MMN 15 minute
4 Comprehensive Discussion
4.3 Synopsis of research
Considering all of the above results, it should be noted that the observed neuronal activity changes that are associated with tinnitus perception overlap in two primary brain regions: the auditory brainstem and the neural structures in the primary and secondary associative auditory cortices. The observed neuroelectrical alterations are characterized by an increased BTT and decreased CAP amplitude in tinnitus subjects and may indicate underlying neuronal activity lesions, which manifest as auditory deafferentation. Regarding to extraction of whatever mentioned in part one, “it was assumed that BTT and other specific features of early AEPs altered associated with RI induced by AES”. Based on results of this study, we came into this point that some of the features of early AEPs and particularly BTT changed associated with RI and therefore our main hypothesis was confirmed.
37 The reduced integrity of the brainstem auditory nuclei and centrifugal pathways in tinnitus subjects (as indexed by ECochG and ABR recordings) and the neural structures in the primary and secondary associative auditory cortices (as indexed by MMN) with other cortical and subcortical structures, all together may indicate a primary lesion that underlies tinnitus pathogenesis. A consequence of such deficits may cause a secondary defect that is characterized by abnormal functionality in these regions. As mentioned in part two “the study hypothesized that the central auditory processing was affected from chronic tinnitus compared to normal hearing (NH) controls.
Also the main aim of the study was to compare the neural correlation of the automatic auditory sensory memory and auditory discrimination in tinnitus subjects and normal hearing (NH) controls”. The results revealed smaller amplitude and area under the curve for multi-feature of MMN responses consisting of frequency, duration and silent gap deviants in the tinnitus subjects (refer to page 80-83). The study concluded that there was a deficit in automatic central auditory processing mechanisms in tinnitus subjects (as supported by the MMN findings).
The following results were extracted from the part one of study:
1- CAP amplitude significantly increased associated with RI in tinnitus subjects.
2- BTT significantly decreased associated with RI in tinnitus subjects.
3- Amplitude ratio of waves III/V and I/V decreased associated with RI in tinnitus subjects.
And the following evidences were concluded from the part two of the study:
1- MMN amplitude and area under the curve decreased for three deviants of frequency, duration and silent gap in tinnitus subjects.
38 2- The patterns of silence in the brain of chronic tinnitus subjects were potentially affected by
abnormal silence code.
The following issues were concluded in chronic tinnitus subjects:
1- Neuro-electrical alterations in early AEPs induced by RI and some changes in peripheral and central auditory functions including auditory nerve fibres, the cochlear nucleus and inferior colliculus and finally modification of cortical activity
2- The roles of synchronizing discharges in auditory nerve fibers and inhibition of abnormal activity of cochlear nerve during RI
3- Subjects with chronic tinnitus indicated a deficit in pre-attentive central auditory processing and auditory sensory memory mechanisms.
4- Possible neuroplastic changes in brain caused by abnormal central auditory activity.
5- Transient and partial normalization of abnormal auditory neural activities associated with RI
This thesis was highlighted the neuro-electrical substrates caused by tinnitus RI using early AEPs and also disclosed that pre-attentive central auditory processing was affected in chronic tinnitus (as indexed by topographical maps of the mismatch negativity responses). Hopefully this study could extend our insight to neurophysiological and pathophysiological aspects corresponding to tinnitus and RI. Meanwhile investigation of pathophysiology of tinnitus and related neural mechanisms through more precise studies with other methods is fully recommended.
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