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

Objective. Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a physician. This guideline provides evidence-based recommendations for the diagnosis...

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Clinical practice guideline: sudden hearing loss.

We used PET to map brain regions responding to changes in tinnitus loudness in four patients who could alter tinnitus loudness by performing voluntary oral facial movements (OFMs). Cerebral blood flow was measured in four patients and six controls at rest, during the OFM, and during stimulation with pure tones. OFM-induced loudness changes affected the auditory cortex contralateral to the ear in which tinnitus was perceived, whereas unilateral cochlear stimulation caused bilateral effects, suggesting a retrocochlear origin for their tinnitus. Patients, compared with controls, showed evidence for more widespread activation by the tones and aberrant links between the limbic and auditory systems. These abnormal patterns provide evidence for cortical plasticity that may account for tinnitus and associated symptoms. Although audiologic symptoms and examinations of these patients were typical, the unusual ability to modulate tinnitus loudness with an OFM suggests some caution may be warranted in generalizing these findings.

The functional neuroanatomy of tinnitus : Evidence for limbic system links and neural plasticity

Tinnitus is an increasing health concern across all strata of the general population. Although an abundant amount of literature has addressed the many facets of tinnitus, wide-ranging differences i...

General review of tinnitus: Prevalence, mechanisms, effects, and management

Objectives:Tinnitus is a well-known, difficult-to-treat symptom of hearing loss. Users of cochlear implants (CIs) have reported a reduction in tinnitus following implantation for bilateral severe-t...

Incapacitating Unilateral Tinnitus in Single-Sided Deafness Treated by Cochlear Implantation

This paper presents a neurophysiological approach to tinnitus and discusses its clinical implications. A hypothesis of discordant damage of inner and outer hair cells systems in tinnitus generation...

A neurophysiological approach to tinnitus: Clinical implications

Tinnitus and oversensitivity to sound are common and hitherto incurable, distressing conditions that affect a substantial number of the population. Pawel Jastreboff's discovery of the mechanisms by which tinnitus and decreased sound tolerance occur has led to a new and effective treatment called Tinnitus Retraining Therapy (TRT). Audiologists, ENT specialists, psychologists and counsellors around the world currently practise this technique, with very high success rates. TRT, the treatment developed by the authors from the model, has already proved to be the most effective and most widely practised worldwide. This book presents a definitive description and justification for the Jastreboff neurophysiological model of tinnitus, outlining the essentials of TRT, reviewing the research literature justifying their claims, and providing an expert critique of other therapeutic practices.

Tinnitus Retraining Therapy: Implementing the Neurophysiological Model

Neurophysiological model of tinnitus: Dependence of the minimal masking level on treatment outcome

A model is proposed for tinnitus and sensorineural hearing loss involving cochlear pathology. As tinnitus is defined as a cortical perception of sound in the absence of an appropriate external stimulus it must result from a generator in the auditory system which undergoes extensive auditory processing before it is perceived. The concept of spatial nonlinearity in the cochlea is presented as a cause of tinnitus generation controlled by the efferents. Various clinical presentations of tinnitus and the way in which they respond to changes in the environment are discussed with respect to this control mechanism. The concept of auditory retraining as part of the habituation process, and interaction with the prefrontal cortex and limbic system is presented as a central model which emphasizes the importance of the emotional significance and meaning of tinnitus.

Tinnitus. I: Auditory mechanisms: a model for tinnitus and hearing impairment.

Contralateral acoustic stimulation reduces the amplitude of the transient evoked otoacoustic emission (TEOAE) in humans. The mechanism is thought to be mediated, at least in part, through the medial olivocochlear efferent system innervating the outer hair cells. To assess its usefulness as a possible clinical test, TEOAE suppression was measured in each ear of 12 subjects over a 6-week period, and these data are shown in detail for four subjects representing extremes of variability in a tinnitus and a non-tinnitus group. Intra-subject test results (n = 18) exhibited a varying extent of suppression values and the variance of each session, consisting of three tests, was not statistically different from one session to another. There was no dependence on variables such as ear (right or left), session, day of testing or their interaction. There was a significant difference in the variability between the tinnitus and the normal group.

Jonathan W. P. Hazell

Papers

A neurophysiological approach to tinnitus: Clinical implications

Tinnitus Retraining Therapy: Implementing the Neurophysiological Model

Neurophysiological model of tinnitus: Dependence of the minimal masking level on treatment outcome

Tinnitus. I: Auditory mechanisms: a model for tinnitus and hearing impairment.

Contralateral suppression of transient evoked otoacoustic emissions: intra-individual variability in tinnitus and normal subjects.