De Ridder Dirk, De Mulder Gert, Verstraeten Edwin, Van der Kelen Karolien, Sunaert Stefan, Smits Marion, Kovacs Silvia, Verlooy Jan, Van de Heyning Paul, Moller Aage R
Department of Neurosurgery and Otorhinolaryngology, University Hospital Antwerp, Antwerp, Belgium.
ORL J Otorhinolaryngol Relat Spec. 2006;68(1):48-54; discussion 54-5. doi: 10.1159/000090491. Epub 2006 Mar 3.
Recent research suggests tinnitus is a phantom phenomenon based on hyperactivity of the auditory system, which can be visualized by functional neuroimaging, and transiently modulated by transcranial magnetic stimulation (TMS). We present the results of the first implanted electrodes on the primary and secondary auditory cortex after a successful TMS suppression.
Twelve patients underwent an auditory cortex implantation, 10 for unilateral and 2 for bilateral tinnitus, based on >50% suppression applying TMS. Results were analyzed for pure tone tinnitus and white noise tinnitus.
TMS results in 77% pure tone tinnitus and 67% white noise reduction. Electrical stimulation via an implanted electrode results in a mean of 97% pure tone tinnitus and 24% white noise suppression. Mean Visual Analogue Scale score decreases from 9.5 to 1.5 for pure tone and from 8.8 to 6.8 for white noise postoperatively.
Pure tone tinnitus might be the conscious percept of focal neuronal hyperactivity of the auditory cortex. Once visualized, this hyperactivity can be modulated by neurostimulation.
The preliminary results of the first implantations suggest that patients with unilateral pure tone tinnitus are good surgical candidates for electrode implantation and permanent electrical stimulation of the auditory cortex, provided that the tinnitus is of recent origin and can be suppressed by TMS.
最近的研究表明耳鸣是一种基于听觉系统过度活跃的幻听现象，可通过功能神经影像学观察到，并可通过经颅磁刺激（TMS）进行短暂调节。我们展示了在成功进行TMS抑制后首次在初级和次级听觉皮层植入电极的结果。
12名患者接受了听觉皮层植入手术，其中10名单侧耳鸣患者和2名双侧耳鸣患者，基于TMS抑制率>50%。对纯音耳鸣和白噪声耳鸣的结果进行了分析。
TMS可使77%的纯音耳鸣和67%的白噪声减轻。通过植入电极进行电刺激可使纯音耳鸣平均减轻97%，白噪声抑制24%。术后，纯音的视觉模拟量表平均评分从9.5降至1.5，白噪声从8.8降至6.8。
纯音耳鸣可能是听觉皮层局灶性神经元过度活跃的有意识感知。一旦观察到这种过度活跃，就可以通过神经刺激进行调节。
首次植入的初步结果表明，单侧纯音耳鸣患者是听觉皮层电极植入和永久性电刺激的良好手术候选者，前提是耳鸣为近期发病且可被TMS抑制。
