Repeated Modified Nerve Blocks and Auditory and Non-Auditory Nerve Stimulation

[David S]

He seems to be a genuine person to me.

Could we ask him if the 2 Americans would feel comfortable telling their story here on Tinnitus Talk? If I had great success, that would be one of the first things that I would be willing to do.

 

[GeorgeLG]

Could we ask him if the 2 Americans would feel comfortable telling their story here on Tinnitus Talk? If I had great success, that would be one of the first things that I would be willing to do.

Agree, we should see if those two would join the forum, or any other English speaking patients for that matter.

George

 

[Uklawyer]

Could we ask him if the 2 Americans would feel comfortable telling their story here on Tinnitus Talk? If I had great success, that would be one of the first things that I would be willing to do.

Exactly what I was thinking, @David S. I have responded asking exactly that question (I mentioned the organisation and asked if they would speak to me and that we would love to hear about their experiences of treatment).

 

[Chinmoku]

Well done, @Uklawyer, some important information here. Also, much more encouraging than the Korean reports my contacts found. It would help a ton finding out who these two US patients are and talking to them.

Dr Heon Man Sirh looks quite genuine to me, in all his comments so far. I didn't want to discourage anyone with my earlier findings but I'll be honest, I had been a little discouraged myself. However, these two US patients who started already benefiting at treatment 4, this is very good news. I hope we can talk to them at some point.

In the meantime, I wrote to two main pain clinics and to one very senior otologist, no one replied. I'll post an update if they ever do.

 

[Uklawyer]

He does seem pretty honest and even ethical in referring to costs of treatment for those who are not extreme cases. I really hope he has some positive news about the US patients.

Thanks for persisting with the UK doctors, @Chinmoku - very disappointing to not even receive a response from them.

 

[DoesItStop]

Question for you all. Is he saying that this treatment is not helpful for sensorineural tinnitus? I see that he feels it produces great results for somatic tinnitus, but do you all think it's safe to say this specific treatment will likely not be helpful for purely sensorineural tinnitus?

 

[Uklawyer]

@DoesItStop, I just wanted to ask the question about tinnitus with a somatic component. I think it has been stated that most people have some form of somatic tinnitus, whether they are able to specifically manipulate their tinnitus with movement or not. That tinnitus is still subjective though (as others cannot hear it) or "sensorineural" if I am not mistaken (even though the doctor appears to draw a distinction between "sensorineural" and "somatic" tinnitus).

In the actual study, there are a large number of individuals whose tinnitus was said to be idiopathic, with no information on whether there was any somatic component to it. So I do not believe that there is any implication (or express statement) to the effect that the treatment only works for tinnitus with a somatic origin or component.

 

[Gb3]

@DoesItStop, I just wanted to ask the question about tinnitus with a somatic component. I think it has been stated that most people have some form of somatic tinnitus, whether they are able to specifically manipulate their tinnitus with movement or not. That tinnitus is still subjective though (as others cannot hear it) or "sensorineural" if I am not mistaken (even though the doctor appears to draw a distinction between "sensorineural" and "somatic" tinnitus).

In the actual study, there are a large number of individuals whose tinnitus was said to be idiopathic, with no information on whether there was any somatic component to it. So I do not believe that there is any implication (or express statement) to the effect that the treatment only works for tinnitus with a somatic origin or component.

It seems though that the doctor has stated it doesn't work as effectively for hearing loss.

 

[Uklawyer]

It seems though that the doctor has stated it doesn't work as effectively for hearing loss.

There was an 85-year-old woman in the study whose 5-year hearing loss tinnitus went from a 10 to a 5 and was rated as a 6 in the one year follow-up.

 

[Padraigh Griffin]

Ok. I have spoken with Europe's top neurotologist. An esteemed Professor of Neurotology at one of the top three University's in the world.

He kindly read the paper and concluded that this treatment is rather invasive and goes very close to facial nerves that he feels could be dangerous.

He is concerned with lack of placebo, and the quality of the trial.

He was surprised it got published.

Overall he was not enthused by it.

That is about it. I could not discuss it in more detail. He did me a favour by reading it and his opinion is highly qualified. Possibly the best set of eyes to read it objectively that we could find anywhere.

However...

I still think myself that this could be the diamond in the rough we need.

Where are those two US citizens who have gone for treatment?

Thanks @Uklawyer for the following up.

 

[Uklawyer]

He kindly read the paper and concluded that this treatment is rather invasive and goes very close to facial nerves that he feels could be dangerous.

And yet, apparently, there has never been any permanent or serious injury in the 10 years of doing this.

I guess the question is: regardless of concerns around safety and the study itself, could this neurological treatment, under which nerves are temporarily blocked and then stimulated, work to affect the signalling process thought to play a part in the generation of tinnitus (and is that hypothesis around signalling and tinnitus generation sound)?

We certainly know that Dr. Susan Shore is targeting signalling at the Dorsal Cochlear Nucleus AND that she is looking at signal resetting via stimulation at that site, together with sound therapy - so it does not appear to be outlandish in any way: in fact, it looks to be evoking similar mechanisms to those that Dr. Susan Shore is targeting.

Pity we had no insight into the neurotologist's views on these treatments.

Thanks @Padraigh Griffin.

 

[GeorgeLG]

Nice work getting a qualified opinion. Be careful with interpreting that opinion, the Korean outfit is not in their "club" and are probably viewed as slumming it to some extent. This is probably similar to signing up for a clinical trial or a treatment getting approved for emergency or compassionate use. I am sure that many of those treatments were dangerous or risky. It all depends on your level of suffering and risk/reward profile, and finances/free time of course.

As to the mechanism, I have read a lot about the nervation through the cervical spine, neck and jaw (TMJ) and its impact on the ears and am pursuing this for myself for noxacusis.

George

 

[Chinmoku]

And yet, apparently, there has never been any permanent or serious injury in the 10 years of doing this.

I guess the question is: regardless of concerns around safety and the study itself, could this neurological treatment, under which nerves are temporarily blocked and then stimulated, work to affect the signalling process thought to play a part in the generation of tinnitus (and is that hypothesis around signalling and tinnitus generation sound)?

We certainly know that Dr. Susan Shore is targeting signalling at the Dorsal Cochlear Nucleus AND that she is looking at signal resetting via stimulation at that site, together with sound therapy - so it does not appear to be outlandish in any way: in fact, it looks to be evoking similar mechanisms to those that Dr. Susan Shore is targeting.

Pity we had no insight into the neurotologist's views on these treatments.

Thanks @Padraigh Griffin.

Thanks @Padraigh Griffin and indeed a pity this professor was not positive, but two caveats here.

1. There is no authority in tinnitus. Even the best UK neurotologists can't help severe cases and they can't even measure tinnitus objectively. There is no real science of tinnitus yet so even the opinion of the best neurotologist is worth very little. Kent Taylor was worth $600 million. He couldn't get help from the best of the best. I do take the point on invasive aspects, but under fluoroscopy and with an experienced surgeon the risk should be acceptable. They claim they never had a case of permanent damage. Heon Man Sirh strikes me as a sincere person but maybe I'm naive.

2. Will Sedley is a neurologist, maybe he is not in Oxbridge but he is no lightweight. He accepted the paper, even with the reservations he expressed here. And he is a tinnitus researcher, even with the caveat n. 1. This counts, in my book.

@Uklawyer, still no answer from the big shots I contacted. Let's see next week.

 

[Padraigh Griffin]

Nice work getting a qualified opinion. Be careful with interpreting that opinion, the Korean outfit is not in their "club" and are probably viewed as slumming it to some extent. This is probably similar to signing up for a clinical trial or a treatment getting approved for emergency or compassionate use. I am sure that many of those treatments were dangerous or risky. It all depends on your level of suffering and risk/reward profile, and finances/free time of course.

As to the mechanism, I have read a lot about the nervation through the cervical spine, neck and jaw (TMJ) and its impact on the ears and am pursuing this for myself for noxacusis.

I agree that most top academics need gold standard research before getting enthused. That is not always the correct position to take.

We just need some feedback from people who have gotten the treatment. That is our only way of finding out.

 

[Ela Stefan]

I agree that most top academics need gold standard research before getting enthused. That is not always the correct position to take.

We just need some feedback from people who have gotten the treatment. That is our only way of finding out.

Agreed.

 

[Ela Stefan]

Is this the kind of tinnitus this treatment would work for? First part of the comment is exactly my situation; damage to the middle ear.

Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis

RESULTS: Some patients with tinnitus, but no other hearing complaints, share several clinical features including (1) an associated somatic disorder of the head or upper neck, (2) localization of the tinnitus to the ear ipsilateral to the somatic disorder, (3) no vestibular complaints, and (4) no abnormalities on neurological examination. Pure tone and speech audiometry of the 2 ears is always symmetric and usually within normal limits. Based on these clinical features, it is proposed that somatic (craniocervical) tinnitus, like otic tinnitus, is caused by disinhibition of the ipsilateral dorsal cochlear nucleus. Nerve fibers whose cell bodies lie in the ipsilateral medullary somatosensory nuclei mediate this effect. These neurons receive inputs from nearby spinal trigeminal tract, fasciculus cuneatus, and facial, vagal, and glossopharyngeal nerve fibers innervating the middle and external ear.

CONCLUSIONS: Somatic (craniocervical) modulation of the dorsal cochlear nucleus may account for many previously poorly understood aspects of tinnitus and suggests novel tinnitus treatments.

And in this article, the reverse linkage is described, how middle ear nerve damage can affect the face (in guinea pigs at least):

Dorsal cochlear nucleus responses to somatosensory stimulation are enhanced after noise-induced hearing loss

Abstract: Multisensory neurons in the dorsal cochlear nucleus (DCN) achieve their bimodal response properties by integrating auditory input via VIIIth nerve fibers with somatosensory input via the axons of cochlear nucleus granule cells. A unique feature of multisensory neurons is their propensity for receiving cross-modal compensation following sensory deprivation. Thus, we investigated the possibility that reduction of VIIIth nerve input to the cochlear nucleus results in trigeminal system compensation for the loss of auditory inputs. Responses of DCN neurons to trigeminal and bimodal (trigeminal plus acoustic) stimulation were compared in normal and noise-damaged guinea pigs. The guinea pigs with noise-induced hearing loss had significantly lower thresholds, shorter latencies and durations, and increased amplitudes of response to trigeminal stimulation than normal animals. Noise-damaged animals also showed a greater proportion of inhibitory and a smaller proportion of excitatory responses compared with normal. The number of cells exhibiting bimodal integration, as well as the degree of integration, was enhanced after noise damage. In accordance with the greater proportion of inhibitory responses, bimodal integration was entirely suppressive in the noise-damaged animals with no indication of the bimodal enhancement observed in a sub-set of normal DCN neurons. These results suggest that projections from the trigeminal system to the cochlear nucleus are increased and/or redistributed after hearing loss. Furthermore, the finding that only neurons activated by trigeminal stimulation showed increased spontaneous rates after cochlear damage suggests that somatosensory neurons may play a role in the pathogenesis of tinnitus.

 

[Rb86]

This study regarding the discovery of an electrophysiologic marker for constant tinnitus popped up a couple of days ago. It's actually a study by Christopher Cederroth, the guy who gave an interview for the latest Tinnitus Talk podcast and makes for quite an interesting read.

I remember Dr Cederroth discussing various technical aspects of his paper during the interview here. But it was actually his advocacy for patient wellbeing that left me holding him in very high regard. And this has only been reinforced by statements in his recent study like; "Patients are looking for evidence of their condition, both for their own peace of mind and to reduce the dismissive attitudes of some health care practitioners, who may attribute all their suffering to "stress"".

Although the study needs validating, if it comes to fruition, we'll have taken a hugely important step towards finding at least some more effective management options I think, because with an objective marker for constant tinnitus there'll be no more device manufacturers/researchers shirking responsibility for proper placebo control for example, or/and hiding behind the kind of flawed THI self-reporting that's plagued this field of medicine for so long.

Another reason for posting the study here is that it mentions the use of Lidocaine, albeit for that drug's ability to temporarily reduce tinnitus whilst they observe the Wave V readout during testing. Intriguing stuff.

That study should be front a center headline news for tinnitus sufferers, no? Actually finding a biomarker would mean we can find a mechanism and target it right?

Everybody who's in the "tinnitus cure game" should collectively spend their resources to identify mechanisms first... everything else is a waste of time with hopes and dreams. If we find the mechanism, then everyone else can go on their own to create the cure.

 

[Uklawyer]

The doctor acknowledged my email request to speak to his US patients and said that he would forward me an email address if either agreed to speak with me.

Fingers crossed.

 

[antonio77]

@DoesItStop, I just wanted to ask the question about tinnitus with a somatic component. I think it has been stated that most people have some form of somatic tinnitus, whether they are able to specifically manipulate their tinnitus with movement or not. That tinnitus is still subjective though (as others cannot hear it) or "sensorineural" if I am not mistaken (even though the doctor appears to draw a distinction between "sensorineural" and "somatic" tinnitus).

In the actual study, there are a large number of individuals whose tinnitus was said to be idiopathic, with no information on whether there was any somatic component to it. So I do not believe that there is any implication (or express statement) to the effect that the treatment only works for tinnitus with a somatic origin or component.

True, I think that we get lost in discussions about somatic or non-somatic and that deep down it is something irrelevant.

 

[David S]

Has anyone tried these Lidocaine patches? It might be a good indicator if you are a candidate for this treatment?

Transdermal lidocaine as treatment for chronic subjective tinnitus: A Pilot Study

 

[DoesItStop]

Has anyone tried these Lidocaine patches? It might be a good indicator if you are a candidate for this treatment?

Transdermal lidocaine as treatment for chronic subjective tinnitus: A Pilot Study

I would be interested in trying these Lidocaine patches. Also curious if anyone else has tried them? I read the study and couldn't figure out what part of the body they are putting the patch on? The reductions in TFI scores were pretty good for the 16 patients that stayed in the study...

Seems this would be a pretty good indicator of whether your tinnitus would be responsive to the treatment in South Korea.

 

[Chinmoku]

Has anyone tried these Lidocaine patches? It might be a good indicator if you are a candidate for this treatment?

Transdermal lidocaine as treatment for chronic subjective tinnitus: A Pilot Study

That's a good idea, although the results in the study are nowhere as good as the ones in the Korean study.

It seems that it's alternating between stimulation and Lidocaine that achieves the tinnitus reset rather than the Lidocaine alone. Definitely worth checking out, though.

 

[David S]

That's a good idea, although the results in the study are nowhere as good as the ones in the Korean study.

It seems that it's alternating between stimulation and Lidocaine that achieves the tinnitus reset rather than the Lidocaine alone. Definitely worth checking out, though.

And the stimulation is nothing but a dry needle into some muscle tissue? I understand that they move the needles around to get even more stimulation. That might calm the infected tissue down. Then we also have the Lidocaine aimed at a more precise area around the important nerves.

I read the study and couldn't figure out what part of the body they are putting the patch on?

I also thought this was strange. I assume they put the plaster on the neck just lower/behind the ears.

 

[Chinmoku]

And the stimulation is nothing but a dry needle into some muscle tissue? I understand that they move the needles around to get even more stimulation. That might calm the infected tissue down. Then we also have the Lidocaine aimed at a more precise area around the important nerves.

Yes, but apparently they don't even move the needles around after insertion as they say in the paper. What they say in the paper is that the mere presence of the needle in the innervated tissue acts as a stimulus. They say electrically or mechanically/manually stimulating the nerve through the inserted needles is too dangerous, so they just leave it there.

What is a still needle doing in terms of stimulation? It's a difficult question really, I wonder too.

 

[Ela Stefan]

Yes, but apparently they don't even move the needles around after insertion as they say in the paper. What they say in the paper is that the mere presence of the needle in the innervated tissue acts as a stimulus. They say electrically or mechanically/manually stimulating the nerve through the inserted needles is too dangerous, so they just leave it there.

What is a still needle doing in terms of stimulation? It's a difficult question really, I wonder too.

Doesn't the needle provide some substance to block the hyperactivity of the nerve? This is what I understood.

 

[Chinmoku]

Doesn't the needle provide some substance to block the hyperactivity of the nerve? This is what I understood.

But how? Is the metal attracting electric impulses? From the nerve? Is it simply the needle's inert mass as a foreign body that does the stimulation through the innervated tissue? Hyperactive neurons can be stopped simply by proximity of a foreign object? I wish we had a clear picture of the mechanism of action.

 

[LGuapo]

I would be interested in trying these Lidocaine patches. Also curious if anyone else has tried them?

I've tried the over-the-counter 4% Lidocaine patches. I put them on the back of my neck. They don't have any quick-acting effect on my tinnitus, nothing within a day or so. Maybe if I used one everyday there could be a cumulative effect eventually, but I haven't done that.

 

[JPGL]

I have used adhesive Lidocaine patches behind my ears. They had no effect on my tinnitus.

 

[lymebite]

Has anyone tried these Lidocaine patches?

I tried TheraCare 4 percent Lidocaine patches near my ears a few years ago. The specific product I tried is at the link. It had no effect for me.

https://www.amazon.com/Maximum-Strength-Pain-Relief-Lidocaine/dp/B07NKTQTQG

 

[Uklawyer]

UPDATE:

Dr. Heon Man Sirh wrote back to me. He gave me the name of one of the US patients undergoing treatment that is willing to speak to me.

I have written to that person - let's see if they respond.

Fingers crossed.