Tinnitus Targeted Therapy

I. General Principles:

Multifactorial/ Multidisciplinary approach for tinnitus treatment/control

• Tinnitus is not a unitary symptom. Clinical types and subtypes have been identified.
• Recommendations based on clinical type(s) of tinnitus and conditions identified in the evaluation.
• Differentiate between sensory/affect components. Sensory: The tinnitus itself. Affect: How the patient responds behaviorally to the sound.
• Medical/surgical treatment for diseases of ear, nose and throat; TMJ.
• Medical treatment for underlying conditions identified in the medical evaluation which are known to influence the tinnitus.
• Diagnostic Radiology Imaging, CTScan; Magnetic Resonance Imaging - Ear/Brain (MRI), Single Photon Emission Tomography (SPECT) of Brain, Positron Emission Tomography (PET) of Brain - Selected and individualized for each patient.
• Quantitative Electroencephalography (qEEG)

II. Instrumentation:

• Tinnitus maskers / Tinnitus instruments
• Amplification/Hearing Aids
• Tinnitus Habituation/Tinnitus Retraining Therapy
• Ultra Quiet Device - Hisonic TRD - ultra high frequency external acoustic stimulation.
• Electrical Stimulation
• Customized Tapes

III. Drug Therapy - Selected and individualized for each patient

• Vasodilators
• Antihistamine
• Antianxiety Anti-depression Drugs; Anti-rheologic Agents
• Neuroprotective Drug Therapy
• Antioxidants
• Anticonvulsants
• Calcium Channel Blocking Agents
• Prostaglandins

IV. Surgical:

• Perfusion of the Inner Ear - for a predominantly cochlear type tinnitus

V. Neurofeedback Therapy:

• Neurofeedback therapy is a specialized form of biofeedback that is used to provide relief for tinnitus, stress, anxiety and/or depression.It utilizes brain wave and central nervous system information. It gives us a computerized display of brain wave activity at the scalp. The patient watches displays or listens to sound and normalizes abnormal brain waves. The patient learns to recognize different brain wave states through learning and training.

VI. Referral for treatment of behavioral response to tinnitus e.g. stress, anxiety, depression, TMJ.

• Stress Management
• Cognitive Behavioral Therapy
• Biofeedback
• Dental Treatment/Referred for TMJ
• Counseling

VII. Combined Therapy

• Frequently combinations of drug therapy and instrumentation are advised.

 

Clinical Research Protocols:

1. Patient Selection for Research Protocols:

Patients accepted and selected for research protocols of the METRC are requested to complete a Medical Audiologic Tinnitus Patient Protocol. The Medical Audiologic Tinnitus Patient Protocol attempts to identify the clinical type of tinnitus; treatment of conditions known to influence the clinical course of treatment and to have had an attempt to provide tinnitus treatment/control prior to entering the research protocol. The components of the symptom of tinnitus are identified. Control of the affect component i.e. a stable personality is required for all patients prior to acceptance into any research protocol.

2. Drug therapy:

Calpain antagonists/inhibitors

Calpain is a normal intracellular cytosolic protease activated by excess intracellular calcium. Calpain inhibitors as well as antagonists are being developed as neuroprotective agents. It is being investigated for perfusion of the inner ear, and for the effect on peripheral and/or central portions of the cochleovestibular system. A collaboration of basic science and clinical research efforts were established in 1997, with the support of the METRC, at SUNY-DMC (A. Stracher, Ph.D; A. Shulman, M.D.) and Buffalo SUNY ( R. Salvi, Ph.D) in an attempt to develop neuroprotective drug therapies for complaints of the hearing and balance systems particularly of hearing loss, tinnitus, and vertigo. One of the neuroprotective agents under investigation in this collaborative research is LXIC, a Calpain antagonist. Significant neuroprotection from noise has been demonstrated in the chinchilla. (Publications in Press). In 1998, a protocol for human investigation is in the process of preparation. Patients selected for this treatment will follow the protocols established for use of neuroprotective drug agents focusing upon CNS pathologies of ischemia, hemorrhage, trauma and neurodegeneration.

3. Instrumentation:

AllHear single channel electrode for tinnitus suppression

Modification of the single channel AllHear cochlear implant device is now in preparation for submission to the FDA for an IDE (W. House, M.D.; M.M. Goldsmith, M.D.; A. Shulman, M.D.;Karen Berliner, Ph. D.;D.W. House, CEO AllHear).