| Notes
from the 24th Annual Meeting of the International
Tinnitus Forum
by
Barry Keate
 The
International Tinnitus Forum (ITF) held its annual
meeting September 16th at the Fairmont Royal York
Hotel in Toronto, Ontario. The Royal York is at the
foot of the Toronto Canada National (CN) Tower, the
tallest building in the world at 1,815 feet. The meeting
provided important information on new therapies and
techniques for preventing and treating tinnitus as
well as further discussion of existing treatments.
It was very encouraging to see how much research is
being invested in the causes of and treatments for
tinnitus.
 The
ITF is an annual meeting of eminent researchers and
scientists concerned with furthering advances in the
prevention and treatment of tinnitus. It is hosted
by the Martha Entenmann Tinnitus Research Center and
State University, New York (SUNY). The Program Chair
is Abraham Shulman, MD, Professor Emeritus of Otolaryngology
at SUNY, and the Program Coordinator is Barbara Goldstein,
PhD, the Director of Audiological Research. Michael
Seidman, MD is the Co-Moderator of the Forum and the
Senior Editor of the International Tinnitus Journal,
which publishes papers presented at the Forum.
This
article offers a brief overview of the presentations.
1
– Abraham Shulman, MD, Martha Entenmann Tinnitus
Center
Dr.
Shulman is interested in the basic science of tinnitus.
He has been developing methods to objectively determine
the severity of tinnitus since 1979. In prior research,
he has determined the final common pathway of tinnitus
relates to the GABA receptors in the brain and has
developed a pharmacological approach to treatment.
This prior research can be seen at http://www.tinnitusformula.com/infocenter/articles/studies/brain.aspx.
In
this presentation he described Tinnitus Desynchronize/Synchronize
Theory (TDST). This is a lack of timing or phase-shift
of the auditory signal as it communicates between
the cochlea and the auditory cortex. He described
the oscillations of normal brain waves, some of which
are generated by the auditory cortex and others generated
by the cochlea. If these oscillations are not synchronous,
that is of the same wavelength and phase, there is
a discontinuity of communication between the two areas
of the brain.
Synchronized
oscillations of broad frequency brain waves are necessary
for learning, memory, hearing and all brain related
functions.
Dr.
Shulman is convinced the desynchronous behavior of
the brainwaves of tinnitus patients is related to
the excitatory vs. inhibitory neural functions that
are controlled by the GABA receptors. Measuring brain
wave dysynchrony provides an objective way to analyze
tinnitus severity.
In
clinical practice, Dr. Shulman begins treatment with
Neurontin and Klonopin. He states that 80-85% of patients
achieve some degree of relief. He also uses tinnitus
maskers and Tinnitus Retraining Therapy (TRT). TRT
is used primarily for those patients with hyperacusis,
a condition of extreme sensitivity to sound.
2
– Paul van de Heyning, MD, Holland
Dr.
van de Heyning’s presentation was on Cochlear
Implantation with electrodes. This is an invasive
treatment requiring surgical implantation of the electrodes
and is usually only conducted on those with severe
hearing loss and tinnitus. It can restore a degree
of hearing and reduce tinnitus sounds for most patients.
In
a small clinical study, conducted in Holland, 20 patients
were implanted with electrodes. All had a positive
response regarding their tinnitus. On a scale of 1
to 10, the mean tinnitus was at 8.5 prior to the implantation.
After implantation, the mean tinnitus was 2.5.
Dr.
van de Heyning’s clinic also uses Tinnitus Phase-out
System™, a sound-based phase-shift system developed
in the US. Tinnitus sound is matched for frequency
and loudness, then played back out of phase with the
tinnitus sound. This results in a reduction of the
tinnitus for a period of time. More information on
this therapy can be read below in this article.
After
clinical treatments, provided they are successful,
the patient is able to purchase a home system. This
is used for 30 minute treatments daily. Their experience
with this system is very limited and there are no
clinical results as yet.
3
– Michael Hoffer, MD, Commander, United States
Navy, Naval Medical Research Center
Dr.
Hoffer did a follow-on presentation of his research
into anti-oxidants and hearing loss. His initial presentation
was given at last year’s ITF in Los Angeles.
He
also presented some new data from the US Navy on the
number of service members who suffer hearing loss
and tinnitus. Over 25% of all returnee service members
experience hearing loss and tinnitus. This number
dramatically escalates to 90% of those who have experienced
blast injuries. Over 30,000 service members per year
file for Veterans Administration compensation for
hearing loss and tinnitus.
Hearing
loss is caused by oxidative stress. Impulse noise
exposure, weapons fire and blast injuries can cause
sudden onset hearing loss. This can be prevented or
greatly reduced by using antioxidants.
Naval
Medical Research Studies show that there is no benefit
from anti-oxidants later than 8 hours following hearing
loss damage. Dr. Hoffer stated he does not know the
effect of anti-oxidants on tinnitus. The studies were
conducted with hearing loss as the primary outcome,
not tinnitus. The data is not valid for secondary
outcomes and Dr. Hoffer would like more studies conducted
with tinnitus as the primary outcome.
The
anti-oxidants Dr. Hoffer is working with are N-Acetyl-Cysteine
(NAC) and Acetyl-L-Carnitine.
 4
– Guest of Honor – John Emmett, MD, Shea
Center for Ears, Memphis, TN
Dr.
Emmett gave a presentation on the history of Lidocaine
treatment for tinnitus. Dr. Emmett introduced Lidocaine
treatment to the United States and has been working
with it for many years.
Lidocaine
is a short-term anti-convulsant. As Hippocrates stated
in 400 BC, “Tinnitus is the little brother of
epilepsy”. Dr. Emmett views tinnitus as an epileptic-like
condition in the Central Nervous System.
It
has been known since 1935 that Lidocaine can greatly
relieve tinnitus. Unfortunately, it has a half-life
of only 100 minutes. This means that half of the Lidocaine
administered to the body will be metabolized in 100
minutes. Half of the remainder metabolizes in the
next 100 minutes, and so on. In other words, the effectiveness
of the medication wears off very quickly.
In
a small clinical study of 54 tinnitus patients at
the Shea Clinic, 43 patients, or 80%, had relief from
their symptoms varying between 20% and 100% reduction.
In this study, Lidocaine was administered by IV infusion
and was followed by oral administration of Tegretol,
an anti-convulsant medication with a half-life of
11 hours. The Tegretol showed significant side effects
in 26% of patients.
Dr. Emmett then tried Lidocaine infusion with oral
Tocainide, a similar medication but one that is not
available in the US. There was a gradual trend toward
relief with fewer side effects.
Dr.
Emmett has also tried Lidocaine perfusion through
the eardrum directly onto the cochlea along with oral
Xanax taken twice daily. There has been some nausea,
vomiting and dizziness with this technique. After
one month 10% of patients had complete reduction,
60% had some reduction and 30% had no reduction. After
one year the same patients had much less reduction
than after one month.
To
date, Dr. Emmett has not developed a standard therapy
for tinnitus patients that shows consistently positive
results. He presented this list, in descending order,
of the treatments he uses.
1-First, he recommends Ginkgo biloba to his tinnitus
patients. He states that the Europeans swear by it
and he has seen positive results. (Note:
Arches Tinnitus Relief Formula® contains pharmaceutical-quality
Ginkgo biloba extract in a dosage of 480 mg daily).
If this is ineffective, he then recommends:
2-Buspar, an anti-anxiety medication, then
3-Amitriptylene, an anti-depressant medication, then
4-Effexor, another anti-depressant medication.
If
none of the above are helpful and the tinnitus is
disabling, Dr. Emmett will then treat his patients
with Lidocaine perfusion through the eardrum along
with Dexamethasone, a steroid medication. This is
an invasive procedure and only used in severe cases.
5
- There was a brief report on Benign Intercranial
Hypertension (BIH) which can cause pulsatile tinnitus.
BIH is elevated blood pressure in the brain. Most,
but not all, of the patients are overweight. In some
cases, Topamax, an anti-seizure medication, can lead
to weight loss, lowered blood pressure and reduced
tinnitus.
6
- Another brief report was on tinnitus that is not
associated with hearing loss. It is usually considered
that damage to inner hair cells causes hearing loss
and tinnitus. The researchers have concluded that
damage to the outer hair cells of the cochlea can
cause tinnitus without hearing loss.
Sound
Based Tinnitus Therapy
During
the annual meeting of the Academy of Otolaryngology,
which began after the ITF concluded, I had a chance
to meet with Calvin Yee, the President of Tinnitus
Control Inc. in New York City. In a previous issue
we discussed the Tinnitus Phase-Out System™
offered by Tinnitus Control. This is the therapy where
a patient’s tinnitus sound is matched for both
frequency and loudness. These parameters are then
programmed into a patient treatment device, which
phase-shifts a matched signal played back to the patient
for 30 minutes for each treatment. This results in
a negation of the tinnitus sound and leads to Residual
Inhibition where the tinnitus is reduced, or even
abolished, for a period of time after the playback.
Please see our article
on sound based tinnitus therapy in our Tinnitus
Information Center for details of the therapy and
contact information.
Mr.
Yee informed me that one of their recently-completed
clinical trials is ready for publication and Tinnitus
Control is developing relationships with clinics across
the US to offer this therapy. He invited me to a presentation
by Ruthann Lipman, DO and Sidney Lipman, MD from Erie,
PA, about their results from a study conducted with
the Phase-Out System.
In
previous studies 83% and 70% of patients responded
to this treatment with at least 6 dB reduction of
tinnitus sound (6 dB equals 50% reduction of intensity).
The Residual Inhibition lasted for varying, but undetermined,
lengths of time before the tinnitus returned to its
previous level.
During
a single-blind, placebo-controlled study conducted
by the clinic in Erie, 57% of 59 patients achieved
at least 6 dB reduction in loudness and 42% had Residual
Inhibition that lasted between one hour and seven
days (average 2 days). Since the end of the study
40% of participants had purchased or expressed interest
in purchasing the portable, home use device offered
by Tinnitus Control.
Mr.
Yee and I also discussed using Arches Tinnitus Formulas
in conjunction with the Sound Based Tinnitus Therapy
as a way to achieve even better results for those
who suffer from tinnitus.
This
therapy should be available in several clinics across
the US by mid-2007. We will report on the progress
of this therapy as we learn more. |