Abstract
IntroductionTinnitus can become a strong stressor for some individuals, leading to imbalance of the autonomous nervous system with reduction of parasympathetic activity. It can manifest itself as sleep disturbances, anxiety and even depression. This condition can be reversed by bioelectrical vagal nerve stimulation (VNS). Conventional invasive VNS is an approved treatment for epilepsy and depression. Transcutaneous VNS (taVNS) stimulating the auricular branch of the vagus nerve has been shown to activate the vagal pathways similarly as an implanted VNS. Therefore, taVNS might also be a therapeutic alternative in health conditions such as tinnitus-related mental stress (TRMS). This retrospective study in 171 TRMS patients reports the clinical features, psychophysiological characteristics, and results of the heart rate variability (HRV) tests before and after test-taVNS. This study also reports the therapy outcomes of 113 TRMS patients treated with taVNS, in combination with standard tinnitus therapy.MethodsDiagnostic tinnitus and hearing profiles were defined. To detect possible cardiac adverse effects, test-taVNS with heart rate monitoring as well as pre- and post-stimulation HRV tests were performed. Daily taVNS home therapy was prescribed thereafter. To assess therapeutic usefulness of taVNS, 1-year follow-up outcome was studied. Results of HRV tests were retrospectively analyzed and correlated to diagnostic data.ResultsThe large majority of patients with TRMS suffer from associated symptoms such as sleep disturbances and anxiety. Baseline HRV data showed that more than three quarters of the 171 patients had increased sympathetic activity before test-taVNS. Test-taVNS shifted mean values of different HRV parameters toward increased parasympathetic activity in about 80% of patients. Test-taVNS did not cause any cardiac or other side effects. No significant adverse effects were reported in follow-up questionnaires.ConclusionTRMS is an example of a stress condition in which patients may benefit from taVNS. As revealed by HRV, test-taVNS improved parasympathetic function, most efficiently in patients with a low starting HRV level. Our tinnitus treatment program, including taVNS, effectively alleviated tinnitus stress and handicap. For wider clinical use, there is a great need for more knowledge about the optimal methodology and parameters of taVNS.
Highlights
Tinnitus can become a strong stressor for some individuals, leading to imbalance of the autonomous nervous system with reduction of parasympathetic activity
Baseline data from 1-min DBT-heart rate variability (HRV) and 5-min shortterm HRV (s-HRV) showed that more than three quarters of tinnitus-related mental stress (TRMS) patients had increased sympathetic activity before testtaVNS. This was deduced from the stress index and the HRV age, which was in this patient population approximately 16 years higher than the mean chronological age
TRMS is an example of a tinnitus-triggered stress condition in which patients may benefit from Transcutaneous vagal nerve stimulation (VNS) (taVNS)
Summary
Tinnitus can become a strong stressor for some individuals, leading to imbalance of the autonomous nervous system with reduction of parasympathetic activity It can manifest itself as sleep disturbances, anxiety and even depression. VNS has been conventionally performed for more than two decades to treat severe epilepsy and depression by applying an electrode surgically implanted to the cervical trunk of the vagus nerve It has been shown by electrophysiological and neuroimaging studies that taVNS of the ABVN activates central vagal pathways as VNS with an implanted electrode (Kraus et al, 2007; Dietrich et al, 2008; Frangos et al, 2015; Yakunina et al, 2017; Badran et al, 2018a)
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