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30.12.2013

Treatment of tinnitus with electrical stimulation, causes and treatment of pulsatile tinnitus - Try Out

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Tinnitus is a debilitating condition thought to be caused by the brain generating a signal in areas no longer stimulated by the auditory system. The Serenity System couples an implantable vagus nerve stimulator with a tone generator that plays sounds of various frequencies while electric signals are delivered by the neurostimulator. Electrical stimulation has been used by neurosurgeons to treat various conditions for many years.
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. Upon recovering from surgery, at the first post-operative visit, the selection of the electrical stimulating paradigm, or model, was decided for each patient. 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.
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.
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.
Researchers at the University of Texas at Dallas are hopeful a new device that stimulates the vagus nerve in the neck could help bring silence to tinnitus sufferers. Electric nerve stimulation to treat tinnitus is delivered using an electrical pulse generator connected to the vagus nerve inside the neck. Vagus nerve stimulation, or VNS, is an approved therapy for treatment of epilepsy and treatment-resistant depression. The approach developed at UT-Dallas combines audible tones with brief pulses of electrical stimulation to the vagus nerve in the neck.
This pacemaker-like device that will be used in a clinical trial on Vagal Nerve stimulation for the treatment of tinnitus. Good informative article, but if anyone else trying to find a good tinnitus treatment try Bodhi Tinnitus Ender (do a google search).


Stimulating the vagus nerve releases chemicals involved in neuroplasticity, so doing so while playing the tones will hopefully train the brain to correlate the various sound frequencies to their normal areas in the auditory cortex.
Early experiments using DC current applied directly to the ear or mastoid bone showed promise in reducing tinnitus symptoms. 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. 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. MV is a 40 year-old female who was involved in a motor vehicle accident with whiplash injury.
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. 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. To change tinnitus, he says, you have to change the activity in the brain and stop the overcompensation. For those with a lesser degree of tinnitus, we have two iPhone apps that help manage the tinnitus annoyance. 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.


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.
According to the Department of Defense, in the past four years, the number of veterans on disability compensation for tinnitus has nearly doubled to an estimated 1.5 million.
Sven Vanneste, an associate professor who works at UT-Dallas’ Callier Center for Communication Disorders, explains some people are helped with hearing aids, others with sound therapy, some with anti-depressants – even meditation.
For a period of a few hours, every 15 to 30 seconds, the device sends tiny jolts of electricity at the same time as a tone – reinforcing the tones you want the brain to respond to, and not the others. Serene Ears provides masking therapy, which helps hide the tinnitus by playing soothing sounds.
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. The other app, Nix TInnitus Amp, is like a low cost hearing aid that can help with tinnitus in two ways. Electrical stimulation of the skin near the ear, cochlea and brainstem has also provided some degree of tinnitus suppression. It has a white noise generator for masking therapy, and it can provide notch therapy by eliminating the frequencies at which tinnitus seems to occur. A prior article discussing the early history of electrical stimulation can be found in our Tinnitus Library.



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