Noise-induced tinnitus: auditory evoked potential in symptomatic and asymptomatic patients

OBJECTIVES:

We evaluated the central auditory pathways in workers with noise-induced tinnitus with normal hearing thresholds, compared the auditory brainstem response results in groups with and without tinnitus and correlated the tinnitus location to the auditory brainstem response findings in individuals with a history of occupational noise exposure.

METHOD:

Sixty individuals participated in the study and the following procedures were performed: anamnesis, immittance measures, pure-tone air conduction thresholds at all frequencies between 0.25–8 kHz and auditory brainstem response.

RESULTS:

The mean auditory brainstem response latencies were lower in the Control group than in the Tinnitus group, but no significant differences between the groups were observed. Qualitative analysis showed more alterations in the lower brainstem in the Tinnitus group. The strongest relationship between tinnitus location and auditory brainstem response alterations was detected in individuals with bilateral tinnitus and bilateral auditory brainstem response alterations compared with patients with unilateral alterations.

CONCLUSION:

Our findings suggest the occurrence of a possible dysfunction in the central auditory nervous system (brainstem) in individuals with noise-induced tinnitus and a normal hearing threshold.     

Different patterns of gray matter atrophy in early- and late-onset Alzheimer’s disease

We assessed patterns of gray matter atrophy according to-age-at-onset in a large sample of 215 Alzheimer’s disease (AD) patients and 129 control subjects with voxel-based morphometry using 3-Tesla 3D T1-weighted magnetic resonance imaging. Local gray matter amounts were compared between late- and early-onset AD patients and older and younger control subjects, taking into account the effect of apolipoprotein E. Additionally, combined effects of age and diagnosis on volumes of hippocampus and precuneus were assessed. Compared with age-matched control subjects, late-onset AD patients exhibited atrophy of the hippocampus, right temporal lobe, and cerebellum, whereas early-onset AD patients showed gray matter atrophy in hippocampus, temporal lobes, precuneus, cingulate gyrus, and inferior frontal cortex. Direct comparisons between late- and early-onset AD patients revealed more pronounced atrophy of precuneus in early-onset AD patients and more severe atrophy in medial temporal lobe in late-onset AD patients. Age and diagnosis independently affected the hippocampus; moreover, the interaction between age and diagnosis showed that precuneus atrophy was most prominent in early-onset AD patients. Our results suggest that patterns of atrophy might vary in the spectrum of AD.     

High frequency localised “hot spots” in temporal lobes of patients with intractable tinnitus: A quantitative electroencephalographic (QEEG) study

Tinnitus, the perception of noise in the absence of an external auditory stimulus, is common, frequently distressing and often intractable. It is associated with a number of conditions including deafness but may arise spontaneously. Brain imaging studies indicate increased neuronal excitability and decreased density of benzodiazepine receptors in temporal (auditory) cortex but the source and mechanism of such changes are unknown. Various electroencephalographic (EEG) abnormalities involving temporal lobe and other brain areas have been described but recordings have been limited to standard EEG wave bands up to frequencies of 22 Hz. This clinical study of otherwise healthy patients with intractable unilateral tinnitus, using quantitative EEG power spectral mapping (QEEG), identified discrete localised unilateral foci of high frequency activity in the gamma range (>40–80 Hz) over the auditory cortex in eight patients experiencing tinnitus during recording. These high frequency “hot spots” were not present in 25 subjects without tinnitus. The results suggest that further EEG investigations should include recordings in the gamma frequency range since such high frequency oscillations are believed to be necessary for perception. Identification of “hot spots” in tinnitus patients would provide a means for monitoring the effects of new treatments. These findings may also provide a model for exploration of more complex phenomena such as verbal and musical hallucinations.     

Frontal-parietal responses to “oddball” stimuli depicting “fattened” faces are increased in successful dieters: An electroencephalographic study

Here we tested the hypothesis that compared with normal weight non dieting (control) subjects, normal weight successful dieters submitted to a rigorous and continuous monitoring of body weight (i.e. karate athletes) are characterized by an increase of cortical responses to oddball visual stimuli depicting the enlargement of faces or foods, as neural underpinning of attention processes related to the control of weight and eating. Electroencephalographic (EEG) data were recorded in 18 successful dieters (5 females) and 24 non dieting subjects (9 females). The subjects were given frequent (70%) and rare (30%) stimuli depicting faces (FACE), food (FOOD), and landscapes (CONTROL). The task was to click the mouse after the rare stimuli. The rare stimuli depicted the frequent stimuli graphically dilated by 25% along the horizontal axis. Cortical responses accompanying attention processes were probed by the difference between positive event-related potentials peaking around 400-500 ms post-stimulus for the rare minus frequent stimuli (P300). The popular freeware LORETA estimated P300 cortical sources. The results showed that in the FACE condition, the amplitude of left frontal (BA 6) and medial parietal (BA 5) P300 sources was higher in the successful dieters (karate athletes) than non dieting subjects. These results disclose that frontal-parietal responses to “oddball” stimuli depicting enlarged faces (i.e. representing face fattening) are enhanced in successful dieters (karate athletes). Future studies should evaluate this effect in other populations of successful dieters (i.e. boxers, top models etc.).     

Electrophysiological evidence for cross-modal plasticity in humans with early- and late-onset blindness

It is commonly believed that sensory deprivation can lead to cross-modal reorganization in an immature hut not in a mature brain. The results of the present study suggest, however, that plasticity between sensory modalities is possible even in adults: activity indicating involvement of parietal or occipital brain areas in pitch-change discrimination was found in individuals blinded after childhood. Event-related brain potentials of early blinded (before the age of 2 years). late-blinded (12–28 years of age), and sighted adults were recorded to stimulus sequences consisting of standard tones occasionally replaced by deviant tones. Even when participants were not attending to auditory stimuli, the deviant tones elicited the mismatch negativity (MMN) in each group. There were no significant MMN front-back scalp distribution differences among the groups. However, when participants were detecting deviant stimuli, these stimuli elicited N2 and P3 waves that were posterior in distribution in both groups of blind participants relative to those of the sighted participants. These results suggest that cross-modal reorganization may occur even in the mature human brain.     

Argyrophilic grains in late-onset Creutzfeldt–Jakob diseased brain

Braak's argyrophilic grains (ArG) are spindle-shaped structures originally described in patients with dementia. Herein, a unique case of sporadic Creutzfeldt-Jakob disease (CJD) accompanied by numerous ArG is presented. The pathological picture was typical of CJD based on the findings of routine hematoxylin-eosin staining. The highest density of ArG was observed throughout the parahippocampal gyrus and the temporal gyri; however, the sector CA1 of the hippocampus showed less ArG. An immunohistochemical analysis for prion protein (PrP) revealed diffuse fine neuropil staining in the cerebral cortex, while the ArG themselves did not demonstrate any immunoreaction for PrP. No correlation was observed between the densities of ArG and either the presence of senile plaques, neurofibrillary tangles or neuropil threads in the present case. To our knowledge, this is the first report of CJD demonstrating numerous ArG.     

Associations of collective self-help activity,health literacy and quality of life in patients with tinnitus

Objective

About 800 of the 13,000 members of the German Tinnitus Association (DTL) are active in self-help groups (SHGs). This study analyzes whether SHG-participation is associated with tinnitus-related Health Literacy (HLit) and Quality of Life (QoL).

Sex differences in blood cell counts in the Lothian Birth Cohort 1921 between 79 and 87 years

Background

Haematological abnormalities are important to detect. In older adults there are few data that inform about normal ranges and the change in blood cell counts with ageing. These few data indicate that sex differences in blood cell counts persist beyond 70 years.

Objective

To determine normal ranges for blood cell counts and changes in counts and to examine the relationship between different blood cell counts for men and women.

Methods

The sample comprised Lothian Birth Cohort 1921 (LBC1921) participants seen at a mean of about 79 and 87 years of age. Full blood count was measured on each occasion. Also recorded were weight, smoking status, years of full-time education, and main occupation, serum B12, folate and creatinine.

Results

We examined blood cell counts in 495 community-resident people with mean age 79.1 (range 77.8–80.6) and repeated this in 157 of them at mean age 86.7 (range 85.7–87.4) years. Normal ranges were similar for men and women for all blood cell types at both ages, but men had persistently significantly higher mean red cell and monocyte counts, and women significantly higher platelet counts. Between 79 and 87 years, red cell, lymphocyte and eosinophil counts fell significantly, neutrophil and platelet counts increased, and monocyte count was stable. Worsening renal function was associated with a decrease in mean red cell count.

Conclusion

Changes in blood cell counts in this cohort are consistent with persistent sex differences, age-related changes in renal function (red cells), background inflammation (neutrophils and platelets) and immunosenescence (lymphocytes).     

Assessing audiological, pathophysiological, and psychological variables in chronic tinnitus: A study of reliability and search for prognostic factors

The development and course of chronic tinnitus are determined by both biological and psychological factors. To combine these different sources of data, we developed a standardized interview to assess tinnitus history, summarize audiological fmdings, screen for etiological conditions, and explore tinnitus-related psychological complaints (Structured Tinnitus Interview). The results of a test-retest study with 65 tinnitus inpatients show that most of these components can be assessed with acceptable or high reliability. Further data based on 166 patients demonstrate that tinnitus annoyance was to some extent different from patterns of general psychological complaints, although there were medium intercorrelations with depression. Significant predictors of tinnitus annoyance were (a) continuous tinnitus without intervals, (b) hearing loss, (c) increasing tinnitus loudness over time, (d) poor maskability, (e) history of sudden hearing loss, and (f) associated craniomandibular disorder. Psychological distress was not significantly increased in patients whose tinnitus was associated to vascular disorder, cervical spine dysfunction, acoustic trauma, Menihre’s disease, or neurological disorder.     

Spontaneous phasic activity in the brain: differences between waves in lateral geniculate and central lateral nuclei across sleep states

SUMMARY  Ponto-geniculo-occipital (PGO) waves are spontaneously-occurring macropotential waveforms recorded in the pons, lateral geniculate body (LGB) and occipital cortex. PGO waves mark the onset and course of rapid eye movement sleep (REM). PGO-like waves can be recorded in several brain areas including the thalamic central lateral nucleus (CL). Alerting stimuli elicit PGO waves (PGO_E) from LGB and waves from CL (CL_E) in all behavioural states. We compared spontaneous activity in LGB and CL across behavioral states to examine the relationship of CL waves to PGO waves. Spontaneous waves in LGB and CL may occur concurrently or separately in all states. Although REM is marked by a high level of LGB PGO activity, CL waves are rare. Frequencies of CL and LGB waves are similar in non-REM (NREM) although the waves do not necessarily occur at the same time. These findings suggest that the widespread phasic activity recorded throughout the brain in sleep cannot be assumed to be a non-specific unitary phenomenon propagated from a single brainstem generator.     

Age-related increase in brain activity during task-related and -negative networks and numerical inductive reasoning

Objective: Recent neuroimaging studies have shown that elderly adults exhibit increased and decreased activation on various cognitive tasks, yet little is known about age-related changes in inductive reasoning. Methods: To investigate the neural basis for the aging effect on inductive reasoning, 15 young and 15 elderly subjects performed numerical inductive reasoning while in a magnetic resonance (MR) scanner. Results: Functional magnetic resonance imaging (fMRI) analysis revealed that numerical inductive reasoning, relative to rest, yielded multiple frontal, temporal, parietal, and some subcortical area activations for both age groups. In addition, the younger participants showed significant regions of task-induced deactivation, while no deactivation occurred in the elderly adults. Direct group comparisons showed that elderly adults exhibited greater activity in regions of task-related activation and areas showing task-induced deactivation (TID) in the younger group. Conclusions: Our findings suggest an age-related deficiency in neural function and resource allocation during inductive reasoning.     

High-frequency priming stimulation does not enhance the effect of low-frequency rTMS in the treatment of tinnitus

Based on its ability to reduce the excitability of the cortex locally, low-frequency repetitive transcranial magnetic stimulation (rTMS) has been investigated for the treatment of hyperexcitability disorders such as auditory hallucinations and tinnitus. Results are promising, but characterized by only moderate improvement and a high inter-individual variability. Experimental data from motor cortex stimulation in healthy subjects indicates that the depressant effect of low-frequency rTMS can be enhanced by high-frequency priming stimulation. Here we will investigate whether high-frequency priming also improves the therapeutic efficacy of low-frequency rTMS in a clinical application. 32 patients with chronic tinnitus were randomly assigned to either a standard protocol of low-frequency rTMS (110% motor threshold, 1 Hz, 2000 stimuli/day) or a stimulation protocol in which priming stimulation with 6 Hz (90% motor threshold, 960 stimuli) preceded low-frequency rTMS (110% motor threshold, 1 Hz, 1040 stimuli/day). Stimulation was applied over the left auditory cortex by using MRI-guided coil positioning. The treatment outcome was assessed with a standardized tinnitus questionnaire. There was no significant difference between the standard protocol and the protocol involving priming stimulation. Both stimulation protocols resulted in significant clinical improvement after 10 days of stimulation, as compared to baseline. Our data does not support an enhancing effect of higher frequency priming on low-frequency rTMS in the treatment of tinnitus. Clinical trial registration: Priming stimulation as an enhancement of low-frequency repetitive Transcranial Magnetic Stimulation (rTMS) for the treatment of tinnitus - .     

Changes in brain activity patterns in aging: The novelty oddball

A decrease in the frontal lobes' efficiency is supposed to play a role in age-related changes in cognitive function. If frontal lobes are involved in the maintenance of working memory, the elderly may require increased frontal activity because of more rapid memory decay. This is consistent with the fact that the P3 component of the eventrelated potential (ERP) has a more frontal orientation with increasing age. However, frontally distributed P3s are also observed in young people when novel stimuli are unexpectedly presented in an oddball paradigm. Young and old subjects were run in an auditory novelty oddball in which ERPs were recorded from 30 scalp sites. The young adults' P3s showed either a posterior (targets) or more frontally oriented (novels) scalp focus. The elderly were less accurate in their memory for the novel stimuli, and their P3s showed anterior and posterior foci to both targets and novels. The young adults' target P3s changed over time from a frontal to a posterior focus, whereas the old adults' did not. These results are consistent with decreased ability of the elderly to maintain the templates needed for stimulus categorization.     

Chromosomal comparative genomic hybridization abnormalities in early- and late-onset human breast cancers: correlation with disease progression and TP53 mutations

Nearly 30% of the breast cancer patients in the Taiwanese community have their diseases diagnosed before the age of 40. Their 5-year survival rate is poorer than that of their late-onset breast cancer counterparts. Genomic abnormalities between these two breast cancer age groups were compared using comparative genomic hybridization (CGH) analyses. The sample set was made up of 44 early-onset (<35 years old) and 54 late-onset cases (>63 years old). Frequent CGH changes were noted, such as gains on 8q, 1q, and 17q and losses on 16q, 17p, and 8p. These were very similar for the two age groups, as well as for Taiwanese women and other ethnic populations. In contrast, several less common lesions, such as gains on 16p and 8p and losses on 11q and 9p, were significantly different between the early- and late-onset breast tumors. In addition, more profound chromosomal changes were consistently associated with the more advanced-stage tumors, and less expression of the estrogen and the progesterone receptors, and of HER-2/neu. About 19% of the breast cancers examined carried a TP53 mutation in exons 4-9. Of these, 88% (15/17) were missense point mutations and these were distributed randomly along the tested gene fragments without apparent clustering, as has been shown in certain other ethnic or regional studies. On average, patients carrying these TP53 mutations had 9.5 CGH lesions per case, compared to only 2.8 changes in samples that had no TP53 mutation. Our results indicate that certain genomic lesions, especially 11q loss, may play a role in early-onset breast tumor formation, and that combined use of genomic patterns and molecular targets may provide a useful tool for diagnostic, therapeutic, and prognostic purposes.     

MCI patients’ EEGs show group differences between those who progress and those who do not progress to AD

The theta/gamma and alpha3/alpha2 ratio were investigated as early markers for prognosticating of progression to dementia. 76 subjects with mild cognitive impairment (MCI) underwent EEG recording, MRI scans and neuropsychological (NPS) tests. After 3 years of follow-up, three subgroups were characterized as converters to Alzheimer's disease (AD, N = 18), converters to non-AD dementia (N = 14) and non-converters (N = 44). The theta/gamma and alpha3/alpha2 ratio, performance on cognitive tests and hippocampal volume, as evaluated at the time of initial MCI diagnosis, were studied in the three groups. As expected, MCI to AD converters had the smallest mean hippocampal volume and poorest performance on verbal learning tests, whereas MCI to non-AD converters had poorest cognitive performance in non-verbal learning tests, abstract thinking, and letter fluency. Increased theta/gamma ratio was associated with conversion to both AD and non-AD dementia; increased alpha3/alpha2 ratio was only associated with conversion to AD.Theta/gamma and alpha3/alpha2 ratio could be promising prognostic markers in MCI patients. In particular, the increase of high alpha frequency seems to be associated with conversion in AD. EEG markers allow a mean correct percentage of correct classification up to 88.3%. Future prospective studies are needed to evaluate the sensitivity and specificity of these measures for predicting an AD outcome.