Important Note: The following information is provided for your education. It should not be relied upon for personal diagnosis or treatment. If you believe that a particular therapy applies to you or someone you care about, be sure to consult a doctor before trying it.
   

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Latest Research on Tinnitus
     
HNO. 2007 Dec 9 [Epub ahead of print]
[Group therapeutic concept for chronic tinnitus.]
[Article in German]
Seydel C, Georgiewa P, Reißhauer A, Klapp BF, Mazurek B.
Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Deutschland.

The aim of this article is to show an established group therapeutic concept for chronic tinnitus. The treatment of chronic tinnitus is intended to improve the way patients cope with tinnitus but it does not eliminate it. It means that patients learn how to reduce the impairment they are experiencing. Patients with tinnitus are supported in the process of habituation through the treatment. Multimodal cognitive behavioral therapeutic interventions in a group setting are particularly helpful because they may demonstrate differences in the influence of cognitive processes on the emotional perception of the tinnitus between the patients. Psychological factors like emotional support through other patients and learning from other examples can ease the process of internalizing coping strategies. Psychological processes seem to be of particular importance. Those processes can have an effect on concentration, appraisal, and coping with the tinnitus. Progressive muscle relaxation using Jacobson's technique, physical therapy, education via lectures, training of selective attention and change of appraisal, mental attitude and behavior concerning the tinnitus are the main factors in tinnitus therapy and can enable tinnitus patients to decrease their psychological strain.

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Prog Brain Res. 2007;166:467-71.
Auditory discrimination therapy (ADT) for tinnitus management.
Herraiz C, Diges I, Cobo P.
Unidad de Otorrinolaringología, Fundación Hospital Alcorcón, Madrid, Spain. cherraizp@seorl.net

Auditory discrimination training (ADT) designs a procedure to increase cortical areas responding to trained frequencies (damaged cochlear areas with cortical misrepresentation) and to shrink the neighboring over-represented ones (tinnitus pitch). In a prospective descriptive study of 27 patients with high frequency tinnitus, the severity of the tinnitus was measured using a visual analog scale (VAS) and the tinnitus handicap inventory (THI). Patients performed a 10-min auditory discrimination task twice a day during one month. Discontinuous 4 kHz pure tones were mixed randomly with short broadband noise sounds through an MP3 system. After the treatment mean VAS scores were reduced from 5.2 to 4.5 (p=0.000) and the THI decreased from 26.2% to 21.3% (p=0.000). Forty percent of the patients had improvement in tinnitus perception (RESP). Comparing the ADT group with a control group showed statistically significant improvement of their tinnitus as assessed by RESP, VAS, and THI.

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Prog Brain Res. 2007;166:415-23.
Tinnitus retraining therapy.
Jastreboff PJ.
Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA 30322, USA. pjastre@emory.edu

Tinnitus retraining therapy (TRT) is a specific clinical method based on the neurophysiological model of tinnitus described by Jastreboff (Jastreboff, P.J. (1990). Neurosci. Res., 8: 221-254). The method is aimed at habituation of reactions evoked by tinnitus, and subsequently habituation of the tinnitus perception. Several other methods have been suggested for habituation of tinnitus, but in TRT two components that strictly follow the principles of the neurophysiological model of tinnitus are implemented and necessary: (1) counseling, aimed at reclassification of tinnitus to a category of a neutral signals and (2) sound therapy, aimed at weakening tinnitus-related neuronal activity as suggested by Jastreboff and Hazell (Jastreboff, P.J. and Hazell, J.W.P. (2004). Cambridge University Press, Cambridge). This chapter outlines the theoretical basis of TRT as well as comments on the clinical outcome of the use of TRT for different kinds of tinnitus.

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Prog Brain Res. 2007;166:397-400.
Microvascular decompression operations.
Møller AR, Møller MB.
School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX 75083-0688, USA. amoller@utdallas.edu

Moving a blood vessel off the intracranial portion of the auditory nerve can successfully cure some individuals with specific forms of subjective tinnitus. This operation, known as microvascular decompression (MVD) is in general use to treat other hyperactive disorders such as hemifacial spasm (HFS) and trigeminal neuralgia (TGN) where the operation has a success rate of approximately 85%. MVD for tinnitus has lower success rate. MVD operations have also been used to treat some forms of vestibular disorders, disabling positional vertigo (DPV). In a study of treatment of a selected group of 72 patients with severe tinnitus and signs of change in the conduction properties of the auditory nerve 13 (18.2%) had total relief from tinnitus after MVD, 16 (22.2%) had marked improvement, 8 slight improvement and 33 (45.8%) no improvement. Two patients became worse (2.8%). There were 40 men and 32 women in the study group and there was considerable difference in the success rate for men and women. Fifty-five percent of the women and 29% of men showed relief or improvement. The success of the operation depended on the length of time the participants in the study had had their tinnitus and it was best for those who had had tinnitus for less than 3 years. The success rate for bilateral tinnitus was much lower than for unilateral tinnitus.

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Prog Brain Res. 2007;166:389-94.
Trans-electrical nerve stimulation (TENS) for somatic tinnitus.
Herraiz C, Toledano A, Diges I.
Unidad de Otorrinolaringología, Fundación Hospital Alcorcón, C/Budapest, 1 Alcorcón 28922, Madrid, Spain. cherraizp@seorl.net

The somatic tinnitus syndrome includes those forms of tinnitus that are associated with a somatic disorder involving the head and upper neck. It has been suggested that physiological mechanisms where interactions occur between the somatosensory and auditory systems are the etiology for that kind of tinnitus. Trans-electrical nerve stimulation (TENS) of areas of skin close to the ear increases the activation of the dorsal cochlear nucleus through the somatosensory pathway and may augment the inhibitory role of this nucleus on the CNS and thereby ameliorate tinnitus. In a prospective descriptive study of 26 patients with the probable diagnosis of somatic tinnitus we found that TENS could improve the tinnitus in 46% of the participants (23% did not hear it anymore, and in 23% its intensity was reduced). VAS scores improved from 6.5 to 6.0 after 2 weeks of treatment (p<0.01). Patients used TENS at home for 2h, once per day during 2 weeks (alternating ramped burst, 150 pps, with pulse duration of 100 micro s, amplitude 0-60 mA; average TENS intensity was 27 mA). Intermittent "typewriter" type of tinnitus was the most responsive. Somatic tinnitus without otologic disease had better response than tinnitus associated to otological causes (p=0.047).

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Prog Brain Res. 2007;166:341-5.
Hearing aids for the treatment of tinnitus.
Del Bo L, Ambrosetti U.
Associazione Ascolta e Vivi, Via Foppa 15, 20144, Milan, Italy. delbo@sordita.it

Clinical evidence shows that the use of hearing aids in tinnitus patients provides two benefits: it makes the patient less aware of the tinnitus and it improves communication by reducing the annoying sensation that sounds and voices are masked by the tinnitus. Hearing loss reduces stimulation from external sounds resulting in increased awareness of tinnitus and deprivation of input may change the function of structures of the auditory pathways. Tinnitus is often caused by expression of neural plasticity evoked by deprivation of auditory input. With hearing aid amplification, external sounds can provide sufficient activation of the auditory nervous system to reduce the tinnitus perception and it may elicit expression of neural plasticity that can reprogram the auditory nervous system and thereby have a long-term beneficial effect on tinnitus by restoring neural function. To obtain the best results, hearing aids should be fitted to both ears, use an open ear aid with the widest amplification band, and disabled noise reducing controls. In some cases a combination device would be preferable. The conditions required in order to obtain good results include not only the use of devices, but above all, their adaptation to the needs of the single patient, by counseling and customization. Wearing the hearing aid must become second nature to the patient even though it is only one element of the therapy.

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Prog Brain Res. 2007;166:323-30.
Antioxidants, minerals, vitamins, and herbal remedies in tinnitus therapy.
Enrico P, Sirca D, Mereu M.
Department of Biomedical Sciences, University of Sassari, V le S Pietro 43/B, 07100, Sassari, Italy. enrico@uniss.it

The use of complementary and alternative medicine (CAM) is very popular in western countries and several CAM products are often used by individuals with tinnitus with or without medical guidance. CAM pharmacological approach to tinnitus today is mainly based on vitamins and minerals (dietary supplements), antioxidants, and herbal medications. Despite the popularity of CAM products, the evidence regarding their efficacy against tinnitus is in general scarce and their potential toxic effects are often underestimated or even neglected. In this paper the available literature on the efficacy of dietary supplements, antioxidants, and herbal medications against tinnitus is reviewed, and some of the major potential toxic effects are discussed. It is concluded that the use of CAM products in tinnitus therapy in general lack substantial scientific support, and that these substances are probably not clinically effective either. However, it is difficult to draw clear-cut conclusions regarding CAM pharmacological approach to tinnitus. In fact, the subjective nature of tinnitus and the reported variability in patient's response to therapy indicate that several non-pharmacological factors may be influencing drug effects, with the placebo effect playing a major role. Nevertheless, in view of the potential harm that may occur from inappropriate use of CAM products, physicians need to be aware of their principal characteristics with particular emphasis on toxicity and possibilities of interaction with prescription drugs.

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Prog Brain Res. 2007;166:249-62.
Drug treatments for tinnitus.
Darlington CL, Smith PF.
Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago Medical School, Dunedin, New Zealand. cynthia.darlington@stonebow.otago.ac.nz

Many of the drug treatments that are presently in use for tinnitus are aimed at either the cochlea, e.g. using intratympanic injections of gentamicin, dexamethasone or lidocaine, or the CNS using systemic delivery. Earlier benzodiazepines and anticonvulsants have been used and more recently, antidepressants have been introduced, partly in an attempt to treat the emotional aspect of tinnitus. The fact that there are many different forms of tinnitus with different and often multiple causes and that the pathophysiology is poorly understood, are obstacles to finding effective treatments. This situation has been exacerbated by the lack of clinical trials to formally test even some of the most commonly used drugs, as well as a lack of preclinical studies to investigate novel agents. It is suggested that the animal models of tinnitus that have been developed could be used to screen potential anti-tinnitus drugs as a preliminary step before conducting clinical trials.

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Prog Brain Res. 2007;166:263-71.
Antidepressants for treatment of tinnitus.
Robinson S.
University of California at San Diego, Veterans Administration Healthcare System, San Diego, CA 92161, USA. skrobinson@ucsd.edu

Antidepressants are commonly prescribed for tinnitus. Research thus far provides some support for that treatment, but the literature also raises concerns because tinnitus is a side effect of antidepressant medication. In this chapter, four published double blind placebo-controlled trials of antidepressants for tinnitus are reviewed. Explanations for the discrepant results are offered, including that antidepressants appear to work best for tinnitus patients who are depressed or anxious, who have more severe tinnitus or who are treated for a longer time with an adequate dose of medication. Possible mechanisms of action are reviewed, with serotonergic and antimuscarinic mechanisms appearing to be the most important. At this time there is no indication that one specific type of antidepressant is more likely to lead to tinnitus as a side effect, or have a beneficial effect on tinnitus. Given SSRIs are tolerated better, these antidepressants have advantages over tricyclic antidepressants and should be used as a first line of treatment.

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Prog Brain Res. 2007;166:273-7
Treatment of tinnitus with acamprosate.
Azevedo AA, Figueiredo RR.
OTOSUL, Otorrinolaringologia Sul-Fluminense, Volta Redonda, Vila Santa Cecília, Rio de Janeiro, Brazil. otosul@otosul.com.br

Acamprosate, a drug used to treat alcohol dependence, was first reported as a potential treatment for tinnitus in 2005. The drug may improve tinnitus by a dual mechanism of action, acting both as a glutamate antagonist and as a GABA agonist. It is suggested that its action may be both on the ear and the nervous system.

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Eur Arch Otorhinolaryngol. 2007 Oct 2; [Epub ahead of print]Microvascular decompression of cochlear nerve for tinnitus incapacity: pre-surgical data, surgical analyses and long-term follow-up of 15 patients.
Guevara N, Deveze A, Buza V, Laffont B, Magnan J.
Department of Otorhinolaryngology, CHU de Nice, Hôpital Pasteur, 30, avenue de la Voie Romaine, B.P. 69, 06002, Nice, Cedex 1, France, guevara.n@chu-nice.fr.

The level of success of neurovascular decompression in ponto-cerebellar angle for hemifacial spasm and trigeminal neuralgia has already established the reality of the pathology to explain such symptoms. However, cochlear nerve compression syndrome by vascular loop is still a controversial topic. We have performed a retrospective cases review with long-term follow-up (5-7 years) concerning the results of microvascular decompression surgery of the cochlear nerve via an endoscopy assisted retrosigmoid approach on 15 patients suffering from unilateral incapacitating tinnitus with abnormal auditory brainstem response and an offending vessel on magnetic resonance imaging. During the surgery, a vascular compression was found on every patient. In a long-term follow-up, 53.3% (8 cases) of our tinnitus cases improved and 20% (3 cases) of them were completely cured. The ABR returned to normal in all patients who had good clinical results (diminished or disappeared tinnitus). When a vertebral artery loop (5 cases) was concerned we obtained 80% of good clinical results. No one showed amelioration or sudden aggravation of their hearing. Three cases required surgical correction of cerebrospinal fluid leak and one case developed spontaneously regressive swallowing problems. Such microvascular decompression surgery of the cochlear nerve appears to be successful in treating incapaciting tinnitus in particular when a vertebral artery loop is observed. Therefore, in such a case, one might recommend neurovascular decompression surgery, keeping in mind that the complications of this surgery should be minimized by a careful closure of the retrosigmoid approach. In order to ensure a better selection of patient more accurate cochlear nerve monitoring and functional MRI should be a promising assessment.

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Otolaryngol Head Neck Surg. 2007 Oct;137(4):589-95.
Which tinnitus patients benefit from transcranial magnetic stimulation?
Kleinjung T, Steffens T, Sand P, Murthum T, Hajak G, Strutz J, Langguth B, Eichhammer P.
Department of Otorhinolaryngology, University of Regensburg, Germany.

OBJECTIVES: Chronic tinnitus is associated with hyperactivity of the central auditory system. Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex has been proposed as a treatment for chronic tinnitus. This study determined the factors that predict a beneficial outcome with rTMS treatment. STUDY DESIGN: Forty-five patients with chronic tinnitus underwent 10 sessions of low-frequency rTMS to their left auditory cortex. The treatment outcome was assessed with a tinnitus questionnaire. Therapeutic success was related to the patients' clinical characteristics. RESULTS: A significant reduction in tinnitus complaints occurred after rTMS. In the questionnaire, 40% of the patients improved by five points or more. Treatment responders were characterized by shorter duration of tinnitus complaints and no hearing impairment. CONCLUSION: Tinnitus-related neuroplastic changes might be less pronounced in patients with normal hearing and a short history of
complaints. This could explain why those patients benefitted more from rTMS treatment.

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Quintessence Int. 2007 Oct;38(9):e564-71.
Otologic symptom improvement through TMD therapy.
Wright EF.
University of Texas Health Science Center at San Antonio, Department of Restorative Dentistry, 78229-3900, USA. wrighte2@uthscsa.edu

OBJECTIVES: Some patients with a temporomandibular disorder (TMD) and coexisting otologic symptoms desire to know the probability of TMD therapy improving their otologic symptoms. The aim of this study was to determine a clinically valid method for identifying which otologic symptoms have a high probability of improving as a result of satisfactory TMD symptom improvement. METHOD AND MATERIALS: Two hundred TMD patients with coexisting tinnitus, otalgia, dizziness, and/or vertigo were asked about their otologic symptom characteristics and associations and were given clinical tests, which were speculated to predict otologic symptom response from TMD therapy. The subjects received conservative TMD therapy in a manner thought to be most advantageous for their disorders. These potential assessment instruments were then evaluated for their ability to predict otologic symptom improvement. RESULTS: After satisfactory TMD symptom improvement was obtained, the percent of subjects report
ing significant improvement or resolution of their tinnitus, otalgia, dizziness, and vertigo was 83%, 94%, 91%, and 100%, respectively. The chi-square and Fisher exact probability tests identified significant correlations for tinnitus, otalgia, and dizziness improvement with younger age; for tinnitus and otalgia improvement with subjects who related that the otologic symptom began when the TMD symptoms began, was worse when the TMD symptoms were worse, and was related to stress; and for dizziness improvement with subjects relating more severe TMD symptoms. CONCLUSION: Asking TMD patients with coexisting otologic symptoms these specific questions will help practitioners identify which otologic symptoms have a high probability of benefiting from TMD therapy.

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Acta Otolaryngol. 2007 Aug 22;:1-5 [Epub ahead of print]
The effect of unilateral multichannel cochlear implant on bilaterally perceived tinnitus.
Quaranta N, Fernandez-Vega S, D'Elia C, Filipo R, Quaranta A.
Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy.

Conclusions. Available multichannel cochlear implants (CIs) provide effective tinnitus suppression. More sophisticated speech strategies are more effective than analogue or slow strategies. The mechanisms by which tinnitus is suppressed by CIs are unclear; however, both acoustic masking and reorganization of the right auditory association cortex induced by the CI are possible mechanisms. CI significantly reduced the tinnitus-related handicap as assessed by the Tinnitus handicap Inventory (THI). Objective. The objective of the study was to evaluate the effects of a unilateral CI on bilaterally perceived tinnitus. Patients and methods. Forty-one profoundly deaf patients implanted with a multichannel CI reporting bilateral tinnitus were evaluated. All patients were asked to complete a questionnaire that evaluated the presence, location and intensity of tinnitus before and after cochlear implantation. Results. Seven patients (17%) reported the perception of a 'new tinnitus' after surgery. With the CI off tinnitus was abolished in 23 patients (56.1%) in the implanted ear and in 22 patients (53.6%) in the contralateral ear. With the CI on tinnitus was abolished in the ipsilateral ear in 27 patients (65.8%) and in the contralateral ear in 27 patients (65.8%). Statistical analysis showed a significant reduction of the total THI score and of each subscale score (p<0.001).

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J Psychosom Res. 2007 Aug;63(2):195-202.
Use of a self-help book with weekly therapist contact to reduce tinnitus distress: a randomized controlled trial.
Kaldo V, Cars S, Rahnert M, Larsen HC, Andersson G.
Department of Psychology, Uppsala University, Uppsala, Sweden. viktor.kaldo@psyk.uu.se

OBJECTIVE: Tinnitus distress can be reduced by means of cognitive-behavior therapy (CBT). To compensate for the shortage of CBT therapists, we aimed, in this study, to investigate the effects of a CBT-based self-help book guided by brief telephone support. METHODS: Seventy-two patients were randomized either to a self-help book and seven weekly phone calls or to a wait-list control condition, later on receiving the self-help book with less therapist support. The dropout rate was 7%. Follow-up data 1 year after completion of treatment were also collected (12% dropout). The Tinnitus Reaction Questionnaire (TRQ) was the main outcome measure, complemented with daily ratings of tinnitus and measures of insomnia, anxiety, and depression. RESULTS: On the TRQ, significant reductions were found in the treatment group both immediately following treatment and at 1-year follow-up. In the treatment group, 32% reached the criteria for clinical significance (at least 50% reduction of the TRQ) compared to 5% in the wait-list group. Directly after treatment, two out of five measures showed significant differences in favor of the treatment with more therapist support compared with the group who, after their waiting period, received little therapist support. The self-help treatment was estimated to be 2.6 (seven phone calls) and 4.8 (one phone call) times as cost-effective as regular CBT group treatment. CONCLUSIONS: Guided self-help can serve as an alternative way to administer CBT for tinnitus. Preliminary results cast some doubts on the importance of weekly therapist contact. The effect size was somewhat smaller than for regular CBT, but on the other hand, the self-help seems far more cost-effective. Future studies should compare treatment modalities directly and explore cost-effectiveness more thoroughly.

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HNO. 2007 Aug 31; [Epub ahead of print]
[Chronic tinnitus and craniomandibular disorders. : Effectiveness of dental functional therapy on perceived tinnitus distress.]
[Article in German]
Bösel C, Mazurek B, Haupt H, Peroz I.
DENTSPLY DeTrey GmbH, Konstanz, Deutschland.

BACKGROUND: Whether the co-occurrence of signs and symptoms of a craniomandibular disorder (CMD) and chronic tinnitus are coincidental or causal is controversial. Therefore, the effects of splint therapy and self-therapy on perceived tinnitus were evaluated. PATIENTS AND METHODS: Fifty-nine patients with chronic tinnitus were divided into three groups. In a cross-over design, two groups received the two different treatments and were compared with a control group. All patients received the initial basic tinnitus therapy. RESULTS: No significant correlation was established between the groups receiving treatment and the control group that would validate a link between tinnitus and CMD. CONCLUSION: The results of this study suggest a coincidental relationship between the two complexes of symptoms.

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Int Tinnitus J. 2007;13(1):29-39.
Clear Tinnitus, middle-ear pressure, and tinnitus relief: a prospective trial.
Goldstein B, Shulman A, Avitable MJ.
Department of Otolaryngology, Health Science Center at Brooklyn, State University of New York, Downstate Medical Center, Brooklyn, USA. metrc@inch.com

GOAL: Our goal was to establish the efficacy, in a 12-week period, of Clear Tinnitus for tinnitus relief in patients with tinnitus of the severe, disabling type. HYPOTHESIS: We hypothesized that tinnitus relief with Clear Tinnitus reflects improvement in the sensory component of the tinnitus complaint by controlling the factor of aeration of the middle ears and improving eustachian tube function. METHOD: In a prospective clinical trial of a homeopathic preparation--Clear Tinnitus--we attempted to identify in 15 tinnitus patients (14 male, 1 female; mean age, 47.6 years) its clinical efficacy for establishing tinnitus relief for a 3-month period. We employed a descriptive data analysis method across dimensions of risk to evaluate a base of multidimensional evidence and establish support for our hypothesis. A medical-audiological tinnitus patient protocol completed by each patient identified the clinical type of tinnitus as predominantly cochlear, with a central and middle-ear component bilaterally. We identified fluctuation in middle-ear pressure (MEP) via patients' clinical history, supported by physical examination and established with tympanometry, as a factor influencing the clinical course of the tinnitus in each patient. RESULTS: Eleven of 15 patients completed the study. Seven responders reported tinnitus relief; four did not respond. Descriptive data analysis failed to detect any trends in a change in response with audiometric tests across the hearing spectrum; thus, we could derive no coefficients of hearing change. Evaluation revealed high-frequency tinnitus in 11 patients. The Feldmann masking curve comparison at the start and end of the study showed no significant change in the 11 patients. There was no significant alteration in the minimum masking levels or loudness discomfort levels before and after the study. Tympanometry and MEP measurement indicated a significant difference in MEP with an improvement on average of -58.18 in the right ear and -40.90 in the left ear for the 11 patients. Quantitative electroencephalography analysis revealed a marked difference in the number of significant abnormal recordings between the different frequency bands, with the delta band significantly higher than the theta, alpha, and beta bands for both the overall cohort of patients (n = 11) and those reporting tinnitus relief (n = 7). The tinnitus outcome questionnaires—the tinnitus intensity index, the tinnitus annoyance index, and the tinnitus reaction questionnaire—revealed a significant difference for the patients (7 of 11) obtaining tinnitus relief. Results of the tinnitus stress test, the tinnitus handicap index, and the measurement of depression scale before and after the study were not statistically significant. CONCLUSIONS: Patients who completed the study demonstrated with tympanometry a statistical and clinical significance in MEP improvement or maintenance of MEP (or both). Patients with tinnitus of the severe disabling type selected for this study and responding to Clear Tinnitus reported tinnitus relief accompanied by improvement in or maintenance of MEP of the middle ears. The statistical and clinical significance of Clear Tinnitus for establishing tinnitus relief remains to be established with a larger cohort of tinnitus patients.

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Acta Neurochir Suppl. 2007;97(Pt 2):451-62.
Auditory cortex stimulation for tinnitus.
De Ridder D, De Mulder G, Verstraeten E, Seidman M, Elisevich K, Sunaert S, Kovacs S, Van der Kelen K, Van de Heyning P, Moller A.
Department of Neurosurgery and Otorhinolaryngology, University Hospital Antwerp, Belgium. dirk.de.ridder@neurosurgery.be

Functional imaging techniques have demonstrated a relationship between the intensity of tinnitus and the degree of reorganization of the primary auditory cortex. Studies in experimental animals and humans have revealed that tinnitus is associated with a synchronized hyperactivity in the auditory cortex and proposed that the underlying pathophysiological mechanism is thalamocortical dysrhythmia; hence, decreased auditory stimulation results in decreased firing rate, and decreased lateral inhibition. Consequently, the surrounding brain area becomes hyperactive, firing at gamma band rates; this is considered a necessary precondition of auditory consciousness, and also tinnitus. Synchronization of the gamma band activity could possibly induce a topographical reorganization based on Hebbian mechanisms. Therefore, it seems logical to try to suppress tinnitus by modifying the tinnitus-related auditory cortex reorganization and hyperactivity. This can be achieved using neuronavigation-guided transcranial magnetic stimulation (TMS), which is capable of modulating cortical activity. If TMS is capable of suppressing tinnitus, the effect should be maintained by implanting electrodes over the area of electrophysiological signal abnormality on the auditory cortex. The results in the first patients treated by auditory cortex stimulation demonstrate a statistically significant tinnitus suppression in cases of unilateral pure tone tinnitus without suppression of white or narrow band noise. Hence, auditory cortex stimulation could become a physiologically guided treatment for a selected category of patients with severe tinnitus.

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Rev Bras Otorrinolaringol (Engl Ed). 2007 May-Jun;73(3):390-7.
Tinnitus treatment with Trazodone.
Dib GC, Kasse CA, Alves de Andrade T, Gurgel Testa JR, Cruz OL.
EPM, UNIFESP.

Tinnitus is a common symptom, defined as a sound perception in absence of a sound stimulus. AIM: Evaluate if Trazodone, an antidepressant drug, which modulates serotonin at central neuronal pathways, is effective in controlling tinnitus. STUDY DESIGN : Prospective, double blind, randomized, placebo-controlled. MATERIALS AND METHODS: Study performed with patients presenting tinnitus. 85 patients were analyzed between February and June of 2005. 43 received trazodone and 42 placebo, for 60 days. The clinical criteria of analysis were tinnitus intensity, discomfort and life quality impact by tinnitus, using an analogue scale varying between 0 and 10, scored by patients before and after drug or placebo use. RESULTS: There was a significant improvement in intensity, discomfort and life quality in both groups after treatment; however, there was no significant difference between the drug and placebo groups. Patients with age equal or over 60 years presented better results after treatment. CONCLUSION: Trazodone was not efficient in controlling tinnitus in the patients evaluated under the doses utilized.

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Rev Bras Otorrinolaringol (Engl Ed). 2007 May-Jun;73(3):384-9.
The effect of timpanoplasty on tinnitus in patients with conductive hearing loss: a six month follow-up.
Lima Ada S, Sanchez TG, Bonadia Moraes MF, Batezati Alves SC, Bento RF.
Otolaryngology, USP. draadrianalima@hotmail.com

Tympanoplasty is done to eradicate ear pathology and to restore the conductive hearing mechanism (eardrum and ossicles). Some patients, however, do not tolerate tinnitus and question physicians about the results of surgery when tinnitus persists. AIM: to evaluate the progression of tinnitus in patients with conductive hearing loss after tympanoplasty. STUDY DESIGN: a prospective cohort study. Material and Methods: 23 consecutive patients with tinnitus due to chronic otitis media underwent tympanoplasty. The patients underwent a medical and audiological protocol for tinnitus before and after tympanoplasty. RESULTS: 82.6% of patients had improvement or elimination of tinnitus after tympanoplasty The mean score of postoperative intolerance to tinnitus (1.91 for 30 and 180 days) was significantly different from preoperative scores (5.26). As to hearing loss, patients improved medically 30 and 180 days after surgery (3.65 and 2.91) compared to the preoperative condition (6.56). Audiometry revealed improvement at all frequencies from 0.25 to 6KHz, except at 8KHz. The air-bone gap was closed or was within 10dB in 14 cases (61%). An intact tympanic membrane was achieved in 78% of the cases. CONCLUSION: Aside from the classical improvement of hearing loss, tympanoplasty also offers good control of tinnitus.

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Otol Neurotol. 2007 Jun;28(4):455-458.
Effect of Atorvastatin on Progression of Sensorineural Hearing Loss and Tinnitus in the Elderly: Results of a Prospective, Randomized, Double-Blind Clinical Trial.
Olzowy B, Canis M, Hempel JM, Mazurek B, Suckfüll M.
*Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde der Ludwig-Maximilians Universität München, München; and †Tinnituszentrum, Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde der Charité-Universitätsmedizin-Berlin, Berlin, Germany.

OBJECTIVE:: To test whether the 3-hydroxy-3-methylglutaryl- coenzyme A reductase inhibitor atorvastatin can slow down the progression of presbycusis. PATIENTS:: Fifty patients 60- to 75-years-old with presbycusis and moderately elevated serum cholesterol. INTERVENTION(S):: In a double-blind design, patients were randomly assigned to treatment with either atorvastatin (40 mg/d orally) or placebo. MAIN OUTCOME MEASURE(S):: Pure-tone audiometry and tinnitus evaluation at enrolment and after 7 and 13 months. RESULTS:: Development of hearing thresholds after 7 and 13 months showed no significant differences between the groups. Tinnitus score continuously improved in the atorvastatin group (34.8 at 7 and 27.6 at 13 mo), whereas it slightly deteriorated in the placebo group (24.8 at 7 and 26.8 at 13 mo). The effect on tinnitus was a tendency without statistic significance (p = 0.0833). CONCLUSION:: Atorvastatin had no effect on the development of hearing thresholds, but resulted in a trend toward a relief of tinnitus.

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Int J Audiol. 2007 May;46(5):217-22.
Results of TRT after eighteen months: Our experience.
Baracca GN, Forti S, Crocetti A, Fagnani E, Scotti A, Bo LD, Ambrosetti U.
U.O. Complessa di Orl-Audiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena. Milan. Italy.

The aim of this study was to evaluate the efficacy of TRT in patients suffering from tinnitus. The tinnitus disorder affects about 10-15% of the population and, in one person out of a hundred, it is a disabling disorder. TRT treatment is based on Jastreboff's neurophysiological model. TRT consists of two parts: counselling, and sound therapy by means of dedicated hearing aids and sound generators. It proved to be useful to reduce the symptoms related to tinnitus. Jastreboff's structured interviews were proposed to a sample of 51 patients with tinnitus belonging to the I-II-III-IV classes according to Jastreboff. These patients were treated for 18 months. Sixty-eight percent of patients reported a reduction in the symptoms related to tinnitus, such as sleep disturbance, problems in concentration, and inability to relax. A percentage (64.7%) of patients thought that their quality of life was improved. Patients who had suffered from tinnitus for less than one year achieved significantly better results than patients who had suffered for a longer period of time. TRT is an effective tool in the treatment of tinnitus.

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Arch Med Res. 2007 May;38(4):456-9. Epub 2007 Mar 12.
Antioxidant therapy in idiopathic tinnitus: preliminary outcomes.
Savastano M, Brescia G, Marioni G.
Department of Otolaryngology Head Neck Surgery, Padua University, Padua, Italy. marina.savastano@unipd.it

BACKGROUND: Reactive oxygen species (ROS) play an important role in several pathogenic processes, damaging various structural and functional cellular components. The endothelium is at major risk of radical-induced lesions and this damage is most manifest in microcirculation. It has been recently observed that ROS are implicated in the pathology of the inner ear and the peripheral and central pathways. In a previous study we detected high serum values of ROS in subjects with idiopathic tinnitus. The purpose of the present study was to evaluate the validity of antioxidant treatment in tinnitus sufferers with high ROS values. METHODS: The study considered 31 consecutive patients with unilateral idiopathic tinnitus. The mean pure tone audiometric threshold (PTA), tinnitus loudness, subjective disturbance level [visual analogue scale (VAS) determination], and the indirect ROS dosage 48 h before and after medical treatment were evaluated. Patients underwent an 18-week oral treatment with a mix of phospholipids and vitamins (glycerophosphorylcholine, glycerophosphorylethanolamine, beta-carotene, vitamin C, vitamin E). RESULTS: ROS levels were significantly reduced following antioxidant treatment (malonaldehyde: 2.10 vs. 1.98 mumol/dL, p = 0.003; 4-hydroxynonenal: 2.36 vs. 2.16 mumol/dL, p = 0.002) In addition, great improvement was observed in the reduction of tinnitus (VAS and tinnitus loudness evaluations). No significant changes in audiometric threshold occurred. CONCLUSIONS: Oral antioxidant therapy in patients with idiopathic tinnitus seems to reduce the subjective discomfort and tinnitus intensity and may be considered as an additional treatment modality.

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J Laryngol Otol. 2007 Apr 23;:1-7 [Epub ahead of print]
Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural therapy approach.
Sadlier M, Stephens SD, Kennedy V.
Physiotherapy Department, University Hospital of Wales, Cardiff, UK.

Background: Chronic tinnitus is a frequent symptom presentation in clinical practice. No drug treatment to date has shown itself to be effective. The aim of the present study was to investigate the effects of cognitive behavioural therapy and meditation in tinnitus sufferers.Methodology: Patients were selected from a dedicated tinnitus clinic in the Welsh Hearing Institute. A waiting list control design was used. Twenty-five chronic tinnitus sufferers were consecutively allocated to two groups, one receiving a cognitive behavioural therapy/meditation intervention of four one hour sessions with the other group waiting three months and subsequently treated in the same way, thereby acting as their own control. The main outcome was measured using the Hallam tinnitus questionnaire. A four to six month follow up was conducted.Results: These showed significant statistical reductions in tinnitus variables both in the active and also in the control group. Post-therapy, no significant change was found after the waiting list period. The improvement was maintained at the four to six month period.Conclusion: The positive findings give support for the use of cognitive behavioural therapy/meditation for chronic tinnitus sufferers.

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Ear Hear. 2007 Apr;28(2):242-59.
Neuromonics Tinnitus Treatment: third clinical trial.
Davis PB, Paki B, Hanley PJ.
Division of Health Sciences, Curtin University of Technology, Perth, Australia. p.b.davis@curtin.edu.au

OBJECTIVES: The Neuromonics Tinnitus Treatment combines the use of a novel approach to acoustic stimulation with a structured program of counseling and support by a clinician specifically trained in tinnitus rehabilitation. The distinctive acoustic component has been designed to provide stimulation to auditory pathways deprived by hearing loss, engage positively with the limbic system, and allow intermittent, momentary tinnitus perception within a pleasant and relaxing stimulus, thereby facilitating desensitization to the tinnitus signal. The purposes of this study were (1) to demonstrate the efficacy of the treatment, when enhanced with various modifications since previously reported trials and (2) to test the relative clinical effectiveness of two variations of the approach. In the first, intermittent tinnitus perception was facilitated throughout treatment through the use of a stimulus in which intensity peaks allowed the patients' tinnitus perception to be completely covered up, whereas in the intensity troughs their tinnitus was briefly discernible. In the second, subjects experienced little tinnitus perception while listening to the treatment for the first 2 mo, then experienced intermittent perception. DESIGN: Thirty-five subjects with a predominantly moderate to severe level of tinnitus-related distress before treatment were randomly allocated into one of two treatment groups, corresponding to the two stage-based variations of the Neuromonics Tinnitus Treatment. Participants were provided with a high-fidelity personal sound player with earphones and an acoustic stimulus that had been spectrally modified according to their individual audiometric profile. They were instructed to use the acoustic stimulus for at least 2 hr per day, particularly at those times when their tinnitus was usually disturbing. Each group had equal amounts of clinician time for education, monitoring, and support. RESULTS: At 2, 4, 6, and 12 mo after commencing treatment, both groups displayed clinically and statistically significant improvements in tinnitus distress, awareness, and minimum masking levels as well as loudness discomfort levels. Improvements increased with time over the first 6 mo of therapy, at which time 91% of all subjects across the two groups reported an improvement in tinnitus disturbance (as measured by the Tinnitus Reaction Questionnaire) of at least 40%, with a mean improvement of 65%. Also, 80% of subjects at 6 mo reported a level of tinnitus disturbance that was no longer clinically significant. There was some indication of a more consistent benefit over 12 mo for the group that was provided initially with a high level of tinnitus interaction; however, inter-group differences were not statistically significant. A relation between reported treatment usage (hours per day) and clinical outcomes was observed, suggesting that a "dosage effect" may apply with the stimulus provided. CONCLUSIONS: This study found that the Neuromonics Tinnitus Treatment provides rapid and profound improvements to the severity of tinnitus symptoms and their effect on the subject's quality of life. This was a consistent effect, provided by a treatment that subjects reported as being pleasant to use. Both of the stage-based variations of the treatment that were tested in this study were shown to be successful in achieving these outcomes.

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Arch Otolaryngol Head Neck Surg. 2007 Apr;133(4):390-7.
Relief of idiopathic subjective tinnitus: is gabapentin effective?
Piccirillo JF, Finnell J, Vlahiotis A, Chole RA, Spitznagel E.
Division of Clinical Outcomes Research, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO 63110, USA. piccirilloj@ent.wustl.edu

OBJECTIVE: To assess the therapeutic benefit of gabapentin (Neurontin) for subjective idiopathic troublesome tinnitus. DESIGN: An 8-week, double-blind, randomized clinical trial. SETTING: Academic otolaryngology clinic in St Louis, Mo. SUBJECTS: One hundred thirty-five subjects with severe idiopathic subjective tinnitus of 6 months' duration or longer. INTERVENTION: Gabapentin, at a maintenance dosage of 900 to 3600 mg/d for 8 weeks, or lactose placebo. MAIN OUTCOME MEASURE: Change in the Tinnitus Handicap Inventory score from baseline to the study end point. RESULTS: The overall change in the Tinnitus Handicap Inventory score for the entire cohort from baseline to week 8 was 11.2; the change among the 59 subjects randomized to the gabapentin arm was 11.3 and the change among the 56 subjects in the placebo arm was 11.0. The difference was 0.03 (95% confidence interval, -5.5 to 6.2; P = .91). CONCLUSION: Gabapentin is no more effective than placebo for the relief of idiopathic subjective tinnitus. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00317850.

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J Neurol Neurosurg Psychiatry. 2007 Feb 21; [Epub ahead of print]
Effects of repetitive transcranial magnetic stimulation on chronic tinnitus. A randomised, cross over, double blind, placebo-controlled study.
Rossi S, De Capua A, Ulivelli M, Bartalini S, Falzarano V, Filippone G, Passero S.
Università di Siena, Italy.

BACKGROUND: chronic tinnitus is a disabling, almost untreatable, condition usually accompanied by psychiatric distress. In patients with complex neuropsychiatric diseases as chronic pain, with whom tinnitus shares pathophysiological similarities, placebo effects may be pronounced. Moreover, it may be difficult to distinguish actual rTMS-induced clinical benefits beyond placebo effects in neuropsychiatric patients. METHODS: 16 patients with chronic tinnitus underwent a randomized, double-blind, cross-over, placebo controlled trial of 1 Hz rTMS (120% of motor threshold; 1200 stimuli/day for 5 days) of the left temporoparietal region. Patients were screened for psychiatric comorbidity; additionally, anxiety and depression were monitored throughout the study. Moreover, an original placebo rTMS procedure produced the same activation of ipsilateral face muscles (a condition which may per se change tinnitus subjective rating) of the real rTMS. RESULTS: responders were 8 out of 14. Two patients dropped out for transient tinnitus worsening. Active rTMS induced an overall significant, but transient, improvement (35% of the basal score) of subjective tinnitus perception, that was independent either by tinnitus laterality or by mood or anxiety changes. No correlations were found between response to rTMS and tinnitus duration, initial subjective score or patients' age. When asked after the study was over, 71.4% of patients failed to identify the temporal sequence of the real or sham rTMS interventions. CONCLUSIONS: beneficial effects of rTMS on tinnitus are independent by mood changes. Moreover, they appear in the context of an original placebo stimulation designed to more closely replicate somatic sensation of active stimulation. Due to the limited temporal duration of the clinical benefit, these neuromodulatory effects could be mediated by transient functional changes taking place in the neural circuits underlying tinnitus processing.

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Cochrane Database Syst Rev. 2007 Jan 24;(1):CD005233.
Cognitive behavioral therapy for tinnitus.
Martinez Devesa P, Waddell A, Perera R, Theodoulou M.

BACKGROUND: Tinnitus is an auditory perception that can be described as the experience of sound, in the ear or in the head, in the absence of external acoustic stimulation (not usually audible to anyone else). At present no specific therapy for tinnitus is acknowledged to be satisfactory in all patients.Cognitive behavioural therapy (CBT) uses relaxation, cognitive restructuring of the thoughts and exposure to exacerbating situations in order to promote habituation and may benefit tinnitus patients, as may the treatment of associated psychological conditions. OBJECTIVES: To assess whether cognitive behavioural therapy is effective in the management of patients suffering from tinnitus. SEARCH STRATEGY: Our search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE and EMBASE. The last search date was June 2006. SELECTION CRITERIA: Randomised controlled trials in which patients with unilateral or bilateral tinnitus as main symptom received cognitive behavioural treatment. DATA COLLECTION AND ANALYSIS: One review author (PMD) assessed every report identified by the search strategy. The four review authors assessed the methodological quality, applied inclusion/exclusion criteria and extracted data. MAIN RESULTS: Six trials comprising 285 participants were included.1. Primary outcome: subjective tinnitus loudnessCBT compared to a waiting list control group: we found no significant difference (Standardised Mean Difference (SMD) 0.06 (95% CI -0.25 to 0.37)).CBT compared to another intervention (Yoga, Education, Minimal Contact - Education and Education): we found no significant difference (SMD 0.1 (95% CI -0.22 to 0.42)).2. Secondary outcomesa) DepressionCBT compared to a waiting list control group: we found no significant difference in either group (SMD 0.29 (95%CI -0.04 to 0.63)).CBT compared to another intervention (Yoga, Education and Minimal Contact - Education): we found no significant difference (SMD 0.01 (95% CI -0.43 to 0.45)).b) Quality of lifeCBT compared to a waiting list control group: we found a significant difference in favour of CBT versus the waiting list group (SMD 0.7 (95% CI 0.33 to 1.08)).CBT compared to another intervention (Education, Minimal Contact - Education and Education): we also found a significant difference between CBT and the other intervention control group (SMD 0.64 (95% CI 0.29 to 1.00)).There were no adverse/side effects reported in any trial. AUTHORS' CONCLUSIONS: We did not find a significant difference in the subjective loudness of tinnitus, or in the associated depression. However we found a significant improvement in the quality of life (decrease of global tinnitus severity) of the participants, thus suggesting that cognitive behavioural therapy has an effect on the qualitative aspects of tinnitus and contributes positively to the management of tinnitus.

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Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004739.
Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus.
Bennett M, Kertesz T, Yeung P.

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSHL) with or without tinnitus is common and presents a health problem with significant effect on quality of life. Hyperbaric oxygen therapy (HBOT) may improve oxygen supply to the inner ear and, it is postulated, may result in an improvement in hearing and/or a reduction in the intensity of tinnitus. OBJECTIVES: To assess the benefits and harms of HBOT for treating ISSHL and/or tinnitus. SEARCH STRATEGY: We initially searched in June 2004 and repeated the search in June 2006. Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2 2006), MEDLINE (1951 to 2006), EMBASE (1974 to 2006), CINAHL, Database of Randomised Trials in Hyperbaric Medicine (DORCTHIM), AMED, LILACS, KOREAMED, INDMED, National Research Register (NRR), CSA, ISI PROCEEDINGS and ZETOC. SELECTION CRITERIA: Randomised studies comparing the effect on ISSHL and/or tinnitus of therapeutic regimens which include HBOT with those that exclude HBOT. DATA COLLECTION AND ANALYSIS: Three authors independently evaluated the quality of the relevant trials using the validated Oxford-Scale (Jadad 1996) and extracted the data from the included trials. MAIN RESULTS: Six trials contributed to this review (308 subjects). Pooled data from two trials involving 114 patients did not show any significant improvement in the chance of a 50% increase in hearing threshold on Pure Tone Average (PTA) when HBOT was used (relative risk [RR] with HBOT 1.53, 95% CI 0.85 to 2.78, P = 0.16), but did show a significantly increased chance of a 25% increase in PTA (RR 1.39, 95% CI 1.05 to 1.84, P = 0.02). There was a 22% greater chance of improvement with HBOT, and the number needed to treat (NNT) to achieve one extra good outcome was five (95% CI 3 to 20). A single trial involving 50 subjects also suggested significantly more improvement in the mean PTA threshold with HBOT, expressed as a percentage of baseline (WMD 37%, 95% CI 22% to 53%, P < 0.001). The significance of any improvement following HBOT in a subjective rating of tinnitus could not be assessed due to poor reporting.There were no significant improvements in hearing or tinnitus reported in the single study to examine chronic presentation (six months) of ISSHL and/or tinnitus. AUTHORS' CONCLUSIONS: For people with early presentation of ISSHL, the application of HBOT significantly improved hearing loss, but the clinical significance of the level of improvement is not clear. We could not assess the effect of HBOT on tinnitus by pooled data analysis. The routine application of HBOT to these patients cannot be justified from this review. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powered trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT.There is no evidence of a beneficial effect of HBOT on chronic presentation of ISSHL and/or tinnitus and we do not recommend use of HBOT for this purpose based on the single study available.

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Adv Otorhinolaryngol. 2007;65:343-7.
How does stapes surgery influence severe disabling tinnitus in otosclerosis patients?
Oliveira CA.
Department of Otolaryngology, Brasilia University Medical School, Brasilia, Brazil.

Tinnitus is a common symptom in otosclerosis patients. Many papers have been written about tinnitus outcome after stapes surgery. However, none has attempted to quantify the intensity of the symptom pre- and postoperatively in order to evaluate the influence of surgery on the degree of annoyance caused by tinnitus. Severe disabling tinnitus (SDT) is defined by Shulman as a symptom severe enough to disrupt the patient's routine and to prevent him from performing his daily tasks. We have studied 48 consecutive otosclerosis patients by means of a visual analogue scale measuring tinnitus intensity before and after stapes surgery. We have accepted tinnitus as severe and disabling when the symptom score was 7 or above in a visual analogue scale from 1 to 10. Of 19 patients with preoperative SDT, 10 reported complete remission and 7 reported significant improvement. Two patients had no change and none reported worsening of tinnitus after stapes surgery. We conclude that stapes surgery can improve SDT significantly in 90% of otosclerosis patients and is very unlikely to make the symptom worse.

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Int Tinnitus J. 2006;12(2):172-4.
Can cochlear implants decrease tinnitus?
Yonehara E, Mezzalira R, Porto PR, Bianchini WA, Calonga L, Curi SB, Stoler G.
Department of Otorhinolaryngology, Head and Neck Surgery, School of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil. emayonehara@yahoo.com.br

Suppression of tinnitus by electrical stimulation via a cochlear implant has been studied in recent years. Some individuals who undergo cochlear implant surgery report total or partial relief of the symptoms even in the contralateral ear. The mechanisms involved in this suppression are not clear. The results obtained in our study demonstrated an improvement of 71% in 29 implant cases, confirming data found in the literature. Our aim was to study tinnitus in individuals before surgery and after cochlear implant activation and to observe improvement in the perception of tinnitus, comparing these results with data in the literature. We conducted a retrospective study of 29 postlingual adults who had profound sensorineural hearing loss and underwent cochlear implant surgery at the cochlear implant sector of the Otorhinolaryngology, Head and Neck Surgery Department, University of Campinas, Sao Paulo, Brazil, between May 2003 and June 2005. The device employed in this procedure was the Nucleus 24K multichannel device (Cochlear Ltd, Lane Cove, Australia). After the internal component was activated, patients completed a questionnaire. Before surgery, 21 of the 29 patients (72%) who later underwent cochlear implant surgery presented with tinnitus, which was bilateral in 14 cases (67%). After the cochlear implant was activated, seven patients (33%) presented with total suppression, and eight patients (39%) reported partial relief. In the 14 cases with bilateral symptoms, tinnitus was totally suppressed or decreased in both ears in 12 cases (86%). Individuals who underwent multichannel cochlear implant surgery presented with reduced tinnitus even in the contralateral ear.

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Int Tinnitus J. 2006;12(2):161-71.
Pharmacotherapy for severe, disabling, subjective, idiopathic tinnitus: 2005-2006.
Shulman A, Goldstein B.
Department of Clinical Otolaryngology, Health Science Center at Brooklyn, State University of New York, Downstate Medical Center, Brooklyn 11203-2098, USA. metrc@inch.com

We present a tinnitus-targeted therapy (TTT), a combined treatment of medication and instrumentation focusing on pharmacotherapy. It embodies ongoing clinical experience (since 1977) in an excess of 8,500 patients with subjective idiopathic tinnitus of the severe disabling type (SIT). All have visited the Tinnitus Clinic of the Downstate Medical Center at the State University of New York (DMC/SUNY) and the Martha Entenmann Tinnitus Research Center, Inc. Since 1989, as a result of our evolving experience with single-photon emission computed tomography (SPECT) of brain, we have defined tinnitus as a sensory disorder of auditory perception exhibiting an aberrant auditory signal produced by interference in the excitatory-inhibitory process or processes involved in neurotransmission. This definition is considered to be dynamic: It embodies the integration of clinical observations and advances reported from neuroscience and nuclear medicine. These investigations have sought to identify an underlying mechanism of tinnitus production and have assisted in the establishment of the medical significance of tinnitus. In general, the goal of tinnitus therapy in 2005-2006 is to attempt to provide tinnitus relief for all clinical types of subjective idiopathic tinnitus (SIT). Although no cure for SIT exists currently, available protocols for diagnosis and treatment increase the efficacy of therapeutic modalities for attempting tinnitus relief. The strategies of TTT are based on the clinical translation of fundamentals of sensory physiology, extrapolation of underlying neurochemistry from nuclear medicine imaging results with SPECT in SIT patients, hypotheses of mechanisms of tinnitus production, and the innovative application of drug therapies designed for indications other than tinnitus. Such strategies have contributed to the development of a new discipline, tinnitology, an integrated multidiscipline of basic science, neuroscience, and clinical medicine attempting to understand an aberrant auditory phenomenon, unrelated to an external source of sound, and how it becomes transformed into one of affect. The goal of increasing accuracy of the SIT diagnosis is the impetus for increased efficacy of therapeutic modalities recommended for tinnitus relief.

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Int Tinnitus J. 2006;12(2):140-4.
Benzodiazepines and GABAergics in treating severe disabling tinnitus of predominantly cochlear origin.
Bahmad FM Jr, Venosa AR, Oliveira CA.
Department of Otolaryngology, Brasilia University Medical School, Brasilia-DF, Brazil.

Severe disabling tinnitus (SDT) refers to a symptom severe enough to disrupt affected patients' routine and keep them from performing their daily activities. SDT of a predominantly central origin has been treated successfully with benzodiazepines and GABAergic drugs. Our aim was to test the control of SDT of predominantly cochlear origin by benzodiazepines and GABAergic drugs. We followed the format of a prospective, randomized, single-blind clinical trial at an academic tertiary-care hospital. We studied 30 patients, all with SDT of clear cochlear origin. We treated 10 patients with placebo (group 1), 10 with benzodiazepine drugs (group 2), and 10 with benzodiazepine and GABAergic drugs (group 3). We recorded a decrease in the annoyance and intensity of SDT as measured by a visual analog scale ranging from 1 (negligible) to 10 (unbearable). We found statistically significant improvement in comparing groups 2 and 3 with group 1 but found no significant difference when groups 2 and 3 were compared. Addition of GABAergic to benzodiazepine drugs does not modify the treatment results in SDT of a predominantly cochlear origin.

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ORL J Otorhinolaryngol Relat Spec. 2006 Dec 8;69(2):107-112 [Epub ahead of print]
Hyperbaric Oxygen in Tinnitus: Influence of Psychological Factors on Treatment Results?
Porubsky C, Stiegler P, Matzi V, Lipp C, Kontaxis A, Klemen H, Walch C, Smolle-Juttner F.
Division of Thoracic Surgery and Hyperbaric Medicine, University of Medicine, Graz, Austria.

Introduction: The standard treatment of subjective tinnitus hardly reaches the level of placebo controls. Though the effectiveness of hyperbaric oxygenation (HBO) for subjective tinnitus has never been objectified, it is still advocated by some institutions. We analyzed the effectiveness of hyperbaric oxygen treatment in the context of accompanying factors. Patients and Methods: We randomized 360 patients suffering from tinnitus into 2 HBO treatment protocols (group A: 2.2 bar for 60 min bottom time and group B: 2.5 bar for 60 min bottom time once a day for 15 days). All patients were asked to fill in a questionnaire (social and medical history, tinnitus characteristics, pre-HBO duration of tinnitus, prior therapy, pretreatment expectation, accompanying symptoms). A subjective assessment of the therapeutic effect was obtained. Results: Twelve patients (3.3%) experienced complete remission of tinnitus, in 122 (33.9) the intensity lessened, and 44 (12.2%) had a subjectively agreeable change of noise characteristics. No change was found in 157 cases (43.6%) and 25 (6.9%) experienced deterioration. There was no statistically significant difference between groups A and B (p > 0.05). Out of 68 patients with a positive expectation of HBO effects, 60.3% stated that the tinnitus had improved whereas only 47.2 and 19%, respectively, out of patients who underwent therapy with an indifferent (n = 271) or negative expectation (n = 21) reported an improvement. The influence of subjective expectation on the outcome was statistically significant (p < 0.05). Conclusion: The therapeutic effects of HBO on subjective tinnitus may be substantially influenced by psychological mechanisms. Copyright (c) 2007 S. Karger AG, Basel.

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Acta Otolaryngol Suppl. 2006 Nov;(556):102-4.
Repetitive transcranial magnetic stimulation and chronic tinnitus.
Langguth B, Hajak G, Kleinjung T, Pridmore S, Sand P, Eichhammer P.
Department of Psychiatry, Psychosomatics and Psychotherapy.

Conclusion: There is a good theoretical basis and early research evidence suggesting that transcranial magnetic stimulation (TMS) may have treatment potential in tinnitus. Further studies with larger sample sizes and additional assessment of neurobiological effects are necessary. Objectives: Tinnitus is a common and often severely disabling disorder for which there is no satisfactory treatment. TMS is a new, non-invasive method of modifying the excitability of the cerebral cortex, which has proven effective in auditory hallucinations and other disorders. Some early studies have been published in which TMS has been used in the treatment of tinnitus. The objective of this paper is to examine the literature and consider the potential for TMS as a therapy in tinnitus. Methods: A thorough search of the tinnitus and TMS literature was conducted, and all available relevant material was examined. Results: Tinnitus is common, with a prevalence of 8.2% in subjects aged 50 years and over, and may be associated with great distress (tinnitus sufferers). There are no effective treatments. Tinnitus is frequently associated with deafness, and may be the result of a pathological plasticity process. Neuroimaging studies demonstrate increased activity within the central auditory system. TMS is a non-invasive method of modulating excitability in cerebral cortex. It uses electromagnetic principles and has been successfully employed in the treatment of other conditions associated with increased activity of the cerebral cortex. Meanwhile, a growing number of studies suggest that repetitive TMS may be effective in the treatment of chronic tinnitus.
  

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