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13.07.2014

Tinnitus and the brain, what helps tinnitus - .

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Researchers have found that the brain is capable of doing something that sufferers from tinnitus cannot do: ignore the ringing sound. In a revolutionary series of experimental surgeries, Michael Seidman, MD, and his team have now shown that an electrode array implanted directly into the auditory cortex area of the brain can control tinnitus levels. Author’s Note: This procedure is still very early in the discovery process and this procedure is not available as a treatment option.
Author’s note: Neural hyperactivity in the auditory cortex has long been associated with tinnitus. The patients were asked to complete a battery of self-assessment questionnaires and underwent an audiological assessment and psychoacoustic measurement. The patients then underwent Magnetic Resonance Imaging (MRI), Functional MRI (fMRI) and Magnetoencephalography (MEG). In patient one, primary cables were tunneled under the scalp and descended below the clavicle where they were connected to an implanted pulse generator. Upon recovering from surgery, at the first post-operative visit, the selection of the electrical stimulating paradigm, or model, was decided for each patient. Each patient was followed at 1 week, 1 month, 3 months, 6 months and 12 months after surgery. The cortical response to MEG imaging was stronger in the right ear so the right auditory cortex was implanted. It is important to note that initially the effect was greater for the opposing ear but subsequently it had effectively eliminated the tinnitus in both ears. High resolution MRI revealed a microvascular compression at the entrance of her spine into the brainstem. Four months later, MV underwent transcranial magnetic stimulation, which suppressed her tinnitus by 20-50% but did not last for any appreciable time. Four months after the original surgery, MV underwent further surgery to replace the four-contact electrode array with two two-contact arrays. Two patients underwent intracranial electrical stimulation of their auditory cortex in an attempt to reduce or eliminate tinnitus. Author’s Note: The limbic system is the part of the brain responsible for pleasure, emotions, sexual arousal and fear.
In many ways, this is similar to the early work of William House with cochlear implantation.
It has been suggested that tinnitus can be affected through cortical and auditory pathway stimulation, provided that reorganization of auditory signals has not yet reached the ultimate phase of irreversibility.
The current investigation utilized magnetoencephalography to map cortical hubs in tinnitus. Tinnitus is typically associated with substantial damage to the hearing system such as a noise trauma or chronic noise exposure. All of these hypotheses stay within the model of the global neuronal workspace as suggested by Deheane and colleagues [9, 10]. To investigate these abnormalities in magnetoencephalographic recordings we used a beamforming technique to reconstruct the brain activity in the source space and investigated the strength of coupling between them.
In this study, the researchers modeled the resting-state networks (the so called default network) in tinnitus and controls by pinpointing the core structures of inflow and outflow. The researchers further correlated the strength of the inflow and outflow with the subjective strength of the tinnitus distress (figure 4). The three clusters discussed above show meaningful correlations of the strength of inflow with the subjective rating of the tinnitus distress. In summary, alterations in the long-range functional network in tinnitus subjects under rest were found, which were asserted to be related to the conscious perception of the distressing tinnitus tone.
Overall, the importance of combining both branches of tinnitus therapy needs to be highly stressed.
Tinnitus, the constant presence of phantom sounds, affects around 10% of adults in the UK; for 1% it is severe enough to affect their quality of life.
At the heart of the study is a method for manipulating tinnitus, called "residual inhibition". Prof Andrew King, an auditory neuroscientist at Oxford University, said the results were a "huge step up" in terms of tracing the detailed underpinnings of tinnitus, particularly compared to brain imaging. Video footage emerges showing a man leaving a backpack inside the Bangkok shrine where a bomb exploded on Monday, killing at least 20 people. The study, led by Beckman Institute researcher Fatima Husain, suggests key differences in the neural bases of tinnitus and the larger disorder of hearing loss. The finding suggests key differences in the neural bases of tinnitus and the larger disorder of hearing loss. Early experiments using DC current applied directly to the ear or mastoid bone showed promise in reducing tinnitus symptoms.
The experiments are ongoing, however, all participants have been chosen and the study is closed. 118 in March, 2008 with the title Direct Electrical Stimulation of Heschl’s Gyrus for Tinnitus Treatment by Michael D. Seidman begins by noting that tinnitus affects 50 million Americans and more than 300 million people worldwide.
Seidman first experimented on animals to examine whether electrical stimulation of the auditory cortex suppresses tinnitus-related neural hyperactivity and found it to be effective.
These determined the hearing levels at precise frequencies and pitch and loudness matching of their tinnitus. These imaging techniques allowed the researchers to pinpoint the exact area in the auditory cortex that was experiencing significant hyperactivity. The skull was breached and electrodes were implanted in the opposing auditory cortex for the patient who had unilateral tinnitus and in the dominant ear of the patient who had bilateral tinnitus. The electrode was turned on and off several times with the patient blinded to the presence or absence of stimulation.


Three months after surgery he reported his tinnitus was essentially gone when the electrode was active and recurred only several days after turning the device off. Seven years after she developed her tinnitus, a microvascular decompression was performed and resulted in successfully treating her vertigo but failed to reduce her tinnitus.
Using fMRI neuronavigation, a linear four-contact electrode array was implanted over the site of the auditory cortex.
By altering the stimulation paradigm, she eventually had a 30% to 35% reduction in her tinnitus. In patient one, the suppression of tinnitus was near complete, whereas in the other, it was moderate and did not last. The primary pitfall is determining which “structures” (areas of the brain) to target to minimize the perception of tinnitus.
It is known that the limbic system plays a major role in the annoyance and aggravation of tinnitus. This implies that tinnitus should be treated as soon as possible, preferably within 5 years of onset.
Tinnitus is defined as an auditory perception in the absence of any physically identifiable source. This damage leads to plastic changes at various levels of the central auditory system and consequently enhanced neuronal synchrony and spontaneous firing rate within the central auditory system. This global neuronal workspace is distributed over distant areas of the cortex, mainly in the parietal lobe, the frontal, and the cingulate cortex. The strength of outflow describes how much the activity within the respective voxel drives the activity of other brain regions. The strength of inflow describes how much the activity within the respective voxel is driven by the activity of other brain regions.
Partial directed coherence (PDC) is a new approach to measure the effective coupling between multivariate time series.
The inflow to voxels in the left and the right temporal cortex correlated positively with the subjective strength of the tinnitus distress.
The stronger the inflow to the clusters, the stronger the subjective strength of tinnitus distress as assessed with a standard German Questionnaire. They compared the inflow (figure 3) and outflow (figure 2) between the tinnitus and the control group and found differences in the long-range cortical networks under rest.
They found three clusters of inflows that correlated positively with the subjective rating of the tinnitus distress. Conceptually, a reduction of the hyperactivity in the auditory cortex cannot eliminate the tinnitus if the global network is still active and drives the tinnitus-related temporal activity. Christopher Fisher, Managing Editor for The Behavioral Medicine Report, received his PhD in Clinical Health Psychology & Behavioral Medicine from University of North Texas. Fisher maintains a private practice in Corpus Christi, Texas, and offers individual therapy, group therapy, peripheral biofeedback, and neurofeedback. Fisher enjoys spending time with family, watching sports and movies, and outdoor activities. Often it takes the form of a ringing sound, but it can be anything from a roar to a hiss.In many cases it begins with partial hearing loss, sometimes due to loud noise wearing out the hair cells that convert sound waves into neural signals, inside the inner ear. On 60 occasions over the course of two days, researchers played their subject a 30-second burst of noise on headphones. Beckman Institute researcher Fatima Husain led the study, which revealed the differences thanks to a novel research approach that included test subjects who had hearing loss but who did not have tinnitus.
Implanted electrodes used to control muscle spasms in Parkinson’s disease patients were found to reduce the sound of tinnitus, even though they were not implanted in the auditory cortex, where hearing occurs. In the US, more than 12 million people annually seek a physician’s help and 3 to 4 million of these are debilitated by their condition. Different frequencies, voltages and pulse widths are tried for 60 seconds on and 60 seconds off.
At 3 and 12 months, audiological assessment and psychoacoustic measures were also completed. The tinnitus would return when the electrode was off for 30-60 seconds and would decrease significantly when the electrode was active. Several subsequent stimulation regimens applied over the succeeding 4 months failed to adequately diminish her tinnitus.
However at her 2-year follow-up examination, her tinnitus had returned to its original levels.
Whether this was due to the more longstanding nature of patient two’s tinnitus or to another reason is still unknown.
Preliminary animal data clearly suggests that auditory cortex stimulation can affect other downstream structures within the auditory pathway. House inserted an electrode in the cochlea and a perception of sound occurred in profoundly deaf people. Almost everyone will experience some form of auditory phantom perceptions such as tinnitus at least once in their lifetime; in most of the cases this sensation vanishes within seconds or minutes. These changes have been well documented in animal and human studies and can be caused by different pathologies [3, 7]. According to this framework, conscious perception requires neuronal activity of the sensory areas together with an entry into this workspace realized by long-range cortical coupling. Four clusters were found with a significant group difference between tinnitus and control participants. Three clusters were found with a significant group difference between tinnitus and control participants. It is based on the concept of Granger causality and captures the direction of the information flow in the frequency domain [19, 20]. The strength of this influence is associated with the subjective strength of the tinnitus distress.


However, a reduction of the tinnitus-related global network activity cannot eliminate the tinnitus either if there is still an untreated abnormal pattern of spontaneous activity in the temporal cortex. His clinical training emphasized biopsychosocial approaches to health and wellness, including Cognitive Behavioral Therapy (CBT), neurofeedback, biofeedback, cranial electrical stimulation (CES), and QEEG. The brain adjusts to that loss of input by boosting certain types of activity, creating the impression of a noise that nobody else can hear.Precious opportunityPrevious efforts to pinpoint those changes within the brain have used scanning techniques (such as fMRI), which are much less precise than the electrodes used in the new study. The first surgery was performed at the Henry Ford Health System in Detroit, MI and the second surgery was performed in Antwerp, Belgium. Two years after the accident, a sudden left-sided tinnitus developed and was associated with short-lasting spells of vertigo. Whether stimulation of the primary auditory cortex will have the greatest effect in alleviating the perception of tinnitus or whether stimulation of other structures, such as those within the limbic system, will have the greatest effect requires further study.
It took many years of biomedical engineering to refine the speech and coding strategies to provide the highest quality sound perception and speech recognition to the patient.
However, in 5 – 10% of the population in western societies the tinnitus persists for more than six months and usually remains chronic [1]. However, the mere hyperactivity of the central auditory system does not explain the diversity of tinnitus symptoms and the variability of the subjective tinnitus distress between patients. Top-down influence from the global workspace on the sensory cortices amplifies the neuronal activity within the respective sensory area. In the present study we used PDC to analyze the directed coupling between all pairs of voxels in a frequency range from 2 to 100 Hz. In directed networks, the information on the directionality of the information flow is retained.
Cluster 1 was significant with P= 0.01 covering large parts of the left temporal cortex and also entering the frontal cortex to a small extent.
First, it was determined that these regions all received input from a large area in the frontal cortex, but with no influence from the right orbitofrontal cortex (Cluster 4 of the outflow; see Figure 2). Repetitive Transcranial Magnetic Stimulation (rTMS) aims to reduce the hyperactivity in the auditory cortex which leads to a reduction of tinnitus loudness [33, 37], however a complete relief of tinnitus is rare.
It is hypothesized that sensory activity above a certain threshold can enter the global workspace in a bottom-up manner [9, 10]. It provides much higher resolution information about the changes that take place in the brain - albeit of this one individual - whilst tinnitus is being perceived."Prof King agreed that the findings were a striking confirmation of the idea that tinnitus is not a simple product of changes within the hearing pathway. Husain decided to explore the relationship between tinnitus and the larger issue of hearing impairment by including measures of brain responses in subjects with only bilateral hearing loss (HL), in addition to subject groups with HL and tinnitus (TIN), and a control group with normal hearing (NH). Electrical stimulation of the skin near the ear, cochlea and brainstem has also provided some degree of tinnitus suppression. Those patients hear a constant ringing, buzzing, or hissing in the ear and this perception is especially dominant when the patient is resting in a quiet environment. Thus, existing theories have stressed the importance of higher order association brain areas that could be involved in the processing of the tinnitus [4, 7, 8].
The inflow to a voxel indicates that the activity of this voxel is driven by another voxel. The correlations were significant for the slow-wave frequencies, alpha, beta, and the lower gamma frequencies (2 – 46 Hz). Secondly, they all received influence from posterior voxels, approximately at the location of the outgoing clusters 1 and 3.
On the other hand, cognitive therapies are also able to reduce tinnitus symptoms partially [38, 39] and in light of the current study it can be argued that cognitive therapies alter the tinnitus-related global network and thus reduce the top-down influence of the global network on the temporal cortex. A prior article discussing the early history of electrical stimulation can be found in our Tinnitus Library. Once the paradigm was optimized to the patient, the electrode configuration was changed to drive the current to the most active site in the cortex. About 1 – 3% of the general population experience tinnitus as bothersome and complain that it affects their quality of life. Cortical areas such as the frontal and the parietal lobe have been suggested to take part in a long-range neuronal network that is involved in the integration of sensory and emotional aspects of the tinnitus [4, 7, 8].
Accordingly, a hub with a strong outflow describes that this voxel influences the activity of many other voxels (Figure 1). Thirdly, they all received input from their directed neighborhood: The left temporal clusters (Cluster 1 and 3) received input from the adjacent left fronto-temporal region. The study found that the HL group performed as well on discrimination tasks as the NH group, but the fMRI revealed that their brains had to work harder and were stimulated in more areas than the NH group. Problems can include difficulties concentrating at work, a decrease in their social life, depression, insomnia or anxiety [2]. Furthermore it has been hypothesized that top-down mechanisms of this higher order network could modulate the activity of the auditory cortex [8]. In the frequency range of 14 – 42 Hz inflows correlated significantly with tinnitus distress. There were clear differences in the responses in those groups and the tinnitus group, as the researchers found “decreased activation in the parietal and frontal lobes in the participants with tinnitus compared to the HL group and decreased response in the frontal lobes relative to the NH group. To try and find the source of his seizures, electrodes were implanted across his left hemisphere for two weeks, ahead of surgery to try and eliminate them.
This cluster was again located in the left temporal cortex and it covered the higher gamma frequencies from 80 – 98 Hz.
It ignores the distracting internal sound, while still maintaining attention to the external sound,” Husain said.
She is using this work to build predictive models of the probability of developing tinnitus and for evaluating, modifying, and developing therapies.



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