by Barry Keate
Many of our readers have asked me to comment on a variety of portable tinnitus instruments. There are a number of these devices on the market and while I cannot address all of them here, I will try to describe the most often asked about devices, discuss the scientific theories of the various treatments and relay my impressions as to their effectiveness in this article.
Ti-Ex Tinnitus Therapy Device
This portable electromagnetic device was developed by an Austrian electronics engineer named Gerald Neuwirth in 1998. Mr. Neuwirth had suffered severe tinnitus for many years and had not experienced relief with any therapy. He developed a hand-held device that directed electromagnetic energy into the cochlea and reported that his tinnitus symptoms disappeared after 10 weeks of use.
The scientific basis of this device is predicated on the belief that electromagnetic waves will stimulate and regenerate hair cells that have been damaged. A quote from their website reads, “In order to understand how ti-ex works, it is important to realize that the hair cells in the inner ear can regenerate. If they are damaged, they regenerate completely from the tip to the root, creating a new hair cell in about two days.”
This dubious statement contradicts all scientific knowledge to date. Hair cells in humans do not regenerate. If they could, or if scientists could find a way to stage the regeneration, hearing loss in humans would become a thing of the past.
Certain cold-blooded animals, such as sharks and frogs can regenerate hair cells. More recently it has been found that some birds can regenerate hair cells as well. This has led to a surge of research into how to duplicate this process in humans. It has not been accomplished so far.
Mr. Neuwirth also makes reference to repetitive Transcranial Magnetic Stimulation (rTMS), as a rationale for the therapy he claims for his instrument. rTMS has been shown to be helpful for some tinnitus patients, and we published an article on rTMS, that is found in our Tinnitus Info Center.
The comparison between a portable electromagnetic device designed for home use and rTMS is a very large stretch. rTMS generators use capacitors that can generate 5,000 to 8,000 Amps. This amount of power is necessary to induce a magnetic field inside the skull which can effectively change the metabolic activity of the auditory cortex. Even at this power level, many researchers believe the magnetic field cannot extend deep enough into the brain to affect tinnitus and that only implanted electrodes will truly accomplish tinnitus relief.
Furthermore, rTMS seems to be effective in interfering with the neuronal changes in the auditory cortex, not by regenerating hair cells.
Ti-ex has not undergone clinical trials. It is available in Europe and costs 290 to 490 Euros (approximately $390.00 to $650.00 US dollars). The device can be found at ti-ex.com/en.
The Neuromonics Tinnitus Treatment consists of a new model of acoustic therapy along with a six-month program of education, support and monitoring from a qualified audiologist. Its aim is to break the negative cycle of tinnitus disturbance, rather than objectively lower the sound level, which results in reduced awareness of tinnitus and its associated disturbance.
Neuromonics is based on the Neurophysiological Model for tinnitus developed by Pawel Jastreboff, who devised Tinnitus Retraining Therapy (TRT). Similar to TRT it is a long-term treatment. Both treatments attempt to reprogram the brain by de-sensitizing it to filter out the sounds of tinnitus. An article on TRT can be seen in our Info Center.
In both TRT and Neuromonics, researchers believe that the problem is not specifically the tinnitus itself but the individual’s reaction to the perception of tinnitus. This reaction involves the emotional centers of the brain’s limbic system which controls emotions and leads to disturbance. By removing the negative association attached to tinnitus perception, the disturbance of tinnitus will decrease.
Whereas TRT utilizes sound generators and couples them with education, emotional support and cognitive therapy, Neuromonics adds advanced audio technology that can reproduce frequencies up to 12,500 KHz. It combines full-spectrum classical music with high frequency sounds to make the sound therapy soothing. The result is less intensive and faster conditioning than with traditional TRT.
The first step of this treatment is to perform a comprehensive personalized assessment to determine an individual’s tinnitus profile. This profile is used to program the Neuromonics Processor, a small, lightweight device about the size of a cell phone. The processor is coupled with high-end headphones to produce acoustic stimulation across a broad spectrum of sound. The theory is the full-spectrum sound stimulates audio pathways in the brain reducing the relative loudness of the single frequency tinnitus. The patient is instructed to listen to the device for at least two hours daily. The time can be broken up to accommodate for work and daily schedule but 2-3 hours daily is the recommended time.
The program costs around $5,000 and takes 6 months to complete. At the end of that period, patients may continue to listen to the device, if desired, for shorter periods or may elect to not use it at all. They have results on their website on their own clinical studies show positive results for this therapy but none of them have been published in a peer-reviewed publication.
I have received many questions about Neuromonics but have no personal experience of it. Nor have I communicated with anyone who has used it. If anyone decides to use this program, I will appreciate any feedback about its effectiveness. There are numerous audiology clinics across the US that are beginning to offer Neuromonics. You can find the US locations online at neuromonics-usa.com. Their home website in Australia is neuromonics.com.
The TinniTool makes use of the theory behind Low Level Laser Therapy (LLLT) developed by Dr. Lutz Wilden in Germany. The theory is that auditory processes require energy in the form of ATP (adenosine tri-phosphate). ATP is considered by biologists to be the energy currency of life. It is the high-energy molecule that stores the energy we need to do just about everything we do. It is produced by the mitochondria in the cells of the inner ear and throughout the body. The mitochondria are considered to be the powerhouse energy producing units in each cell.
If the cochlea is over-strained, its sensory cells are affected as well and they inevitably lose part of their functional capacity due to a lack of ATP. Using LLLT, Dr. Wilden has been able to produce a biological reaction, the end result of which is ATP production, even in damaged cells. This therapy may be more beneficial in patients in the early stages of tinnitus as it may have more benefit in damaged cells than in dead ones.
In my opinion, the jury is still out on the effectiveness of LLLT, especially for long-term chronic conditions. While I have heard some encouraging results from people who were treated by Dr. Wilden, I have not heard anything positive coming from anyone who visited LLLT clinics in the US. We previously published an article on LLLT which is in our Tinnitus Info Center.
To my knowledge, there has been only one published study relating to LLLT and tinnitus. Unfortunately, the study encompassed three treatment methods, all of which were used simultaneously. It appears that 73% of the people in the LLLT study were using Ginkgo biloba for their tinnitus as well and others were using ginkgo and also undergoing cranio-physical manipulation. It is unclear which part of the therapy was helpful and it may well have been the Ginkgo biloba.
Dr. Wilden uses two separate laser beams on the mastoid bone that are calculated to penetrate into the cochlea from behind the ear. He also simultaneously uses a third beam aimed down the ear canal. Typical treatment sessions are 60 minutes and there are 10 session over a period of 10-14 days.
The TinniTool is a portable, home-use device that produces a single beam. It is not aimed through the mastoid bone but down the ear canal. It is difficult for me to believe that this device would be helpful for people with chronic tinnitus.
The TinniTool has not undergone clinical trials. It is available from the United Kingdom at a cost of 270 British Pounds, about $540 US dollars. It is sold through on-line shopping markets in the UK and can be found at bizrate.com.uk.
Tinnitus Phase-Out System
This is a tinnitus treatment therapy more than an actual scientific instrument although the therapy can be accomplished at home. It was developed by Daniel S.J. Choy, MD and is offered through the Tinnitus Control Center in New York City. The Tinnitus Phase-Out System utilizes recent advances in industrial sound cancellation principles to produce a sound that results in significant Residual Inhibition (RI). Residual Inhibition refers to the inhibition of tinnitus that occurs after a tinnitus masking session. In the great majority of cases RI lasts only seconds. Using the Tinnitus Phase-Out System, researchers claim to have produced RI lasting hours and, sometimes, days.
We published an article about this under the heading Sound-based Tinnitus Therapy.
This therapy is available for patients with pure-tone tinnitus where the frequency of the sound does not vary even though loudness can vary. Each patient is first given a thorough medical examination to eliminate the possibility of a serious condition. Their tinnitus is then evaluated and matched to both frequency and loudness. The individual tinnitus tones are then reproduced and processed through a proprietary computer program. The program shifts the phase of the sound through 360 degrees in 6 degree increments every 30 seconds. In this manner the sound is completely phase-shifted every 30 minutes and is effectively totally out of phase with the person’s tinnitus for 1/3 the total time. During this out of phase period, the sound cancels out the tinnitus sound and tinnitus is not heard.
The phase-shifted sound is then burned into a CD and played for the patient at the Tinnitus Control Center. There are four sessions after which the patient decides if it is helpful in reducing tinnitus. If it is, the patient can purchase the CD and use it at home on any high-quality audio system.
The cost of the program is $850.00 for the evaluation and four office treatment sessions. If successful, the cost of the CD is an additional $1,500.00.
There have been several research papers presented at medical symposiums but as yet there are no published studies. One paper was presented at the Osteopathic College of Ophthalmology and Otolaryngology in 2006. It stated that the company’s research found that 46% of their patients demonstrated complete residual inhibition for 1-7 days.
Another paper presented at the 8th Annual International Tinnitus Seminar in Pau, France in 2005 found that 82% of patients experienced a reduction of tinnitus symptoms. It did not state for how long the reductions lasted.
The Tinnitus Control Center is actively seeking to license the technology to medical clinics throughout the US and the world. So far it is only offered in New York City and Erie, PA. For further information, visit their website at tinnituscontrol.com.
Arches Tinnitus Formulas can be used with any of the therapies discussed in this article and will enhance results. We have discussed combining our products with the Tinnitus Phase-Out System using a combination therapy and anticipate that this will be forthcoming.