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      Effects of Vibrant Soundbridge on tinnitus accompanied by sensorineural hearing loss

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          Abstract

          Objectives

          Tinnitus is a common symptom among patients with hearing loss, and many studies have reported successful tinnitus suppression with hearing devices. Active middle ear implantation of the Vibrant Soundbridge (VSB) is a good alternative to existing hearing devices. This study evaluated the effects of VSB implantation on tinnitus and sought to identify the main audiological factor that affects tinnitus suppression.

          Methods

          The study participants were 16 adults who had tinnitus with sensorineural hearing loss, and who underwent VSB implantations. Pure-tone audiometry; word recognition test; tinnitus handicap inventory (THI); and visual analog scale (VAS) assessment of loudness, awareness, and annoyance were performed before and 12 months after surgery. Changes in hearing threshold, word recognition scores (WRS), THI scores, and VAS scores were analyzed.

          Results

          VAS scores for loudness (mean difference: 1.9, 95% CI: 0.6, 3.1), awareness (mean difference: 1.6, 95% CI: 0.4, 2.8), and annoyance (mean difference: 1.7, 95% CI: 0.7, 2.8) showed significant improvements from baseline to 12 months after surgery. In addition, THI scores showed a significant decrease (mean difference: 13.8, 95% CI: 2.9, 24.9). The average hearing threshold level, WRS, and most comfortable level (MCL) also showed significant improvements at 12 months after surgery (mean difference: 17.3, 95% CI: 13.3, 21.3; mean difference: −7.6, 95% CI: −15.1, −0.1; mean difference: 26.3, 95% CI: 22.9, 29.6, respectively). Among the aforementioned factors, changes in MCL were best correlated with those in THI scores (mean difference: 2.55, 95% CI: 0.90, 4.21).

          Conclusion

          A VSB implant is beneficial to subjects with tinnitus accompanied by sensorineural hearing loss. The changes in THI scores best correlated with those in MCL. This improvement may represent a masking effect that contributes to tinnitus suppression in patients with VSB implants.

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          Most cited references24

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          Phantom auditory perception (tinnitus): mechanisms of generation and perception.

          Phantom auditory perception--tinnitus--is a symptom of many pathologies. Although there are a number of theories postulating certain mechanisms of its generation, none have been proven yet. This paper analyses the phenomenon of tinnitus from the point of view of general neurophysiology. Existing theories and their extrapolation are presented, together with some new potential mechanisms of tinnitus generation, encompassing the involvement of calcium and calcium channels in cochlear function, with implications for malfunction and aging of the auditory and vestibular systems. It is hypothesized that most tinnitus results from the perception of abnormal activity, defined as activity which cannot be induced by any combination of external sounds. Moreover, it is hypothesized that signal recognition and classification circuits, working on holographic or neuronal network-like representation, are involved in the perception of tinnitus and are subject to plastic modification. Furthermore, it is proposed that all levels of the nervous system, to varying degrees, are involved in tinnitus manifestation. These concepts are used to unravel the inexplicable, unique features of tinnitus and its masking. Some clinical implications of these theories are suggested.
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            Development of the Tinnitus Handicap Inventory.

            To develop a self-report tinnitus handicap measure that is brief, easy to administer and interpret, broad in scope, and psychometrically robust. A standardization study of a self-report tinnitus handicap measure was conducted to determine its internal consistency reliability and convergent and construct validity. Audiology clinics in tertiary care centers in two sites. In the first investigation, 84 patients reporting tinnitus as their primary complaint or secondary to hearing loss completed the 45-item alpha version of the Tinnitus Handicap Inventory (THI). In the second investigation, 66 subjects also reporting tinnitus completed the 25-item beta version. Convergent validity was assessed using another measure of perceived tinnitus handicap (Tinnitus Handicap Questionnaire). Construct validity was assessed using the Beck Depression Inventory, Modified Somatic Perception Questionnaire, symptom rating scales (annoyance, sleep disruption, depression, and concentration), and perceived tinnitus pitch and loudness judgments. From the alpha version of the THI, we derived a 25-item beta version with the items grouped into functional, emotional, and catastrophic subscales. The total scale yielded excellent internal consistency reliability (Cronbach's alpha = .93). No significant age or gender effects were seen. Weak correlations were observed between the THI and the Beck Depression Inventory, Modified Somatic Perception Questionnaire, and pitch and loudness judgments. Significant correlations were found between the THI and the symptom rating scales. The THI is a self-report measure that can be used in a busy clinical practice to quantify the impact of tinnitus on daily living.
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              Ringing ears: the neuroscience of tinnitus.

              Tinnitus is a phantom sound (ringing of the ears) that affects quality of life for millions around the world and is associated in most cases with hearing impairment. This symposium will consider evidence that deafferentation of tonotopically organized central auditory structures leads to increased neuron spontaneous firing rates and neural synchrony in the hearing loss region. This region covers the frequency spectrum of tinnitus sounds, which are optimally suppressed following exposure to band-limited noise covering the same frequencies. Cross-modal compensations in subcortical structures may contribute to tinnitus and its modulation by jaw-clenching and eye movements. Yet many older individuals with impaired hearing do not have tinnitus, possibly because age-related changes in inhibitory circuits are better preserved. A brain network involving limbic and other nonauditory regions is active in tinnitus and may be driven when spectrotemporal information conveyed by the damaged ear does not match that predicted by central auditory processing.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: Methodology
                Role: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                4 February 2020
                2020
                : 15
                : 2
                : e0228498
                Affiliations
                [1 ] Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
                [2 ] Department of Otorhinolaryngology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Bupyeong, Incheon, Korea
                [3 ] Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
                Lamar University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-2793-9045
                http://orcid.org/0000-0003-3826-8830
                http://orcid.org/0000-0002-3951-5074
                Article
                PONE-D-19-23345
                10.1371/journal.pone.0228498
                6999863
                32017804
                799ba648-9434-417d-b6a9-3a17fba4a0aa
                © 2020 Lee et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 August 2019
                : 16 January 2020
                Page count
                Figures: 1, Tables: 3, Pages: 10
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100002701, Ministry of Education;
                Award ID: 2018R1D1A1A02085472
                Award Recipient :
                This study was supported by a grant from the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2018R1D1A1A02085472) to I.S.M.
                Categories
                Research Article
                Medicine and Health Sciences
                Otorhinolaryngology
                Otology
                Hearing Disorders
                Tinnitus
                Medicine and Health Sciences
                Neurology
                Tinnitus
                Medicine and Health Sciences
                Otorhinolaryngology
                Otology
                Hearing Disorders
                Deafness
                Medicine and Health Sciences
                Otorhinolaryngology
                Otology
                Audiology
                Social Sciences
                Linguistics
                Cognitive Linguistics
                Word Recognition
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Hearing
                Biology and Life Sciences
                Psychology
                Sensory Perception
                Hearing
                Social Sciences
                Psychology
                Sensory Perception
                Hearing
                Biology and Life Sciences
                Bioengineering
                Biotechnology
                Medical Devices and Equipment
                Engineering and Technology
                Bioengineering
                Biotechnology
                Medical Devices and Equipment
                Medicine and Health Sciences
                Medical Devices and Equipment
                Biology and Life Sciences
                Anatomy
                Head
                Ears
                Medicine and Health Sciences
                Anatomy
                Head
                Ears
                Biology and Life Sciences
                Anatomy
                Head
                Ears
                Middle Ear
                Medicine and Health Sciences
                Anatomy
                Head
                Ears
                Middle Ear
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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