THE EFFECT OF MASKING ON AUDITORY EVOKED BRAINSTEM RESPONSES IN INDIVIDUALS WITH TINNITUS

Abstract

Aim: In this study, we aimed to compare the auditory brainstem response (ABR) results of individuals with and without tinnitus with normal hearing, and to investigate the effect of masking therapy, which is often used in the treatment of tinnitus, on the ABR results of individuals with tinnitus. Method: The study included 12 individuals with chronic subjective tinnitus and normal hearing and 20 individuals without tinnitus and normal hearing.After a detailed physical examination by an otolaryngologist, pure-tone and speech audiometry, immittance measurements, tinnitus evaluation, distortion product otoacoustic emissions (DPOAE), ABR tests and the Tinnitus Disability Questionnaire (TDQ) were performed. After masking therapy, ABR and TEA were repeated. Results: It was observed that ABR I wave amplitude values of individuals with tinnitus increased and latency shortened after masking therapy compared to before therapy. This change was also reflected in the individuals' TEA scores, and a decrease in questionnaire scores was observed after masking therapy. At the same time, it was observed that the signal-to-noise ratio (SNR) values at DPOAE 6-8 and 10kHz frequencies decreased in individuals with tinnitus compared to normals. Conclusion: It has been suggested that the cause of tinnitus in individuals with normal hearing but chronic subjective tinnitus (CST) may be due to cochlear synaptopathy. In our study, ABR test and TEA results showed that the effects of this condition can be reduced by masking therapy. At the same time, the DPOAE test decreased the SNR values, especially in the high frequency band, in the presence of tinnitus even in individuals with normal hearing, which once again showed us the importance of the use of this test in the process of tinnitus follow-up.

Keywords

• auditory
• brain stem
• evoked potentials
• tinnitus
• objective

TİNNİTUSU OLAN BİREYLERDE MASKELEMENİN İŞİTSEL UYARILMIŞ BEYİNSAPI YANITLARINA ETKİSİ

Abstract

Amaç: Normal işitmeye sahip tinnitusu olan ve olmayan bireylerin işitsel beyin sapı yanıtları (ABR) sonuçlarını karşılaştırmaya ek olarak tinnitus tedavisinde sıklıkla kullanılan maskeleme terapisi yönteminin tinntusa sahip olan bireylerdeki ABR sonuçları üzerine etkisini incelemektir. Yöntem: Çalışmaya normal işitmeye sahip kronik subjektif tinnituslu (KST) 12 birey ve normal işitmeye sahip tinnitusu olmayan 20 birey dahil edilmiştir. Bireylere kulak burun boğaz uzmanı tarafından ayrıntılı bir fiziki muayene yapıldıktan sonra saf ses/konuşma odyometri, immitansmetrik ölçümler, tinnitus değerlendirmesi, distortion product otoakustik emisyon (DPOAE), ABR testleri ve Tinnitusu Engellilik Anketi (TEA) uygulandı. Terapi sonrasında ise ABR testi ve TEA tekrarlandı. Bulgular: Tinnitusa sahip bireylerin maskleme terapisi sonrasında ABR I. dalga amplitüd değerlerinin terapi öncesine göre artış gösterdiği ve latansının ise kısaldığı gözlenmiştir. Bu değişim bireylerin TEA skorlarına da yansımış olup maskelem terapisi sonrası anket skorlarında azalma gözlenmiştir. Aynı zamanda tinnitusa sahip bireylerde DPOAE 6-8 ve 10kHz frekanlarındaki Signal-Noise Ratio (SNR) değerlerinin normallere kıyasla azaldığı gözlenmiştir. Sonuç: Normal işitmeye sahip ama KST’ si olan bireylerdeki tinnitus sebebinin koklear sinaptopati kaynaklı olabileceği düşünülmektedir. Çalışmamızda bu durumun etkilerinin maskeleme terapisiyle azaltılabileceği ABR testi ve TEA sonuçlarında gösterilmiştir. Aynı zamanda DPOAE testinin de normal işitmeye sahip olsa dahi tinnitus varlığında özellikle yüksek frekans bölgesindeki SNR değerlerini azalttığı; bu da bizlere tinnitus takibi sürecinde bu testin kullanımının önemini bir kere daha göstermiştir.

Keywords

• beyin sapı
• işitsel
• subjektif
• tinnitus
• uyarılmış potansiyeller

References

1. 1.Sweetow RW. Tinnitus: A Self-Management Guide for the Ringing in Your Ears. Ear and Hearing. 2003 Oct ;24(5):461.
2. 2. Yetiser S, Tosun F, Satar B, Arslanhan M, Akcam T, Ozkaptan Y. The role of zinc in management of tinnitus. Auris Nasus Larynx. 2002;29(4):329-33.
3. 3. Koçak Ö. Tinnitus Şikayeti Olan Bireylere Verilen Danışmanlık Hizmetinde Türkçe Standart Görsel Materyal Kullanımının Etkisinin Araştırılması. Hacettepe Üniversitesi/Sağlık Bilimleri Enstitüsü 2014.
4. 4. Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States. JAMA Otolaryngology–Head & Neck Surgery. 2016;142(10):959-65.
5. 5. Chari DA, Limb CJ. Tinnitus. Medical Clinics. 2018;102(6):1081-93.
6. 6. Tanrıöver Ö, Doan M, Tezvaran Z, Küçük Ceyhan A. Birinci basamakta tinnitus ile başvuran hastaya yaklaşım. Turkish Journal of Family Practice/ Türk Aile Hek Derg 2011;15(1):24-28.
7. 7. Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, Chandrasekhar SS, Cunningham Jr ER, et al. Clinical practice guideline: tinnitus. Otolaryngology–Head and Neck Surgery. 2014;151:S1-S40.
8. 8. Esmaili AA, Renton J. A review of tinnitus. Aust J Gen Pract. 2018;47(4):205-8.

9. 9. Suzuki FAdB, Suzuki FA, Onishi ET, Penido NdO. Psychoacoustic Classification of Persistent Tinnitus. Brazilian Journal of Otorhinolaryngology. 2018;84,583-590.
10. 10. Hoare DJ, Kowalkowski VL, Kang S, Hall DA. Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. The Laryngoscope. 2011 Jun 10;121(7):1555–64.
11. 11. Kim SH, Kim D, Lee JM, Lee SK, Kang HJ, Yeo SG. Review of Pharmacotherapy for Tinnitus. Healthcare [Internet]. 2021 Jun 1;9(6):779.
12. 12. Cima RFF. Bothersome tinnitus. HNO. 2018 Apr 30;66(5):369–74. 13. Jastreboff PJ. Tinnitus Retraining Therapy. Textbook of Tinnitus. 2011;575–96.
13. 14. Polonenko MJ, Maddox RK. The Parallel Auditory Brainstem Response. Trends Hear. 2019;23:2331216519871395. 15. Spitzer E, White-Schwoch T, Carr KW, Skoe E, Kraus N. Continued maturation of the click-evoked auditory brainstem response in preschoolers. J Am Acad Audiol. 2015;26(1):30-5. 16. Sininger YS, Hunter LL, Hayes D, Roush PA, Uhler KM. Evaluation of Speed and Accuracy of Next-Generation Auditory Steady State Response and Auditory Brainstem Response Audiometry in Children With Normal Hearing and Hearing Loss. Ear Hear. 2018;39(6):1207-23.
14. 17. Laumen G, Ferber AT, Klump GM, Tollin DJ. The Physiological Basis and Clinical Use of the Binaural Interaction Component of the Auditory Brainstem Response. Ear Hear. 2016;37(5):e276-e90. 18. Park Y, Shin SH, Byun SW, Lee ZY, Lee HY. Audiological and psychological assessment of tinnitus patients with normal hearing. Front Neurol. 2022;13:1102294. 19. Milloy V, Fournier P, Benoit D, Noreña A, Koravand A. Auditory brainstem responses in tinnitus: a review of who, how, and what? Frontiers in Aging Neuroscience. 2017;9:237.
15. 20. Kehrle HM, Granjeiro RC, Sampaio AL, Bezerra R, Almeida VF, Oliveira CA. Comparison of auditory brainstem response results in normal-hearing patients with and without tinnitus. Archives of Otolaryngology–Head & Neck Surgery. 2008;134(6):647-51.
16. 21. Lemaire MC, Beutter P. Brainstem auditory evoked responses in patients with tinnitus. Audiology. 1995;34(6):287-300.
17. 22. Ikner CL, Hassen AH. The effect of tinnitus on ABR latencies. Ear Hear. 1990;11(1):16-20. 23. Bose A, Chatterjee I. Impact of Tinnitus Masking on Auditory Brainstem Response Results. Int Tinnitus J. 2021;25(1):34-8. 24. Lidén G. The scope and application of current audiometric tests. The Journal of Laryngology & Otology. 1969;83(6):507-20.
18. 25. Jerger J. Clinical experience with impedance audiometry. Archives of otolaryngology. 1970;92(4):311-24. 26. Thornton AR, Raffin MJ. Speech-discrimination scores modeled as a binomial variable. Journal of speech and hearing research. 1978;21(3):507-18.
19. 27. Suutarla S, Rautio J, Ritvanen A, Ala-Mello S, Jero J, Klockars T. Microtia in Finland: comparison of characteristics in different populations. International journal of pediatric otorhinolaryngology. 2007;71(8):1211-7.
20. 28. Newman CW, Weinstein BE, Jacobson GP, Hug GA. The Hearing Handicap Inventory for Adults: psychometric adequacy and audiometric correlates. Ear and hearing. 1990;11(6):430-3.
21. 29. Aksoy S, Firat Y, Alpar R. The Tinnitus Handicap Inventory: a study of validity and reliability. International tinnitus journal. 2007;13(2):94.
22. 30. Sobhy O, Elbanby N, Elmoazen D. Study of auditory brainstem response in tinnitus patients with normal hearing. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2021;22(22):1-9.
23. 31. Melcher JR, Sigalovsky IS, Guinan JJ, Levine RA. Lateralized Tinnitus Studied With Functional Magnetic Resonance Imaging: Abnormal Inferior Colliculus Activation. Journal of Neurophysiology. 2000 Feb 1;83(2):1058–72.
24. 32. Carrera ELL, Rosa MRD da, Oliveira JRM de, Lopes AC, Mondelli MFCG. Characterization of patients with tinnitus seen by the Hearing Health service. Revista CEFAC. 2022 Dec 9;24:e7922.
25. 33. Yenigün A, Doğan R, Aksoy F, Akyüz S, Dabak H. Assessment of tinnitus with tinnitus severity index, tinnitus handicap inventory and distortion product otoacoustic emissions in patients with normal hearing and hearing loss. The Turkish Journal of Ear Nose and Throat. 2014;24(1):11-6.
26. 34. Schaette R, McAlpine D. Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model. Journal of Neuroscience. 2011;31(38):13452-7.
27. 35. Guest H, Munro KJ, Prendergast G, Howe S, Plack CJ. Tinnitus with a normal audiogram: Relation to noise exposure but no evidence for cochlear synaptopathy. Hearing Research. 2017 Feb;344:265–74.
28. 36. Jedrzejczak WW, Pilka E, Ganc M, Kochanek K, Skarzynski H. Ultra-High Frequency Distortion Product Otoacoustic Emissions for Detection of Hearing Loss and Tinnitus. International Journal of Environmental Research and Public Health. 2022 Feb 14;19(4):2123.
29. 37. Karimiani A, Rouhbakhsh N, Zamiri Abdollahi F, Jalaie S. Estimation of outer hair cells function in chronic bilateral tinnitus patients with normal hearing using distortion product otoacoustic emissions. Auditory and Vestibular Research. 2021 May 2.