International Tinnitus Mini-Seminar: Cutting Edge Treatment Options (2010)
by Barry Keate
Regular readers of these articles will know we have covered meetings of the International Tinnitus Forum (ITF) since 2004. This is an annual meeting of researchers and scientists from around the world who present their findings on causes, effects and potential treatments for tinnitus.
In previous years the ITF convened the day prior to the opening of the American Academy of Otolaryngology (AAO) annual meeting and convention. The meetings lasted about 5 hours and attendance ranged from 50 to 75 physicians, scientists and researchers.
This year, the Tinnitus Forum morphed into a mini-seminar and was held during the first day of the AAO convention, on Sunday, September 26th. The time was reduced to about an hour and a half and attendance jumped to 650 interested physicians. This has created a much higher level of visibility for the Forum and for the Martha Entenmann Tinnitus Research Center, led by Abraham Shulman, MD and Barbara Goldstein, PhD, the hosts of the meeting. The meeting and convention were held in the Boston Convention Center in Boston, MA.
Because of the large increase in first-time attendees, the presentations made at this mini-seminar combined an overview of previous work along with new research.
Abraham Shulman, MD presented his findings on the final common pathway for all tinnitus development. He stressed that this is not a hypothesis but can be demonstrated that the pathway for tinnitus is through the GABA receptors in the brain.
GABA is an acronym for gamma-amino butyric acid and is a calming neurotransmitter in the brain. Glutamate is an excitatory neurotransmitter and is generated by damaged hair cells in the cochlea. Glutamate will overpower GABA when neuronal structures are damaged and excite nerve cells until they become depleted and die.
Editor’s Note: Arches Tinnitus Formula is helpful for tinnitus in part because it is a powerful glutamate antagonist and inhibits GABA reuptake.
Jeff Carroll, PhD presented on hypermonitoring, the process where a person perceives tinnitus at a higher level than it really exists. He says this is not simply a matter of paying too much attention but is an abnormal brain process.
It is possible to objectively determine the loudness of a person’s tinnitus. Pitch and loudness matching are common practices in audiology clinics. If two people have tinnitus at the same level but one has a higher degree of hearing loss, tinnitus will subjectively appear to be louder to the person with the most hearing loss.
He presented data and graphs that showed results from hundreds of patients and discussed which of these would be better served by tinnitus masking, Tinnitus Retraining Therapy and other cognitive therapies aimed at habituating the patient to their tinnitus.
Tobias Kleinjung, MD discussed auditory and non-auditory brain changes in those with tinnitus. Changes occur in the auditory cortex but also in the limbic system, responsible for primitive “fight or flight” responses.
Electrical stimulation, as in repetitive Transcranial Magnetic Stimulation (rTMS), has the potential to lower excitation in the auditory cortex. In this therapy, powerful magnets outside the skull induce electrical currents inside the brain.
Many aspects of the therapy are still in development: shape of the magnetic coil, frequency and duration of the stimulation, location of stimulation, and other issues.
Electrical stimulation seems to work best with those whose tinnitus is less than 4 years old. Advances in treatments should make it more helpful for those with longer standing conditions.
Michael Seidman, MD, discussed his ongoing experiments with deep brain implanted electrodes for tinnitus control.
Experiments in restoring hearing and tinnitus control using direct electrical current eventually led to the development of cochlear implants. When cochlear implants were first used, the patient only heard a series of beeps. It took decades of work by some very bright coding specialists and electrical engineers before they figured out the correct speech coding strategies for the cochlear implants to work effectively. Dr. Seidman compared these early attempts at cochlear implants to where the current state of deep brain electrical stimulation is now. He stated that there is still extensive research required before this therapy will be fully realized.
His one criticism of rTMS is that it only penetrates about 2.5 cm in the brain. The auditory cortex is located 5 cm deep. This may be enough to be helpful but he thinks the target is deeper.
Dr. Seidman utilizes neuronavigation with Magnetoencephalography (MEG) to locate the exact place for the insertion. MEG measures magnetic emissions from the brain. It is non-invasive and quiet, with no need for injected dies. It is highly accurate and can give a more pinpointed image of the brain than other imaging techniques.
Dr. Seidman has conducted six electrode implants for tinnitus. His first patient, who was severely disabled, rating a 10 on a scale of 1-10 was essentially cured. The patient reports his tinnitus is now 0-2. When it hits 2, he turns on a pulse generator in his hip, activating the electrode and it knocks down the sound level. The second patient had a 30% improvement. Overall, 4 out of 6 patients have reported a 30-90% improvement while two out of 6 patients have had no improvement.
Editor’s Note: Dr. Seidman is Chief Medical Advisor to Arches and endorses Arches Tinnitus Formulas. In 2009 at the last AAO convention, he was elected by his peers to serve a three-year term as Chair of the AAO Board of Governors.
Carey Balaban, PhD spoke on the common pathways for tinnitus as well as other disorders. He believes there is a common pathway for balance, anxiety and migraine. Historically, tinnitus and vertigo were considered symptoms of migraine disorder.
Animal research shows noise exposure lights up, or excites, areas of the brain associated with balance and anxiety. There are common pathways between the vestibular system, the trigeminal system, which is involved in pain, and the cochlea. This means that tinnitus, balance and migraine are all related. Treatment therapies can be developed that would work for all three disorders.