Barbara Goldstein

Electrophysiology quantitative electroencephalography/low resolution brain electromagnetic tomography functional brain imaging (QEEG LORETA): Case report: Subjective idiopathic tinnitus - predominantly central type severe disabling tinnitus.

The clinical significance of QEEG LORETA data analysis performed sequentially within 6 months is presented in a case report of a predominantly central type severe disabling subjective idiopathic tinnitus (SIT) before and following treatment. The QEEG LORETA data is reported as Z-scores of z = ± 2.54, p < 0.013. The focus is on demonstration of patterns of brain wave oscillations reflecting multiple brain functions in multiple ROIs in the presence of the tinnitus signal (SIT). The patterns of brain activity both high, middle and low frequencies are hypothesized to reflect connectivities within and between multiple neuronal networks in brain. The Loreta source localization non auditory ROI Images at the maximal abnormality in the very narrow band frequency spectra (24.21 Hz), showed the mathematically most probable underlying sources of the scalp recorded data to be greatest in the mid-cingulate, bilateral precuneus, cingulate and the bilateral caudate nucleus. Clinical correlation of the data with the history and course of the SIT is considered an objective demonstration of the affect, behavioral, and emotional component of the SIT. The correlation of the caudate activity, SIT as the traumatic event with the clinical course of PTSD, and the clinical diagnosis of PTSD is discussed. The clinical translation for patient care is highlighted in a SIT patient with multiple comorbidities by translation of QEEG/LORETA electrophysiologic data, as an adjunct to: provide an objectivity of patterns of brain wave activity in multiple regions of interest (ROIs) reflecting multiple brain functions, in response to and in the presence of the tinnitus signal, recorded from the scalp and analyzed with the metrics of absolute power, relative power, asymmetry, and coherence, for the subjective tinnitus complaint (SIT); 2) provide an increase in the accuracy of the tinnitus diagnosis; 3) assess/monitor treatment efficacy; 4) provide a rationale for selection of a combined tinnitus targeted therapy of behavioral, pharmacologic, sound therapy modalities of treatment attempting tinnitus relief; 5) provide insight into the medical significance of the SIT; 6) attempt discriminant function analysis for identification of a particular diagnostic clinical category of CNS neuropsychiatric disease; and 7) attempt to translate what is known of the neuroscience of sensation, brain function, QEEG/LORETA source localization, for the etiology and prognosis of the individual SIT patient.

Brain Imaging and tinnitus

The theme of the AAO HNS Martha Entenmann, Abraham Shulman, M.D., Barbara Goldstein, PhD, International Tinnitus Miniseminar 2012 was “Brain Imaging and Tinnitus. The meeting, well attended , provided to the attendees a take home message that clinical application of the brain imaging technologies of nuclear medicine, single photon emission tomography, (SPECT), photon emission tomography(PET), functional MRI brain imaging ,fMRI, magnetoencephalography, (MEG), can provide an objectivity for tinnitus, a subjective sensory aberrant auditory complaint.

AAO HNS Tinnitus Miniseminar "Tinnitus Lessons Learned from Combat and Service". Summary 2015.

The theme of the AAO-HNS Tinnitus Miniseminar, 09/23/2014, was “Tinnitus Lessons Learned from Combat and Service.” The speakers discussed their clinical experiences as well as lessons learned from combat and service for translation to tinnitus theory, basic science and clinical research, and tinnitus patient diagnosis and treatment. The program chairman and moderator was: - Michael E. Hoffer, M.D., F.A.C.S., Professor of Otolaryngology, Department Otolaryngology HNS, University of Miami

Tinnitus neural map; A positron emission tomography study

The neural map of tinnitus involves more than the classical auditory pathways and the limbic system. PET findings in six patients, with severe problem tinnitus, revealed the involvement of the cerebellum, insula and frontal cortices when these patients were imaged before and after high frequency bone conduction therapy. The frontal cortex and cerebellum demonstrated the highest ratios of metabolic change but changes were also noted in the thalamus and the medial temporal lobe system. The PET data supports the view that the frequency specific map of auditory cortex is dynamic and can change with high frequency therapy, presumably due to neural reorganization. The PET data further reflect alterations in multiple areas of brain in all patients to tinnitus and/or high frequency therapy. Encouraging was the observation that patients with the most dramatic change in their global pre/post PETs were also the ones who exhibited the greatest behavioral improvement in regards to tinnitus relief measured by informal ...

High‐frequency stimulation in tinnitus treatment

Limited but convincing evidence suggests neural plasticity plays a role in the development and maintenance of tinnitus. Tinnitus is generally pitch matched with high frequencies (<6 kHz) and is often associated with very hearing loss, although the conventional audiometric thresholds may be normal or near normal. It is hypothesized that the brain experiences high‐frequency air conduction auditory deprivation and this is a causative factor in tinnitus. If the low‐pass middle ear is circumvented by bone conduction stimulation, residual high‐frequency receptors in the cochlea can again be activated. High‐frequency bone conduction transducers were fabricated to deliver frequencies from 6 to 40 kHz. The transducers were aluminum ceramic bimorphs with circular topology which were heavily damped by mass loading to the mastoid with resonances at 9 and 39 kHz. Ten subjects with persistent tinnitus were selected to listen to proprietary high‐frequency patterned stimulation for two half‐hour sessions for 4 weeks. Exi...

Committee on Geriatric Otolaryngology

Spindle cell carcinoma (pseudosarcoma) is a rare biphasic tumor with longstanding controversy in the literature concerning histogenesis and appropriate management. This study was performed to elucidate the tumors biologic behavior, clarify its pathologic features and probable histogenesis, identify prognostic factors, and determine treatment results. We reviewed the clinical records of 34 cases of laryngeal (25) and hypopharyngeal (9) spindle cell carcinomas treated at our institution from 1960 to 1990. All cases were studied by paraffin section immunostains, and 31 underwent ploidy analysis of the sarcomatoid component. Of the 31 patients who underwent their initial treatment at our institution, there were 25 men and six women with a median age at presentation of 64.6 years. A T1 glottic tumor was most common (16 cases), usually seen as an exophytic, firm mass. The spindle cells were nondiploid in 84%, and keratin immunostains were positive in 74%. The median length of follow-up was 3.7 years. Recurrent tumor after partial or total laryngectomy/pharyngectomy occurred in 10 patients. At last contact, eight patients had died of their disease. The Kaplan-Meier estimate of surviving at least 3 years after initial treatment is 56.8%. Keratin positivity adversely affected overall survival (p <0.02). The survival of patients with hypopharyngeal tumors was worse than those with laryngeal lesion (p <0.01). The presence of keratin positivity and nondiploid DNA content in the spindle cell population supports the neoplastic epithelial origin of these tumors (sarcomatoid carcinoma). Because the entire lesion represents a malignant epithelial neoplasm rather than a reactive process, it should be treated appropriately. Overall tumor behavior and surgical therapy appear comparable to similar staged squamous cell carcinomas. Additional clinical and pathologic features of prognostic significance will be presented.

Tinnitus Treatment Strategies Including Neuropharmacology

Educational objectives: To develop a strategy for increased efficacy of tinnitus control and medical significance and to select modalities of therapy based on identification of clinical types of tinnitus and factors known to influence tinnitus with a medical-audiologic tinnitus patient protocol.