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Biomedical subjects

Abraham Shulman

Publications and source records attributed to Abraham Shulman.

At least 19 recordsLinked to original sources
PubMed2006

Congenital atresia of the external ear and tinnitus: a new syndrome.

Congenital atresia of the external ears and severe tinnitus has been reported by two patients to be contralateral to the atretic ear. The use of the nuclear medicine imaging technique of single-photon emission computed tomography (SPECT) of brain has demonstrated hypoperfusion in brain areas supplied by the middle cerebral artery on the side of the atretic ear. Ultrahigh-frequency audiometry (UHFA) has revealed a bilateral loss of hearing greater than expected for the age of affected patients. Quantitative electroencephalography (QEEG) has shown a significant central nervous system electrical dysfunction correlated with the SPECT of brain findings. One case is reported in detail at this time. Completion of the medical audiological tinnitus patient protocol, including SPECT of brain, UHFA, and QEEG, accurately established the clinical tinnitus diagnosis of predominantly a central-type tinnitus, a clinical hypothesis that the medical significance of the tinnitus is a "soft" sign of cerebrovascular disease, and provided a rationale for treatment directed to a presumed ischemia of brain based on a receptor-targeted therapy targeted to the GABA-A receptor, resulting in significant tinnitus relief. Questions that have arisen include (1) the incidence of occurrence of hypoperfusion of the middle cerebral artery in congenital atresia patients; (2) implications and long-term consequences of this finding in this patient population for development of cerebrovascular disease; (3) brain plasticity for tinnitus relief (i.e., neuronal reprogramming, particularly in response to treatment recommendations for complaints of the cochleovestibular system in general and specifically for tinnitus); (4) the clinical significance of the UHFA thresholds of bilateral hearing loss greater than expected for the age of the patient; and (5) whether congenital atresia of the external ear may be part of a syndrome that includes hypoperfusion in brain areas supplied by the middle cerebral artery on the side of the atretic ear, ultra-high-frequency bilateral loss of hearing greater than expected for the age of the patient, and significant central nervous system electrical dysfunction. As far as we can determine, these findings, highlighted by the brain SPECT, have not previously been reported in patients with congenital atresia of the external ear.

Adult↗
PubMed2006

Brain and inner-ear fluid homeostasis, cochleovestibular-type tinnitus, and secondary endolymphatic hydrops.

Secondary endolymphatic hydrops (SEH) has clinically been found to have a significant incidence of occurrence in patients with subjective idiopathic tinnitus (SIT) of a severe disabling type. The diagnosis is made clinically and has been established by integration in a medical audiological tinnitus patient protocol of the clinical history with results of electrodiagnostic cochleovestibular testing that fulfill the diagnostic criteria of inner-ear disease consistent with Ménière's disease. SEH is hypothesized to be a factor, not an etiology, influencing the clinical course of SIT. Alterations over time (i.e., delay in the homeostatic mechanisms in normnal function of the fluid compartments of the inner-ear perilymph, endolymph, or brain cerebrospinal fluid) result in endolymphatic hydrops and interference in normal function of the inner ear, with resultant inner-ear complaints that can be highlighted by tinnitus rather than by vertigo. The endolymphatic hydrops may be either localized or diffuse within the cochlear or vestibular labyrinth. The etiologies and mechanisms of cochleovestibular-type tinnitus are multiple and are influenced by the SEH. Classically, the tetrad of symptoms--episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and ear blockage--associated with the histopathological correlate endolymphatic hydrops has been diagnosed as Ménière's disease. Specifically, key etiological agents that have been identified as playing a role in the clinical course of tinnitus (e.g., noise exposure, stress) may serve as "triggers" or stressors (or both), resulting in interference in normal biochemical and physiological function of sensorineural structures in the inner ear or in neural structures in the brain. In both conditions, the alterations over time (i.e., delay) in the clinical manifestation of the tetrad of symptoms of inner-ear dysfunction, when highlighted by SIT rather than vertigo, otherwise fulfill the criteria for diagnosing SEH. The chief complaint of SIT, when presenting as one of the tetrad of inner-ear symptoms and otherwise diagnosed as Ménière's disease, has also been associated clinically with perfusion asymmetries in brain, identified by nuclear medicine brain imaging (single-photon emission computed tomography [SPECT] of brain), and reflects an interference in homeostasis in the blood-brain labyrinth or blood-brain barriers, with a resulting SEH. The medical significance of the SIT in some patients may be a gradual, progressive sensorineural hearing loss. The inclusion of SPECT of brain in SIT patients demonstrates a global approach for improving the accuracy of diagnosing the SIT symptom, for focusing on the contribution of central nervous system dysfunction to the development of SEH, and for understanding and influencing the clinical course of SIT.

Blood-Brain Barrier↗
PubMed2005

Tinnitus improvement with ultra-high-frequency vibration therapy.

This study reports on the long-term benefit of ultra-high-frequency masking with the UltraQuiet device. A commercial product, UltraQuiet provides a new form of high-frequency bone conduction therapy. To assess its effectiveness in tinnitus treatment, we selected 15 patients with problematic tinnitus and randomly assigned them to three variations of the medical-audiological tinnitus patient protocol modified for the UltraQuiet study. We assessed tinnitus relief by questionnaires directed at weighing patient response to overall effectiveness, tinnitus loudness, tinnitus severity, and tinnitus annoyance. Additionally, we performed audiological measures (including pure-tone and speech audiometry, minimal masking levels, pitch and loudness matching, and residual inhibition). All patients showed some long-term gains, and most exhibited relief in at least one measurement parameter, providing support for the use of high-frequency vibration in the treatment of tinnitus.

Acoustic Stimulation↗
PubMed2005

Ultra-high-frequency ultrasonic external acoustic stimulation for tinnitus relief: a method for patient selection.

We proposed a method for patient selection and application of criteria for predicting success with bone-conduction external acoustic stimulation using high-audio-frequency sound in the ranges of 10-20 kHz and 20-26 kHz for individuals with subjective idiopathic tinnitus (SIT) of the severe disabling type. Ultra-high-frequency (UHF) stimulation for tinnitus relief has been found to be most effective when residual neuronal function exists in the acoustic ranges of 10-14 kHz, with thresholds no greater than 40-50 dB sound pressure level (SPL). Ultrasonic (US) acoustic stimulation is recommended for patients with audiometric thresholds greater than 50-60 dB SPL for frequencies of 10-14 kHz. Fifty-two consecutive patients seen for the primary complaint of SIT of the severe disabling type received a trial of either UHF or US bone-conduction acoustic stimulation. Tinnitus relief was reported in 22 of the 52 patients. The application of criteria for patient selection predicted tinnitus relief in 20 of the 22.

Acoustic Stimulation↗
PubMed2004

Benzodiazepine receptor distribution in severe intractable tinnitus.

Tinnitus affects nearly 50 million people in the United States, with a minority demonstrating marked functional impairment. Alterations of gamma aminobutyric acid (GABA) neuronal function and benzodiazepine receptor (BZR) function in particular have been implicated in the pathophysiology of severe, chronic tinnitus. The purpose of our study was to evaluate the distribution of BZR in the brain using 123I-iomazenil single-photon emission computed tomography (SPECT) imaging in patients with severe, intractable central tinnitus. Six patients with severe intractable tinnitus received a bolus and constant infusion of 123I-iomazenil intravenously over 7 hours with SPECT and magnetic resonance imaging of the brain. After magnetic resonance imaging coregistration, standardized regions of interest were placed over the cerebellar, frontal (control), superior temporal, hippocampal, and thalamic regions bilaterally on (SPECT) images. Venous blood samples were drawn at specified intervals to determine equilibrium distribution volumes (V3') for each of the regions. Variation in V3' values in homotypic regions were calculated using a Wilcoxon signed rank test. Twelve normal control subjects were compared to the study subjects using statistical parametric mapping. Comparison of homotypic brain regions showed statistically significant asymmetry in the V3' data in the superior temporal cortex (p = .03 for both). No statistically significant difference was noted in any of the other regions studied. Comparison of the group of study subjects to healthy controls revealed an insignificant trend toward reduction in BZR density in the frontal lobes bilaterally (p = .000) and a reduction in the cerebellum (p = .045). Current understanding suggests GABA receptors and the temporal lobe system as the final common pathway. This pilot study suggests possible alterations on 123I-iomazenil SPECT imaging and the need for larger studies.

Adult↗
PubMed2004

Ultra-high-frequency acoustic stimulation and tinnitus control: a positron emission tomography study.

Ultra-high-frequency (UHF) external acoustic stimulation with the UltraQuiet device (UQ) has been reported to provide significant relief of severe disabling-type tinnitus. The nuclear medicine imaging technique of positron emission tomography (PET) was selected as a monitoring system to compare objectively metabolic alterations in brain function before and after UHF/UQ and to correlate the PET data with the subjective behavioral response of patients reporting tinnitus relief. PET of brain was completed on 6 patients randomly selected from a cohort of 15 patients included in a protocol to establish long-term tinnitus relief with UHF/UQ. Twelve specific regions of interest (ROI) were selected for PET of brain examination on the basis of results obtained with single-photon emission computed tomography (SPECT) of brain examinations recommended for patients with severe disabling-type tinnitus and demonstrating significant perfusion asymmetries in the right and left brain ROI of the primary auditory cortex; frontal, temporal, parietal, and medial temporal lobes; and cerebellum. PET of brain results included ratios of post- and pre-UHF/UQ stimulation that demonstrated no random response in the selected PET of brain ROI and ratios of post- and pre-UHF/UQ stimulation that demonstrated three categories of response in the selected PET brain ROI for all six patients: hypermetabolism in three patients; hypometabolism in two; and a mixed response in one. Correlation was established for each patient among PET and electrophysiological responses of alteration in minimal masking levels, the residual UHF neuronal response as reflected in the UHF audiogram, and the subjective reported behavioral responses of patients (obtained from outcome questionnaires for tinnitus relief, which focused on tinnitus intensity, annoyance, severity index, and a subjective scale of value of the UHF/UQ device for tinnitus relief. The subjective behavioral response for tinnitus relief with UHF/UQ was found to reflect a dual effect: acoustic stimulation of the residual neuronal function in the UHF range (10-14 kHz) and audiometric thresholds of 40-50 dB sound pressure level (SPL), and the metabolic activity at brain cortex for neuronal reprogramming. The PET of brain categories of response suggested that the UHF/UQ "masking" is predominantly reflective of neuronal reprogramming at the brain cortex. Nuclear medicine PET of brain imaging has provided an objective monitoring system for attempting to establish the efficacy of UHF/UQ for tinnitus relief. No complication of the tinnitus was reported secondary to the PET of brain examination. This limited PET of brain study supports the clinical recommendation of the efficacy of UHF/UQ external acoustic stimulation for a selected population of patients with tinnitus of the severe disabling type.

Acoustic Stimulation↗
PubMed2003

Tinnitus outcome profile and tinnitus control.

This reports recommends the consideration of development of additional outcome measures to be used as a battery of subjective self-assessment questionnaires for patients with tinnitus. The goal is improved overall care for the tinnitus patient. Five existing outcome measurements have been incorporated into this profile, which is called the tinnitus outcome profile: the tinnitus intensity index, the tinnitus annoyance index, the tinnitus stress test, the tinnitus handicap inventory, and the measurement of depression scale. Frequently, there is an inconsistency between the self-report outcomes and the patient's subjective report to the doctor. This study reports outcomes based on the tinnitus outcome profile for 19 patients who were seen for evaluation and treatment of subjective idiopathic tinnitus of the severe disabling type and who completed a treatment protocol called receptor-targeted therapy directed to the GABAA receptor. The drugs used were gabapentin and clonazepam. Using the 0.05 significance level, the tinnitus intensity index, tinnitus annoyance index, and tinnitus stress test scores all declined significantly over time. In contrast, there was no significant change in either the tinnitus handicap inventory or the measurement of depression scale. The percent of tinnitus control reported to the doctor by the patient did not appear to be correlated with the degree of change measured on the tinnitus outcome profile.

Adult↗
PubMed2003

Use of high-frequency and muscle vibration in the treatment of tinnitus.

Although tinnitus is defined as an internal auditory sensation, external auditory stimuli can mask tinnitus under some circumstances. High-frequency vibration delivered as bone conduction stimulation is effective in masking high-pitched tinnitus. In this preliminary report, somatosensory stimulation in the form of low-frequency muscle vibration can also mask high-frequency tinnitus. Somatosensory stimulation provides fast, immediate relief, whereas high-frequency vibration provides longer-lasting benefit. Either modality can stand alone or can be used in conjunction for tinnitus treatment. A clinically feasible technique has been identified for more wide-scale evaluation.

Adult↗
PubMed2003

Sustained-release delivery of leupeptin in the chinchilla: hearing results.

Transtympanic medical therapy is becoming an increasingly popular modality for the treatment of "inner-ear disorders." While investigators continue to examine the best dosing paradigms for gentamicin in the treatment of Ménière's disease and for steroids in the treatment of hearing loss, they have also begun to focus on the use of other agents. In particular, transtympanic therapy has been advocated as a plausible route for the treatment of tinnitus. Transtympanic therapy for tinnitus is not new, and a number of groups have reported success in the past. Despite this success, a number of laboratories have been focusing on newer agents that might yield higher success rates in the treatment of tinnitus and other inner-ear disorders. Many of these agents could have systemic side effects when delivered in high enough doses; therefore, they are ideal candidates for transtympanic administration. The goal of this study is to begin to define the effects of one of these agents--leupeptin, a calpain antagonist--on the normal inner ear of an animal model. In this investigation, we demonstrate the effects of sustained-release delivery of leupeptin (2.5 micrograms/ml) on the hearing of chinchillas. The medicine produced no hearing loss at the early time points but did produce some hearing loss at later time points. We discuss these results and begin to outline the next steps in the investigation of this agent.

Animals↗
PubMed2002

Quantitative electroencephalography: preliminary report--tinnitus.

This preliminary report is an account of 21 consecutive patients who had tinnitus of the severe disabling type and were examined with quantitative electroencephalography (QEEG). A multimetric analysis of the raw data was highlighted by an abnormal incidence of significant central nervous system electrical dysfunction identified in each patient (21 of 21). Relative power was increased or decreased in the temporal region in 10 of 21 patients. Relative power was reported to be increased or decreased in temporal frontal regions in 20 of 21 patients. Coherence irregularity was identified in all 21 patients. QEEG preliminary data support the hypothesis of a final common pathway for tinnitus and the significant role of the temporal and temporofrontal regions of interest in patients with tinnitus of the severe disabling type. QEEG with multimetric analysis is considered a significant addition to the medical audiological tinnitus patient protocol as one of a battery of electrophysiological tests for the clinical identification of a predominantly central type of tinnitus.

Adult↗
PubMed2002

Measurement of bone conduction levels for high frequencies.

For assessment of safety, it is necessary to measure the maximum possible force exerted by a bone conduction device coupled to the human head. Calibration of bone conduction hearing aids and vibrators in the audiometric range is based on measurement of acceleration and force using an artificial mastoid. Extending the measurement to the high audio range was accomplished using a live head. To assess safety of the UltraQuiet tinnitus treatment system, as an example, acceleration was measured from 5 to 20 kHz on a live human head as compared with calibrated levels at 6 kHz on an artificial mastoid and the live head. Using head acceleration and anchoring it to established calibration levels is a means of establishing clinical safety. Stimulation in the high audio frequencies at low levels was found to be safe. In contrast, stimulation with ultrasound requires more energy (approximately 75-90 dB re 6 kHz), which may increase the risk of damage to the car.

Auditory Threshold↗