Advances in Treatment of Tinnitus (Ear Ringing)

Tinnitus is a common neurological condition affecting up to 10% or more of elderly individuals.  Variable it severity, in it's most serious form it can be disabling and quite distressful.  Due to the chronic nature of the disorder, many patients with tinnitus develop depression.  Suicide rates have been estimated to be increased in those with tinnitus-related. 

Althought the exact cause is unknown for tinnitus, abnormalities in spontaneous neural activity in the auditory brain system are a suspected mechanism.  Animal models of tinnitus support abnormal neuronal activity in the auditory system including: increased spontaneous activity (hyperactivity), increased neuronal burst activity and impairment in timing of neuronal discharges.

Significant research is targeted to new an innovative treatment strategies in the hope to reduce suffering for those with tinnitus.  Transcranial magnetic stimulations (TMS) is a potential treatment modality.  TMS has been shown to alter excitatory and inhibitory brain ciruits in the brain with the effects dependent on the region receiving the stimulus.  So it was reasonable to explore the potential role of TMS in tinnitus.

Dr. Jay Piccirillo and colleagues at the Washington University School of Medicine, recently published an early clinical trial of TMS in tinnitus.  Fourteen patients between 42 and 59 underwent a double-blind randomized crossover  trial.  Unfortunately, the trial proved to be negative with sham treatment producing the same effect as active TMS stimulation.

Although tolerated well, the TMS stimulation that was done daily for two weeks did not influence patients subject distress with their tinnitus.  The authors commented that some previous postitve reports of TMS in tinnitus were either uncontrolled or did not guard against  placebo effects.  Their study was well-controlled and casts doubt on some of the previous reports.   The authors did note it is possible their trial was not of sufficient duration to induce therapeutic changes.  They also noted their sample is somewhat unusual.  The required subjects to have high tinnitus severity rating but to not be depressed.  The screened over 285 subjects to get the 22 enrolled in the study.  Obviously, many of those with severe tinnitus were at least moderately depressed as they used a cutoff score of over 14 on the Beck Depression Inventory.

On a more hopeful note, an early online study published in the International Journal of Audiology examing tinnitus treatment found evidence of significant symptom reduction with two available treatments.  Tinnitus commonly occurs in conjuction with high frequency hearing loss.  This study randomized subjects to receive either an open ear digital hearing aid or us of an ear sound generator.  Both groups received education about tinnitus along the model known as Tinnitus Retraining Therapy.  Both groups had about a 50% reduction in the level of distress from their tinnitus.

So although there are not yet any revolutionary tinnitus treatment, research continues to find better approaches to this common.  In the mean time, open ear digital hearing aids and noise generators may provide significant reduction in distress for many individuals
 

Piccirillo JF, Garcia KS, Nicklaus J, Pierce K, Burton H, Vlassenko AG, Mintun M, Duddy D, Kallogjeri D, & Spitznagel EL Jr (2011). Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus. Archives of otolaryngology--head & neck surgery, 137 (3), 221-8 PMID: 21422304

Parazzini M, Del Bo L, Jastreboff M, Tognola G, & Ravazzani P (2011). Open ear hearing aids in tinnitus therapy: An efficacy comparison with sound generators. International journal of audiology PMID: 21595527

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