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An Integrative Model Accounting for the Symptom Cluster Triggered After an Acoustic Shock

机译:声震后症状群触发的综合模型

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Acoustic shocks and traumas sometimes result in a cluster of debilitating symptoms, including tinnitus, hyperacusis, ear fullness and tension, dizziness, and pain in and outside the ear. The mechanisms underlying this large variety of symptoms remain elusive. In this article, we elaborate on the hypothesis that the tensor tympani muscle (TTM), the trigeminal nerve (TGN), and the trigeminal cervical complex (TCC) play a central role in generating these symptoms. We argue that TTM overuse (due to the acoustic shock), TTM overload (due to muscle tension), and ultimately, TTM injury (due to hypoxia and “energy crisis”) lead to inflammation, thereby activating the TGN, TCC, and cortex. The TCC is a crossroad structure integrating sensory inputs coming from the head–neck complex (including the middle ear) and projecting back to it. The multimodal integration of the TCC may then account for referred pain outside the ear when the middle ear is inflamed and activates the TGN. We believe that our model proposes a synthetic and explanatory framework to explain the phenomena occurring postacoustic shock and potentially also after other nonauditory causes. Indeed, due to the bidirectional properties of the TCC, musculoskeletal disorders in the region of the head–neck complex, including neck injury due to whiplash or temporomandibular disorders, may impact the middle ear, thereby leading to otic symptoms. This previously unavailable model type is experimentally testable and must be taken as a starting point for identifying the mechanisms responsible for this particular subtype of tinnitus and its associated symptoms.
机译:声震和外伤有时会导致一系列虚弱的症状,包括耳鸣,听觉亢进,耳部充盈和紧张,头晕和耳内外疼痛。多种症状背后的机制仍然难以捉摸。在本文中,我们详细阐述以下假设:张量鼓膜肌肉(TTM),三叉神经(TGN)和三叉颈椎复合体(TCC)在产生这些症状中起着核心作用。我们认为,TTM过度使用(由于电击),TTM超负荷(由于肌肉张力),最终导致TTM损伤(由于缺氧和“能量危机”)导致炎症,从而激活TGN,TCC和皮质。 TCC是一个十字路口结构,整合了来自头颈复合体(包括中耳)并向后投射的感觉输入。然后,TCC的多峰整合可以解决中耳发炎并激活TGN时在耳朵外引起的疼痛。我们认为,我们的模型提出了一个综合性的解释框架,以解释声震后以及其他非听觉原因之后可能发生的现象。实际上,由于TCC的双向特性,头颈复合体区域的肌肉骨骼疾病(包括由于鞭打或颞下颌疾病引起的颈部损伤)可能会影响中耳,从而导致耳部症状。这种以前不可用的模型类型在实验上是可测试的,必须作为识别该耳鸣这种特定亚型及其相关症状的机制的起点。

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