Browsing by Subject "tinnitus"

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  • Szibor, Annett; Lehtimäki, Jarmo; Ylikoski, Jukka; Aarnisalo, Antti A.; Mäkitie, Antti; Hyvärinen, Petteri (2018)
    Affective processing appears to be altered in tinnitus, and the condition is to a large extent characterized by the emotional reaction to the phantom sound. Psychophysiological models of tinnitus and supporting brain imaging studies have suggested a role for the limbic system in the emergence and maintenance of tinnitus. It is not clear whether the tinnitus-related changes in these systems are specific for tinnitus only, or whether they affect emotional processing more generally. In this study, we aimed to quantify possible deviations in affective processing in tinnitus patients by behavioral and physiological measures. Tinnitus patients rated the valence and arousal of sounds from the International Affective Digitized Sounds database. Sounds were chosen based on the normative valence ratings, that is, negative, neutral, or positive. The individual autonomic response was measured simultaneously with pupillometry. We found that the subjective ratings of the sounds by tinnitus patients differed significantly from the normative ratings. The difference was most pronounced for positive sounds, where sounds were rated lower on both valence and arousal scales. Negative and neutral sounds were rated differently only for arousal. Pupil measurements paralleled the behavioral results, showing a dampened response to positive sounds. Taken together, our findings suggest that affective processing is altered in tinnitus patients. The results are in line with earlier studies in depressed patients, which have provided evidence in favor of the so-called positive attenuation hypothesis of depression. Thus, the current results highlight the close link between tinnitus and depression.
  • Kaiharju, Juuso (Helsingin yliopisto, 2020)
    Tutkielman tarkoitus Mobiilisovellukset ovat levinneet laajaan käyttöön lääketieteen saralla. Tämän tutkielman tarkoituksena oli etsiä tieteellisiä julkaisuja, jotka käsittelevät korva-, nenä- ja kurkkutautien lääkärin näkökulmasta käyttökelpoisia mobiiliapplikaatioita. Lisäksi etsittiin ilmaisia sovelluksia kolmeen yleiseen korvalääkärin työssään kohtaamaan vaivaan.Sovelluksia koekäytettiin ja arvioitiin niiden käytettävyyttä lääkärin työssä. Kirjallisuuskatsaus Tutkielmassa tehtiin kirjallisuushaku PubMed-tietokannasta. Hakutuloksista kirjallisuuskatsaukseen valittiin 12 julkaisua, jotka olivat mahdollisimman kattavia sekä käsittelivät myös kolmea tutkielmaan valittua oiretta. Hakutuloksista rajattiin pois ennen vuotta 2014 julkaistut tutkimukset sekä muut kuin englanninkieliset julkaisut. Sovellushaku Joulukuussa 2019 tehtiin sovellushaku Google Play ja App Store sovelluskauppoihin. Tutkielmaan valittiin kolme korvalääkärin kannalta olennaista oirekuvaa: huimaus, tinnitus sekä kuulonalenema. Jokaisesta aiheesta valittiin kaksi erilaista suosittua sekä maksutonta sovellusta, joihin perehdyttiin tarkemmin. Tulokset ja pohdinta KNK-lääkärin mobiilisovelluksia on tutkittu vielä varsin vähän. Muutamia laajoja katsauksia löytyy pääasiassa vuodelta 2019, mutta valtaosa tutkimuksista on kapea-alaisia soveltuvuusselvityksiä. Kontrolloituja tutkimuksia on vähän. Mobiilisovelluksista vain harva soveltuu sellaisenaan kliiniseen työhön. Sovellusten sisällön tieteellisessä paikkansapitävyydessä on epävarmuutta ja lääketieteen ammattilainen osallistuu sovellusten kehitykseen harvoin. Lääkärikuntaa tulisi kannustaa osallistumaan sovellusten suunnitteluun nykyistä enemmän. Kliiniseen käyttöön suunnitellut sovellukset tulisi rekisteröidä lääketieteellisiksi laitteiksi ja tietosuojaan sekä sisällön tieteelliseen laatuun tulisi kiinnittää enemmän huomiota.
  • Ylikoski, Jukka; Lehtimaki, Jarmo; Pirvola, Ulla; Makitie, Antti; Aarnisalo, Antti; Hyvarinen, Petteri; Ylikoski, Matti (2017)
    Conclusion: Transcutaneous vagal nerve stimulation (tVNS) might offer a targeted, patient-friendly, and low-cost therapeutic tool for tinnitus patients with sympathovagal imbalance. Objectives: Conventionally, VNS has been performed to treat severe epilepsy and depression with an electrode implanted to the cervical trunk of vagus nerve. This study investigated the acute effects of tVNS on autonomic nervous system (ANS) imbalance, which often occurs in patients with tinnitus-triggered stress. Methods: This study retrospectively analysed records of 97 patients who had undergone ANS function testing by heart rate variability (HRV) measurement immediately before and after a 15-60min tVNS stimulation. Results: The pre-treatment HRV recording showed sympathetic preponderance/reduced parasympathetic activity in about three quarters (73%) of patients. Active tVNS significantly increased variability of R-R intervals in 75% of patients and HRV age was decreased in 70% of patients. Either the variability of R-R intervals was increased or the HRV age decreased in 90% of the patients. These results indicate that tVNS can induce a shift in ANS function from sympathetic preponderance towards parasympathetic predominance. tVNS caused no major morbidity, and heart rate monitoring during the tVNS treatment showed no cardiac or circulatory effects (e.g. bradycardia) in any of the patients.
  • Shore, Neal D.; Tammela, Teuvo L.; Massard, Christophe; Bono, P.; Aspegren, John; Mustonen, Mika; Fizazi, Karim (2018)
    Background: ODM-201, a new androgen receptor antagonist for treatment of metastatic castration-resistant prostate cancer (mCRPC), demonstrated antitumour activity and acceptable tolerability in phase 1/2 trials. Objective: To determine the antitumour activity and safety profile of extended treatment with ODM-201 in men with mCRPC. Design, setting, and participants: ARADES and ARAFOR trials with ODM-201 enrolled chemotherapy-naïve and CYP17 inhibitor (CYP17i)-naïve mCRPC patients. Both trials had extended follow-up. Here we report results for chemotherapy-naïve and CYP17i-naïve patients from both trials (data cutoff October 2014 for ARADES and April 2015 for ARAFOR) after extended follow-up. Intervention: A total of 41 chemotherapy-naïve and CYP17i-naïve patients received oral ODM-201 twice daily (total daily dose of 1200, 1400 or 1800 mg). Outcome measurements and statistical analysis: Antitumour activity was assessed in terms of prostate-specific antigen (PSA) declines and PSA/radiographic progression. Safety was assessed until disease progression and/or drug discontinuation due to any intolerable adverse event (AE). Results and limitations: ODM-201 safety data after a median treatment time of 13.5 mo (95% confidence interval [CI] 9.7–15.6, interquartile range [IQR] 7.5–22.0) were similar to those reported in the main ARADES and ARAFOR trials. The overall AE incidence was 80.5% (n = 33/41), with 58.5% (n = 24/41) of patients experiencing only grade 1–2 AEs. The most common AEs were fatigue, back pain, diarrhoea, nausea, and pain in extremity. The median times to PSA and radiological progression were 12.4 mo (95% CI 6.3–18.2, IQR 5.5–22.0) and 15.3 mo (95% CI 9.5–not reached [NR], IQR 6.3–NR), respectively. Conclusions: Extended treatment with ODM-201 (1200–1800 mg/d) was well tolerated, with no new safety concerns, and provided evidence of sustained antitumour activity in chemotherapy-naïve and CYP17i-naïve patients with mCRPC. Patient summary: Prolonged treatment with high doses of ODM-201 was well tolerated and provided long-lasting disease control in patients with mCRPC. ODM-201 represents a therapeutic treatment option for mCRPC. The ARAFOR trial (including the follow-up stage) and the follow-up component of the ARADES trial are registered with ClinicalTrials.gov as trial numbers NCT01784757 and NCT01429064. Extended treatment with ODM-201 was well tolerated and provided long-lasting disease control in chemotherapy- naïve and CYP17 inhibitor-naïve patients with metastatic castration-resistant prostate cancer (mCRPC). ODM-201 may represent an additional effective treatment option for mCRPC. © 2017 European Association of Urology
  • Ylikoski, Jukka; Markkanen, Marika; Pirvola, Ulla; Lehtimaki, Jarmo Antero; Ylikoski, Matti; Jing, Zou; Sinkkonen, Saku T.; Mäkitie, Antti (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.