People afflicted with Tinnitus hear one or several phantom sounds on a chronic basis. These sounds, or rather noises, have no real existence outside the patient’s head.

This post will discuss new  Tinnitus therapy techniques  that fall  into the followings categories :  Music Therapy,  Phase Shift , Drugs and Pharmacology and Psychological training

But first, let us have a look at the various types of Tinnitus

A study in the American Journal of  Audiology [1] classifies Tinnitus in 4 groups:

  • Constant distressing tinnitus,
  • Varying tinnitus
  • Tinnitus patients who are copers [who can cope with Tinnitus] and whose tinnitus is not influenced by touch (somatic modulation)
  • Tinnitus patients who are copers, but whose tinnitus is worse in quiet environments.
To this several other categories can be added, such as:
  • Pulsative Tinnitus, which is not necessarily the same as the “varying Tinnitus” above [13]

 

The Human Ear System

 

Clearly, some of Tinnitus management techniques must  be more suited to one of these category than to another. But we could not find the “category’ variable in the Tinnitus Management studies [2-7], except in a study on retraining technology [8] , done in 1999! And the categories were different there, particularly because they include hyperacusis (pain resulting from loud sound) as a variable

Note that [8]’s emphasis  on counselling, to which they add some auditory manipulation. The more recent studies seem to reverse the accent towards intervention attempting to “rewire” the brain’s auditory path.

The therapy techniques from the more recent studies [2-7] fall themselves into several categories: Music Therapy [2-6], Phase Shift [7-8], Drugs and Pharmacology [9-10],  Psychological training [11-12]

  1. Music Therapy [2-6]

The type of music here does not matter; what matters are the “notches”, or the frequency gaps  created in the recorded music. The frequency gaps correspond to the patient’s own auditory frequency gaps.
Here is a youtube video of the essential method, patterned after a clinic at the University of Muenster, Germany [5]:

 

 While there is an abundance of details on the “notched music” method itself, the fundamentals of why it works are sparse. It seems  more adapted to stable frequencies Tinnitus.
  1. Phase Shift [7-8]

    Here  the technique consists of cancelling out the offending phantom sound, quoting {8]:
    “…This technique is based on a theory advocating that the induction of a sound wave with a 180 degrees phase-shift compared to the sound experienced by the patient could result in sound cancelling, likely by negation of the cortical perception of tinnitus or residual inhibition, which can be partial or complete…”
    This technique applies however to pure ton Tinnitus and/or narrow band Tinnitus
  2. Drugs and Pharmacology [9-10]

The drugs studied are of different origins :
  • Dopamine D(2) antagonists: Dopamine, a neurotransmitter, plays a major role in the brain system that is responsible for reward-driven learning
  • Selective serotonin reuptake inhibitors (SSRIs), standard treatment againt depression and anxiety
  • GABA) agonists : GABA is an inhibitory neurotransmitter
  • Zinc dietary supplements.

3. Psychological training [11,12]: 

Training in [11] includes progressive muscle relaxation according to Jacobson, physiotherapy, educative seminars, training of selective attention and, lastly, the change of judgment, attitude and behaviour towards tinnitus.

 With all these  possible treatments, the simpler the tinnitus cases, where the sounds do not vary too much, and not too many frequencies, present a good chance for relief.  The more complex Tinnitus, with time varying, multiple frequencies,  will still present a challenge for the sound based  techniques. Psychological and behavioral techniques would then be more important.

 

Pulsative Tinnitus is in a different class, as its source has a physical origin: blood pulsation. Quoting [13], the treatments vary:

“…Several pharmacological treatments have been described (benzodiazepine, carbamazepine) as have surgical ones (tenotomy), but the one used most is an injection of botulinum toxin at a dose of between 4 and 10 U, and that is repeated according to the patient’s progress. 15 Electrostimulation through TENS (trans-electrical nerve stimulation) systems prove to be an effective method…”

The authors also mention myclonias or ” …masseter muscle contraction or changes in the temporomandibular joint, but a central disorder must be ruled out as a possible aetiology: multiple sclerosis, cerebral artery trunk infarction, or cerebellar change…”

 

Bring this material for discussion  your health provider!

Useful sites:

  1. American Tinnitus Association
  2. National Institute On Deafness and Other Communication Disorders
  3. Dr Andrea Latorre ; (Not endorsed by MND)

Sources:

  1. American Journal of Audiology ; “Identifying tinnitus subgroups with cluster analysis.” ; 2008
  2. International Tinnitus Journal ; “Auditive stimulation therapy as an intervention in subacute and chronic tinnitus: a prospective observational study.” ; 2005
  3. HNO ; “Music therapy for tinnitus patients: an interdisciplinary pilot study of the Heidelberg Model” ; 2007
  4. PNAS ; “Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity” ;Dec 2009
  5. University of Muenster ; Institute fur Biomagnetismus
  6. PlosOne ; “Short and Intense Tailor-Made Notched Music Training against Tinnitus: The Tinnitus Frequency Matters” ; 2011
  7. B-Ent ; “Phase-shift tinnitus treatment: an open prospective clinical trial.” ; 2007
  8. European Archive of otorhinolaringology ; “Phase-shift treatment for tinnitus of cochlear origin.” ;2010
  9. Drugs of The Future ; “PHARMACOLOGICAL TREATMENTS FOR TINNITUS: NEW AND OLD” ; 2009
  10. Frontiers In System Neuroscience ; “Tinnitus: network pathophysiology-network pharmacology.” ; 2012
  11. Gesundheitswesen ; “Integrated intensive treatment of tinnitus: decrease of the tinnitus-related distress during a one-year follow-up study” ; 2007
  12. Tinnitus and Hyperacusis Center ; “Results of tinnitus retraining therapy” ; 1999
  13. elsevier ; “Diagnostic Clues in Pulsatile Tinnitus” ; 2007

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