Traitement des acouphènes : aspects neurochirurgicaux

Tinnitus is a very frequent symptom affecting 10% of the general population. It corresponds to the perception of an internal noise that can severely impair the quality of life. Tinnitus management requires a multidisciplinary approach in which neuromodulation and neurosurgery tend to play major roles. Classification of tinnitus separates objective tinnitus (i.e., tinnitus that can be heard or recorded) from the more frequent subjective tinnitus (i.e., tinnitus only perceived by the patient). Objective tinnitus is either pulsatile synchronous with heartbeat or asynchronous. In the former, appropriate radiological testing should search for a vascular abnormality as well as other neurological diseases (intracranial hypertension, Arnold-Chiari malformation, vascular loops, etc.). Asynchronous objective tinnitus generally corresponds to muscular contractions that require specific management. The pathophysiology of subjective tinnitus is more complex, showing strong analogies with postamputation pain syndromes. After peripheral middle ear or inner ear damage, auditory deafferentation could result in hyperactivity and/or functional reorganization within central auditory and nonauditory structures. This could explain the persistence of tinnitus after total hearing amputation (e.g., translabyrinthine approach for vestibular schwannoma) and associated symptoms such as hyperacusis or anxiety and depression. This central model finds strong support in animal experiments and in functional neuroimagery (PET, fMRI, MEG). Since no etiologically based therapies are currently available, severe subjective tinnitus management only targets tinnitus tolerance with sound enrichment or cognitive behavior therapy. However, in the near future better knowledge of tinnitus pathophysiology and innovative therapeutic tools could emerge from neuromodulation techniques such as repeated transcranial magnetic or epidural electric stimulation.     

Bifenestral surgical and chemical labyrinthectomy,a new effective ablative surgical approach to intractable vertigo in Ménière disease elderly patients

IntroductionIn this article, the bi-fenestral surgical chemical labyrinthectomy is introduced as a surgical demolition technique for treating resisting incurable forms of Meniere’s disease in patients aged over 70 and/or with low hearing residues refractory to medical treatment.Materials and methodsThe results on participants fitting the inclusion criteria (n = 16) were reported using anamnesis (frequency of the crisis), Dizziness Handicap Inventory (DHI) and Functional Level Scale (FLS) before and after the intervention.ResultsVertigo control was achieved in all patients of this case series. A difference of 57 and 3.67 in mean DHI (from 68 (SD 16.7) to 11 (SD 14)) and FLS (from 4.68 (SD 0.7) to 0.1 (SD 0.3)) scores respectively were seen after an average of 16.28 months. Contextually tinnitus was reported to improve in seven patients (43.75%), aggravate in three (18.75%) and remain unchanged in the remaining six (37.5%).ConclusionBi-fenestral surgical chemical labyrinthectomy appears a safe, immediate, and effective demolition treatment for vertigo control in a restricted class of patients affected by intractable Meniere disease.     

Auditory cortex hyperconnectivity before rTMS is correlated with tinnitus improvement

IntroductionRepetitive transcranial magnetic stimulation (rTMS) has been used as a potential treatment for tinnitus; however, its effectiveness is variable and unpredictable. We hypothesized that resting-state functional connectivity before rTMS may be correlated with rTMS treatment effectiveness.MethodsWe applied 1-Hz rTMS to the left primary auditory (A1) and dorsolateral prefrontal cortices (DLPFC) of 10 individuals with tinnitus and 10 age-matched controls. Resting-state functional magnetic resonance imaging (fMRI) studies were performed approximately one week before rTMS. Seed-based connectivity analyses were conducted for each individual, with seed regions as rTMS target areas.ResultsCompared to controls, the left superior temporal areas showed significantly increased positive connectivity with the left A1 and negative connectivity with the left DLPFC in the tinnitus group. The left frontoparietal and right cerebellar areas showed significantly increased negative connectivity with the left A1 and positive connectivity with the left DLPFC. Seed-based hyperconnectivity was correlated with tinnitus improvement (pre-rTMS vs. 2-week post-rTMS Tinnitus Handicap Inventory scores). Tinnitus improvement was significantly correlated with left A1 hyperconnectivity; however, no correlation was observed with left DLPFC connectivity. Positive rTMS outcomes were associated with significantly increased positive connectivity in bilateral superior temporal areas and significantly increased negative connectivity in bilateral frontal areas.ConclusionsOur results suggest that oversynchronisation of left A1 connectivity before rTMS of the left A1 and DLPFC is associated with treatment effectiveness.     

Psychometric properties of a Chinese (Cantonese) version of the Tinnitus Questionnaire

The objective of this study was to determine the psychometric properties of a Chinese (Cantonese) version of the Tinnitus Questionnaire (TQ), which is a psychometric self-report measure of perceived tinnitus-related distress. The subjects were 114 adults who attended audiology clinics with a primary or secondary complaint of tinnitus. They completed the Chinese versions of the TQ (TQ-CH), Short-Form 36 Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). The subjective severity of tinnitus and tinnitus-related problems were scored using rating scales. The TQ-CH and its subscales had good internal consistency reliability estimates (α=0.75–0.94), which were comparable to those of the original version. Significant correlations were observed between the TQ-CH and psychological distress, tinnitus-related problem ratings, and severity ratings. Factor analysis showed the high construct validity of the TQ-CH subscales. High test-retest reliablity (intraclass correlation coefficient=0.96) was observed. The results suggest that the TQ-CH is a reliable and valid measure of general tinnitus-related distress that can be used in clinical settings to quantify the impact of tinnitus on daily living.     

Efficacy of photobiomodulation in the management of tinnitus: A systematic review of randomized control trials

There is a controversy in regards to the efficacy of photobiomodulation (PBM) in the management of tinnitus. The aim was to systematically review randomized controlled trials (RCTs) that assessed the efficacy of PBM (low-level laser therapy) in the management of tinnitus. The focused question was “Is PBM effective in the management of tinnitus?”. Indexed databases were searched up to and including June 2020 using different combinations of the following key words: (a) laser; (b) diode; (c) low-level laser therapy; (d) photobiomodulation; (e) tinnitus; (f) medium-level laser; (g) photo-biomodulation; and (h) low-power laser; and RCTs performed on humans were included. Letters to the editor; case reports/series; commentaries; experimental studies and historic reviews were excluded. The risk of bias was assessed using the modified cochrane collaboration tool. The format of the current systematic review was personalized to summarize the appropriate information. Ten RCTs (2 single-blinded and 8 double-blinded) were included. One study reported 30% and 100% resolution of tinnitus using diode and Neodymium-doped Yttrium Aluminum Garnet lasers; respectively. One study reported that PBM was effective in relieving tinnitus for up to 3 months. Eight studies reported that PBM was ineffective in the management of chronic tinnitus. The risk of bias was high; medium and low in 4; 5 and 1 studies; respectively. The effectiveness of PBM in the management of tinnitus remains debatable. Further power-adjusted and well-designed RCTs with long-term follow-up are needed.     

Undetected Metallic Chopstick Stabbed on Neck Resulting Tinnitus and Foreign Body Sensation

Penetrating neck injuries constitute 5-10% of all trauma cases. These injuries may cause life-threatening suppurative or vascular complications, but the severity and extent of damage depends upon the inflicting object and the involved structures. If significant complications are not expected, then it is best to leave the foreign body embedded and avoid surgical risks. We present a rare case of a foreign body embedded in the neck causing tinnitus and foreign body sensation.     

耳鸣患者1/24倍频程精细化纯音测试结果分析

目的了解精细化匹配耳鸣位点与听损最大点之间的关系,分析耳鸣患者听力及临床特征与耳鸣的关系。方法对常频听力正常及异常组均进行1/24倍频程精细化纯音测听,寻找听损最大点及耳鸣位点;两组患者均进行病史分析,分析耳鸣患者听力及临床特征与耳鸣的关系。结果常频听力正常的患者38例行1/24倍频程精细化听力测试,检出听力损失者12例;两组患者127例均进行1/24倍频程听力精细化测试及耳鸣位点精细化评估,其中36例患者听力损失最大点和耳鸣位点一致。将常频听力正常组和异常组临床特征对比分析,常频听力异常组高血压、脑供血不足、睡眠障碍的发病率高于常频听力正常组。结论常频听力正常的患者行1/24倍频程精细化纯音测听可提高耳鸣声治疗的“靶向性”。     

老年血压正常高值耳鸣患者药物疗效分析

目的通过口服药物对老年血压正常高值伴耳鸣患者进行临床治疗,观察耳鸣疗效并分析可能影响因素。方法根据入选标准筛选上海市黄浦区五里桥街道社区卫生服务中心门诊诊断为老年血压正常高值且病程3个月及以上的耳鸣患者120例,给予松龄血脉康胶囊口服1．5g／次,3次／d,12d一个疗程,共服用2个疗程。疗程结束后根据疗效评定标准评价耳鸣疗效,观察治疗前后患者血压变化情况并分析疗效的相关因素。结果120例患者中,痊愈15例,显效31例,有效48例,无效26例;总有效率78．3％;经统计分析发现：疗效与耳鸣持续时间呈负相关,而年龄、耳鸣严重程度与疗效之间无统计学相关性;药物治疗后老年患者血压较治疗前有所下降,但差异无统计学意义。结论松龄血脉康胶囊治疗老年血压正常高值伴耳鸣患者有一定疗效,且对降低血压有积极作用。