Publications by authors named "Reijo Johansson"

13 Publications

  • Page 1 of 1

Neuronavigated Versus Non-navigated Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus: A Randomized Study.

Trends Hear 2019 Jan-Dec;23:2331216518822198

10 Department of Clinical Neurophysiology, Division of Medical Imaging, Turku University Hospital and University of Turku, Finland.

Repetitive transcranial magnetic stimulation (rTMS) has shown variable effect on tinnitus. A prospective, randomized 6-month follow-up study on parallel groups was conducted to compare the effects of neuronavigated rTMS to non-navigated rTMS in chronic tinnitus. Forty patients (20 men, 20 women), mean age of 52.9 years (standard deviation [ SD] = 11.7), with a mean tinnitus duration of 5.8 years ( SD = 3.2) and a mean tinnitus intensity of 62.2/100 ( SD = 12.8) on Visual Analog Scale (VAS 0-100) participated. Patients received 10 sessions of 1-Hz rTMS to the left temporal area overlying auditory cortex with or without neuronavigation. The main outcome measures were VAS scores for tinnitus intensity, annoyance, and distress, and Tinnitus Handicap Inventory (THI) immediately and at 1, 3, and 6 months after treatment. The mean tinnitus intensity (hierarchical linear mixed model: F = 7.34, p = .0006), annoyance ( F = 4.45, p = .0093), distress ( F = 5.04, p = .0051), and THI scores ( F = 17.30, p < .0001) decreased in both groups with non-significant differences between the groups, except for tinnitus intensity ( F = 2.96, p = .0451) favoring the non-navigated rTMS. Reduction in THI scores persisted for up to 6 months in both groups. Cohen's d for tinnitus intensity ranged between 0.33 and 0.47 in navigated rTMS and between 0.55 and 1.07 in non-navigated rTMS. The responder rates for VAS or THI ranged between 35% and 85% with no differences between groups ( p = .054-1.0). In conclusion, rTMS was effective for chronic tinnitus, but the method of coil localization was not a critical factor for the treatment outcome.
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November 2019

Psychiatric (Axis I) and personality (Axis II) disorders and subjective psychiatric symptoms in chronic tinnitus.

Int J Audiol 2018 04 30;57(4):302-312. Epub 2017 Nov 30.

g Department of Clinical Neurophysiology , Turku University Hospital and University of Turku , Turku , Finland.

Objective: Chronic tinnitus has been associated with several psychiatric disorders. Only few studies have investigated these disorders using validated diagnostic interviews. The aims were to diagnose psychiatric and personality disorders with structured interviews, to assess self-rated psychiatric symptoms and elucidate temporal relations between psychiatric disorders and tinnitus.

Design: Current and lifetime DSM-IV diagnoses of axis-I (psychiatric disorders) and axis-II (personality disorders) were assessed using structured clinical interviews (SCID-I and -II). Current subjective psychiatric symptoms were evaluated via self-rating instruments: the Symptom Check List-90 (SCL-90), the Beck Depression Inventory, and the Dissociative Experiences Scale (DES).

Study Sample: 83 patients (mean age 51.7, 59% men) with chronic, disturbing tinnitus and a median Tinnitus Handicap Inventory score of 32.

Results: The rates of lifetime and current major depression were 26.5% and 2.4%. The lifetime rate of obsessive-compulsive personality disorder (type C) was 8.4%. None of the patients had cluster B personality disorder or psychotic symptoms. The SCL-90 subscales did not differ from the general population, and median DES score was low, 2.4.

Conclusions: Tinnitus patients are prone to episodes of major depression and often also have obsessive-compulsive personality features. Psychiatric disorders seem to be comorbid or predisposing conditions rather than consequences of tinnitus. Clinical trial reference: (ID NCT 01929837).
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April 2018

Electric field-navigated transcranial magnetic stimulation for chronic tinnitus: a randomized, placebo-controlled study.

Int J Audiol 2017 09 18;56(9):692-700. Epub 2017 Apr 18.

b Department of Clinical Neurophysiology , Turku University Hospital and University of Turku , Turku , Finland.

Objective: Repetitive transcranial magnetic stimulation (rTMS) may alleviate tinnitus. We evaluated effects of electric field (E-field) navigated rTMS targeted according to tinnitus pitch. No controlled studies have investigated anatomically accurate E-field-rTMS for tinnitus.

Design: Effects of E-field-rTMS were evaluated in a prospective randomised placebo-controlled 6-month follow-up study on parallel groups. Patients received 10 sessions of 1 Hz rTMS or placebo targeted to the left auditory cortex corresponding to tonotopic representation of tinnitus pitch. Effects were evaluated immediately after treatment and at 1, 3 and 6 months. Primary outcome measures were visual analogue scores (VAS 0-100) for tinnitus intensity, annoyance and distress, and the Tinnitus Handicap Inventory (THI).

Study Sample: Thirty-nine patients (mean age 50.3 years).

Results: The mean tinnitus intensity (F = 15.7, p < 0.0001), annoyance (F = 8.8, p = 0.0002), distress (F = 9.1, p = 0.0002) and THI scores (F = 13.8, p < 0.0001) decreased in both groups over time with non-significant differences between the groups. After active rTMS, 42% and 37% of the patients showed excellent response at 1 and 3 months against 15% and 10% in the placebo group (p = 0.082 and p = 0.065).

Conclusions: Despite the significant effects of rTMS on tinnitus, differences between active and placebo groups remained non-significant, due to large placebo-effect and wide inter-individual variation.
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September 2017

Electric field navigated transcranial magnetic stimulation for chronic tinnitus: A pilot study.

Int J Audiol 2015 18;54(12):899-909. Epub 2015 Jun 18.

d Department of Clinical Neurophysiology , Turku University Hospital and University of Turku , Turku , Finland.

Objective: Repetitive transcranial magnetic stimulation (rTMS) has shown potential in reducing tinnitus symptoms. We evaluated effects of electric field (E-field) navigated rTMS targeted neuroanatomically according to tinnitus pitch.

Design: In this open methodological pilot study, the patients received E-field navigated 1-Hz rTMS in daily treatment sessions to the left superior temporal gyrus, targeted according to tonotopic representation of their individual tinnitus pitch. Patients rated their tinnitus intensity and annoyance with a numeric rating scale (NRS) from 0 to 10 at the baseline and after each rTMS session. They also rated their global impression of change (scale - 3 to + 3) after the treatment.

Study Sample: Thirteen patients (mean age 53 years; 10 men, 3 women) with chronic, intractable tinnitus.

Results: The mean intensity was 7.1 (SD 1.8) at the baseline, decreasing to 4.5 (SD 2.2) after the rTMS (p < 0.0001). The mean annoyance 7.0 (SD 1.8) at the baseline decreased to 4.0 (SD 2.4) after the treatment (p < 0.0001). Intensity diminished at least 30% in 8/13 patients and annoyance in 9/13 patients. A total of 10/13 patients felt subjective benefit from the treatment.

Conclusions: These preliminary observations suggest that E-field-rTMS may improve the current treatment options for intractable tinnitus.
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August 2016

The mismatch negativity (MMN) brain response to sound frequency changes in adult cochlear implant recipients: a follow-up study.

Acta Otolaryngol 2013 Aug 14;133(8):853-7. Epub 2013 Jun 14.

Speech Sciences, Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.

Conclusion: Plasticity of auditory pitch discrimination driven by cochlear implant (CI) use uring a 2.5-year follow-up was indicated by an enhancement of the amplitude of mismatch negativity (MMN) event-related brain potential (ERP) to pure tone frequency changes.

Objectives: To follow up changes in MMN elicited to frequency and duration changes in tones during 2.5 years of CI use and to compare MMN results with audiometric speech recognition scores (SRSs).

Methods: Postlingually deafened adults with Cochlear Nucleus CI-22 and spectra processor with SPEAK strategy were recruited. MMN was measured at 1 and 2.5 years after CI activation. Repetitive 100 ms standard tones with a frequency of 500, 1000, 2000 or 4000 Hz in separate sequences were delivered to participants concentrating on a silent movie. Deviant tones occurring infrequently among standard tones were 20% lower in frequency or 50% shorter in duration than the standards. Speech recognition ability was followed with SRSs.

Results: Both time from CI activation and the frequency range of tones had significant effects on the MMN amplitude. A significant enhancement was observed for the MMN elicited by 3200 Hz deviant tones among 4000 Hz standards. Also SRSs significantly increased with time and correlated with MMN amplitudes to the 3200 Hz deviants in both measurements.
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August 2013

Speech recognition and communication outcomes with cochlear implantation in Usher syndrome type 3.

Otol Neurotol 2012 Jan;33(1):38-41

Department of Otorhinolaryngology, University of Helsinki, Helsinki, Finland.

Background: Usher syndrome Type 3 (USH3) is an autosomal recessive disorder characterized by variable type and degree of progressive sensorineural hearing loss and retinitis pigmentosa. Cochlear implants are widely used among these patients.

Objectives: To evaluate the results and benefits of cochlear implantation in patients with USH3.

Study Design: A nationwide multicenter retrospective review.

Materials And Methods: During the years 1995-2005, in 5 Finnish university hospitals, 19 patients with USH3 received a cochlear implant. Saliva samples were collected to verify the USH3 genotype. Patients answered to 3 questionnaires: Glasgow Benefit Inventory, Glasgow Health Status Inventory, and a self-made questionnaire. Audiological data were collected from patient records.

Results: All the patients with USH3 in the study were homozygous for the Finnish major mutation (p.Y176X). Either they had severe sensorineural hearing loss or they were profoundly deaf. The mean preoperative hearing level (pure-tone average, 0.5-4 kHz) was 110 ± 8 dB hearing loss (HL) and the mean aided hearing level was 58 ± 11 dB HL. The postoperative hearing level (34 ± 9 dB HL) and word recognition scores were significantly better than before surgery. According to the Glasgow Benefit Inventory scores and Glasgow Health Status Inventory data related to hearing, the cochlear implantation was beneficial to patients with USH3.

Conclusion: Cochlear implantation is beneficial to patients with USH3, and patients learn to use the implant without assistance.
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January 2012

Relationship between self-reported hearing and measured hearing impairment in an elderly population in Finland.

Int J Audiol 2011 May 8;50(5):297-302. Epub 2011 Feb 8.

Department of Otorhinolaryngology, Turku University Hospital, Finland.

Objective: The objective of this study was to evaluate the usefulness of the Finnish version of the Hearing Handicap Inventory for Elderly Screening (HHIE-S) questionnaire and a simple single-question method in detecting hearing loss.

Design: We compared the HHIE-S score and the single question with audiometry results. By analysing the receiver operating characteristic (ROC) curves of the HHIE-S scores we estimated the appropriate cut-off points for the different degrees of hearing loss.

Study Sample: 164 home-dwelling subjects in the age cohorts of 70, 75, 80 and 85 years in an industrialized town in Finland filled in the questionnaire, and attended the audiometry.

Results: For the detection of moderate or worse hearing loss (i.e., pure tone average at 0.5-4 kHz frequencies >40 dB), the HHIE-S cut-off score of >8 had a sensitivity of 100% and a specificity of 59.7%. The single question had a sensitivity of 100% and a specificity of 70.7%. Thus, the single question was equally sensitive and more specific in detecting moderate or worse hearing loss than the HHIE-S score. However, for the detection of mild hearing loss (i.e., pure tone average >25 dB), the HHIE-S was more sensitive but less specific than the single question.
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May 2011

Diffusion tensor imaging of the inferior colliculus and brainstem auditory-evoked potentials in preterm infants.

Pediatr Radiol 2009 Aug 9;39(8):804-9. Epub 2009 May 9.

Department of Paediatrics, Turku University Central Hospital, Vaha-Hameenkatu 1 A 6, Turku, 20500, Finland.

Background: Preterm and low-birth-weight infants have an increased risk of sensorineural hearing loss. Brainstem auditory-evoked potentials (BAEP) are an effective method to detect subtle deficits in impulse conduction in the auditory pathway. Abnormalities on diffusion tensor imaging (DTI) have been shown to be associated with perinatal white-matter injury and reduced fractional anisotropy (FA) has been reported in patients with sensorineural hearing loss.

Objectives: To evaluate the possibility of a correlation between BAEP and DTI of the inferior colliculus in preterm infants.

Materials And Methods: DTI at term age and BAEP measurements were performed on all very-low-birth-weight or very preterm study infants (n=56). FA and apparent diffusion coefficient (ADC) of the inferior colliculus were measured from the DTI.

Results: Shorter BAEP wave I, III, and V latencies and I-III and I-V intervals and higher wave V amplitude correlated with higher FA of the inferior colliculus.

Conclusion: The association between the DTI findings of the inferior colliculus and BAEP responses suggests that DTI can be used to assess the integrity of the auditory pathway in preterm infants.
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August 2009

Alexithymia, depression and tinnitus in elderly people.

Gen Hosp Psychiatry 2007 Sep-Oct;29(5):431-5

Department of Otorhinolaryngology, Turku University Central Hospital, P.O. Box 52, FIN-20521 Turku, Finland.

Objective: Tinnitus is known to have an association with depression and other psychiatric disorders. As part of a larger epidemiological survey, we evaluated the associations among tinnitus, depression and alexithymia in a group of elderly people.

Methods: A survey of hearing loss, audiological rehabilitation and associated morbidity in a senior population was conducted in Turku, Finland. The study sample consisted of 583 participants aged between 70 and 85 years. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia, whereas the 13-item version of the Beck Depression Inventory was used to measure depression; the subjective experience of tinnitus was queried with a questionnaire.

Results: Depression had a clear association with subjectively annoying tinnitus. Contrary to expectations, the TAS-20 score did not correlate with the severity of tinnitus. In fact, the highest TAS-20 scores were found among the subjects who had tinnitus but did not find it to be subjectively annoying. No significant association between high TAS-20 scores and hearing loss was found.

Conclusion: Although we found an association between TAS-20 scores and the presence of tinnitus, alexithymia does not seem to be helpful in explaining tinnitus annoyance among elderly people.
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January 2008

Mismatch negativity brain response as an index of speech perception recovery in cochlear-implant recipients.

Audiol Neurootol 2004 May-Jun;9(3):160-2

Department of Phonetics, University of Helsinki, Helsinki, Finland.

Speech-discrimination performance and the mismatch negativity (MMN) response elicited by vowel changes were used to track vowel-perception improvement of 5 adult cochlear-implant (CI) recipients. The MMN was recorded several times during the first 3 years after CI activation. Artefacts, presumably caused by CI, contaminated most of the brain responses until 1 year after CI activation. We found that speech discrimination improved over time and the MMN, observed in all patients after 2.5 years of CI use, was first seen for the larger vowel difference and later for the smaller one.
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May 2004

Stability of memory traces for speech sounds in cochlear implant patients.

Logoped Phoniatr Vocol 2002 ;27(3):132-8

Department of Audiology, Turku University Hospital, Kiinamyllynkatu 3, 20100 Turku, Finland.

For this study, we examined the perception and production of vowels by postlingually deafened patients with cochlear implant. Four patients and one normally hearing subject produced typical vowel sounds of Finnish by using a speech synthesizer. Also acoustic analyses of the pronounced vowels were made. The first (F1) and the second (F2) formant frequencies were measured. The mismatch negativity (MMN), a cortical cognitive auditory event related potential, was used to measure objectively the patients' preattentive discrimination of a prototypical /i/ sound from deviants differing in the F2 continuum. In the phonetic tests the hyperspace effect was seen also among the patients. The MMN, which reflects the phonetic discrimination ability, could be identified from the patient with the best vowel perception abilities. The phonetic memory traces once developed for vowels seem to remain quite stable even though they have not been activated by vowel information for years.
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April 2003

Hearing loss in Finnish adults with osteogenesis imperfecta: a nationwide survey.

Ann Otol Rhinol Laryngol 2002 Oct;111(10):939-46

Department of Otorhinolaryngology-Head and Neck Surgery, Vaasa Central Hospital, Kuurila, Finland.

Hearing loss, bone fragility, and blue sclerae are the principal clinical features in osteogenesis imperfecta (OI), a genetic disorder of connective tissue. In a nationwide search, an audiometric evaluation of 133 adult patients was performed. According to the criteria introduced by Sillence, type I was the most common form of OI. Of the patients with normal hearing on audiometry, 17.1% reported subjective hearing loss, and 19.1% of the patients with impaired hearing did not recognize it. On audiometry, 57.9% of the patients had hearing loss, which was progressive, often of mixed type, and mostly bilateral, and began in the second to fourth decades of life. The frequency or severity of the hearing loss was not correlated with any other clinical features of OI. Hearing loss is common, affecting patients with all types of OI. Subjective misjudgment of hearing ability supports the need for repeated audiometry in all OI patients. A baseline study at the age of OI years followed by audiograms every third year thereafter is recommended.
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October 2002