Ylikoski Jukka, Markkanen Marika, Pirvola Ulla, Lehtimäki Jarmo Antero, Ylikoski Matti, Jing Zou, Sinkkonen Saku T, Mäkitie Antti
Helsinki Ear Institute, Helsinki, Finland.
Salustim Group Inc., Kempele, Finland.
Front Psychol. 2020 Sep 17;11:570196. doi: 10.3389/fpsyg.2020.570196. eCollection 2020.
INTRODUCTION: Tinnitus can become a strong stressor for some individuals, leading to imbalance of the autonomous nervous system with reduction of parasympathetic activity. It can manifest itself as sleep disturbances, anxiety and even depression. This condition can be reversed by bioelectrical vagal nerve stimulation (VNS). Conventional invasive VNS is an approved treatment for epilepsy and depression. Transcutaneous VNS (taVNS) stimulating the auricular branch of the vagus nerve has been shown to activate the vagal pathways similarly as an implanted VNS. Therefore, taVNS might also be a therapeutic alternative in health conditions such as tinnitus-related mental stress (TRMS). This retrospective study in 171 TRMS patients reports the clinical features, psychophysiological characteristics, and results of the heart rate variability (HRV) tests before and after test-taVNS. This study also reports the therapy outcomes of 113 TRMS patients treated with taVNS, in combination with standard tinnitus therapy. METHODS: Diagnostic tinnitus and hearing profiles were defined. To detect possible cardiac adverse effects, test-taVNS with heart rate monitoring as well as pre- and post-stimulation HRV tests were performed. Daily taVNS home therapy was prescribed thereafter. To assess therapeutic usefulness of taVNS, 1-year follow-up outcome was studied. Results of HRV tests were retrospectively analyzed and correlated to diagnostic data. RESULTS: The large majority of patients with TRMS suffer from associated symptoms such as sleep disturbances and anxiety. Baseline HRV data showed that more than three quarters of the 171 patients had increased sympathetic activity before test-taVNS. Test-taVNS shifted mean values of different HRV parameters toward increased parasympathetic activity in about 80% of patients. Test-taVNS did not cause any cardiac or other side effects. No significant adverse effects were reported in follow-up questionnaires. CONCLUSION: TRMS is an example of a stress condition in which patients may benefit from taVNS. As revealed by HRV, test-taVNS improved parasympathetic function, most efficiently in patients with a low starting HRV level. Our tinnitus treatment program, including taVNS, effectively alleviated tinnitus stress and handicap. For wider clinical use, there is a great need for more knowledge about the optimal methodology and parameters of taVNS.
引言：耳鸣对一些人来说可能成为强大的压力源，导致自主神经系统失衡，副交感神经活动减少。它可表现为睡眠障碍、焦虑甚至抑郁。这种情况可通过生物电迷走神经刺激（VNS）得到改善。传统的侵入性VNS是一种已获批准的治疗癫痫和抑郁症的方法。经皮VNS（taVNS）刺激迷走神经的耳支已被证明与植入式VNS一样能激活迷走神经通路。因此，taVNS在诸如耳鸣相关精神压力（TRMS）等健康状况下也可能是一种治疗选择。这项对171例TRMS患者的回顾性研究报告了测试taVNS前后的临床特征、心理生理特征以及心率变异性（HRV）测试结果。本研究还报告了113例接受taVNS联合标准耳鸣治疗的TRMS患者的治疗效果。 方法：定义诊断性耳鸣和听力特征。为检测可能的心脏不良反应，进行了带有心率监测的测试taVNS以及刺激前和刺激后的HRV测试。此后规定了每日taVNS家庭治疗。为评估taVNS的治疗效用，研究了1年的随访结果。对HRV测试结果进行回顾性分析并与诊断数据相关联。 结果：绝大多数TRMS患者伴有睡眠障碍和焦虑等相关症状。基线HRV数据显示，171例患者中有超过四分之三在测试taVNS前交感神经活动增强。测试taVNS使约80%患者的不同HRV参数平均值向副交感神经活动增强方向转变。测试taVNS未引起任何心脏或其他副作用。随访问卷中未报告显著不良反应。 结论：TRMS是一种患者可能从taVNS中获益的应激状况。如HRV所示，测试taVNS改善了副交感神经功能，在起始HRV水平较低的患者中效果最为显著。我们包括taVNS的耳鸣治疗方案有效减轻了耳鸣压力和障碍。为更广泛地应用于临床，非常需要更多关于taVNS最佳方法和参数的知识。
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