Tinnitus

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Tinnitus is a common condition that temporarily afflicts most individuals at one time or another. Tinnitus is the perceived sensation of sound without actual acoustic stimulation. Common causes include excessive aspirin consumption, or the after effects of attending a loud musical concert. When chronic, it can be extremely frustrating and sometimes incapacitating.

Approximately, 40 million people in the United States experience chronic tinnitus and 10 million of these people consider their tinnitus to be a significant problem. There are many different treatments for tinnitus. However, no one treatment or combinations of treatments have been found to be effective. Consequently, the FDA has not approved any treatment for tinnitus. Many investigators have noted similarities between tinnitus and chronic neuropathic pain. This has lead to the chronic pain explanation for tinnitus.

The significance of this research is that troublesome tinnitus is a very common health problem and treatment options for these patients are quite limited. The findings from this research could have significant health impact for a large number of people..

Current Studies

07-0689-Collaborative Tinnitus Research at Washington University

There is no known medication that cures tinnitus (ringing, buzzing, whistling noise in the ears). About 40 million people in the United States experience chronic tinnitus and 10 million of these people consider their tinnitus to cause significant problems in their daily lives. The sounds patients hear when they are bothered with tinnitus most likely originate inside the brain in an area just above and behind the ear, the “auditory cortex”. Treatment for tinnitus using an electro-magnetic device named rTMS (repetitive Transcranial Magnetic Stimulation) is being studied. The use of rTMS for tinnitus is investigational (not FDA approved). Research continues to be done around the world to look at establishing the safety and efficacy of rTMS as a treatment for tinnitus. rTMS works by placing the magnetic instrument against the scalp, near the auditory cortex, and delivering a magnetic stimulus to the brain. Medical researchers believe that rTMS stimulation causes the area of the brain associated with tinnitus to become less active and that the result maybe be a diminished sound of tinnitus. It is important to understand that some rTMS tinnitus research studies have reported that rTMS works well and some have reported that rTMS does not work to stop tinnitus. The purpose of this study is to investigate the safety and the effective use of rTMS to treat people suffering from tinnitus. This study hopes to add to the medical knowledge about how tinnitus responds to rTMS treatments.

09-0551-rTMS To The Dorsolateral Prefrontal Cortex For Patients with Subjective

There is growing recognition that the bothersome features of tinnitus originate inside the brain and not directly inside of the ear. The bothersome tinnitus sounds seem to be caused by the brain “paying too much attention” and eliciting too strong an emotional response to the auditory stimulation.. This pilot study examines the impact of treating the dorsolateral prefrontal cortex (DLPFC) area of the brain. The DLPCF controls mood and also plays a part in attention and is thought to be responsible for awareness of the tinnitus. The treatment intervention is called repetitive Transcranial Magnetic Stimulation or rTMS. It involves placing an electro-magnetic device on the scalp and stimulating the brain. Treatment for tinnitus has been studied here at Washington University by Drs. Piccirillo, Garcia, Jarvis, and Hullar. rTMS is approved by the Food and Drug Administration (FDA) for the treatment of major depression; however, it is still investigational when doctors use rTMS to treat tinnitus. The use of electromagnetic stimulation in the treatment of tinnitus was first reported in 1993. Research continues to be done around the world to look at establishing the safety and efficacy of rTMS as a treatment for tinnitus. It is important to understand that some rTMS tinnitus research studies have reported that rTMS works well and some have reported that rTMS does not work to stop tinnitus. During rTMS a magnet is placed against the scalp, on the forehead above the left eye, and produces a magnetic stimulus near the area of the brain called the left dorsolateral pre-frontal cortex (DLPFC). Medical researchers believe that stimulating the brain with rTMS in the DLPFC will cause the sounds to become less bothersome. It is thought that by treating this area, patients may be better able to ignore the tinnitus.

09-0481-Exploring Voluntary Control of Tinnitus

Certain patients report that they are able to modulate the loudness or pitch of their tinnitus temporarily through various means, including attention re-direction or somatosensory mechanisms such as oral facial movements or head turning. This subset of patients may represent a unique opportunity for the researcher to gain insight into the mechanisms responsible for tinnitus. Neural activity in the brain has been linked to increases in blood flow and blood oxygenation. These changes in the concentration of oxyhemoglobin versus deoxyhemoglobin alter the magnetic resonance signal of blood which may then be detected using an appropriate MR pulse sequence as blood-oxygen-level-dependent (BOLD) contrast. In addition to increases in blood flow due to evoked neural activity, the brain exhibits continuous low frequency spontaneous activity. These fluctuations tend to be synchronous in functionally related, but spatially distinct, regions of the brain even when not performing a prescribed task. The phrase functional connectivity has been used to implicate the neural activity that facilitates the coordinated activity of functionally related brain regions. This study will use functional connectivity magnetic resonance imaging (fcMRI) to measure the network of synchronous brain activity in patients with tinnitus. Several targeted networks are those linked to the auditory system, attention, and control systems and the emotion systems linked to prefrontal cortex. Previously, functional MRI (fMRI) used changes in blood flow and blood oxygenation within the brain to detect which isolated regions of the brain were active during a task. The goal of functional connectivity research is to describe a pattern of interactions or a picture of the connectivity that occurs within distinct regions of the brain when the individual is not involved in a task.

For further information on these projects please contact:
Joyce Nicklaus, RN, BS

or

Marie Tedesco Scott

All studies conducted in St. Louis, Missouri at the Washington University School of Medicine.