The manifestation of vortical and secondary flow in the cerebral venous outflow tract: An in vivo MR velocimetry study

Aberrations in flow in the cerebral venous outflow tract (CVOT) have been implicated as the cause of several pathologic conditions including idiopathic intracranial hypertension (IIH), multiple sclerosis (MS), and pulsatile tinnitus (PT). The advent of 4D flow magnetic resonance imaging (4D-flow MRI) has recently allowed researchers to evaluate blood flow patterns in the arterial structures with great success. We utilized similar imaging techniques and found several distinct flow characteristics in the CVOT of subjects with and without lumenal irregularities. We present the flow patterns of 8 out of 38 subjects who have varying heights of the internal jugular bulb and varying lumenal irregularities including stenosis and diverticulum. In the internal jugular vein (IJV) with an elevated jugular bulb (JB), 4Dflow MRI revealed a characteristic spiral flow that was dependent on the level of JB elevation. Vortical flow was also observed in the diverticula of the venous sinuses and IJV. The diversity of flow complexity in the CVOT illustrates the potential importance of hemodynamic investigations in elucidating venous pathologies.     

饮食习惯改善、情绪调节及睡眠干预对老年耳鸣患者生活质量及负面情绪影响

目的:探讨饮食习惯改善、情绪调节及睡眠干预对老年耳鸣患者生活质量及负面情绪影响。方法:选取我院2017年3月-2019年3月所收治的120例老年耳鸣患者,将患者按照住院号排序,取随机数字后重新排序分为研究组和对照组,每组60例数,其中对照组采取常规护理,研究组采取综合护理干预,包括饮食习惯改善、情绪调节及睡眠干预等。对比两组护理方案对老年耳鸣患者生活质量及负面情绪影响。结果:研究组的总有效率为93.7%,明显高于对照组的63.3%(P0.05);两组干预前焦虑自评量表(Self-Rating Anxiety Scale,SAS)、抑郁自评量表(Self-Rating Depression Scale,SDS)对比无统计学差异(P0.05),经不同干预方式,两组的心理状态都得到不同程度改善,且研究组的SAS、SDS评分明显低于对照组(P0.05);两组干预前生活质量评分对比无统计学差异(P0.05),而干预后,研究组的生活质量评分明显高于对照组(P0.05)。结论:老年耳鸣患者的饮食、情绪及睡眠等都是不容忽视的重要影响因素,通过改善饮食习惯,调节情绪,及时干预患者睡眠,可有效改善患者的负面情绪,提升患者的生活质量,更有利于治疗。     

Electric field and current density distribution in an anatomical head model during transcranial direct current stimulation for tinnitus treatment

Tinnitus is considered an auditory phantom percept. Recently, transcranial direct current stimulation (tDCS) has been proposed as a new approach for tinnitus treatment including, as potential targets of interest, either the temporal and temporoparietal cortex or prefrontal areas. This study investigates and compares the spatial distribution of the magnitude of the electric field and the current density in the brain tissues during tDCS of different brain targets. A numerical method was applied on a realistic human head model to calculate these field distributions in different brain structures, such as the cortex, white matter, cerebellum, hippocampus, medulla oblongata, pons, midbrain, thalamus, and hypothalamus. Moreover, the same distributions were evaluated along the auditory pathways. Results of this study show that tDCS of the left temporoparietal cortex resulted in a widespread diffuse distribution of the magnitude of the electric fields (and also of the current density) on an area of the cortex larger than the target brain region. On the contrary, tDCS of the dorsolateral prefrontal cortex resulted in a stimulation mainly concentrated on the target itself. Differences in the magnitude distribution were also found on the structures along the auditory pathways. A sensitivity analysis was also performed, varying the electrode position and the human head models. Accurate estimation of the field distribution during tDCS in different regions of the head could be valuable to better determine and predict efficacy of tDCS for tinnitus suppression.     

Auditory Discrimination Training for the Treatment of Tinnitus

This paper presents a series of 12 cases of chronic tinnitus patients who participated in 4 weeks of auditory discrimination training either close to or far removed from the tinnitus frequency. The training was based on the assumption that tinnitus is related to a shift of the representation of the tinnitus frequency in auditory cortex outside of the normal tonotopic map and that training close to but not removed from the tinnitus frequency should result in a reduction in the severity of the tinnitus. Tinnitus severity was measured 4 times per day during the entire treatment and other tinnitus-related variables were assessed 1 week before and 1 month posttreatment. The comparison of the training close to as compared to remote from the tinnitus frequency did not yield a statistically significant difference. However, a post hoc analysis revealed that patients who engaged in regular training as compared to those who practiced irregularly were significantly more successful in reducing tinnitus severity independent of the trained frequencies. Treatment success was best predicted by days of training and general activity levels. The data suggest that auditory discrimination training shows a dose response effect irrespective of training location and that treatment success is also related to psychological variables. For more substantial changes in multiple variables an extended training period with additional consideration of emotional variables would be necessary. In addition, controls for nonspecific training effects need to be implemented.     

Comparison of the outcomes of repetitive transcranial magnetic stimulation to the ipsilateral and contralateral auditory cortex in unilateral tinnitus

Transcranial magnetic stimulation (TMS) is a noninvasive method of activating or deactivating focal areas of the human brain. Repetitive TMS (rTMS) applied over the temporoparietal cortex has been reported to show therapeutic effects on tinnitus. We compared the effects of 1?Hz rTMS delivered either contralaterally or ipsilaterally to the symptomatic ear in patients with unilateral tinnitus. Forty patients with asymmetric hearing loss and non-pulsatile tinnitus localized to poorer ear of 6 months in duration or greater who were refractory to medication were enrolled in this study. Patients were assigned randomly to one of two treatment groups: with 1?Hz stimulation applied the temporoparietal junction either ipsilaterally (n?=?21) or contralaterally (n?=?19) to the symptomatic ear. The patients were given 600 pulses per session daily for 5?d. Changes in the tinnitus handicap inventory (THI) and self-rating visual analog scores (VAS) for loudness, awareness and annoyance were analyzed before, immediately after and 1 month after treatment. There was no significant difference in the rate of patients with marked improvement between ipsilateral and contralateral stimulation groups. In addition, there were no significant differences in the amount of decreases in THI scores and VAS between the two groups immediately or 1 month after rTMS. Finally, significant decreases in THI scores and most VAS were observed 1 month after rTMS in both groups compared to pretreatment. Daily treatment with 1?Hz rTMS ipsilaterally and contralaterally to the side of tinnitus both had significant beneficial effects. The laterality of stimulation with 1?Hz rTMS is not the decisive factor in relieving symptoms.     

A study on relationship between pulsatile tinnitus and temporal bone pneumatization grade

Pulsatile tinnitus (PT) is a common symptom in otology. In some cases, the venous flow in the sigmoid sinus (SS) is the source of PT. It is suggested that the venous sound is propagated into the tympanic cavity through the air pathway of temporal bone air cells (TBAC). The hyperpneumatization of TBAC was hypothesized as a direct pathology of PT through amplifying the venous sound, but there is no quantitative analysis. This study aims to quantify the relationship between the venous sound amplification and the pneumatization grade of TBAC. The acoustic numerical simulation and statistical analysis were performed based on the radiology data of 21 pulsatile tinnitus patients. The TBAC of these patients were classified into hypopneumatization, normal pneumatization and hyperpneumatization grades according to three standards. The in vitro acoustic experiment was done as the validation of simulation. It is indicated that the SS standard is effective for the clinical evaluation of venous sound amplification. The TBAC amplifies the venous sound due to the acoustic resonance at the first mode frequency, regardless of the pneumatization grades. The normal pneumatic TBAC exhibits the highest sound amplification effect on the venous sound amongst the three grades, contributing mostly to PT, but would not induce PT without any other causes.     

交替取穴电针治疗神经性耳鸣的疗效分析及对机体微循环状态和中枢神经递质的影响

摘要 目的：探讨交替取穴电针治疗神经性耳鸣的疗效及对机体微循环状态和中枢神经递质的影响。方法：采用随机数字表法，将中国中医科学院广安门医院2018年4月~2022年5月收治的80例神经性耳鸣患者分为对照组（常规西医治疗）和实验组（对照组的基础上接受交替取穴电针治疗），各为40例。对比两组疗效、症状评分、微循环相关指标、中枢神经递质水平。结果：实验组的临床总有效率高于对照组（P<0.05）。与对照组相比，实验组治疗后的耳鸣残疾评估量表（THI）、耳鸣评价量表（TEQ）评分更低（P<0.05）。与对照组相比，实验组治疗后的流态积分、管襻积分、襻周积分、总积分更低（P<0.05）。与对照组相比，实验组治疗后的5-羟色胺（5-HT ）更低，γ-氨基丁酸（GABA）更高（P<0.05）。结论：交替取穴电针治疗神经性耳鸣疗效较好，可改善临床症状、中枢神经递质水平，调节机体微循环。     

An aural myiasis case in a 54-year-old male farmer in Korea

A 54-year-old male farmer residing in Chunchon, Korea, complaining of blood tinged discharge and tinnitus in the left ear for two days, was examined in August 16, 1996. Otoscopic examination revealed live maggots from the ear canal. The patient did not complain of any symptoms after removal of maggots. Five maggots recovered were identified as the third stage larvae of Lucilia sericata (Diptera: Calliphoridae). This is the first record of aural myiasis in Korea.     

Sigmoid sinus cortical plate dehiscence induces pulsatile tinnitus through amplifying sigmoid sinus venous sound

Sigmoid sinus cortical plate dehiscence (SSCPD) is common in pulsatile tinnitus (PT) patients, and is treated through SSCPD resurfacing surgery in clinic, but the bio-mechanism is not clear as so far. This study aimed to clarify the bio-mechanism of PT sensation induced by SSCPD, and quantify the relationship of cortical plate (CP) thickness and PT sensation intensity. It was hypothesized that SSCPD would induce PT through significantly amplifying sigmoid sinus (SS) venous sound in this study. Finite element (FE) analysis based on radiology data of typical patient was used to verify this hypothesis, and was validated with clinical reports. In cases with different CP thickness, FE simulations of SS venous sound generation and propagation procedure were performed, involving SS venous flow field, vibration response of tissue overlying dehiscence area (including SS vessel wall and CP) and sound propagation in temporal bone air cells. It was shown in results that SS venous sound at tympanic membrane was 56.9 dB in SSCPD case and −45.2 dB in intact CP case, and was inaudible in all thin CP cases. It was concluded that SSCPD would directly induce PT through significantly amplifying SS venous sound, and thin CP would not be the only pathophysiology of PT. This conclusion would provide a theoretical basis for the design of SSCPD resurfacing surgery for PT patients with SSCPD or thin CP.