Treatment Of Subjective Tinnitus Research Articles

Effectiveness of transcutaneous vagus nerve stimulation (tVNS) on salicylate-induced tinnitus

IntroductionTinnitus is the most common symptom of auditory system disorders. It affects the quality of life of millions of people, but it is still incurable in most cases. Vagus nerve stimulation (VNS) therapy is a potential new treatment for subjective tinnitus. In this study, transcutaneous vagus nerve stimulation (tVNS) combined with tones was utilized to treat salicylate-induced tinnitus since salicylate is a reliable and convenient approach for rapidly inducing tinnitus. MethodsWistar rats were divided into acoustic stimulation alone (AS, n = 6), tVNS alone (n = 6), and tVNS with AS (n = 6) groups for behavioral and electrophysiological tests. They were assessed by auditory brainstem response (ABR), prepulse inhibition (PPI), gap prepulse inhibition of the acoustic startle (GPIAS), social interactions, and aggressive behavior tests at baseline and seven days’ post-salicylate (175 mg/kg, twice a day) injection. ResultsThe inhibition percentage of the GPIAS test was significantly reduced post-salicylate injection in the tVNS and AS alone groups, while it was not significant in the tVNS with AS group. There was no significant difference in the mean percentage of the GPIAS test between the tVNS groups (with or without AS) after salicylate injections. Social interactions were significantly different in the AS alone group pre- and post-salicylate injections, but they were not significant in other groups. Moreover, the results of aggressive behavior tests showed significantly increased post-salicylate injections in the AS alone group, while they were not significant in the tVNS groups (with or without AS). ConclusionsThe current study revealed that the application of tVNS alone produced improved social interaction and mood and alleviated salicylate-induced tinnitus severity. Moreover, combining tVNS with acoustic stimulation can prevent salicylate-induced tinnitus.

Acupuncture decreases amygdala functional connectivity in subjective tinnitus.

Subjective tinnitus is a common and intractable ear disease. The effectiveness of acupuncture in the treatment of subjective tinnitus has been confirmed, but its mechanism of action is not clear. The structures of the amygdala (AMYG) are mainly closely related to emotion in the human brain. This study aimed to investigate the changes in functional connectivity (FC) of AMYG in subjective tinnitus to elucidate the neural mechanism of acupuncture. Correlation scale scores of 26 patients with subjective tinnitus were collected, including Tinnitus Evaluation Questionnaire (TEQ), Tinnitus Handicap Inventory (THI) and Visual Analog Scale (VAS). Meanwhile, rs-fMRI data were collected before and after acupuncture treatment in the patients, and in healthy controls (HC) matching the patient's gender and age. Then, AMYG was selected as region of interest to perform FC analysis. Finally, FC patterns of AMYG were first compared between patients with subjective tinnitus and HC, and then within subjects pre-acupuncture and post-acupuncture. Simple linear regression models between correlation scale scores and FC-values were established as well. Acupuncture treatment relieved the severity of tinnitus. With the acupuncture treatment, the total THI score, TEQ score, and VSA score of patients were significantly lower than before (p < 0.05). Compared with HC, FC of tinnitus patients between AMYG and right inferior temporal gyrus and right precuneus significantly decreased before acupuncture (voxel p < 0.001, cluster p < 0.05, corrected with GRF), while FC of tinnitus patients between AMYG and left superior frontal gyrus and right superior temporal gyrus significantly decreased after acupuncture treatment (voxel p < 0.001, cluster p < 0.05, corrected with GRF). FC of tinnitus patients between the AMYG and right superior frontal gyrus and left paracingulate gyrus showed significant decrease after acupuncture treatment (voxel p < 0.001, cluster p < 0.05, corrected with GRF). Besides, the linear regression models of the effect of THI on FC and VAS on FC performed were statistically significant (p < 0.05). The findings demonstrate that acupuncture can decrease FC of AMYG, which could be positively correlated with the relief of tinnitus symptoms. This result suggests that acupuncture stimulation can effectively relieve the severity of tinnitus by decreasing FC of AMYG in subjective tinnitus patients.

Brain Waves Evaluation of Sound Therapy in Chronic Subjective Tinnitus Cases Using Wavelet Decomposition.

Management and treatment of subjective tinnitus is an ongoing focus of research activities. One of the most viable assessments of such treatment is the evaluation of brain activity in addition to patient response and clinical assessment. This study focuses on sound therapy and evaluation of patients’ electroencephalogram (EEG) in order to verify the potency of this approach. Broadband sound therapy was applied to nineteen participants aging from 25 to 64 and suffering from chronic subjective tinnitus to study the difference of brain activity, a) before fake treatment, b) after fake treatment and c) after the main treatment, using EEG and Visual Analog Scale (VAS) for evaluating Residual Inhibition (RI). Four features were extracted using 4-level wavelet decomposition with Symlet 8 as its mother wavelet. For the “After the main treatment” stage, the mean value of wavelet coefficients for the last wavelet level, which corresponded to delta band of EEG, was lower in the FC3 channel based on Two-Sample T-Test with significance level of 0.01, as compared to the same channel of the “before the treatment” stage, for cases in which decreased tinnitus loudness were reported.

Tinnitus perception in patients after vagal nerve stimulator implantation for epilepsy

PurposeVagal nerve stimulation in conjunction with sound therapy has been proposed as a treatment for subjective tinnitus. The purpose of this study is to retrospectively review the effect of VNS on perception of tinnitus in epilepsy patients. We explore the incidence of tinnitus and its perceived reduction in patients requiring implantation of VNS for medically refractory seizures. Materials and methodsA phone survey was conducted in adult patients with prior VNS implantation. A questionnaire including the visual analog scale (VAS) of tinnitus loudness was used to determine the presence and severity of tinnitus. ResultsOut of the 56 patients who had completed the phone survey, 20 (35%) reported the presence of pre-operative tinnitus. The tinnitus positive group was significantly older (p = 0.019). Of the 20 pre-operative tinnitus positive patients, all patients continued to have tinnitus post-operatively. Four (20%) noted no changes in VAS of tinnitus loudness while 16 (80%) had at least a one-point decrease. The mean difference between pre- and post-operative VAS of loudness was 2.05, with a standard deviation of 1.84 and this was statistically significant (p < 0.001). ConclusionsIn this study, we evaluate the potential of vagal nerve stimulation to alter the perception of tinnitus in patients with refractory epilepsy. Eighty percent of patients noted some level of subjective tinnitus improvement after VNS implantation. Given this finding, there may be a potential additional benefit to the use of VNS in patients with epilepsy.

Core Outcome Domains for early phase clinical trials of sound-, psychology-, and pharmacology-based interventions to manage chronic subjective tinnitus in adults: the COMIT\u2019ID study protocol for using a Delphi process and face-to-face meetings to establish consensus

BackgroundThe reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is, therefore to, develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes.MethodsThe ‘Core Outcome Measures in Tinnitus: International Delphi’ (COMIT’ID) study will use a mixed-methods approach that incorporates input from health care users at the pre-Delphi stage, a modified three-round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following Core Outcome Set publication.DiscussionThe COMIT’ID study aims to develop a Core Outcome Domain Set that is agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the Core Outcome Set in the long term.Trial registrationThis project has been registered (November 2014) in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative.

Outcome of audiometric masking therapy on subjective tinnitus patients in different age groups

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Theoretical consideration suggests an impact of the age at tinnitus onset influencing tinnitus distress. The use of masking for tinnitus is a primary method of treatment of tinnitus. The objective was to study effectiveness of masking by introducing audiometric reference signal in treatment of subjective tinnitus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The 90 patients (45 males and 45 females) were assessed by pure tone audiometer. Patients were divided into 6 age group sets for evaluation. The reference signal (90 to 100 dB SPL for 2-3 minutes in tinnitus ear of frequency 1000 Hz) was used for masking therapy. Outcome of the study was measured by using the tinnitus handicap inventory (THI) score and awareness time (tinnitus perception) before and after audiometric reference signal masking therapy. Success rate was measured to measure therapeutic efficacy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our results depict improvement in subjective tinnitus by 57.78% (in males), 55.56% (in females) and overall 56.67% success in patients aged between 21 to 60 years by using our audiometric reference signal masking therapy. Regarding gender, the finding of THI score, Awareness time and Success rate in our study showed females being affected more than males. Our study also evidenced a highest percentage of tinnitus after the age of 70 followed by the decades 61–70 and 51–60.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our new economically viable approach to subjective tinnitus patients by audiometric reference signal seems to be an effective in improv­ing the patient’s distress in age group 21 to 60 years. Before taking decision for selection of high cost hearing aids, we can use it for poor people.

Different Teams, Same Conclusions? A Systematic Review of Existing Clinical Guidelines for the Assessment and Treatment of Tinnitus in Adults.

Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults.Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines.Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively.Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe.

A Randomized, Placebo-Controlled, Double-Blind, Parallel Groups Study Evaluating the Performance and Safety of a Steady State Coherent Biomodulator Patch in the Treatment of Subjective Tinnitus.

The objectives of this study were to evaluate the performance and safety of an innovative passive light photon driven microscopic biomodulator patch as an alternative medical device for tinnitus relief. Eighty-two (82) patients were randomized to receive either an active (biomodulator) patch or a placebo patch, for a 3-week treatment period. Patch performance (evaluated with questionnaires related to tinnitus and quality-of-life) and safety were assessed after 3 weeks of treatment (Week 3) and at a follow-up visit 4-weeks after end of treatment (Week 7). The biomodulator patch was safe and well-tolerated and was efficacious, with significant difference (p < 0.05) between the groups at Week 7; active patch had 30% responders compared to 10% for placebo, measured as a decrease from baseline in at least 2 points in tinnitus annoyance visual analogue scale (VAS, 0-10). Tinnitus handicap inventory (THI, 0-100) improved by mean -16 points significantly (p = 0.0005) for the active responder group, but with no statistically significant changes for the placebo group or between the groups. Well-being questionnaire also improved for the active responder group, but not statistically significant. The placebo responder group did not improve in well-being. Other tinnitus related symptoms did not show significant changes. There was no statistically significant difference in performance between the active (biomodulator) and placebo groups directly at the end of treatment (Week 3). In a cost-risk-benefit rationale according to this study it can be reasonable to recommend the biomodulator patch for treatment of tinnitus. Improvements were shown at Week 7 (4 weeks after the end of treatment period).

Current opinion: the management of tinnitus.

The purpose of this review is to describe our experience with management of chronic tinnitus and to review the recent literature on the best treatment options available for treating patients who are troubled by their tinnitus. In addition, we want to highlight our experience and approach to this very common problem. Treatment options for patients are based on the severity of the tinnitus and any associated problems. The use of nutritional supplements has a place in the treatment of mild-to-moderate tinnitus. Ginkgo biloba and B-complex vitamins may have an impact on selected patients. Treatment of underlying or accompanying anxiety disorders especially with cognitive behavior therapy can help to reduce the distress associated with tinnitus. Surgical treatment options, such as cochlear implant, have been shown to be very effective in reducing tinnitus in patients with sudden unilateral hearing loss as the cause of tinnitus. Other surgical approaches, such as repetitive transcranial magnetic stimulation and vagal stimulator, have had some limited benefits. Treatment for subjective tinnitus can range from the conventional to the investigational modalities. Best treatment options take into account the possible cause of the tinnitus and other associated symptoms.

Clinical efficacy of tinnitus retraining therapy and cognitive behavioural therapy in the treatment of subjective tinnitus: a systematic review.

This study aimed to compare the outcomes of two frequently employed interventions for the management of tinnitus: tinnitus retraining therapy and cognitive behavioural therapy. A systematic review of literature published up to and including February 2013 was performed. Only randomised control trials and studies involving only human participants were included. Nine high-quality studies evaluating the efficacy of tinnitus retraining therapy and cognitive behavioural therapy were identified. Of these, eight assessed cognitive behavioural therapy relative to a no-treatment control and one compared tinnitus retraining therapy to tinnitus masking therapy. Each study used a variety of standardised and validated questionnaires. Outcome measures were heterogeneous, but both therapies resulted in significant improvements in quality of life scores. Depression scores improved with cognitive behavioural therapy. Both cognitive behavioural therapy and tinnitus retraining therapy are effective for tinnitus, with neither therapy being demonstrably superior. Further research using standardised, validated questionnaires is needed so that objective comparisons can be made.

Current Trends in the Treatment of Subjective Tinnitus at University Hospitals in Korea

Current Trends in the Treatment of Subjective Tinnitus at University Hospitals in Korea

Long-lasting neuronal desynchronization caused by coordinated reset stimulation

A number of brain diseases, e.g. movement disorders such as Parkinsons disease, are characterized by abnormal neuronal synchronization. Within the last years permanent high-frequency (HF) deep brain stimulation became the standard therapy for medically refractory movement disorders. To overcome limitations of standard HF deep brain stimulation, we use a model based approach. To this end, we make mathematical models of affected neuronal target populations and use methods from statistical physics and nonlinear dynamics to develop mild and efficient control techniques. Along the lines of a top-down approach we test our control techniques in oscillator networks as well as neural networks. In particular, we specifically utilize dynamical self-organization principles and plasticity rules. In this way, we have developed coordinated reset (CR) stimulation, an effectively desynchronizing brain stimulation technique. The goal of CR stimulation is not only to counteract pathological synchronization on a fast time scale, but also to unlearn pathological synchrony by therapeutically reshaping neural networks. The CR theory, results from animal experiments as well as clinical applications will be presented: Animal and human data will be shown on electrical CR stimulation for the treatment of Parkinsons disease via chronically implanted depth electrodes. Furthermore, acoustic CR stimulation for the treatment of subjective tinnitus will be explained. Subjective tinnitus is an acoustic phantom phenomenon characterized by abnormal synchronization in the central auditory system. In a multicenter proof of concept study it has been shown that acoustic CR stimulation significantly and effectively counteracts tinnitus symptoms as well as the underlying pathological neuronal synchronization processes.

A Review of Efficacy of Behavioral Techniques in the Treatment of Subjective Tinnitus

A Review of Efficacy of Behavioral Techniques in the Treatment of Subjective Tinnitus

A multiple-baseline evaluation of the treatment of subjective tinnitus with relaxation training and biofeedback.

Six subjects with subjective tinnitus received training in relaxation techniques and EMG and thermal biofeedback in a multiple-baseline across-subjects design. Daily tinnitus disturbance and sleep disturbance diaries were kept throughout. Audiological and psychological evaluations were made at various treatment phases. At posttreatment assessment, subjects also completed global ratings of their perceived improvement in ability to cope with the tinnitus, stress caused by the tinnitus, and severity of the tinnitus, as well as their overall satisfaction with the treatment. Ratings on the global scales were generally very positive. By way of contrast, the daily diary results revealed little if any treatment effect. The implications of these disparate results are discussed.

Anesthesia of the Tympanic Plexus in the Treatment of Subjective Tinnitus

THE sensation of subjective tinnitus, its timbre and intensity can be extremely varied. Depending on the nature of the basic disease, it is sometimes even observed not to cause significant difficulty, while in other cases it is intense and troublesome. Since the time that Lempert,1in 1946, advanced the original theory, according to which subjective tinnitus can arise as a result of pathological changes in the tympanic plexus, interest in the neurogenic origin of tinnitus has significantly increased. A series of facts previously unknown about the anatomical structure of the tympanic plexus was established by the investigations of Kruchinina,2Lebedeva,3Rosen,4and Frenckner.5The branches of the tympanic plexus do not always lie exposed under the mucoperiosteum. Sometimes its major branches pass in bony canals. It was established that two branches are always revealed in the tympanic plexus, n. cochlearis and n. vestibularis, which are