Shulman Abraham, Strashun Arnold M, Avitable Matthew J, Lenhardt Martin L, Goldstein Barbara A
Department of Otolaryngology-Head and Neck Surgery, King's County Hospital, Brooklyn, New York, USA.
Int Tinnitus J. 2004;10(2):113-25.
Ultra-high-frequency (UHF) external acoustic stimulation with the UltraQuiet device (UQ) has been reported to provide significant relief of severe disabling-type tinnitus. The nuclear medicine imaging technique of positron emission tomography (PET) was selected as a monitoring system to compare objectively metabolic alterations in brain function before and after UHF/UQ and to correlate the PET data with the subjective behavioral response of patients reporting tinnitus relief. PET of brain was completed on 6 patients randomly selected from a cohort of 15 patients included in a protocol to establish long-term tinnitus relief with UHF/UQ. Twelve specific regions of interest (ROI) were selected for PET of brain examination on the basis of results obtained with single-photon emission computed tomography (SPECT) of brain examinations recommended for patients with severe disabling-type tinnitus and demonstrating significant perfusion asymmetries in the right and left brain ROI of the primary auditory cortex; frontal, temporal, parietal, and medial temporal lobes; and cerebellum. PET of brain results included ratios of post- and pre-UHF/UQ stimulation that demonstrated no random response in the selected PET of brain ROI and ratios of post- and pre-UHF/UQ stimulation that demonstrated three categories of response in the selected PET brain ROI for all six patients: hypermetabolism in three patients; hypometabolism in two; and a mixed response in one. Correlation was established for each patient among PET and electrophysiological responses of alteration in minimal masking levels, the residual UHF neuronal response as reflected in the UHF audiogram, and the subjective reported behavioral responses of patients (obtained from outcome questionnaires for tinnitus relief, which focused on tinnitus intensity, annoyance, severity index, and a subjective scale of value of the UHF/UQ device for tinnitus relief. The subjective behavioral response for tinnitus relief with UHF/UQ was found to reflect a dual effect: acoustic stimulation of the residual neuronal function in the UHF range (10-14 kHz) and audiometric thresholds of 40-50 dB sound pressure level (SPL), and the metabolic activity at brain cortex for neuronal reprogramming. The PET of brain categories of response suggested that the UHF/UQ "masking" is predominantly reflective of neuronal reprogramming at the brain cortex. Nuclear medicine PET of brain imaging has provided an objective monitoring system for attempting to establish the efficacy of UHF/UQ for tinnitus relief. No complication of the tinnitus was reported secondary to the PET of brain examination. This limited PET of brain study supports the clinical recommendation of the efficacy of UHF/UQ external acoustic stimulation for a selected population of patients with tinnitus of the severe disabling type.
据报道，使用UltraQuiet设备（UQ）进行的超高频（UHF）外耳道刺激可显著缓解严重致残型耳鸣。正电子发射断层扫描（PET）的核医学成像技术被选作监测系统，以客观比较UHF/UQ治疗前后脑功能的代谢变化，并将PET数据与报告耳鸣缓解的患者的主观行为反应相关联。对15名参与使用UHF/UQ实现长期耳鸣缓解方案的患者进行队列研究，从中随机选取6名患者进行脑部PET检查。基于针对严重致残型耳鸣患者推荐的脑部单光子发射计算机断层扫描（SPECT）结果，并显示初级听觉皮层的左右脑感兴趣区域（ROI）、额叶、颞叶、顶叶和颞内侧叶以及小脑存在显著灌注不对称，为脑部PET检查选取了12个特定ROI。脑部PET结果包括UHF/UQ刺激前后的比率，在所选脑部PET ROI中未显示随机反应，以及UHF/UQ刺激前后的比率，在所有6名患者的所选脑部PET ROI中显示出三类反应：3名患者代谢亢进；2名患者代谢减退；1名患者为混合反应。针对每位患者，在PET与最小掩蔽水平变化的电生理反应、UHF听力图中反映的残余UHF神经元反应以及患者的主观报告行为反应（从耳鸣缓解结果问卷中获得，该问卷侧重于耳鸣强度、烦恼程度、严重程度指数以及UHF/UQ设备对耳鸣缓解的主观价值量表）之间建立了相关性。发现UHF/UQ缓解耳鸣的主观行为反应反映了双重效应：UHF范围内（10 - 14 kHz）残余神经元功能的声学刺激以及40 - 50 dB声压级（SPL）的听力阈值，以及大脑皮层用于神经元重新编程的代谢活动。脑部PET反应类别表明，UHF/UQ“掩蔽”主要反映大脑皮层的神经元重新编程。脑部核医学PET成像提供了一个客观监测系统，用于尝试确定UHF/UQ缓解耳鸣的疗效。未报告脑部PET检查继发耳鸣并发症。这项有限的脑部PET研究支持了UHF/UQ外耳道刺激对特定严重致残型耳鸣患者群体疗效的临床推荐。
