Inhibition-induced plasticity in tinnitus patients after repetitive exposure to tailor-made notched music

Stein, Alwina; Engell, Alva; Junghöfer, Markus; Wunderlich, Robert; Lau, Pia; Wollbrink, Andreas; Rudack, Claudia; Pantev, Christo

doi:10.1016/j.clinph.2014.08.017

Cited by 40 publications

(41 citation statements)

References 47 publications

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“…However, more recent studies suggest that short-term changes in neurophysiological brain activity elicited through TMNMT already begin to occur after three days [ 19 , 20 ]. Brain plasticity effects are often first observed on a neural level and may only later manifest behaviorally [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…Teismann et al [ 54 ] found effects for the THQ but not for the VAS. Stein et al [ 19 ] as well as Stein et al [ 20 ] found effects in the VAS. So far, these studies have been performed using smaller samples and most of them did not have a placebo group to control the effects.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, it became obvious that to obtain more stable effects, a longer period of training might be necessary [ 18 ]. However, effects of TMNMT have already been demonstrated after 3 days of training using a notch width of half an octave [ 19 – 21 ]. A further methodological modification of TMNMT was suggested by Stein et al [ 20 , 22 ], who investigated the role of the notch edges.…”

Section: Introductionmentioning

confidence: 99%

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Clinical trial on tonal tinnitus with tailor-made notched music training

et al. 2016

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BackgroundTinnitus is a result of hyper-activity/hyper-synchrony of auditory neurons coding the tinnitus frequency, which has developed due to synchronous mass activity owing to the lack of inhibition. We assume that removal of exactly these frequencies from a complex auditory stimulus will cause the brain to reorganize around tonotopic regions coding the tinnitus frequency through inhibition-induced plasticity. Based on this assumption, a novel treatment for tonal tinnitus - tailor-made notched music training (TMNMT) - has been introduced and was tested in this clinical trial.MethodsA randomized controlled trial in parallel group design was performed in a double-blinded manner. We included 100 participants with chronic, tonal tinnitus who listened to tailor-made notched music for two hours a day for three consecutive months. Our primary outcome measures were the Tinnitus Handicap Questionnaire and Visual Analog Scales measuring perceived tinnitus loudness, awareness, distress and handicap. Participants rated their tinnitus before and after the training as well as one month after cessation of the training.ResultsWhile no effect was found for the primary outcome measures, tinnitus distress, as measured by the Tinnitus Questionnaire, a secondary outcome measure, developed differently in the two groups. The treatment group showed higher distress scores while the placebo group revealed lower distress scores after the training. However, this effect did not reach significance in post-hoc analysis and disappeared at follow-up measurements. At follow-up, tinnitus loudness in the treatment group was significantly reduced as compared to the control group. Post hoc analysis, accounting for low reliability scores in the Visual Analog Scales, showed a significant reduction of the overall Visual Analog Scale mean score in the treatment group even at the post measurement.ConclusionThis is the first study on TMNMT that was planned and conducted following the CONSORT statement standards for clinical trials. The current work is one more step towards a final evaluation of TMNMT. Already after three months the effect of training with tailor-made notched music is observable in the most direct rating of tinnitus perception – the tinnitus loudness, while more global measures of tinnitus distress do not show relevant changes.Trial registrationCurrent Controlled Trials ISRCTN04840953; Trial registration date: 17.07.2013

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical trial on tonal tinnitus with tailor-made notched music training

et al. 2016

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“…With respect to the correlation between the ASSR and subjective tinnitus loudness demonstrated by Okamoto et al [ 16 ], that we were not able to confirm in the current study, we would like to comment that it seems that this correlation is not very consistent. Other studies were also not successful to replicate it [ 17 , 36 ] or reported a correlation between change of tinnitus loudness and N1m decrement [ 18 ]. Besides the addressed methodological problems, there are more general reasons why comparing subjective ratings with neurophysiological data can be intricate.…”

Section: Discussionmentioning

confidence: 99%

“…The size of the effect of lateral inhibition depends on the bandwidth of the notch that is used. While Okamoto et al [ 16 ] used a 1-octave notch width, a notch width of ½ octave also proved to be effective after three days of exposure to TMNMT [ 18 ]. In a study with band-eliminated broad band noise and healthy participants, eliminated bandwidths of a ¼-octave and a ½-octave caused an even larger N1m decrement than notches of one whole octave in a forward masking paradigm [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Spectral Notch Width on Neurophysiological Plasticity and Clinical Effectiveness of the Tailor-Made Notched Music Training

Wunderlich¹,

Lau

Stein

et al. 2015

PLoS ONE

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Tinnitus, the ringing in the ears that is unrelated to any external source, causes a significant loss in quality of life, involving sleep disturbance and depression for 1 to 3% of the general population. While in the first place tinnitus may be triggered by damage to the inner ear cells, the neural generators of subjective tinnitus are located in central regions of the nervous system. A loss of lateral inhibition, tonotopical reorganization and a gain-increase in response to the sensory deprivation result in hypersensitivity and hyperactivity in certain regions of the auditory cortex. In the tailor-made notched music training (TMNMT) patients listen to music from which the frequency spectrum of the tinnitus has been removed. This evokes strong lateral inhibition from neurons tuned to adjacent frequencies onto the neurons involved in the tinnitus percept. A reduction of tinnitus loudness and tinnitus-related neural activity was achieved with TMNMT in previous studies. As the effect of lateral inhibition depends on the bandwidth of the notch, in the current study we altered the notch width to find the most effective notch width for TMNMT. We compared 1-octave notch width with ½-octave and ¼-octave. Participants chose their favorite music for the training that included three month of two hours daily listening. The outcome was measured by means of standardized questionnaires and magnetoencephalography. We found a general reduction of tinnitus distress in all administered tinnitus questionnaires after the training. Additionally, tinnitus-related neural activity was reduced after the training. Nevertheless, notch width did not have an influence on the behavioral or neural effects of TMNMT. This could be due to a non-linear resolution of lateral inhibition in high frequencies.

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Individual Reliability of the Standard Clinical Method vs Patient-Centered Tinnitus Likeness Rating for Assessment of Tinnitus Pitch and Loudness Matching

Hébert

2018

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Current individualized sound therapies for tinnitus rely on tinnitus pitch assessment, which is commonly derived from the standard clinical 2-alternative forced-choice (2-AFC) approach driven by the examiner. However, this method is limited by lack of individual test-retest reliability and focuses on a single rather than multiple tinnitus frequencies. OBJECTIVE To assess individual test-retest reliability of the 2-AFC, with a single final frequency (and corresponding loudness), and the tinnitus likeness rating (TLR), with the participant exposed to the entire audible frequency spectrum, from which 3 dominant frequencies and corresponding loudness were extracted. DESIGN, SETTING, AND PARTICIPANTS In this case series, participants with tinnitus underwent testing twice with both methods at a 1-month interval by experienced clinicians from January 6 through March 17, 2017. Each clinician tested each patient only once at visit 1 or 2 in a university audiology training setting with standardized equipment and was blind to previous assessment. Participants with bilateral or unilateral chronic tinnitus for longer than 6 months, in good health, without total deafness in either ear, and without cerumen in the ear canal were recruited through advertisements (community and clinics) and word of mouth (volunteer sample). The audiologists were likewise participants in the planned comparison between TLR and 2-AFC in the test-retest measures. MAIN OUTCOMES AND MEASURES Test-retest concordance with 95% CIs for each method, calculated as the proportion of participants with the same final frequency between the 2 visits (2-AFC) or with at least 1 concordant dominant frequency (TLR) as well as loudness differences of no greater than 10 dB. RESULTS The study sample included 31 participants (55% men; mean [SD] age, 50.7 [13.7] years). For TLR, 26 of 31 participants had at least 1 concordant dominant frequency between the 2 visits (proportion, 0.84; 95% CI, 0.66-0.95), whereas for 2-AFC, 7 of 31 participants had a concordant final tinnitus pitch in either ear (proportion, 0.23; 95% CI, 0.10-0.41). Loudness reliability followed the same pattern, with more concordant loudness levels in the TLR (proportion, 0.73; 95% CI, 0.52-0.88) than in the 2-AFC (proportion, 0.40; 95% CI, 0.05-0.85). Mean time taken to complete the tests was less than 15 minutes, and general appreciation by participants with tinnitus and audiologists were overall similar for both. CONCLUSIONS AND RELEVANCE Superior test-retest concordance can be demonstrated at the individual level using the several dominant frequencies extracted from the patient-centered TLR.

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Inhibition-induced plasticity in tinnitus patients after repetitive exposure to tailor-made notched music

Cited by 40 publications

References 47 publications

Clinical trial on tonal tinnitus with tailor-made notched music training

Clinical trial on tonal tinnitus with tailor-made notched music training

Impact of Spectral Notch Width on Neurophysiological Plasticity and Clinical Effectiveness of the Tailor-Made Notched Music Training

Individual Reliability of the Standard Clinical Method vs Patient-Centered Tinnitus Likeness Rating for Assessment of Tinnitus Pitch and Loudness Matching

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