Listening handicap in tinnitus patients with normal extended high frequencies from the perspective of the autonomic nervous system-Effort or fatigue?

OBJECTIVE: In previous studies, the results regarding the presence of listening effort or fatigue in tinnitus patients were inconsistent. The reason for this inconsistency could be that extended high frequencies, which can cause listening handicap, were not within normal limits. Therefore, this study aimed to evaluate the listening skills in tinnitus patients by matching the normal hearing thresholds at all frequencies, including the extended high frequency. METHODS: Eighteen chronic tinnitus patients and thirty matched healthy controls having normal pure-tone average with symmetrical hearing thresholds was included. Subjects were evaluated with 0.125-20 kHz pure-tone audiometry, Montreal cognitive assessment test (MoCA), Tinnitus Handicap Inventory (THI), Matrix Test, Pupillometry. RESULTS: Pupil dilatation in the 'coding' phase of the sentence presented in tinnitus patients was less than in the control group (p < 0.05). There was no difference between the groups for Matrix test scores (p > 0.05) Also, there was no statistically significant correlation between THI and Pupillometry components nor between MoCA (p > 0.05). CONCLUSION: Even though tinnitus patients had normal hearing in the range of 0.125-20 kHz, their autonomic nervous system responses during listening differed from healthy subjects. This difference was interpreted for potential listening fatigue in tinnitus patients.

Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss.

OBJECTIVE: In previous animal studies, sound enhancement reduced tinnitus perception in cases associated with hearing loss. The aim of this study was to investigate the efficacy of sound enrichment therapy in tinnitus treatment by developing a protocol that includes criteria for psychoacoustic characteristics of tinnitus to determine whether the etiology is related to hearing loss. METHODS: A total of 96 patients with chronic tinnitus were included in the study. Fifty-two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment. RESULTS: There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p < .01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p < .01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p < .05) and at all months for VAS-1 (tinnitus severity) (p < .05) and VAS-2 (tinnitus discomfort) (p < .05). CONCLUSION: In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55 dB HL in a relatively short period of 1 month.

Subcortical auditory system in tinnitus with normal hearing: insights from electrophysiological perspective.

PURPOSE: The mechanism of tinnitus remains poorly understood; however, studies have underscored the significance of the subcortical auditory system in tinnitus perception. In this study, our aim was to investigate the subcortical auditory system using electrophysiological measurements in individuals with tinnitus and normal hearing. Additionally, we aimed to assess speech-in-noise (SiN) perception to determine whether individuals with tinnitus exhibit SiN deficits despite having normal-hearing thresholds. METHODS: A total 42 normal-hearing participants, including 22 individuals with chronic subjective tinnitus and 20 normal individuals, participated in the study. We recorded auditory brainstem response (ABR) and speech-evoked frequency following response (sFFR) from the participants. SiN perception was also assessed using the Matrix test. RESULTS: Our results revealed a significant prolongation of the O peak, which encodes sound offset in sFFR, for the tinnitus group (p < 0.01). The greater non-stimulus-evoked activity was also found in individuals with tinnitus (p < 0.01). In ABR, the tinnitus group showed reduced wave I amplitude and prolonged absolute wave I, III, and V latencies (p ≤ 0.02). Our findings suggested that individuals with tinnitus had poorer SiN perception compared to normal participants (p < 0.05). CONCLUSION: The deficit in encoding sound offset may indicate an impaired inhibitory mechanism in tinnitus. The greater non-stimulus-evoked activity observed in the tinnitus group suggests increased neural noise at the subcortical level. Additionally, individuals with tinnitus may experience speech-in-noise deficits despite having a normal audiogram. Taken together, these findings suggest that the lack of inhibition and increased neural noise may be associated with tinnitus perception.

Does sleep quality affect balance? The perspective from the somatosensory, vestibular, and visual systems.

OBJECTIVE: Previous studies have focused on the balance system's involvement in sleep deprivation or disorders. This study investigated how daily routine sleep quality affects the balance system of people without sleep deprivation or diagnosed sleep disorders. METHODS: The study included 45 participants with a BMI score of <25. The PSQI was used to determine sleep quality. The SOT, HS-SOT, and ADT evaluated the vestibular system's functionality. RESULTS: In SOT, condition 3, 4, 5, and 6 composite scores, VIS and VEST composite balance scores, and HS-SOT 5 scores were lower in the HPSQI group. At the same time, there is a statistically significant negative correlation between these scores and PSQI scores. CONCLUSION: Poor sleep quality may be a factor influencing the balance system. Sleep quality affects the visual and vestibular systems rather than the somatosensory system. The population should be made aware of this issue, and clinicians should consider the potential impact of sleep quality when evaluating the balance system.

The Effect of Time-Restricted Feeding on Postural Balance: From Vestibular Perspective.

OBJECTIVE: The aims of the present study were to evaluate postural balance performance of the subjects on the time-restricted feeding (TRF) and reveal the effect of TRF on the vestibular system by comparing the results to those of traditional daily dietary (DD) condition. METHODS: Sixteen adults (3 males, 13 females; mean age 25.4 ± 4) who had experienced at least one month of TRF were included in the study. Sensory Organization Test (SOT) and Head-Shake Sensory Organization Test (HS-SOT) -which evaluate proprioceptive, visual and vestibular systems- were performed on TRF and DD conditions via the Computerized Dynamic Posturography System. RESULTS: Significant differences were obtained between TRF and DD situations in SOT-5 (p=.008), SOT-6 (p=.01), and HS-SOT5 (p =.007) conditions in which the vestibular system dominated. CONCLUSION: We revealed that time-restricted feeding has an effect on postural balance in the absence of proprioceptive and visual systems. This feeding model is a negative stressor that has a substantial effect on the vestibular system, but this impact is minimal once the proprioceptive and visual systems are intact. To best of our knowledge, it is the first study to evaluate postural balance utilizing vestibular parameters in time-restricted feeding.

WITHDRAWN: Listening handicap in tinnitus patients by controlling extended high frequencies - Effort or fatigue?

This article has been withdrawn: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal). This article has been withdrawn at the request of the editor and publisher. The publisher regrets that an error occurred which led to the premature publication of this paper. This error bears no reflection on the article or its authors. The publisher apologizes to the authors and the readers for this unfortunate error.

Evaluation of musical emotion perception and language development in children with cochlear implants.

OBJECTIVES: While the primary purpose of cochlear implant (CI) fitting is to improve individuals' receptive and expressive skills, musical emotion perception (MEP) is generally ignored. This study assesses the MEP and language skills (LS) of children using CI. METHODS: 26 CI users and 26 matched healthy controls between the ages of 6 and 9 were included in the study. The Test of Language Development (TOLD) was applied to evaluate the LS of the participants, and the Montreal Emotion Identification Test (MEI) was applied to evaluate the MEP. RESULTS: MEI test scores and all subtests of TOLD were statistically significantly lower in the CI group. Also, there was a statistically significant and moderate correlation between the listening subtest of TOLD and the MEI test. CONCLUSIONS: MEP and language skills are poor in children with CI. Although language skills are primarily targeted in CI performance, improving MEP should also be included in rehabilitation programs. The relationship between music and the TOLD's listening subtest may provide evidence that listening skills can be improved by paying attention to the MEP, which is frequently ignored in rehabilitation programs.

An Exploratory Study of the Effect of Tinnitus on Listening Effort Using EEG and Pupillometry.

OBJECTIVE: Previous behavioral studies on listening effort in tinnitus patients did not consider extended high-frequency hearing thresholds and had conflicting results. This inconsistency may be related that listening effort is not evaluated by the central nervous system (CNS) and autonomic nervous system (ANS), which are directly related to tinnitus pathophysiology. This study matches hearing thresholds at all frequencies, including the extended high-frequency and reduces hearing loss to objectively evaluate listening effort over the CNS and ANS simultaneously in tinnitus patients. STUDY DESIGN: Case-control study. SETTING: University hospital. METHODS: Sixteen chronic tinnitus patients and 23 matched healthy controls having normal pure-tone averages with symmetrical hearing thresholds were included. Subjects were evaluated with 0.125 to 20 kHz pure-tone audiometry, Montreal Cognitive Assessment Test (MoCA), Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), electroencephalography (EEG), and pupillometry. RESULTS: Pupil dilation and EEG alpha band in the "coding" phase of the sentence presented in tinnitus patients was less than in the control group (p < .05). VAS score was higher in the tinnitus group (p < .01). Also, there was no statistically significant relationship between EEG and pupillometry components and THI or MoCA (p > .05). CONCLUSION: This study suggests that tinnitus patients may need to make an extra effort to listen. Also, pupillometry may not be sufficiently reliable to assess listening effort in ANS-related pathologies. Considering the possible listening difficulties in tinnitus patients, reducing the listening difficulties, especially in noisy environments, can be added to the goals of tinnitus therapy protocols.

Multi-feature mismatch negativity: How can reliable data be recorded in a short time?

OBJECTIVE: The aim of the study was to conduct multi-feature mismatch negativity (MMN) implementations and identify via a test-retest study the reliability of MMN responses obtained through a 5-stimulus version of the MMN paradigm. It was also aimed to identify a reliable MMN recording number by comparing the MMN responses obtained under conditions of ten and four recordings conditions while making the recording time shorter. METHODS: Twenty-one healthy volunteers, aged between 18 and 36 years, were included in the study. A 5-stimulus version of the multi-feature MMN paradigm was presented to participants. Ten recordings were obtained for each participant under both test and retest conditions. The MATLAB program was utilized in the evaluation of MMN amplitude and latency. The Fz was chosen for the statistical analysis. Four of the ten recordings were chosen at random, and statistical analyses were performed again for those four recordings. RESULTS: There was no statistically significant difference in amplitudes obtained from test and retest conditions with ten recordings. With four recordings, for frequency, intensity, duration, and gap deviants, there were no statistically significant differences between amplitudes obtained under test and retest conditions. However, there was a statistically significant difference between amplitudes of the location deviant. No statistically significant difference was observed among latencies under test-retest conditions with both ten and four recordings. CONCLUSIONS: These findings demonstrate that MMN amplitudes could be used reliably as short-time evaluations with four recordings, but more recordings are required for MMN latencies. In terms of practicality, four recordings are more advantageous and comfortable for both clinicians and patients in MMN practice. SIGNIFICANCE: When behavioral tests are required, MMN is regarded as an objective test that can be used reliably for adults, children, and infants who cannot be evaluated using behavioral methods. It is concluded that conditions with four recordings aremore advantageous and comfortable for both clinicians and patients in MMN practice.

Auditory brainstem response in unilateral tinnitus patients: does symmetrical hearing thresholds and within-subject comparison affect responses?

OBJECTIVE: In recent studies, cochlear synaptopathy has been suggested as a potential pathophysiology mechanism for tinnitus, which occurs in individuals with normal hearing thresholds. Auditory Brainstem Response (ABR) is a noninvasive method frequently used in the literature to evaluate cochlear synaptopathy in tinnitus patients. However, possible factors such as high-frequency pure-tone hearing thresholds, age, gender, and head characteristics that may affect ABR were not considered sufficiently in previous studies. Therefore, the present study aims to evaluate tinnitus ears and non-tinnitus ears with ABR in unilateral chronic tinnitus patients with symmetrical hearing. METHODS: Twenty unilateral chronic tinnitus patients having normal pure-tone average with symmetrical hearing thresholds was included in the study. Subjects were evaluated with 0.25-16 kHz pure-tone audiometry, Tinnitus Handicap Inventory (THI) and ABR were administered. All ears were evaluated monaurally using click stimuli at 80 dB nHL, alternating polarity (21.1 rate/s, 2000 sweeps). RESULTS: Wave I amplitude of the ABR and the ratio of III/I, V/I, and V/III wave amplitudes from tinnitus ears was higher than non-tinnitus ears. At the same time, there was a positive correlation between THI and V-I and V-III interpeak latency range, and a negative correlation between V/III wave amplitude ratio. CONCLUSION: ABR can be used as an evaluation method to provide evidence that the neural organizations of individuals with chronic tinnitus differ in certain regions in their auditory pathways. The correlation between THI and ABR findings suggests that there may be a connection between tinnitus distress and the neural organization of the auditory system.

The mismatch negativity responses of individuals with tinnitus with normal extended high-frequency hearing-is it possible to use mismatch negativity in the evaluation of tinnitus?

OBJECTIVE: This study uses the multi-feature paradigm to compare the MMN responses of individuals with normal hearing thresholds, including the high frequencies with and without tinnitus. METHODS: Sixteen subjects with chronic subjective idiopathic tinnitus and twenty matched healthy controls were included in the study. Participants with hearing thresholds (0.125-16 kHz) less than 20 dB HL and MoCA test scores above 21 were included in the study. MMN responses and topographical maps of the responses resulting from the multi-feature MMN paradigm were recorded from 22 surface scalp electrodes. Amplitude and latency parameters of the MMN responses of five different deviants, consisting of frequency, intensity, duration, location, and silent gap, were compared between the two groups. RESULTS: The amplitudes of MMN responses were lower in the tinnitus group than in the control group at Fz electrode for all deviant types. At the same time, there was no difference between the groups for MMN latencies and, no correlation was found between THI and MMN. CONCLUSION: According to our results, the MMN might indicate a possible impairment in pre-attentive and automatic central auditory processing for chronic tinnitus patients. Since MMN responses in the tinnitus group differ from those of healthy individuals, it might be used as a reference for evaluating the central auditory pathways of tinnitus patients.