HIFU (High-Intensity Focused Ultrasound) Surgery

[dan]

Well, audiograms are objective, but they are not predictive of tinnitus severity. Brainwaves are. When your brain is buzzing, you are having increased abnormal oscillations. These oscillations are measurable and do indicate either loudness, annoyance, or both.

Audiograms are just a measurement of hearing loss, and, some would argue, miss a lot of invisible damage to the cochlea.

How can I explain this to you...severe hearing loss around the tinnitus frequency is very indicative of the tinnitus thalamocortical dysrhythmia model. As it stands now, this is very early stage experimental work. They want to be sure that the tinnitus is caused by auditory deafferentation and not other psychological factors, stress, medications, head trauma, etc.
Just like in most other studies, they are cherry picking candidates to those MOST likely to benefit- Am I wrong on this?

 

[bill 112]

What exactly do they do with this laser??Cut parts of the auditory cortex??

 

[jazz]

How can I explain this to you...severe hearing loss around the tinnitus frequency is very indicative of the tinnitus thalamocortical dysrhythmia model. As it stands now, this is very early stage experimental work. They want to be sure that the tinnitus is caused by auditory deafferentation and not other psychological factors, stress, medications, head trauma, etc.

Yes, it often is. And I agree with that model. But some people do have severe tinnitus, but little measurable hearing loss. And loudness is evidenced on qEEG studies. Plus, there is a difference between loudness and annoyance. Some people, not me, have very loud tinnitus that they can ignore. Loudness and annoyance, in general, are activated by different parts of your brain. But severity is probably measured by annoyance, not loudness.

 

[dan]

What exactly do they do with this laser??Cut parts of the auditory cortex??

No- in the thalamus. If you touch the auditory cortex, your hearing will be affected.

 

[dan]

But some people do have severe tinnitus, but little measurable hearing loss.

In this case, at this point in time, they will most likely be rejected, but, I am not the doctor.

 

[bill 112]

Ok cool thanks Dan I read somewhere on this forum that they said if the T was from overexcitation that this could be corrected which makes me wonder wouldnt this work for H too??

 

[nills]

I think they zap part of the thalamus, not auditory cortex ... the doctors answer to me personally in an email said that if hearing regeneration ever happend this treatment would not block you from regaining all the possible hearing a future treatement would bring. The ablation will only stop the neuron cycle causing the ringing.

so little to no side effects witht his treatement and considered very safe.

 

[dan]

Ok cool thanks Dan I read somewhere on this forum that they said if the T was from overexcitation that this could be corrected which makes me wonder wouldnt this work for H too??

If the H was due to the same root cause as the T, then I would think that it would correct it as well.
One of the problems I see with this surgery is that the patient has to be exposed to 3 Tesla MRI for at least 4 hours!
This is because as they ablate portions inside the brain, the MRI guides the laser to the target area. When the laser begins to ablate the tissue, or more precisely, as it heats up before the cells actually destroyed, it is detected on the MRI (real time target confirmation). If the target is spot on, the surgeon will proceed to heat target area to approx. 60 degrees Celcius, which will destroy the tissues.
MRI 3T noise can go up to 130 decibels, not sure on that figure exactly, maybe 120dB. But even with earplugs (muffs cannot be used due to stereotactic head frame), the patient will be exposed to noises around 90dB or more?
A person with more than mild hyperacusis could not take that much punishment for 4-6 hours.

 

[attheedgeofscience]

To those reading my posts:

As is (almost) always the case with Internet forums, some members will start questioning the price, audiograms, procedure, and the science behind it. The information I have provided in bullet points 1 to 3 in this post

https://www.tinnitustalk.com/posts/42580/

are from the conversation with the professor. It is therefore what I would consider reliable information. Being a professor in a unique field of surgery, he is (obviously) not your average doctor "down the block". Personally, I would not even begin to second guess his capabilities, as I would otherwise be happy to do with the average GP or ENT in the world.

I am a pioneer in experimental medicine. And what I do, I do very well. In fact, I do it so well, that I wouldn't want anyone doing my "job" for me. With my posts, I offer others insights into an otherwise hidden world. Feel free to look the other way, if that is not "your thing".

 

[attheedgeofscience]

What degree of hearing loss qualifies? Hearing loss often accompanies tinnitus, but the degree of hearing loss is not necessarily correlated with tinnitus severity. Instead, tinnitus severity is associated with abnormal brain wave activity. Below is a citation to one study that attempts to establish tinnitus by gamma oscillations:

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0007396

I imagine brain wave abnormalities would constitute a better objective measurement of severity than audiograms. Then, of course, there are people with normal audiograms who have severe tinnitus.

I am not really comfortable answering your question (as stated in my post, I am not an expert on the procedure/brain). But, the keyword from my post in relation to audiogram is starting point. As such, the audiograms are not used for anything except to determine if it makes sense to go ahead with a full day of evaluations and brain scans. It is the brain scans that ultimately determine whether or not a patient is a candidate for surgery. If you have no hearing loss, but firmly believe that your tinnitus originates from the ear, then I think you could still convince the professor to go ahead with evaluations.

I cannot comment on your link or brain wave abnormalities. I have essentially no knowledge of the (human) brain.

 

[Raytr]

I'm sure I've read this information on a study about HIFU but I don't remember where...regarding my story,I had an acoustic trauma nine months ago (while listening to loud music) with first tinnitus onset in the right ear and a slight hearing loss at 4k hertz. They disappeared with some steroid injections but ten days later tinnitus returned after the first post-trauma exposition to noisy environment. Since then my tinnitus has had at least ten other spikes, now it's in my head with chronic headache, it seems it's increasing to infinite…what a nightmare.

That's exactly me .... Just.some slight hearing loss at 4k MHz and I don't believe my T its from hearing loss ....hope you are doing better ...

 

[Jacob_zjm]

attheedgeofscience said: ↑
It seems to me that Autifony is trying to do chemically what HIFU is trying to do surgically.

Great clear point. We're looking for a pharmacological alternative to HIFU.


And low voltage–activated (T-type) calcium channels CONTROL thalamocortical bursting behaviours.
They have a pacemaker gating function, which is why they are now drug targets for epilepsy and neuropathic pain.

from a Frontiers articlet:
"The fine-tuning of neuronal excitability relies on a tight control of Ca2+ homeostasis. The low voltage-activated (LVA) T-type calcium channels (Cav3.1, Cav3.2 and Cav3.3 isoforms) play a critical role in regulating these processes." But while there are drugs which non-selectively hit T-channels, there's a shortage of drugs targetting the sub-types eg 3.1,etc.

Dan said:
Type 2 Calcium channels are predominant in the thalamus which is the final stop before tinnitus reaches auditory cortex - not an ideal target pharmacologically speaking(?). Valporate has nasty side effects so I've heard.

Well said Dan. But there must be some anecdotal evidence somewhere on the net giving us a clue if this is the right direction. Tinnitus is so commonly triggered by so many drugs (presumably because of CNS Stress as a common denominator), there must be cross-references.

A number of epilepsy drugs block calcium channels. Like ethosuximide, valproic acid, etc.

Interestingly, ethosuximide was found (by Huguenard) to reduce low-threshold Ca currents in T-channels in freshly removed thalamic neurons but they were unable to replicate this success with valproic acid.

I was hoping that there'd be enough data on the net based on the zillions of prescriptions issued each year.


On a connected note,
does ANYBODY know of ANYBODY who has ever been to Zurich to be HIFU treated by Dr.Jeanmonod?
It actually works I believe for tremors, etc. but has wider scale application as you all already know.
He treats a LOT of people. Has anybody read ANY successful patient feedbacks?

Mine T was noise induced.Last period I was lucky to have had a long conversation with Dr.Jeanmonod ,who is quite warm and friendly. Regarding HIFU,the main points I got is,according to Dr.Jeanmonod the tinnitus have three main types :

1. about brain resistance .. (sorry I could not explain it in very professional words,but this is different from most of our cases and this is exact what HIFU may help in future)
2.tension in muscle/neck
3.damage of brain/cochlea due to noise exposure,etc(which many of us have).

HIFU could not help above 2 and 3.So Dr.Jeanmonod suggested even my paying a visit to his place for a further diagnosis seems a waste of time and money.

This is all what I learnt to be shared with you/

 

[john2012]

Really good of you to chime in. thank you.
We must pay attention here, Jacob has spoken to the big guy.

If HIFU treats 'brain resistance' can anybody EXPLAIN what that is?

I always thought HIFU was ideal for noise-induced tinnitus. Can anybody clarify?
I've heard of him turn away candidates with anxiety limbic complications.

 

[Littlebailey]

What does that mean? Does that mean that it can't help patients with 'imaginary tinnitus'?

Indeed. What is psychogenic T?

 

[dan]

Indeed. What is psychogenic T?

Ok this is what Prof.Jeanmonod explained to me.
A lesion in the inner ear causes deafferentation of the auditory nerve in certain frequencies.
That loss of input eventually causes the type 2 Calcium channels in the auditory thalamus to hyperpolarize. Once that happens it couples with and sends regions of the auditory cortex into an abnormal oscillation, neighboring neurons form an "edge effect" - which is tinnitus.
The auditory cortex however is unfortunately, closely coupled with the Insula and prefrontal cortex. If these areas get activated once tinnitus is established, then you still might hear the tinnitus since the limbic system perpetuates the signal between itself and the auditory cortex thru its own separate coupling, even though the thalamus may have repolarized back to normal or has been surgically modulated!
Hence, people with psychogenic tinnitus are more or less normal neurologically but abnormal in the limbic system - as I understand it. You might look at it as a figment of their imagination (?)
Keep in mind this is his working theory, since nothing has been concretely proven yet.
But as I see it he uses it to select his patients because he needs an explanation as to why his procedure does not eliminate tinnitus in all cases - that's my theory lol.

 

[Christian78]

I will rephrase myself here, and say what information i got, so you can think for yourself: and you can turn a blind eye to it:

 

[Christian78]

From: franziska.rossi@sonimodul.ch
To: stompiedepompie@hotmail.com
Subject: RE: sonimodul.ch
Date: Mon, 26 May 2014 08:55:44 +0200

Dear Mr. Beauprez


Thank you very much for your questions concerning the treatment of your tinnitus. The following points may be mentioned :


1) A neurosurgical treatment of tinnitus, based on the concept of thalamocortical dysrhythmia and using the technology of focused ultrasound, can only be considered when tinnitus has become chronic (at least 1 year), invalidating and therapy-resistant (resistance to drugs, tinnitus retraining therapy and psychotherapy)


2) There has to be a known audiological cause to the tinnitus (auditory nerve problem/damage, relevant hearing trauma, etc.)


3) Needed is a description of the tinnitus localization (ears, head, which side)


4) And a description of the qualities of the tinnitus perception (pure tone or noise, frequency, narrow- or broadband)


We would need from you one or more detailed ENT report(s). On the basis of these data, we would be able to decide if an outpatient diagnostic consultation of a whole day is indicated, with clinical and quantitative EEG examinations. This consultation would allow to determine if a focused ultrasound treatment is indicated.


Focused ultrasound treatments for tinnitus will only begin in one or two years, but you may send us your ENT data for advice already now.


The all inclusive cost for pre-operative diagnostic clinical and neurophysiological assessment and for the ultrasound treatment, hospital stay, medical visits, laboratory, patient administration with medical reports and radiology (MR and CT) amounts to about CHF 38'200.-. The due amounts are to be paid in one invoice one month in advance on our bank account.


With best regards


So price went bit up, and time got longer, while diagnostic functions perfect and money for it is taken on regular basis that is what I meant.

 

[dan]

Dr.Jeanmonod seems to have updated his website.

www.sonimodul.ch

 

[nills]

Dr.Jeanmonod seems to have updated his website.

www.sonimodul.ch

you can use the search function for tinnitus, give a few pages

http://sonimodul.ch/?s=tinnitus

 

[Eric Gabrielsen]

HIFU? That's odd because that's exactly what my 3 ENT doctors said to me!

 

[Viking]

what happen if (i have a very unstable monolateral/bilateral tinnitus) i do an qEEG in a "quiet" day of tinnitus??? I ask this question because I have realized that it is a fundamental diagnostic investigation and, unfortunately, I live from day to day with my infamous T!

 

[Viking]

I had another conversation with Dr. Jeanmonod, a few told me that they have no plan to treat tinnitus but only clinical hypotheses. I would love to know who has been to encourage this type of approach that has never been experienced in straight lines. They can only perform a qEEG, and does not mean that beyond the result, then there is a treatment. He was very cautious. the possibility of application with HIFU treatment on tinnitus is more far away.

 

[attheedgeofscience]

For those interested in the HIFU diagnosis/treatment option, I am releasing the documents I have so far received from the clinic (which is already half a year ago now - due to the long waiting list). The cost for the clinical evaluation is CHF 2.200,-

My appointment with the professor in Switzerland is next week.

If I have something important to share after my evaluation, I will do so (eg. images of my brain).

 

[Viking]

For those interested in the HIFU diagnosis/treatment option, I am releasing the documents I have so far received from the clinic (which is already half a year ago now - due to the long waiting list). The cost for the clinical evaluation is CHF 2.200,-

My appointment with the professor in Switzerland is next week.

If I have something important to share after my evaluation, I will do so (eg. images of my brain).

I have the same exam on the 10 February 2015. I have hearing loss and very very fluctuating tinnitus.
Let us know

 

[dan]

@valeri , the evaluation now has gone down to 2,200 CHF from 3,200 CHF, apparently.
I feel like I was ripped off.
Still @attheedgeofscience is ignoring me - can somebody please ask him answer me
At least acknowledge that you are seeing my messages and just say something like = I don't wish to discuss things with you etc. for such reasons... I mean I haven't done anything to deserve your ignorance?

 

[lapidus]

@attheedgeofscience
Please answer Dan's questions.

 

[valeri]

Wow, I'm speechless that somebody can charge that much money yet can't help!
Wow!

 

[Robb]

Wow, I'm speechless that somebody can charge that much money yet can't help!
Wow!

In case of the doctor working at SoniModul remember that his knowledge and time are very valuable. If there where more doctors like him HIFU treatments could be offered against lower costs.
So try to see what you pay in perspective also the equipment he uses is extraordinary expensive!
Have a look at their website!

 

[valeri]

In case of the doctor working at SoniModul remember that his knowledge and time are very valuable.
If there where more doctors like him HIFU treatments could be offered against lower costs.
So try to see what you pay in perspective also the equipment he uses is extraordinary expensive!
Have a look at their website!

He can be great God as far as I'm concerned but unless
you walk out of there with no f.....g madness in your head he has no right to charge that much.
And for cure I would sell my house!

 

[Robb]

He can be great God as far as I'm concerned but unless
you walk out of there with no f.....g madness in your head he has no right to charge that much.
And for cure I would sell my house!

I doubt if he has no solution; if I am correct (@attheedgeofscience ) is HIFU able to reduce Tinnitus symptoms in the correct patient profile. So his work is tremendously important as he is one of the few doctors who develops new insights that can lead for better T treatments for all of us!