Auditory cortical basis of tinnitus.

The waveforms of the auditory evoked magnetic field (AEF) in normal-hearing individuals and patients suffering from tinnitus are distinctly different. In tinnitus patients, the magnetic wave M200 (corresponding to the electric wave P200, or P2) is delayed and only poorly developed or even completely missing, while the amplitude of the magnetic wave M100 (corresponding to the electric wave N100, or N1) is significantly augmented. A very characteristic feature turned out to be the amplitude ratio of the two waves M200 and M100. Below the age of 50, the amplitude ratio M200/M100 represents a clear-cut criterion to distinguish between tinnitus patients and individuals without tinnitus. In tinnitus patients, the ratio is less than 0.5 independent of age, whereas, in young and middle-aged normal-hearing individuals, it is greater than 0.5. Since in normal-hearing individuals the average amplitude ratio decreases linearly with age, the clusters of amplitude ratios of the two groups begin to overlap beyond the age of 50. The hypothesis is put forward that the decrease of the average amplitude ratio in normal-hearing individuals reflects a degenerative process probably initiated by multiple exogenous and endogenous factors, which leads to both an increased excitability of the generators of a particular component of wave M100 and a sustained neural activity in the generators of one particular component of wave M200 and eventually gives rise to the sensation of tinnitus. The absence or poor development of wave M200 is a concomitant phenomenon, resulting from the involved generators being less responsive to external stimuli. Our hypothesis has been supported by one exemplary case in which we were able to trace the process of tinnitus remission during a period of 256 days after acute onset of tinnitus (due to an acute noise trauma), showing a recovery of the amplitude ratio from an initial value of 0 to a normal value of approximately 1.