Abraham Shulman, Barbara Goldstein, Arnold Strashun
Department Otolaryngology, SUNY Downstate, Brooklyn, NY, USA.
Int Tinnitus J. 2013;18(1):75-95. doi: 10.5935/0946-5448.20130010.
Neuroplasticity (NPL), neuromodulation (NM), and neuroprotection (NPT) are ongoing biophysiological processes that are linked together in sensory systems, the goal being the maintenance of a homeostasis of normal sensory function in the central nervous system. It is hypothesized that when the balance between excitatory - inhibitory action is broken in sensory systems, predominantly due to neuromodulatory activity with reduced induced inhibition and excitation predominates, sensory circuits become plastic with adaptation at synaptic levels to environmental inputs(1). Tinnitus an aberrant auditory sensation, for all clinical types, is clinically considered to reflect a failure of NPL, NM, and NPT to maintain normal auditory function at synaptic levels in sensory cortex and projected to downstream levels in the central auditory system in brain and sensorineural elements in ear. Clinically, the tinnitus sensation becomes behaviorally manifest with varying degrees of annoyance, reflecting a principle of sensory physiology that each sensation has components, i.e. sensory, affect/behavior, psychomotor and memory. Modalities of tinnitus therapies, eg instrumentation, pharmacology, surgery, target a particular component of tinnitus, with resultant activation of neuromodulators at multiple neuromodulatory centers in brain and ear. Effective neuromodulation at sensory neuronal synaptic levels results in NPL in sensory cortex, NPT and tinnitus relief. Functional brain imaging, metabolic (PET brain) and electrophysiology quantitative electroencephalography (QEEG) data in a cochlear implant soft failure patient demonstrates what is clinically considered to reflect NPL, NM, NPT. The reader is provided with a rationale for tinnitus diagnosis and treatment, with a focus on ES, reflecting the biology underlying NPL, NM, NPT.
神经可塑性（NPL）、神经调节（NM）和神经保护（NPT）是持续进行的生物生理过程，它们在感觉系统中相互关联，目标是维持中枢神经系统正常感觉功能的稳态。据推测，当感觉系统中兴奋性 - 抑制性作用的平衡被打破时，主要是由于神经调节活动导致诱导抑制减少且兴奋占主导，感觉回路会在突触水平上随着对环境输入的适应而变得具有可塑性（1）。耳鸣是一种异常的听觉感受，对于所有临床类型而言，临床上认为它反映了神经可塑性、神经调节和神经保护在感觉皮层突触水平上无法维持正常听觉功能，并投射到脑内中枢听觉系统的下游水平以及耳内的感觉神经元件。临床上，耳鸣感受会以不同程度的烦恼在行为上表现出来，这反映了感觉生理学的一个原则，即每种感觉都有组成部分，即感觉、情感/行为、心理运动和记忆。耳鸣治疗方法，如器械治疗、药物治疗、手术治疗，针对耳鸣的特定组成部分，从而在脑和耳的多个神经调节中心激活神经调节剂。在感觉神经元突触水平上进行有效的神经调节会导致感觉皮层的神经可塑性、神经保护和耳鸣缓解。一名人工耳蜗软故障患者的功能性脑成像、代谢（PET脑）和电生理定量脑电图（QEEG）数据表明了临床上认为反映神经可塑性、神经调节和神经保护的情况。本文为读者提供了耳鸣诊断和治疗的理论依据，重点是电刺激，反映了神经可塑性、神经调节和神经保护背后的生物学原理。
