Dysfunction of the inner ear as caused by presbyacusis, injuries or noise traumata may result in subjective tinnitus, but not everyone suffering from one of these diseases develops a tinnitus percept and vice versa. The reasons for these individual differences are still unclear and may explain why different treatments of the disease are beneficial for some patients but not for others. Here we for the first time compare behavioral and neurophysiological data from hearing impaired Mongolian gerbils with (T) and without (NT) a tinnitus percept that may elucidate why some specimen do develop subjective tinnitus after noise trauma while others do not. Although noise trauma induced a similar permanent hearing loss in all animals, tinnitus did develop only in about three quarters of these animals. NT animals showed higher overall cortical and auditory brainstem activity before noise trauma compared to T animals; that is, animals with low overall neuronal activity in the auditory system seem to be prone to develop tinnitus after noise trauma. Furthermore, T animals showed increased activity of cortical neurons representing the tinnitus frequencies after acoustic trauma, whereas NT animals exhibited an activity decrease at moderate sound intensities by that time. Spontaneous activity was generally increased in T but decreased in NT animals. Plastic changes of tonotopic organization were transient, only seen in T animals and vanished by the time the tinnitus percept became chronic. We propose a model for tinnitus prevention that points to a global inhibitory mechanism in auditory cortex that may prevent tinnitus genesis in animals with high overall activity in the auditory system, whereas this mechanism seems not potent enough for tinnitus prevention in animals with low overall activity.

Noise-induced hearing loss (NIHL) and resulting comorbidities like subjective tinnitus are common diseases in modern societies. A substance shown to be effective against NIHL in an animal model is theGinkgo bilobaextract EGb 761. Further effects of the extract on the cellular and systemic levels of the nervous system make it a promising candidate not only for protection against NIHL but also for its secondary comorbidities like tinnitus. Following an earlier study we here tested the potential effectiveness of prophylactic EGb 761 treatment against NIHL and tinnitus development in theMongolian gerbil. We monitored the effects of EGb 761 and noise trauma-induced changes on signal processing within the auditory system by means of behavioral and electrophysiological approaches. We found significantly reduced NIHL and tinnitus development upon EGb 761 application, compared to vehicle treated animals. These protective effects of EGb 761 were correlated with changes in auditory processing, both at peripheral and central levels. We propose a model with two main effects of EGb 761 on auditory processing, first, an increase of auditory brainstem activity leading to an increased thalamic input to the primary auditory cortex (AI) and second, an asymmetric effect on lateral inhibition in AI.

Human hearing loss (HL) and comorbidities like tinnitus pose serious problems for people’s daily life which in most severe cases may lead to social isolation, depression and suicide. Here we investigate the relationship between hearing deficits and tinnitus. To this end we conducted a retrospective study on anonymized pure tone and speech audiometric data from patients of the ENT hospital Erlangen in which we compare audiometric data between patients with and without tinnitus. Overall data from 37661 patients with sensorineural (SHL) or conductive hearing loss (CHL) with (T, 9.5%) or without (NT, 90.5%) a tinnitus percept in different age groups and with different tinnitus pitches were included in this study. The results of the pure tone audiometry comparisons showed significant differences in T patients compared to NT patients. In young patients, we generally found lower hearing thresholds in T compared to NT patients. In adult patients, differences were more heterogeneous: hearing thresholds in T patients were lower in low frequency ranges, while they were higher at high frequencies. Furthermore, lower thresholds were more often found in CHL patients and could rarely be detected in SHL patients. In speech audiometry only CHL patients with high pitched tinnitus showed lower thresholds compared to NT patients’ thresholds. The results of this study may point to a biologically plausible functional benefit on hearing thresholds in HL tinnitus patients. We hypothesize that the physiological mechanism of stochastic resonance counteracts HL by adding neuronal noise to the system. This neuronal noise may induce changes in the auditory pathway and finally – as a side effect of threshold improvement – lead to the development of a tinnitus percept. We propose a general model of changed hearing thresholds in T patients, being either decreased or increased compared to NT patients.

Human hearing loss (HL) is often accompanied by comorbidities like tinnitus which is affecting up to 15% of the adult population. Rodent animal studies could show that tinnitus may not only be a result of apparent HL due to cochlear hair cell damage but can also be a consequence of synaptopathy at the inner hair cells (IHC) already induced by moderate sound traumata. Here we investigate synaptopathy previously shown in mice in our animal model, the Mongolian gerbil, and relate it to behavioral signs of tinnitus. Tinnitus was induced by a mild monaural acoustic trauma leading to monaural noise induced HL in the animals, quantified by auditory brainstem response (ABR) audiometry. Behavioral signs of tinnitus percepts were detected by measurement of prepulse inhibition of the acoustic startle response in a gap-noise paradigm. 14 days after trauma, the cochleae of both ears were isolated and IHC synapses were counted within several spectral regions of the cochlea. Behavioral signs of tinnitus were only found in animals with IHC synaptopathy, independent of type of HL. On the other hand, animals with apparent HL but without behavioral signs of tinnitus showed a reduction in amplitudes of ABR waves I&II but no significant changes in the number of synapses at the IHC. We conclude – in line with the literature – that HL is caused by damage to the IHC or by other reasons but that the development of tinnitus, at least in our animal model, is closely linked to synaptopathy at the IHC.

Despite the high prevalence of tinnitus in Germany of nearly 12% of the general population, there have been no systematic studies on the socioeconomic costs for German society caused by tinnitus so far. Here we analyzed data from 258 chronic tinnitus patients—namely tinnitus severity and health utility index (HUI)—and correlated them with their tinnitus-related public health care costs, private expenses, and economic loss due to their tinnitus percept as assessed by questionnaires. We found correlations of the HUI with health care costs and calculated the mean socioeconomic costs per tinnitus patient in Germany. According to our most conservative estimate, these sum up to EUR 4798.91 per year. Of that EUR 2206.95 account for the public health care, EUR 290.45 are carried by the patient privately and the remaining EUR 2301.51 account for economical loss due to sick leave. With a prevalence of 5.5% with at least bothersome tinnitus, this sums up to 21.9 billion Euro per year and with 25.82 sick leave days; tinnitus patients miss work more than double the time of the average German employee (10.9 days). The findings fit within the cost ranges of studies from other European countries and the USA and show that the socioeconomic burden of this disease-like symptom is a global problem. In comparison with the costs of other major chronic diseases in Germany—such as chronic obstructive pulmonary diseases (ca. 16 billion Euro) or diabetes mellitus (ca. 42 billion Euro)—the relevance of the ‘symptom’ tinnitus for the German social economy becomes even more obvious.

Besides visual sleep stage scoring, it is possible to separate sleep stages by analyzing spatially distributed three-channel electroencephalogram (EEG) root mean square (RMS) amplitudes. This approach allows qualitative and quantitative evaluation of sleep architecture. The aim of this study was to analyze the effect of apnea–hypopnea index (AHI) and state of vigilance on the microstructure of cortical activity during sleep using EEG cluster analysis.