Skip to main content
The Egyptian Journal of Otolaryngology
Download PDF

Electrophysiological differences in sensorineural hearing loss patients with and without problem-tinnitus

The Egyptian Journal of Otolaryngology volume 28, pages 22–34 (2012)Cite this article

En

Abstract

Objects

Problem-tinnitus refers to tinnitus that is sufficiently severe to produce a major disruption in the patient’s life; tinnitus of such severity involves a number of regions of the auditory system and other brain systems may also play an essential role. Auditory brainstem responses (ABR) and event-related potentials (ERP) were recorded from sensorineural hearing loss (SNHL) patients with problem-tinnitus and were then compared with responses from normal hearing and hearing loss tinnitus-free patients.

Aim

To study whether differences exist in ABR and/or ERP parameters in SNHL patients with and without problem-tinnitus when matched as closely as possible for hearing loss, age, and sex to investigate the mechanism responsible for tinnitus.

Materials and Methods

Ninety participants were included in this study. They were divided into two groups: the study group included 66 participants with bilateral symmetrical SNHL that did not exceed a moderate degree. The study group was divided into two subgroups: 36 patients had problem-tinnitus and 30 patients were tinnitus-free (SNHL, age, and sex matched). Participants in each of these subgroups were compared with each other and were also compared with 24 healthy individuals in the control group (age and sex matched with the study group). All participants were subjected to a basic audiological evaluation and electrophysiological tests (ABR and ERP).

Results

This work had shown a higher prevalence of ABR abnormalities in tinnitus patients in comparison with either the control group or the SNHL tinnitus-free group. Statistically significant differences were found in III–V and I–V interpeak latencies and in the VI amplitude ratio in problem-tinnitus female patients compared with tinnitus-free female patients. Meanwhile, in problem tinnitus male patients when compared with tinnitus-free male patients at III–V interpeak latencies and at VI amplitude ratio.

As regards the results of ERP in this work, an increase in latency and amplitude reduction were found. Statistically significant differences were observed regarding both the mean latency values of waves N1, P2, and P300 and the amplitude mean values of P2 and P300 when we compared the problem-tinnitus subgroup with either the tinnitus-free subgroup or the control group (both female and male patients.

Conclusion

A variety of ABR and ERP components are altered in tinnitus patients; this would indicate impairment in both the central auditory pathway and central auditory processing. Thus, it is suggested that this form of ABR, ERP testing could be considered as an objective measure to complement behavioral, audiologic, and other physiologic methods of assessing tinnitus, rather than a single definitive tinnitus measure in an attempt to supplement and thereby extend knowledge of the nature and origins of tinnitus. Furthermore, these results provide the basis for future neurofeedback-based tinnitus therapies aiming at maximizing the ability to shift attention away from the tinnitus.

References

  1. Gerken GM, Hesse PS, Wiorkowski JJ. Auditory evoked responses in control subjects and in patients with problem-tinnitus. Hearing Res. 2001; 157: 52–64

    CAS  Article  Google Scholar 

  2. Mirz F, Pedersen CB, Ishizu K, Johannsen P, Ovesen T, Stødkilde Jørgensen H, et al. Positron emission tomography of cortical centers of tinnitus. Hearing Res. 1999; 134: 133–144

    CAS  Article  Google Scholar 

  3. Melcher JR, Sigalovsky IS, Guinan JJ Jr., Levine RA. Lateralized tinnitus studied with functional magnetic resonance imaging: abnormal inferior colliculus activation. J Neurophysiol. 2000;83:1058–1072

    CAS  Article  Google Scholar 

  4. Lockwood AH, Salvi RJ, Coad ML, Towsley ML, Wack DS, Murphy BW. The functional anatomy of tinnitus: evidence for limbic system links and neural plasticity. Neurology. 1998; 50: 114–120

    CAS  Article  Google Scholar 

  5. Hoffman HJ, Reed GW, Snow JB. Epidemiology of tinnitus. In: Snow JB, editor. Tinnitus: Theory and management. 2004 Hamilton, Ontario, Canada: B.C. Decker:16–41

    Google Scholar 

  6. Mercier V, Luy D, Hohmann BW. The sound exposure of the audience at a music festival. Noise Health. 2003; 5: 51–58

    CAS  Google Scholar 

  7. Sindhusake D, Golding M, Newall P, Rubin G, Jakobsen K, Mitchell P. Risk factors for tinnitus in a population of older adults: the Blue Mountains Hearing Study. Ear Hearing. 2003; 24: 501–507

    Article  Google Scholar 

  8. Eggermont JJ. Central tinnitus. Auris Nasus Larynx. 2003;30(Suppl):S7–S12

    Article  Google Scholar 

  9. Dauman R, Tyler RS, Aran JM, Dauman R. Some considerations on the classification of tinnitus. Proceedings of the fourth international tinnitus seminar. 1992 Bordeaux, France:225–229

  10. Kenmochi M, Eggermont JJ. Salicylate and quinine affect the central nervous system. Hearing Res. 1997; 113: 110–116

    CAS  Article  Google Scholar 

  11. Spangler KM, Warr WB, Altschuler RA, Bobbin RP, Clopton BM, Hoffman DW. The descending auditory system. In: Altschuler RA, Bobbin RP, Clopton BM, Hoffman DW, editors. Neurobiology of hearing: the central auditory system. 1991 New York: Raven Press;27–45

    Google Scholar 

  12. König O, Schaette R, Kempter R, Gross M. Course of hearing loss and occurrence of tinnitus. Hearing Res. 2006; 221: 59–64

    Article  Google Scholar 

  13. Lockwood AH, Salvi RJ, Burkard RF. Tinnitus. N Engl J Med. 2002; 347: 904–910

    Article  Google Scholar 

  14. House JW, Brackman DE, Evered D, Lawrenson G. Tinnitus: surgical treatment. In: Evered D, Lawrenson G, editors. Tinnitus Ciba Found Symp. 1981 London: Pitman;3–9

    Google Scholar 

  15. Gardner G. Neurotologic surgery and tinnitus. J Laryngol Otol. 1983;97(Suppl 9):311–318

    Google Scholar 

  16. Gerken GM. Central tinnitus and lateral inhibition: an auditory brainstem model. Hearing Res. 1996; 97: 75–83

    CAS  Article  Google Scholar 

  17. Jastreboff PJ, Sasaki CT. An animal model of tinnitus: a decade of development. Am J Otol. 1994; 15: 19–27

    CAS  Google Scholar 

  18. Jastreboff PJ, Hazell JWP. A neurophysiological approach to tinnitus: clinical implications. Br J Audiol. 1993; 27: 7–17

    CAS  Article  Google Scholar 

  19. Meikle MB, Vernon JA, Moller AR. The interaction of central and peripheral mechanisms in tinnitus. In: Vernon JA, Moller AR, editors. Mechanisms of tinnitus. 1995 Boston, MA: Allyn and Bacon; 181–206

    Google Scholar 

  20. Hallam RS, Hazell JWP. Psychological approaches of the evaluation and management of tinnitus distress. In: Hazell JWP, editor. Tinnitus. 1987 Edinburgh: Churchill Livingstone;156–175

    Google Scholar 

  21. Jacobson GP, Calder JA, Newman CW, Peterson EL, Wharton JA, Ahmad BK. Electrophysiological indices of selective auditory attention in subjects with and without tinnitus. Hearing Res. 1996; 97: 66–74

    CAS  Article  Google Scholar 

  22. Cuny C, Norena A, El Massioui F, Chéry Croze S. Reduced attention shift in response to auditory changes in subjects with tinnitus. Audiol Neurootol. 2004; 9: 294–302

    Article  Google Scholar 

  23. Tyler RS, Baker LJ. Difficulties experienced by tinnitus sufferers. J Speech Hearing Disord. 1983; 48: 150–154

    CAS  Article  Google Scholar 

  24. Sanchez L, Stephens D. A tinnitus problem questionnaire in a clinic population. Ear Hearing. 1997; 18: 210–217

    CAS  Article  Google Scholar 

  25. Kaltenbach JA. The dorsal cochlear nucleus as a participant in the auditory, attentional and emotional components of tinnitus. Hearing Res. 2006;216–217:224–234

    Article  Google Scholar 

  26. Dobie RA. Depression and tinnitus. Otolaryngol Clin North Am. 2003; 36: 383–388

    Article  Google Scholar 

  27. Kau RJ, Sendtner Gress K, Ganzer U, Arnold W. Effectiveness of hyperbaric oxygen therapy in patients with acute and chronic cochlear disorders. ORL. 1997; 59: 79–83

    CAS  Article  Google Scholar 

  28. Shulman A, Seitz MR. Central tinnitus–diagnosis and treatment. Observations simultaneous binaural auditory brain responses with monaural stimulation in the tinnitus patient. Laryngoscope. 1981; 91: 2025–2035

    CAS  Article  Google Scholar 

  29. Shulman A. ABR and tinnitus. An overview. J Laryngol Otol. 1983;97(Suppl 9):170–177

    Google Scholar 

  30. Shulman A. Auditory brainstem response and tinnitus. In: Shulman A, editor. 1991 Philadelphia: Lea & Febiger;138–183 277–292

  31. Robinson K, Rudge P. Abnormalities of the auditory evoked potentials in patients with multiple sclerosis. Brain. 1977; 100: 19–40

    Article  Google Scholar 

  32. Paludetti G, Ottivan F, Gallai V, Tassoni A, Maurizi M. Auditory Brainstem Response (ABR) in multiple sclerosis. Scand Audiol. 1985; 14: 17–34

    Article  Google Scholar 

  33. Maurizi M, Ottaviani F, Paludetti G. Contribution to the differentiation of peripheral versus central tinnitus via auditory brain stem response evaluation. Audiology. 1985; 24: 207–216

    CAS  Article  Google Scholar 

  34. Filha VAVDS, Matas CG. Late auditory evoked potentials in individuals with tinnitus. Braz J Otorhinolaryngol. 2010; 76: 263–270

    Article  Google Scholar 

  35. Gabr TA, El Hay MA, Badawy A. Electrophysiological and psychological studies in tinnitus. Auris Nasus Larynx. 2011; 38: 678–683

    Article  Google Scholar 

  36. Attias J, Urbach D, Gold S, Shemesh Z. Auditory event related potentials in chronic tinnitus patients with noise induced hearing loss. Hearing Res. 1993; 71: 106–113

    CAS  Article  Google Scholar 

  37. Walpurger V, Hebing Lennartz G, Denecke H, Pietrowsky R. Habituation deficit in auditory event-related potentials in tinnitus complainers. Hearing Res. 2003; 181: 57–64

    Article  Google Scholar 

  38. Chung DY, Gannon RP, Mason K. Factors affecting the preFilhace of tinnitus. Audiology. 1984; 23: 441–452

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. Ochi K, Ohashi T, Kenmochi M. Hearing impairment and tinnitus pitch in patients with unilateral tinnitus: comparison of sudden hearing loss and chronic tinnitus. Laryngoscope. 2003; 113: 427–431

    Article  PubMed  PubMed Central  Google Scholar 

  40. Surr RK, Kolb JA, Cord MT, Garrus NP. Tinnitus handicap inventory (THI) as a hearing aid outcome measure. J Am Acad Audiol. 1999; 10: 489–495

    CAS  Google Scholar 

  41. Folmer RL, Carroll JR. Long-term effectiveness of ear-level devices for tinnitus. Otolaryngol Head Neck Surg. 2006; 134: 132–137

    Article  Google Scholar 

  42. Jastreboff PJ, Jastreboff MM. Tinnitus retraining therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol. 2000; 11: 162–177

    CAS  Google Scholar 

  43. American National Standards Institute. American National Standard specifications for audiometers. 1969. December 31; ANSI S3-6-1969

  44. Lemaire MC, Beutter P. Brainstem auditory evoked responses in patients with tinnitus. Audiology. 1995; 34: 287–300

    CAS  Article  Google Scholar 

  45. Don M, Kwong B. ABR: differential diagnosis. In: Katz J, editor. Handbook of clinical audiology. 2002 5th ed. Media, PA: Lippincott Williams & Wilkins Publishing:274–297

    Google Scholar 

  46. Ikner CL, Hassen AH. The effect of tinnitus on ABR latencies. Ear Hearing. 1990; 11: 16–20

    CAS  Article  Google Scholar 

  47. Rosenhall U, Axelsson A. Auditory brainstem response latencies in patients with tinnitus. ScandAudiol. 1995; 24: 97–100

    CAS  Google Scholar 

  48. Attias J, Pratt H, Reshef I, Bresloff I, Horowitz G, Polyakov A, et al. Detailed analysis of auditory brainstem responses in patients with noise-induced tinnitus. Audiology. 1996; 35: 259–270

    CAS  Article  Google Scholar 

  49. Moller AR, Jannetta PJ. Evoked potentials from the inferior colliculus in man. Electroencephalogr Clin Neurophysiol. 1982; 53: 612–620

    CAS  Article  Google Scholar 

  50. Hall JW Anatomy and physiology. In: Hall JW., editor. Handbook of auditory evoked responses. 1992 Boston, MA: Allyn & Bacon;41–69

    Google Scholar 

  51. Kehrle HM, Granjeiro RC, Sampaio ALL, Bezerra R, Almeida VF, Oliveira CA. Comparison of auditory brainstem response results in normal-hearing patients with and without tinnitus. Arch Otolaryngol Head Neck Surg. 2008; 134: 647–651

    Article  Google Scholar 

  52. Charles G, Hansenne M. P300 event related potential: clinical interest in three psychopathological diseases and neurobiology: a review. Encephale. 1992; 18: 225–236

    CAS  Google Scholar 

  53. Tonndorf J. Endolymphatic hydrops: mechanical causes of hearing loss. Arch Otorhinolaryngol. 1976; 212: 293–299

    CAS  Article  Google Scholar 

  54. Tonndorf J. Stereociliary dysfunction, a cause of sensory hearing loss, recruitment, poor speech discrimination and tinnitus. Acta Otolaryngol. 1981; 91: 469–479

    CAS  Article  Google Scholar 

  55. Cassvan A, Ralescu S, Moshkovski FG, Shapiro E. Brainstem auditory evoked potential studies in patients with tinnitus and/or vertigo. Arch Phys Med Rehabil. 1990; 71: 583–586

    CAS  Google Scholar 

  56. Hood LJ. Introduction and overview. In: Hood LJ, editor. Clinical applications of the auditory brainstem response. 1998 San Diego, CA

  57. Shulman A, Goldstein B. Tinnitus dyssynchrony-synchrony theory: a translational concept for diagnosis and treatment. Int Tinnitus J. 2006; 12: 101–114

    CAS  Google Scholar 

  58. Jastreboff PJ. Clinical implication of the neurophysiological model of tinnitus. In: Reich GE, Vernon JA, editors. Proceedings of the Fifth International Tinnitus Seminar. 1996 Portland: American Tinnitus Association;500–506

    Google Scholar 

  59. Jastreboff PJ. Processing of the tinnitus signal within the brain. In: Reich GE, Vernon JA, editors. Proceedings of the fifth international tinnitus seminar. 1996 Portland: American Tinnitus Association;58–65

    Google Scholar 

  60. Landgrebe M, Langguth B, Rosengarth K, Braun S, Koch A, Kleinjung T, et al. Structural brain changes in tinnitus: grey matter decrease in auditory and non-auditory brain areas. Neuroimage. 2009; 46: 213–218

    Article  Google Scholar 

  61. Hallam RS, McKenna L, Shurlock L. Tinnitus impairs cognitive efficiency. Int J Audiol. 2004; 43: 218–226

    CAS  Article  Google Scholar 

  62. Born J, Bathelt B, Pietrowsky R, Pauschinger P, Fehm HL. Influences of peripheral adrenocorticotropin 1–39 (ACTH) and human corticotropin releasing hormone (h-CRH) on human auditory evoked potentials (AEP). Psychopharmacology. 1990; 101: 34–38

    CAS  Article  Google Scholar 

  63. Pietrowsky R, Fehm HL, Er A, Bathelt B, Born J. Influences of the cholecystokinin analog ceruletide on human sleep and evoked potentials. Neuropsychobiology. 1990; 23: 41–47

    CAS  Article  Google Scholar 

  64. Norena A, Cransac H, Chéry Croze S. Towards an objectification by classification of tinnitus. Clin Neurophysiol. 1999; 110: 666–675

    CAS  Article  Google Scholar 

  65. Jacobson GP, McCaslin DL. A reexamination of the long latency N1 response in patients with tinnitus. J Am Acad Audiol. 2003; 14: 393–400

    Article  Google Scholar 

  66. Picton TW. The P300 wave of the human event-related potential. J Clin Neurophysiol. 1992; 9: 456–479

    CAS  Article  Google Scholar 

  67. Calero MD, Navarro E. Relationship between plasticity, mild cognitive impairment and cognitive decline. Arch Clin Neuropsychol. 2004; 19: 653–660

    Article  Google Scholar 

  68. Kraus N, McGee T Middle and long latency auditory evoked potentials. In: Katz J. editor. Tratado de audiologia Clínica. 1999:403–420

  69. Junqueira CAO, Colafêmina JF. Investigation of inter and intra-examiner stability to P300 auditory identification: analysis of errors. Rev Bras Otorrinolaringol. 2002; 68: 468–478

    Article  Google Scholar 

  70. Bellis TJ. Comprehensive central auditory assessment. Assessment and management of central auditory processing disorders in the educational setting from science to practice. 2003 2nd ed Singular: Thomson Delmar Learning:231–265

    Google Scholar 

  71. Coelho CCB, Sanchez TG, Bento RF. Tinnitus characteristics of patients attended in a tinnitus clinic. Arq Otorrinolaringol. 2004; 8: 216–224

    Google Scholar 

  72. Shulman A. Clinical classification of subjective idiopathic tinnitus. J Laryngol Otol Suppl. 1981; 4: 102–106

    Google Scholar 

  73. Musiek FE, Lee WW. Middle and long latency auditory evoked potentials. In: Musiek FE, Rintelmann WF, editors. Perspectivas atuais em avaliação auditiva. 2001 São Paulo: Ed. Manole;239–267

    Google Scholar 

  74. Attias J, Shemesh Z, Bleich A, Solomon Z, Bar Or G, Alster J, et al. Psychological profile of help-seeking and non-help-seeking tinnitus patients. Scand Audiol. 1995; 24: 13–18

    CAS  Article  Google Scholar 

  75. Alster J, Shemesh Z, Ornan M, Attias J. Sleep disturbance associated with chronic tinnitus. Biol Psychiatry. 1993; 34: 84–90

    CAS  Article  Google Scholar 

  76. Hoke M, Pantev C, Lutkenhoner B, Lehnertz K. Auditory cortical basis of tinnitus. Acta Otolaryngol Suppl. 1991; 491: 176–182

    CAS  Article  Google Scholar 

  77. Fioretti A, Eibenstein A, Fusetti M. New trends in tinnitus management. Open Neurol J. 2011; 5: 12–17

    PubMed Central  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Otolaryngology - Head and Neck Surgery, Assiut University Hospitals, Assiut University School of Medicine, Assiut, Egypt

    Eman A. Said

Authors
  1. Eman A. Said
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Said, E.A. Electrophysiological differences in sensorineural hearing loss patients with and without problem-tinnitus. Egypt J Otolaryngol 28, 22–34 (2012). https://doi.org/10.7123/01.EJO.0000411078.05971.d1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.7123/01.EJO.0000411078.05971.d1

Keywords

  • auditory brainstem responses
  • event-related potentials
  • sensorineural hearing loss
  • tinnitus