New University of Michigan Tinnitus Discovery — Signal Timing

Article source: https://gizmodo.com/this-small-device-could-silence-the-maddening-symptoms-1821739320

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A device developed by researchers at the University of Michigan, seen above being tested on a guinea pig, might help treat people's tinnitus. Photo: David Martel, Christopher Chang/University of Michigan.

Millions of Americans suffer from a medical condition known as tinnitus, a disorder so tormenting that it makes Edgar Allen Poe's talking, taunting raven sound charming. People with tinnitus are plagued by phantom noises, usually ringing or buzzing, sometimes to the point where they can no longer work or function. Worse still, cases are often chronic and incurable: Current treatments include cognitive behavioral therapy to help people manage the distress it causes, using actual sounds to mask the ringing, or invasive brain surgery that often doesn't work. But the findings of a new study, published today in Science Translational Medicine, seem to offer something much more promising—a noninvasive treatment that attacks the root source of tinnitus while making life noticeably easier for its sufferers.

Researchers at the University of Michigan believe they've figured out how to short-circuit the complex neurological process that results in tinnitus.

One of the leading theories behind what causes most cases of chronic tinnitus is that it begins with misfiring neurons in the dorsal cochlear nucleus—one of the two regions of the brainstem where auditory information is first processed. These neurons, called fusiform cells, are meant to fire when the brain receives input from the outside world, which is one of the first links in an almost simultaneous chain of events that leads to us correctly "hearing" the sound something makes. In people with tinnitus, this synchrony is thrown off-kilter and the fusiform cells fire whenever they please, leading to people hearing sounds that aren't there. This initial imbalance can be caused by anything from damaging loud noises to ear infections, it's thought, and often accompanies hearing loss.

The University of Michigan team, based on research they had done with guinea pigs, created (and patented) a device they think can retrain the brain circuitry involved in causing at least some cases of tinnitus.

"We worked out in animal studies that specific combinations of sound and pulses could either increase or decrease the activity of these [fusiform] cells that activate the rest of the brain," senior author Susan Shore of the university's Kresge Hearing Research Institute told me in an email. So their device, via headphones and electrodes placed on the person's neck and head, sends out bursts of sounds and mild electrical pulses that alternate with one another. This theoretically resets the fusiform cells and decreases how often and severely a person's tinnitus should happen.

After successful animal experiments, the researchers recruited 20 volunteers with tinnitus to take part in a 16-week experiment where they would take home and use a device every day. Half of the volunteers used the sounds-and-shocks device daily for four weeks, took a four-week break, and then used a similar device that only emitted sounds, but no shocks, for another four weeks, and finally took another four-week break. The other half did the same schedule of four weeks on followed by four weeks off, but they instead started with the sounds-only device, and then moved on to the sounds-and-shocks device.

During the weeks the volunteers were using the real device (the one that emitted both sounds and shocks), they reported less noisy and high-pitched episodes of tinnitus along with fewer episodes overall—two even said their tinnitus went fully away. That predictably led to a better quality of life and reduced stress for the volunteers.

Wonderful as an noninvasive and practically risk-free device (unless you can't stand mild shocks) to treat tinnitus could be, it might not come without its limitations. The subjects' tinnitus largely returned a week after they stopped using the device, even for the two people who reported losing it completely. The researchers also only used volunteers with a particular form of tinnitus. These sufferers are able to soften their episodes by applying pressure to their head or clenching their jaw—a rudimentary version of keeping their fusiform cells in check, it's thought. That could mean the device won't work for the 20 percent to 40 percent of tinnitus sufferers without that particular quirk.

The device's effects did seem to accumulate the more it was used, Shore said, suggesting that a longer course could provide longer-term relief. "This treatment is only 30 minutes a day, so even if people had to use it every day or once a week, it would be helpful," she added.

The team next plans to test out their device with a much larger group of people. This new study is already recruiting volunteers and is set to start in April. Researchers elsewhere are exploring a similar "bi-modal stimulation" approach to treating tinnitus. If this work continues to pay off, these devices could be a game-changer. It's estimated that at least 15 percent of Americans, or 50 million people, suffer from tinnitus, while two million have a severe or debilitating case of it.

Update: Those interested in learning more about the team's new trial can email them at tinn.trial@umich.edu.
 
WOW! Now that is some good news for 2018!!!! I told you guys that the first treatments that at least for some of us that could alleviate some of the symptoms was just around the corner. This will be the first of many!
 
We been saying this all year that "60% to 80% of tinnitus sufferers display a somatic component in addition to sound trauma. Hypertension and depression also connects to physical properties. This is promising @Aaron123. With this and a safe depression/hypertension drug which I believe will be coming, tinnitus will be less of a worry to many of us.
 
This is great news! Hard to tell how the contraption works. Looks minimally invasive? However, is the treatment permanent or do you have to continue treatment to maintain the reduction in loudness?

Effects wore off as mentioned in the paper, and @linearb also said this happened. It's speculated that longer use could give longer relief.

It's exciting, but let's not get carried away as only small samples have been tested and bigger samples need to be tested first to prove it.

If it works then it'll be worth the money because it won't be cheap.

Also, I can only modulate my tinnitus by pushing my ear in (putting pressure on blocking the ears and the tinnitus increases frequency and intensity) - is that even 'somatic tinnitus'?
 
The release of this product with Frequency Therapeutics hair cell generation might be a SOLID solution towards hearing loss and tinnitus. I am excited!
 
If you are local and near U of M, you can apply to take part in their new clinical trial for 2018. You have to be close to be able to go there once a week during the trial. Email: tinn.trial@umich.edu. (currently this email addy is not working, they are aware of it and will fix it soon)
 
Isn't it true that this product will be on the market faster since it is not an actual drug? How long would trials for a medical device such as this take on average?
 
My tinnitus goes up and down all the time, I can't control how loud or how quiet it can be, the less mental stress I have though the better off I am and the less I think about it the better off I am and nerve pain in my body is what I believe caused tinnitus in my case, so something that messes with the nerves in the back of my neck, no thanks I don't want to try it.
 
This is promising, but it is important to keep in mind what is actually in the paper.

First, the average reductions in TFI in the active treatment and active washout phases are 7.51 and 6.71 points, respectively. These were both significantly different from 0, but they are both much less than 13 which is the cutoff for clinical significance. Additionally, the mean reduction during the sham phase is about 2 points, and the sham washout has a mean reduction of a bit less than 2. Thus, the effect of the treatment itself (active - sham) is about 5.5 to 4.7 points - not large. Either way, on average the treatment has a statistically significant but clinically insignificant effect on the TFI.

Second, 10 of the 20 subjects did have a clinically meaningful reduction of at least 13 points during the active treatment. This is good. However, we don't know what reductions these individuals had during the sham phase. In fact, 4 participants had clinically significant reductions during the sham phase, and 2 participants had clinically significant reductions during BOTH phases. The authors do say that the two who experienced reductions during both phases experienced larger reductions during the active phase, but they don't provide the information so that the reader can understand the differences. It would have been useful to see individual level data. This would be possible with only 20 subjects, and it would allow the reader to see the degree to which individuals who saw improvement in the active phase also saw improvement in the sham phase. (Ideally you would like to see responses during the active phase and no response during the sham phase for each person. Assuming they are correct that the sham is truly a sham, it acts like a placebo so if you see a reduction in TFI or loudness during the sham period this is due to the placebo effect. That's why you need to subtract out the effect of the placebo in order to determine the effect of the treatment.)

Third, assuming the treatment truly does have a clinically significant reduction for a significant proportion of people who are treated, it would be useful to know ahead of time who might benefit. In this case, there were no demographic differences between the people who improved significantly and those that didn't. This may be due to the very small sample. Assuming the results persist in a larger sample, perhaps observable differences will observe.

Fourth, there is a reduction in loudness during the treatment of about 8 dB. Unlike the reduction in TFI, this effect becomes smaller during the active washout. Thus, it appears that any sustained reduction in perceived loudness requires continued use of the device. However, the 8 dB reduction isn't all due to the treatment. The effect during sham treatment is a reduction in loudness of about 3.5 dB or so (hard to say exactly from the figure). Thus the net reduction due to the treatment is about 4.5 dB. (In Figure 6C, it's interesting that there is a similar relationship from sham to sham washout that there is between the active and active washout.)

Fifth, 2 people did report the elimination of tinnitus "toward the end of the active treatment period" though there is no information the durability of that result.

So there are promising results here, but they aren't earth-shattering. It's important to remember this is a small study with some promising results. We won't really know more until they do a larger study which is or will soon be underway.
 
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Hi. I'm 3.5 years into my T and still experience very loud/mod loud/quiet days in a non-regular pattern (always loud when I wake up in the morning though) One day can be loud...the next little to none. I'm grateful for the quiet days...but still get depressed sometimes. Taking a shower in the morning relieves the T 70% of the time, often for the remainder of the day.

This study by Michigan scientists sounds promising. I've read that it is geared towards those with somatic T. I know that mine was caused by loud noise exposure but I've never been told exactly what type of T I have.

I've noticed that when I plug my ears and focus on the sound and then clench my jaw there is an increase in the volume slightly. This supposedly is somatic T?

So hopefully they'll be some advances in treatment in the next few years. I'm 64 years old and would like to think that there's light at the end of the tunnel.

I hope 2018 brings health and happiness to all. Cheers.
 
@linearb
I understand you, the cost of travel is too expensive but looking at the results obtained if the next clinic trial will take place in the Antartic I'll go there. Who know may be it's a chance to make your tinnitus disappear.
 
@Aaron123 I'm taking a positive progressive view with a larger study that will focus on both neurophysiological and pathological hypersynchrony thru the use of a somatic physiology examination / pain. Not just health trial requirements with justification focused on modulation findings.

In the first study, stimulation being of a transcutaneous nature was only positioned on the skin overlying either the trigeminal ganglion or the cervical spinal cord in the region of C2.

Each person of the 60- 80% that can modulate also have different spectrum traumatic associations. There's four major somatic definition areas for somatic tinnitus besides corresponding nerve supply routes and centers. They include the C spine, SCM, trapezius and temporalis muscles and joint areas, and the vagus nerve / trigeminal.

Beyond the definition areas is the physical or physiology connections - The cervical spine with most emphasis on disc regions C1 and C2, spondylosis, joint hypertrophy / facet arthritis, disc narrowing C5 - C7 with or without trauma loss of normal lordosis are all noted as causing somatic T.

So this new study will include the pain factor areas and not just modulation this and that. That's a big difference. There's differences between trial phases and we must consider that.
 
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