New guidelines for tinnitus treatment align with promising new therapies
If you are one of the millions of people who suffer from tinnitus, you’ll likely consider just about anything to get relief from the symptoms. From dietary supplements to apple cider vinegar to “miracle cures” hawked by snake-oil marketers, it seems like there is a promising new solution lurking around every corner.
The problem with these remedies, though, is that they don’t usually work.
Tinnitus is essentially the presence of noise where none exists. Manifesting itself with ringing, humming, buzzing or whistling in the ears, it can be debilitating to those who suffer from it. Those afflicted report having lower quality of life, insomnia, depression, isolation and, in worst case scenarios, suicidal thoughts or actions.
Tinnitus is a complex problem, and recent research has found that many different parts of the brain are involved. For the first time ever, scientists at the University of Iowa were able to study the brain activity of a patient with tinnitus; they found that tinnitus does not just involve the part of the brain that receives sound, but rather all of the hearing parts, along with those parts of the brain related to attention, emotion, and memory.
Affecting 50 million Americans, tinnitus is a particular problem for those in the military returning from Iraq and Afghanistan; 1.5 million returning vets are affected. Sometimes it goes away on its own, but 20 percent of patients need medical intervention. But since the problem is so complex, and understanding thus far is limited, there is no cure. Treatments to ease symptoms, however, are another matter, and are definitely worth investigating.
The good news is that new guidelines on tinnitus treatment have been released by the American Academy of Otolaryngology-Head and Neck Surgery. Though they are mostly focused on tinnitus that is “bothersome and persistent," lasting six months or longer, and with a negative effect on the patient’s quality of life, the guidelines are applicable to shorter durations as well.
The new guidelines recommend a complete targeted medical history and thorough exam, followed by a hearing test. Tinnitus sometimes accompanies hearing loss, so those who do have hearing loss might benefit from a hearing aid evaluation as well. Lastly, counseling on ways to manage tinnitus is crucial to improvement of symptoms. Management can include many different types of therapies including cognitive behavioral therapies, different incarnations of sound therapy and music therapy.
The AAO-HNS recommends against routine scans and MRIs to diagnose the tinnitus, as well as medications such as antidepressants and anticonvulsants or dietary supplements such as Ginkgo biloba, melatonin or zinc. The technique of transcranial magnetic stimulation, which uses magnetic fields to stimulate nerve cells in the brain, is also not recommended. They are, however, neutral on the subject of acupuncture, neither advising for it or against it.
So are there new treatments in alignment with the new guidelines and more importantly, do they work?
Fortunately, the answer is yes on both counts. There are several new therapies in clinical trials that are in alignment with the new guidelines released by the AAO-HNS. One promising therapy being tested by researchers at SUNY Brooklyn and Virginia Commonwealth University is called UltraQuiet. Researchers found that using vibrations created by synthesized music, symptoms of tinnitus improved in eight out of 10 patients. It works by reprogramming the nerve cells by exposing them to high frequency vibrations. The vibrations are processed and conducted down the bone thus bypassing the middle ear and sending the high frequency signals straight to the cochlea to be processed by the brain.
The UltraQuiet equipment consists of a music player, amplifier and headpiece which contains a small disk which is then held against the mastoid bone. The disk turns the music into vibration which replicates high frequency sounds coming in the ear, and that in turn stimulates the nerve cells to respond accordingly.
Patients who received the therapy were between the ages of 35 and 72, with severe disabling tinnitus and mild to moderate high frequency hearing loss. After four weeks of treatment, patients reported significant improvement, and the duration of improvement lasted several weeks as opposed to seconds or minutes as with conventional masking therapies.
The complexity of tinnitus continues to astound researchers, and is believed to be the main reason one-note remedies do not work. Until recently, it was thought that tinnitus was a result of the brains response to damage of the tiny hair cells in the inner ear, making it, in effect, an ear problem. The auditory brain centers would then try to fill in the gaps caused by hair cell damage by creating phantom sounds. But Phillip Gander at the University of Iowa not only disputes that theory, he calls it wrong. He and his team believe they have discovered the neuronal signature of tinnitus by using electrodes to monitor the brain waves of a person with tinnitus. The findings were important not only to the understanding of tinnitus but to its future treatment.
“Maybe the reason tinnitus is so treatment-resistant,” said Gander, “is because it’s involved with so many parts of the brain. So any sort of treatment might not be able to knock out one area of that system. You might have to target all of them, which might be very difficult.”
And scientists at University of Massachusetts Eye and Ear Infirmary are using music therapy to use the brains neural plasticity, aka its ability to be remolded, to treat tinnitus. During the treatment, a patient listens to music of his choice that has been filtered to remove the phantom tone specific to that patient, which them calms the portion of the brain which would otherwise be overstimulated by that tone. After successful trials with the patients, neuroscientist Daniel Polley concludes that music works for tinnitus therapy because it is imbued with meaning, and is therefore special and personal. Together with the Iowa research, the trials offer further confirmation that the abnormal brain waves of tinnitus are intertwined with emotion, attention and memory.
So while there is no cure for tinnitus due to its complexity, there is relief available. And the hope is that new tinnitus treatment guidelines along with new understanding of tinnitus can help doctors and patients focus in on what actually works, instead of what doesn’t.