Posit Science Corporation, San Francisco, California.
Coleman Memorial Laboratory, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 1;144(10):938-943. doi: 10.1001/jamaoto.2018.1856.
Critical to the success of many medical therapeutics is a consideration of the brain's miraculous ability to dynamically rewire itself anatomically and neurochemically on the basis of incoming information. We argue that white noise exposure, a commonly recommended therapy for patients with tinnitus, engages these plastic processes in a way that induces maladaptive changes in the brain that degrade neurological health and compromise cognition.
The pathophysiologic mechanisms commonly associated with hearing loss and tinnitus reflect cortical dedifferentiation and widespread loss of inhibitory tone throughout the central auditory pathway. Importantly, these same changes are also induced by exposure to unstructured noise, even at nontraumatic levels in the adult nervous system. Not by coincidence, the same changes appear in age-related decline of central auditory function, suggesting that both tinnitus and white noise accelerate the aging of the brain.
Noise exposure therapies offer a seductive short-term solution for relief but, in the long term, undermine the functional and structural integrity of the central auditory system and the brain more generally. Sound therapies using unstructured, random ("white") noise should be avoided as a treatment for tinnitus. Alternative therapeutics that drive positive, adaptive plastic changes are discussed.
许多医学疗法成功的关键在于考虑大脑基于传入信息在解剖和神经化学上动态重塑自身的神奇能力。我们认为，白噪声暴露是一种常用于治疗耳鸣患者的常见疗法，它以一种诱导大脑产生适应不良变化的方式参与这些可塑性过程，从而降低神经健康并损害认知能力。
与听力损失和耳鸣相关的常见病理生理机制反映了皮质去分化和整个中枢听觉通路中广泛丧失抑制性音调。重要的是，即使在成年神经系统的非创伤性水平下，暴露于无结构噪声也会引起这些相同的变化。并非巧合的是，相同的变化也出现在与年龄相关的中枢听觉功能下降中，这表明耳鸣和白噪声都会加速大脑的衰老。
噪声暴露疗法为缓解提供了一种诱人的短期解决方案，但从长期来看，会破坏中枢听觉系统以及更广泛的大脑的功能和结构完整性。应避免使用无结构、随机（“白”）噪声的声音疗法来治疗耳鸣。讨论了驱动积极、适应性可塑性变化的替代治疗方法。
