainthiscausalconnectionhasbeenproposedthatlinksdisinhibitionofthedorsal

cochlearnucleuswith chronic irritationof the craniofacial nervesand the1st and2nd spinal

nerves.Theaimofthepresentresearchwastoassesstherelationshipbetweenchronictinnitus

andcraniocervicalmusculoskeletaldysfunction.

Methods

Twenty participants (mean age 56.3 years) with chronic tinnitus for more than 2 years took

part in thispilotstudy.Participants twicevisited thehearingand tinnitusclinic, locatedat the

UniversityofAuckland.Thefirstsessionbuiltahearingandtinnitusprofileusingextendedhigh

frequencyaudiometry,theassessmentoftinnituspitch,loudness,andminimummaskinglevel.

Questionnaires were used to collect a tinnitus-related case history, functional index, severity

numericscale,handicapinventory,andascaleofdepressionanxietyandstress.Informationwas

alsocollectedaboutparticipants’self-perceptionregardingtheircraniocervicalmusculoskeletal

status.Duringthesecondappointmentacraniocervicalspecialist(blindtotheparticipants’data)

assessed participants’ jaw and cervical spine articular function. Data were analysed by the

audiologistandasecondindependentandblindedcraniocervicalspecialisttoassessrelationships

betweentinnitusandmusculoskeletalfunction.

Results

Of the 20 participants, 5 reported a percept of tinnitus modulation related to craniofacial

musculoskeletal(MS)activity,and15hadevidenceofMSdysfunction.Ofthe5reportingtinnitus

modulation,clearevidenceofmandibleand/oruppercervicalspinedysfunctionwasdetected.

Interestingly in participants with no MS-reported dysfunction the assessor did not detect any

evidenceofMSdysfunctionin5participantsandMSdysfunctionwasdetectedin10participants.

90

TUES

DAY

11 M

AR

CH

Conclusion

The present study revealed a high incidence of craniocervical dysfunction consistent with

the incidenceforpeoplewhoreportheadandneckpain.Wethereforeexpected tofindsome

participantswithevidenceofMSdysfunctionthatdidnotreportanMS-relatedmodulationoftheir

tinnitus.Importantly,all5participantsreportinganMS-relatedmodulationperceptoftheirtinnitus

hadevidenceofMSdysfunction,butofthe15whodidnotreportanMS-relatedmodulation,5did

nothaveevidenceofMSdysfunction.Althoughoursamplesizewassmall,ourfindingspromote

theexcitinghypothesisthatforpeoplewhoreportMS-relatedmodulationandwhohaveevidence

ofcraniocervicaldysfunction,restoringnormalMSfunctionmayimprovetheirtinnitus.Weplanto

testthishypothesisinafuturestudy.

References

1. Rubinstein B. Tinnitus and craniomandibular disorders--is there a link? Swed Dent J Suppl. 1993;95:1-

46.

2. Bernhardt O, Gesch D, Schwahn C, et al. Signs of temporomandibular disorders in tinnitus patients and

in a population-based group of volunteers: results of the Study of Health in Pomerania. J Oral Rehabil.

2004;31(4):311-319.

91

TUESDAY 11 MA

RCH

MULTIMODALITY EVALUATION AND TREATMENT OF TINNITUS

Minami, S.B1.; Shinden, S 2.; Kanzaki, S3; Oishi, N3.; Suzuki, D2.; Goto, F.1; Okamoto,Y.4; Masuda, M.5; Mizutari, K.6; Watabe, T3.; Fujioka, M3.; Wasano, K.7; Inagaki, Y.3;Wakabayashi,S.3;Yamada,H.3;Saito,H.3;Matsunaga,T1.;Sato,M.3;Inoue,Y.3;Ogawa,K.3

1National Tokyo Medical Center, National Institute of Sensory Organs2Saiseikai Utsunomiya Hospital, Department of Otolaryngology3Keio University, School of Medicine, Department of Otolaryngology, Head and Neck surgery4Inagi City Hospital, Department of Otolaryngology5Kyorin University, Department of Otolaryngology6National Center for Children and Development, Department of Otorhinolaryngology7Japanese Red Cross Shizuoka Hospita, Department of Otolaryngology

Both the auditory pathway and non-auditory brain are involved in the pathophysiological

mechanismsoftinnitus,andthereforebothmustbetreatmenttargets.Beforestartingtreatment,

we have to evaluate both of these in patients.We evaluate auditory pathways by pure tone

audiometry, pitch matching, and resting-state fMRI. It is hypothesized that cochlear hearing

loss reduces cochlear nerve activity, and this reduced activity within the affected auditory

pathwaydown-regulates inhibitorycorticalprocesses, leading tohyperexcitabilitywithincentral

auditorystructures, includingtheprimaryauditorycortex.Wecheckthefunctionalconnectivity

(FC)betweentheleftandrightauditorycorticesbyresting-statefMRI.Accordingtoourdata,FC

betweenleftandrightauditorycortexintinnituspatientsissignificantlyreducedascomparedto

controls.Next,weevaluatethenon-auditorybrainbythefollowingquestionnaires:THI(tinnitus

handicapinventory),SDS(self-depressionscale),STAI(state-traitanxietyindex),HADS(hospital

anxietyanddepressionscale)andPSQI(Pittsburghsleepqualityindex),andresting-statefMRI.

Accordingtodatafromour1424tinnituspatients,about40%ofseverelyhandicappedpatients

(THI score>58)havedepressive tendencies (SDSscore>50),80%of severepatientshave

GradeIVandVstate-traitanxiety,and90%ofseverepatientshavesleepdisorders.Basedon

theresults,weproposethattinnituscanbeagreatdistresswhenaberrantneuronalactivityin

theprimaryauditorycortex isconnected toabroadercortical“distressnetwork” involving the

anteriorandtheposteriorcingulatecortex,thedorsolateralprefrontalcortex,theamygdala,and

thehippocampus.Our resting-state fMRIdatashows thatFCbetween theauditorycortexand

distressnetworkcorticeswaselevatedinsubjectswithtinnitus.

92

TUES

DAY

11 M

AR

CH

Tinnitustreatmentthatdealswiththeauditorypathwayaimstorestorethereducedperipheral

auditoryactivitybyhearingaidsorcochlearimplantsorregulatedirectlytheauditorycortexby

rTMS(repetitivetranscranialmagneticstimulation)ortDCS(transcranialdirectcurrentstimulation).

Forhearinglossthatcanbeimprovedwithhearingaids,soundtherapieswithhearingaidsare

thetreatmentofchoice. Inoursoundtherapies,thehearingaid isadjustedfollowingthehalf-

gainruleandthepatientwearsitalldaylong.Thisinducesplasticityoftheauditoryandnon-

auditorynetworks.Our76tinnituspatientswithbilateralhearinglosswhoreceivedcounseling

and sound therapywith bilateral hearing aids showed significant reduction ofTHI score after

6months (58±25→14±16).The resting-state fMRIshows thatFCbetween leftand right

auditory cortex returns to normal levels after sound therapy with hearing aids.Treatment for

thenon-auditorybrain is tomanagethedepression,anxiety,attention,cognition,andmemory

bycounseling,pharmacologicaltreatment(e.g.antidepressants),andpsychotherapy.Allpatients

receivecounselingtounderstandthenatureandcausesoftinnitusandhowtomanageit.Most

tinnituspatientshaveincorrectnegativebeliefsconcerningtinnitus,suchasthattinnitussignals

aseriousmedicalproblemandthattheymustmonitorchangesinthetinnitustone.Wecorrect

themisconceptionsthroughcounseling.

Wewillintroduceourmultimodalityevaluationsandtreatmentsoftinnitusandshowourdataat

thepresentation.

93

TUESDAY 11 MA

RCH

ARE TREATMENTS FOR TINNITUS EFFECTIVE?

Hall,D.A.

Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit

Asresourcesbecomeincreasinglylimited,allocationsofbothresearchandhealthcarefunding

aredependentuponhighqualityevidence.Historically,tinnitushasbeenthepoorcousinofa

cinderellascience,withlowqualityclinicalresearchprovidingunreliableestimatesofeffect,and

withdevicesmarketed for tinnituswithoutstrongevidence for thoseproductclaims.However,

thefieldischanging.Anumberofleadingclinicalandacademicexpertsontinnitushaverecently

madecallstothefieldtoimprovethedesign,implementationandreportingofclinicaltrials.Since

2008, theNIHRNottinghamHearingBRUhasestablished itselfas theUK’s leadingcentre for

earlyphaseclinicaltrialsontinnitus.Thistalkenablesmetoexpandongeneralmethodological

innovationsusingspecificexamplesofourownworkandthatofothergroupsaroundtheworld.

Topics include efficacy and effectiveness; multi-disciplinary collaboration; registration of trial

protocols;outcomemeasures;anddataanalysisandinterpretation.

Theviewsexpressedarethoseoftheauthor(s)andnotnecessarilythoseoftheNHS,theNIHRor

theDepartmentofHealth.

94

TUES

DAY

11 M

AR

CH

Poster Session 1 / TahiNumbers refer to poster board allocation

TINNITUS PRECEDED DEPRESSIVE SYMPTOMS IN COMMUNITY-DWELLING OLDER

JAPANSES: A PROSPECTIVE COHORT STUDY

Mizutari, K.;Michikawa,T.;Nishiwaki,Y.;Saito,H.;Ogawa,K.

01

VALIDATION OF THE TINNITUS FUNCTIONAL INDEX IN NEW ZEALAND

Chandra,N.;Lee,A.;Searchfield, G.

07

ARE PEOPLE WITH TINNITUS SATISFIED WITH THEIR INTERACTION WITH THE HEALTHCARE

SYSTEM?

Carmody,N.;Eikelboom,R.H

13

TINNITUS IN NEW ZEALAND

Wu, B.; Exeter, D.; Searchfield, G.D.

19

CLINICAL CHARACTERISTICS OF PATIENTS WITH TINNITUS EVALUATED WITH TINNITUS

SAMPLE CASE HISTORY QUESTIONNAIRE IN JAPAN

Kojima, T.;Kanzaki,S.;Oishi,N.;Watabe,T.;Inagaki,Y.;Wakabayashi,S.;Yamada,H.;Ogawa,K.

25

CLINICALLY RELEVANT CHANGES ON THE PRIMARY TINNITUS OUTCOME MEASURES;

NORMS AND RELIABLE CHANGE ANALYSES

Cima, R.;Vlaeyen,J.

21

ASSESSMENT OF HYPERACUSIS SEVERITY USING QUESTIONNAIRES AND ITS CLINICAL

USEFULNESS

Sakashita, T.;Kato,S.;Yamane,H.

37

95

TUESDAY 11 MA

RCH

EFFECT OF DRINKING ALCOHOL, BATHING, AND EXERCISING ON TINNITUS

Kato, S.;Sakashita,T.;Yamane,H.

43

PROPOSAL OF THE CLASSIFICATION OF TINNITUS SEVERITY AND MANAGEMENT

Takahashi, M.;Kabaya,K;Sekiya,Y.;Murakami,S.

49

CHARACTERISING THE PSYCHOSOCIAL EXPERIENCES OF CHRONIC TINNITUS SUFFERERS

Callander, K.J.;McLachlan,N.M.;Wilson,S.J.

57

SEASONAL AFFECTIVE DISORDER IN PATIENTS WITH CHRONIC TINNITUS

Kim,Y.H.

63

THE RELATION BETWEEN TINNITUS LOUDNESS, SLEEP DISORDERS AND EMOTIONAL

DISTRESS

Jangholi, N.;GhodratiToostani,I.;MauriceErnaClaessens,P.

69

USE OF THE SIGNIFICANT OTHER TO GAUGE TINNITUS SEVERITY

Sheehan, T.;Davis,P.

75

VALIDATION OF THE TINNITUS FUNCTIONAL INDEX IN A UK RESEARCH POPULATION

Hoare, D.;Fackrell,K.;Barry,J.;Hall,D.

80

DEVELOPMENT OF OBJECTIVE MEASUREMENT FOR TINNITUS

Kanzaki,S.1;Takayama,K.2;Mitsukura,Y.2;Oishi,N.1;Yamada,H1;Inagaki,Y.1;Wakabayashi,S.1;

Kojima,T.1;Ogawa,K.1

88

96

TUES

DAY

11 M

AR

CH

Poster Session 2 / RuaNumbers refer to poster board allocation

TINNITUS: A SEMINAR IN THE LANCET

Hall, D.A.;Baguley,D.;McFerran,D.

02

IS GENTLE SKIN STIMULATION MODULATING TINNITUS DISTRESS AMONG TINNITUS

PATIENTS?

Tanuma,F.;Nakagawa,M.;Fukasawa,S.;Mori,Y.;Watanabe,S.

08

MULTISENSORY CONTRIBUTORS TO TINNITUS: HEARING, PAIN, TASTE AND SMELL

Kerridge,M.;Searchfield,G.

14

MULTISENSORY TRAINING FOR TINNITUS

Linford,T.;Spiegel,D.;Searchfield,G.D.

20

Multisensory tinnitus treatment and saccadic eye movements

Spiegel,D.P.;Thompson,B.;Petoe,M.;Kobayashi,K.;Linford,T.;Searchfield,G.D.

26

A NONINVASIVE NEUROMODULATION APPROACH FOR TREATING TINNITUS UTILIZING

MULTIMODAL ACTIVATION AND PLASTICITY

Markovitz,C.;Smith,B.;Gloeckner,C.;Lim,H.

32

THE TEMPORAL CORTEX AND ITS ROLE IN A TINNITUS NETWORK. AN MEG-STUDY

Lau, P.;Pantev,C.

38

THE ROLE OF INDIVIDUAL PAIN TOLERANCE AND PAIN TRESHOLD IN BEARING TINNITUS

Aslan, S.;Aksoy,S.;Yılmaz,T.;Keser,I.;Kirdi,N.

44

97

TUESDAY 11 MA

RCH

PREVALENCE AND FACTORS ASSOCIATED WITH NECK AND JAW MUSCLE MODULATION OF

TINNITUS

Yoo,SY.;Park,HY.;Nam,EC.

50

NOISE PROTECTION FOR HYPERACUSIS PATIENTS WITH STRESS ON TEACHERS

A CASE PRESENTATION OF A NEW APPROACH

Lux-Wellenhof,G.

58

GENTLE SKIN STIMULATION MODULATES THE BALANCE BETWEEN THE SYMPATHETIC

NERVE AND THE VAGAL NERVE AMONG NORMAL ADULT

Nakagawa, M.;Tanuma,F.;Fukasawa,S.;Mori,Y.;Watanabe,S.

70

ON THE PERCEPTUAL AND NEURONAL VARIABILITY IN CHRONIC TINNITUS

Schlee, W.;Herrmann,J.;Pryss,R.;Langguth,B.

76

ELDERLY PATIENTS BENEFIT FROM COCHLEAR IMPLANTATION REGARDING AUDITORY

REHABILITATION, QUALITY OF LIFE, TINNITUS AND PSYCHOLOGICAL COMORBIDITIES

Olze,H.;Gräbel,S.;Förster-Ruhrmann,U;Mazurek,B.

90

RESPONSIVENESS TO THREATENING SOUNDS: A SELECTIVE ATTENTION PARADIGM

Cima, R.;Schrooten,M.;Janssen,S.;Vlaeyen,J.

95

THE RELATIONSHIP BETWEEN TINNITUS AND CRANIOCERVICAL MUSCULOSKELETAL

DYSFUNCTION

Stinear,J.W.;Shekhawat,G.S.;Backhouse,D.P.;Searchfield,G.D.

96

98

TUES

DAY

11 M

AR

CH

99

WED

NESDAY 12 M

AR

CH

PLASTICITY OF MULTISENSORY PROCESSING IN THE DORSAL COCHLEAR NUCLEUS: ITS ROLE IN TINNITUS GENERATION AND SUPPRESSION

Shore,S.E.

Long-termalterationsindorsalcochlearnucleus(DCN)neuralfiringratesoccurfollowingpaired

somatosensoryandauditorystimuli(Dehmeletal.,JournalofNeuroscience,2012).Thisplastic

phenomenonis‘stimulus-timingdependent’inthatthestrengthanddirectionofthe“bimodal”

plasticitydependson theorderand timingofbimodalstimulation. Hebbianandanti-Hebbian

timingrulesgeneratedinthiswayreflectinvitrospike-timingdependentplasticity(Koehlerand

Shore,PloSOne,2013).

Followingnoise-exposureandtinnitusinduction,stimulus-timingdependentplasticityintinnitus

animalsaremore likely tobeanti-Hebbian thananimals thatdonotdevelop tinnitusandare

broaderforthosebimodalintervalsinwhichtheneuralactivitywasenhanced.Furthermore,units

from exposed animals with tinnitus are more weakly suppressed than those without tinnitus.

Broadenedtimingrulesintheenhancementphaseinanimalswithtinnitus,andinthesuppressive

phaseinexposedanimalswithouttinnituswouldbeexpectedtoproducegreaterneuralexcitation

inanimalswithtinnitusandreducedexcitationinanimalswithouttinnitus(KoehlerandShore,J.

Neuroscience,2013).

Theseresultshighlightalterationsofstimulus-timingdependentplasticityintheDCNasanew

neuralcorrelateoftinnitusopeningthewayforatherapeutictargetfortinnitus.

This work was supported by NIH P01 DC00078, R01 DC004825, T32 DC001 and P30DC05188.

100

WED

NES

DAY

12 M

AR

CH

TINNITUS AND ABNORMAL PROCESSING IN THE CENTRAL AUDITORY SYSTEM

vanDijk,P.1,2;Boyen,K.1,2;vanGendt,M.1deKleine,E.1,2;Langers,D.R.M.3;

Lanting,C.P.1,2

1 Department of Otorhinolaryngology / Head and Neck Surgery, University of Groningen, University

Medical Center Groningen, Groningen, The Netherlands2 Graduate School of Medical Sciences, Research School of Behavioural and Cognitive

Neurosciences, University of Groningen, Groningen, The Netherlands.3 NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom.

Tinnitus is a multifactorial symptom that may involve mechanisms in het peripheral hearing

organ,theauditorybrainandnon-auditoryportionsofthebrain.Functionalmagneticresonance

imaging isamethodtostudy thebrainmechanisms involved in tinnitus. Inparticular, itoffers

theopportunitytotestinhumans,hypothesesthatweredevelopedfromexperimentinanimals.

Animalexperimentsshowclearevidenceofreorganizationofthecorticalmapwithhearingloss,

whichispossiblyassociatedwithtinnitus.Incontrast,fMRIexperimentsshowthattinnitusmay

occurwithoutevidenceofcorticalremapping.Inastudyofgaze-modulatedtinnitus,thegazewas

associatedwithadecreaseinthalamicactivityandanincreaseincorticalactivity.Intwoother

studies,subjectswithandwithouttinnituswerecomparedwithrespecttothebrain’sresponse

tosound.Inthefirststudy,subjectshadnormaltonear-normalaudiogram.Inthesecondstudy,

thesubjectshadamoderatesensorineuralhearing loss.FunctionalMRIsuggesteda reduced

functionalconnectivitybetweenthebrainstemandthecortexintinnituspatients,whichsignifies

abnormalauditoryprocessing.Together,theseresultsareconsistentwithanabnormalroleofthe

thalamusintinnitus.Futurestudiesmustfurtherdefinethisabnormalityandmaypointtowards

targetedtreatmentsfortinnitus.

101

WED

NESDAY 12 M

AR

CH

PARAHIPPOCAMPAL-AUDITORY CORTEX COMMUNICATION IN TINNITUS

De Ridder, D1.;Congedo,M².;Vanneste,S.³1 University of Otago, New Zealand

² Inserm Grenoble, France

³ University of Texas, USA

IntroductionTheparahippocampalareaandauditorycortexareimportanthubsintinnitus,asdemonstrated

byEEG,MEG,fMRIandPET.Furthermore,thefunctionalconnectivitybetweentheseareasisthe

onlyrobustfindinginrestingstatefMRIstudiesintinnitus.

Methods and materialsTofurtherexplorethiscriticalconnectionweperformedEEGsin129tinnituspatientsWeanalyzed

theneural correlatesofhearing lossandsubjective tinnitus loudness (NRS)onawholebrain

analysis as well as the functional and effective connectivity between the auditory cortex and

parahippocampalarea.

ResultsHearing loss is related to bilateral parahippocampal theta activity and right-sided alpha

parahippocampal activity.Tinnitus loudness is related to gamma band activity in the auditory

cortex leftparahippocampus,aswellasalpha in the left insula, lowbeta rightdorsalanterior

cingulatecortex.

A significant correlation is found between the subjective loudness and lagged phased

synchronization(=functionalconnectivity)betweentheleftparahippocampusandtheleftauditory

cortexforthethetafrequencyband,aswellasforthepercentageoftimethereistheta-gamma

nestingintheleftparahippocampusandauditorycortex.

Theeffectiveconnectivitydependsonthehearingloss.Themorehearinglossapatienthasthe

moreinformationistransferredfromtheparahippocampalareatotheauditorycortex

Discussion and conclusionTheparahippocampusandauditorycortexcommunicateusingthethetabandasacarrierwave

onwhichgammabandactivityisnested.Thegammabandcorrelateswiththetinnitusloudness.

Inhearinglossthemissinginformationseemstobepulledfromhippocampalmemory.

102

WED

NES

DAY

12 M

AR

CH

MODULATING ALPHA AND BETA OSCILLATIONS WITHIN POSTERIOR CINGULATE CORTEX THROUGH REAL-TIME SOURCE LOCALIZED NEUROFEEDBACK AND ITS EFFECT ON TINNITUS RELATED DISTRESS

Joos,K.1;DeRidder,D.2;Vanneste,S.3

1 Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Belgium2 Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand3 Lab for Auditory & Integrative Neuroscience, School of Behavioral and Brain Sciences, The

University of Texas at Dallas, USA

Upto25%ofthepeopleaffectedbytinnitusreportinterferencewiththeirlivesastinnituscauses

aconsiderableamountofdistress. It isknown thatdistresscanplayan important role in the

developmentoftinnitusleadingtopsychologicalcomplicationssuchasannoyance,concentration

problems, depression, anxiety, irritability, sleep disturbances, and intense worrying. Previous

researchalreadyindicatedthatdecreasedalphapower isassociatedwithactivelyengagingin

processingastimulusandthattheposteriorcingulatecortexformsacoreregionofthedefault

network.Highlydistressedtinnituspatientsareactivelyengagedtotheirtinnitusassuchitseems

reasonablethatadecreasedalphapowerisobtainedwithintheposteriorcingulatecortex.The

beta-bandoscillationson theotherhandhavebeenassociated tomaintenanceof thecurrent

cognitivestate.Thatis,betaoscillationsarerelatedtoendogenousmodulationofearlyauditory

responsesandmaybeenhanced if thestatusquo isgivenpriorityoveranewsignal.As this

phantomsound isconstantlypresentandcouldbe interpretedasstatusquo thathaspriority

overanewsignal,certainlyinpatientthatarereallydistressedbytheirtinnitus.Thisfitswiththe

findingsthathighlydistressedtinnituspatientshaveincreasedbeta-bandoscillationswithinthe

posteriorcingulatecortex.Consequently,itcanbehypothesizedthatreal-timesourcelocalized

neurofeedback to voluntarily up-regulate alpha activity and down-regulate beta activity within

theposteriorcingulatecortexcanmodulatetinnitusrelateddistress.Thisapproachgoesbeyond

conventional imaging studies that only correlate ongoing activity with changes in tinnitus, as

neurofeedbackallowsustodirectlymanipulateongoingbrainactivityandtherebytoestablish

a causal link between ongoing activity and tinnitus perception.The posterior cingulate cortex

is a particular well-suited target for neurofeedback because its activity can be modulated by

top-downcontrolmechanisms,suchasattentionandimagery.Hereweshowinalargegroupof

50tinnituspatients,inaplacebo-controlledway,thatup-regulatingalphaanddown-regulating

beta oscillations targeting the posterior cingulate cortex through real-time source localized

neurofeedbackhasacleareffectonthetinnitusrelateddistressbutnotontheloudness.These

resultsaresupportedbypowerchangesandchangesinphasecoherence.

103

WED

NESDAY 12 M

AR

CH

CHANGE IN SPONTANEOUS CORTICAL ACTIVITY DURING TINNITUS REMEDIATION

Mathur,A.;Ibrahim,R.;McMahon,C.M.

Audiology Section, Department Linguistics, Macquarie University, NSW, Australia

Introduction

Tinnitusremediationprogramsvaryintheireffectivenesstoprovidelong-termrelieffortinnitus

sufferers.Understandingthelinkbetweensubjectivebenefitandtheneurophysiologicalchanges

which occur throughout remediation may provide a better understanding of the physiological

mechanisms underpinning tinnitus relief and may be important for developing individualised

therapies.However,currentlythisislimitedbyapaucityofsensitiveandobjectivetests.Recent

advancesinimagingtechniqueshaveshownsomepromiseinidentifyingandquantifyingtinnitus-

relatedneuralactivityanditsrelationshipwithsubjectiveindicatorsoftheimpactofthetinnitus

ontheindividual(Hoke,Feldmannetal.1989;Weisz,Morattietal.2005).Inthisstudy,weaim

toevaluatetheneurophysiologicalchangesevidentintinnitusandnon-tinnitussufferersandto

evaluatethechangesinspontaneousbrainactivityduringatinnitustreatmentprogram.

Aims / Objectives

Theaimsofthepresentstudyare:

1. Identifychangesinthespontaneousactivityofthebraininpatientswithclinicallysignificant

tinnitususingMagnetoencephalography(MEG).

2. Measurechanges inspontaneousbrainactivityprior,duringandpost tinnitusremediation

program.

3. Identifyifanyassociationexistsbetweenthesubjective(TRQ)andobjective(MEG)measures

oftinnitus.

Method

Thetinnitusgroup(N=12)underwentextendedaudiometricevaluationandcompletedabattery

ofquestionnairesrulingoutclinicaldepressionandanxietyasaprobablecauseof,orassociation

withtinnitus.AfiveminutespontaneousMEGrecordingwasacquiredwhiletheywereinastate

of relaxed wakefulness. The tinnitus participants were provided with Neuromonics treatment

program,whileatthesametimehadtheirMEGdatarecordedpriorto,duringandposttreatment

program.Asacomparison,spontaneousMEGrecordingsofcontrolgroup(N=10)withclinically

normalhearingandnocomplaintoftinnituswerealsoacquired.TheMEGdatawereanalysed

usingBrainElectricalSourceAnalysis(BESA)software.

104

WED

NES

DAY

12 M

AR

CH

Results and Conclusion

Ourresultsshowedthatthespontaneousalpha(8-13Hz)temporal-parietalbrainactivitiesinthe

tinnitusgroupweresmallerwhencomparedtothatofthecontrolgroup. Incrementalchanges

ofalphawereseenasthetreatmentprogressed.Inaddition,aninverseassociationbetweenthe

TRQscoreandalphapowermeasuredfromthecortexwerefound.Wewilldiscussthepotential

implicationsofusingMEGasatooltoobjectivelymeasuretinnitus.

Hoke, M., H. Feldmann, et al. (1989). “Objective evidence of tinnitus in auditory evoked magnetic fields.”

Hearing Research 37(3): 281-286.

Weisz, N., S. Moratti, et al. (2005). “Tinnitus perception and distress is related to abnormal spontaneous brain

activity as measured by magnetoencephalography.” PLoS medicine 2(6): e153.

105

WED

NESDAY 12 M

AR

CH

TONOTOPIC MAP CHANGES DURING TINNITUS REMEDIATION

Ibrahim,R.K.;McMahon,C.M.;Mathur, A.

Dept. of Linguistics, Macquarie University, North Ryde, NSW, Australia

Background

Tinnitus has been associated with the abnormal organisation of the tonotopic map in the

auditorycortex(Eggermont,2006).However,itiscurrentlynotclearwhethersuccessfultinnitus

remediationwhich shows improved subjective outcomes, can affect the reorganisation of the

tonotopicmaptowardsanon-disruptedstate.Thereforetheaimsofthepresentstudywere:(i)to

comparetonotopicmapsacquiredfrommagnetoencephalography(MEG)recordingsinindividuals

withsignificanttinnituswithnon-tinnitusparticipantstodeterminewhetherdisruptionscouldbe

measured;(ii)toidentifywhetherchangesinthetonotopicmapandevokedresponsesoccurred

during and after a tinnitus remediation program; and (iii) to identify whether these changes

occurredinparallelwithsubjectivechangesoftinnitusimpact.

Method

Twelve tinnitus participants were recruited and completed audiometric evaluation, subjective

measurement of tinnitus using the tinnitus reaction questionnaire (TRQ), measurement of

psychoacousticcharacteristicsoftinnitus,andevaluationofdepressionandanxietybeforeduring

andafter tinnitus remediation.Tennormalhearingnon-tinnitusparticipantswere recruited for

comparison.Soundstimuliof500Hz,1kHz,2kHz,4kHzand8kHztoneswerepresentedtoeach

earindividuallyandcorticalactivitywasmeasuredusingMEG.Alltinnitusparticipantscompleted

aNeuromonicsrehabilitationprogramover25weeksandMEGwasmeasuredat5or10week

intervals.MEGdatawereanalysedusingBrainElectricalSourceAnalysis(BESA).

Results & conclusions

MEGresultsindicatedthatthetinnitussubjects’sourcelocationsweremoreanteriorcomparedto

thatofthecontrolgroup(forallpresentedfrequencies).Afterundergoingremediation,thetinnitus

subjects’ source strengths increased (for normal hearing frequencies) while source locations

movedtowardsamoreposteriorlocation(towardsthatofnon-tinnitusparticipants).Theseresults

suggeststhattinnitusremediationusingNeuromonicsaffectssourcestrengthandtonotopicmap

ofthetinnitusparticipants.

Reference

1. Eggermont JJ. Otolaryngol. Suppl. 2006; 556:9-12.

106

WED

NES

DAY

12 M

AR

CH

CHANGES IN RESTING-STATE FMRI ACTIVITY DURING SALICYLATE-INDUCED TINNITUS AND SOUND STIMULATION

Chen,Y.-C.1;Wang,J.1,2,3;Jiao,Y.1;Zang,F.-C.1;Yang,M.1;Tong,J.-X.1;Salvi, R. 4;

Teng,G.-J.1

1Department of Radiology, 2Department of Physiology and Pharmacology, Medical School of Southeast University, Nanjing

China3School of Human Communication Disorders, Dalhousie University, Halifax, Canada4Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, USA.

Aims / Objectives

Theneuralmechanismsthatgiverisetothephantomsoundoftinnitusarepoorlyunderstood,

but recentstudiessuggest that low frequencyneuraloscillatoryactivitycontributes to tinnitus

generation.Toexplorethisissue,wemeasuredtheamplitudeoflow-frequencyfluctuations(ALFF)

inresting-statefunctionalmagneticresonanceimaging(fMRI)duringsalicylate-inducedtinnitus

andduringsoundstimulation.

Methods

Ratswerescannedwitha7.0TMRIsystem;15weretreatedwith300mg/kgofsalicylateto

inducetinnitusandtheremaining15wereinjectedwithsalineascontrols.BaselinefMRIscans

werecollectedwithmusicstimulation(85dBSPLLeq)andwithoutmusic(control).Afterwards,

themeasurementswererepeated2haftersalicylateorsalinetreatment.Statisticalparametric

mappingwasusedtodeterminewhichregionsofthebrainshowedsignificantchangesinALFF

activityduetosalicylateormusicstimulation.

Results

SalicylateinducedsignificantbilateralincreasesofALFFactivityinseveralauditoryregion(auditory

cortex,medialgeniculatebody,inferiorcolliculus,trapezoidbody)aswellasseveralnon-auditory

regionsincludingtheparaflocculusofthecerebellum,visualcortex,somatosensorycortexand

amygdala. Incontrast, salicylatesignificantlydecreasedALFFactivity in thehippocampusand

striatum.Furthermore,salicylatetreatmentenhanced(hyperactivity)theALFFneuralresponses

tomusicstimuliinseveralbrainregions,includingtheauditorycortex,inferiorcolliculus,medial

geniculatebody,trapezoidbodyandsomatosensorycortex.

107

WED

NESDAY 12 M

AR

CH

Conclusions

Salicylate significantly increasedALFF oscillatory activity in several auditory and non-auditory

regionspreviously implicated insalicylateand/ornoise-induced tinnitus. Interestingly, several

newregionsofaberrantALFFactivitywereobservedinvisualandsomatosensorycortex,sensory

areasknowntointerconnectwiththeauditorycortex.Musicstimulationtendedtopotentiatethe

salicylate-inducedhyperactivity in theALFFresponses inmanyauditoryareas,consistentwith

previouselectrophysiologicalreportsofsoundevokedhyperactivityinthecentralauditorypathway.

Theseresultssuggest that theperceptionof tinnitusmaybedue inpart to large increases in

low-frequencyneuraloscillationswithinthecentralauditorypathwayalongwithaberrantneural

oscillationsintheamygdala,paraflocculusandvisualandsomatosensorycortices.Resting-state

ALFFfMRImightthereforeproveusefulinidentifyingtheaberrantneuralnetworksinhumanswho

sufferfromsevere,debilitatingtinnitus.

108

WED

NES

DAY

12 M

AR

CH

AUDITORY-LIMBIC NETWORK IN TINNITUS REVEALED BY RESTING-STATE FUNCTIONAL CONNECTIVITY MRI

Turesky,T.;Leaver,A.M.;Seydell-Greenwald,A.S.;Rauschecker,J.P.

Laboratory of Integrative Neuroscience and Cognition, Dept. of Neuroscience

Georgetown University Medical Center, Washington, DC 20057, USA

Tinnitusischaracterizedbytheperceptionofsoundintheabsenceofanexternalsource.Despite

theprevalenceofthisdisorder,itspathophysiologyremainspoorlyunderstood.Alargebodyof

evidencehasrevealedplasticity-relatedchangesintheauditorysystemofpatientswithtinnitus,

including modifications in one or more sites along the auditory pathway, both peripheral and

central.Althoughlesion-inducedplasticityofauditorystructuresmaybeanecessaryprecondition,

itdoesnotseemsufficienttocausechronictinnitus.Giventhisconstraint,andthegrowingbody

ofevidence implicating limbic involvement in tinnitus,weproposethat limbicdysfunctionmay

playacriticalroleincausing,aswellasperpetuating,thetinnituspercept.

For our current study, we chose to elucidate this dysfunction by using magnetic resonance

imagingtomeasurefunctionalconnectivity(fcMRI).Sincethetinnitusperceptismostnoticeable

atrest,i.e.intheabsenceoftasksordistractors,wechosetoanalyzeconnectivityfromresting-

statefcMRIdata,thatis,dataacquiredwhensubjectswerenotperforminganytasks.Specifically,

weusedIndependentComponentAnalysis(ICA),adata-driven,non-a-prioristatisticaltechnique,

to identify roughly 25 functionally connected resting-state networks (RSNs). Auditory, visual,

“default-mode,” and other neurophysiologically plausible networks were consistently detected

inallsubjects,alongwithnon-neurophysiologicalnetworks,havingtodowith,e.g.,respiration

andheartrate,whichwereremovedfromfurtheranalysis.Ofparticularinterestwasanetwork

thatappearedinICAsoftinnituspatients,butnotofcontrolsmatchedforageandhearingloss.

ThisnetworkdemonstratedauniqueinverserelationshipbetweenmedialHeschl’sgyrus(mHG)

andtheNucleusAccumbens(NAc),suggestingadirectorindirectconnectionbetweenthetwo

regions.Apartfromrevealinganovelauditory-limbicnetwork,theseresultsareconsistentwith

previousreportsofNAcinvolvementintinnitus[1],andsuggestafar-reachingtinnitusnetwork

incorporating non-auditory regions [2]. The present study offers the additional advantage of

superiorspatialresolutionaffordedbyfcMRIwhileelucidatingthisnetworkmoreprecisely.

109

WED

NESDAY 12 M

AR

CH

Overall,ourdatasuggestamuch larger role for the limbicsystem in tinnituspathophysiology

than previously thought, thus opening new avenues for potential treatments of the disorder.

Furthermore,additionalstudyoflimbicconnectivitymayshedlightonthesystem’sinvolvementin

multiplesensorypathways,whichcouldprovidearobustmultidisciplinaryapproachforthestudy

oftinnitusaswellascertainformsofchronicpain.

1. Leaver AM, Renier L, Chevillet MA, Morgan S, Kim HJ, Rauschecker JP. Dysregulation of limbic

and auditory networks in tinnitus. Neuron, 2011; 69(1):33-43.

2. Schlee W, Weisz N, Bertrand O, Hartmann T, Elbert T. Using auditory steady state responses to

outline the functional connectivity in the tinnitus brain. PloS One, 2008; 3(11):e3720.

110

WED

NES

DAY

12 M

AR

CH

INFLUENCE OF TINNITUS ON AUDITORY SPECTRAL AND TEMPORAL RESOLUTION, AND SPEECH PERCEPTION ABILITY IN TINNITUS PATIENTS

Shim,HJ.1;Kang,HW.1;An,YH.1;Won,JH.2

1 Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine,

Seoul, KOREA2 Department of Audiology and Speech Pathology, University of Tennessee Health Science Center,

Knoxville, TN 37996, USA

Aims

Theaimsofthisstudyweretoinvestigate1)theinfluenceoftinnitusupontheauditoryspectral

andtemporalresolutionand2)theeffectoftinnitusonspeechperceptionabilityinnoise.

Methods

Toexcludetheeffectofdecreasedhearingthreshold,unilateralidiopathictinnituspatientswith

symmetrichearingthresholdswereenrolledinthisstudy.Subjectswere19patientswhohave

symmetrichearingloss>20dBHLandabinauraldifference<10dBat0.25,0.5,1,2,3,4,

and8kHz,orwhohavenormalhearingthresholdsandabinauraldifference<10dBat0.25,

0.5,1,2,3,4,and8kHz,andthresholddiscrepancies<15dBat9,11.2,12.5,14,16,18and

20kHz.Seventeennormalhearingsubjectswithout tinnituswereenrolledasacontrolgroup.

Fourdifferentpsychoacousticmeasurementswereperformed:1)spectral-ripplediscrimination,

2)temporalmodulationdetection,3)Schroeder-phasediscrimination,and4)wordrecognitionin

noise.

Results

Therewerenosignificantdifferencesinspectral-ripplethresholds,temporalmodulationdetection

thresholds,andSchroeder-phasediscriminationscoresbetweenaffectedsidesandnon-affected

sidesofunilateraltinnituspatients.Forthewordinnoisetest,affectedsidesshowedsignificantly

worseperformancecomparedtonon-affectedsides(p<0.05).

Conclusion

Wecouldnotfindanyevidencethatthetinnitus-affectedearsshowworsespectralandtemporal

processing compared to non-tinnitus ears in unilateral tinnitus patients. The spectral ripple

discriminationdatasuggeststhatthetinnitus-affectedearsmaynothavebroaderauditoryfilters

compared to non-affected ears with the same hearing thresholds. However, the difference in

111

WED

NESDAY 12 M

AR

CH

speech perception ability in noise suggests that tinnitus might have a masking effect when

subjects try to understand target speech.These results imply that the occurrence of tinnitus

doesnotdependuponthedegreeofcochleardamage,butuponthechangeofcentralauditory

pathwaybydeafferentation.

Acknowledgement

ThepsychoacoustictestmaterialswereprovidedbytheRubinsteinLabatVirginiaMerrillBloedel

HearingResearchCenter.

Funding

ThisresearchwassupportedbyEMBRIGrants2012fromtheEuljiUniversity.

112

WED

NES

DAY

12 M

AR

CH

EFFECT OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON AUDITORY RESIDUAL INHIBITION OF TINNITUS

Shekhawat,G.S.;Searchfield,G.D.;Stinear,C.M.

Section of Audiology, University of Auckland, New Zealand

Aims / Objectives

Transcranialdirectcurrentstimulation(tDCS)isapainless,safeandnon-invasiveneuromodulation

technique1,whereelectrodes(anodeorcathode)arepositionedoverthetargetareaofthehead,

to facilitate or suppress cortical activity. Feldman (1971)2observedbrief tinnitus suppression

followingcessationofthemaskerandthisphenomenonoftinnitussuppressionforabriefperiod

followingtheoffsetofanappropriatemaskingstimuluswaslaterknownasResidualInhibition(RI).

RIusuallylastsforlessthanaminute.TheeffectofanodaltDCSofthelefttemporoparietalarea

onauditoryresidualinhibitionoftinnituswasinvestigatedinthisshamcontrolledstudy.

Methods

Tenparticipants(meanage59.18years,rangingfrom45yearsto76years)withchronictinnitus

(sufferingfromtinnitusformorethan2years)wererecruitedtoundertakefoursessionsoftDCS

combinedwith1minuteofbroadbandnoisestimulation(presentedatminimummaskinglevel

[MML]+10dB),either:before,during,immediatelyaftertDCSorinashamcontrolledsession.

VolunteerswereexcludediftheyhadanycontraindicationsforundergoingtDCS(asscreenedby

aneurologist).Oneparticipantdeclinedcontinuinginthetrialhalfwaythroughthetesting(after

twosessions)duetoworseningoftinnitussymptoms.Participantsratedtheirtinnitusloudness

onaratingscaletwicebeforethetesting(immediatelyafterarrival insoundtreatedroomand

10minutesafterthearrival)andonceafterthecompletionoftesting.Participantswererequired

tocontinuouslyselecttheirtinnitusMMLbyusingadialandcustomsoftware.Thetestingwithin

each session tookapproximately60minutes (5minutesof initialmonitoringofMMLwithno

stimulation,followedbyMMLmonitoringduring20minutesofanodaltDCSofLTA,followedby

30minutesofMMLmonitoringposttDCS).

Results

Although 7 out of 9 participants reported tinnitus suppression with anodal tDCS of the LTA,

changes inMMLwere seen primarilywhen auditory stimuliwas presented immediately after

tDCS(2outof9participantsonly).

113

WED

NESDAY 12 M

AR

CH

Conclusion

Thispilotstudywasanattempttoexploretheimplicationsofneuromodulation(tDCS)onauditory

residualinhibitiontofindwaystoincreaseauditoryresidualinhibitionandinvestigateitsunderlying

mechanisms.PreliminaryevidencesuggeststhattDCSoftheLTAmayenhanceauditoryRIwhen

acoustic stimulation follows immediately after tDCS. However, further investigation is needed

usingmodifiedmethodology(shorttestingtime,screeningparticipantsforRIandalargersample

size)toconfirmthesefindings.

References

1. Vanneste S, De ridder D. Transcranial direct current stimulation (tDCS): a new tool for the treatment

of tinnitus ? In: Moller. A. R, Langguth. B, De Ridder. D, Tobias. K, eds. Text book of Tinnitus. New York:

Springer Science + Business Media; 2010:711-716.

2. Feldmann H. Homolateral and contralateral masking of tinnitus by noise-bands and by pure tones. Int J

Audiol. 1971;10:138-144.

114

WED

NES

DAY

12 M

AR

CH

CHANGES OF TINNITUS IN SUDDEN SENSORINEURAL HEARING LOSS: RELATIONSHIP BETWEEN TINNITUS PITCH AND AUDIOMETRIC SHAPE

Jong-IkLee,TaeSuKim,HyeRanHong,ByungSooShim,HwanSeoLee,JoongHoAhn,JongWooChung,TaeHyunYoon,HongJuPark

Objectives

Differentmechanisms,suchaslateral inhibitionandhomeostaticplasticity,areproposedtobe

involvedintinnitusgeneration.Theaimsofthisstudyweretoevaluatethechangesoftheacute

and1-monthfollow-uptinnituspitchinpatientswithidiopathicsuddensensorineuralhearingloss

(SSNHL)andtoexplorethemechanismsoftinnitusgeneration.

Design

Thirty-six patients with SSNHL with new-onset tinnitus who underwent audiological tests,

includingpure-toneaudiometryandpitch-matchingand loudness-balance tests,atboth initial

andfollow-upexaminationswereincluded.Therelationshipbetweenthetinnituspitchandthe

maximumhearinglossortheedgefrequencywasevaluated.

Results

Theinitialmeantinnituspitch(2.9kHz),whichwasclosetotheinitialedgefrequency(2.7kHz),

increasedtoasignificantlyhigherfrequency(4.6kHz)at1-monthfollow-up,whichwascloseto

thefrequencyofmaximumhearingloss(5.6kHz).Therewerenosignificantdifferencesinthe

frequencyofmaximumhearingloss,theedgefrequency,andtheloudnessoftinnitusbetween

initial and follow-up examinations. The tinnitus pitch had a more significant correlation with

theedge frequency (r=0.46,p=0.005) than the frequencyofmaximumhearing loss (r=0.33,

p=0.047) at initial examination; however, at 1-month follow-up, the tinnitus pitch showed a

significantcorrelationonlywiththefrequencyofmaximumhearingloss(r=0.52,p=0.001),not

withtheedgefrequency.

Conclusion

Ourfindingssuggestthattheremaybediversemechanismsbywhichtinnituscanoccurinpatients

with SSNHL.The change in the tinnitus pitch from the edge frequency at initial examination

towardsthefrequencyofmaximumhearinglossatfollow-upsuggeststhattinnitusisgenerated

mostlybyreducedlateralinhibitionatacutehearinglossandthatahomeostaticmechanismplays

amajorroleintinnitusgenerationatthechronicstage.

115

WED

NESDAY 12 M

AR

CH

EXAMINING THE ROLES OF CONTEXTUAL STIMULI AND PERSONALITY TRAITS UNDER THE ADAPTATION LEVEL THEORY MODEL OF TINNITUS

Aruldasan,M.;Kobayashi,K.;Searchfield,G.D.

Section of Audiology, University of Auckland, Auckland, New Zealand

Objective

Thisstudyassessed thevalidityofanovelpsychoacousticALTmodelof tinnitusproposedby

Searchfieldetal.(2012)[1],basedonHelson’s(1964)adaptationleveltheory(ALT)[2].Tinnitus

is conceptualized as a sensory stimuluswith an existing internal adaptation level (AL),which

acts as a reference point for all tinnitus-related judgments.ThisAL is susceptible to change

fromattention,background(context)andresidual(personality,memory/prediction,physiological

arousalandemotion)influences.Theeffectsofeachcomponentcantheoreticallybequantified

andmodeledmathematically,makingthemodelsignificantforempiricaltinnitusresearch.The

ideallevelofinterventionsoundfortinnitusremainsdebatable.Personalitytraitsactaspredictors

for tinnitus distress and perception: it is possible these traits can influence tinnitus-sound

interactions.Twocomponentsof themodelwere investigated:backgroundnoise (context)and

personalitytraits(singleresidualcomponent),inanattempttoisolatetheireffectsontinnitus.

Design

Loudnesslevelmatches,andratingscalesforloudnessanddistressweremeasuredbeforeand

after20minutesof:quiet,NarrowBandNoise(NBN)atthresholdlevel,10dBsensationleveland

20dBsensationlevel.PersonalityvariableswereassessedusingtheMultidimensionalPersonality

QuestionnaireFormNZ(MPQ-FormNZ).Studysample:Twentyparticipantswithchronictinnitus

participatedinthestudy.

Results

Tinnitus distress interacted with contextual noise levels in a manner consistent with theALT

model; tinnitus loudness matches to sound did not change.The 20 dB sensation level noise

ledtothegreatestreductionintinnitusmeasures;howeverthiswasnotstatisticallysignificant.

The personality traits of social closeness, positive emotionality, stress reaction and negative

emotionality were seen to influence contextual noise-tinnitus interactions. The emergence of

‘adaptation-sensitive’ and ‘adaptation-insensitive’ persons was observed. The ALT model’s

conceptualizationofthetinnitusloudnessparadoxwassupported.

116

WED

NES

DAY

12 M

AR

CH

Conclusions

Thefirstempiricalstudy testing theALTmodelof tinnitus ispromising.Tinnitus loudnessand

distressmightrepresenttwoseparateunderlyingconstructswithdifferentadaptationlevels.Also,

underlyingindividualdifferencesinadaptationsensitivitymaybepresent.

References

1. Searchfield, G.D., Kobayashi, K., & Sanders, M. An adaptation level theory of Tinnitus audibility. Front

Syst Neurosci, 2012; 6: 46.

2. Helson, H. Adaptation-level theory: an experimental and systematic approach to behavior.New York:

Harper and Row; 1964

117

WED

NESDAY 12 M

AR

CH

CORTICAL PLASTICITY IN TINNITUS PATIENTS AFTER REPETITIVE EXPOSURE TO TAILOR-MADE NOTCHED MUSIC

Engell,A.1*;Stein,A.1*;Pantev,C.1

1 Institute for Biomagnetism and Biosignalanalysis, University of Münster, Germany

* Both authors contributed equally to this work

Objectives

Chronic tinnitus is assumed to be a result of reduced inhibition of neurons corresponding to

the tinnitus frequency.Onepossibility to reverse theeffectsof thismaladaptation is to induce

inhibitiononneuronscorrespondingto thetinnitusfrequencybyauditorystimulation.Thiscan

beachievedbypresentingmusicwithreducedenergyinthefrequencybandwidthscenteredat

thetinnitusfrequencyusinganotchfilter(tailor-madenotchedmusic).Theaimofthisstudywas

toassesstheimpactofrepetitivestimulationwithtailor-madenotchedmusicontheneuraland

behavioralcorrelatesof tinnitusperception.Weexpected tofindplasticchanges in theneural

activityofauditorycorticalregions.Furthermore,wewantedtoinvestigatewhetherotherbrain

regionsareinvolvedintheprocessofshort-termplasticity.

Methods

Tensubjectssufferingfromchronictonaltinnituslistenedtomusicpassingthroughanotch-filter

centered at the tinnitus frequency for three hours on each of three consecutive days.Neural

activityevokedbyeitheratoneatthetinnitusfrequency(tinnitustone)orbyacontrol toneof

500Hzwasmeasuredbymagnetoencephalography(MEG)beforeandimmediatelyaftermusic

exposure.Tinnitusloudnesswasmeasuredviavisualanalogscales.Adistributedsourcemodel

wasusedtoinvestigatetheneuralactivityinauditoryaswellasinfrontalcorticalregionsinthe

N1mtimewindow.

Results

Aftermusicexposure,neuralactivityevokedbythetinnitustoneinthetemporallobedecreased

significantly,whereasneuralactivityevokedbythecontroltoneremainedunaffected.Additionally,

tinnitus loudness was rated significantly lower after music exposure.There was a significant

correlationbetweenthereductionofneuralactivityinthetemporallobeevokedbythetinnitus

toneandthetinnitus loudnessratings.Furthermore,therewasasignificant increaseofneural

activityevokedbythecontroltoneinthefrontallobeaftermusicexposure,whichcouldnotbe

observedintheneuralactivityevokedbythetinnitustone.

118

WED

NES

DAY

12 M

AR

CH

Conclusion

Tailor-madenotchedmusicevokesneuralplasticityintemporalaswellasinfrontalcorticalareas

of tinnitus patients.Additionally, there is a clear connectionbetween the reduction of tinnitus

loudnessandtheneuralreorganizationinthetemporalcortex.Theseeffectswerefoundaftera

shortperiodofmusicexposure,indicatingafastneuralreorganizationandbehavioraladaptation.

119

WED

NESDAY 12 M

AR

CH

ABNORMAL BRAIN ACTIVITY AND CROSS-FREQUENCY COUPLING IN THE TINNITUS NETWORK

Adamchic, I.1;Langguth,B.2,3;Hauptmann,C.1;TassP.A.1,4,5

1 Institute of Neuroscience and Medicine-Neuromodulation, Jülich Research Center, Jülich,

Germany2 Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany3 Interdisciplinary Tinnitus Center, University of Regensburg, Regensburg, Germany4 Department of Neuromodulation, University of Cologne, Cologne, Germany5 Clinic for Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany

Background and aims

Neuroimagingstudieshave identifiednetworksofbrainareasandoscillationsassociatedwith

tinnitus perception. Nevertheless, it is still unclear how oscillations in the different frequency

bandswithinvariousnodesofthetinnitusnetworkinteract.Cross-frequencycoupling(CFC)of

theamplitudeofhigh-frequencyactivitytothephaseofsloweroscillationshasbeendescribed

bothinhumansandinanimals,buthasneverbeeninvestigatedinsubjectivetinnitus.Herewe

usedEEGrecordingstotestthehypothesisthatinhumantinnituspatientsasidefromtheknown

alterations of oscillatory activity, there is also an altered periodicity of amplitude variations of

higherfrequency(gamma)oscillationswithcertainphasesoflower(delta/theta/alpha)frequency

oscillations.

Methods

Hierarchical phase-amplitude coupling for a tinnitus related network of localized EEG brain

sourceswascalculatedintinnituspatientsandinthegroupoftinnitusfreecontrols.Forthis,we

usedthecomodulationanalysisandthemodulationindexbetweenthetimecourseofthepower

inanumberofgammafrequencysub-bandsandphasesofasetofintrinsicmodefunctionsof

lowerfrequencyoscillations(providedbyempiricalmodedecomposition).

Results

In tinnituspatientsascompared to tinnitus freecontrols, aside from thepreviouslydescribed

changes of oscillatory activity, there were also changes of CFC within nodes of the tinnitus

network and between these nodes. Reduction of tinnitus severity after acoustic coordinated

resettherapyledtoapartialnormalizationofcross-frequencyinteractioninvariousnodesofthe

tinnitusnetworkandbetweenthesenodes.

120

WED

NES

DAY

12 M

AR

CH

Conclusions

In our study we found clear evidence of increased delta/theta-gamma and decreased alpha-

gamma coupling in tinnitus patients. Tinnitus intensity was also associated with a more

pronouncedcross-frequencyinteractionbetweencognitive,sensoryareasandanteriorcingulate

cortexregion.ThetinnitusspecificpatternofCFCwasatleastpartiallyrevertedbya12weeks

acoustic CR treatment. CFC can coordinate tinnitus-relevant activity in the tinnitus network

providingamechanismforeffectivecommunicationbetweennodesofthisnetworkinprocessing

ofthedifferentaspectsoftinnitus.

121

WED

NESDAY 12 M

AR

CH

SURFACE BASED MORPHOMETRY ANALYSIS OF NEUROPLASTICITY INDUCED CHANGES IN THE BRAIN OF PATIENTS WITH TINNITUS

Kleinjung,T.1;Neff,P.2;Langguth,B.3;Meyer,M.2;Schecklmann,M.3

1 Department of Otorhinolaryngology, University of Zurich, Switzerland2 Psychological Institute, University of Zurich, Switzerland3 Department of Psychiatry and Psychotherapy, University of Regensburg, Germany

Objectives

Different neuroimaging techniques (MRI, PET, EEG, MEG) have been used to identify brain

structures involved in tinnitus pathophysiology. Multiple studies detected neuronal correlates

of tinnitus in auditory (temporal) and non-auditory (frontal, parietal, limbic, subcallosal) brain

regions suggesting the existence of a wide-spread neural network responsible for tinnitus

awareness.Mostofthesestudiesappliedafunctionalapproachandmeasuredtinnitusrelated

activity changes in involved brain regions and networks. Only a few studies concentrated on

structuralchangesanalyzingvolumedifferencesofgrayandwhitematterbycomparingsubjects

withandwithouttinnitus(voxel-basedmorphometry).Thestudiespublishedsofardemonstrated

someinconsistencyintheextentofvolumechangesandthelocalizationofinvolvedstructures.

To reconcile these contradictory results the aim of this project is a systematic re-analysis of

neuroanatomicaltraits(corticalthickness,corticalarea,corticalvolume)bymeansofaninnovative

observer-idependent surface-based morphometry approach (FreeSurfer). Unlike the traditional

voxel-based morphometry (VBM) approach, FreeSurfer allows the separate computation of

independentneuroanatomicaltraits,namelysurfaceareaandcorticalthickness

Methods

FreeSurfer is a set of software tools for the study of cortical and subcortical anatomy. In the

corticalsurfacestream,thetoolsconstructmodelsoftheboundarybetweenwhitematterand

cortical graymatter aswell as the pial surface.Once these surfaces are known, an array of

anatomicalmeasuresbecomespossible, including:cortical thickness,surfacearea,curvature,

andsurfacenormalateachpointon thecortex.333structuralMRIdatasetsofpatients)with

tinnituswhichwerealreadyanalyzedbymeansofVBM1wereincludedinthestudy.Additional

MRI data of 100 subjectswithout tinnitus alloweda global analysis of structural neuroplastic

changesasafunctionofchronictinnitusperceptionintermsofagroupcomparison.Accurate

phenotypicalcharacterizationoftinnitussubjectsallowedanidentificationoftinnitussubgroups

(e.g.lowvs.hightinnitusrelateddistress;impairedvs.normalhearing,etc.).

122

WED

NES

DAY

12 M

AR

CH

Results

A negative correlation between tinnitus distress and temporal grey matter (proposed core

networks) could be replicated methodwise and corrected for multiple comparisons. Further

correlations of tinnitus distress in salience or self-perception networks includingACC, insula,

parietaland(pre)cuneuswereobserved.Groupcomparisonsoftwosubsetsmatchedforageand

genderandage,genderandhearing function respectively (normalvs. impairedhearing)were

performed.Theseanalysesrevealeddifferencesinbilateralparietalareas(corrected),ACC,PCC,

parahippocampal,(pre)cuneustemporal(incl.insula)andinfrontalareas.

Conclusions

Re-analysis of the large dataset by means surface based morphometry (FreeSurfer) showed

consistent effects in comparison to a previous analysis with VBM1. However, the FreeSurfer

methodseemstobemoresensitiveandgeneratesawiderarrayofresults.Thefindingsfitinto

a frameworkasproposedbyDeRidderetal.2andcontributesolidanatomicalevidence.The

interpretationofvolumeandthicknesschangesrelatedtodistressandgroupaffiliationmustbe

discussed.Furthermore,ananalysisandcomparisonoftheparameters(volume,thickness,area

andgyrification)andtheirinterplayisoflargeinterest.

References

1. Schecklmann M, Lehner A, Poeppl TB, et al. Auditory cortex is implicated in tinnitus distress: a voxel-

based morphometry study. Brain Struct Funct 2013;218:1061-70.

2. De Ridder D, Vanneste S, Weisz N, et al. An integrative model of auditory phantom perception: Tinnitus as

a unified percept of interacting separable subnetworks. Neurosci Biobehav Rev 2013.

123

WED

NESDAY 12 M

AR

CH

ELECTROPHYSIOLOGICAL EFFECTS OF ATTENTION IN NORMAL HEARING AND IN TINNITUS

Paul,B.;Bruce,I.;Bosynak,D.J.;Thompson,D.C.;Roberts,L.E.

Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, Ontario,

Canada L8S 4K1

Objective

We recently reported that modulation of the amplitude of the 40-Hz auditory steady-state

response(ASSR,localizingtonotopicallytoprimaryauditorycortex)andN1response(localizing

tonontonotopicsecondaryauditoryregions)byattentionisimpairedinindividualswithtinnitus

comparedtocontrolsubjects,whentheresponsesareevokedby5kHz40-HzAMsoundinthe

tinnitus frequency region (TFR) of the tinnitus group.1 One explanation of this finding is that

persistentaberrantnetworkactivityoccurring in theTFRof tinnitussubjectsmaydriveneural

activityinthisregionaswellasinA2,makingtheASSRandN1resistanttomodulationbythe

auditoryattentionsystem.

Methods

WeassessedthishypothesisbydeterminingwhethermodulationofASSRandN1responsesby

attentionisimpairedintinnituswhenthecarrierfrequencyusedtoevoketheseresponsesis500

Hz,whichiswellbelowtheTFRwheretinnitus-relatedneuralactivityisexpectedtooccur.The

taskwas identical to theauditorydetectiontaskusedpreviously,except for thechange inthe

carrierfrequencyofthe40-HzAMsound.WealsoextendedtheanalysistoincludeP1,P2,and

N2transientresponsesandtheauditorysustainedresponseinthetinnitusandcontrolgroups

testedhereat500Hz,andinthetinnitusandcontrolgroupstestedpreviouslyat5kHz.

Results

ASSR responses were modulated significantly by attention at 500 Hz (ASSR larger on active

attendedcomparedtopassiveunattendedblocks)incontrolsubjectsaswellasinsubjectswith

tinnitus.ModulationofN1byattentionwasalsoobservedat500Hzincontrolsubjects;however

modulationofN1byattentionat500Hzwasnotsignificantinthetinnitusgroup.Modulation

ofN2andtheauditorysustainedresponsebytheattentionalrequirementwassignificantinthe

tinnitusandcontrolgroupstestedat500Hz,andinthesegroupstestedearlierat5kHz.

124

WED

NES

DAY

12 M

AR

CH

Conclusion

Tinnitus-relatedneuralactivity inprimaryauditorycortexmayberesponsible for the failureof

taskattentiontomodulatethe5kHz40-HzASSRinindividualswithtinnitus.Thisactivitycould

alsoexplainthefailureofN1modulationintinnitussubjectsat500Hz,ifitdrivesactivityinA2

whichisnottonotopicallyorganized.Modulationoflonglatencyresponses(N2andthesustained

response)requiresadifferentinterpretation.Theseresponseshaveatopographydifferentfrom

N1 and may reflect neural activity in nonauditory regions that support task requirements not

relatedtoattention.

1. Roberts LE, Bosnyak DJ, Thompson DC. Front. Syst. Neurosci. 2012; 6:40. doi: 10.3389/fnsys.2012.00040

(Supported by NSERC of Canada)

125

WED

NESDAY 12 M

AR

CH

PARAHIPPOCAMPAL-AUDITORY CORTEX COMMUNICATION IN TINNITUS

De Ridder, D.1;Congedo,M.2;Vanneste,S.3

1 University of Otago, New Zealand

² Inserm Grenoble, France

³ University of Texas, USA

Introduction

Theparahippocampalareaandauditorycortexareimportanthubsintinnitus,asdemonstrated

byEEG,MEG,fMRIandPET.Furthermore,thefunctionalconnectivitybetweentheseareasisthe

onlyrobustfindinginrestingstatefMRIstudiesintinnitus.

Methods and materials

TofurtherexplorethiscriticalconnectionweperformedEEGsin129tinnituspatientsWeanalyzed

theneural correlatesof hearing lossandsubjective tinnitus loudness (NRS) onawholebrain

analysis as well as the functional and effective connectivity between the auditory cortex and

parahippocampalarea.

Results

Hearing loss is related to bilateral parahippocampal theta activity and right-sided alpha

parahippocampal activity.Tinnitus loudness is related to gamma band activity in the auditory

cortex leftparahippocampus,aswellasalpha in the left insula, lowbeta rightdorsalanterior

cingulatecortex.

A significant correlation is found between the subjective loudness and lagged phased

synchronization(=functionalconnectivity)betweentheleftparahippocampusandtheleftauditory

cortexforthethetafrequencyband,aswellasforthepercentageoftimethereistheta-gamma

nestingintheleftparahippocampusandauditorycortex.

Theeffectiveconnectivitydependsonthehearingloss.Themorehearinglossapatienthasthe

moreinformationistransferredfromtheparahippocampalareatotheauditorycortex

Discussion and conclusion

Theparahippocampusandauditorycortexcommunicateusingthethetabandasacarrierwave

onwhichgammabandactivityisnested.Thegammabandcorrelateswiththetinnitusloudness.

Inhearinglossthemissinginformationseemstobepulledfromhippocampalmemory.

126

WED

NES

DAY

12 M

AR

CH

MODULATING ALPHA AND BETA OSCILLATIONS WITHIN POSTERIOR CINGULATE CORTEX THROUGH REAL-TIME SOURCE LOCALIZED NEUROFEEDBACK AND ITS EFFECT ON TINNITUS RELATED DISTRESS

Joos,K.1;DeRidder,D.2;Vanneste,S.31 Department of Translational Neuroscience, Faculty of Medicine, University of Antwerp, Belgium2 Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand3 Lab for Auditory & Integrative Neuroscience, School of Behavioral and Brain Sciences, The

University of Texas at Dallas, USA

Upto25%ofthepeopleaffectedbytinnitusreportinterferencewiththeirlivesastinnituscauses

aconsiderableamountofdistress. It isknown thatdistresscanplayan important role in the

developmentoftinnitusleadingtopsychologicalcomplicationssuchasannoyance,concentration

problems, depression, anxiety, irritability, sleep disturbances, and intense worrying. Previous

researchalreadyindicatedthatdecreasedalphapowerisassociatedwithactivelyengagingin

processingastimulusandthattheposteriorcingulatecortexformsacoreregionofthedefault

network.Highlydistressedtinnituspatientsareactivelyengagedtotheirtinnitusassuchitseems

reasonablethatadecreasedalphapowerisobtainedwithintheposteriorcingulatecortex.The

beta-bandoscillationson theotherhandhavebeenassociated tomaintenanceof thecurrent

cognitivestate.Thatis,betaoscillationsarerelatedtoendogenousmodulationofearlyauditory

responsesandmaybeenhanced if thestatusquo isgivenpriorityoveranewsignal.As this

phantomsound isconstantlypresentandcouldbe interpretedasstatusquo thathaspriority

overanewsignal,certainlyinpatientthatarereallydistressedbytheirtinnitus.Thisfitswiththe

findingsthathighlydistressedtinnituspatientshaveincreasedbeta-bandoscillationswithinthe

posteriorcingulatecortex.Consequently,itcanbehypothesizedthatreal-timesourcelocalized

neurofeedback to voluntarily up-regulate alpha activity and down-regulate beta activity within

theposteriorcingulatecortexcanmodulatetinnitusrelateddistress.Thisapproachgoesbeyond

conventional imaging studies that only correlate ongoing activity with changes in tinnitus, as

neurofeedbackallowsustodirectlymanipulateongoingbrainactivityandtherebytoestablish

a causal link between ongoing activity and tinnitus perception.The posterior cingulate cortex

is a particular well-suited target for neurofeedback because its activity can be modulated by

top-downcontrolmechanisms,suchasattentionandimagery.Hereweshowinalargegroupof

50tinnituspatients,inaplacebo-controlledway,thatup-regulatingalphaanddown-regulating

beta oscillations targeting the posterior cingulate cortex through real-time source localized

neurofeedbackhasacleareffectonthetinnitusrelateddistressbutnotontheloudness.These

resultsaresupportedbypowerchangesandchangesinphasecoherence.

127

WED

NESDAY 12 M

AR

CH

CHANGE IN SPONTANEOUS CORTICAL ACTIVITY DURING TINNITUS REMEDIATION

Mathur,A.;Ibrahim,R.;McMahon,C.M.

Audiology Section, Department Linguistics, Macquarie University, NSW, Australia

Introduction

Tinnitusremediationprogramsvaryintheireffectivenesstoprovidelong-termrelieffortinnitus

sufferers.Understandingthelinkbetweensubjectivebenefitandtheneurophysiologicalchanges

which occur throughout remediation may provide a better understanding of the physiological

mechanisms underpinning tinnitus relief and may be important for developing individualised

therapies.However,currentlythisislimitedbyapaucityofsensitiveandobjectivetests.Recent

advancesinimagingtechniqueshaveshownsomepromiseinidentifyingandquantifyingtinnitus-

relatedneuralactivityanditsrelationshipwithsubjectiveindicatorsoftheimpactofthetinnitus

ontheindividual(Hoke,Feldmannetal.1989;Weisz,Morattietal.2005).Inthisstudy,weaim

toevaluatetheneurophysiologicalchangesevidentintinnitusandnon-tinnitussufferersandto

evaluatethechangesinspontaneousbrainactivityduringatinnitustreatmentprogram.

Aims / Objectives

Theaimsofthepresentstudyare:

4. Identifychangesinthespontaneousactivityofthebraininpatientswithclinicallysignificant

tinnitususingMagnetoencephalography(MEG).

5. Measurechanges inspontaneousbrainactivityprior,duringandpost tinnitusremediation

program.

6. Identifyifanyassociationexistsbetweenthesubjective(TRQ)andobjective(MEG)measures

oftinnitus.

Method

Thetinnitusgroup(N=12)underwentextendedaudiometricevaluationandcompletedabattery

ofquestionnairesrulingoutclinicaldepressionandanxietyasaprobablecauseof,orassociation

withtinnitus.AfiveminutespontaneousMEGrecordingwasacquiredwhiletheywereinastate

of relaxed wakefulness. The tinnitus participants were provided with Neuromonics treatment

program,whileatthesametimehadtheirMEGdatarecordedpriorto,duringandposttreatment

program.Asacomparison,spontaneousMEGrecordingsofcontrolgroup(N=10)withclinically

normalhearingandnocomplaintoftinnituswerealsoacquired.TheMEGdatawereanalysed

usingBrainElectricalSourceAnalysis(BESA)software.

128

WED

NES

DAY

12 M

AR

CH

Results and Conclusion

Ourresultsshowedthatthespontaneousalpha(8-13Hz)temporal-parietalbrainactivitiesinthe

tinnitusgroupweresmallerwhencomparedtothatofthecontrolgroup. Incrementalchanges

ofalphawereseenasthetreatmentprogressed.Inaddition,aninverseassociationbetweenthe

TRQscoreandalphapowermeasuredfromthecortexwerefound.Wewilldiscussthepotential

implicationsofusingMEGasatooltoobjectivelymeasuretinnitus.

Hoke, M., H. Feldmann, et al. (1989). “Objective evidence of tinnitus in auditory evoked magnetic fields.”

Hearing Research 37(3): 281-286.

Weisz, N., S. Moratti, et al. (2005). “Tinnitus perception and distress is related to abnormal spontaneous brain

activity as measured by magnetoencephalography.” PLoS medicine 2(6): e153.

129

WED

NESDAY 12 M

AR

CH

TONOTOPIC MAP CHANGES DURING TINNITUS REMEDIATION

Ibrahim,R.K.;McMahon,C.M.;Mathur, A.

Dept. of Linguistics, Macquarie University, North Ryde, NSW, Australia

Background

Tinnitus has been associated with the abnormal organisation of the tonotopic map in the

auditorycortex(Eggermont,2006).However,itiscurrentlynotclearwhethersuccessfultinnitus

remediationwhich shows improved subjective outcomes, can affect the reorganisation of the

tonotopicmaptowardsanon-disruptedstate.Thereforetheaimsofthepresentstudywere:(i)to

comparetonotopicmapsacquiredfrommagnetoencephalography(MEG)recordingsinindividuals

withsignificanttinnituswithnon-tinnitusparticipantstodeterminewhetherdisruptionscouldbe

measured;(ii)toidentifywhetherchangesinthetonotopicmapandevokedresponsesoccurred

during and after a tinnitus remediation program; and (iii) to identify whether these changes

occurredinparallelwithsubjectivechangesoftinnitusimpact.

Method

Twelve tinnitus participants were recruited and completed audiometric evaluation, subjective

measurement of tinnitus using the tinnitus reaction questionnaire (TRQ), measurement of

psychoacousticcharacteristicsoftinnitus,andevaluationofdepressionandanxietybeforeduring

andafter tinnitus remediation.Tennormalhearingnon-tinnitusparticipantswere recruited for

comparison.Soundstimuliof500Hz,1kHz,2kHz,4kHzand8kHztoneswerepresentedtoeach

earindividuallyandcorticalactivitywasmeasuredusingMEG.Alltinnitusparticipantscompleted

aNeuromonicsrehabilitationprogramover25weeksandMEGwasmeasuredat5or10week

intervals.MEGdatawereanalysedusingBrainElectricalSourceAnalysis(BESA).

Results & conclusions

MEGresultsindicatedthatthetinnitussubjects’sourcelocationsweremoreanteriorcomparedto

thatofthecontrolgroup(forallpresentedfrequencies).Afterundergoingremediation,thetinnitus

subjects’ source strengths increased (for normal hearing frequencies) while source locations

movedtowardsamoreposteriorlocation(towardsthatofnon-tinnitusparticipants).Theseresults

suggeststhattinnitusremediationusingNeuromonicsaffectssourcestrengthandtonotopicmap

ofthetinnitusparticipants.

Reference

2. Eggermont JJ. Otolaryngol. Suppl. 2006; 556:9-12.

130

WED

NES

DAY

12 M

AR

CH

CHANGES IN RESTING-STATE FMRI ACTIVITY DURING SALICYLATE-INDUCED TINNITUS AND SOUND STIMULATION

Chen,Y.-C.1;Wang,J.1,2,3;Jiao,Y.1;Zang,F.-C1.;Yang,M.1;Tong,J.-X.1;Salvi, R.4;Teng,G.-J.1

1 Department of Radiology2 Department of Physiology and Pharmacology, Medical School of Southeast University, Nanjing

China3 School of Human Communication Disorders, Dalhousie University, Halifax, Canada4 Center for Hearing and Deafness, University at Buffalo, Buffalo, NY, USA

Aims / Objectives

Theneuralmechanismsthatgiverisetothephantomsoundoftinnitusarepoorlyunderstood,

but recentstudiessuggest that low frequencyneuraloscillatoryactivitycontributes to tinnitus

generation.Toexplorethisissue,wemeasuredtheamplitudeoflow-frequencyfluctuations(ALFF)

inresting-statefunctionalmagneticresonanceimaging(fMRI)duringsalicylate-inducedtinnitus

andduringsoundstimulation.

Methods

Ratswerescannedwitha7.0TMRIsystem;15weretreatedwith300mg/kgofsalicylateto

inducetinnitusandtheremaining15wereinjectedwithsalineascontrols.BaselinefMRIscans

werecollectedwithmusicstimulation(85dBSPLLeq)andwithoutmusic(control).Afterwards,

themeasurementswererepeated2haftersalicylateorsalinetreatment.Statisticalparametric

mappingwasusedtodeterminewhichregionsofthebrainshowedsignificantchangesinALFF

activityduetosalicylateormusicstimulation.

Results

SalicylateinducedsignificantbilateralincreasesofALFFactivityinseveralauditoryregion(auditory

cortex,medialgeniculatebody,inferiorcolliculus,trapezoidbody)aswellasseveralnon-auditory

regionsincludingtheparaflocculusofthecerebellum,visualcortex,somatosensorycortexand

amygdala. Incontrast, salicylatesignificantlydecreasedALFFactivity in thehippocampusand

striatum.Furthermore,salicylatetreatmentenhanced(hyperactivity)theALFFneuralresponses

tomusicstimuliinseveralbrainregions,includingtheauditorycortex,inferiorcolliculus,medial

geniculatebody,trapezoidbodyandsomatosensorycortex.

131

WED

NESDAY 12 M

AR

CH

Conclusions

Salicylate significantly increasedALFF oscillatory activity in several auditory and non-auditory

regionspreviously implicated in salicylateand/ornoise-induced tinnitus. Interestingly, several

newregionsofaberrantALFFactivitywereobservedinvisualandsomatosensorycortex,sensory

areasknowntointerconnectwiththeauditorycortex.Musicstimulationtendedtopotentiatethe

salicylate-inducedhyperactivity in theALFFresponses inmanyauditoryareas,consistentwith

previouselectrophysiologicalreportsofsoundevokedhyperactivityinthecentralauditorypathway.

Theseresultssuggest that theperceptionof tinnitusmaybedue inpart to large increases in

low-frequencyneuraloscillationswithinthecentralauditorypathwayalongwithaberrantneural

oscillationsintheamygdala,paraflocculusandvisualandsomatosensorycortices.Resting-state

ALFFfMRImightthereforeproveusefulinidentifyingtheaberrantneuralnetworksinhumanswho

sufferfromsevere,debilitatingtinnitus.

132

WED

NES

DAY

12 M

AR

CH

AUDITORY-LIMBIC NETWORK IN TINNITUS REVEALED BY RESTING-STATE FUNCTIONAL CONNECTIVITY MRI

Turesky,T.;Leaver,A.M.;Seydell-Greenwald,A.S.;Rauschecker,J.P.

Laboratory of Integrative Neuroscience and Cognition, Dept. of Neuroscience

Georgetown University Medical Center, Washington, DC 20057, USA

Tinnitusischaracterizedbytheperceptionofsoundintheabsenceofanexternalsource.Despite

theprevalenceofthisdisorder,itspathophysiologyremainspoorlyunderstood.Alargebodyof

evidencehasrevealedplasticity-relatedchangesintheauditorysystemofpatientswithtinnitus,

including modifications in one or more sites along the auditory pathway, both peripheral and

central.Althoughlesion-inducedplasticityofauditorystructuresmaybeanecessaryprecondition,

itdoesnotseemsufficienttocausechronictinnitus.Giventhisconstraint,andthegrowingbody

ofevidence implicating limbic involvement in tinnitus,weproposethat limbicdysfunctionmay

playacriticalroleincausing,aswellasperpetuating,thetinnituspercept.

For our current study, we chose to elucidate this dysfunction by using magnetic resonance

imagingtomeasurefunctionalconnectivity(fcMRI).Sincethetinnitusperceptismostnoticeable

atrest,i.e.intheabsenceoftasksordistractors,wechosetoanalyzeconnectivityfromresting-

statefcMRIdata,thatis,dataacquiredwhensubjectswerenotperforminganytasks.Specifically,

weusedIndependentComponentAnalysis(ICA),adata-driven,non-a-prioristatisticaltechnique,

to identify roughly 25 functionally connected resting-state networks (RSNs). Auditory, visual,

“default-mode,” and other neurophysiologically plausible networks were consistently detected

inallsubjects,alongwithnon-neurophysiologicalnetworks,havingtodowith,e.g.,respiration

andheartrate,whichwereremovedfromfurtheranalysis.Ofparticularinterestwasanetwork

thatappearedinICAsoftinnituspatients,butnotofcontrolsmatchedforageandhearingloss.

ThisnetworkdemonstratedauniqueinverserelationshipbetweenmedialHeschl’sgyrus(mHG)

andtheNucleusAccumbens(NAc),suggestingadirectorindirectconnectionbetweenthetwo

regions.Apartfromrevealinganovelauditory-limbicnetwork,theseresultsareconsistentwith

previousreportsofNAcinvolvementintinnitus[1],andsuggestafar-reachingtinnitusnetwork

incorporating non-auditory regions [2]. The present study offers the additional advantage of

superiorspatialresolutionaffordedbyfcMRIwhileelucidatingthisnetworkmoreprecisely.

Overall,ourdatasuggestamuch larger role for the limbicsystem in tinnituspathophysiology

than previously thought, thus opening new avenues for potential treatments of the disorder.

133

WED

NESDAY 12 M

AR

CH

Furthermore,additionalstudyoflimbicconnectivitymayshedlightonthesystem’sinvolvementin

multiplesensorypathways,whichcouldprovidearobustmultidisciplinaryapproachforthestudy

oftinnitusaswellascertainformsofchronicpain.

1. Leaver AM, Renier L, Chevillet MA, Morgan S, Kim HJ, Rauschecker JP. Dysregulation of limbic and

auditory networks in tinnitus. Neuron, 2011; 69(1):33-43.

2. Schlee W, Weisz N, Bertrand O, Hartmann T, Elbert T. Using auditory steady state responses to outline the

functional connectivity in the tinnitus brain. PloS One, 2008; 3(11):e3720.

134

WED

NES

DAY

12 M

AR

CH

TINNITUS AND DYSFUNCTIONAL INTERACTIONS BETWEEN DISTRIBUTED RESTING STATE NETWORKS

Maudoux,A.1-2;Vanneste,S.3;DeRidder,D.4;Vanhecke,W.5;VandeHeyning,P.6;Cabay,J.-E.7;Demertzi,A.1;Laureys,S.1-8;Soddu,A.1;Lefebvre,Ph.9;GomezF.1

1 Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium2 OtoRhinoLaryngology Head and Neck Surgery Department, Erasme University Hospital,

University of Brussels, Belgium3 Lab of Auditory & Integrative neuroscience. School of Behavioral and Brain Science. University

of Texas at Dallas. Dallas, USA4 Surgical Sciences, Surgery, Neurosurgery, Dunedin School of Medicine, New-Zeland 5 Brai2n, TRI & Department of Neurosurgery, Antwerp University Hospital, Antwerp, Belgium6 OtoRhinoLaryngology Head and Neck Surgery Department, Antwerp University Hospital,

Antwerp, Belgium7 Radiology Department, CHU Sart Tilman Hospital, University of Liège, Belgium8 Neurology Department, CHU Sart Tilman Hospital, University of Liège, Belgium9 OtoRhinoLaryngology Head and Neck Surgery Department, CHU Sart Tilman Hospital, University

of Liège, Belgium

It is known thatperipheral lesions in thecochleaor theauditorynerveproducedysfunctional

input tocentralauditorystructuresand inducechanges in theauditorysystem.Associated to

plasticchangesincentralauditorystructures,extra-auditoryregionshavebeenimplicatedinthe

tinnituspathophysiology.Recently,ithasbeenproposedthattheunifiedperceptoftinnituscould

beconsideredasanemergentpropertyofmultipleoverlappingdynamicbrainnetworks,each

encodingaspecifictinnituscharacteristic.Indeed,moreandmoreresearchessuggestthatthe

braincortexisorganizedintoparallel,segregatedsystemsofbrainnetworksthatarespecialized

forprocessingdistinctformsofinformation.Regardingtinnitus,preliminaryevidenceusingEEG,

MEGandPETindicatesthatspecificclinicalcharacteristicsarecorrelatedtospecificbrainarea

activations.Theseevidencesprovideafirstinsightabouttheroleofnetworkinteractionforthe

emergenceofclinicaltinnituscharacteristics.

Theaimofourstudywastoinvestigatetheneuronalactivationpatternsassociatedwithspecific

clinical tinnitus characteristicsusing fMRI.Wehypothesize that tinnitus clinical characteristics

couldbeassociatedwithspecificresting-stateactivityandconnectivitypatternsandthatthiscould

betestedbylookingatthespontaneousbrainactivityof136tinnituspatients.Alltinnitussubjects

135

WED

NESDAY 12 M

AR

CH

benefitedfromanindepthclinicalevaluation.Wecombineanindividualindependentcomponent

analysis (ICA) with an automated component selection method to select 10 components of

interesttobeusedinasecondlevelanalysis.Weperformedananalysistoidentifythecorrelation

betweendifferenttinnituscharacteristics(distress,duration,intensity,type,lateralization…)and

the functional connectivity pattern of these10different resting-state networks (RSN).Wewill

discussourresultsandrelatethesetopreviousfindingsusingdifferentneuroimagingtechniques

andtinnituspathophysiologicalmodels.

136

WED

NES

DAY

12 M

AR

CH

INFUSION OF GABAB RECEPTOR AGONISTS INTO THE COCHLEAR NUCLEUS ON TINNITUS DEVELOPMENT FOLLOWING ACOUSTIC TRAUMA IN RATS

Zheng,Y.;Vulinovich,A.;Stiles,L.;Darlington,C.L.;Smith, P.F.

Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago

Medical School, and the Brain Health Research Centre, University of Otago, Dunedin, New Zealand

BackgroundChronictinnitusisexperiencedbyabout10%ofthepopulationandproducesmanydetrimental

effects on the quality of life.There are very limited drug treatment options, mainly due to a

lack of understanding of the underlying mechanisms. It has been suggested that tinnitus is

generatedbyneuronalhyperactivityinmultipleareasofthebrain,includingthedorsalcochlear

nucleus,inferiorcolliculusandprimaryauditorycortex.Furthermore,bilaterallesionsofthedorsal

cochlear nucleus before the acoustic-trauma, but not afterwards, prevented the development

of tinnitus in rats.Recently,wehavedemonstrated that L-baclofen,whichactivates inhibitory

neurotransmissionthroughGABABreceptors,dose-dependentlyreducednoisetrauma-induced

tinnitus in rats. In the present study, we further investigated the possibility of preventing the

developmentoftinnitusbyinfusingtheGABABreceptoragonists,L-baclofenorCGP7930,into

thecochlearnucleuspriortoacoustictrauma.

Materials and MethodsMaleWistarratsweredividedinto8groups(n=8-19pergroup):Sham-saline,Sham-DMSO,

Sham-Baclofen, Sham-CGP7930, Acoustic trauma-saline, Acoustic trauma-DMSO, Acoustic

trauma-BaclofenandAcoustictrauma-CGP-7930.Theacoustictraumaconsistedofa16kHz,

115dBpure tone delivered unilaterally for 1 h under anaesthesia. Saline,DMSO, L-baclofen

(2mMat0.5µl/h)orCGP7930(100µMat0.5µl/h)wasadministeredintobilateralcochlear

nucleithroughcannulaeconnectedtoOsmoticminipumpsfor7daysstartingat24hbeforethe

acoustictrauma.Thebehaviouralsignsoftinnitusineachratweremeasuredbyaconditionedlick

suppressionparadigmatabout1monthaftertheacoustictrauma.Followingthetinnitustesting,

theanimalswereperfusedtranscardiallywith10%neutralbufferedformalinandthebrainswere

removed,sectionedandstainedwithCresylViolettoconfirmthecannulaplacement.

ResultsThepreliminaryresultssuggestedthatneithertheL-balofennortheCGP7930infusedintothe

cochlearnucleuspreventedthedevelopmentoftinnitusinducedbyacoustictrauma.Theresults

willbefinalizedwiththeconfirmationofthecannulaplacement.

137

WED

NESDAY 12 M

AR

CH

Conclusion

DirectlyactivatingtheGABABreceptorsinthecochlearnucleusmaynotbesufficienttoprevent

thedevelopmentoftinnitusinducedbyacoustictrauma.

138

WED

NES

DAY

12 M

AR

CH

STRESS-ASSOCIATED CHANGES OF MITOCHONDRIAL PROTEINS IN AUDITORY CORTEX

Szczepek,A.J.;Mazurek,B.

ORL Research Laboratory and Tinnitus Center Charité University Hospital, 10117 Berlin, Germany

Aims

Chronic form of tinnitus has been proposed to reflect called plastic changes in the auditory

structures. Emotional and psycho-social stress was shown to induce functional changes in

the auditory system of experimental animals consistent with hypersensitivity in the inner ear

(increasedamplitudesofDPOAEs)andintheauditorybrainstem(changesinABR).However,little

isknownaboutthemechanisms,inwhichemotionalandpsycho-socialstressaffectstheauditory

system.To find out if stress affects mitochondrial integrity or mitochondrial protein-mediated

plasticity,wehavemonitoredthe levelsofmitochondrialproteinsBcl-2,BaxandBcl-xL in the

auditorycortexfollowingexperimentalstress.

Methods

Twostrainsofrats(fourweeksold,female,100–120gweight)wereused–WistarHannover

andLewis.WistarHannover isanoutbreadstrainderived fromWistarusedasageneral,all-

purposeoutbredmodelforuseinbiomedicalresearchandknownasdevelopingrelatively low

levelofanxietyunderstressfulconditions.Lewisratsareaninbreadstraincharacterizedinneuro-

psychologicalresearchasdevelopingrelativelyhighlevelofanxietyunderstressfulconditions.

Theratswereexposedto24-hpsycho-socialstress.Afterfunctionaltestsofauditorypathways,

auditory cortices were dissected from sacrificed animals, and the proteins were purified and

analyzedusingWesternblotfollowedbychemiluminescenceanddensitometry.Theresultswere

statisticallyanalyzedwithSigmaStat.

Results

AuditorycorticesofWistarratscontainedsignificantlymoreBaximmediatelyafterfinishingthe

stressperiod,ascomparedtonon-stressedanimals(P<0.01,one-wayANOVA).TheBaxlevels

returnedtobaselinesixhourslater.Bcl-2andBcl-xLremainedunchanged.Incontrast,auditory

corticesofLevis ratscontainedsignificantlymoreBcl-xL followingstress,ascompared to the

controls(P<0.01,one-wayANOVA).

139

WED

NESDAY 12 M

AR

CH

Conclusions

Psycho-socialstresscanmodulateBaxandBcl-xLlevelsintheauditorycortexofhadincreased

amount of Bax after finishing stress whereas the anxiety-prone Lewis rats had increased

amountofBcl-xLintheauditorycortexafterfinishingstress.Besidesplayinganimportantrole

inmitochondrial integrityandcellsurvival,BaxandBcl-xLhavetheabilitytoregulatesynaptic

plasticityandthus,cancontributetoandreflecttheplasticchangesinauditorycentralsystem

followingpsycho-socialstress.

140

WED

NES

DAY

12 M

AR

CH

EVIDENCE FOR NEUROGENESIS IN THE COCHLEAR NUCLEUS FOLLOWING ACOUSTIC TRAUMA IN RATS

Zheng,Y.;Smythies,H.;Aitken,P.;Darlington,C.L.;Smith,P.F.

Department of Pharmacology and Toxicology, School of Medical Sciences,

University of Otago Medical School, and the Brain Health Research Centre, University of Otago,

Dunedin, New Zealand

BackgroundTinnitus induced by acoustic trauma results in electrophysiological changes in the cochlear

nucleus (CN)which appear to cause neuronal hyperactivity. In neurogenic areas of the brain,

for example, the dentate gyrus, such electrophysiological changes have been shown to alter

neurogenesis.Thepresentstudyinvestigatedtheeffectsofacoustictraumathathasbeenproven

tocausetinnitus,oncellproliferationandneurogenesisintheCNofrats.

Materials and MethodsRats received either sham or unilateral acoustic trauma (16 kHz at 115 dB for 1 h) under

anaesthesia.Auditorybrainstemresponses(ABRs)weremeasuredtodeterminetheeffectsofthe

acoustictraumaonhearing.Animalswereinjectedwiththecellularproliferationmarker,BrdU,at

72hsfollowingtheacoustictrauma,andthen2hsor24hslater,weresacrificedbytranscardial

perfusionwith4%paraformaldehydeand thebrainswereremoved,sectionedandstained for

BrdUusingimmunohistochemistry.Doublelabellingimmunofluorescenceimmunohistochemistry

wasperformedforBrdUandKi-67,amarkerforcellsintheSphaseofthecellcycle,CD11b,a

markerformicroglialcells,anddoublecortin(DCX),amarkerforimmatureneurons.

ResultsAcoustic traumaresulted inasignificantelevationof theABRthresholds, indicativeofhearing

loss.AcoutictraumaalsoresultedinanincreaseinBrdU

labelingintheCN,whichsignificantlyco-labeledwithanantibodyforKi-67,suggestedwasdue

tothegenerationofnewcellsratherthanDNArepair.Therewasnosignificantco-labelingfor

CD11b,suggestingthatthenewcellswerenotmicroglialcells.However,therewassignificant

co-labelingforDCX,suggestingthatmanyofthenewcellswereimmatureneurons.

ConclusionThepresentstudysuggests that thecellproliferation thatoccurs in theCNfollowingacoustic

traumarepresentsneurogenesis.

141

WED

NESDAY 12 M

AR

CH

SOUND-TRIGGERED SUPPRESSION OF NEURONAL FIRING IN THE AUDITORY CORTEX: IMPLICATION TO THE RESIDUAL INHIBITION OF TINNITUS

Galazyuk, A.V.1;Grimsley,C.A1;Longenecker,R.J.1,2

1 Northeast Ohio Medical University, Rootstown, Ohio, USA. 2 Kent State University, Biomedical Science Program, Kent, Ohio, USA

Aims / Objectives

Tinnituscanbesuppressedbrieflyfollowingtheoffsetofanexternalsound.Thisphenomenon,

termed“residual inhibition,”hasbeenknown foralmost fourdecades,although itsunderlying

cellularmechanism remainsunknown. Inourpreviousworkwehaveshown that themajority

ofneuronsintheinferiorcolliculus(IC)exhibitlonglastingsuppressionofspontaneousactivity

followingtheoffsetofanexternalsound.Thetimecourseofsuppressioncorrespondedtothe

timecourseofresidualinhibitionintinnituspatients.Tinnituspatientsoftenreportanincreased

effectoftinnitus-matchedpuretonesonthedurationoftheirresidualinhibition.Ourdatashow

puretonesinducelongersuppressionthanwidebandnoise.Ifthesuppressionisanunderlying

mechanism,theauditorycortex(AC)neuronsshouldalsoexhibitsuppressionbecauseresidual

inhibition of tinnitus is a perceptual phenomenon. To test this hypothesis, we studied sound

evokedsuppressioninauditorycortexneuronsofawakemice.Animalswithbehavioralsignsof

tinnitusandcontrolunexposedmicewereused.

Methods

ExperimentswereconductedonadultCBA/CaJmice.Fortinnitusinductionmicewereexposed

toanarrowbandnoisecenteredat12.5kHzpresentedat116dBSPLunilaterally for1hour

undergeneralanesthesia(Ketamine/Xylazine).Tinnituswasthenassessedutilizinggap-induced

prepulse inhibition of the acoustic startle reflex. Extracellular recordings were performed in

auditorycortexcontra-and/oripsilateraltotheexposedearinawakerestrainedanimals.Pure

tonesatneurons’characteristicfrequencyand/orwidebandnoisestimuli30secdurationwere

deliveredinthefree-field.

Results

Wefoundthatauditorycortexneuronsincontrolmiceexhibitedsound-triggeredsuppressionof

theirspontaneousfiring.SimilartotheIC,thedurationofthissuppressionaftersoundoffsetin

ACneuronsroughlycorrespondedtothestimulusduration(about30s).ACneuronsalsoshowed

longer suppression to tones at their characteristic frequency than to wideband noise stimuli.

142

WED

NES

DAY

12 M

AR

CH

UnliketheIC,inadditiontothesuppressionafterstimulusoffset,themajorityofACneuronsalso

showedsuppressionduringstimuluspresentation.

Conclusions

SimilartotheIC,ACneuronsexhibitlonglastingsuppressionoftheirspontaneousfiringfollowing

soundoffsets.Thetimecourseof thissuppressioncorrespondstothetimecourseofresidual

inhibition in tinnitus patients. These data further suggest that suppression may be a neural

correlateoftheresidualinhibitionoftinnitusinhumans.

This research was supported by grant R01 DC011330 and 1F31DC013498-01A1 from the National Institute

on Deafness and Other Communication Disorders of the U.S. Public Health Service.

143

WED

NESDAY 12 M

AR

CH

EFFECTS OF PARAFLOCCULUS REMOVAL ON HYPERACTIVITY AFTER ACOUSTIC TRAUMA

Vogler, D.P.1;Robertson,D1.;Mulders,WHAM.1

1 Auditory Laboratory, School of Anatomy, Physiology and Human Biology, University of Western

Australia, Crawley, Western Australia, Australia

Acoustictraumanotonlycauseshearinglossbutalsoresultsinavarietyofplasticchangesin

centralauditorypathways,suchas increasedspontaneousactivity.Thisso-calledhyperactivity

maybeinvolvedinthegenerationoftinnitus,aphantomauditorysensation.Thoughmanyanimal

studieshaveconsistentlyshownhyperactivityinauditorycentresafterhearingloss,tinnitusdoes

not always develop. It has therefore been suggested that there may be involvement of non-

auditory structuresperforminga regulatory rolebringing the increasedactivity in theauditory

systemtoconsciousperception.Recentevidencepointstotheparaflocculusofthecerebellumas

havingsucharole.Theparaflocculusreceivesdirectinputfromthecochleaandisanatomically

connectedtocentralauditorystructures.Therefore,weinvestigatedtheeffectsofparaflocculus

removalonhyperactivityinguineapiginferiorcolliculus2weeksafteracoustictrauma(continuous

10kHztoneat124dBSPLfor2hours).Spontaneousactivitywasrecordedfrom477neurons

(4animals)withparaflocculusandfrom559neurons(5animals)withparaflocculusaspirated.

Results showed a significant increase in hyperactivity (p =0.02) with paraflocculus removed.

These results suggest thatparaflocculusexertsan inhibitoryeffect onhyperactivity in inferior

colliculusat2weeksafteracoustic trauma.Theresultsaresurprising inviewofobservations

in another animalmodel that paraflocculus removal results in reduction of tinnitusmeasured

behaviourally. However, these latter studies were performed at much later time-points after

acoustic trauma. Studiesareunderway to investigate theeffectsofparaflocculusremovalon

hyperactivityatlatertime-points.

144

WED

NES

DAY

12 M

AR

CH

HYPERACTIVITY IN THE INFERIOR COLLICULUS AFTER NOISE TRAUMA AND ITS MODULATION BY EXTRA-COCHLEAR ELECTRIC STIMULATION

Norena, A.1;Mulders,H.2;Robertson,D.2

1 National Center of Scientific Research, Aix-Marseille University2 University of Western Australia

Manystudieshaveshownanincreaseofspontaneousfiringintheauditorycentersafternoise

trauma. It has been suggested that this central hyperactivity may underlie the perception of

tinnitus.Recentstudiesshowedthatcentralhyperactivitydependsoncochlearactivity:reducing

thespontaneousfiringinthecochlearnerveabolishesneuralhyperactivityintheinferiorcolliculus

(atleastwithinthefirstfewweeksafternoisetrauma).Extra-cochlearstimulationofthecochlea

hasbeenshowntomodulatethefiringinthecochlearnerve:whilepositivedirectcurrent(DC)

reducedneuralactivityinthecochlearnerve,negativeDChastheoppositeeffect.Interestingly,

somehumanstudiesshowedthatpositiveDCappliedatthepromontoryorroundwindowcould

reliablysuppresstinnitus.Thegoalofthepresentstudywastoinvestigatewhetherextra-cochlear

DCcurrentappliedattheroundwindowwasabletomodulateneural(hyper)activityintheinferior

colliculus.Ourresultsshowthat,forneuronswithacharacteristicfrequencyhigherthanaround

10kHz,positiveDCsuppressesneuralactivityininferiorcolliculuswhilenegativeDCenhances

it.Forneuronswithlowercharacteristicsfrequencies,effectsofelectricalstimulationwereeither

absentorreversed.Ourresultssuggestthatextra-cochlearelectricstimulationmayreducethe

tinnitusperceptbyreducingcentral(hyper)activity,.Thisapproachmayleadtoimportantfuture

developmentsprovidingthat theelectricalstimulationused inclinic is innocuousforbiological

tissues.

145

WED

NESDAY 12 M

AR

CH

REFLEX MODIFICATION AUDIOMETRY AS A TOOL TO ASSESS HEARING IN MICE

Longenecker,R.J.1,2;Alghamdi,F.1;Galazyuk,A.V.1

1 Northeast Ohio Medical University, Department of Anatomy and Neurobiology, Rootstown, Ohio,

USA

2 Kent State University, Biomedical Sciences Program, Kent, Ohio, USA

Aims / Objectives

Traditional methods for measuring animal hearing performance can be invasive and time

consuming.Abehavioraltestthatdoesnotrequireformaloperanttrainingwouldbeusefulto

quicklymeasureananimal’shearing.Inourpreviousworkwehavedemonstratedthatcontinuous

narrowband noise suppresses startle responses in mice, to startle stimuli, embedded in that

noise.Furthermore,thissuppressionwassoundlevel-andfrequency-depended.Thefrequency-

dependentsuppressioncurveapproximated theknownbehavioralaudiogram.Thegoalof this

studywastodevelopareliablemethodforassessmentofhearingperformanceinnormalanimals

andpossiblehearingdeficitsintheanimalsexposedtoloudsounds.

Methods

InitialacousticstartleperformancewasassessedforeachCBA/CaJmousebyproducingastatle

input/outputfunction.Toeffectivelyalterastartlewithbackgroundnoise,thestartlevaluewas

setto75%ofthemaximumstartleresponse.Narrowbandnoiserangingincenterfrequencyfrom

4to31.5kHz(inonethirdoctavesteps)waspresentedat0to80dBSPL.Foracoustictrauma

induction,agroupofmicewereexposedtoanarrowbandnoisecenteredat12.5kHzpresented

at116dBSPLunilaterallyfor2hourundergeneralanesthesia(Ketamine/Xylazine).

Results

Priortosoundexposure,allmiceshowedthresholdssimilartothatofanaudiogramforCBA/CaJ

mice.Althoughtherewassomevariancebetweenmice,thegreatestdegreeofstartlemasking

wasachievedby12.5and16kHzbackgroundnoise.Thestartlereflexwasmaskedtheleastby

4kHzand31.5kHzbackgroundnoise. Followingsoundexposure the input/ouputcurvewas

altered,showinghigherthresholdsat12.5to16kHz,reflectingdamageatthefrequencyrange

oftheexposure.Maskingthresholdsatthisrangeincreasedsignificantlycomparedtothepre-

exposuredthresholds.

146

WED

NES

DAY

12 M

AR

CH

Conclusions

Reflexmodificationaudiometrycouldbeausefultoolforfastassessinganimals’audiometry.

This research was supported by grant R01 DC011330 and 1F31DC013498-01A1 from the National Institute

on Deafness and Other Communication Disorders of the U.S. Public Health Service.

147

WED

NESDAY 12 M

AR

CH

UNILATERAL HEARING LOSS IN THE FERRET: A NEW DIRECTION FOR TINNITUS RESEARCH

Gold, J.R.;Nodal,F.R.;King,A.J.;Bajo,V.M.

Department of Physiology, Anatomy and Genetics, University of Oxford, UK

Background / Aims

Thecurrent lackofconsensusregarding theneurobiologicalbasisof tinnitusnecessitates the

developmentofnovelanimalmodelsofthedisease,tonotonlyunderstandcorticalprocessing

changesthatdevelopfollowingpartialhearingloss(akeycomorbidityassociatedwithtinnitusin

humanpatients),butalsotocorrelatethosechangeswithbehaviouralandelectrophysiological

data thatobjectively identify thepresenceofaphantompercept.The ferret (Mustelaputorius

furo)mayrepresentasuitablecandidatefortinnitusresearch:ferretsperformeffectivelyinaudio-

guidedbehaviours,whileitslargeskullandwell-definedauditorycorticalfieldsmakethisanimal

veryappropriateforinvestigatingcorticalchanges.Therefore,withinthesamecohortofferrets

(N=7),wesoughttoexaminechangesinbehaviouralperformanceonagapdetectiontask,as

well as changes in brainstemand cortical neurophysiology following a unilateral lesionmade

selectivelyinthehighfrequencydomainofthespiralganglion.

Methods

Inatwo-alternativecategorisationtask,animalsweretrainedunderpositiveoperantconditioning

todiscriminateanuninterruptedsound(bandwidth0-30kHzor0.5-octavebandpassed,centred

at 1kHz, 4kHz, or 16kHz; digitally flattened; 77dB SPL; 2080 ms) from the same sound in

whichgapsareembedded(fourinterleavedgaps,varyingbetween3-270msinduration).After

consistent performance was obtained, animals underwent unilateral mechanical lesion of the

highfrequencydomainofthespiralganglion.Followingrecovery,animalswereretestedonthe

same behavioural protocol. Auditory brainstem responses (ABRs) were recorded in response

to monaurally presented broadband clicks and narrowband noise bursts, and acute bilateral

electrophysiological recordingswereperformed in theprimaryauditorycorticesofasubsetof

animals(N=3)toestablishtonotopyandcorticalmulti-unitresponseproperties.

Results

Prior to lesion, stable performance in gap detection behaviour was obtained for all animals,

with group performance on broadband and narrow band-passed stimuli resembling that

previously described in the ferret. Following lesion, behavioural performance measurements

148

WED

NES

DAY

12 M

AR

CH

wereheterogeneous,withasubsetofanimalsdisplayingsignsoftinnitus-likebehaviour.Upon

investigationofABRmodulationsinthemid-to-chronicphasepost-lesion,deviationsofABRlatency

andwaveformamplitudewerefoundtobeassociatedwithabehaviourally-definedtinnitus-like

percept,asdistinctfromthoseanimalswithhearinglossintheabsenceofaphantompercept.On

thebasisofthesedata,corticalmulti-unitneurophysiologyindicatedtinnitus-correlatedchanges

-includingmodifiedtonotopy,elevatedspontaneousfiringrates,andtemporalcodingchanges-

consistentwithourbehaviouralandABR-definedcriteria.

Conclusions

Partial unilateral lesion of the spiral ganglion impairs the gap-detection sensitivity of awake,

behaving ferrets, possibly through the development of a phantom tinnitus-like percept; the

observations of lesion-related changes to brainstemand cortical auditory processing suggest

possiblesubstratesforinterventionandbehaviouralrescue,whichwewillseektoexplorewith

optogeneticsilencingoftheauditorycortex.

This study was supported by Action on Hearing Loss and the Wellcome Trust.

149

WED

NESDAY 12 M

AR

CH

EFFECTS OF STRESS-INDUCED SLEEP DISTURBANCE ON TINNITUS PERCEPTION AND BRAIN OREXIN EXPRESSION IN RATS FOLLOWING ACOUSTIC TRAUMA

Chien,Y.T.;Stiles,L.;Milne,M.;Darlington,C.L.;Smith,P.F.;Zheng,Y.

Department of Pharmacology and Toxicology, School of Medical Sciences,

University of Otago Medical School, and the Brain Health Research Centre, University of Otago,

Dunedin, New Zealand

Background

Tinnitustreatmentiscomplicatednotonlybyapoorunderstandingofitsmechanisms,butalso

bythevariationsinindividuals’reactionstoitsperception.Tinnitusseverityhasbeenassociated

withhighlevelsofanxiety,depressionandsleepdisturbance.Moreover,thesleepmeasurements

intinnituspatientswithdisturbedsleepareverysimilartothosethatoccurininsomnia.Studies

havesuggestedthatinsomniamay,infact,beariskfactor/predictorfortinnitus-relateddistress

and the two conditions may share common neurobiological mechanisms. Since orexin plays

an important role in sleep-wake regulation and inappropriate activation of the orexin system

hasbeenattributedtothepathophysiologyofinsomnia,itmightalsobeapromoterfortinnitus

perception.The present study investigated the effects of stress on sleeping patterns and the

susceptibilitytoacoustictrauma-inducedtinnitusinrats.

Materials and Methods

ThirtymaleWistarratsweredividedintothreegroups:control(n=6),acoustictraumaonly(n

=12)andacoustictraumawithstress(n=12).Theanimalsreceivedeithershamorunilateral

acoustictrauma(16kHzat110dBfor1h)underanaesthesia.Twenty-fourhoursafteracoustic

trauma,stresswasinducedbyplacingtheanimalinacagepreviouslyoccupiedbyanothermale

ratfor5.5hduringwhichtheanimal’ssleepingbehaviourwasrecorded.Tinnitusassessment

wascarriedout2weekspost-exposureusingaconditionedlicksuppressionparadigm.Atthe

conclusion of the experiment, the animals were sacrificed by transcardial perfusion with 4%

paraformaldehyde and the brains were removed, sectioned and stained for orexin-A using

immunohistochemistry.

150

WED

NES

DAY

12 M

AR

CH

Results

Stress resulted in a significant reduction in the number of sleep periods in acoustic trauma

exposedanimals.However,therewasnodifferenceinthenumberofratsexhibitingbehavioural

signsoftinnitusbetweenstressandnon-stressgroupsandtherewasalsonodifferenceinthe

totalnumberoforexinergicneuronsinhypothalamus.

Conclusion

In thepresent study, stress-inducedsleepdisturbancedidnot result in long-termchanges in

orexinsystemanddidnotchangetheperceptionoftinnitusinrats.

151

WED

NESDAY 12 M

AR

CH

PAIRED ASSOCIATIVE STIMULATION OF THE HUMAN AUDITORY CORTEX AND ITS EFFECTS ON THE AUDITORY STEADY STATE RESPONSE

Engel,S.;Markewitz,R.;Schecklmann,M.;Langguth,B.

University of Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany

Aims

Pairedassociativestimulation(PAS)hasoftenbeenshowntoinducechangesinneuroplasticityof

themotorcortex.PairinganacousticstimuluswithaTMSpulseovertheauditorycortexhasthe

potentialtochangetheamplitudeoflateacousticevokedpotentials,whichhasfirstlybeenproven

inarecentpilotstudy.TheaimofthepresentstudywastoinvestigateifPASoftheauditorycortex

iscapabletochangeauditorysteadystateresponses(ASSR).

Methods

20healthy objects have been presented two different PASprotocols, bothwith 200 acoustic

stimuli(4kHz),afrequencyof0.1Hz,andaninterstimulusinterval(ISI)of45msbetweentone

onsetand theTMSpulse.With respect to theconditions, theacousticstimulidiffered in their

length (PAS (23ms) vs. PAS (400ms)).Auditory steady state responseswith 40Hz amplitude

modulatedtones(800ms)weremeasuredbeforeandaftertheinterventionusingthepairedtone

(4kHz)andacontroltone(1kHz).

Results

AfterthePAS(400ms)protocolincreasedpoweroftheASSRwasfoundintheleftandrightfronto-

temporalelectrodes,butnoneafterthePAS(23ms)protocol.Therewasnodifferenceinchanges

concerningthetonepairedduringthePASintervention(4kHz)andthecontroltone(1kHz).

Conclusion

Earlier findings about the effects of PASon the auditory cortex could be partially repeated, but

specificeffectswithrespecttothetonefrequencywerenotobserved.Theincreaseof40HzASSR

poweraffirmsthemodelofASSRsassuperpositionofmiddlelatencyacousticevokedpotentials-in

thiscasethePawhichhasalatencyof25ms.Accordingtothemodelofspike-timingdependent

plasticitypotentialswhicharecorticallyprocessedbeforetheTMSpulsearefacilitated.Additionally,

attentionisapotentialfactorimpactingtheresultsofPASontheauditorycortex.

1. Stefan K, Kunesch E. Brain, 2000; 123:572-584

2. Schecklmann M, Volberg G. PLoS One, 2011; 6:e27088

152

WED

NES

DAY

12 M

AR

CH

PAIRED ASSOCIATIVE STIMULATION OF THE HUMAN AUDITORY CORTEX AND ITS EFFECTS ON LATE AUDITORY EVOKED POTENTIALS

Markewitz, R.D.H.;Engel,S.;Schecklmann,M.;Langguth,B.

University of Regensburg, Department of Psychiatry and Psychotherapy, Regensburg, Germany

Aims / Objectives

Pairedassociativestimulation (PAS),a formofnoninvasivecorticalstimulationthatconsistsof

theapplicationoftranscranialmagneticstimulationbeingpairedwithperipheralsomatosensory

input, has been shown to be capable of inducing neuroplastic effects in the human motor

cortex.Inonerecentlyconductedexperiment,thesefindingswereshowntobeapplicabletothe

humanauditorycortexaswell.Onequestionarisingfromthispilotstudywasifthelengthofthe

pairedstimulusisessentialfortheinductionofPAS-likeeffects.Thus,theaimofthisstudyisto

investigatetheeffectsoftwodifferentPASconditions(shortandlongPAStone)onlateauditory

evokedpotentials(LAEPs).

Methods

TwodifferentprotocolsofPASwerecompared in twodifferentsessionscarriedoutoneweek

apartinrandomizedorder.Bothconsistedofanacousticstimulus(4kHz)beingpairedwithTMS

with an interstimulus interval of 45ms, i.e., tone onset was followed by theTMS pulse.The

protocolsdifferedwith respect to thedurationof theacousticstimulus,whichwasdefined to

be400ms(PAS(400ms))or23ms(PAS(23ms)).A totalof20healthysubjectswerepresented

with200pairedstimuli(tone+TMSpulse)atafrequencyof0.1Hz.Priorto,aswellasafterthe

interventionAEPsweremeasuredusinganamplitudemodulatedtoneof4kHz(comparabletothe

PAStone)aswellasacontroltoneof1kHz(both800ms).

Results

AreductionintheamplitudeoftheP1-N1-P2complexwasobservedonlyafterPAS(400ms),with

noeffectsforthePAS(23ms)condition.Thiseffectwasfoundforthe4kHzandthe1kHzcontrol

tone.

153

WED

NESDAY 12 M

AR

CH

Conclusion

TheseobservationsreinforceearlierfindingsthatPAScanbeemployedtoinduceneuroplastic

changesintheauditorycortex.Furthermore,theyseemtosuggestaninfluenceofattentionon

theeffectsofPASasthelongtoneisperceivedmoreconsciously.Aspecificeffectdependingon

thefrequencyofthepairedacousticstimuluscouldnotbeconfirmed.

1 Stefan K, Kunesch E. Brain, 2000; 123:572-578

2 Schecklmann M, Volberg G. PLoS ONE, 2011; 6:e27088

154

WED

NES

DAY

12 M

AR

CH

BUILDING A NEURAL-PSYCHOLOGICAL-IMMUNE- ENDOCRINAL MODEL OF TINNITUS (T-NPIE)

Alsalman,O.1;Tucker,D1;Michel,G.1,2

1 University of North Carolina at Greensboro, Department of Communication Science and Disorders2 University of North Carolina at Greensboro, Department of Psychology

Asoundthatisperceptinthebraininabsenceofactualexternalacousticstimulusisknownas

tinnitus.Ithaslongbeenobservedthatpatientsvaryinhowdisturbingtinnitusistotheirdaily

lives.Individualdifferintheirreactionstostressfulsituationsbytheautonomicnervoussystem

(measuredbyalphaamylase),adrenalcorticalsecretions(measuredbycortisol),andcircadian

cycles (measuredbymelatonin)contributestosuch individualdifferences in theexperienceof

tinnitus.Concerns for theexperienceof theperson (e.g.,with tinnitus)with theempiricaland

systematicexaminationof thephysiological (endocrineandneural)processesunderlyingsuch

experienceisnotfullyunderstoodyet.This,duetotinnituscomplexnature,thosewithtinnitus

canexperienceadisablingsenseofhaplessness,depression,anxiety,stress,sleepdifficulties,

andinsomecasessuicide.Studiesthatexaminethecomplexnatureoftinnitusshouldpayspecial

attentiontoidentifyingtheemotionalandpsychologicaldisturbancesassociatedwithtinnitusto

bettertheapplicationoftreatmentandmanagementoptions.

Objective

Theaimofthispreliminarystudyistobuildamodeloftheexperienceoftinnituswithafocuson

theinfluencesofphysiologicalchangesintheendocrineandimmunesystems.Byassessinghow

disruptionofspecificendocrinesecretionsandaweakeningof the immunesystemcontribute

to the manifestation and experience (i.e., how disturbing tinnitus is to the patient) of tinnitus

symptoms.

Methods: twomaleparticipantswithtinnitusandfivemalecontrolswithouttinnitusages21to

35yearswereexposedtoaninducedstresstaskandsalivasamplingforcortisol,alpha-amylase,

melatoninandNeopterinwereobtained.Thetinnitusintakehistoryquestionnaire(TIHQ)andthe

tinnitusseverityindexwereadministrated,followedbyaudiologictestmeasures.

Preliminary results

Twoparticipantswithtinnitus,and7controlswereexposedtoaninducedstresstask(counting

backward) and cortisol, alpha-amylase, melatonin and neopterin sampling, were obtained at

155

WED

NESDAY 12 M

AR

CH

four different point of times (baseline, 5min posttest, 30min posttest, 60min posttest). Mean

valueswerecomparedandusedasasuggestiveevidenceofapotentialdifferenceofcortisoland

alpha-amylaseresponsesat5minposttestandatbaseline,andapossibledifferenceat5and

60minposttestformelatoninresponses.Inaddition,thispreliminarydatasuggestedapossible

differenceatbaselineforneopterininthetinnitusgroupwhencomparedwithhealthycontrols.

Conclusion

Todate,thereisnocurefortinnitus,althoughdifferentcausesoftinnitushavebeenproposed,none

ofthemareexclusive.Theaimofthispreliminarystudywastodocumentwhetherhypothalamic

nucleithatcontrolautonomicneuralactivityandthosethatcontroladrenalhormonescontribute

to chronic tinnitus perception, and aid in the building of a newT-NPIEmodel of tinnitus that

demonstrates the roleofstressdisturbances inadrenal regulationandANScontrol inchronic

tinnitus.Results of this preliminary research study demonstrated the feasibility of this project

tothediscoveryofnewformsoftinnitusnetworksnotlimitedtothebrain,butthatinvolvethe

autonomic,immune,andendocrinalsystems.

156

WED

NES

DAY

12 M

AR

CH

GAP DETECTION THRESHOLDS IN TINNITUS SUBJECTS: DOES TINNITUS FILL IN THE SILENT GAPS?

Boyen,K.1,2;Başkent,D.1,2;vanDijk,P.1,2

1 Department of Otorhinolaryngology / Head and Neck Surgery, University of Groningen, University

Medical Center Groningen, Groningen, The Netherlands

2 Graduate School of Medical Sciences, Research School of Behavioural and Cognitive

Neurosciences, University of Groningen, Groningen, The Netherlands

Objectives

Evaluationoftinnitusinhumansgreatlyreliesonsubjectivemeasuressuchasquestionnaires,

visualratingscalesandself-reports.Recently,itwashypothesizedthattinnituswouldperceptually

fill ingapsinongoingstimuli.Basedonthis,thegapdetectionparadigmwasproposedasan

objectivemeasuretomodeltinnitusinanimals.Themainpurposeofthisstudywastoevaluatethe

applicabilityofthisapproachintinnituspatients.Hence,wefirsthypothesizedthatgapdetection

wouldbeimpairedintinnituspatients,andsecond,thatgapdetectionwouldbemoreimpairedat

frequenciesclosetothetinnitusfrequencyofthepatient.

Methods

Twenty-two adults with bilateral tinnitus and twenty age- and hearing loss-matched subjects

withouttinnitusparticipatedinthestudy.Todeterminethecharacteristicsofthetinnitus,subjects

matchedanexternallyprovidedsoundtotheirperceivedtinnituspitchandloudness.Todetermine

theminimumdetectablegap,anadaptivepsychoacoustictestwasperformedthreetimesbyeach

subject.Inthisgapdetectiontest,fourdifferentstimuli,withvaryingfrequenciesandbandwidth,

werepresentedatthreedifferentintensitylevels,determinedwithrespecttohearingthresholds

measuredwiththeteststimuli.

Results

Similartopreviousreportsofgapdetection,increasingsensationlevelyieldedbettergapdetection

performance forallstimuli inbothgroups. Interestingly, the tinnitusgroupdidnotdisplaygap

detection impairment in any of the four frequency stimulus bands compared to the matched

control group.Moreover, visual inspectionof thedata revealedno relationbetweenperceived

tinnituspitchandstimulusfrequencyband.

157

WED

NESDAY 12 M

AR

CH

Conclusion

Thesefindingsshowthattinnitusinhumanshasnoeffectontheabilitytodetectgapsinauditory

stimuli.Thus, the testingprocedure in itspresent form isnotsuitable forclinicaldetectionor

diagnosisoftinnitus.Moreover,gapdetectionparadigms,asappliedinanimals,maynotbeable

todetecttinnitusinhumans.

158

WED

NES

DAY

12 M

AR

CH

TINNITUS CLINICAL SYMPTOMS GENERATION AND MAINTENANCE

Toostani,I.G.1,3;Fattahzadeh,A.3;Jangholi,N.2

1 Universidade de São Paulo, Bioengineering department, Sao Carlos, Brazil2 Universidade Federal do ABC, Cognitive and Complex Systems Unit, São Paulo, Brazil3 FGSco research and development department, Tehran, Iran

OurknowledgeaboutTinnitushasvigorouslyimprovedincurrentdecay,butmainmechanismsof

changingperceivingneutralphantomsoundintotinnitusdistresshavenotyetbeenunderstood.

Non-causalassociationofTinnitusclinicalsymptomswithneutralphantomsoundspecifications

canbeelucidatedbylearningoperation.Oursuggestingforexplainingnegativesymptomsrelated

totinnitusisbasedontop-downcognitiveprocessestogetherwithclassicalconditioninglearning

procedurewhenemotionallyneutralconditionedstimulus(CS) ispresented inassociationwith

anaversiveunconditionedstimulus(US),andtheconditionedresponseisthelearnedresponse

tothepreviouslyneutralstimulus.Currentmodelscondition,orat leastemphasize,theroleof

externaleventscongruentlypairedwith thecausalphysicalevent thatoriginated thephantom

perception(1).

Tobetterunderstandingthisphenomenonintinnitusinitiationandreinforcement,weproposeda

newNeurofunctionalmodelfortinnitusinearlystagesanditsdevelopment.Ourdetailedmodel

includedascendingauditorypathways,thethalamus(reticular,medialgeniculateanddorsalnuclei),

thelimbicsystem,brainstem,basalganglia,striatum,andtheauditoryandprefrontalcortices.

Weprojectedthemediatingpathwaysoftinnitusdistressincorporatewiththeconvergenceofthe

CSandUSpathwaysinthemedialgeniculatenucleus(MGN)andlateralnucleusoftheamygdala

(LA)fromthalamicandcorticalprocessingregionsinthesensorysystemsthatprocesstheCS

(auditorysystem)andUS(emotionalmechanism).TheMGNprojectsintoauditorycorticesandLA.

Italsoreceivesinhibitoryinputfromthalamicreticularnucleus(TRN).TheLAthenconnectswith

thecentralnucleusofamygdala(CE)directlyandbythewayofotheramygdalaregions.Outputs

oftheCEthencontroltheexpressionoffearresponsesandrelatedautonomicnervoussystem

(e.g.,bloodpressureandheartrate)andendocrine(pituitaryadrenalhormones)responses.

Functionally,weassumecontinuousor intermittentabnormal signalat theperipheral auditory

systemormidbrainauditorypathways.Dependingoncognitive-emotionalinitiatedvalueandthe

availabilityofattentionalresourcesleadtoconsciousawarenessperceivingoftheneutralTinnitus

whichcancognitivelyinterpretassuspiciousandcontingentswithemotionalappraisal(US)such

asfeeloffear.Thenegativereaction(e.g.fear)isthelearnedresponsetoneutralTinnitus.Fear

159

WED

NESDAY 12 M

AR

CH

individuallycantriggerthefeeloffearinapositivefeedbackloop,thereforecontinuingperceiving

Tinnitus contingent with feel of fear reinforces the negative reaction. Furthermore Tinnitus

negativereactionisbeingweakenedbythebothfearingintheabsenceofperceivingtinnitus,and

perceiveTinnituswithouttriggeringthefeeloffear.DevelopmentofneuroplasticityinMGN(2),LA

andauditoryprimarycortexareexhibiteddynamicmolecularneuronmodificationinbrainwhich

cancausereciprocalpsychiatriccomorbiditiessuchasanxiety,stress,phobiasand/ordepression

symptoms.Wepresentempiricalevidencefromstudiesusingneuroimaging,electrophysiology,

brainlesionandbehavioraltechniquestosupportthemodel.Thismodelrepresentsanadvancein

ourunderstandingofclinically-significanttinnitussymptomsandmighteventuallyhelptoimprove

currenttreatments.

1. Jastreboff PJ, Gray WC, Gold SL. Neurophysiological approach to tinnitus patients. The American journal

of otology. 1996;17(2):236-40.

2. Weinberger NM. The medial geniculate, not the amygdala, as the root of auditory fear conditioning. Hear

Res. 2011;274(1-2):61-74.

160

WED

NES

DAY

12 M

AR

CH

INFUSION OF GABAB RECEPTOR AGONISTS INTO THE COCHLEAR NUCLEUS ON TINNITUS DEVELOPMENT FOLLOWING ACOUSTIC TRAUMA IN RATS

Zheng,Y.;Vulinovich,A.;Stiles,L.;Darlington,C.L.;Smith, P.F.

Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago

Medical School, and the Brain Health Research Centre, University of Otago, Dunedin, New Zealand

Background

Chronictinnitusisexperiencedbyabout10%ofthepopulationandproducesmanydetrimental

effects on the quality of life.There are very limited drug treatment options, mainly due to a

lack of understanding of the underlying mechanisms. It has been suggested that tinnitus is

generatedbyneuronalhyperactivityinmultipleareasofthebrain,includingthedorsalcochlear

nucleus,inferiorcolliculusandprimaryauditorycortex.Furthermore,bilaterallesionsofthedorsal

cochlear nucleus before the acoustic-trauma, but not afterwards, prevented the development

of tinnitus in rats.Recently,wehavedemonstrated that L-baclofen,whichactivates inhibitory

neurotransmissionthroughGABABreceptors,dose-dependentlyreducednoisetrauma-induced

tinnitus in rats. In the present study, we further investigated the possibility of preventing the

developmentoftinnitusbyinfusingtheGABABreceptoragonists,L-baclofenorCGP7930,into

thecochlearnucleuspriortoacoustictrauma.

Materials and Methods

MaleWistarratsweredividedinto8groups(n=8-19pergroup):Sham-saline,Sham-DMSO,

Sham-Baclofen, Sham-CGP7930, Acoustic trauma-saline, Acoustic trauma-DMSO, Acoustic

trauma-BaclofenandAcoustictrauma-CGP-7930.Theacoustictraumaconsistedofa16kHz,

115dBpure tone delivered unilaterally for 1 h under anaesthesia. Saline,DMSO, L-baclofen

(2mMat0.5µl/h)orCGP7930(100µMat0.5µl/h)wasadministeredintobilateralcochlear

nucleithroughcannulaeconnectedtoOsmoticminipumpsfor7daysstartingat24hbeforethe

acoustictrauma.Thebehaviouralsignsoftinnitusineachratweremeasuredbyaconditionedlick

suppressionparadigmatabout1monthaftertheacoustictrauma.Followingthetinnitustesting,

theanimalswereperfusedtranscardiallywith10%neutralbufferedformalinandthebrainswere

removed,sectionedandstainedwithCresylViolettoconfirmthecannulaplacement.

161

WED

NESDAY 12 M

AR

CH

Results

ThepreliminaryresultssuggestedthatneithertheL-balofennortheCGP7930infusedintothe

cochlearnucleuspreventedthedevelopmentoftinnitusinducedbyacoustictrauma.Theresults

willbefinalizedwiththeconfirmationofthecannulaplacement.

Conclusion

DirectlyactivatingtheGABABreceptorsinthecochlearnucleusmaynotbesufficienttoprevent

thedevelopmentoftinnitusinducedbyacoustictrauma.

162

WED

NES

DAY

12 M

AR

CH

STRESS-ASSOCIATED CHANGES OF MITOCHONDRIAL PROTEINS IN AUDITORY CORTEX

Szczepek,A.J.;Mazurek,B.

ORL Research Laboratory and Tinnitus Center Charité University Hospital, 10117 Berlin, Germany

Aims

Chronic form of tinnitus has been proposed to reflect called plastic changes in the auditory

structures. Emotional and psycho-social stress was shown to induce functional changes in

the auditory system of experimental animals consistent with hypersensitivity in the inner ear

(increasedamplitudesofDPOAEs)andintheauditorybrainstem(changesinABR).However,little

isknownaboutthemechanisms,inwhichemotionalandpsycho-socialstressaffectstheauditory

system.To find out if stress affects mitochondrial integrity or mitochondrial protein-mediated

plasticity,wehavemonitoredthe levelsofmitochondrialproteinsBcl-2,BaxandBcl-xL in the

auditorycortexfollowingexperimentalstress.

Methods

Twostrainsofrats(fourweeksold,female,100–120gweight)wereused–WistarHannover

andLewis.WistarHannover isanoutbreadstrainderived fromWistarusedasageneral,all-

purposeoutbredmodelforuseinbiomedicalresearchandknownasdevelopingrelatively low

levelofanxietyunderstressfulconditions.Lewisratsareaninbreadstraincharacterizedinneuro-

psychologicalresearchasdevelopingrelativelyhighlevelofanxietyunderstressfulconditions.

Theratswereexposedto24-hpsycho-socialstress.Afterfunctionaltestsofauditorypathways,

auditory cortices were dissected from sacrificed animals, and the proteins were purified and

analyzedusingWesternblotfollowedbychemiluminescenceanddensitometry.Theresultswere

statisticallyanalyzedwithSigmaStat.

Results

AuditorycorticesofWistarratscontainedsignificantlymoreBaximmediatelyafterfinishingthe

stressperiod,ascomparedtonon-stressedanimals(P<0.01,one-wayANOVA).TheBaxlevels

returnedtobaselinesixhourslater.Bcl-2andBcl-xLremainedunchanged.Incontrast,auditory

corticesofLevis ratscontainedsignificantlymoreBcl-xL followingstress,ascompared to the

controls(P<0.01,one-wayANOVA).

163

WED

NESDAY 12 M

AR

CH

Conclusions

Psycho-socialstresscanmodulateBaxandBcl-xLlevelsintheauditorycortexofhadincreased

amount of Bax after finishing stress whereas the anxiety-prone Lewis rats had increased

amountofBcl-xLintheauditorycortexafterfinishingstress.Besidesplayinganimportantrole

inmitochondrial integrityandcellsurvival,BaxandBcl-xLhavetheabilitytoregulatesynaptic

plasticityandthus,cancontributetoandreflecttheplasticchangesinauditorycentralsystem

followingpsycho-socialstress.

164

WED

NES

DAY

12 M

AR

CH

EVIDENCE FOR NEUROGENESIS IN THE COCHLEAR NUCLEUS FOLLOWING ACOUSTIC TRAUMA IN RATS

Zheng,Y.;Smythies,H.;Aitken,P.;Darlington,C.L.;Smith,P.F.

Department of Pharmacology and Toxicology, School of Medical Sciences,

University of Otago Medical School, and the Brain Health Research Centre, University of Otago,

Dunedin, New Zealand

BackgroundTinnitus induced by acoustic trauma results in electrophysiological changes in the cochlear

nucleus (CN)which appear to cause neuronal hyperactivity. In neurogenic areas of the brain,

for example, the dentate gyrus, such electrophysiological changes have been shown to alter

neurogenesis.Thepresentstudyinvestigatedtheeffectsofacoustictraumathathasbeenproven

tocausetinnitus,oncellproliferationandneurogenesisintheCNofrats.

Materials and MethodsRats received either sham or unilateral acoustic trauma (16 kHz at 115 dB for 1 h) under

anaesthesia.Auditorybrainstemresponses(ABRs)weremeasuredtodeterminetheeffectsofthe

acoustictraumaonhearing.Animalswereinjectedwiththecellularproliferationmarker,BrdU,at

72hsfollowingtheacoustictrauma,andthen2hsor24hslater,weresacrificedbytranscardial

perfusionwith4%paraformaldehydeand thebrainswereremoved,sectionedandstained for

BrdUusingimmunohistochemistry.Doublelabellingimmunofluorescenceimmunohistochemistry

wasperformedforBrdUandKi-67,amarkerforcellsintheSphaseofthecellcycle,CD11b,a

markerformicroglialcells,anddoublecortin(DCX),amarkerforimmatureneurons.

ResultsAcoustic traumaresulted inasignificantelevationof theABRthresholds, indicativeofhearing

loss.AcoutictraumaalsoresultedinanincreaseinBrdUlabelingintheCN,whichsignificantlyco-

labeledwithanantibodyforKi-67,suggestedwasduetothegenerationofnewcellsratherthan

DNArepair.Therewasnosignificantco-labelingforCD11b,suggestingthatthenewcellswere

notmicroglialcells.However,therewassignificantco-labelingforDCX,suggestingthatmanyof

thenewcellswereimmatureneurons.

ConclusionThepresentstudysuggests that thecellproliferation thatoccurs in theCNfollowingacoustic

traumarepresentsneurogenesis.

165

WED

NESDAY 12 M

AR

CH

SOUND-TRIGGERED SUPPRESSION OF NEURONAL FIRING IN THE AUDITORY CORTEX: IMPLICATION TO THE RESIDUAL INHIBITION OF TINNITUS

Galazyuk, A.V.1;Grimsley,C.A.1;Longenecker,R.J.1,2

1 Northeast Ohio Medical University, Rootstown, Ohio, USA

2 Kent State University, Biomedical Science Program, Kent, Ohio, USA

Aims / Objectives

Tinnituscanbesuppressedbrieflyfollowingtheoffsetofanexternalsound.Thisphenomenon,

termed“residual inhibition,”hasbeenknown foralmost fourdecades,although itsunderlying

cellularmechanism remainsunknown. Inourpreviousworkwehaveshown that themajority

ofneuronsintheinferiorcolliculus(IC)exhibitlonglastingsuppressionofspontaneousactivity

followingtheoffsetofanexternalsound.Thetimecourseofsuppressioncorrespondedtothe

timecourseofresidualinhibitionintinnituspatients.Tinnituspatientsoftenreportanincreased

effectoftinnitus-matchedpuretonesonthedurationoftheirresidualinhibition.Ourdatashow

puretonesinducelongersuppressionthanwidebandnoise.Ifthesuppressionisanunderlying

mechanism,theauditorycortex(AC)neuronsshouldalsoexhibitsuppressionbecauseresidual

inhibition of tinnitus is a perceptual phenomenon. To test this hypothesis, we studied sound

evokedsuppressioninauditorycortexneuronsofawakemice.Animalswithbehavioralsignsof

tinnitusandcontrolunexposedmicewereused.

Methods

ExperimentswereconductedonadultCBA/CaJmice.Fortinnitusinductionmicewereexposed

toanarrowbandnoisecenteredat12.5kHzpresentedat116dBSPLunilaterally for1hour

undergeneralanesthesia(Ketamine/Xylazine).Tinnituswasthenassessedutilizinggap-induced

prepulse inhibition of the acoustic startle reflex. Extracellular recordings were performed in

auditorycortexcontra-and/oripsilateraltotheexposedearinawakerestrainedanimals.Pure

tonesatneurons’characteristicfrequencyand/orwidebandnoisestimuli30secdurationwere

deliveredinthefree-field.

Results

Wefoundthatauditorycortexneuronsincontrolmiceexhibitedsound-triggeredsuppressionof

theirspontaneousfiring.SimilartotheIC,thedurationofthissuppressionaftersoundoffsetin

ACneuronsroughlycorrespondedtothestimulusduration(about30s).ACneuronsalsoshowed

longer suppression to tones at their characteristic frequency than to wideband noise stimuli.

166

WED

NES

DAY

12 M

AR

CH

UnliketheIC,inadditiontothesuppressionafterstimulusoffset,themajorityofACneuronsalso

showedsuppressionduringstimuluspresentation.

Conclusions

SimilartotheIC,ACneuronsexhibitlonglastingsuppressionoftheirspontaneousfiringfollowing

soundoffsets.Thetimecourseof thissuppressioncorrespondstothetimecourseofresidual

inhibition in tinnitus patients. These data further suggest that suppression may be a neural

correlateoftheresidualinhibitionoftinnitusinhumans.

This research was supported by grant R01 DC011330 and 1F31DC013498-01A1 from the National Institute

on Deafness and Other Communication Disorders of the U.S. Public Health Service.

167

WED

NESDAY 12 M

AR

CH

EFFECTS OF PARAFLOCCULUS REMOVAL ON HYPERACTIVITY AFTER ACOUSTIC TRAUMA

Vogler, D.P.1;Robertson,D.1;Mulders,WHAM.1

1 Auditory Laboratory, School of Anatomy, Physiology and Human Biology, University of Western

Australia, Crawley, Western Australia, Australia

Acoustictraumanotonlycauseshearinglossbutalsoresultsinavarietyofplasticchangesin

centralauditorypathways,suchas increasedspontaneousactivity.Thisso-calledhyperactivity

maybeinvolvedinthegenerationoftinnitus,aphantomauditorysensation.Thoughmanyanimal

studieshaveconsistentlyshownhyperactivityinauditorycentresafterhearingloss,tinnitusdoes

not always develop. It has therefore been suggested that there may be involvement of non-

auditorystructuresperforminga regulatory rolebringing the increasedactivity in theauditory

systemtoconsciousperception.Recentevidencepointstotheparaflocculusofthecerebellumas

havingsucharole.Theparaflocculusreceivesdirectinputfromthecochleaandisanatomically

connectedtocentralauditorystructures.Therefore,weinvestigatedtheeffectsofparaflocculus

removalonhyperactivityinguineapiginferiorcolliculus2weeksafteracoustictrauma(continuous

10kHztoneat124dBSPLfor2hours).Spontaneousactivitywasrecordedfrom477neurons

(4animals)withparaflocculusandfrom559neurons(5animals)withparaflocculusaspirated.

Results showed a significant increase in hyperactivity (p =0.02) with paraflocculus removed.

These results suggest thatparaflocculusexertsan inhibitoryeffectonhyperactivity in inferior

colliculusat2weeksafteracoustic trauma.Theresultsaresurprising inviewofobservations

in another animalmodel that paraflocculus removal results in reduction of tinnitusmeasured

behaviourally. However, these latter studies were performed at much later time-points after

acoustic trauma. Studiesareunderway to investigate theeffectsofparaflocculusremovalon

hyperactivityatlatertime-points.

168

WED

NES

DAY

12 M

AR

CH

HYPERACTIVITY IN THE INFERIOR COLLICULUS AFTER NOISE TRAUMA AND ITS MODULATION BY EXTRA-COCHLEAR ELECTRIC STIMULATION

Norena, A.1;Mulders,H.2;Robertson,D.2

1 National Center of Scientific Research, Aix-Marseille University,

2 University of Western Australia

Manystudieshaveshownanincreaseofspontaneousfiringintheauditorycentersafternoise

trauma. It has been suggested that this central hyperactivity may underlie the perception of

tinnitus.Recentstudiesshowedthatcentralhyperactivitydependsoncochlearactivity:reducing

thespontaneousfiringinthecochlearnerveabolishesneuralhyperactivityintheinferiorcolliculus

(atleastwithinthefirstfewweeksafternoisetrauma).Extra-cochlearstimulationofthecochlea

hasbeenshowntomodulatethefiringinthecochlearnerve:whilepositivedirectcurrent(DC)

reducedneuralactivityinthecochlearnerve,negativeDChastheoppositeeffect.Interestingly,

somehumanstudiesshowedthatpositiveDCappliedatthepromontoryorroundwindowcould

reliablysuppresstinnitus.Thegoalofthepresentstudywastoinvestigatewhetherextra-cochlear

DCcurrentappliedattheroundwindowwasabletomodulateneural(hyper)activityintheinferior

colliculus.Ourresultsshowthat,forneuronswithacharacteristicfrequencyhigherthanaround

10kHz,positiveDCsuppressesneuralactivityininferiorcolliculuswhilenegativeDCenhances

it.Forneuronswithlowercharacteristicsfrequencies,effectsofelectricalstimulationwereeither

absentorreversed.Ourresultssuggestthatextra-cochlearelectricstimulationmayreducethe

tinnitusperceptbyreducingcentral(hyper)activity,.Thisapproachmayleadtoimportantfuture

developmentsprovidingthat theelectricalstimulationused inclinic is innocuousforbiological

tissues.

169

WED

NESDAY 12 M

AR

CH

MULTIDISCIPLINARY ASSOCIATION FOR PSYCHEDELIC STUDIES

Doblin,R.

AreviewoftheregulatoryroutesofapprovalforSchedule1drugsespeciallyMDMA,marijuana,

psilocybin, LSD, Ibogaine,Ayahuasca. Discussion will include national rules and international

treatyobligations.AsummaryofMAPS’researchportfoliowhichincludes:multisitestudiesfor

MDMA-assistedpsychotherapyforPTSD,US-basedstudiesonMDMAtherapyforAutisticadults

with social anxiety, andMDMA-assistedpsychotherapy for peoplewith life threatening illness

whoare dealingwith anxiety related to endof life issues.MAPS’ studies onpsilocybin, LSD,

IbogaineandAyahuascawillbeoutlined.Alsoincludedwillbearisk/benefitanalysisbasedon

over 4,000 papers on Medline with topics on MDMA or ecstasy, along with a discussion of

remainingmethodologicalissuestobeaddressedpriortophase3studies.

170

WED

NES

DAY

12 M

AR

CH

MDMA-ASSISTED PSYCHOTHERAPY FOR TINNITUS AND PTSD

Emerson,A.

ThispresentationwillsummarizetheMAPSclinicalresearchstudiesofpsychotherapyassisted

with 3,4-methylenedioxymethamphetamine (MDMA) for the treatment of severe chronic,

treatment-resistantPTSD.Pilotstudiesindicatelargeeffectsizesthatmaynecessitateaparadigm

shiftintreatmentofrefractorycasesofPTSD.

Datafrom2completedMAPS-sponsoredPhase2clinicaltrialsandPreliminarydatafromone

ongoing trial inveteransandfirst responderswillbesummarized.Casereportsofchanges in

TinnitussymptomsduringtreatmentofPTSDwillbepresented.

171

WED

NESDAY 12 M

AR

CH

NEURAL PLASTICITY AND ATTENTION IN NORMAL HEARING AND IN TINNITUS

Roberts,L.E.

Department of Psychology Neuroscience and Behaviour, McMaster University, Hamilton, Ontario,

Canada L8S 4K1

Mostifnotallmodelsoftinnitusgenerationproposethatneuralplasticitycontributestotheneural

changesthatunderlietinnitus.Sensorytrainingtherapiesfortinnitusaresimilarlybasedonthe

assumptionthat,notwithstandingneuralchangesrelatedtotinnitus,auditorytrainingcanalterthe

responsepropertiesofneuronsinauditorypathways.InthistalkIwillsummarizewhatwehave

learnedabout therulesthatdescribehowneuralplasticity isexpressed in thenormalhearing

humanbrain,andhowtheserulesappeartobemodifiedinindividualsexperiencingtinnitus.The

findingssupport the view that stimulus-driven formsofneuralplasticity contribute strongly to

auditoryremodelinginnormalhearingindividualsthroughoutthelifespan.Whiletheseformsare

likelyatworkintinnitusaswell,theoutcomeofauditoryremodelingismodifiedbythepresence

oftinnitus-relatedneuralactivity.Tinnitus-relatedmodificationsincludearelaxationofconstraints

onauditoryrepresentationsinprimaryauditorycortex,impairedtemporalplasticityinsubcortical

pathways, and reduced modulation by attention of brain responses evoked by sounds in the

tinnitusfrequencyregion. Implicationsof thesefindingsformodelsof tinnitusandforsound

therapieswillbediscussed.(SupportedbyNSERCofCanadaandtheTinnitusResearchInitiative)

172

WED

NES

DAY

12 M

AR

CH

Poster Session 3 / ToruNumbers refer to poster board allocation

INFLUENCE OF TINNITUS ON AUDITORY SPECTRAL AND TEMPORAL RESOLUTION, AND

SPEECH PERCEPTION ABILITY IN TINNITUS PATIENTS

Shim,HJ.;Kang,HW.;An,YH.;Won,JH.

03

EFFECT OF TRANSCRANIAL DIRECT CURRENT STIMULATION ON AUDITORY RESIDUAL

INHIBITION OF TINNITUS

Shekhawat,G.S.;Searchfield,G.D.;Stinear,C.M.

09

CHANGES OF TINNITUS IN SUDDEN SENSORINEURAL HEARING LOSS: RELATIONSHIP

BETWEEN TINNITUS PITCH AND AUDIOMETRIC SHAPE

Jong-IkLee,TaeSuKim,HyeRanHong,ByungSooShim,HwanSeoLee,JoongHoAhn,Jong

WooChung,TaeHyunYoon,HongJuPark

15

EXAMINING THE ROLES OF CONTEXTUAL STIMULI AND PERSONALITY TRAITS UNDER THE

ADAPTATION LEVEL THEORY MODEL OF TINNITUS

Aruldasan,M.;Kobayashi,K.;Searchfield,G.D.

21

CORTICAL PLASTICITY IN TINNITUS PATIENTS AFTER REPETITIVE EXPOSURE TO TAILOR-

MADE NOTCHED MUSIC

Engell,A.;Stein,A.;Pantev,C.

27

ABNORMAL BRAIN ACTIVITY AND CROSS-FREQUENCY COUPLING IN THE TINNITUS

NETWORK

Adamchic, I.;Langguth,B.;Hauptmann,C.;TassP.A.

33

173

WED

NESDAY 12 M

AR

CH

SURFACE BASED MORPHOMETRY ANALYSIS OF NEUROPLASTICITY INDUCED CHANGES IN

THE BRAIN OF PATIENTS WITH TINNITUS

Kleinjung,T.;Neff,P.;Langguth,B.;Meyer,M.;Schecklmann,M.

39

ELECTROPHYSIOLOGICAL EFFECTS OF ATTENTION IN NORMAL HEARING AND IN TINNITUS

Paul,B.;Bruce,I.;Bosynak,D.J.;Thompson,D.C.;Roberts,L.E.

45

PARAHIPPOCAMPAL-AUDITORY CORTEX COMMUNICATION IN TINNITUS

De Ridder, D.;Congedo,M.;Vanneste,S.

53

MODULATING ALPHA AND BETA OSCILLATIONS WITHIN POSTERIOR CINGULATE CORTEX

THROUGH REAL-TIME SOURCE LOCALIZED NEUROFEEDBACK AND ITS EFFECT ON TINNITUS

RELATED DISTRESS

Joos,K.1;DeRidder,D.2;Vanneste,S.3

59

CHANGE IN SPONTANEOUS CORTICAL ACTIVITY DURING TINNITUS REMEDIATION

Mathur,A.;Ibrahim,R.;McMahon,C.M.

65

TONOTOPIC MAP CHANGES DURING TINNITUS REMEDIATION

Ibrahim, R.K.;McMahon,C.M.;Mathur,A.

71

CHANGES IN RESTING-STATE FMRI ACTIVITY DURING SALICYLATE-INDUCED TINNITUS AND

SOUND STIMULATION

Chen,Y.-C.;Wang,J.;Jiao,Y.;Zang,F.-C.;Yang,M.;Tong,J.-X.;Salvi, R.;Teng,G.-J

77

AUDITORY-LIMBIC NETWORK IN TINNITUS REVEALED BY RESTING-STATE FUNCTIONAL

CONNECTIVITY MRI

Turesky,T.;Leaver,A.M.;Seydell-Greenwald,A.S.;Rauschecker,J.P.

81

174

WED

NES

DAY

12 M

AR

CH

TINNITUS AND DYSFUNCTIONAL INTERACTIONS BETWEEN DISTRIBUTED RESTING STATE

NETWORKS

Maudoux,A.;Vanneste,S.;DeRidder,D.;Vanhecke,W.;VandeHeyning,P.;Cabay,J.-E.;Demertzi,

A.;Laureys,S.;Soddu,A.;Lefebvre,Ph.;GomezF.

97

Poster Session 4 / WhaNumbers refer to poster board allocation

REFLEX MODIFICATION AUDIOMETRY AS A TOOL TO ASSESS HEARING IN MICE

Longenecker,R.J.;Alghamdi,F.;Galazyuk,A.V.

04

UNILATERAL HEARING LOSS IN THE FERRET: A NEW DIRECTION FOR TINNITUS RESEARCH

Gold, J.R.;Nodal,F.R.;King,A.J.;Bajo,V.M.

10

EFFECTS OF STRESS-INDUCED SLEEP DISTURBANCE ON TINNITUS PERCEPTION AND BRAIN

OREXIN EXPRESSION IN RATS FOLLOWING ACOUSTIC TRAUMA

Chien,Y.T.;Stiles,L.;Milne,M.;Darlington,C.L.;Smith,P.F.;Zheng,Y.

16

PAIRED ASSOCIATIVE STIMULATION OF THE HUMAN AUDITORY CORTEX AND ITS EFFECTS ON

THE AUDITORY STEADY STATE RESPONSE

Engel,S.;Markewitz,R.;Schecklmann,M.;Langguth,B.

22

PAIRED ASSOCIATIVE STIMULATION OF THE HUMAN AUDITORY CORTEX AND ITS EFFECTS ON

LATE AUDITORY EVOKED POTENTIALS

Markewitz, R.D.H.;Engel,S.;Schecklmann,M.;Langguth,B.

28

BUILDING A NEURAL-PSYCHOLOGICAL-IMMUNE- ENDOCRINAL MODEL OF TINNITUS (T-NPIE)

Alsalman,O.;Tucker,D;Michel,G.

34

175

WED

NESDAY 12 M

AR

CH

GAP DETECTION THRESHOLDS IN TINNITUS SUBJECTS: DOES TINNITUS FILL IN THE SILENT

GAPS?

Boyen,K.;Başkent,D.;vanDijk,P.

40

TINNITUS CLINICAL SYMPTOMS GENERATION AND MAINTENANCE

Toostani,I.G.;Fattahzadeh,A.;Jangholi,N.

46

INFUSION OF GABAB RECEPTOR AGONISTS INTO THE COCHLEAR NUCLEUS ON TINNITUS

DEVELOPMENT FOLLOWING ACOUSTIC TRAUMA IN RATS

Zheng,Y.;Vulinovich,A.;Stiles,L.;Darlington,C.L.;Smith, P.F.

54

STRESS-ASSOCIATED CHANGES OF MITOCHONDRIAL PROTEINS IN AUDITORY CORTEX

Szczepek,A.J.;Mazurek,B.

60

EVIDENCE FOR NEUROGENESIS IN THE COCHLEAR NUCLEUS FOLLOWING ACOUSTIC

TRAUMA IN RATS

Zheng,Y.;Smythies,H.;Aitken,P.;Darlington,C.L.;Smith,P.F.

66

SOUND-TRIGGERED SUPPRESSION OF NEURONAL FIRING IN THE AUDITORY CORTEX:

IMPLICATION TO THE RESIDUAL INHIBITION OF TINNITUS

Galazyuk, A.V.;Grimsley,C.A.;Longenecker,R.J.

72

EFFECTS OF PARAFLOCCULUS REMOVAL ON HYPERACTIVITY AFTER ACOUSTIC TRAUMA

Vogler, D.P.;Robertson,D..;Mulders,WHAM.

78

HYPERACTIVITY IN THE INFERIOR COLLICULUS AFTER NOISE TRAUMA AND ITS MODULATION

BY EXTRA-COCHLEAR ELECTRIC STIMULATION

Norena, A.;Mulders,H.;Robertson,D.

82

176

WED

NES

DAY

12 M

AR

CH

177

THUR

SDAY 13 MA

RCH

Moseley, G.L.

Lorimer’swork into theroleof thebrainandmind inchronicpainhasclear relevanceforour

understandingandtreatmentoftinnitus.Manyoftheproblemsthatfacepainresearchersand

clinicians seem to bemirrored in the tinnitusworld. Inmany chronic pain states, the pain is

effectivelyanillusionbecauseitisalertingthesufferertoaproblemthatdoesnotinfactexist-

thatproblembeingtissueinneedofprotection.Thissituationisterrificallydifficulttounderstand

ifonethinksaboutpainasanentitythatexistsinthetissuesthemselves.Animportantpartof

Lorimer’s researchhasbeen to takeon thesubstantialchallengeofhelpingpeople inpain to

reconceptualisewhatpainactuallyisandhowitworks.Theapproach,colloquiallycalled‘Explain

Pain’ is now endorsed in clinical guidelines around the world. Other work targets findings of

functionalchangesinthebrain’srepresentationofsensoryinputandthosetechniquestoo,are

nowsupportedbyclinicaltrialevidence.Inthislecture,Lorimerwillgiveanoverviewofthiswork

andspeculate,fromtheperspectiveofatinnitusoutsider,onhowthetwofieldsmightlearnfrom

eachothertomorequicklyprogressboth.

178

THUR

SDAY

13

MA

RCH

ATTENTION AND SUBJECTIVE TINNITUS: FROM A CLINICAL POINT OF VIEW

Londero,A.

Hôpital Européen G. Pompidou, Paris, France

Inachallengingworld,auditoryattentionisanessentialpropertyofmammalianbrains.Rather

thanprocessingalloftheauditoryinformationwhichismostlyrelegatedinthebackgroundofthe

auditoryscene,weselectivelyshiftourattentiontovariousrelevantauditoryevents,eitherevents

ofinterestoreventsthatcaptureourattentionspontaneously.

Even if tinnitus is usually defined as a “phantom sound”, it is indeed an auditory form. In

impaired tinnitus patients, it is mainly perceived as a distressing component of the auditory

sceneforegroundthatcapturesattention.Onthecontrarynonbotheredpatientsdealwiththeir

tinnitusasifitwereameaninglessbackgroundsignal.Reallifepatients’statementshighlightthe

importanceofattentionprocessesintheclinicalcontextofinvalidatingtinnitus.However,todate

andfromaclinicalpointofview,verylittlemedical“attention”hasbeenpaidtotheseattention-

relatedissueswithinthetinnitusfield.

Oneplausiblereasonfor thisdiscrepancy is thedifficulty togiveaclear-cutdefinitionofwhat

attentionactually is.Forexample,auditoryattentionnotonlydependson thepsycho-acoustic

propertiesofauditoryeventsthatmakespecificsoundsmoresalientandmorepronetopop-out

in theauditoryscene,butalsoonhigh levelcognitive functions includingshortand long-term

memoryoremotionalconnotationofsounds.Moreover,inaquitepuzzlingauto-referentialway,

attention is closely linked to the notions of object andmotion.Top-down intentional attention

literally creates theauditoryobjects. Indeedobjects thatdonot exist for thebrainbeforeour

attentionhasbeenfocusedtowardthemwithsubsequentgazeandbodyorientatingreactions.

But in reverseway bottom-up attention detects specific unexpected or threatening objects in

ordertoallowusproperreaction.

A pragmatic way to understand attention is to consider it as a“biased” way to analyze and

filteroursensations,thatsystematicallyfavorseitherunpredictedevents(i.e.deviantfrombrain

expectations)viaabottom-upfilteringthatmainlyreliesonbasicpropertiesofsensoryinputor

interestingeventsviaatop-downmodulationbasedonmemoryandemotions.Neuralcorrelates

involvedinthesecomplexattentionalprocessesarestillamatterofdebate.

179

THUR

SDAY 13 MA

RCH

Theclinicalusefulnessofsuchaparadigmofanalysisoftinnitusintrusivenessisstillanopen

question.Howevervirtualrealitytechniquesthatallowastandardizedandreproducibleimmersion

in controlled environments could represent an interesting novel tool to better understand the

implicationofattentionprocessesinimpairedtinnituspatients.

180

THUR

SDAY

13

MA

RCH

AN ENT DOCTOR’S JOURNEY TO THE BRAIN: THE AUDITORY AND NON-AUDITORY BRAIN AREAS INVOLVED IN TINNITUS AND TINNITUS-RELATED DISTRESS

Song,J.J.

Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang

Hospital, Seongnam, Korea

Tinnitusisaphantomsoundperceptionwithoutanidentifiablesoundsource.Itischaracterized

bysensorycomponentssuchasperceived loudnessandpitch, the laterality (uni-orbilateral),

the tinnitus type (pure tone or noise-like) and associated emotional components, such as

distress and mood changes. Functional imaging studies using positron emission tomography

(PET), functional magnetic resonance imaging (fMRI), magnetoencephalography (MEG), and

quantitativeelectroencephalography(qEEG)havedemonstratedtheinvolvementofnotonlythe

auditorybrainareassuchastheprimary-andsecondaryauditorycorticesbutalsoseveralnon-

auditorybrainareassuchastheanterior-andposteriorcingulatecortices,dorsolateralprefrontal

cortex,insula,supplementarymotorarea,orbitofrontalcortex(includingtheinferiorfrontalgyrus),

parahippocampus,and theprecuneus, indifferentaspectsof tinnitus.Also,many researchers

have explained these auditory and non-auditory brain areas as constituents of separable

subnetworks,eachreflectingaspecificaspectofthetinnitusperceptandtinnitus-relateddistress.

In this talk, Iwould like tofirstsummarizecorticalareas thathavebeen found tobe involved

in tinnitusperception and tinnitus-relateddistress, then combine thoseareas to formalleged

subnetworks.Duringthetalk,also,Iwouldliketointroducemyshortresearchexperienceand

resultsfoundprimarilybyqEEG-basedsourcelocalizationandfunctionalconnectivitystudies.

181

THUR

SDAY 13 MA

RCH

PRISM (PICTORIAL REPRESENTATION OF ILLNESS AND SELF MEASURE) AS A NEW ASSESSMENT TOOL FOR SUFFERING IN TINNITUS PATIENTS

Peter,N.1;Kleinjung,T.1;Horath,L.1;Wichser,N.1;Buechi,S.2;Weidt,S.3

1 Department of Otorhinolaryngology, University of Zurich, Switzerland2 Clinic for Psychotherapy and Psychosomatics “Hohenegg”, Meilen, Switzerland3 Department of Psychiatry and Psychotherapy, University of Zurich, Switzerland

Objectives

Chronic subjective tinnitus is a frequent condition that affects thequality of life ofmillionsof

sufferersworldwide.Thelackofobjectivemeasuresoftinnitusnecessitatestheuseofself-report

questionnairesforevaluatingtinnitusseverityandannoyance.Theanalysesofthesequestionnaires

allow medical staff to select adequate treatment modalities and monitor treatment effects.

However, thewiderangeofdifferentquestionnaireshampersan internationalandcomparable

standardintinnitusassessment.Furthermore,mostofthesequestionnaireshaveshortcomings

intermsofresponsivenesstotreatmentrelatedchanges, insufficienttranslationandvalidation

indifferent languagesand time-consumingaspects.PRISM (PictorialRepresentationof Illness

andSelfMeasure)isamethodtoassesssufferingandqualityoflife.Sofar,PRISMwasvalidated

asamarkerofburdenindifferentpsychologicalandphysicalconditionslikePTSD,rheumatoid

arthritis,chronicurticariaandorofacialpain.TheaimofthisstudyistovalidatePRISMasamarker

of impairment in tinnitus patients in a prospective observational study.The results of PRISM

assessmentwerecomparedtodifferentstandardquestionnairesusedintinnitusevaluation.

Methods

Participating subjects were asked to fulfill an online-base survey including the following

questionnaires:THI (TinnitusHandicap Inventory),TQ (TinnitusQuestionnaire)TBF-12 (German

shortversionofTHI),WHOQOL-BREF(WHOQualityofLife-Questionnaire),BDI(BeckDepression

Inventory).Atthetimeofconsultationintheclinicthesubjectswereaskedtoperformanaudio-

visual taskonPRISMusingan IPad.Patientswereshownawhitepanelon thewholedisplay

(14.7x19.6cm)ofthe Ipad(representingtheir life)withayellowcircle(diameter4.9cm)atthe

bottomright-handcornerrepresentinghisorher“self”atthistime.Afterwardstheywereasked

tomoveanothersmallerredcircle(3.5cm)representingtheirtinnitusinrelationtotheirselfatthis

moment.TheanswersonthetwodimensionalPRISMweredividedinto4groups.Comparisonsto

thequestionnairescoreswerecorrelatedusingt-testorANOVA(SPSS).

182

THUR

SDAY

13

MA

RCH

Results

A total of 130 subjectswere included in the analysis (48women, 82men) since2012.The

answersonthetwodimensionalPRISMweredividedinto4groupsreflectingdifferentgradesof

tinnitusseverity:Ingroup1theredtinnitus-circlewascompletelyplacedintheyellowself-circle

(mostsevere);ingroup2theredtinnitus-circlewasoverlappingtheyellowself-circleandwasnot

partofgroup1;ingroup3theredtinnitus-circlewasplacedunderavirtualdiagonallinefromthe

leftbottomtotherightuppercornerandwasnotpartofgroup1or2;ingroup4theredtinnitus-

circlewasplacedinthetriangleabovethevirtualdiagonallinefromtheleftbottomtotheright

uppercorner(leastsevere).ThedifferentPRISMgroupsdemonstratedastatisticallysignificant

correlationwiththecorrespondinggradinginthetraditionaltinnitusquestionnaires(e.g.THI,TQ).

Conclusion

PRISMisanewvisualmethodtoassesssufferinginpatientswithtinnitusinashorttime.We

couldshowasignificantcorrelationbetween the traditionallyused tinnitus-questionnairesand

PRISM.

183

THUR

SDAY 13 MA

RCH

PROPORTION AND DIVERSIFICATION OF UNDERLYING CAUSES OF 242 UNILATERAL VENOUS PULSATILE TINNITUS CASES IN DUAL-PHASE CONTRAST-ENHANCED CT

Dong, C1; Wang, Z.C.1; Liu, Z.H.2; Zhao, P.F.2

1 Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100050,

China2 Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100050,

China

Objectives

ToevaluatetheproportionanddiversificationofunderlyingvenousPTcauses.

Materials and Methods

Thedual-phasecontrast-enhancedCT(DP-CECT)imagesof242patientswithunilateralvenous

PT were retrospectively reviewed. The underlying causes of venous PT reported in previous

literatureswereevaluated.Furthermore,thenumberofunderlyingcausesofvenousPTineach

patientwascounted.

Results

(1)Of all patients, only58patients (24.0%)werediagnosedwith only oneunderlying cause,

while170patients (70.2%)werewithmore thanonecause. (2)Themostcommonunderlying

cause of venous PT was dehiscent sigmoid plate (86.4%), followed by lateral sinus stenosis

(55.8%),highjugularbulb(47.1%),sigmoidsinusdiverticulum(34.3%),jugularbulbdiverticulum

(13.6%),dehiscentjugularbulb(13.6%),largeemissaryvein(4.1%),sinusthrombosis(1.2%),

petrosquamosalsinus(0.8%).

Conclusion

DehiscentsigmoidplateiscommoninvenousPT.ThecausesofvenousPTcouldbediversified

inmostPTpatients.

Keywords:Pulsatiletinnitus,computedtomography

184

THUR

SDAY

13

MA

RCH

THE DURAL SINUS WALL DEHISCENCE PRESENTING WITH PULSATILE TINNITUS: EVALUATION WITH CT VENOGRAPHY

Zhao,P.BeijingChina;Wang,Z.;Xian,J.;Yan,Y.;etal.

Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No.1,

Dongjiaominxiang, Dongcheng District, Beijing 100730, China

Objectives

ToassessthedetailedCTfindingsaboutdurasinuswalldehiscenceinpatientspresentingwith

pulsatiletinnitus(PT)onCTvenography(CTV)

Methods

Following approval of the institutional review board, 131 hospitalized patients with PT from

2008to2013,whounderwentthoroughclinicalandlaboratorytestsincludingCTarteriography

and venography and digital subtraction angiography, were retrospectively evaluated. Finally,

30patientswere included.All thesepatienswere foundwith dural sinuswall dehiscence on

thesymptomaticsideandtheirnoisewastotallyeliminatedaftercoveringthedehiscencewith

tempralis facia.The signs were invesgated as follows: the location,extent and amount of the

dehiscence,thepresenceofoneormorearachnoidgranulationsbeneaththetransversesinus,

thepresenceoftransversesinusstenosis,thepresenceofhighjugularbulbandthepresenceof

venousoutflowdominance.

Results

Fortytwodehiscenceweredetectedinthese30patients,withthearearangefrom2*2to5*8

mm(average3*5mm).Thesingledehiscencewasfoundin24of30patients(80%).Thebonywall

abovethecommoncruswasinvolvedin29of42dehiscence(69%).Theanterolateralwallwas

involvedin35of42patients(83%).Forotherimagingfindings,thelargearachnoidgranulation

beneaththetransversesinuswasdemonstratedin25patients(83%)onthesymptomaticside

whilein26(87%)onthecontralateralside;theipsilateralhighjugularbulbwasrevealedin28

patients(93%);thesymptomaticsidewasconsistentwiththedominantsidein23of25patients

(92%)withunilateraldominantvenoussystem.Thetransversesinusstenosiswasfoundin25

(83%)patientonthesymptomaticsidewhile28(93%)onthecontralateralside.

Conclusion

TheduralsinusdehiscencepresentingwithPT,whichseemstobeadirectcauseofPT,mostly

185

THUR

SDAY 13 MA

RCH

manifests as single bony defect with the lateral wall of dural sinus at a relatively high level

involved. The hemodynamic abnormalities caused by diversified factors, including bilateral

transverse sinus stenosis, ipsilateral high jugular bulb, ipsilateral outflow dominance bilateral

arachnoidgranulation(s)beneaththetransversesinus,maybetherootcauseofduralsinuswall

dehiscencepresentingwithPT.

IaminreadingMDofRadiologyinBeijingTongrenhospitalwhichwastheNo1atthediagnosis

andtreatmentofotolaryngologyinChina.Mymaindirectionisaboutpulsatiletinnitus. In last

fouryears,Ihavemadediagnosisformorethanonethousandpatientswithpulsatiletinnituswith

variouscauses.Besides, Ihavesubmittedfivepapers inChineseuntilnowand Ihavewritten

threepapersinEnglish,oneofwhichhasbeenacceptedbyActaRadiologica.

186

THUR

SDAY

13

MA

RCH

DEEP BRAIN STIMULATION OF THE INFERIOR COLLICULUS FOR TREATING TINNITUS

Offutt,S.J.;Konop,A.R.;Lim,H.H.

Department of Biomedical Engineering – University of Minnesota, 312 Church St SE, Minneapolis,

MN 55455, USA

Onepossible tinnitus treatmentoption is toutilizedeepbrainstimulationonnon-lemniscalor

secondaryauditorynucleitodirectlymodulateandcreateplasticchangesinlemniscalauditory

nuclei with aberrant neural activity related to tinnitus.A potential strategy is to stimulate the

dorsalcortexoftheinferiorcolliculus(ICD)tomodulateneuralactivityinthecentralregion(ICC),

anucleusintheauditorymidbrainshowntohavehyperactivityandincreasedneuralsynchrony

in tinnitus patients and/or animals. ICD can also modulate other lemniscal regions involved

with tinnitus through ascending and descending pathways.We have a unique opportunity to

stimulate the ICDdirectly in tinnituspatients inanupcomingclinical trialwithanewauditory

midbrainimplant(AMI).TheAMIwillbeimplantedintheinferiorcolliculusinpatientsforhearing

restoration,butmanyofthesepatientsalsohavetinnitus.Priortothisclinicaltrial,wesoughtto

identifyeffectivestimulationlocationsinICDandastimulationstrategythatcouldalterICCactivity

relevantfortinnitussuppressioninananimalmodel.

Multi-siteelectrodesarrayswerepositionedacross the ICCand ICDofketamine-anesthetized

guineapigs.SpikeactivityinICCwasrecordedinresponsetobroadbandnoisestimulationbefore

andafterrepeatedelectricalstimulationoftheICDtoidentifyresidualchangesinneuralactivity.

Electrical stimulation was paired with broadband noise stimulation at different inter-stimulus

intervalsandalone tocompareresidualeffects.Histologicalstepswere taken toproduce3-D

reconstructionsofthemidbrainandtoidentifythelocationofelectrodesitesacrosstheIC.

OurresultsrevealthateveryICDstimulationlocationinducesacomplexpatternofmodulationof

neuralactivityinICC,withsignificantlymoreinhibitionthanfacilitation.Additionally,modulationis

significantlydependentontheelectricalstimulationparadigmused.Electricalstimulationpaired

withbroadbandnoisewithalonginter-stimulusdelay(18ms)resultedinmoreinhibitionthan

eitherelectricalstimulationpairedwithbroadbandnoisewithashortinter-stimulusdelay(8ms)

orelectricalstimulationalone.

Basedonourfindings,wecanstimulateanyICDlocationtomodulateICCactivity.Thestronger

187

THUR

SDAY 13 MA

RCH

residual inhibitionthatoccurswhenpairingtheelectricandacousticstimulationwitha longer

delay(i.e.,18msversus8ms)maybefromweakenedsynapticconnections,perhapsdueto

spike timing dependent plasticity.With the correct timing, the paired stimulation could inhibit

hyperactivityanddisruptneuralsynchronywithlong-lastingeffects,whichmayinduceplasticity

in the ICC that leads to suppression of the tinnitus percept. The results from this study are

encouraging fordeepbrainstimulationasa treatment for tinnitus.Futurestudieswillneed to

investigatehowICDstimulationaltersactivationpatternsinotherauditorynucleilinkedtotinnitus,

suchasintheauditorycortex,andintinnitusanimalmodels.WewillinitiallytestICDstimulation

paired with ICC stimulation (since acoustic stimulation is not possible) in deaf patients with

tinnituswhowillbeimplantedwiththeAMI.

188

THUR

SDAY

13

MA

RCH

IMPACT OF SPECTRAL NOTCH WIDTH ON THE CLINICAL EFFECTIVENESS OF THE TAILOR-MADE NOTCHED MUSIC TRAINING

Wunderlich,R.1;Teismann,H.1;Lau,P.1;Engell,A.1;Stein,A.1;Wollbrink,A.1;

Shaykevich,A.2;Pantev,C.1

1 Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Germany2 University of Western Australia

Tinnitus,theringingintheearsthatisunrelatedtoanyexternalsource,causesasignificantloss

inqualityoflife,involvingsleepdisturbanceanddepressionfor1to3%ofthegeneralpopulation.

In the first place tinnitus may be triggered by damage to the inner ear cells, but the neural

generatorsofnoise-inducedtinnitusarelocatedincentralregionsofthebrain.Alossoflateral

inhibition,tonotopicalreorganizationandagain-increaseinresponsetothesensorydeprivation

result inhypersensitivityandhyperactivity in theauditorycortex.Negativeemotionalappraisal

andattentionmightsupportthedevelopmentofatinnitusnetwork.Withinthetrainingwithtailor-

madenotchedmusic(TMNMT)patients listentomusicfromwhichthefrequencyspectrumof

the tinnitushasbeenremoved.Thisevokesstrong lateral inhibitionof theneurons involved in

the tinnituspercept fromneurons tuned toother frequencies.Areductionof tinnitus loudness

wasachievedwithTMNMTispreviousstudies.Theeffectoflateralinhibitioncanbeenhanced

withasmallerbandwidthofthenotch.Weassumethatthetrainingwillbemoreeffectivewith

anotchwidthofa½octaveorevena¼octavecompared toonewholeoctave.Participants

can choose their favoritemusic for the training that includes threemonth of two hours daily

listening.Ouroutcomevariableswerestandardizedtinnitusquestionnaires,visualanalogscales

and Magnetoencephalography (MEG).We found a reduction of tinnitus distress in all groups.

Participants inthe½octavegroupshowthestrongest improvement.Wealsofoundapositive

correlationoftinnitusloudnessreductionandreductionoftheevokedauditoryresponseinthe

MEG.

189

THUR

SDAY 13 MA

RCH

COMPARISON OF POSITIONING THE CATHODE IN TDCS

Rabau, S.1,2;Mariën,P.1;VandeHeyning,P.1,2

1 University Department of otorhinolaryngology and Head & Neck surgery, Antwerp University

Hospital, Edegem, Belgium2 Faculty of Medicine, Campus Drie Eiken, University of Antwerp, Antwerp, Belgium

ObjectivesInthecaseoftDCS,currentisappliedtothebrainbymeansof2electrodes:theanodeonthe

dysfunctionalsiteandthecathodeona‘silent’partofthebody.Nowadays,mostlybifrontaltDCS

isapplied in tinnituspatients: theanodeandcathodeplacedonrespectively therightand left

dorsolateralprefrontalcortex(DLPC).Ourhypothesisisthattheplacementofthecathodeonthe

shoulderminimises therisk that thecurrent justflowsthroughtheskin to theotherelectrode

andnotreachesthegreymatter.Asaconsequenceoftheshoulderplacementtheactualcurrent

couldstimulateadeeperandwiderbrainareaandlateralisesmoretothecontralateralDLPC.The

objectiveofthepresentstudywastocomparetheoutcomeoftheplacementofthecathodeon

theleftDLPCwiththeplacementontheshoulder.

MethodsPatients considered for the trial were chronic non-pulsatile tinnitus patients with complaints

longerthan6monthsandaTinnitusFunctionalIndex(TFI)scorethatexceeded25.Patientswere

randomisedbyminimisationinordertocreatetwoequalgroupsbasedontheparametersage,

TFIscore,aetiology,genderanddegreeofhearingloss.Inthefirstgroup‘bifrontal’theelectrodes

wereplacedontheleftandrightDLPC,whileinthesecondgroup‘shoulder’thecathodewas

placedontheshoulder.Eachpatientreceived2sessionstDCSeveryweekandintotal8sessions.

Evaluationstookplaceat thefirstvisitontheENT-consultation,at thestartof therapy,after8

sessionsoftDCSandatlastthefollow-upvisittookplaceafter84daysofthestartofthetherapy.

Subjective outcomemeasurements such asTFI ,VisualAnalogScales of loudness (VAS) and

percentageofconsciousnessoftinnitusweretakenwitheverypatient.Torevealthepreferenceof

oneplacement,statisticalanalysiswasperformedonthedata.

ResultsTheresultswillbepresentedatthecongress.

Acknowledgements

ResearchwassupportedbyaTOP-BOFmandateoftheUniversityofAntwerp.

190

THUR

SDAY

13

MA

RCH

OBJECTIVE MEASUREMENTS OF TINNITUS DISTRESS

Masuda,M.1;Kohno,N.1;Ogawa,K.2

1 Department of Otolaryngology, Kyorin University School of Medicine, 6-20-2 Shinkawa,

Mitaka-shi, Tokyo 181-8611, Japan2 Department of Otolaryngology, Keio University School of Medicine, 35 Shinanomachi,

Shinjuku-ku, Tokyo 160-8582, Japan

Objectives

Tinnitus is intrinsicuncomfortablesound forpatientswith tinnitus,so it isdistress for tinnitus

patients.Inthepresentstudy,weexposedsubjectstouncomfortablesoundandanalyzedstress

responsesobjectivelyandquantitatively.

Methods

Subjects

Thesubjectswerethirteenadultswithouttinnitus(healthysubjects)andsixtinnituspatients.

Determinationofthesimulatedtinnitussound:Todeterminepitchandloudnessoftinnitusofeach

patient,standardpitch-andloudness-matchtestswereconducted.Wedefinedthesamepitch

and10dBSPLloudersoundasthesimulatedintrinsicuncomfortablesound(Tinnitus+10).In

otherwords,itisthesimulatedtinnitussound.

Soundexposure

Eachtinnituspatientwasexposedtotheownsimulatedtinnitussoundandabandnoisecentered

at500Hzwith loudnessof theuncomfortable level+10dBHL (500HzUCL+10). Healthy

subjectswereexposedtotwokindsofbandnoisescenteredat500and4kHzwithloudnessof

theuncomfortablelevel+10dBHL(500HzUCL+10,4kHzUCL+10),althoughtheyareextrinsic

uncomfortablesoundbutnotintrinsicsound.Inadditiontothoseuncomfortablesounds,tinnitus

patientsandhealthysubjectswereexposedtoabandnoisecenteredat500Hzwithloudness

ofthecomfortablelevel(500HzMCL).Asubjectlaydownonarecliningbedforfourminutes

withoutanysound,wereexposedtooneofthesoundsmentionedabovefortwominutes,and

laydownforsevenminutes.Therefore,ittookthirteenminutestoanalyzestressresponsesto

onesound.

191

THUR

SDAY 13 MA

RCH

Measurement parameters

The following five parameters were measured sequentially and simultaneously. 1.

Hematoencepalographywithnearinfrared,2.Electroencephalography,3.Heartratevariability,4.

Fingertiptemperature,5.Skinconductance.

Results

ThefingertiptemperaturesignificantlydecreasedwhentinnituspatientswereexposedtoTinnitus

+10butnotto500Hz+10and500HzMCL.Ontheotherhand,thetemperaturesignificantly

decreasedwhenhealthysubjectswereexposedto500Hz+10butnotto4kHz+10and500Hz

MCL.Otherparametersdidnotshowsignificantchange.

Conclusion

Tinnituspatientsmusthavethespecificstressresponseto their tinnitussound,andwecould

detecttheresponseobjectively.

192

THUR

SDAY

13

MA

RCH

DEEP BRAIN STIMULATION OF THE INFERIOR COLLICULUS FOR TREATING TINNITUS

Offutt,S.J.;Konop,A.R.;Lim,H.H.

Department of Biomedical Engineering – University of Minnesota, 312 Church St SE, Minneapolis,

MN 55455, USA

Onepossible tinnitus treatmentoption is toutilizedeepbrainstimulationonnon-lemniscalor

secondaryauditorynucleitodirectlymodulateandcreateplasticchangesinlemniscalauditory

nuclei with aberrant neural activity related to tinnitus.A potential strategy is to stimulate the

dorsalcortexoftheinferiorcolliculus(ICD)tomodulateneuralactivityinthecentralregion(ICC),

anucleusintheauditorymidbrainshowntohavehyperactivityandincreasedneuralsynchrony

in tinnitus patients and/or animals. ICD can also modulate other lemniscal regions involved

with tinnitus through ascending and descending pathways.We have a unique opportunity to

stimulate the ICDdirectly in tinnituspatients inanupcomingclinical trialwithanewauditory

midbrainimplant(AMI).TheAMIwillbeimplantedintheinferiorcolliculusinpatientsforhearing

restoration,butmanyofthesepatientsalsohavetinnitus.Priortothisclinicaltrial,wesoughtto

identifyeffectivestimulationlocationsinICDandastimulationstrategythatcouldalterICCactivity

relevantfortinnitussuppressioninananimalmodel.

Multi-siteelectrodesarrayswerepositionedacross the ICCand ICDofketamine-anesthetized

guineapigs.SpikeactivityinICCwasrecordedinresponsetobroadbandnoisestimulationbefore

andafterrepeatedelectricalstimulationoftheICDtoidentifyresidualchangesinneuralactivity.

Electrical stimulation was paired with broadband noise stimulation at different inter-stimulus

intervalsandalone tocompareresidualeffects.Histologicalstepswere taken toproduce3-D

reconstructionsofthemidbrainandtoidentifythelocationofelectrodesitesacrosstheIC.

OurresultsrevealthateveryICDstimulationlocationinducesacomplexpatternofmodulationof

neuralactivityinICC,withsignificantlymoreinhibitionthanfacilitation.Additionally,modulationis

significantlydependentontheelectricalstimulationparadigmused.Electricalstimulationpaired

withbroadbandnoisewithalonginter-stimulusdelay(18ms)resultedinmoreinhibitionthan

eitherelectricalstimulationpairedwithbroadbandnoisewithashortinter-stimulusdelay(8ms)

orelectricalstimulationalone.

Basedonourfindings,wecanstimulateanyICDlocationtomodulateICCactivity.Thestronger

193

THUR

SDAY 13 MA

RCH

residual inhibitionthatoccurswhenpairingtheelectricandacousticstimulationwitha longer

delay(i.e.,18msversus8ms)maybefromweakenedsynapticconnections,perhapsdueto

spike timing dependent plasticity.With the correct timing, the paired stimulation could inhibit

hyperactivityanddisruptneuralsynchronywithlong-lastingeffects,whichmayinduceplasticity

in the ICC that leads to suppression of the tinnitus percept. The results from this study are

encouraging fordeepbrainstimulationasa treatment for tinnitus.Futurestudieswillneed to

investigatehowICDstimulationaltersactivationpatternsinotherauditorynucleilinkedtotinnitus,

suchasintheauditorycortex,andintinnitusanimalmodels.WewillinitiallytestICDstimulation

paired with ICC stimulation (since acoustic stimulation is not possible) in deaf patients with

tinnituswhowillbeimplantedwiththeAMI.

194

THUR

SDAY

13

MA

RCH

Evaluation of a Self-administered Tinnitus Measurement System

Kam, A.C.S.1,2;Leung,E.K.S.1,2;Sung,J.K.K.1,2;Lee,T.3;vanHasselt,C.A.1,2

1 Department of Otorhinolaryngology, Head & Neck Surgery, Chinese University of Hong Kong,

Hong Kong2 Institute of Human Communicative Research, Chinese University of Hong Kong, Hong Kong3 Department of Electronic Engineering, Chinese University of Hong Kong, Hong Kong

IntroductionThebasicstepinmosttinnitusmanagementprogramsistoquantifythecharacteristics,including

pitch and loudness, of the perceived tinnitus. The success of some contemporary tinnitus

managementapproaches,suchastinnitusnotchedtherapy,reliesontheaccuracyofthetinnitus

pitchmatched.Ourresearchteamdevelopedaself-administeredtinnitusmeasurementsystem

whichiscapabletomeasuretinnitusfrequencyinonehertzresolutionviaatablet.

Aim To investigate the application feasibility and accuracy of the self-administered tinnitus

measurementsystem.

MethodsFortypatientswithsubjectivetinnituswererecruitedinanaudiologyclinicinahospitalsetting.

Thesubjectscompletedtheconventionalproceduresortheautomatedtinnitusmeasurementina

randomizedorder.Subjectswereaskedtorateonan11-pointvisualanalogscaleonthesimilarity

ofthemeasuredtinnitusandtheoneperceived.Tinnituspitchandloudnessobtainedwithboth

methodswerecompared. Test-retest reliabilityof theself-administered tinnitusmeasurement

wasinvestigatedbothwithin-sessionandbetweensessionswhichwereoneweekapart.

ResultsTherewassignificantdifferenceinthetinnituspitchandloudnessmatchedwiththetwomethods.

Self-matchedtinnituspitchandloudnesswerereportedtobemoresimilartotheperceivedone.

Goodtest-retestreliabilitywiththeself-administeredtinnitusmeasurementmethodwasobserved

bothwithin-andbetween-session.Morevariabilitywasobservedinbetween-sessionmeasures.

ConclusionIt is feasible to perform tinnitus pitch and loudness measurement with the self-administered

system.

195

THUR

SDAY 13 MA

RCH

THE ROLE OF INDIVIDUAL PAIN TOLERANCE AND PAIN TRESHOLD IN BEARING TINNITUS

Aksoy,S.1;Yılmaz,T.2;Keser,I.3;Aslan,S.1;Kırdı,N.4

1 Hacettepe University, Faculty of Health Sciences, Department of Audiology2 Turgut Özal University, School of Medicine, Department of ENT3 Gazi University, Faculty of Health Sciences, Department of Phsical Therapy and Rehabilitation,4 Hacettepe University, Faculty of Health Sciences, Department of Phsical Therapy and

Rehabilitation, Ankara, Turkiye

Tinnitusisachronicanddisturbingsymptomthataffectsmillionsofpeopleworldwide.

Inthisstudy,thedifferences(andsimilarities)betweenshorttermandlongtermtinnitusandpain

isevaluated.Pain thresholdandpain toleranceofpatientswith tinnitusweremeasured three

timesandtheaveragewasrecorded.

Forty-fivepatientsattendingtheAudiologydepartmentofHacettepeUniversity(HU)Hospitalwere

evaluated.Patientsconsistedof19femaleand26male,withanagerangebetween24to79

years,anddurationoftinnitusofatleast3monthspriortotesting.Theresultswerecomparedto

acontrolgroupofhealthy(non-tinnitussufferers)individuals,20femalesand25males,withan

agerangebetween21and48years.

Painthresholdandpaintolerancemeasurementsofthepatientsandcontrolgrouphavebeen

recordedintheDepartmentofPhysicalTherapyandRehabilitationofHU.Thesemeasurements

weretakenusingelectricalstimulation.ForpainthresholdandtolerancemeasurementDimeq

MedModule5(Bosch)instrumentwasused.

Measurementsweremadeatroomtemperatureof22degreesCelsius,inasittingposition,90

degreesflexionoftheelbowandforearmpronationandSupination,whilerecordedbetweenthe

neutralpositions.Measurementsoftheradialsideoftheforearm,proximaltotherightpassive

electrode, theactiveelectrodewasplacedat thedistalendof theRadius. Thepatientswere

askedtorespondwhentheyfeelpainsensation.Painthresholdandpaintolerancemeasurements

were repeated for three times. The average of these three values obtained and recorded in

milliamp’s.Theresultsfromthepatientsgroupandthecontrolgroupwerestatisticallycompared

usingtheMann-WhitneyUtestandStudent’sT-Test.

196

THUR

SDAY

13

MA

RCH

Results

Therewasnostatisticallysignificantdifferenceinpainthresholdbetweenthestudyandcontrol

groups,thesamegoesforthepaintoleranceresults.

Conclusion

Itwaspossibletoendureshort-termpainandtinnitus.However,itwasnotpossibletoendurethe

painandtinnituswhenthedurationisincreased.

Tolerancetotinnituswasassociatedwithcorticalfamiliarization(habituation)orbrainplastisite

andcorticalprintmaking (suppression).Researchandstudies in thisdirectionareexpected to

givepositiveresults.

Keywords:Pain,Threshold,Tinnitus,TinnitusSuferer

197

THUR

SDAY 13 MA

RCH

MODERN THERAPEUTIC APPROACH TO THE DISEASE OF TINNITUS

Calenti,C;Ciabattoni,A.

U.o. Orl area vasta n°5 asur marche ascoli piceno – s.benedetto del tronto

Introduction

Thehypothesisoftheinvolvementofthelimbicsystemandtheautonomicnervoussysteminthe

pathologyoftinnitusisduetoPJJastreboffneurophysiologicalmodelthatestablishesthetinnitus

andthesubsequenttherapeuticstrategy:TinnitusRetrainingTherapy(TRT).Thepurposeofthe

followingstudywastoevaluatetheresultsoftheTRTatadistanceofabout5yearssinceits

introductionasatreatmentprotocoloftinnitusinourclinic.

Subjects and Methods

Intheperiodbetween1January2008andDecember31,2010wereprogressivelyrecruited53subjects,

including 30malesand 23females, sufferingfromtinnitusand/orhyperacusis. The selected

patients were monitored for a period of 18 months at monthly intervals for the first three

monthsand thereafterat intervalsof threemonths.Allsubjectsunderwent testingemoryand

audiological evaluation, including tonal and vocal audiometry and brainstem auditory evoked

potentialsDizionario-Visualizzadizionariodettagliato.Patientsfurtherselectedfromthissecond

levelofassessmentweresenttotherapy(TRT)followingthemethodsdescribedbyJastreboff.

Results

Therapeutic successwas foundafter18months, theestablisheddurationof treatment in38

patients(82.6%). Inothercases,regardedasfailure, therewaspersistenceofsymptomsin5

(10.8%)andabandonmentoftreatmentby3subjects(6.6%).Ascolta

Trascrizionefonetica

Dizionario-Visualizzadizionariodettagliato

Ascolta

Trascrizionefonetica

Dizionario-Visualizzadizionariodettagliato

Conclusions

TheoverallresultsofourexperienceshowsagoodefficacyofTRTinthestudypopulation(82.6%)

in linewiththeliterature(Sheldrakeetal.,1999)thatcannotbeattributedtoaplaceboeffect

giventhelongdurationoftherapy.

198

THUR

SDAY

13

MA

RCH

LONG-TERM EFFECTS OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION TO THE AUDITORY CORTEX IN CHRONIC UNILATERAL TINNITUS: IPSILATERAL VS. CONTRALATERAL

Moon, I.1;Kim,H.1;Oh,H.1;Sim,N.1;Kim,D.2

1 Department of Otorhinolaryngology, Yonsei University College of Medicine2 Department of Rehabilitation Medicine, Yonsei University College of Medicine

BackgroundRepetitivetranscranialmagneticstimulation(rTMS)appliedoverthetemporoparietalcortexhas

beenreportedtobeeffectiveinthetreatmentoftinnitus.Weinvestigatedthelong-termeffects

of1-HzrTMSdeliveredtothetemporoparietalareaandcomparedcontralateralandipsilateral

applicationtothesymptomaticearinpatientswithunilateraltinnitus.

Material and methodsAtotalof61patientswithasymmetrichearinglossandnon-pulsatilechronictinnituslocalizedto

thepoorerearwhowererefractorytomedicaltreatmentwereenrolledinthisstudy.Patientswere

randomlyassignedtooneoftwotreatmentgroups:1-Hzstimulationappliedtothetemporoparietal

junctioneitheripsilaterally(n=30)orcontralaterally(n=31)tothesymptomaticear.Thepatients

weregiven600pulsespersessiondailyforfivedays.Changesinthetinnitushandicapinventory

(THI)scoresandself-ratingvisualanalogscores(VAS)forloudness,awareness,andannoyance

wereanalyzedbeforeandaftertreatmentfor6months.Improvedpatientsweredefinedasthose

withdecreasesintheirTHIscoresbymorethan10pointsand20%.

ResultsTherewerenomajorcomplicationsorworseningofhearingthreshold.WhenanalyzingtheTHI

scores andVASpre-rTMSand6months after rTMS, significant decreases inTHI scores and

VASwereobserved inpatientsoverall (p<0.001). For thecomparisonof long-termoutcomes

between the ipsilateral and contralateral stimulation groups, therewere no differences in the

degreeofdecreaseinTHIscoresorVASbetweenthetwogroups(p>0.05).Inaddition,therewas

nosignificantdifferenceintherateofpatientswhoimprovedbetweentheipsilateral(14/30)and

contralateral(16/31)stimulationgroups(p=0.800). Intermsofthespeedof improvement,the

ipsilateralgroupshowedamorerapidimprovementthanthecontralateralgroup.

ConclusionDailyapplicationof1-HzrTMStotheauditorycortexisasafetreatmentmodalityfortinnitusand

haslong-termbeneficialeffects.Thelateralityofstimulationisnotthedecisivefactorinrelieving

symptoms.

199

THUR

SDAY 13 MA

RCH

COMPARISON OF POSITIONING THE CATHODE IN TDCS

Rabau, S.1,2;Mariën,P.1;VandeHeyning,P.1,2

1 University Department of otorhinolaryngology and Head & Neck surgery, Antwerp University

Hospital, Edegem, Belgium2 Faculty of Medicine, Campus Drie Eiken, University of Antwerp, Antwerp, Belgium

ObjectivesInthecaseoftDCS,currentisappliedtothebrainbymeansof2electrodes:theanodeonthe

dysfunctionalsiteandthecathodeona‘silent’partofthebody.Nowadays,mostlybifrontaltDCS

isapplied intinnituspatients: theanodeandcathodeplacedonrespectively therightand left

dorsolateralprefrontalcortex(DLPC).Ourhypothesisisthattheplacementofthecathodeonthe

shoulderminimisestherisk that thecurrent justflowsthroughtheskin to theotherelectrode

andnotreachesthegreymatter.Asaconsequenceoftheshoulderplacementtheactualcurrent

couldstimulateadeeperandwiderbrainareaandlateralisesmoretothecontralateralDLPC.The

objectiveofthepresentstudywastocomparetheoutcomeoftheplacementofthecathodeon

theleftDLPCwiththeplacementontheshoulder.

MethodsPatients considered for the trial were chronic non-pulsatile tinnitus patients with complaints

longerthan6monthsandaTinnitusFunctionalIndex(TFI)scorethatexceeded25.Patientswere

randomisedbyminimisationinordertocreatetwoequalgroupsbasedontheparametersage,

TFIscore,aetiology,genderanddegreeofhearingloss.Inthefirstgroup‘bifrontal’theelectrodes

wereplacedontheleftandrightDLPC,whileinthesecondgroup‘shoulder’thecathodewas

placedontheshoulder.Eachpatientreceived2sessionstDCSeveryweekandintotal8sessions.

Evaluationstookplaceat thefirstvisitontheENT-consultation,at thestartof therapy,after8

sessionsoftDCSandatlastthefollow-upvisittookplaceafter84daysofthestartofthetherapy.

Subjective outcomemeasurements such asTFI ,VisualAnalogScales of loudness (VAS) and

percentageofconsciousnessoftinnitusweretakenwitheverypatient.Torevealthepreference

ofoneplacement,statisticalanalysiswasperformedonthedata.

ResultsTheresultswillbepresentedatthecongress.

Acknowledgements

ResearchwassupportedbyaTOP-BOFmandateoftheUniversityofAntwerp.

200

THUR

SDAY

13

MA

RCH

ENDLYMPHATIC HYDROPS IN PATIENTS WITH TINNITUS AS MAJOR COMPLAIN

Yoshida, T.; Teranishi, M.; Kato, M.; Otake, H.; Kato, K.; Sone, M.; Naganawa, S.;Nakashima,T.

Department of aOtorhinolaryngology and bRadiology,

Nagoya University Graduate School of Medicine, Nagoya, Japan

Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine 65, Tsurumai-

cho, Showa-ku, Nagoya 466-8550, Japan

Objectives

Tinnitus is one of the symptoms of Meniere’s disease. The relationship between a clinical

presentationofsubjective tinnitusorear fullnessandendolymphatichydrops (EH)hasnotyet

beenexplored.

Methods

We studied 15 patients with symptoms of tinnitus as their major complaint, with or without

hearingloss,whowereevaluatedusingmagneticresonanceimaging(MRI).Themeanageofthe

subjectswas59years(range35–79years).Ninewerewomenandsixweremen.Patientswere

dividedintotwogroupsbasedonwhethertheyhadfluctuatingorstabletinnitus.Thesegroups

weresubdividedinthepresenceorabsenceofaccompanyingsensationofearfullness.MRIwas

performed4hafter intravenousgadoliniumadministration[1].ThegradeofEHwasdiagnosed

basedonpreviousMRIstudieswhichwereobtainedbysameprotocol.A radiologistwhowas

blindedtothepatients’clinicaldataevaluatedthegradeofEH.Thedataforage,sex,thedegree

ofEHinthecochleaandthevestibule,subjectivecomplaintsanddiseasedurationwereencoded

andanalyzedusingSPSS(SPSSver.19.0,SPSS,IBM,Armonk,NewYork,USA).Theρ2testand

Mann–WhitneyUtestwereusedtoanalyzethedata,andP<0.05wasconsideredsignificant.

Results

Overall,30earswereevaluated.EHinthecochleawaspresentin14of25symptomaticears(56

%)inpatientswithtinnitusasthemajorcomplaint.Significanthydropswaspresentin7of14

earsandmildhydropswaspresentintheotherears.Ofthefiveasymptomaticcontralateralears,

oneshowedmildEH.Therewasasignificantrelationshipbetweenfluctuatingtinnitusandthe

presenceofEHinthecochleaoftheaffectedinnerear(p<0.01;ρ2test).Patientswithfluctuating

tinnitus hadEHmore frequently thanpatientswith stable tinnitus. Furthermore, thepresence

201

THUR

SDAY 13 MA

RCH

ofear fullnessalsocorrelatedwith thepresenceofEH in thecochlea.However, therewasno

significantrelationshipbetweenEHinthecochleaandage,sex,durationoftinnitus,hearinglevel

ortheconfigurationoftheaudiogram.

Conclusion

OurstudyrevealedthatpatientswhohadtinnitusastheirmajorsymptomoftenhadEH.UsingMRI

toidentifythiscovertearlyEHinpatientswhohavetinnitusastheirmajorsymptommaybroaden

thetreatmentoptionsfortinnitus.

1. Tagaya, M., et al., 3 Tesla magnetic resonance imaging obtained 4 hours after intravenous gadolinium

injection in patients with sudden deafness. Acta Otolaryngol, 2010. 130(6): p. 665-9.

202

THUR

SDAY

13

MA

RCH

CHANGE IN TINNITUS AFTER TREATMENT OF VESTIBULAR SCHWANNOMA: MICROSURGERY VS. GAMMA KNIFE RADIOSURGERY

Moon,I.1;Park, S.2;Oh,H.1

1 Department of ORL, Yonsei University College of Medicine, Seoul, Korea, 2 Department of ORL,

Keimyung University College of Medicine, Daegu, Korea

Purpose

Tinnitusisaverycommonsymptomofvestibularschwannoma,presentin45to80%ofpatients.

Weevaluatedchangesintinnitusaftertranslabyrinthinemicrosurgery(TLM)orgammaknife

radiosurgery(GKS).

Materials and Methods

Among 78 patients with vestibular schwannoma who underwent TLM or GKS at Severance

Hospitalfrom2009-2012,46patientswithpre-orpostoperativetinnituswhoagreedtoparticipate

wereenrolled.Puretoneaudiometry, tinnitushandicap inventory,visualanaloguescalescores

for loudness,awareness,andannoyanceweremeasuredbeforeandaftertreatment.Changes

of tinnitushandicap inventoryandvisualanaloguescalescoreswereanalysedandcompared

accordingtotreatmentmodality,tumourvolume,andpreoperativeresidualhearing.

Results

IntheTLMgroup(n=27),vestibulocochlearnervesweredefinitelycut.Therewasahigherrate

oftinnitusimprovementinTLMgroup(52%)thanGKSgroup(16%,p=0.016).TheGKSgrouphad

a significantly higher rate of tinnitus worsening(74%) thanTLM group(11%, p<0.001). Mean

scores of tinnitus handicap inventory(THI) and visual analogue scale(VAS) scores significantly

decreasedintheTLMgroupincontrasttosignificantincreasesintheGKSgroup.Tumorvolume

and preoperative hearing did not affect the changes in tinnitus handicap inventory or visual

analoguescales.

Conclusion

Gammaknife radiosurgery can save vestibulocochlear nerve continuity butmaydamage the

cochlea,cochlearnerveandcancauseworseningtinnitus.Incaseswherehearingpreservation

is not intended, microsurgery with vestibulocochlear neurectomy during tumor removal can

sometimesrelieveorpreventtinnitus.

203

THUR

SDAY 13 MA

RCH

OSTEOPOROSIS AND TINNITUS

Kahveci, O.K.; Demirdal S.U.

Osteoporosisisapainlessweakeningofthebonesthatconstitutesanenormoussocioeconomic

crisis, with a harmful impact on morbidity and mortality. Metabolic changes and possible

degeneration of cochlear capsule may cause hearing loss and otolaryngological symptoms

suchastinnitusinosteoporoticpatients.Theaimofthisstudywastoevaluatethepossiblelink

betweentinnitusandosteoporosis.Onehundredosteoporosispatients,50osteopenicpatients

and25healthycontrolswereevaluatedprospectively.Bonemineraldensity (BMD)ofpatients

wasmeasuredbydual-energyx-rayabsorptiometry(DEXA).Otorhinolaryngologicexaminations

wereperformedinallpatientstogetherwithanotologicsymptomssurvey,puretoneaudiometry,

speech discrimination test, and distortion product otoacoustic emission (DPOE). Forty-two

patients inosteoporosisgroup,9patients inosteopenicgroupand3healthycontrolshad the

complaint of tinnitus. Statistically, the incidence of tinnitus was found remarkably higher in

osteoporosispatients thanothergroups (p<0.01).Meanpure toneaudiometryfindingsof the

patients and controls were significantly different in all frequencies (p<0.01). DPOE results of

osteoporoticpatients in1kHzand6kHzwere significantly lower thancontrols andosteopenic

patients (p<0.05).Therewasnodifference inmeanBMDscoresofpatientswith tinnitusand

without tinnitus.The data shows that osteoporosis may be associated with tinnitus. Cochlear

degenerationandhearinglossmayplayroleinthistinnituscomplaint.

Keywords:Osteoporosis,tinnitus,hearing

204

THUR

SDAY

13

MA

RCH

INTRATYMPANIC STEROID TREATMENT FOR TINNITUS PATIENTS WITH ACUTE LOW FREQUENCY SENSORINEURAL HEARING LOSS WITHOUT VERTIGO: PROSPECTIVE CONTROLLED STUDY

An,Y.;Shim,H.

Department of Otorhinolaryngology, Eulji Medical Center, Eulji University School of Medicine,

Seoul, Korea

Objective

Tocompare theeffectivenessof treatment foracute low frequencysensorineuralhearing loss

(LFHL)withtinnitusandwithoutvertigobetweenintratympanicdexamethasoneinjections(ITDI)

andoraldiuretics

Methods

Atotal35tinnituspatientswithLFHLthathaddevelopedwithinprevious2weekswereenrolled

andthenwererandomlyassignedintotwogroups:1)treatedwithITDIfourtimesoneachof4

consecutivedays(19patients)and2)treatedwithdiureticsorallyfor2weeks(16patients).The

groupassignmentsandtheprocessoftreatmentswereperformeddouble-blindly.After8weeks,

we analyzed treatment outcomes of LFHL using subjective symptom score and audiometric

change.

Results

ThecurerateofITDIgroup(42.1%)wassignificantlyhigherthanthatofdiureticsgroup(25.0%).

Forsubjectivesymptomscore,therewerenostatisticallysignificantdifferencesofimprovement

rateinbothgroups(ITDI63.2%,diuretics56.3%).Inpuretoneaudiometry,theimprovementrate

ofITDIgroup(73.7%)wassignificantlyhigherthanthatofdiureticsgroup(62.5%).Therewasa

significantcorrelationbetweenthecurerateanddurationofsymptoms.

Conclusion

ITDI is more effective treatment modality than oral diuretics for LFHL within 2 weeks of

development.DurationofsymptomaffectsthecurerateofacuteLFHLwithtinnitusandwithout

vertigo.

205

THUR

SDAY 13 MA

RCH

PRESCRIPTION AND NON-PRESCRIPTION DRUG USE AMONGST TINNITUS SUFFERERS

Corry,M.;Searchfield,G.D.

Audiology Department, The University of Auckland

Aims and objectives

Theaimofthisstudywastoidentifythefrequencyandnatureofsubstanceuseamongsttinnitus

patientsinNewZealand,andtoidentifyanysubstanceswhichmayhaveadirecteffectontinnitus

loudnessandmeritfurtherresearch.

Methods

An anonymous questionnaire-based survey to evaluate the use of pharmaceutical medicines,

complementarymedicines and other drugs (including alcohol) amongst tinnitus suffererswas

mailedtoparticipants.Ascopingreviewlookingatthecurrentinformationregardingsubstances

forthetreatmentoftinnituswasalsoperformed.

Results

Thestudyhadaresponserateof36.5%,119participantsreportedtreatingtheirtinnituswith

substances:66participants reportedusingcomplementarymedicines for tinnitus, followedby

47whousedotherdrugsand21whousedpharmaceuticals.Themain reportedbenefitwas

improvedsleep, followedby improved relaxation.Alcoholwas themostcommonlyuseddrug,

while vitamins/minerals and herbal remedies were the most commonly used complementary

medicines.Themain classesof pharmaceuticals identifiedasbeingbeneficial byparticipants

were SSRIs, anxiolytics, other hypnotics and TCAs. The anti-platelet drug clopdirogrel was

identifiedby2patientshashavingadirect,negativeeffectontinnitusloudness.

Conclusion

Thisstudyhasprovidedaninsightintothenatureofsubstanceuseamongsttinnituspatients.It

hasalsoallowedsomesubstancestobeidentifiedwhichmaymeritfurtherresearch(egtinnitus

onset with clopidogrel) and will hopefully provide more information into possible treatment

strategiesforthemanagementoftinnitus.

206

THUR

SDAY

13

MA

RCH

PRISM (PICTORIAL REPRESENTATION OF ILLNESS AND SELF MEASURE) AS A NEW ASSESSMENT TOOL FOR SUFFERING IN TINNITUS PATIENTS

Peter,N.1;Kleinjung,T.1;Horath,L.1;Wichser,N.1;Buechi,S.2;Weidt,S.3

1 Department of Otorhinolaryngology, University of Zurich, Switzerland2 Clinic for Psychotherapy and Psychosomatics “Hohenegg”, Meilen, Switzerland3 Department of Psychiatry and Psychotherapy, University of Zurich, Switzerland

Objectives

Chronic subjective tinnitus is a frequent condition that affects thequality of life ofmillionsof

sufferersworldwide.Thelackofobjectivemeasuresoftinnitusnecessitatestheuseofself-report

questionnairesforevaluatingtinnitusseverityandannoyance.Theanalysesofthesequestionnaires

allow medical staff to select adequate treatment modalities and monitor treatment effects.

However, thewiderangeofdifferentquestionnaireshampersan internationalandcomparable

standardintinnitusassessment.Furthermore,mostofthesequestionnaireshaveshortcomings

intermsofresponsivenesstotreatmentrelatedchanges, insufficienttranslationandvalidation

indifferent languagesand time-consumingaspects.PRISM (PictorialRepresentationof Illness

andSelfMeasure)isamethodtoassesssufferingandqualityoflife.Sofar,PRISMwasvalidated

asamarkerofburdenindifferentpsychologicalandphysicalconditionslikePTSD,rheumatoid

arthritis,chronicurticariaandorofacialpain.TheaimofthisstudyistovalidatePRISMasamarker

of impairment in tinnitus patients in a prospective observational study.The results of PRISM

assessmentwerecomparedtodifferentstandardquestionnairesusedintinnitusevaluation.

Methods

Participating subjects were asked to fulfill an online-base survey including the following

questionnaires:THI (TinnitusHandicap Inventory),TQ (TinnitusQuestionnaire)TBF-12 (German

shortversionofTHI),WHOQOL-BREF(WHOQualityofLife-Questionnaire),BDI(BeckDepression

Inventory).Atthetimeofconsultationintheclinicthesubjectswereaskedtoperformanaudio-

visual taskonPRISMusingan IPad.Patientswereshownawhitepanelon thewholedisplay

(14.7x19.6cm)ofthe Ipad(representingtheir life)withayellowcircle(diameter4.9cm)atthe

bottomright-handcornerrepresentinghisorher“self”atthistime.Afterwardstheywereasked

tomoveanothersmallerredcircle(3.5cm)representingtheirtinnitusinrelationtotheirselfatthis

moment.TheanswersonthetwodimensionalPRISMweredividedinto4groups.Comparisonsto

thequestionnairescoreswerecorrelatedusingt-testorANOVA(SPSS).

207

THUR

SDAY 13 MA

RCH

Results

A total of 130 subjectswere included in the analysis (48women, 82men) since2012.The

answersonthetwodimensionalPRISMweredividedinto4groupsreflectingdifferentgradesof

tinnitusseverity:Ingroup1theredtinnitus-circlewascompletelyplacedintheyellowself-circle

(mostsevere);ingroup2theredtinnitus-circlewasoverlappingtheyellowself-circleandwasnot

partofgroup1;ingroup3theredtinnitus-circlewasplacedunderavirtualdiagonallinefromthe

leftbottomtotherightuppercornerandwasnotpartofgroup1or2;ingroup4theredtinnitus-

circlewasplacedinthetriangleabovethevirtualdiagonallinefromtheleftbottomtotheright

uppercorner(leastsevere).ThedifferentPRISMgroupsdemonstratedastatisticallysignificant

correlationwiththecorrespondinggradinginthetraditionaltinnitusquestionnaires(e.g.THI,TQ).

Conclusion

PRISMisanewvisualmethodtoassesssufferinginpatientswithtinnitusinashorttime.We

couldshowasignificantcorrelationbetween the traditionallyused tinnitus-questionnairesand

PRISM.

208

THUR

SDAY

13

MA

RCH

IMPACT OF SPECTRAL NOTCH WIDTH ON THE CLINICAL EFFECTIVENESS OF THE TAILOR-MADE NOTCHED MUSIC TRAINING

Wunderlich,R.1;Teismann,H.1;Lau,P.1;Engell,A.1;Stein,A.1;Wollbrink,A.1;

Shaykevich,A.2;Pantev,C.1

1 Institute for Biomagnetism and Biosignalanalysis, University Hospital of Münster, Germany2 University of Western Australia

Tinnitus, the ringing in theears that is unrelated toanyexternal source, causesa significant

loss inquality of life, involvingsleepdisturbanceanddepression for1 to3%of thegeneral

population.Inthefirstplacetinnitusmaybetriggeredbydamagetotheinnerearcells,butthe

neural generatorsofnoise-induced tinnitusare located in central regionsof thebrain.A loss

of lateral inhibition, tonotopical reorganizationandagain-increase in response to thesensory

deprivationresultinhypersensitivityandhyperactivityintheauditorycortex.Negativeemotional

appraisalandattentionmightsupportthedevelopmentofatinnitusnetwork.Withinthetraining

with tailor-made notched music (TMNMT) patients listen to music from which the frequency

spectrumofthetinnitushasbeenremoved.Thisevokesstronglateralinhibitionoftheneurons

involvedinthetinnitusperceptfromneuronstunedtootherfrequencies.Areductionoftinnitus

loudnesswasachievedwithTMNMTispreviousstudies.Theeffectof lateral inhibitioncanbe

enhanced with a smaller bandwidth of the notch.We assume that the training will be more

effectivewithanotchwidthofa½octaveorevena¼octavecomparedtoonewholeoctave.

Participantscanchoose their favoritemusic for the training that includes threemonthof two

hours daily listening. Our outcome variables were standardized tinnitus questionnaires, visual

analogscalesandMagnetoencephalography(MEG).Wefoundareductionoftinnitusdistressin

allgroups.Participantsinthe½octavegroupshowthestrongestimprovement.Wealsofounda

positivecorrelationoftinnitusloudnessreductionandreductionoftheevokedauditoryresponse

intheMEG.

209

THUR

SDAY 13 MA

RCH

PROPORTION AND DIVERSIFICATION OF UNDERLYING CAUSES OF 242 UNILATERAL VENOUS PULSATILE TINNITUS CASES IN DUAL-PHASE CONTRAST-ENHANCED CT

Dong, C.1; Wang, Z.C.1; Liu, Z.H.2; Zhao, P.F.2

1 Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100050,

China2 Department of Radiology, Capital Medical University, Beijing Friendship Hospital, Beijing 100050,

China

Objectives

ToevaluatetheproportionanddiversificationofunderlyingvenousPTcauses.

Materials and Methods

Thedual-phasecontrast-enhancedCT(DP-CECT)imagesof242patientswithunilateralvenous

PT were retrospectively reviewed. The underlying causes of venous PT reported in previous

literatureswereevaluated.Furthermore,thenumberofunderlyingcausesofvenousPTineach

patientwascounted.

Results

(1)Of all patients, only58patients (24.0%)werediagnosedwith only oneunderlying cause,

while170patients (70.2%)werewithmore thanonecause. (2)Themostcommonunderlying

cause of venous PT was dehiscent sigmoid plate (86.4%), followed by lateral sinus stenosis

(55.8%),highjugularbulb(47.1%),sigmoidsinusdiverticulum(34.3%),jugularbulbdiverticulum

(13.6%),dehiscentjugularbulb(13.6%),largeemissaryvein(4.1%),sinusthrombosis(1.2%),

petrosquamosalsinus(0.8%).

Conclusion

DehiscentsigmoidplateiscommoninvenousPT.ThecausesofvenousPTcouldbediversified

inmostPTpatients.

Keywords:Pulsatiletinnitus,computedtomography

210

THUR

SDAY

13

MA

RCH

THE DURAL SINUS WALL DEHISCENCE PRESENTING WITH PULSATILE TINNITUS: EVALUATION WITH CT VENOGRAPHY

Zhao,P.BeijingChina;Wang,Z.;Xian,J.;Yan,Y.;etal.

Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No.1,

Dongjiaominxiang, Dongcheng District, Beijing 100730, China

Objectives

ToassessthedetailedCTfindingsaboutdurasinuswalldehiscenceinpatientspresentingwith

pulsatiletinnitus(PT)onCTvenography(CTV)

Methods

Following approval of the institutional review board, 131 hospitalized patients with PT from

2008to2013,whounderwentthoroughclinicalandlaboratorytestsincludingCTarteriography

and venography and digital subtraction angiography, were retrospectively evaluated. Finally,

30patientswere included.All thesepatienswere foundwith dural sinuswall dehiscence on

thesymptomaticsideandtheirnoisewastotallyeliminatedaftercoveringthedehiscencewith

tempralis facia.The signs were invesgated as follows: the location,extent and amount of the

dehiscence,thepresenceofoneormorearachnoidgranulationsbeneaththetransversesinus,

thepresenceoftransversesinusstenosis,thepresenceofhighjugularbulbandthepresenceof

venousoutflowdominance.

Results

Fortytwodehiscenceweredetectedinthese30patients,withthearearangefrom2*2to5*8

mm(average3*5mm).Thesingledehiscencewasfoundin24of30patients(80%).Thebonywall

abovethecommoncruswasinvolvedin29of42dehiscence(69%).Theanterolateralwallwas

involvedin35of42patients(83%).Forotherimagingfindings,thelargearachnoidgranulation

beneaththetransversesinuswasdemonstratedin25patients(83%)onthesymptomaticside

whilein26(87%)onthecontralateralside;theipsilateralhighjugularbulbwasrevealedin28

patients(93%);thesymptomaticsidewasconsistentwiththedominantsidein23of25patients

(92%)withunilateraldominantvenoussystem.Thetransversesinusstenosiswasfoundin25

(83%)patientonthesymptomaticsidewhile28(93%)onthecontralateralside.

211

THUR

SDAY 13 MA

RCH

Conclusion

TheduralsinusdehiscencepresentingwithPT,whichseemstobeadirectcauseofPT,mostly

manifests as single bony defect with the lateral wall of dural sinus at a relatively high level

involved. The hemodynamic abnormalities caused by diversified factors, including bilateral

transverse sinus stenosis, ipsilateral high jugular bulb, ipsilateral outflow dominance bilateral

arachnoidgranulation(s)beneaththetransversesinus,maybetherootcauseofduralsinuswall

dehiscencepresentingwithPT.

IaminreadingMDofRadiologyinBeijingTongrenhospitalwhichwastheNo1atthediagnosis

andtreatmentofotolaryngologyinChina.Mymaindirectionisaboutpulsatiletinnitus. In last

fouryears,Ihavemadediagnosisformorethanonethousandpatientswithpulsatiletinnituswith

variouscauses.Besides, Ihavesubmittedfivepapers inChineseuntilnowand Ihavewritten

threepapersinEnglish,oneofwhichhasbeenacceptedbyActaRadiologica.

212

THUR

SDAY

13

MA

RCH

SUSTAINED BENEFIT OF MINDFULNESS BASED TINNITUS STRESS REDUCTION (MBTSR) IN ADULTS WITH CHRONIC TINNITUS

Gans, J.J.;Cole,M.A.

This 12-month follow-up aims to evaluate the long-term effects of an 8-week Mindfulness

BasedTinnitus Stress Reduction (MBTSR) course on tinnitus handicap in adults with chronic

tinnitus.Sevenindividualswithchronictinnituswhohadparticipatedinan8-weekMindfulness

BasedTinnitusStressReduction(MBTSR)pilotstudywereassessedinasubsequent12-month

follow-up.After12months, continued reduction in tinnitushandicapwasobservedacrossall

subjects.MeanTHIscoresimmediatelyatpostMBTSRinterventionwere41.7.MeanTHIscores

at 12-months post MBTSR intervention were 22.8. Effect sizes are clinically significant and

demonstrateasubstantialdecreasefor itemsmeasuringperceivedtinnitushandicap(d=1.25)

at 12-months post-intervention. In adults with chronic tinnitus, benefits in perceived tinnitus

handicap from themindfulness skills taught inan8-weekMBTSRprogramcanbe sustained

showingcontinuedimprovementfor12-months.

213

THUR

SDAY 13 MA

RCH

CONSENSUS ON HEARING-AID CANDIDATURE AND FITTING FOR MILD HEARING LOSS, WITH AND WITHOUT TINNITUS: DELPHI REVIEW

Sereda,M.1;Hoare,D.J.1;Nicholson, R.2;Smith,S.1;Hall, D.A.1

1 NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, UK, 2 Nottingham Audiology Services, Nottingham, UK

Objectives

Hearing aids are often a first-line of audiological intervention for many people with tinnitus.

Neverthelessthereisalackofhighqualityevidencetosupporttheirbenefitfortinnitusandwide

variability inclinicalpractice1.Theaimofthisstudywasto identifyclinicalconsensusonthe

criteriaforhearingaidcandidatureandclinicalpracticeinfittingdevicesformildhearinglosswith

andwithouttinnitusintheUK.

Methods

WechosetousetheDelphitechnique,asystematicmethodologythatseeksconsensusamongst

experts through consultation using a series of iterative questionnaires2.A three-roundDelphi

survey explored this clinical consensus among a panel of experts comprising 29 UK hearing

health professionals.Wemeasuredpanel agreement on115 statements covering: (i)General

factorsaffectingdecisiontofithearingaids, (ii)Protocoldrivenfactorsaffectingdecisiontofit

hearingaids,(iii)Generalpractice,and(iv)Clinicalobservations.Consensuswasdefinedas≥70%

agreement.

Results

Consensus was reached for 58 out of 115 statements.The main areas of consensus were:

factorsimportanttoconsiderwhenfittinghearingaids;devicetechnology/featuresofferedand

routine;andimportantclinicalassessmenttoverifyhearingaidfit.Forpatientswithmildhearing

loss,greatest importancewasgivenbyclinicians topatient-centredcriteria for fittinghearing

aids:hearingdifficulties;motivationtowearhearingaids,andimpactofhearinglossonquality

oflife.Moreobjectivemeasureshadalowerpriorityforfittingdecisions:degreeofhearingloss;

shapeof theaudiogram.Themainareaswhereconsensuswasnot reachedwere: theuseof

questionnaires to predict and verify benefit for both hearing and tinnitus; audiometric criteria

forfittinghearingaids;andthesafetyofusingloudsoundswhenverifyinghearingaidfittingfor

patientswithtinnitus.

214

THUR

SDAY

13

MA

RCH

Conclusions

Thestudyidentifiedareasofconsensusandlackofconsensusintheclinicalpracticeoffitting

hearingaidsanddifferencesinpracticebetweenpatientswithandwithouttinnitus.Statements

forwhich consensuswas reached in this review should be considered as inclusion/exclusion

criteriainclinicaltrialsevaluatingthebenefitsofhearingaidsfortinnitus.Statementsforwhich

consensuswasnotreachedshouldguideselectionofbaselineandoutcomemeasurementsso

thatsomeoftheindividualvariabilityinhearingaidoutcomesmightbebetterexplained.

Acknowledgements

Theviewsexpressedarethoseoftheauthor(s)andnotnecessarilythoseoftheNHS,theNIHRor

theDepartmentofHealth.Part-fundedbytheBritishSocietyofAudiologyAppliedResearchGrant.

References

1. Hoare DJ, Edmondson-Jones AM, Sereda M, Akeroyd MA, Hall DA. (in press) Cochrane Database of

Systematic Reviews Amplification with hearing aids for patients with tinnitus and co-existing hearing

loss..

2. Lindstone H.A. & Turoff M (eds.) The Delphi Method: Techniques and Applications. Reading, MA: 1975.

Addison-Wesley Publishing Company.

215

THUR

SDAY 13 MA

RCH

FREQUENCIES CHARACTERESTICS OF TINNITUS AND ITS IMPACT ON DIFFERENT SOUND-RELATED TREATMENT METHODS

Kong,W.1;Wang,Z.1;Xie,M.1;Xie,W.1;Cheng,H.1;Salvi,R.J.21 Department of Otolaryngology, Union Hospital of Tongji Medical College, Huazhong University of

Science and Technology 2 Hearing and Deafness Center, the State University of New York at Buffalo

Objectives

Toobservethefrequenciescharacteresticsoftinnitusanddifferentimpactondifferenttreatments

whichusecertainsoundbyanalysisinformationfromclinicalpatientssufferedfromtinnitus.

Methods:The337tinnituspatientsinaverageage41.15+14.33with368earswereexamined

byaudiometricthresholdtest,tinnitusmatchingtest,residualinhibition(RI)test,andthendivided

intodifferentgroupsaccordingtocharacteristicfrequencies(CF),hearinglossfrequenciesregion

,shapeofaudiogram.Allofthe209earswithhearinglossareallsensorineuralhearinglossand

thepathogenyaboutpatientswithmiddle-ear inflammationhistoryandmetabolismsyndrome

wereanalysiseither.Then121patientsaccepted thedetailedRI tests ,whichwereoperated

bybothpure-tonesound(PT)andnarrowbandnoise(NBN),in10dB louder,smallerand justat

the mixmal-masking-level(MML) at 125Hz, 250Hz,500Hz ,1000Hz,2000 Hz,3000Hz,4000

Hz,6000Hz,8000Hzpitches respectively.Besides,wegive161patientswhowerenotsogood

to the inhibition testanewmethod in thewayof tinnitus relievator,whichcangivepatientsa

narrowbandorwhitenoisesound,orthehearingaidwithaZensound(thesoundaimstoreduce

emotionproblemsandgivesomekindofinhibitiontotinnitus)for85patientswhowerehearing

lostathighfrequencies.Thenwegetsomefollowupdata.

Results

Thepatientswithnormalhearingthresholdandlighthearinglossgetmorepositiveratio(73.1%and

77.8%)thantheseverehearinglossgroup(58.4%).The10dBloudersuppressivesoundgetbetter

inhibitionresults:thepositiveratioatlowfrequenciesgroupis54.2%whileatMML39.6%and

10dBlower20.8%;atmiddlefrequenciesgroupis62.5%whileatMML50.0%and10dBlower

37.5%;athighfrequenciesgroupis26.3%whileatMML26.3%and10dBlower11.3%.Andfor

eachCFgroup,theeffectisbetterwhentheinhibitionsoundisatthesamepitch,detailsinthearticle.

ThehigherCFgroupgetsbettereffect(2000Hz-81.5%,3000Hz87.5%,4000Hz78.8%,6000Hz

74.3%,and8000Hz80.5%) than the lowerCF(125Hz73.9%,250Hz61.1%,and500Hz76.0%).

In the 14 middle ear disease history patients all of which the disease were cured and ear

216

THUR

SDAY

13

MA

RCH

membraneswerecontact,andonly2ofthemCFareinlowfrequencyregionandothersarein

high.The41metabolismsyndromepatientsgetthesimilaraudiometricandinhibitionpatternas

thepatientswithoutthehistories.Andthediscendingaudiometriccurveandflatcurvegroupsget

betterresultsateachCFgroups.Thetinnitus-relievatorshowpositiveeffectin73%ofpatients.

TheZENsoundhearingaidgiveabetterlifequalityin81%patients.

Conclusion

Theresidualinhibitionandsoundtherapyshouldchoosethetype-frequency,andtheloudness

accordingtodifferentcharacteristicfrequencieswhichismoreindividuallyeffective.Anddifferent

soundandmethodcanbecomboundedforabettereffectbothinrelievetinnitusandlevel-up

oflifequality.

Keywords:tinnitus,residualinhibition,frequency,history

217

THUR

SDAY 13 MA

RCH

SPACE: THE 3RD DIMENSION OF TINNITUS

Searchfield,G.D.1;Kobayashi,K.1,Irving,S.2

1 Audiology Section, The University of Auckland2 Bionics Institute and University of Melbourne, Melbourne, Australia

Aims and objectives

Tinnitus is usually characterised psychoacoustically by its loudness and intensity. An often

overlookedoroversimplifiedaspectoftinnitusisitspercievedlocationinspace.Wewillpresent

a review of work undertaken in the last 5 years to characterise and manage tinnitus using

“3-Dimensional”sounds.Thereviewhastwoprimaryaims,1)toascertaintheabilitytoobtain,

andthereliabilityof,a3Dlocationmatchinauditoryspacerelativetoperceivedtinnituslocation

and2)tocomparetheeffectivenessof3Dmaskerswithbilateralmaskers.

Methods

The 3D tinnitus assessment and 3D masker used audio tracks manipulated by an average

HeadRelatedTransferFunction(HRTF).Aspatialmatchwasachievedbyplayingtheindividual

their tinnituspitch-matched toneatdifferenthorizontal and vertical positions renderedby the

software,maskingwasachievedusingthesametechniquebutthetonalstimuluswasreplaced

bybroadband“rain”noise.Threeseparatestudieswillbepresented:1)Aproofofconceptstudy

investigatingtinnituslocalisationandmaskingusingsoundplayedoverheadphonesatthesame

perceivedlocation(N=19).2)Anevaluationoftest-retestreliability (1weekbetweentests)of

the3Dassessmenttechnique(N=50).3)Across-overtrialofshort-termtinnitusmasking(using

tracks stored on iPods played via DirectAudio Input to binaural ReSoundAzure hearing aids

(N=14))ataperceivedlocationatthecentreoftheheadversusoneoverlappingwiththetinnitus

inspace(3D).Eacharmofthetrialwas2weeksinduration.

Results – Study 1

The3Dlocationwasreportedasagoodlocationmatchtotinnitusforthemajorityofparticipants.

More participants preferred the 3D masker to conventional maskers (left, right, centre).

MinimumMaskingLevels(MML)were lowerforthe3Dmasker inthemajorityofparticipants,

but theMMLwasnot statisticallydifferentbetweengroups. Study2. Tinnitus3Dmeasures

were consistent with participants’ global tinnitus localization (left, right, centre) but the tester

enabledmoreaccuratedescriptionsof localization(e.g. left front,abovetheeyes). Test-retest

reliability(horizontalr=0.63,verticalr=0.48)wassimilartotinnituspitch(r=0.62)andloudness

218

THUR

SDAY

13

MA

RCH

(r=0.39)measures.Study3.Therewasastrongpreferenceforthe3Dmaskingstimulus,with

asignificantlygreaterreduction inTinnitusHandicap Inventoryscores(p<0.01)following3D

masking.ThechangeinMMLwasgreater(marginaldifference,p=0.08)after2weeks’useof

the3Dmaskerthanchangewiththeconventionalmasker.

Conclusions

This early evidence supports the use of a technique employing HRTF altered sounds in the

assessmentandmanagementoftinnitus.Useof3Dsoundsenabledanaccurateassessment

oftheparticipants’perceivedtinnituslocationandappearstobeasuperiormaskingstimulusto

conventionalmasking.Themethodhasramificationsforstudiesattemptingtoreplicatetinnitus

psychoacousticcharacteristics forEEGandMRImeasures;andmayprovetobean important

considerationforfuturesoundtherapies.

219

THUR

SDAY 13 MA

RCH

TOTAL OR SIGNIFICANT REMISSION OF TINNITUS – WHAT CAN WE LEARN FROM PATIENTS WHO HAVE REACHED THIS STAGE?

Sanchez,T.G1;DelBo,L.2

1 Instituto Ganz Sanchez; University of São Paulo, Brazil2 Fondazione Ascolta e Vivi, Milan, Italy

Introduction

Inthepast20years,thenumberofscientificpaperspublishedperyearabouttinnitushaschanged

from150references(Pubmed,1994)to641(Pubmed,2012),meaninganincreaseofmorethan

400%.Thisreflectsagreaterworldwideinterestinunderstandingthisphenomenonandreaching

improvementandeventuallythecure.However,thegoldstandardwayofresearchingtreatment

attemptsthroughclinicaltrialsisexpensiveandtimeconsuming.

Objective

Inordertoacceleratethesearchforthecure,weaimedtointerviewpatientswhohavealready

reachedtotal/significantremissionoftinnitus–suchasanon/offmechanism-toverifyapossible

subgroupsuitabletohavebetterprognosisfortreatment.

Methods

Thisstudywasperformedintwocenters(SãoPaulo/BrazilandMilan/Italy).Weincludedpatients

whohavehadtinnitusofanyetiologyforat least1monthandreachedoneof twostages:1.

Total remission (TR,100%), defined as complete absence of tinnitus in 10 out of 10 regular

days;2.Significantpartialremission(SPR,80-90%):completeabsenceoftinnitusin8or9out

of10regulardays,associatedtopossibleshortrecurrences(1-2days)relatedtoawell-known

factor (stress,noiseexposure, intakeof food/drink/drug, infectionsetc).Weexcludedpatients

withpulsatiletinnitusandthosewhoreachedacomfortablelevelofhabituationormasking,but

stillperceiveit,somehow,veryoften.Aspecificprotocolwascreatedtointerviewtheselected

patients,consideringtheregionaldifferencesofattendingpatients.

Results

Inthefirst6monthsofresearch,20patientswereselected(55%males;45%females).Their

meanagewas47.95years(26to89y),andthemeantimeofexistenceoftinnituswas7.6months

(1to18mo)inBraziland5.3years(2to15y)inItaly.Beforetreatment,themeanhandicapwas

6.72 (throughVAS in11cases)and43.22 (throughTHI in9cases).Hearing thresholdswere

220

THUR

SDAY

13

MA

RCH

symmetricallynormalin60%ofcases(n=12).Consideringthatallpatientshavebeenminimally

counseled,themainmethodsthatallowedthestageofTRweremedicationandspecificdiets

inBrazil, andmanual therapyandhearingdevices in Italy.ThestageofSPRwas reachedby

medicationandsoundstimulation.ThemeantimethatpatientsreachedthelevelsofTRorSPR

was7.18yearsago.

Conclusions

Initial resultsshowthat totalorsignificantpartial remissionof tinnitus (consideringandon-off

behavior)maybeachievableforastableperiodoftime.Thenormalaudiometryseemedtobe

arelevantfactorforgoodprognosisinbothcenters,aswellastheshorttimeoftinnitusbefore

treatment inBrazilian center. Further inclusionof patients fromdifferent placesmighthelp to

acceleratethesearchforthecure.

221

THUR

SDAY 13 MA

RCH

THE SHORT-TERM EFFECTS OF EXTENDED BANDWIDTH COMBINATION INSTRUMENTS ON TINNITUS PERCEPTION

Cummins,A.;Searchfield,G.D.

Audiology Section, The University of Auckland

Aims and objectives

Acommontreatmentfortinnitusistheuseofsound;soundtherapy.Soundtherapyiscommonly

undertakenusingear-leveldevices,whichhaveanmaximumhigh frequency limitof6-8kHz,

which isoftenbelow tinnituspitch. Althoughsome researchersbelieve that the frequencyof

soundrelativetotinnituspitchisnotimportant,othersbelievethatthemosteffectivetherapeutic

soundwillincorporatethetinnituspitchrange.Thedevicesusedinthisstudy(AustarLenx16

Receiver-In-The-Earcombinationhearingdevices)hadamaskingoutputupto16kHz.Thisstudy

wasundertaken toexplore theeffectson tinnitusperception (loudnessandannoyance),noise

perceptionandmaskingfunctionofextendedhighfrequencymaskingnoise.

Methods

Sixteen participants had psychoacoustic (e.g. audiometry, pitch, loudness) and psychometric

(e.g.TinnitusFunctionalIndex)assessments.Maskingfunctionsweredeterminedbyfirstfinding

thresholdandminimummaskinglevel(MML)for4differentbandwidthsofbilateraltherapeutic

sound(broadbandnoise,highpass,lowpassandfilteredrelativetohearingloss),andthenhaving

participantsratetinnitusloudnessandannoyance,maskingnoiseloudnessandannoyance,and

mixingpointon11-pointratingscalesasthelevelwasincreasedfromthresholdtoMML.Boththe

ratingatMMLandtheslope(changeinratingasafunctionofmaskingintensity)werecalculated

andanalysed.

Results

Therewasnosignificantdifferencebetweenthenoiseloudness,noiseannoyanceormixingpoint

ratings for thebandwidths.However, therewasastatisticallysignificantdifference for tinnitus

annoyance: at MML, the broadband noise bandwidth resulted in significantly lower tinnitus

annoyancethanthehighpass,lowpassorfilteredconditions.Inaddition,atMMLthehighpass

andfilterbandwidthsyieldedlesstinnitusannoyancethanthelowpasscondition.

Conclusions

Resultsindicateabroaderbandwidthyieldedagreatereffectofmaskingontinnitusperception.

222

THUR

SDAY

13

MA

RCH

AN ADAPTATION INDEX FOR INDIVIDUALISED SELECTION OF SOUND THERAPY LEVEL

Kobayashi,K.1;Searchfield,G.D.1,2

1 Audiology, The University of Auckland, New Zealand2 Centre for Brain Research, The University of Auckland, New Zealand

Aim and objectives

Theappropriatelevelfortinnitussoundtherapyisacontroversialtopic;levelsfromnearthreshold

tomixingtototalmaskingareusedclinically.Thereisaneedforabetterempiricalunderstanding

ofhowtoselectsoundtherapyforanindividual.AmodeloftinnitusaudibilitybasedonHelson’s

Adaptation LevelTheory (ALT) has been hypothesized (1) to explain the relationship between

tinnitusaudibility,personality,memoryandattention.Thistheoryattemptstodescribehowtinnitus

audibilityormightchangewithcontext. In thisstudyweuseALTtomodel thesound level for

soundtherapy,anddescribeanoptimumlevelthe“ComfortablePoint”(CP).ThisCPwasdesigned

byusingassessmentsof tinnitusannoyanceandnoiseannoyance tofindanadaptation level

inannoyanceatwhichthepatientcancomfortablyaccommodateboththetinnitusandsound

therapy.

Method

ThiswasasecondaryanalysisofdataobtainedbyWarr (2).27participantswith tinnitusofa

constantandbothersomenaturewererecruitedfromourHearingandTinnitusClinic.Thesound

level of broadband noise from an audiometer was increased in 2dB steps between hearing

thresholdandminimummaskinglevel.Ateachstep,tinnitusannoyance,noiseannoyanceand

tinnitus+ noise annoyancewere rated on11 or 21 point scales to createmasking intensity

functions.Thepointatwhichtinnitusandsoundmixed(bothaudiblebutblending)wasrecording

as themixingpoint (MP). The ratingswere thenfitted toa linear regression tocalculate the

adaptationleveltotinnitusannoyance.TheCPwascalculated:

CP=(N5/T0p)1/q

whereN5wassoundlevelatmediumnoiseannoyance,T0wasaconvertedsoundleveloftinnitus

annoyanceinsilence,pandqwereweightingfactorsrepresentingthefocusonstimulus(tinnitus)

andbackgroundstimulus(therapeuticsound-broadbandnoise).

223

THUR

SDAY 13 MA

RCH

Results

TheCPwasabletobeaccuratelycalculatedfor16of27participants.For8participantstinnitus

annoyance increased with increase in sound level and 3 participants had atypical masking

functions.FourofthesuccessfulparticipantsshowedthattheCPwasaclosematchtotheMP.

For12participantstheCPwaspredictedtobelowerthantheMP,withlesstinnitusandlower

annoyancetothetherapeuticsound.

Conclusion

TheCPissuggestedasanewindexofappropriatesoundlevelfortinnitustherapy,andenables

theempiricalevaluationbetweentinnitusmagnitudeandbackgroundnoiselevel.Althoughthis

firstattempttomathematicallymodelsoundtherapylevelcouldnotaccommodateallmasking

functions,it isanimportantsteptowardsbeingabletoidentifyastartingpointforselectionof

soundtherapylevelbasedonindividualpsychoacousticcharacteristics.

1. Searchfield, GD, Kobayashi, K and M Sanders. Front Syst Neurosci. 2012; 6, 46.

2. Warr, AA. Masters of Audiology Dissertation. The University of Auckland. 2000.

224

THUR

SDAY

13

MA

RCH

EFFECTIVE CLINIC PRACTICE AND STAGED MANAGEMENT OF THE TINNITUS: 14 YEARS OF THE UNIVERSITY OF AUCKLAND HEARING AND TINNITUS CLINIC

Kaur, M.; Hadfield, D.; Searchfield, G.D.

Aims and objectives

TheUniversityofAucklandHearingandTinnitusclinicwasestablished in2001withastrong

commitmenttoalleviatingtinnitusandrapidtranslationofresearchintoclinicalpractice.Withan

increaseinawarenessamongstthebroaderpublicandtheprofessionals,thenumberofclients

seekinghelpforthemanagementoftinnitushasincreasedandnewtreatmentshavedeveloped.

Tinnitusperceptioncanbeavariableandanindividualexperience;ourclientsmaybecurious,

botheredordistraught.Tocatertothevaryingneedsoftheclientstheclinichasdevelopeda

stagedapproachtocaterfortheindividualneedsofthetinnituspopulation.

Methods

AreviewoftheclinicalprotocolsoftheHearingandTinnitusClinicispresented.Moremanagement

clients are divided into three main categories i) hearing loss and tinnitus not bothersome ii)

annoyingtinnitusbutcopingalrightandiii)tinnitusandunabletocope.

Results

Clinicalmethodshavebeendevelopedkeepinginmindoptimaluseofresources,timeconstraints

andtinnituscliniceffectiveness.Evidencebasedpracticeguidelineswhichinvolveacombination

ofcounselingandsoundtherapyarebeingcontinuallyrefined.Recentlyanewtherapystructure

“Tinnitus Adaptation Level Therapy” has been introduced which integrates computer based

tinnitusassessment,aspecificformofadaptationcounseling(theAREAmodel)andsound

therapyselectionbasedonaudiometric,psychometricandpsychoacoustictinnitusassessment.

Conclusions

Constantresearchhasshapedourguidelinesresultinginbothaneffectiveandefficienttinnitus

clinic.

225

THUR

SDAY 13 MA

RCH

HEARING AIDS WITH FRACTAL TONE AND PORTABLE MUSIC PLAYER IN TINNITUS RETRAINING THERAPY

Takanashi,Y.1;Kawase,T.1,2;Oda,K.1;Miyazaki,H.1;Yahata,I.1;Katori,Y.1

1 Departments of Otolaryngology – Head and Neck Surgery Tohoku University Graduate School

of Medicine2 Laboratory of Rehabilitative Auditory Science, Tohoku University Graduate School of Biomedical

Engineering

1-1Seiryo-machi,Aoba-ku,Sendai980-8574,Japan

Method

Treatmentoutcomesof51 tinnituspatientswhovisited theoutpatientclinic for tinnitusat the

Department of Otolaryngology – Head and Neck Surgery, Tohoku University Hospital since

2012 were reviewed retrospectively. After the initial assessment using THI and VAS at our

facility,thetherapeuticstrategywasdeterminedbasedontheTHIscore,hearingcondition,and

informedconsentfortheactualtherapy.Ofthe51patients,15severecaseswithhearingloss

underwentTRT using a fractal tone with amplification.Also,TRT was conducted for 8 cases

withoutremarkablehearinglossusingwhitenoisewithaportablemusicplayersubstitutedfor

commercial SG.Another 28 cases were treated with educational counseling only (this group

includedmildcaseswithtinnitusandseverecasesprovidingnoagreementtoTRTrecommended

by the doctor). This study compared the therapeutic effectiveness recorded for these three

differenttreatmentgroups.

Results

InagroupusingtheHAwithafractaltone,80%(12/15)ofpatientssubjectivelyreportedrelief

of tinnitus. In thisgroup, theaverageTHIscorebefore the treatmentwas66.1.However, that

atthreemonthsafterthetreatmentwasimprovedsignificantlyto32.1(p<0.01).AverageVAS

was improved significantly from 71.4 (before treatment) to 41.4 (3 months after treatment)

(p<0.01).However, inagroupusingaportablemusicplayer,only50.0%(4/8)ofthepatients

subjectivelyreportedreliefoftinnitus.TheaverageTHIscore improvedonlyslightly, from39.3

before treatment to35.3after treatment. Inagroupwitheducationalcounseling,only32.1%

(9/28)ofpatientsimprovedsubjectively.NosignificantdifferencewasfoundbetweenTHIscores

beforetreatment(48.3)andaftertreatment(38.9).

226

THUR

SDAY

13

MA

RCH

Conclusion

BecauseTHIscoresbeforethetreatmentdifferedgreatlyamongthethreegroups,thesedataare

notnecessarilycomparableamonggroups.Nevertheless,theresultssuggesttheeffectivenessof

theTRTwithHAwithafractaltone.

Abbreviations: HA, Hearing aid; SG, Sound generators; TRT, Tinnitus retraining therapy; THI,

Tinnutishandicapinventory;VAS,Visualanalogscale

227

THUR

SDAY 13 MA

RCH

THE EFFECTS OF INFORMATIONAL VERSUS ENERGETIC MASKING ON TINNITUS MINIMUM MASKING LEVELS

Proudfoot,K.1;Kobayashi,K.1,2;Searchfield,G.1,2

1 Audiology Section, The University of Auckland2 Centre for Brain Research, The University of Auckland

Aims Recent tinnitus research suggests an important role for attention in tinnitus perception,

particularlywithinthecontextofAuditorySceneAnalysisandtherelativesalienceofexogenous

andendogenousauditoryobjects.Similarproposalshavebeenmadeformechanismsunderlying

informational masking, which appears to affect cognitive processing and the ability to focus

attentionselectivelyontargetauditorystreams.Basedonthesetheoriessuggestinginfluenceof

attentionalmechanismsonbothtinnitusandinformationalmasking,theprimaryaimofthisstudy

wastodetermineifinformationalmaskingwouldresultinlowertinnitusminimummaskinglevels

(MML)thanenergeticmasking.

Methods Stimuli known to produce informational masking (one-, four- and seven-talker speech) and

energeticmasking(one-,four-andseven-talkerreversedspeechandspeech-modulatednoise,

derivedfromandenergeticallyequivalenttotheone-,four-andseven-talkerspeechstimuli)were

randomlypresentedto22participantswithconstanttinnitus.TinnitusMMLsforeachstimulus

wasmeasuredandparticipantswereaskedtosubjectivelyratethestimulus.

ResultsAcomparisonbetween speechand reversed speech revealednodifference in tinnitusMMLs

in a mild-to-moderate tinnitus severity group, but a lower tinnitus MML for the four-talker

speechstimuluswasfoundinaseveretinnitusgroup.Acomparisonofthespeechandspeech-

modulatednoisestimuli revealed lower tinnitusMMLs forspeech in thesevere tinnitusgroup

and the opposite effect for the mild-to- moderate tinnitus group. No difference between the

reversed-speechandspeech-modulated-noisemaskingstimuliwasobservedforeithertinnitus

severitygroup.Theone-talkermaskingstimuliacrossallthreemaskingtypesresultedinhigher

tinnitusMMLsthanthefour-andseven-talkermaskingstimuliforbothtinnitusseveritygroups.

Stimulipreferenceratingsrevealedthat,onthewhole,themostpreferredstimuliresultedinthe

lowesttinnitusMMLsfortheseveretinnitusgroup;howevertheresultswerelessclearforthe

mild-to-moderatetinnitusgroup.

228

THUR

SDAY

13

MA

RCH

Conclusion

Overall, the results suggested that informational masking resulted in lower tinnitus MMLs in

individualswithseveretinnitusthantheequivalentenergeticmaskingstimuli.Theseresultswere

interpretedasindicatingthatincasesofseveretinnitusperceptioninformationalmaskingdisrupts

theattentionalorcognitiveresourcesallocatedtotinnitus,resultinginlowertinnitusMMLs.Forthe

mild-to-moderatetinnitusgroup,theresultssuggestedthatacousticallysimilar,butsubjectively

different,masking stimuli affected tinnitusMMLs in different, as yet to be determined,ways.

Thestudysuggeststhatindividualsexperiencingseveretinnitusmayconstituteaspecialclinical

sub-group.Theprimaryfindingofthestudy,thatinformationalmaskingresultedinlowertinnitus

MMLs inparticipantswithsevere tinnitus,couldpotentiallyprovide insight into theunderlying

mechanismsofbothtinnitusandinformationalmasking.

229

THUR

SDAY 13 MA

RCH

TINNITUS ADAPTATION LEVEL THERAPY AND THE AREA MODEL OF TINNITUS COUNSELLING

Hodgson,S.A.;Searchfield,G.D.

Audiology Section, The University of Auckland

Aims and objectives

Tinnitushasbeenlinkedtoauditory,neurological,cognitive,emotionalandattentionalprocesses;

neurology, pharmacology, ophthalmology, psychology, otology and audiology fields have all

soughttreattinnitus.Despitethistheprimarymeansofmanagingtinnitusisthroughcounselling.

However tinnituscliniciansareoften insufficiently trained inpsychotherapeuticapproaches,or

believe that tinnituscounselling is too timeconsumingand impractical touse inmostclinical

settings.Thereisaneedtoprovidepracticalcounsellingtoolswhichcanbeutilisedwithinthe

clinicalsettingontheirownorasanadjuncttoothertherapies(suchassoundtherapy).Ouraim

wastocreateacounsellingtool,basedonadaptationleveltheoryandtheAREA(Attend,React,

Explain,Adapt)model of affective adaptation as proposed byWilson et al. (1),whereby it is

postulatedthatweadapttoeventswhichwecanunderstand.

Methods

Acounsellingframeworkhasbeendevelopedandtestedintheclinic,thisstudyisapresentation

ofthecounsellingconceptsandpreliminaryresults.Thecounsellingmaterial ispicture-based

andimplementedasaneasytounderstandandpatientfriendlyflipchartpresentation..Theflip

chartincorporatesimagerywhichisbothentertainingandinformative.Themethodmakesuse

ofguidedimageryandrelaxationtherapy,andpatientsareencouragedtoidentifytheirtinnitus

withaneutralorsafeobject.Theyarethenencouragedtoplacetheirtinnitusobjectinapeaceful

environment.Practiceisprovidedandanobjectischoseninthesessionafterwhichpatientsare

providedwithhomeworkhandoutstocontinuethispracticeathome.

Results

Preliminaryresultsandobservationshavebeenverypositivewithpatientsindicatingthattheyfind

thistoolveryuseful.Tinnitussufferershaveparticularlyreportedthebenefitofthiscounselling

methodasitprovidesthemwithpracticaltoolstoassistwithadaptingtotheirtinnitus.

230

THUR

SDAY

13

MA

RCH

Conclusions

Thereisaneedforeasilyimplementedtinnituscounsellingtools.TheAREAmodelappearsto

provideaneffectiveframworkfortinnitustherapy.

1. Wilson, Timothy D., and Daniel T. Gilbert. 2008. Explaining away a model of affective adaptation.

Perspectives on Psychological Science 3(5): 370-386.

231

THUR

SDAY 13 MA

RCH

INGENUITY OF TRT WITH NATURAL ENVIRONMENT SOUNDS, OPTICAL ILLUSIONS AND PARABLES

Tsuge, H.1; Morimoto, K.1; Kato, Y.2; Kato, D.2; Koga, H.3; Tokura, T.4; Yoshida, T.5;Nakashima,T.5

1 Department of Otorhinolaryngology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35

Michishita-Cho, Nakamura-ku, Nagoya, 453-8511, JAPAN2 Speech-Language-Hearing Therapist, Japanese Red Cross Nagoya Daiichi Hospital3 Clinical Psychologist, Japanese Red Cross Nagoya Daiichi Hospital4 Dentist, Tokura Dental Clinic, 395-2 Sangen-Cho, Kita-ku, Nagoya, 462-0004, JAPAN5 Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65

Tsuruma-Cho, Showa-ku, Nagoya, 466-8560, JAPAN

InTinnitusRetrainingTherapy(TRT),werealizedthatweessentiallyhearwiththebrain,andthat

plasticityofbraincausesenormouslyharmful influencesof tinnituspaindue to viciouscircle,

whileproducingexcellentabilities.Atourhospital,patientsarethereforetreatedundercondition

thatplasticityofbraineffectivelyexhibitstheeffects.

ThefollowingsaretheingenuitytoenhancetheeffectofTRT.

1. Sound Therapy

LowerfrequencyinuseofnoiseofSoundGenerator(SG)couldbeseenthanbefore,because

thefrequencyofsuggestiontopatientsformurmuroftheriverandsoundofforest,whichhas

similarfrequencyspectrumtoahearingaidandbroadbandnoise,hasincreased.Soundvolume

ofnaturalenvironmentsoundsisapartialcoveraswellasSG.

According to thedataofprevious investigations, itwasshown thatasoundofwavewasnot

suitablefornaturalenvironmentsounds,andthatasoundofbirdsandinsectshadthetendency

to encourage hyperacusis of patients with auditory disorder. And also, SG exhibited better

portabilitythanMP3player.

Itisthoughtthatevenwiththesoundtherapyduringdaytime,brainplasticitydoesnothavethe

properefficacyforimprovingviciouscircleoftinnitus,incasethepatientsfeeltinnituspainatthe

timeofnightawakeningandtheirbedtime.Usingnaturalenvironmentsoundsduringnighttimeis,

therefore,considerablyvaluableincludingtherelaxationeffects.

232

THUR

SDAY

13

MA

RCH

Andalso,frequencyofapplyingahearingaidhasincreasedforpatientswithauditorydisorder

regardlessofthedegreesevenwithslightdisorder.Thus,morecasessuchasahearingaidduring

daytimeandBGMofnaturalenvironmentsoundsduringnighttimeshouldbesuggestedcanbe

seen.However,commerciallyavailableCDsofnaturalenvironmentsoundsneedtobeselected,

becausesomeofthemareunsuitableforsoundtherapy.

2. Directive counseling

Asafirststep,necessity toavoidnighttime tranquilityand the importanceofsleepshouldbe

explainedandinstructedtopractice.

ThesecondstepbeginswithexplanationofphilosophyofTRTusingslidepresentationbyclinical

psychologists.

Asthethirdstep,mainlymedicaldoctorsandspeechtherapistsconducttheadditionalexplanation

oftheessenceoftinnitustreatment.Regardingthatthebraincontrolstinnitusintensity,itwould

promote better understandings of the patients by using the examples of optical illusion and

parables.Forexample,wepresentan illusionproducedby lateral inhibitionofvisualsense to

patientsinsteadofshowinglateralinhibitionofauditorysystems,whichisconsideredatriggerfor

increaseoftinnitusintensity.Andalso,thepatientscanexperiencethatthemisleadingintensity

cannotbeovercomeevenconsciouslyduetoanillusionofEdwardHAdelson.

3. Et Cetera

Clinically,leadingpatientstohavepositivefeelingaboutthetreatmentisalsoofgreatimportance.

Medical cooperation with the department of psychosomatic medicine and the department of

psychiatryshouldbeconductedaccordingtothecases.

Andalso,adoseofstrongtranquilizerneedstobeconsidereddependingonthecases,because

itinhibitstheplasticityofbrain.

233

THUR

SDAY 13 MA

RCH

EVALUATION OF TINNITUS USING HIGH FREQUENCY AUDIOMETRY, LOUDNESS -PITCH MATCH, TINNITUS HANDICAP INVENTORY AND IT’S SUPPRESSION USING HEARING AIDS

Thomas,B.1;Mathew,B.2;Niveditha,P.1;Balaji,S.1;JavaraNaya,M.S.1

1 Nayak’s hearing care clinics, #1/1. 12th cross, Wilson garden, Bangalore-5600272 Prayatna Centre for child development, Ernakulum

Tinnitusistheperceptionofasoundbyanindividualwithoutanexternalstimulus,oftenoccurring

inconjunctionwithhearingimpairment.Individualswithcomplaintoftinnitusbutwithandwithout

hearingdifficulty,usinghigh-frequencyaudiometryhasathresholddifferenceinbothgroupsat

highfrequencies.Greatertinnitusintensity,whenloudnessmatchingdone,inhearingimpaired

groupdenotedaworsehearing[1].Theperceivedpitchoftinnitusisveryoftenassociatedwith

audiometric losses at the corresponding frequencies. The Tinnitus Handicap Inventory (THI)

questionnairemaybeusedasameasure forquantifying the impactof tinnitusondaily living

[2].Useofahearingaidforhearing-impairedpeopleprovidingimprovedperceptionofexternal

sounds,canbebeneficialagainsttinnitus[1].

Aim

Toevaluatethetinnitususinghighfrequencyaudiometrythresholds,loudness-pitchmatchand

effectonqualityoflifeusingtinnitushandicapinventoryamongbothnormalhearingandhearing

impairedgroupwithtinnitusandalsotounderstandtheuseofhearingaids insuppressionof

tinnitusinindividualswithhearingimpairment.

Methodology

Thesubjectsparticipated in theagegroupof45and65years,allwithcomplaintofbilateral

tinnitus.Thesubjectsweredividedintotwogroups,onewithNormalhearingwithtinnitusand

othergroupcomplaintoftinnitusbutwithmoderatetoseveresensoryneuralhearingloss

High-frequency audiometry done using circum-aural headphones. Subjective pitch matching

andSubjectiveloudnessmatchingwasdoneusingsupraauralearphonesforfrequency250-

8,000Hz..Thesubjectswereaskedtoself-assesstheeffectoftinnitusontheirqualityoflifeby

answeringquestionnaire inTinnitushandicap inventory.Subjectswithhearing impairmentand

tinnitusweregivenaweektrialwithsuitableHearingaidtoseeforanysuppressioninperception

oftinnitus.

234

THUR

SDAY

13

MA

RCH

Results

ThehearingimpairedgroupsubjectsexhibitedhigherhearingthresholdsatallfrequenciesinHigh

frequencyAudiometry.Statisticallysignificancedifferencewasfoundatfrequencies10kHz,12

kHz,14kHz,16kHzbetweenbothnormalandhearingimpairedgroup.Statisticallysignificance

differenceswerefoundfor loudnessandpitchmatchinginbothgroups.Thetinnitushandicap

inventoryresultsindicatedmildhandicapfornormalhearinggroupandmoderatehandicapfor

hearing impaired group. With regard to hearing aid benefits, among those hearing impaired

group,35%reportedtinnitussuppressionwithvaryingdegrees.Thisresultshowsnonoticeable

suppressioneffectwithuseofhearingaid.

Conclusion

Individuals with tinnitus and hearing impairment have higher high-frequency thresholds, with

complete hearing loss at some frequencies, as compared to those without hearing loss.The

pitchofthetinnitusishigheramongindividualswithouthearingloss,whereashearingimpaired

perceives loud tinnitus thannormalswith tinnitus. Individualswithhearing losshaveapoorer

quality of life than individuals without hearing loss. Hearing aid is not a treatment option of

patientswhosufferingfromtinnitus.

References

[1] Trotter MI, Donaldson I. J Laryngol Otol, 2008; 122:1052-1056

[2] Schmidt LP, Teixeira VN, Igna CD, et al. Brazil J Otolaryngol, 2006;72(6):808-810

235

THUR

SDAY 13 MA

RCH

THE EFFECTIVENESS OF TURKISH STANDARDIZED VISUAL COUNSELING MATERIAL ABOUT TINNITUS

Kocak,O.;Aksoy,S.

Hacettepe University, Health Sciences Faculty, Audiology Department, Ankara, TURKIYE

Objective

Tinnitusisdefinedasperceptionofsoundintheabsenceofacorrespondingexternalstimulushas

leadtodecrementinqualityoflifepeoplewhohavetinnitus(PWT).Therefore,severaltreatments

allofwhichhavecounselingstepcouldbeappliedforthisdebilitatingsymptom.Itisnecessaryto

consultthePWTaboutallaspectsoftinnitusinordertocopewithitmoreeffectivelyregardlessof

whichkindoftreatmentsapplied.Thecounselingincludedbothinformationandcopingstrategies

relatedtotinnitushastobeenprovidedbysuitable,understandableandstandardizedmaterials.

TheaimofthisstudyistodevelopaTurkishstandardizedvisualcounselingmaterialabouttinnitus

andtoassessitseffectivesintermsofsatisfactionofPWT.

Methods

Aftergivenethicalpermission,fortypeoplediagnosedwithsubjectivetinnitusincludedthestudy.

Allparticipantswereconducted initial interviewtoevaluate theirconditions (especially tinnitus

severitywithvisualanalogscale)beforethecounseling,audiologicalassessments(Audiological

evaluation,DPOAE,ABRandtinnitusmapping)andcompletedtheTinnitusHandicap Inventory

(THI)todeterminetinnitusseverity.Turkishstandardizedvisualcounselingmaterialwasdeveloped

accordingtobasicallyneurophysiologicalmodeloftinnitusandinformationgainedintheAmerican

TinnitusAssociationwebsites.Itscomprehensiblenessandsuitabilitywereassessedwithapilot

studywhichincludedanexpertpersonandfourPWTandthenitwasrevisedaccordingtoresults

ofpilotstudy.Theparticipantsweredivedandrandomlyassignedtwogroups;firstonewasgiven

counselingwithTurkishstandardizedvisualcounselingmaterialandsecondwasgivencounseling

onlyverballywithsamecontent.Aftercounseling,thefollow-upinterviewandTHIwereappliedto

evaluatetheirconditionsandsatisfactionlevels.

Results

Thecollecteddatawill be inanalysisphase. Itwill beexpected that therewill bedifferences

betweenpeoplegivencounselingwithTurkishstandardizedvisualcounselingmaterialandpeople

givenonlyverballycounselingintermsofthetinnitusseverityandsatisfactionlevel.

236

THUR

SDAY

13

MA

RCH

Conclusion

Thecounselingstepincludinginformationandcopingstrategiesabouttinnituswillbemandatory

inthealltreatmentsofferedfortinnitusbecauseitwillprovidehighsatisfactionlevelandincrease

positivethoughtrelatedtohandlingtothatproblem.Theusageofstandardizedvisualmaterial

willfacilitatetoachievetheseduetothefactthatgiventheinformationbyvisual,standardand

suitablewaycouldimprovethecomprehensiblenessofinformation.

237

THUR

SDAY 13 MA

RCH

CLINICAL VALIDATION OF A NOVEL COMBINATION HEARING AID AND TINNITUS THERAPY DEVICE

Hicks,M.;Abrams,H.;Henry,J.;Frederick,M.;Sell,S.;Griest,S.

Starkey Hearing Technologies, Eden Prairie, MN

National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR

Objective

Hearingaidsarewell known toamelioratebothhearingand tinnitusproblems.Somehearing

aidshavebuilt-innoise/soundgeneratorsthatareintendedtoprovideaddedbenefittopatients

withtinnitus.However,ithasnotbeenproventhat“combinationinstruments”aremoreeffective

fortinnitusmanagementthanhearingaidsalone.Thepurposeofthisstudywastoacquiredata

addressingthisquestion.

Methods

Thirtyindividualsmeetingstudyrequirements(bothersometinnitus,hearingaidcandidate,nouse

ofhearingaidsfortheprevious12months)wereenrolled.AllparticipantscompletedtheTinnitus

Functional Index (TFI) and were fitted with the combination instruments adjusted to optimize

hearingability.Participantswererandomizedtoeithertheexperimentalgroup(N=15)whichhad

thenoisestimulusturnedonandadjustedtoachievethegreatestdegreeofrelieffromtinnitus,

orthecontrolgroup(N=15)whichdidnothavethenoisestimuluson.Allparticipantsreturned

1-2weeks after fitting to check the proper fitting and adjustment of the instruments, and to

receivecounselingbasedonProgressiveTinnitusManagement.Threemonthsafterfitting, the

participantsreturnedandcompletedtheTFItwice;oncetoindicatetheirresponseswithrespect

towhentheywereusinghearingaids,andagainwhennotusinghearingaids.

Results

Datawereanalyzedfortheexperimentalandcontrolgroupsseparately.Foreachgroup,meanTFI

scoreswerecalculatedforthreeconditions:baseline,3-monthswithhearingaids,and3-months

withouthearingaids.RepeatedmeasuresANOVAwasusedtocomparebetweengroupsbetween

conditions.Fortheexperimentalgroup,themeanbaselineTFIscorewas56.1.At3months,the

meanscorewas16.8(withhearingaids)and45.3(withouthearingaids).Themeanreductions

of41.5points (withhearingaids)and10.8points (withouthearingaids)werebothsignificant

(p<.0001andp=.034,respectively). For thecontrolgroup, themeanbaselineTFIscorewas

60.5.At3months,themeanscorewas27.6(withhearingaids)and44.3(withouthearingaids).

238

THUR

SDAY

13

MA

RCH

Themeanreductionsof32.9points(withhearingaids)and16.2points(withouthearingaids)

werebothsignificant (p<.0001andp=.002, respectively). Comparinggroups, therewereno

significantdifferencesinmeanTFIscoresbetweengroups(allp’s>.05)atbaseline,3monthswith

hearingaids,and3monthswithouthearingaids.

Conclusion

Both groups of subjects revealed significant improvement based on reductions in mean TFI

scores,indicatingthathearingaidsaloneorhearingaidsplussoundgeneratorsbothprovided

significantbenefitforalleviatingtheeffectsoftinnitus.Differencesbetweenthetwogroupsat3

monthswerenotstatisticallysignificant.However,itshouldbenotedthattheexperimentalgroup

showedamean reduction in theTFI thatwas8.6pointsgreater than thecontrolgroup.This

differenceapproachedsignificance(p=.09),suggestingthatalargergroupofsubjectsmayhave

resultedinasignificantdifferencebetweengroups.Itthusmaybeconcludedthatuseofhearing

aidsplusasoundgeneratorappearstoprovidegreaterbenefitthanhearingaidsalone,although

alargerstudyisneededtoconfirmthisfinding.

239

THUR

SDAY 13 MA

RCH

COUNSELING FOR TINNITUS PATIENTS

Lim,J.J.;Yuen,H.W.;Hsu,P.P.;Lu,P.;Koh,D.

Department of Otolaryngology, Changi General Hospital, Singapore

Patientswith subjective tinnitus tend to think that tinnitus indicates that something iswrong.

Counselinghasbeenadvocatedasinitialtreatmentforsuchpatients.

Objective

Toillustratekeylearningpointsfrompatientsmanagedbytinnituscounseling.

Methods

All patients who were counseled were referrals from ear, nose and throat specialists and all

hadtherelevanthearingandotherdiagnostictestsperformed.Fourcaseswereselectedfrom

patientsseenintheTinnitusCounsellingClinicatChangiGeneralHospitalinSingapore.

Results

Case1.A75yearold femalehadbilateralmoderately severesensorineuralhearing lossand

unbearable bilateral roaring tinnitus. She appeared ‘very deaf’ and a hearing aid trial was

conducted after brief counseling.The patient subsequently bought the hearing aid.After one

month,shewasverysatisfiedwithher‘new-found’hearingandlearnttoignorehertinnitus.

Case2.A66yearoldtinnitus-distressedmalehadnormalhearinginbothears.Aftercounseling,

he gradually accepted his tinnitus as part of his life.A few months after the counseling, he

complained of unilateral ear blockage and loud tinnitus. He was quickly scheduled for full

audiologicalassessment.Hewasunawarehesufferedamildhearinglossinthediscomfortear

andwastreatedwithmedicationsforsuddenhearingloss.

Aftertwoweeks,hehadnomoreeardiscomfortandnoaudiologicalabnormality.Hefelthappy

histinnitusremainsthesame.

Case 3. A 37 year old male patient had sudden unilateral hearing loss and tinnitus. He is

occasionallydepressedbutrefusedpsychologicalreferralandisnotkeentousehearingaid.As

such, constant encouragement and reinforcement on various self- help strategiesweregiven

wheneverherequestedhelpwithhistinnitus.

240

THUR

SDAY

13

MA

RCH

Case4.A50yearoldfemaletinnituspatientattendedinitialcounseling.Ayearlater,shereturned

feelingstressed.Inhernewquietworkingenvironment,everyonespokesoftly.Hertinnitusbecame

louderandmaskedthespeechsounds.Therewasnochangeinheraudiogramwhichrevealeda

borderline25dBhearinglevel.AhearingaidwithZenprogramtrialwasconducted.Thetrialwas

verypositivewithonehearingaid.Sheisabletohearwell.TheZenprogramprovidesherwith

soothingsoundstoreduceherattentiontothetinnituswheneveritisneeded.

Conclusion

Managingtinnituspatientswithcounselingcanbechallenging.Theabovecasesdemonstrate

theimportanceofthefollowing:

1. Hearingaidscanbeusefulinmanagingtinnituswhencombinedwithcounseling.Tinnitus

patientswithhearinglossmaybeunawarethattinnitusmaynotbetherealissue.

2. Tinnitusmaybealife-longcondition.Itisimportantfortinnituspatientstorecognizeother

ear-relatedconditionsandseekimmediatehelpwhensuddeneardiscomfortsoranyhearing

lossoccurs;evenwhentinnitusisnotbothersome.

3. Patientsneedtimetoaccepttheirtinnitus.Providingconstantempathy,encouragementand

supporttopatientsishelpful.

4. Whenever tinnitus becomes bothersome, counseled patients should be taught alternative

copingstrategiestoempowerthemtomanagetheirconditioneffectively.

241

THUR

SDAY 13 MA

RCH

TINNITUS THERAPY BASED ON THE TINNATURA MODEL

Aksoy, S.1;Buyukatalay,C.1;Yagcioglu,S.2;Coban,N.3

1 University of Hacettepe Health Sciences Faculty, Audiology Department, TURKIYE2 University of Hacettepe Medical Faculty, Biophysics Department, TURKIYE3 Novalit, Electronics Comm. Ind. Inc. Co., TURKIYE

Aims / Objective

TinnitusRetrainingTherapyisstillayounganddevelopingprocedureandregardingtheliterature,

the information introduced about it up till now, is not sufficient to describe it thoroughly.The

purposeofthisstudyistoformaneffective,short-term,speciallycustomizedfortheindividual

andon-linecontrollabletinnitustherapymodelforthetherapyofTinnitususingtheTINNATURA

model.

Methods

Afterbeinggrantednecessarypermissionsfromtheethicalcommittee,atotalnumberoftwenty

peoplediagnosedwithsubjectivetinnitus,wereincludedthestudy.Aftercarryingoutthecomplete

audiological, immitansmetric andobjectiveevaluations, thepatientswereasked tofill out the

TinnitusHandicapInventoryinordertoassesstheseverityofthetinnitus.Accordingtotheresults

of theTHI,only thepatientsassessedwithgrade2andover,were included to thestudy.The

evaluations:SpecificTinnitusMeasurements (Pitch,Loudness,MinimalMaskingLevel–MML

andResidualInhibition–RI)andSpecificSoundToleranceMeasurements(LoudnessDiscomfort

Level– LDLandUncomfortable Loudness Level–UCL)were carried out respectively. For all

theindividualstakingpartinthestudy,the“TinnitusInitialInterviewForms”werefilledandthey

weremonitoredusingtheFollow-UpForms.Inlinewiththeresultsoftheevaluations,aspecially

customizedTINNATURA programme was prepared for each individual after informing her/him

regardingtheapplication.Themonitoringprocessforalltheindividualswasplannedtorecord

thefollow-upsonthe3rd–4thweeksand2nd,3rdand6thmonths.Inaddition,patientswere

requestedtocallshouldanyquestionsorconcernsarise.

Results

WiththeuseoftheTINNATURAmodel,itisdeterminedthatwithinthe80%ofthepatients,the

severityoftinnitusdropssignificantlyattheendofthefirstmonthandattheendofthethirdmonth,

theeffectivenessisobservedtoincreaseover80%.Consequently,atherapyprogrammethathas

nosideeffects,causesnoharmtotheindividual,isdriventoincreasethelifequality,decreases

242

THUR

SDAY

13

MA

RCH

theperceptionoftinnitusandovercomesthediscomfortresultingfromtinnitus,issuccessfully

achieved.EventhoughsomenegativeaspectsoftheComprehensiveApproachTINNATURAmodel

hadbeenobservedduringthefirststages,togetherwiththeactiveparticipationandtrainingofthe

individuals,positiveresultswereobtained.

Conclusion

SuccessrateofknownTinnitusTherapytechniquesisratherhigh,howeverthetimereservedfor

the individualpatient is redundantly toomuch,andamong thecommerciallyavailable tinnitus

soundgeneratorsinthemarkettoday,manyofthemneedsignificantimprovements.Withtheuse

ofthenewtechniqueandsupportingitwithnewgenerationsoundgeneratorsandsystems,the

therapyisexpectedtobeexpandedtoawideraudience.Inthistechnique,thetimereservedfor

theindividualpatientwilldecreasesignificantlyandtogetherwithusingtoday’scommunication

technologies, thepatients’ behavioursand their daily improvements canbemonitoredalmost

simultaneously by online remote connection. This system and related new devices, will be

availableinthemarketstartingfrom4rdquarteroftheyear2014.

243

THUR

SDAY 13 MA

RCH

AMPLIFICATION WITH HEARING AIDS FOR PEOPLE WITH TINNITUS AND COEXISTING HEARING LOSS: COCHRANE REVIEW

Hoare, D.1;Edmondson-Jones,M.1;Sereda,M.1;Akeroyd,M.2;Hall,D.1

1 NIHR Nottingham Hearing Biomedical Research Unit, University of Nottingham, UK 2 MRC Institute of Hearing Research, Glasgow, UK

Background

Inthecurrentabsenceofacurefortinnitus,clinicalmanagementtypicallyfocusesonreducing

theeffectsofco-morbidsymptomssuchasdistressorhearingloss.Hearinglossiscommonlyco-

morbidwithtinnitusandsologicimpliesthatamplificationofexternalsoundsbyhearingaidswill

reduceperceptionofthetinnitussoundandthedistressassociatedwithit.Theobjectiveofthe

reviewwastoassesstheeffectsofhearingaidsspecificallyintermsoftinnitusbenefit,compared

toothermedicaldevices,otherformsofstandardorcomplimentarytherapyorcombinationsof

therapies,nointervention,oraplacebointervention.

Methods

WesearchedtheCochraneEar,NoseandThroatDisordersGroupTrialsRegister;theCochrane

Central Register ofControlledTrials (CENTRAL); PubMed; EMBASE;CINAHL;Webof Science;

Cambridge ScientificAbstracts; ICTRP and additional sources for published and unpublished

trials.Randomisedcontrolled trialsandnon-randomisedcontrolled trials recruitingadultswith

subjectivetinnituswereselected,wheretheinterventioninvolvesamplificationwithhearingaids

andthisiscomparedtointerventionsinvolvingothermedicaldevices,otherformsofstandardor

complementarytherapyorcombinationsoftherapies,nointervention,orplacebointerventions.

Threeauthorsindependentlyscreenedallselectedabstracts.Twoauthorsindependentlyextracted

data and assessed those potentially suitable studies for risk of bias. For studiesmeeting the

inclusioncriteria,weusedstandardisedmeandifferences(SMD)tocompareeffects.

Results

One randomised controlled trial (91 participants) was included.The trial was judged to have

lowriskofbiasformethodofrandomisationandoutcomereporting,andanunclearriskofbias

forothercriteria.Nonon-randomisedcontrolledtrialsmeetingourcriteriawere identified.The

includedstudymeasuredchangeintinnitusseverityusingatinnitusquestionnairemeasure,and

changeintinnitusloudnessonavisualanaloguescale.Othersecondarymeasuresofinterest,

namely change in psychoacoustic characteristics of tinnitus, change in self-reported anxiety,

244

THUR

SDAY

13

MA

RCH

depression, quality of life, and change in neurophysiological measures were not investigated

inthisstudy.Theincludedstudycomparedhearingaidusetosoundgeneratoruseandfound

nosignificantdifferenceinchangeofseverityorloudness.Nonegativeoradverseeventswere

reported.

Conclusions

Thecurrentevidencebaseforhearingaidprescriptionfortinnitusisoflimitedqualityduetoa

lackofrandomisedandnon-randomisedcontrolledtrials.Tobeuseful, futurestudiesof these

designswillneedtomakeadequateuseofblindingandobservealevelofconsistencyintheir

use of outcome measures.Whilst hearing aids are sometimes prescribed as part of tinnitus

management, there is currently no evidence to support or refute their use as amore routine

interventionfortinnitus,certainlyintheabsenceofco-morbidhearingdifficulties.

245

THUR

SDAY 13 MA

RCH

SOUND THERAPY ON PATIENTS WITH TINNITUS ACCOMPANYING ONE-SIDED SENSORINEURAL HEARING LOSS – COMPARISON BETWEEN HEARING AIDS AND NOISE GENERATORS

Oishi, N.1; Shinden, S.1, 2, Inagaki, Y.1; Suzuki, D.2; Wakabayashi, S.1; Kanzaki, S.1;Watabe,T.1;Yamada,H.1;Kojima,T.1;Okazaki,H.2;Ogawa,K.1

1 Department of Otolaryngology- Head and Neck Surgery, Keio University School of Medicine,

Tokyo, Japan2 Department of Otolaryngology, Saiseikai Utsunomiya Hospital, Tochigi, Japan

Aims / Objectives

To compare the effects of sound therapy on patients with tinnitus accompanying one-sided

sensorineuralhearinglossbetweenbyhearingaids(HAs)andbynoisegenerators(NGs)

Methods

Thesubjectsarepatientswithchronictinnituswhohaveone-sidedsensorineuralhearingloss.

Thehearing levelsareworse than30dBHL inaverage inanaffectedearandbetter than30

dBHLinaverageinanunaffectedear.Thirty-threepatientsweretreatedbyNGsatKeioUniversity

Hospital from2002 and2008 (NGgroup), and22 patientswere treated byHAs at Saiseikai

UtsunomiyaHospitalorKeioUniversityHospitalfrom2007and2012(HAgroup).Allthepatients

hadsufferedfromtinnitusformorethan3months.Ofthe33patientsintheNGgroup,themean

pure toneaveragewas57.0dBHL inaffectedearsand64%of thepatientswerediagnosed

withsuddensensorineuralhearingloss.Ofthe22patientsintheHAgroup,themeanpuretone

averagewas56.5dBHLinaffectedearsand64%ofthepatientswerediagnosedwithsudden

sensorineuralhearingloss.

The effects of treatment were assessed withTHI andVASs for tinnitus loudness and tinnitus

annoyanceat6monthsafterthestartoftreatment.

Results

In theNGgroup, themeanTHIscoresignificantly improvedfrom61.5to49.8,andthemean

VASfortinnitusannoyancesignificantlyimprovedfrom87.8to76.2,whereasthemeanVASfor

tinnitusdidnotchange.Ontheotherhand,intheHAgroup,themeanTHIscoreimprovedfrom

56.6to19.0;themeanVASfortinnitus loudness improvedfrom64.0to32.9;andthemean

VASfortinnitusannoyanceimprovedfrom67.8to27.6.ThesechangesintheHAgroupwere

246

THUR

SDAY

13

MA

RCH

allsignificant,andtheimprovementwasmuchmoreobviouscomparedtotheimprovementin

theNGgroup.Moreover,about40%ofthepatientsintheHAgroupreportedcompleteornearly

completedisappearanceoftinnitus,whereasnopatientsintheNGgroupreporteddisappearance

oftinnitus.

Conclusion

TheresultsofthisstudyindicatedthatsoundtherapybyHAscanbeaveryeffectivemethodto

treattinnitusinpatientswithone-sidedsensorineuralhearingloss.AsaTRTprotocolbyJastreboff

recommends,anactivecompensationforhearingimpairmentcanbemoreeffectiveintreating

tinnitusthanjustenrichingbackgroundsoundinpatientswithhearingloss.

247

THUR

SDAY 13 MA

RCH

DEVELOPMENT OF A PLACEBO CONTROL FOR ACOUSTIC COORDINATED RESET NEUROMODULATION

Adamchic, I.1;Toth,T.1;Hauptmann,C.1;Walger,M.2;Langguth,B.3,4;Klingmann,I.5;vonWedel,H.2;Tass,P.A.1,7

1 Institute of Neuroscience and Medicine–Neuromodulation, Jülich Research Center, Jülich,

Germany. 2 Department of Audiology, University of Cologne, Cologne, Germany3 Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany4 Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany5 Pharmaplex bvba, Wezembeek-Oppem, Belgium6 Department of Neuromodulation, University of Cologne, Cologne, Germany7 Clinic for Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany

Background and aims

Acoustic coordinated reset (CR) neuromodulation is a novel, noninvasive tinnitus therapy1.

To conduct high-quality randomized, placebo-controlled clinical studies using acoustic CR

neuromodulation,itisnecessarytohaveaconvincingacousticplacebotreatmentathand.Acoustic

CRneuromodulationconsistsofarandomizedsequenceoffourphaseresettingtonesthatcause

adesynchronizationofpathologicalrhythms(i.e.,adecreaseofthepowerinthecertainfrequency

bands)andareductionoftinnitussensation.Accordingly,anoptimalacousticplacebostimulation

is required to psychophysically mimic the acoustic sensation of CR neuromodulation without

havingatherapeuticeffectonthetinnitussensationandwithoutinducingadesynchronizationof

corticalactivity.Theaimofthisstudywastotestthehypothesisthatournewlydevelopedacoustic

placebo stimulation: (i) causes no reduction of tinnitus sensation after switching the placebo

stimulationoffand(ii)causesnolastingmodulationofcorticalactivity.

Methods

Thehypothesiswasstudiedinasingle-blindcrossoverdesignin18patientswithchronictonal

tinnitusbyadministeringthreedifferentstimulationprotocols:acousticCRneuromodulation,an

noisyCR-likestimulation(noisyreferstothepseudorandomselectionofthefrequenciesofthe

stimulation tones)anda lowfrequencyrange (LFR)stimulation.Wemeasuredvisualanalogue

scaleandspontaneousEEGactivitybefore,duringandaftereachtypeofstimulation.

248

THUR

SDAY

13

MA

RCH

Results

Thethreestimulationtechniques-acousticCRneuromodulation,thenoisyCR-likestimulation

andtheLFRstimulation-differedwithrespecttotheireffectonthetinnitusloudness,annoyance

andtheoscillatorybrainactivity.Furthermore,acousticCRneuromodulationcausedthelongest

significantreductionofdeltaandincreaseofalphaoscillatoryactivity.ThenoisyCR-likestimulation

andtheLFRstimulationshowedchangesintheoscillatoryactivitythatdifferedbothinstrength

andintimecoursefromthechangescausedbyacousticCRneuromodulation.

Conclusions

ThesefindingssuggestthatacousticCRneuromodulationinduceschangesintinnitusintensity

and oscillatory brain activity that are distinct from those associated with the noisy CR-like

stimulationandtheLFRstimulation.Weconcludethatitispossibletocreateanacousticplacebo

stimulationwiththeclinicalandneurophysiologicaleffectssignificantlydifferentfromacousticCR

neuromodulation.

1. Tass PA, Adamchic I, Freund HJ, von Stackelberg T, Hauptmann C. Counteracting tinnitus by acoustic

coordinated reset neuromodulation. , 2012; 30(2): 137-159.

249

THUR

SDAY 13 MA

RCH

CONSENSUS ON HEARING-AID CANDIDATURE AND FITTING FOR MILD HEARING LOSS, WITH AND WITHOUT TINNITUS: DELPHI REVIEW

Sereda,M.1;Hoare,D.J.1;Nicholson, R.2;Smith,S.1;Hall, D.A.1

1 NIHR Nottingham Hearing Biomedical Research Unit, Nottingham, UK2 Nottingham Audiology Services, Nottingham, UK

Objectives

Hearing aids are often a first-line of audiological intervention for many people with tinnitus.

Neverthelessthereisalackofhighqualityevidencetosupporttheirbenefitfortinnitusandwide

variability inclinicalpractice1.Theaimofthisstudywasto identifyclinicalconsensusonthe

criteriaforhearingaidcandidatureandclinicalpracticeinfittingdevicesformildhearinglosswith

andwithouttinnitusintheUK.

Methods

WechosetousetheDelphitechnique,asystematicmethodologythatseeksconsensusamongst

experts through consultation using a series of iterative questionnaires2.A three-roundDelphi

survey explored this clinical consensus among a panel of experts comprising 29 UK hearing

health professionals.Wemeasuredpanel agreement on115 statements covering: (i)General

factorsaffectingdecisiontofithearingaids, (ii)Protocoldrivenfactorsaffectingdecisiontofit

hearingaids,(iii)Generalpractice,and(iv)Clinicalobservations.Consensuswasdefinedas≥70%

agreement.

Results

Consensus was reached for 58 out of 115 statements.The main areas of consensus were:

factorsimportanttoconsiderwhenfittinghearingaids;devicetechnology/featuresofferedand

routine;andimportantclinicalassessmenttoverifyhearingaidfit.Forpatientswithmildhearing

loss,greatest importancewasgivenbyclinicians topatient-centredcriteria for fittinghearing

aids:hearingdifficulties;motivationtowearhearingaids,andimpactofhearinglossonquality

oflife.Moreobjectivemeasureshadalowerpriorityforfittingdecisions:degreeofhearingloss;

shapeof theaudiogram.Themainareaswhereconsensuswasnot reachedwere: theuseof

questionnaires to predict and verify benefit for both hearing and tinnitus; audiometric criteria

forfittinghearingaids;andthesafetyofusingloudsoundswhenverifyinghearingaidfittingfor

patientswithtinnitus.

250

THUR

SDAY

13

MA

RCH

Conclusions

Thestudyidentifiedareasofconsensusandlackofconsensusintheclinicalpracticeoffitting

hearingaidsanddifferencesinpracticebetweenpatientswithandwithouttinnitus.Statements

forwhich consensuswas reached in this review should be considered as inclusion/exclusion

criteriainclinicaltrialsevaluatingthebenefitsofhearingaidsfortinnitus.Statementsforwhich

consensuswasnotreachedshouldguideselectionofbaselineandoutcomemeasurementsso

thatsomeoftheindividualvariabilityinhearingaidoutcomesmightbebetterexplained.

Acknowledgements

Theviewsexpressedarethoseoftheauthor(s)andnotnecessarilythoseoftheNHS,theNIHRor

theDepartmentofHealth.Part-fundedbytheBritishSocietyofAudiologyAppliedResearchGrant.

References

1. Hoare DJ, Edmondson-Jones AM, Sereda M, Akeroyd MA, Hall DA. (in press) Cochrane Database of

Systematic Reviews Amplification with hearing aids for patients with tinnitus and co-existing hearing

loss..

2. Lindstone H.A. & Turoff M (eds.) The Delphi Method: Techniques and Applications. Reading, MA: 1975.

Addison-Wesley Publishing Company.

251

THUR

SDAY 13 MA

RCH

FREQUENCIES CHARACTERESTICS OF TINNITUS AND ITS IMPACT ON DIFFERENT SOUND-RELATED TREATMENT METHODS

Kong,W.1;Wang,Z.1;Xie,M.1;Xie,W.1;Cheng,H.1;Salvi,R.J.21 Department of Otolaryngology, Union Hospital of Tongji Medical College, Huazhong University of

Science and Technology 2 Hearing and Deafness Center, the State University of New York at Buffalo

Objectives

Toobservethefrequenciescharacteresticsoftinnitusanddifferentimpactondifferenttreatments

whichusecertainsoundbyanalysisinformationfromclinicalpatientssufferedfromtinnitus.

Methods:The337tinnituspatientsinaverageage41.15+14.33with368earswereexamined

byaudiometricthresholdtest,tinnitusmatchingtest,residualinhibition(RI)test,andthendivided

intodifferentgroupsaccordingtocharacteristicfrequencies(CF),hearinglossfrequenciesregion

,shapeofaudiogram.Allofthe209earswithhearinglossareallsensorineuralhearinglossand

thepathogenyaboutpatientswithmiddle-ear inflammationhistoryandmetabolismsyndrome

wereanalysiseither.Then121patientsaccepted thedetailedRI tests ,whichwereoperated

bybothpure-tonesound(PT)andnarrowbandnoise(NBN),in10dB louder,smallerand justat

the mixmal-masking-level(MML) at 125Hz, 250Hz,500Hz ,1000Hz,2000 Hz,3000Hz,4000

Hz,6000Hz,8000Hzpitches respectively.Besides,wegive161patientswhowerenotsogood

to the inhibition testanewmethod in thewayof tinnitus relievator,whichcangivepatientsa

narrowbandorwhitenoisesound,orthehearingaidwithaZensound(thesoundaimstoreduce

emotionproblemsandgivesomekindofinhibitiontotinnitus)for85patientswhowerehearing

lostathighfrequencies.Thenwegetsomefollowupdata.

Results

Thepatientswithnormalhearingthresholdandlighthearinglossgetmorepositiveratio(73.1%and

77.8%)thantheseverehearinglossgroup(58.4%).The10dBloudersuppressivesoundgetbetter

inhibitionresults:thepositiveratioatlowfrequenciesgroupis54.2%whileatMML39.6%and

10dBlower20.8%;atmiddlefrequenciesgroupis62.5%whileatMML50.0%and10dBlower

37.5%;athighfrequenciesgroupis26.3%whileatMML26.3%and10dBlower11.3%.Andfor

eachCFgroup,theeffectisbetterwhentheinhibitionsoundisatthesamepitch,detailsinthearticle.

ThehigherCFgroupgetsbettereffect(2000Hz-81.5%,3000Hz87.5%,4000Hz78.8%,6000Hz

74.3%,and8000Hz80.5%) than the lowerCF(125Hz73.9%,250Hz61.1%,and500Hz76.0%).

252

THUR

SDAY

13

MA

RCH

In the 14 middle ear disease history patients all of which the disease were cured and ear

membraneswerecontact,andonly2ofthemCFareinlowfrequencyregionandothersarein

high.The41metabolismsyndromepatientsgetthesimilaraudiometricandinhibitionpatternas

thepatientswithoutthehistories.Andthediscendingaudiometriccurveandflatcurvegroupsget

betterresultsateachCFgroups.Thetinnitus-relievatorshowpositiveeffectin73%ofpatients.

TheZENsoundhearingaidgiveabetterlifequalityin81%patients.

Conclusion

Theresidualinhibitionandsoundtherapyshouldchoosethetype-frequency,andtheloudness

accordingtodifferentcharacteristicfrequencieswhichismoreindividuallyeffective.Anddifferent

soundandmethodcanbecomboundedforabettereffectbothinrelievetinnitusandlevel-up

oflifequality.

Keywords:tinnitus,residualinhibition,frequency,history

253

THUR

SDAY 13 MA

RCH

SPACE: THE 3RD DIMENSION OF TINNITUS

Searchfield,G.D.1;Kobayashi,K.1,Irving,S.2

1 Audiology Section, The University of Auckland.2 Bionics Institute and University of Melbourne, Melbourne, Australia

Aims and objectives

Tinnitus is usually characterised psychoacoustically by its loudness and intensity. An often

overlookedoroversimplifiedaspectoftinnitusisitspercievedlocationinspace.Wewillpresent

a review of work undertaken in the last 5 years to characterise and manage tinnitus using

“3-Dimensional”sounds.Thereviewhastwoprimaryaims,1)toascertaintheabilitytoobtain,

andthereliabilityof,a3Dlocationmatchinauditoryspacerelativetoperceivedtinnituslocation

and2)tocomparetheeffectivenessof3Dmaskerswithbilateralmaskers.

Methods

The 3D tinnitus assessment and 3D masker used audio tracks manipulated by an average

HeadRelatedTransferFunction(HRTF).Aspatialmatchwasachievedbyplayingtheindividual

their tinnituspitch-matched toneatdifferenthorizontal and vertical positions renderedby the

software,maskingwasachievedusingthesametechniquebutthetonalstimuluswasreplaced

bybroadband“rain”noise.Threeseparatestudieswillbepresented:1)Aproofofconceptstudy

investigatingtinnituslocalisationandmaskingusingsoundplayedoverheadphonesatthesame

perceivedlocation(N=19).2)Anevaluationoftest-retestreliability (1weekbetweentests)of

the3Dassessmenttechnique(N=50).3)Across-overtrialofshort-termtinnitusmasking(using

tracks stored on iPods played via DirectAudio Input to binaural ReSoundAzure hearing aids

(N=14))ataperceivedlocationatthecentreoftheheadversusoneoverlappingwiththetinnitus

inspace(3D).Eacharmofthetrialwas2weeksinduration.

Results – Study 1

The3Dlocationwasreportedasagoodlocationmatchtotinnitusforthemajorityofparticipants.

More participants preferred the 3D masker to conventional maskers (left, right, centre).

MinimumMaskingLevels(MML)were lowerforthe3Dmasker inthemajorityofparticipants,

but theMMLwasnot statisticallydifferentbetweengroups. Study2. Tinnitus3Dmeasures

were consistent with participants’ global tinnitus localization (left, right, centre) but the tester

enabledmoreaccuratedescriptionsof localization(e.g. left front,abovetheeyes). Test-retest

254

THUR

SDAY

13

MA

RCH

reliability(horizontalr=0.63,verticalr=0.48)wassimilartotinnituspitch(r=0.62)andloudness

(r=0.39)measures.Study3.Therewasastrongpreferenceforthe3Dmaskingstimulus,with

asignificantlygreaterreduction inTinnitusHandicap Inventoryscores(p<0.01)following3D

masking.ThechangeinMMLwasgreater(marginaldifference,p=0.08)after2weeks’useof

the3Dmaskerthanchangewiththeconventionalmasker.

Conclusions

This early evidence supports the use of a technique employing HRTF altered sounds in the

assessmentandmanagementoftinnitus.Useof3Dsoundsenabledanaccurateassessment

oftheparticipants’perceivedtinnituslocationandappearstobeasuperiormaskingstimulusto

conventionalmasking.Themethodhasramificationsforstudiesattemptingtoreplicatetinnitus

psychoacousticcharacteristics forEEGandMRImeasures;andmayprovetobean important

considerationforfuturesoundtherapies.

255

THUR

SDAY 13 MA

RCH

TOTAL OR SIGNIFICANT REMISSION OF TINNITUS – WHAT CAN WE LEARN FROM PATIENTS WHO HAVE REACHED THIS STAGE?

Sanchez,T.G1;DelBo,L.2

1 Instituto Ganz Sanchez; University of São Paulo, Brazil2 Fondazione Ascolta e Vivi, Milan, Italy

Introduction

Inthepast20years,thenumberofscientificpaperspublishedperyearabouttinnitushaschanged

from150references(Pubmed,1994)to641(Pubmed,2012),meaninganincreaseofmorethan

400%.Thisreflectsagreaterworldwideinterestinunderstandingthisphenomenonandreaching

improvementandeventuallythecure.However,thegoldstandardwayofresearchingtreatment

attemptsthroughclinicaltrialsisexpensiveandtimeconsuming.

Objective

Inordertoacceleratethesearchforthecure,weaimedtointerviewpatientswhohavealready

reachedtotal/significantremissionoftinnitus–suchasanon/offmechanism-toverifyapossible

subgroupsuitabletohavebetterprognosisfortreatment.

Methods

Thisstudywasperformedintwocenters(SãoPaulo/BrazilandMilan/Italy).Weincludedpatients

whohavehadtinnitusofanyetiologyforat least1monthandreachedoneof twostages:1.

Total remission (TR,100%), defined as complete absence of tinnitus in 10 out of 10 regular

days;2.Significantpartialremission(SPR,80-90%):completeabsenceoftinnitusin8or9out

of10regulardays,associatedtopossibleshortrecurrences(1-2days)relatedtoawell-known

factor (stress,noiseexposure, intakeof food/drink/drug, infectionsetc).Weexcludedpatients

withpulsatiletinnitusandthosewhoreachedacomfortablelevelofhabituationormasking,but

stillperceiveit,somehow,veryoften.Aspecificprotocolwascreatedtointerviewtheselected

patients,consideringtheregionaldifferencesofattendingpatients.

Results

Inthefirst6monthsofresearch,20patientswereselected(55%males;45%females).Their

meanagewas47.95years(26to89y),andthemeantimeofexistenceoftinnituswas7.6months

(1to18mo)inBraziland5.3years(2to15y)inItaly.Beforetreatment,themeanhandicapwas

6.72 (throughVAS in11cases)and43.22 (throughTHI in9cases).Hearing thresholdswere

256

THUR

SDAY

13

MA

RCH

symmetricallynormalin60%ofcases(n=12).Consideringthatallpatientshavebeenminimally

counseled,themainmethodsthatallowedthestageofTRweremedicationandspecificdiets

inBrazil, andmanual therapyandhearingdevices in Italy.ThestageofSPRwas reachedby

medicationandsoundstimulation.ThemeantimethatpatientsreachedthelevelsofTRorSPR

was7.18yearsago.

Conclusions

Initial resultsshowthat totalorsignificantpartial remissionof tinnitus (consideringandon-off

behavior)maybeachievableforastableperiodoftime.Thenormalaudiometryseemedtobe

arelevantfactorforgoodprognosisinbothcenters,aswellastheshorttimeoftinnitusbefore

treatment inBrazilian center. Further inclusionof patients fromdifferentplacesmighthelp to

acceleratethesearchforthecure.

257

THUR

SDAY 13 MA

RCH

TINNITUS: WHY NOT STOP IT BEFORE IT STARTS?

Martin,W.H.

Whatcanwedountilwefindacure?Tinnitusprevention

Tinnitus is a complex condition triggered by several factors the most common of which is

exposuretoloudsounds.Noiseinducedhearinglossandresultingtinnitushavebeencommonly

associatedandsoundexposure is themostcommonly reported factor related to theonsetof

tinnitus.Thegoodnewsisthatthevastmajorityofthesecasescanbepreventedthroughsimple

strategies.DangerousDecibels®isanevidence-basedprogramwithseveralinterventionsthat

havebeendemonstratedtochangeknowledge,attitudesandintendedbehaviorsrelatedtosound

exposureandappropriateuseofhearingprotectivestrategiesinelementaryschoolstudent.The

programhasresourcesinuseinall50U.S.Statesand37countries.Areviewoftinnitusreported

inchildrenandanoverviewoftheDangerousDecibelsprogramwillbepresented.

258

THUR

SDAY

13

MA

RCH

Poster Session 5 / RimaNumbers refer to poster board allocation

OBJECTIVE MEASUREMENTS OF TINNITUS DISTRESS

Masuda,M.;Kohno,N.;Ogawa,K.

11

DEEP BRAIN STIMULATION OF THE INFERIOR COLLICULUS FOR TREATING TINNITUS

Offutt,S.J.;Konop,A.R.;Lim,H.H.

17

EVALUATION OF A SELF-ADMINISTERED TINNITUS MEASUREMENT SYSTEM

Kam, A.C.S.;Leung,E.K.S.;Sung,J.K.K.;Lee,T.;vanHasselt,C.A.

23

THE ROLE OF INDIVIDUAL PAIN TOLERANCE AND PAIN TRESHOLD IN BEARING TINNITUS

Aksoy,S.;Yılmaz,T.;Keser,I.;Aslan,S.;Kırdı,N.

29

MODERN THERAPEUTIC APPROACH TO THE DISEASE OF TINNITUS

Calenti,C;Ciabattoni,A.

35

LONG-TERM EFFECTS OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION TO THE

AUDITORY CORTEX IN CHRONIC UNILATERAL TINNITUS: IPSILATERAL VS. CONTRALATERAL

Moon, I.;Kim,H.;Oh,H.;Sim,N.;Kim,D.

41

COMPARISON OF POSITIONING THE CATHODE IN TDCS

Rabau, S.;Mariën,P.;VandeHeyning,P.

47

ENDLYMPHATIC HYDROPS IN PATIENTS WITH TINNITUS AS MAJOR COMPLAIN

Yoshida,T.;Teranishi,M.;Kato,M.;Otake,H.;Kato,K.;Sone,M.;Naganawa,S.;Nakashima,T..

51

259

THUR

SDAY 13 MA

RCH

CHANGE IN TINNITUS AFTER TREATMENT OF VESTIBULAR SCHWANNOMA: MICROSURGERY

VS. GAMMA KNIFE RADIOSURGERY

Moon,I.;Park, S.;Oh,H.

55

OSTEOPOROSIS AND TINNITUS

Kahveci, O.K.; Demirdal S.U

61

INTRATYMPANIC STEROID TREATMENT FOR TINNITUS PATIENTS WITH ACUTE LOW

FREQUENCY SENSORINEURAL HEARING LOSS WITHOUT VERTIGO: PROSPECTIVE

CONTROLLED STUDY

An,Y.;Shim,H.

67

PRESCRIPTION AND NON-PRESCRIPTION DRUG USE AMONGST TINNITUS SUFFERERS

Corry,M.;Searchfield,G.D.

73

PRISM (PICTORIAL REPRESENTATION OF ILLNESS AND SELF MEASURE) AS A NEW

ASSESSMENT TOOL FOR SUFFERING IN TINNITUS PATIENTS

Peter,N.;Kleinjung,T.;Horath,L.;Wichser,N.;Buechi,S.;Weidt,S.

83

IMPACT OF SPECTRAL NOTCH WIDTH ON THE CLINICAL EFFECTIVENESS OF THE TAILOR-

MADE NOTCHED MUSIC TRAINING

Wunderlich,R.;Teismann,H.;Lau,P.;Engell,A.;Stein,A.;Wollbrink,A.;Shaykevich,A.;Pantev,C.

84

PROPORTION AND DIVERSIFICATION OF UNDERLYING CAUSES OF 242 UNILATERAL VENOUS

PULSATILE TINNITUS CASES IN DUAL-PHASE CONTRAST-ENHANCED CT

Dong, C.; Wang, Z.C.; Liu, Z.H.; Zhao, P.F.

85

260

THUR

SDAY

13

MA

RCH

THE DURAL SINUS WALL DEHISCENCE PRESENTING WITH PULSATILE TINNITUS:

EVALUATION WITH CT VENOGRAPHY

Zhao,P.BeijingChina;Wang,Z.;Xian,J.;Yan,Y.;etal.

87

Poster Session 6 / OnoNumbers refer to poster board allocation

THE SHORT-TERM EFFECTS OF EXTENDED BANDWIDTH COMBINATION INSTRUMENTS ON

TINNITUS PERCEPTION

Cummins,A.;Searchfield,G.D.

06

AN ADAPTATION INDEX FOR INDIVIDUALISED SELECTION OF SOUND THERAPY LEVEL

Kobayashi,K.;Searchfield,G.D.

12

EFFECTIVE CLINIC PRACTICE AND STAGED MANAGEMENT OF THE TINNITUS: 14 YEARS OF

THE UNIVERSITY OF AUCKLAND HEARING AND TINNITUS CLINIC

Kaur, M.; Hadfield, D.; Searchfield, G.D.

18

HEARING AIDS WITH FRACTAL TONE AND PORTABLE MUSIC PLAYER IN TINNITUS

RETRAINING THERAPY

Takanashi,Y.;Kawase,T.;Oda,K.;Miyazaki,H.;Yahata,I.;Katori,Y.

24

THE EFFECTS OF INFORMATIONAL VERSUS ENERGETIC MASKING ON TINNITUS MINIMUM

MASKING LEVELS

Proudfoot,K.;Kobayashi,K.;Searchfield,G.

30

TINNITUS ADAPTATION LEVEL THERAPY AND THE AREA MODEL OF TINNITUS COUNSELLING

Hodgson,S.A.;Searchfield,G.D.

36

261

THUR

SDAY 13 MA

RCH

INGENUITY OF TRT WITH NATURAL ENVIRONMENT SOUNDS, OPTICAL ILLUSIONS AND

PARABLES

Tsuge, H;Morimoto,K.;Kato,Y.;Kato,D.;Koga,H.;Tokura,T.;Yoshida,T.;Nakashima,T.

42

EVALUATION OF TINNITUS USING HIGH FREQUENCY AUDIOMETRY, LOUDNESS -PITCH

MATCH, TINNITUS HANDICAP INVENTORY AND IT’S SUPPRESSION USING HEARING AIDS

Thomas,B.;Mathew,B.;Niveditha,P.;Balaji,S.;JavaraNaya,M.S.

48

THE EFFECTIVENESS OF TURKISH STANDARDIZED VISUAL COUNSELING MATERIAL ABOUT

TINNITUS

Kocak,O.;Aksoy,S.

52

CLINICAL VALIDATION OF A NOVEL COMBINATION HEARING AID AND TINNITUS THERAPY

DEVICE

Hicks,M.;Abrams,H.;Henry,J.;Frederick,M.;Sell,S.;Griest,S.

56

COUNSELING FOR TINNITUS PATIENTS

Lim,J.J.;Yuen,H.W.;Hsu,P.P.;Lu,P.;Koh,D.

62

TINNITUS THERAPY BASED ON THE TINNATURA MODEL

Aksoy, S. ;Buyukatalay,C.1;Yagcioglu,S.;Coban,N.

68

AMPLIFICATION WITH HEARING AIDS FOR PEOPLE WITH TINNITUS AND COEXISTING

HEARING LOSS: COCHRANE REVIEW

Hoare, D.;Edmondson-Jones,M.;Sereda,M.;Akeroyd,M.;Hall,D.

74

262

THUR

SDAY

13

MA

RCH

SOUND THERAPY ON PATIENTS WITH TINNITUS ACCOMPANYING ONE-SIDED

SENSORINEURAL HEARING LOSS – COMPARISON BETWEEN HEARING AIDS AND NOISE

GENERATORS

Oishi,N.;Shinden,S.,Inagaki,Y.;Suzuki,D.;Wakabayashi,S.;Kanzaki,S.;Watabe,T.;Yamada,

H.;Kojima,T.;Okazaki,H.;Ogawa,K.

79

DEVELOPMENT OF A PLACEBO CONTROL FOR ACOUSTIC COORDINATED RESET

NEUROMODULATION

Adamchic, I.;Toth,T.;Hauptmann,C.;Walger,M.;Langguth,B.;Klingmann,I.;vonWedel,H.;

Tass,P.A.

86

CONSENSUS ON HEARING-AID CANDIDATURE AND FITTING FOR MILD HEARING LOSS, WITH

AND WITHOUT TINNITUS: DELPHI REVIEW

Sereda,M.;Hoare,D.J.;Nicholson, R.;Smith,S.;Hall, D.A.

91

FREQUENCIES CHARACTERESTICS OF TINNITUS AND ITS IMPACT ON DIFFERENT SOUND-

RELATED TREATMENT METHODS

Kong,W.;Wang,Z.;Xie,M.;Xie,W.;Cheng,H.;Salvi,R.J.

92

SPACE: THE 3RD DIMENSION OF TINNITUS

Searchfield,G.D.;Kobayashi,K.,Irving,S.

93

TOTAL OR SIGNIFICANT REMISSION OF TINNITUS – WHAT CAN WE LEARN FROM PATIENTS

WHO HAVE REACHED THIS STAGE?

Sanchez,T.G;DelBo,L.

94

263

Author Page

Abraham,W.C. 55

Abrams,H. 237

Adamchic,I. 119,247

Ahn,J.H. 114

Aitken,P. 140,164

Akeroyd,M. 243

Aksoy,S.77,195,235,241

Alghamdi,F. 145

Alsalman,O. 154

An,Y. 204

An,YH. 110

Aruldasan,M. 115

Aslan,S. 77,195

Backhouse,D.P. 89

Baguley,D. 65

Bajo,V.M. 147

Balaji,S. 233

Barry,J. 27,52

Başkent,D. 156

Bosynak,D.J. 123

Boyen,K. 100,156

Bruce,I. 123

Buechi,S. 181,206

Buyukatalay,C. 241

Cabay,J-E. 134

Calenti,C. 197

Callander,K.J. 21,46

Carmody,N. 33

Chandra,N. 31

Cheng,H. 215,251

Cheng,Y-C. 106,130

Chien,Y.T. 149

Chung,J.W. 114

Ciabattoni,A. 197

Cima,R. 38,56,87

Coban,N. 241

Congedo,M. 101,125

Corry,M. 205

Cummins,A. 221

Darlington,C.L. 136,140,

149,160,164

Davis,P. 25,50

DeKleine,E. 100

DelBo,L. 219,255

Demertzi,A. 134

Demirdal,S.U. 203

DeRidder,D. 101,102,

125,126,134

Doblin,R. 169

Dong,C. 183,209

Edmondson-Jones,M. 243

Eikelboom,R.H. 33

Emerson,A. 170

Engel,S. 151,152

Engell,A. 117,208

Exeter,D. 35

Fackrell,K. 27,52

Fattahzadeh,A. 158

Förster-Ruhrmann,U.63,85

Frederick,M. 237

Fujioka,M. 91

Fukasawa,S. 60,66,82

Galazyuk,A.V. 141,

145,165

Gans,J. 212

GhodratiToostani,I. 23,48

Gloeckner,C. 73

Gold,J.R. 147

Gomez,F. 134

Goto,F. 91

Gräbel,S. 63,85

Griest,S. 237

Grimsley,C.A. 141,165

Hadfield,D. 224

Hall,D.A. 27,52,65,93,

213,243,249

Hauptmann,C. 119,247

Henry,J. 237

Herrmann,J. 62

Hicks,M. 237

Hoare,D. 27,52,213,

243,249

Hodgson,S.A. 229

Hong,H.R. 114

Horath,L. 181,206

Hsu,P.P. 239

Hunter,P. 19

Indexofauthors

264

Ibrahim,R. 103,105,

127,129

Inagaki,Y. 36,54,91,245

Inoue,Y. 91

Irving,S. 217,253

Jangholi,N. 23,48,158

Janssen,S. 56,87

JavaraNaya,M.S 233

Jiao,Y. 106,130

Joos,K. 102,126

Kabaya,K. 44

Kahveci,O.K. 203

Kam,A.C.S. 194

Kang,HW. 110

Kanzaki,S. 36,54,91,245

Kato,D. 231

Kato,K. 200

Kato,M. 200

Kato,S. 40,42

Kato,Y. 231

Katori,Y. 225

Kaur,M. 224

Kawase,T. 225

Kerridge,M. 68

Keser,I. 77,195

Kim,D. 198

Kim,H. 198

Kim,T.S. 114

Kim,Y.H. 22,47

King,A.J. 147

Kirdi,N. 77,195

Kleinjung,T. 121,181,206

Klingmann,I. 247

Kobayashi,K. 71,115,

217,222,227,253

Kocak,O. 235

Koga,H. 231

Koh,D. 239

Kohno,N. 190

Kojima,T. 36,54,245

Kong,W. 215,251

Konop,A.R. 186,192

Langers,D.R.M. 100

Langguth,B. 20,62,119,

121,151,152,247

Lanting,C.P. 100

Lau,P. 75,188,208

Laureys,S. 134

Leaver,A.M. 108,132

Lee,A. 31

Lee,H.S. 114

Lee,J.I. 114

Lee,T. 194

Lefebvre,PH. 134

Leung,E.K.S. 194

Lim,H. 73

Lim,H.H. 186,192

Lim,J.J. 239

Linford,T. 69,71

Liu,Z.H. 183,209

Londero,A. 178

Longenecker,R.J. 141,

145,165

Lu,P. 239

Lux-Wellenhof,G. 58,80

Mariën,P. 189,199

Markewitz,R. 151,152

Markovitz,C. 73

Martin,W.H. 257

Masuda,M. 91,190

Mathew,B. 233

Mathur,A. 103,105,

127,129

Matsunaga,T. 91

Maudoux,A. 144

MauriceErna

Claessens,P. 23,48

Mazurek,B. 63,85,

138,162

McFerran,D. 65

McLachlan,N.M. 21,46

McMahon,C.M. 103,105,

127,129

Meyer,M. 121

Michel,G. 154

Michikawa,T. 29

Milne,M. 149

Minami,S.B. 91

Mitsukura,Y. 54

Miyazaki,H. 225

Mizutari,K. 91

Mizutari,Z. 29

Moon,I. 198

Mori,Y. 60,66,82

Morimoto,K. 231

Moseley,L.(G.L) 177

Mulders,H. 144,168

Mulders,WHAM. 143

Murakami,S. 44

Naganawa,S. 200

Nakagawa,M. 60,66,82

Nakashima,T. 200,231

Nam,EC. 79

Neff,P. 121

Nicholson,R. 213,249

265

Nishiwaki,Y. 29

Niveditha,P. 233

Nodal,F.R. 147

Norena,A. 144,168

Oda,K. 225

Offutt,S.J. 186,192

Ogawa,K. 29,54,91,

190,245

Oh,H. 198,202

Oishi,N. 36,54,91,245

Okamoto,Y. 91

Okazaki,H. 245

Olze,H. 63,85

Otake,H. 200

Pantev,C. 75,117,

188,208

Park,HY. 79

Park,H.J. 114

Park,S. 202

Paul,B. 123

Peter,N. 181,206

Petoe,M. 71

Proudfoot,K. 227

Pryss,R. 62

Rabau,S. 189,199

Rauschecker,J.P. 108,132

Roberts,L.E. 123,171

Robertson,D.143,144,168

Saito,H. 29,91

Sakashita,T. 40,42

Salvi,R. 106,130,215,251

Sanchez,T.G. 219,255

Schecklmann,M. 121,

151,152

Schlee,W. 62,84

Schrooten,M. 56,87

Searchfield,G.D. 31,35,

68,69,71,89,112,115,

205,217,221,222,225,

227,229,253

Sekiya,Y. 44

Sell,S. 327

Sereda,M. 213,243,249

Seydell-Greenwald,A.S. 108,

132

Shaykevich,A. 188,208

Sheehan,T. 25,50

Shekhawat,G.S. 89,112

Shim,B.S. 114

Shim,H. 204

Shim,HJ. 110

Shinden,S. 91,245

Shore,S.E 99

Sim,N. 198

Soddu,A. 134

Spiegel,D. 69,71

Smith,B. 73

Smith,P.F. 136,140,149,

160,164

Smith,S. 213,249

Smythies,H. 140,164

Sone,M. 200

Song,J.J. 180

Stein,A. 117,188,208

Stiles,L. 136,149,160

Stinear,J.W. 89

Stinear,C.M. 112

Sung,J.K.K. 194

Suzuki,D. 91,245

Szczepek,A.J. 138,162

Tanuma,F. 60,66,82

Takahashi,K. 44

Takanashi,Y. 225

Takayama,K. 54

Tass,P.A. 119,247

Teismann,H. 188,208

Teng,G-J. 106,130

Teranishi,M. 200

Thomas,B. 233

Thompson,B. 71

Thompson,D.C. 123

Tokura,T. 231

Tong,J-X. 106,130

Toostani,I.G. 158

Toth,T. 247

Tsuge,H. 231

Tucker,D. 154

Turesky,T. 108,132

VandeHeyning,P. 134,

189,199

VanDijk,P. 100,156

VanGendt,M. 100

VanHasselt,C.A. 194

Vanhecke,W. 134

Vanneste,S. 101,102,

125,126,134

Vlaeyen,J. 38,56,87

Vogler,D.P. 143,167

VonWedel,H. 247

Vulinovich,A. 136,160

Walger,M. 247

Wang,J. 106,130

Wang,Z.184,210,215,251

Wang,Z.C. 183,209

Wasano,K. 91

266

Watabe,T. 36,91,245

Watanabe,S. 60,66

Wakabayashi,S. 36,54,

91,245

Weidt,S. 181,206

Wichser,N. 181,206

Wilson,S.J. 21,46

Wollbrink,A. 188,208

Won,JH.

Wu,B. 35

Wunderlich,R. 188,208

Xian,J. 184,210

Xie,M. 215

Xie,W. 215,251

Yagcioglu,S. 241

Yahata,I. 225

Yäimaz,T. 77

Yamada,H, 36,54,91,245

Yamane,H. 40,42

Yan,Y. 184,210

Yang,M. 106,130

Yilmaz,T. 195

Yoo,SY. 79

Yoon,T.H. 114

Yoshida,T. 200,231

Yuen,H.W. 239

Zhang,F-C. 106,130

Zhao,P.F. 183,209

Zhao,P. 184,210

Zheng,Y. 136,140,149,

160,164

267

268

Pre Conference Workshop

1

Programme

Monday 10 March - Pre Conference Workshop

0830 – 0910 Welcome & workshop objectives

DrGrantSearchfield

0910–0950 Recentonset-tinnitus:TheENTperspective

Dr Alain Londero

0950–1030 Tinnitus:Awarningsymptominnonotologicalpathologies

Assoc Prof Amr El Refaie

1030–1100 Morningtea

1100–1140 Choosingpatientpathways

Prof Dirk De Ridder

1140–1220 MindfulnessBasedTinnitusStressReduction(MBTSR)Workshop:Making

mindfulnessaccessibletopatients

Dr Jennifer Gans

1220–1300 How,whenandwhat-ifsoftranscranialdirectcurrentstimulationfortinnitus

Assoc Prof Cathy Stinear & Dr Giriraj Shekhawat

1300–1400 Lunch

1400–1440 Cognitivehabituationtinnitustherapy

Dr Natan Bauman

1440–1520 Clientcentredsoundtherapyselection:Tinnitusassessmentintopractice

Dr Grant Searchfield

1520–1550 Afternoontea

1550–1630 Assessmentandmanagementofacousticshock/tonictensortympani

syndrome(TTS)/hyperacusis

Myriam Westcott

1630–1710 Buildingatinnituspracticefromthegroundup:Howtobringtinnitusandsound

tolerancecaretoplaceswhereitdoesn’texist

Prof William Martin

1710–1930 Welcome Reception

2

RECENT ONSET-TINNITUS: THE ENT PERSPECTIVE

Londero,A.

Hôpital Européen G. Pompidou, Paris, France

Chronic subjective tinnitus is a very common symptom affecting, with various degrees of

intrusiveness,about10%ofthegeneralpopulation.Basicandclinicalresearcheffortsare,for

themostpart,actuallyaimedattreatingchronictinnituspatients.But,onanotherhand,it isa

truismtostatethat,atanearlystageofitsevolution,everysinglechronictinnitushasbeenan

acuteone.However, little isknownon thegrounds thatexplainwhy, inaminorityofpatients,

appearsaharmfulevolutiontowardsachroniclong-standingdisablingtinnitus.Similarly,to-date,

thereisnoconsensusandnoscientificallyvalidatedguidelinesforthemanagementofsucha

common clinical situation, especially in the ENT practice. Indeed, because subjective tinnitus

isoftenperceived inoneorbothearsandbecause it isalmostalwaysassociatedwithother

cochleo-vestibular symptomsENTsaremostof the time thefirsthealth-careprofessionals to

whichthepatientsaskforassistance.

Ithastobehighlighted,here,thatsubjectivetinnitusisnotadiagnosisnoradisease,butrathera

symptomofsomeotherpathologicalcondition.Then,accordingtoastep-by-stepprocedure,the

maingoalofENTmanagementistodeterminetheaetiologyandtoprovideacausallyorientated

treatment.

The first step is to make a differential diagnosis with less frequent conditions such as the

perceptionofsomato-soundsandauditoryhallucinationswhichrequirespecificmanagement.

Thesecondstepistodeterminetheoriginofsubjectivetinnitus.Eveniftherearenumerouscauses

oftinnitus,inourexperiencethiscanalmostalwaysbedone,oratleaststronglysuspected,bythe

simplemeansofastructuredmedicalinterview,acarefultympanicmembraneevaluation,and

astandardaudiometry.Additionalaudiologictestingandradiologic imagingorother laboratory

examinationsareonlyaimedatprovingorconfirmingclinicalevidence.

Thatlaststepistoprovide,ifpossible,acausallyorientedtreatmentandtoaddressspecifically

the tinnitus symptom itself, if necessary. Despite a weak evidence-based rationale, a wide

varietyofearly-stageinterventionscaneventuallybeproposedincluding:drugtherapies,intra-

tympanic injections, hyperbaric oxygen therapy, sound therapies, psychological interventions,

surgical procedures. Integrating thesedifferent therapeutic options into one single structured,

3

andpatient-oriented,interventionprogramisthecoreofENTexpertiseininitialsubjectivetinnitus

management.

Duringthe“HowIdoit”sessionoftheTRIMeeting2014,ourpurposewillbetohighlightpractical

andarchetypalcasesofENTs’managementforrecent-onsetsubjectivetinnitus.

Notes

4

5

TINNITUS: A WARNING SYMPTOM IN NON-OTOLOGICAL PATHOLOGIES

ElRefaie,A.

Tinnitusisapresentingsymptomforalargearrayofotologicalandnon-otologicalpathologies.

Managementofidiopathictinnitusshouldnotstartbeforeafulldiagnosticevaluationofthepatient

todiscoveranytreatableorsinistercauses,whichshouldbethefirstaimofmanagement(though

treatingthecausativepathologydoesnotautomaticallyleadtothedisappearanceoftinnitus)

Audiologistisoftenthefirstcliniciantoencounterthetinnitussufferer,andagoodknowledgeof

thesymptomsandsignsofpathologiescontributingtothesensationoftinnitusisessentialfor

properandtimelyreferraltoothermedicalspecialists.Thistalkwillconcentrateontwoofthenon-

otologicalpathologiesthatcanpresentastinnitus,namelyTemporo-MandibularPainDysfunction

SyndromeandMultiplesclerosis(MS).Thetalkwillincludeabriefdiscussionoftheaetiologies,

epidemiologyandclinicalpresentations,aswellastheonsetandcharacteristicsoftinnitusand

otheraudio-vestibularsymptomsinbothconditions.

Notes

6

7

CHOOSING PATIENT PATHWAYS

DeRidder,D.

Tinnitusisnotoriouslydifficulttocure,eventhoughmanytreatmentoptionsexist.Fromaclinical

pointofviewaflowchartcanbecreatedtoguidetinnitustreatment,basedonapathophysiological

evidencebasedbasis.ThishasbeenproposedbytheTRI (http://www.tinnitusresearch.org/en/

projects/flowchart).

But how to go about it practically, especially considering that there is not a lot of evidence

availabletoguidetinnitustreatment?Asahealthcareprovideroneshouldalwaysremember

thattheabsenceofproofisnotproofofabsenceoftreatmenteffect.

Afteraskingsomenumericratingscalesforloudnessanddistress(0=notbotheredatall,10=

suicidal)andwhatpercentageoftimethetinnitusisdominantlypresent,whichgivesanimpression

oftheimpactondailyliving,aninitialstepistogetahistorythatcanguidethetherapy,aided

byoneormorequestionnairesthatevaluatetheaffectivecomponentsofthetinnitus(distress,

depression).

Afirstquestioniswhetherthetinnitusispulsatileinnatureornot,andifpulsatilewhetheritis

heartbeatsynchronousorsoundsmorelikehumwhichisrespiratorysynchronous.Isituni-or

bilateral,positionalorcanitbesuppressedbypressingatspecificpointsintheneckorhead?

Thissuggestsdifferentpossiblecauses,butmostof the time imagingandaudiometrywillbe

required.

Alsoinnon-pulsatiletinnitusassociatedsymptomscandirectthehealthcareprovidertofurther

targetedinvestigations:headaches,vertigo,hemifacialspasms,geniculateneuralgia,autophony,

Tulio’sphenomenon,masticatorypain,headandneckproblems,sensoryormotorchanges in

limbsorbody,ortinnitusworseningonValsalvamanoeuversareimportantsymptomssuggesting

specifictreatablecausesfortinnituswhichcanguidefurther investigationssuchasABR,MRI,

angiographyetc.

However, most patients present without a treatable cause resulting in a more symptomatic

approach.Ingeneralitishelpfultotellthepatientthatmultipletreatmenttrialsmightbenecessary

andthateachtreatmentonlyhas20to30%changeofgivingaclinicallymeaningfulbenefit,in

8

ordertopreventdesillusionswithanyformoftreatment.Counselingwithorwithoutmasking(TRT)

canbehelpfulforsomepatientsandcanbecombinedwithothertreatmentoptions.

Ifthereishearinglossitdependsontheamountofhearinglosswhatcanbeoffered.Forexample

completeunilateraldeafnessinthetinnitusearcanbeapproachedeitherbyatrialwithaBAHA

orCI,whereas inhearing lossmatching the tinnitus frequencyhearingaidscouldbeoffered,

withorwithoutmasking.Ifthetinnitusisnottooloud,activeaudiologicaltreatmentcanalsobe

considered(neuromonics,coordinatedresetetc).

Ifthisisnotbeneficial,medicationcanbetried,butthisonlyifthetinnitusiseitherveryloudor

perceiveddominantlymostoftheday.Astepwiseapproachof3to4differentdrugscanbetried,

allatlowdosestopreventsideeffectsthatcouldpotentiallyfurtherworsenthepatient’squality

oflife.

Ifneitheraudiologicalnormedicationbenefitsthepatient,neuromodulationisanoption.Thiscan

consistofrTMS,tDCS,tACS,tRNSorneurofeedback.Thesetechniquescaneitherbeusedasa

prognostictestformoreinvasiveproceduresorasatreatmentattempt.Theycanbeguidedby

functionalimagingifnothingelseworks.

Itshouldbekeptinmindthathowfaronegoesinofferingtreatmentoptionsdependsonhow

muchdistressandhowloudthetinnitusisperceived,andhowmuchofthetimethetinnitusis

dominantly present. But all of thiswithin a context of reasonable expectations of the patient,

andaccepting thatsomepatientgroupsaremoredifficult to treat,suchasmusicians,people

withOCD,peoplewhoarecontrolefreaks,orpeoplewithsuicidaltendencies,eachfortheirown

particularreasons.

The workshop will be practically oriented (how I do it?) and should demonstrate how a

multidisciplinaryapproachcanbenefitboththepatientandthehealthcarprovider.

9

Notes

10

MINDFULNESS BASED TINNITUS STRESS REDUCTION (MBTSR) WORKSHOP: MAKING MINDFULNESS ACCESSIBLE TO PATIENTS

Gans,J.

TheMindfulnessBasedTinnitusStressReduction (MBTSR)Workshopwill bepart experiential

andpartinstructionalonimplementationofamindfulnessprograminabusyclinicalpractice.In

ordertounderstandandgainasenseofhowpracticingmindfulnessinday-to-daylifecanaffect

one’srelationshiptoasymptomsuchastinnitus,itisimportanttoexperiencemindfulnessfirst

hand.Wewill thenexplorebrainscienceandwhatappearstobehappeninginthemeditating

brainandtheoverlapwithwhatwebelieveishappeninginthebraintogeneratetheperception

ofthetinnitussignal.MakingtheMBTSRprogramaccessibletopatientswillbeexploredthrough

discussionandpracticewiththeonlinecourseMindfulTinnitusRelief.com.

Notes

11

12

HOW, WHEN AND WHAT IFS OF TRANSCRANIAL DIRECT CURRENT STIMULATION FOR TINNITUS

Stinear,C.;Shekhawat,G.S.

University of Auckland, New Zealand

Tinnitus isanauditoryphantomsensation (ringingof theears) experiencedwhennoexternal

soundispresent1.Inthepastdecadeattentionhasbeendrawntowardstheuseofnon-invasive

brainstimulationfortinnitusmanagement.Morerecently,theeffectsoftranscranialdirectcurrent

stimulation(tDCS)havebeenexploredinhumans,inbothhealthyandneurologicalpopulations.

Dependinguponthepolarityofthestimulation,tDCScanincreaseordecreasetheexcitabilityof

theunderlyingcortex.Anodalstimulationincreasesexcitabilityduetoneuronaldepolarisationand

cathodalstimulationdecreasesexcitabilityduetoneuronalhyperpolarisation.Itispostulatedthat

theafter-effectsoftDCScouldpossiblybeduetochangeinintracorticalinhibitionorfacilitation

whichiscontrolledbysynapticactivity2.Inthispresentationwewillbediscussingtheclinical

factorsassociatedwithtDCS,itssafetyandapplicationespeciallyforpeoplewithtinnitus.Existing

researchwillbecriticallydiscussedalongwiththepossibilitiesoffutureresearchtounderstand

andfurtherdevelopthistechniqueanditsapplicabilityfortinnitus.

References

1. Eggermont JJ, Roberts LE. The neuroscience of tinnitus. Trends Neurosci. 2004;27:676-682.

2. Nitsche MA. Modulating parameters of excitability during and after transcranial direct current stimulation

of the human motor cortex. J. Physiol. 2005;568:291-303.

Notes

13

14

COGNITIVE HABITUATION TINNITUS THERAPY

Bauman,N.

CognitiveHabituationTinnitusTreatment,akaCHaTT,wasdevelopedbyanaudiologist,Dr.Natan

Bauman. CHaTT is an outgrowth of working with hundreds of tinnitus and Sound Sensitivity

Disorderpatients,over tenyears. Itwasofficially introduced to theaudiologists viaseminars

sponsoredbytheTinnitusPractitionersAssociation(TPA)organizationin2009.

CHaTTisatreatmentprogramwhichisbasedontheneurophysiologicalmodeldescribedbyDr.

PawelJastreboff.Whichmeansitsbasicprincipleishabituationofthereaction.Thedifferenceis

initsmorecomprehensivetherapeuticapproachwhichincludesaheavydoseofCBTaspartof

counselinginadditiontosoundtherapy.

CHaTTcategorizestinnituspatientsinto6categoriesbasedontheirtinnitusreactionscore.The

categoriesarelinkedtothecalculatedreactionscoreandpresenceorabsenceofhearingloss.

Additional4categoriesare for thosewhohaveSSDwith tinnitusorwithout tinnitusandwith

orwithouthearingloss.Thus,alltogether,therearewelldefined10categories.Eachcategory

hasitsownstepbystepdefinedprotocolwhichhelpsthecliniciantoengagepatients intheir

treatmentprogram.Inaddition,therearespecialprotocolswhichdealwithphonophobia,TTTS,

acousticshockandmisophonia.

Notes

15

16

CLIENT CENTRED SOUND THERAPY SELECTION: TINNITUS ASSESSMENT INTO PRACTICE

Searchfield,G.D.

Audiology section, The University of Auckland and Centre for Brain Research, The University of

Auckland

Tinnitusisaveryindividualexperience.Peoplewithtinnitusperceivedifferentsounds,indifferent

locations in head or ears, with different reactions and different effects on daily activities. It

appearsthatmanyclinicianshaveanaprioriviewofhowtinnitusshouldbemanagedandthisis

applieduniformly,withlimitedcontributionfromthepatientindecisionmaking.Italsoappears

thatalthoughcliniciansoftenassesstinnitusthisisseldomusedtoinformtherapyselection.In

thistalkaperson-centredapproachtotinnituswillbeintroducedthatmakesuseofanAdaptation

Level framework for sound therapy. This framework considers the psychoacoustical and

psychologicalcharacteristicsoftheindividualstinnitusthatcanbeusedtoguidesoundtherapy

selection,andhowthepatientcanbeactivelyinvolvedasapartnerinthetherapyprocess.

Notes

17

18

ASSESSMENT AND MANAGEMENT OF ACOUSTIC SHOCK/TONIC TENSOR TYMPANI SYNDROME (TTTS)/HYPERACUSIS

Westcott,M.

Dineen Westcott Moore Audiology, Melbourne, Australia

Hyperacusisisanabnormalintoleranceofcertainsounds,whichmostotherstoleratewell.Itcan

developinthebeliefthatears/hearingmaybedamagedbythesesounds,orpre-existingtinnitus

maybeaggravated.Theconsensusisthatabout40%oftinnituspatientshavesomedegreeof

hyperacusis.Misophoniaisastronglyaversiveresponsetospecificsounds,oftenmadebyother

people.Whilehyperacusisandmisophoniacanoccurconcurrently,theyareseparateconditions.

Acousticshock(AS)isaninvoluntaryfrightresponsetoasoundperceivedastraumatic(usually

asudden,unexpected,loudsoundheardneartheear),resultinginaspecific,consistentpattern

ofsubjectiveneurophysiologicalsymptoms.Thesecaninclude;hyperacusis;tinnitus;auralpain/

fullness;‘muffled’hearing;disequilibrium;andpain,numbnessoraburningsensationaroundthe

ear.Ifsymptomspersist,anASbecomesanacousticshockdisorder(ASD).Thepotentialseverity

andpersistenceofASDsymptomshassignificantclinical,occupational,militaryandmedico-legal

diagnostic/rehabilitationimplications.

Tonictensortympanisyndrome(TTTS)isaninvoluntaryconditionwherethecentrallymediated

reflexthresholdfortensortympanimuscleactivityislowered,resultinginafrequentspasm.This

can triggersymptoms inandaround theear from tympanicmembrane tension,alterations in

middleearventilationandtrigeminalnerveirritability.

TTTShasbeenproposedasthemechanismunderlyingmanyofthepersistentsymptomsofASD.

SymptomsconsistentwithTTTSarealsofrequentlyseenintinnituspatients,particularlyifthey

havedevelopedhyperacusis.TTTSprovidesanexplanationforauralpainandtinnitusaggravation

triggeredby intolerablesoundexposure. If thesepatientsarenotgivenanexplanationoftheir

symptoms,theresultantanxietyanddistresscanplayarolenotonlyintinnitusandhyperacusis

escalationbutalsoinlimitingthedegreeofefficacyoftherapeuticintervention.

Hyperacusis, misophonia, TTTS and AS evaluation, diagnosis and therapy will be discussed.

DesensitisationcanbeachievedusingaTinnitusRetrainingTherapy(TRT)approach, including

demystificationofanysymptomsconsistentwithTTTS,withtheadditionofcognitivebehavioural

therapy(CBT)strategiestoreframemaladaptivebeliefsandmanageauditoryhypervigilance.

19

20

BUILDING A TINNITUS PRACTICE FROM THE GROUND UP: HOW TO BRING TINNITUS AND SOUND TOLERANCE CARE TO PLACES WHERE IT DOESN’T EXIST

Martin,W.H.

IntheUSandEurope,thetopicsoftinnitusandsoundtoleranceconditionsenjoymediaattention,

grantfundingandgeneralpublicawareness.Whatabouttherestoftheworld?Inmanyregions

therethemedicalandpatientcommunitiesknowlittleornothingabout theseconditions, their

diagnosis, treatmentandmanagement. Thispresentation identifies issuesandstrategies that

need consideration when introducing tinnitus and sound tolerance disorder care programs

intonewregionsof theworld. Topicsandexampleswill includedocumentingneeds, raising

awareness,culturalbarriers,politicalsensitivities,appropriatingresources,buildingpartnerships

and funding. The concepts can apply to new and developing tinnitus care programs in any

context.

Notes

21

22

23

24

You can manage tinnitus. We can help

Many people with hearing loss also experience ringing, humming, buzzing or other sounds in their ears – as a hearing care professional, you’re the most important resource for clients with tinnitus.

We are therefore pleased to tell you about the new ReSound Verso TS, our third-generation combination hearing instrument and tinnitus solution. It comes with a comprehensive Tinnitus Management Package, designed to support you in your work.

The Tinnitus Management Package includes step-by-step guidelines, a complete set of client counseling tools, advice on how to use them and training material.

For more information, or to set up a meeting to talk about what ReSound Verso TS can do for your patients, contact us on 0800 900 126.

ReSound Verso TS