Factors affecting the quality of life in hemifacial spasm patients

Background and purposeHemifacial spasm (HFS), a movement disorder manifested by unilateral spasms of the muscles innervated by the facial nerve, interferes with social life in about 90% of patients, causing social isolation and depression and having a significant impact on the quality of life. The aim of the study was to assess factors affecting the quality of life in patients with HFS in respect of influence of the severity of depression symptoms and botulinum toxin type A (BTX-A) therapy.Material and methodsEighty-five out of 129 patients included in the HFS database of the Movement Disorders Out-patient Clinic, Department of Neurology, University Hospital, Cracow who fulfilled the inclusion criteria and had no exclusion criteria (suffering from concomitant movement disorders, other severe chronic diseases or cognitive impairment) were studied. Demographic and clinical data (age at onset, disease duration and accompanying symptoms) were collected. Severity of HFS was assessed by the five-point clinical scale and seven-point Clinical Global Impression scale. Quality of life was assessed with the HFS-36 questionnaire and severity of depressive symptoms was evaluated with the Beck Depression Inventory. HFS-36 was performed twice, before BTX-A injection and two weeks later.ResultsThe mean global score of HFS-36 was 47 ± 31 (maximum: 140 pts). Decreased HFS-36 score resulted from divergent deterioration in all subscales included in the questionnaire. Independent risk factors of deterioration in HFS-36 were increased severity of HFS and depressive symptoms as well as accompanying trismus. The HFS-36 score depended on the number and type of accompanying symptoms as well. Botulinum toxin type A therapy led to a significant improvement of HFS-36, particularly high in patients with multiple (> 4) HFS-related symptoms.ConclusionsThe HFS-36 score depends mostly on severity of HFS, depressive symptoms and occurrence of accompanying trismus. It improves after BTX-A treatment.     

Hemifacial spasm non-motor and motor-related symptoms and their response to botulinum toxin therapy

Hemifacial spasm (HFS) is a chronic movement disorder which presents as clonic and/or tonic facial muscle contractions frequently accompanied by many other sensory (visual or auditory disturbances, pain), motor (facial weakness, trismus, bruxism, dysarthria) and/or autonomic (lacrimation, salivation) symptoms. The aim of the study was to assess the occurrence of HFS non-motor and motor-related symptoms and their responsiveness to botulinum toxin type A (BTX-A) therapy. 56 HFS patients were included in the open-label design study. Patients were examined three times: before BTX-A injection, and 2 and 12 weeks later. The occurrence of non-motor and motor-related symptoms was assessed by a special questionnaire, and the severity of HFS was rated by the Clinical Global Impression-Severity scale (CGI-S) and depression symptoms by the Beck Depression Inventory (BDI). Over 81% of the patients before BTX-A therapy reported HFS non-motor and motor-related symptoms. Almost 50% of the patients reported more than three symptoms. The most frequent symptoms were: tearing (44.5%), eye irritation (39.3%), facial paraesthesia (26.8%) and hearing of a “clicking” sound (25.0%). 2 weeks after BTX-A injection 75% of the patients did not report any symptoms and 20% reported only one or two. 3 months later the number of symptoms had increased again, with 57% of patients reporting at least one. The number of HFS non-motor and other symptoms did not correlate with the patients’ age, disease duration and the presence of neuro-vascular conflict, but were positively correlated with the CGI-S and BDI scores. This study showed that muscle contractions in HFS patients are commonly accompanied by non-motor and other motor-related symptoms and most of them are reduced following BTX-A treatment.     

Microvascular decompression of the cochlear nerve in patients with severe tinnitus. Preoperative findings and operative outcome in 22 patients

Abstract

We evaluated the operative outcome in 22 consecutive patients who underwent microvascular decompression (MVO) of the intracranial portion of the cochlear nerve to relieve incapacitating tinnitus and related it to preoperative findings. The patients were selected for operation from the following criteria: severe tinnitus with sensorineural hearing loss and/or changes in brainstem auditory evoked potentials (BAEPs). Fifty percent had unilateral tinnitus. Before operation, 77 patients (77%) had sensorineural hearing loss in their affected ear. BAEPs were abnormal in 27 patients (95%) and acoustic middle ear reflex response was abnormal in six patients (27%). Vascular compression of the cochlear nerve was found in all patients during the operation. After the operation, 33% had relief of their tinnitus (two patients were totally free of tinnitus and five were markedly improved). Eight patients were slightly improved (38%), and the tinnitus did not change in four patients; two patients (70%) became worse. Of the patients with unilateral tinnitus, 63% had relief oftheir tinnitus. In one patient hearing was noticeably improved after the operation. Five patients (23%) had mild to moderate sensorineural hearing loss due to the operation. No other complications were detected. [Neural Res 1998; 20: 242-248]     

肉毒毒素治疗偏侧面肌痉挛伴耳部症状的临床和电生理研究

目的 探讨偏侧面肌痉挛(HFS)伴耳部症状患者耳后肌受累以及A型肉毒毒素耳后肌注射的作用.方法 2009年7月至2010年1月就诊我科临床诊断为特发性HFS,同时伴有耳鸣或杂音、耳中"滴答声"或弹响、耳部不适等耳部症状的63例患者,其中33例于额肌、眼轮匝肌、颧肌及颊肌等常规位点注射(常规组),30例除常规位点外另予以耳后肌注射(耳后组).注射前后记录口轮匝肌和耳后肌的异常肌反应(AMR)、测量峰-峰波幅值;注射后至少4周,平均(29.5±2.5)d时随访.结果 (1)注射后两组患者均有耳部症状缓解,耳后组[76.7％(23/30)]的缓解率比常规组[45.5％(15/33)]更高(x2=6.40,P=0.011).(2)注射后痉挛侧AMR波幅均显著降低.注射前后常规组口轮匝肌波幅(μV)分别为304.0±30.3、129.3±9.6(t=5.820,P=0.000),耳后肌波幅(μV)分别为298.0±33.3、184.7±20.2(t=2.818,P=0.014);注射前后耳后组口轮匝肌波幅(μV)分别为405.3±66.7、116.0±10.0(t=4.214,P=0.001),耳后肌波幅(μV)分别为390.0±53.6、72.0±9.7(t=6.011,P=0.000).(3)在耳后组,注射后耳后肌AMR波幅降低比常规组更明显(t=4.237,P=0.001).结论 在HFS伴耳部症状患者中电生理检测有助于指导治疗;除常规位点外,耳后肌注射可更好地改善患者的耳部症状.     

The auditory characteristics of tinnitus resulting from cerebral injury.

Six patients with tinnitus resulting from head injuries were subjected to a variety of audiometric procedures in an attempt to determine the auditory characteristics of their tinnitus. For all patients but one, it was possible to match the tinnitus frequencies with sinusoidal test tones of specific frequencies. Presenting the matching test tone to the ear contralateral to that in which the tinnitus was heard resulted in a binaural fusion of the test tone and the tinnitus, causing a single sound image to be heard. By raising the intensity of the test tone, it was possible to lateralize the sound image entirely to the ear receiving the test tone, with the other ear silent. Whenever it was possible to fuse a patient's tinnitus with a contralateral test tone, it was also possible to create binaural beats between the tinnitus and the test tone by changing slightly the frequency of the test tone. One patient, W.P., when presented individually with contralateral test tones of the same apparent frequency as his two tinnitus, reported hearing neither his tinnitus nor the test tones. This observation confirms Wegel's report (7) that a tinnitus and a contralateral test tone may “cancel” each other. The only tinnitus that could not be matched by pure tones was the consequence of peripheral nerve damage rather than cortical injury. In general, tinnitus of central origin seems to have the same auditory characteristics as external sounds normally generated; by contrast, tinnitus of peripheral origin does not participate in the same forms of binaural interaction. The different characteristics of these two forms of tinnitus are the basis for the conflicting claims in the literature about the auditory characteristics of tinnitus.     

A different view on the link between tinnitus and cognition; is there a reciprocal link?

Abstract

Tinnitus is the conscious perception of sound in the absence of any corresponding acoustic stimulus and is one of common auditory symptoms. There is some evidence that tinnitus patients suffer from difficulties in cognitive function including attention and memory. However, how exactly tinnitus affects the cognitive functions is still under debate. It seems that there is a reciprocal relationship between tinnitus and cognitive functions like auditory selective attention and working memory. In other words, as tinnitus can disrupt attention and memory functions, alterations in cognitive functions would in turn play an important role in tinnitus generation and persistence. This study reviews the literature on the relationship between tinnitus and cognition from a different view (a likely reciprocal link) and discusses its possible mechanisms.     

Enhancement of steady-state auditory evoked magnetic fields in tinnitus

The steady-state auditory evoked magnetic field and the Pbm, the magnetic counterpart of the second frontocentrally positive middle latency component of the transitory auditory evoked potential, were measured in ten tinnitus patients using a 122-channel gradiometer system. The patients had varying degrees of hearing loss. In all patients, the tinnitus frequency was located above the frequency of the audiometric edge, i.e. the location on the frequency axis above which hearing loss increases more rapidly. Stimuli were amplitude-modulated sinusoids with carrier frequencies at the tinnitus frequency, the audiometric edge, two frequencies below the audiometric edge, and two frequencies between the audiometric edge and the tinnitus frequency. Below the audiometric edge, the root-mean-square field amplitude of the steady-state response computed across the whole head as well as the contralateral and the ipsilateral dipole moment decreased as a function of carrier frequency. With carrier frequency above the audiometric edge, the steady-state response increased again. The amplitudes of the transitory Pbm component were patterned in a qualitatively similar way, but without the differences being significant. For the steady-state response, both whole-head root-mean-square field amplitude and the dipole moment of the sources at the tinnitus frequency showed significant positive correlations with subjective ratings of tinnitus intensity and intrusiveness. These correlations remained significant when the influence of hearing loss was partialled out. The observed steady-state response amplitude pattern likely reflects an enhanced state of excitability of the frequency region in primary auditory cortex above the audiometric edge. The relationship of tinnitus to auditory cortex hyperexcitability and its independence of hearing loss is discussed with reference to loss of surround inhibition in and map reorganization of primary auditory cortex.     

Zentrale Hyperakusis mit Phonophobie bei Multipler Sklerose

Auditory disturbances are a well known symptom in patients with multiple sclerosis (MS). Uni- or bilateral hypacusis or deafness in patients with normal auditory testing is considered to be a result of lesions in the central auditory pathway. Only rarely described is a central phonophobia whereby acoustic stimuli induce unpleasant and painful perceptions, with consecutive avoidance of these factors. Our first patient described acute shooting pain in the right cheek, triggered only through the ringing of a telephone. The second patient had uncomfortable perception of nonverbal noise. For example the wrinkling of paper bags was unbearable for him. The third patient had difficulties localizing the source of sound and disturbing echos while listening to speech or music. Clinically, in all patients symptoms of a brainstem syndrome were found, whereas auditory testing including inspection, audiometry, and stapedius reflex was normal. We found pathological acoustic evoked potentials (AEP) in all three patients with a prolonged latency III-V and T2 lesions in the ipsilateral pons and central auditory pathway. In case one, we suppose a lateral spread between the lateral lemniscus and the central trigeminal pathway. In the other cases, a dysfunction of the central sensory modulation which controls the regulation of sensitivity of incoming acoustic stimuli seems to be the cause of hyperacusis. All our patients developed clinically confirmed MS in the further course after suffering from phonophobia as their first symptom.     

Self-reported auditory problems are associated with adverse mental health outcomes and alcohol misuse in the UK Armed Forces

Purpose

Auditory problems, such as hearing loss and tinnitus, have been associated with mental health problems and alcohol misuse in the UK general population and in the US Armed Forces; however, few studies have examined these associations within the UK Armed Forces. The present study examined the association between auditory problems and probable common mental disorders, post-traumatic stress disorder and alcohol misuse.

Methods

5474 serving and ex-service personnel from the UK Armed Forces were examined, selected from those who responded to phase two (data collection 2007–09) and phase three (2014–16) of a military cohort study. Multivariable logistic regression was used to examine the association between auditory problems at phase two and mental health problems at phase three.

Results

9.7% of participants reported ever experiencing hearing problems alone, 7.9% reported tinnitus within the last month alone, and 7.8% reported hearing problems with tinnitus. After adjustment, hearing problems with tinnitus at phase two was associated with increased odds of probable common mental disorders (AOR = 1.50, 95% CI 1.09–2.08), post-traumatic stress disorder (AOR = 2.30, 95% CI 1.41–3.76), and alcohol misuse (AOR = 1.94, 95% CI 1.28–2.96) at phase three. Tinnitus alone was associated with probable post-traumatic stress disorder (AOR = 1.80, 95% CI 1.03–3.15); however, hearing problems alone were not associated with any outcomes of interest.

Conclusions

The association between auditory problems and mental health problems emphasises the importance of the prevention of auditory problems in the Armed Forces: through enhanced audiometric screening, improved hearing protection equipment, and greater levels of utilisation of such equipment.

     

Hemifacial spasm caused by cross type vascular compression

Abstract

Objectives: The meatal segment of anterior inferior cerebellar artery usually crosses over the gap between cranial nerves VII and VIII, and may compress the cisternal portion (CP) of the facial nerve. This is defined as cross type compression, which is easy to be neglected and thus leads to poor outcome. Here our experience in treating patients of cross type hemifacial spasm (HFS) is reported.

Methods: Twenty-one patients of HFS due to cross type compression were treated with microvascular decompression (MVD) surgery with the aid of abnormal muscle response monitoring.

Results: In addition to cross type compression at CP, there were typical vascular compressions on the root exit zone and attached segment in 20 cases. After MVD surgery, 17 patients were cured, 3 patients achieved good resolution of spasm, and the other 1 patient got delayed resolution. Three patients had postoperative transient hearing loss and/or tinnitus.

Discussion: Even there are apparently typical vascular compressions at proximal portion of the facial nerve, the surgeon should be aware that cross type compression at the CP may co-exist. With the aid of abnormal muscle response (AMR) monitoring, MVD is efficient for patients due to cross type compression.     

Using Extracochlear Multichannel Electrical Stimulation to Relieve Tinnitus and Reverse Tinnitus-Related Auditory-Somatosensory Plasticity in the Cochlear Nucleus

ObjectivesTinnitus has no reliable cure but may be significantly relieved by the usage of cochlear implants. However, not all tinnitus patients necessitate cochlear implantation that can impair hearing. This study was to investigate whether a novel extracochlear electrical stimulation (EES) strategy could relieve tinnitus of guinea pigs without hearing impairment, and the roles of auditory-somatosensory plasticity in the cochlear nucleus in the tinnitus relief.Materials and MethodsWe used a novel four-electrode extracochlear implant to electrically stimulate the cochlea of tinnitus guinea pigs. Tinnitus was assessed by the gap-prepulse inhibition of the acoustic startle reflex (GPIAS) ratios and the tinnitus index. The plasticity of auditory and somatosensory innervation in the different subdivisions of cochlear nucleus was evaluated by immunostaining of vesicular glutamate transporter 1 (VGLUT1) and VGLUT2, respectively.ResultsThe EES induced significant decreases of GPIAS ratios and the tinnitus index of tinnitus guinea pigs, indicating reductions of tinnitus behavioral manifestations. Meanwhile, the EES reversed the abnormal auditory-somatosensory innervation in the cochlear nucleus of tinnitus animals but did not change the hearing and the numbers of inner hair cell synapses.ConclusionsThis study demonstrated that the novel EES strategy could effectively relieve tinnitus without impairment to hearing and cochlear structure of tinnitus animals. The reversal of tinnitus-related auditory-somatosensory plasticity in the cochlear nucleus was correlated with the tinnitus relief induced by the EES.     

Early evoked potentials in patients with acoustic neuroma.

Using clicks with varying interstimulus intervals and coherent tone-bursts, early components of the auditory evoked potential (brain stem responses) were studied in four patients with confirmed acoustic neuroma. Abnormalities in responses appeared with shorter interstimulus intervals and with tone-bursts delivered monaurally to the involved ear; bilateral alterations occurred in one patient with brain stem displacement. The results indicate that BSR can provide a stable, independent, noninvasive measure of auditory nerve function useful in the early detection of acoustic neuroma. The results contribute to the understanding of the so-called human FFR.     

Transcranial magnetic stimulation and acoustic trauma or hearing loss in children.

Transcranial magnetic stimulation is a non-invasive method used to assess motor function in humans; however, some reports suggest it may cause internal ear damage (cochlear). Eighteen patients with normal auditory function (ages 2 months to 16 years, mean 6.8 years), two medical doctors and two technicians who performed the studies were tested with brain stem auditory evoked potentials, otoacoustic emissions, acoustic reflex and a pure tone audiometric and logoaudiometric test when possible, before and after transcranial magnetic stimulation for central motor conduction studies in different neurological conditions. All the tests were repeated two weeks and two months later. Patients had no auditory protection nor history of seizures. Motor evoked potentials and silent periods were recorded from the right abductor pollicis brevis and the first dorsal interosseous muscles at rest and during weak voluntary contraction when possible. A mean of 48 transcranial magnetic stimulations with 50%-75% Tesla intensity were used. Natural logarithmic transformation of latency and amplitude data had a normal distribution. There were no significant differences in auditory function testing.     

Endonasal approach of salpingopharyngeus muscle for the treatment of ear click related to palatal tremor

Palatal tremor (PT) is a rare disease associated with rhythmic movements of the soft palate. It can be separated into two distinct clinical entities: symptomatic and essential. Most patients with essential PT complain of the rhythmic ear clicks and in some cases tinnitus, but usually have an uneventful medical history. Symptomatic PT patients are often unaware of the palatal movements and have symptoms and signs of brainstem or cerebellar dysfunction. We describe the case of a 25-year-old patient who developed severe essential PT, with very distressing bilateral objective tinnitus, constantly perceived as ear clicks. Several oral medications were prescribed with poor results. No significant improvement was obtained with repetitive injections of botulinum toxin type A (BTX A) distributed in soft palate muscles. Because of the continuous tinnitus and its impact on the patient's quality of life, chemical denervation of the salpingopharyngeus muscles, which is involved in the production of tinnitus, with BTX A was performed endonasally under endoscopic guidance. The result was very satisfactory. Tinnitus due to essential PT may be satisfactorily treated by endonasal injection of BTX into the salpingopharyngeus and palatopharyngeus muscles.     

听神经病在纯音听阈测听和声导抗检查中的特征性表现

目的 探讨听神经病在纯音听阈测听及声导抗检查中的临床听力学特点及诊断要点.方法 回顾性分析中山大学附属第三医院耳鼻喉科收治的17例(32耳)听神经病确诊患者在纯音听阈测听、声导抗检查中的听力学特点.结果 17例患者中15例为双侧发病,呈左右对称性听力曲线;26耳以轻至中度低频感音性聋为主(听力图上升型);病程<5年的听力损失主要为轻度、中度听力障碍(17/32耳),病程>5年的听力损失主要为重度、极重度听力障碍.16例(31耳)声导抗为"A"型鼓室图,15例(30耳)同侧及交叉镫骨肌声反射均未引出,2例(2耳)镫骨肌声反射阈值升高.结论 听神经病在纯音听阔测听及声导抗检查中主要表现为:(1)为双侧对称性、渐进性听力下降;(2)早期为低频上升型听力图,后期为全频听力下降;(3)呈"A"型鼓室图,镫骨肌声反射阈值升高或引不出;(4)患耳无响度重振现象.     

听神经病在纯音听阈测听和声导抗检查中的特征性表现

目的 探讨听神经病在纯音听阈测听及声导抗检查中的临床听力学特点及诊断要点.方法 回顾性分析中山大学附属第三医院耳鼻喉科收治的17例(32耳)听神经病确诊患者在纯音听阈测听、声导抗检查中的听力学特点.结果 17例患者中15例为双侧发病,呈左右对称性听力曲线;26耳以轻至中度低频感音性聋为主(听力图上升型);病程<5年的听力损失主要为轻度、中度听力障碍(17/32耳),病程>5年的听力损失主要为重度、极重度听力障碍.16例(31耳)声导抗为"A"型鼓室图,15例(30耳)同侧及交叉镫骨肌声反射均未引出,2例(2耳)镫骨肌声反射阈值升高.结论 听神经病在纯音听阔测听及声导抗检查中主要表现为:(1)为双侧对称性、渐进性听力下降;(2)早期为低频上升型听力图,后期为全频听力下降;(3)呈"A"型鼓室图,镫骨肌声反射阈值升高或引不出;(4)患耳无响度重振现象.     

Intrinsic network activity in tinnitus investigated using functional MRI

Tinnitus is an increasingly common disorder in which patients experience phantom auditory sensations, usually ringing or buzzing in the ear. Tinnitus pathophysiology has been repeatedly shown to involve both auditory and non‐auditory brain structures, making network‐level studies of tinnitus critical. In this magnetic resonance imaging (MRI) study, two resting‐state functional connectivity (RSFC) approaches were used to better understand functional network disturbances in tinnitus. First, we demonstrated tinnitus‐related reductions in RSFC between specific brain regions and resting‐state networks (RSNs), defined by independent components analysis (ICA) and chosen for their overlap with structures known to be affected in tinnitus. Then, we restricted ICA to data from tinnitus patients, and identified one RSN not apparent in control data. This tinnitus RSN included auditory–sensory regions like inferior colliculus and medial Heschl's gyrus, as well as classically non‐auditory regions like the mediodorsal nucleus of the thalamus, striatum, lateral prefrontal, and orbitofrontal cortex. Notably, patients' reported tinnitus loudness was positively correlated with RSFC between the mediodorsal nucleus and the tinnitus RSN, indicating that this network may underlie the auditory–sensory experience of tinnitus. These data support the idea that tinnitus involves network dysfunction, and further stress the importance of communication between auditory–sensory and fronto‐striatal circuits in tinnitus pathophysiology. Hum Brain Mapp 37:2717–2735, 2016. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc .     

听神经病在纯音听阈测听和声导抗检查中的特征性表现

目的 探讨听神经病在纯音听阈测听及声导抗检查中的临床听力学特点及诊断要点.方法 回顾性分析中山大学附属第三医院耳鼻喉科收治的17例(32耳)听神经病确诊患者在纯音听阈测听、声导抗检查中的听力学特点.结果 17例患者中15例为双侧发病,呈左右对称性听力曲线;26耳以轻至中度低频感音性聋为主(听力图上升型);病程<5年的听力损失主要为轻度、中度听力障碍(17/32耳),病程>5年的听力损失主要为重度、极重度听力障碍.16例(31耳)声导抗为"A"型鼓室图,15例(30耳)同侧及交叉镫骨肌声反射均未引出,2例(2耳)镫骨肌声反射阈值升高.结论 听神经病在纯音听阔测听及声导抗检查中主要表现为:(1)为双侧对称性、渐进性听力下降;(2)早期为低频上升型听力图,后期为全频听力下降;(3)呈"A"型鼓室图,镫骨肌声反射阈值升高或引不出;(4)患耳无响度重振现象.     

Deafness associated with vertebrobasilar insufficiency.

The incidence of auditory disturbances in vertebrobasilar insufficiency (VBI) is considered much rarer than vestibular disturbances, but no routine audiometric test results for VBI patients have been published. To determine the incidence of deafness associated with VBI and the sites predominantly involved in deafness, we studied 70 vertiginous patients with VBI using a routine audiological examination and magnetic resonance imaging (MRI). MRI detected a lacunar infarct involving the cochlear nuclei in one patient, but lacunae did not involve central auditory structures in the other patients. Twenty-five patients experienced tinnitus, deafness, or both, during vertigo episodes. Audiological examinations confirmed the development of unilateral deafness in 15 (21%) patients, involving the cochlea in 14 and cochlear nuclei in one. These findings indicate that hearing loss occurs in approximately one-fifth of VBI patients, much less frequently than vestibular disturbances, and that deafness associated with VBI mainly involves the cochlea.     

Rapid increases of gamma power in the auditory cortex following noise trauma in humans

Tinnitus is an auditory perception in the absence of any external sound source. It has been suggested that tinnitus is related to enhanced synchronization of neuronal activity in the auditory cortex. Usually a hearing damage can be identified suggesting auditory deprivation to central auditory regions to be fundamental for neurophysiological processes related to tinnitus. Until now, human research has been conducted on patients with chronic tinnitus (>6 months). However, neuronal activity accompanying auditory deprivation and putatively tinnitus may not remain constant over time, making it difficult to directly relate outcomes of current animal studies (acute tinnitus) to chronic tinnitus in humans, and vice versa. We investigated 14 amateur rock musicians who frequently reported a short-term tinnitus immediately after band practice. Magnetoencephalographic resting-state recordings, audiometry and tinnitus testing were performed at two separate occasions: with and without previous exposure to loud music. Analyses revealed that transient tinnitus was accompanied by temporary hearing loss in both ears and increased gamma activity in the right auditory cortex in 13 out of 14 cases. Additionally, tinnitus frequency was strongly correlated to hearing loss. Analogous to animal studies, our results show for the first time in humans that noise trauma leads rapidly to increased neuronal synchrony in the auditory cortex. Importantly, the strongly right-lateralized effect implies that it does not reflect tinnitus percept per se. This could rather have been triggered by greater discontinuities of hearing loss at high frequencies that were particularly pronounced in the left ear.