Task-Based Functional MRI (fMRI) in Patients With Severely Bothersome Tinnitus

Study Overview
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Brief Summary
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Tinnitus is a poorly understood symptom that is often described either as ringing, clicking, ocean sounds, or nature sounds. There is no cure for tinnitus. Approximately 50 million Americans are affected with a small minority being severely affected. This study targets patients with tinnitus who are severely bothered. Through MRI the investigators plan to evaluate the cortical networks of the brain in hopes to better understand this complex process.

Detailed Description
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Tinnitus is the perceived sensation of sound without actual acoustic stimulation that affects 50 million Americans, with 15 million being significantly bothered. Using functional connectivity MRI (fcMRI), the investigators have found distinct differences in the cortical attention networks between patients with bothersome tinnitus and age-matched controls. These novel findings suggest that some of the classic and most disturbing characteristics of tinnitus result from derangements in cortical pathways. Using a validated task-based functional MRI (fMRI) paradigm developed at Washington University, the investigators will explore the ventral and dorsal frontoparietal cortical attention networks in patients with bothersome tinnitus and non-tinnitus controls. This will be an experimental task-based fMRI pilot study involving the neurocognitive and neuroimaging assessment of patients with severely bothersome tinnitus. The investigators plan to perform a pilot study and enroll a total of 10 subjects to undergo task-based imaging. These results will be compared to a control (no tinnitus) cohort (n=35) that has already undergone task-based fMRI. This task-based paradigm will allow us to advance knowledge about the role of the attention, control, and other cortical networks in the development and maintenance of bothersome tinnitus. The investigators anticipate it will take one year to successfully enroll and test a total of 10 patients. All scans will be performed on the Washington University grounds.

Official Title
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Task-Based Functional MRI (fMRI) Exploration of the Cortical Attention Network in Patients With Severely Bothersome Tinnitus

Conditions
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Tinnitus

Intervention / Treatment
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* Procedure: MRI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women between the ages of 18 to 60 years Subjective, unilateral or bilateral, non-pulsatile tinnitus of 6 month's duration or greater Either moderately bothered or severely bothered on the Global Bothersome scale Able to give informed consent Able to read, write, speak and understand English fluently If applicable, a negative urine pregnancy test An audiogram within the past 12 months THI score >38 Exclusion Criteria: Patients experiencing tinnitus related to cochlear implantation, retrocochlear lesion, Ménière's Disease, or other known anatomic lesions of the ear and temporal bone Patients with hyperacusis or misophonia (hyper-sensitivity to noises) Patients with cardiac pacemakers, intracardiac lines, implanted medication pumps, implanted electrodes in the brain, or any other contraindication for MRI scan Patients with an acute or chronic unstable medical condition which, in the opinion of the investigator, would require stabilization prior to initiation of magnetic stimulation Patients with any active ear disease that, in the opinion of the PI, needs to be further evaluated Patients with symptoms of depression as evidenced by a score of 14 or greater on the Beck Depression Inventory Any psychiatric co-morbidity that may complicate the interpretation of study results Any tinnitus related to a Workman's Compensation claim or litigation-related event Weight over 300 pounds A Mini-Mental Status Exam score less than 27 Patients with a history of claustrophobia Inability to lay flat for 2 hour Active alcohol and/or drug dependence or history of alcohol and/or drug dependence within the last year Any medical condition that, in the opinion of the investigators, confounds study results or places the subject at greater risk Unable to provide informed consent Currently pregnant

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Bothered Tinnitus<br>Either responds with a Global Tinnitus Scale of Moderately or Severely Bothered. Score >30 on the Tinnitus Handicap Index (THI). | Procedure: MRI<br>* This is an observational study, no intervention will occur.<br>* Other names: This is an observational study, no intervention will occur.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perform task based functional imaging on severely bothered tinnitus patients | By undergoing a task based function MRI, we are able to delineate the various attention networks involved with tinnitus. By isolating these networks, insight will be gained on why bothered tinnitus patients have such difficutly. | Analysis will begin after a participant is finished with the study, we anticipate two weeks per patient for complete analysis. Multiple patients can be analyzed at concurrently. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perform neurocognitive testing on severely bother tinnitus patients | Through our previously experiences, we have found that those patients with severely bothersome tinnitus have difficulty with neurocognitive testing involving memory and attention. | Analysis will begin after a participant is finished with the study, we anticipate two weeks per patient for complete analysis. Multiple patients can be analyzed at concurrently. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Tinnitus, MRI, fMRI, task based MRI, Otolaryngology