ISSN 1612-3352

Editors in Chief

Prof. Dr. Claus F. Claussen, Neurootological Research Institute of the Research Society for Smell, Taste, Hearing and Equilibrium Disorders at Bad Kissingen (4-G-F). Bad Kissingen, Germany.
Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.

Production Managers

Dr. med. Julia M. Bergmann,
Dr. med. Guillermo O. Bertora,
Otoneuroophthalmological Neurophysiology,
Buenos Aires, Argentina.


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Central Nervous System Neurodegeneration and Tinnitus: A Clinical Experience Part I: Diagnosis

Abstract

CNS Neurodegeneration and Tinnitus IIn an evolving clinical experience since 1979, the medical significance of the
symptom of tinnitus has been identified as a “soft” sign of neurodegeneration (ND) in the central
nervous system (CNS) in a particular subset of tinnitus patients diagnosed with a predominantly
central-type, severe, disabling, subjective idiopathic tinnitus.To highlight this
experience, a retrospective review and analysis of consecutive tinnitus patients (N96) was
conducted. Ninety-six tinnitus patients (ages 22–90 years) were seen in neurotological consultation
from November 1, 2005, to June 30, 2007, all of whom had subjective idiopathic tinnitus
of the severe disabling type (SIT). Of these 96 patients, 54 had SIT of the predominantly central
type and of these, 18 (ages 39–75 years) were recommended for nuclear medicine imaging
(single-photon emission computed tomography [SPECT] and fluorodeoxyglucose–positron
emission tomography/computed tomography [FDG-PET/CT]). Patient selection for nuclear
medicine imaging fulfilled the criteria of a medical-audiological ND tinnitus profile: completion
of a patient protocol that diagnosed a predominantly central-type, severe, disabling, subjective,
idiopathic tinnitus lasting in excess of 1 year, and failure of existing modalities of
treatment attempting tinnitus relief. In 16 of the 18 patients, objective evidence of ND was reported
in multiple neural substrates of brain obtained with SPECT or FDG-PET/CT of brain.
Classification of CNS ND and tinnitus differentiated between (1) ND of nonspecific or unknown
etiology; (2) ND manifested by perfusion asymmetries in brain associated with ischemia
(n 11/18); and (3) neurodegenerative CNS disease consistent with nuclear medicine
criteria for senile dementia of the Alzheimer’s type (n 5/18). The diagnosis has been associated
with cerebrovascular disease (n 16/18). The identification of neurodegenerative CNS
disease in a selected cohort of patients with subjective idiopathic tinnitus as a soft sign of such
CNS disease has implications for diagnosis and treatment.

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