SaluSTIM — tVNS Therapy Device

And this is the tinnitus study referenced in the link Markku just posted http://www.ncbi.nlm.nih.gov/pubmed/21228773

EDIT - really pleased I'm not a rat, they really do get it from researchers. 115dB for 1 hour at 15KHz to induce noise trauma.

 

It is worth quite a lot I think. Excellent find! It seems fairly OK now to say that if anyone wants to perform this treatment on themselves then they can do so very cheaply by buying a low cost TENS machine, the electrode suggested by ChrisJ (or similar), and by making notched sound files or other appropriate sound therapy such as Steve's files.

The settings advised in the instructions for the Salustim are:
Pulse rate: 25-30Hz
Pulse width: 250 microseconds
Intensity: 5-8. Unfortunately I cannot quantify that, but for me I start to feel the current at around 15, so assuming a linear scale maybe you want to set your TENS at around half of the intensity at which you start to feel it.

I believe it is advised to be careful not to use sound stimulation too close to your t frequency.

 

Yes it does seem to be the way that these things work, I can create files with broadband noise that seems to quiet my tinnitus and then each person can notch them to their own personal frequency.

From the study, supporting the use of tones like you say: We speculated that pairing VNS with randomly interleaved pure tones that span the rat hearing range, but exclude the overrepresented frequencies, could decrease the cortical representation of the excluded frequencies

We seem to have a bit of information already around TT in different threads so maybe we should start a DIY tVNS thread and collate the most useful info to find what the recommended program is, a competitively priced device and what the best sequence of tones is?

 

Sounds good to me!

 

I might rent one for testing purposes, as in... testing it on myself as well as analyzing the unit.
I repair synthesizers and audio gear so I have all the necessary equipment to analyse the output of this unit.
Having said that, it might not be much of a secret, I haven't put in the research.

 

Nurse in Helsinki Tinnitus Clinic told me that 80% of patients got benefit to tinnitus and hyperacusis from the device. So might be worth to try, though. Personally I'm doing pretty well now with my tinnitus & hyperacusis, so maybe later...

 

Photos of the device






Photos of the documentation

 

I have been using the device for 20 minutes now. I cannot say I feel anything. Besides, I am way overanalysing my senses at the moment.

Nevertheless, I have been hearing this pulse/dial like tone that I have never heard before... Naturally, an eerie feeling to hear a new tone join the tinnitus orchestra.

Someone with more knowledge in the field: Is this possible/excepted at all?

 

I can't comment on the tone you're hearing as I don't know enough about the machine, but I can say from experience that when you are doing something to actively treat your tinnitus it is natural for it to feel worse. The focus of attention, deliberately listening to it to see if there is any change, is a negative psychological thing.

Whether it works or not it will take time, so if you can, try to stop paying too much attention to your tinnitus in the short term.

What frequency have you used for the notched audio files?

 

After posting that I have started playing computer games to distract myself. That helped me to completely stop thinking about tinnitus, as usual.

I am not listening any audio. Doing only tVNS

 

You will need to listen to something whilst doing it, the stimulation of the vagus nerve is supposed to help you learn things better. So if you have something like notched music or a specific tone sequence then it should be listened to whilst using the device. Still play games to distract from focusing on it, probably a useful pairing for someone like me that just can't distract and stop listening.

That's from my understanding of it.

 

Interesting... when I discussed my difficulty identifying a frequency with Nathan from TTC, he seemed to suggest using tVNS on its own. RaZaH said this below about his conversation with Nathan. May I ask... were you also advised to use the tVNS without sound therapy?

I guess if the TTC is just one guy and he is manually notching tracks for all of his customers I can see why he might be happy to advise that they are not needed. My understanding is that @Steve is correct in what he says about some kind of sound therapy being important. I used notched white noise earlier today, but intend to do some more experimenting and settle on a firm strategy soon.

 

OK I didn't expect anything to happen immediately, but I have some news. I have so far used tVNS three times for an hour each:

1 Yesterday I did one session with the tVNS and white noise notched at 8kHz. It didn't have a huge effect - I thought maybe my t was more hissy and less shrill for a few mins afterwards, but really nothing significant and may have been imagination.

2 Last night I then did another session, this time using @generalfuzz's DIY ACRN also set at 8kHz. At the end of that my t was definitely more of an unfocussed hiss with less noticeable tones going on. Also the low pitched whirring noise that I got courtesy of some neomycin eardrops (cheers doc!) was much more noticeable. This all settled down quite quickly and within half an hour when I got to bed I'd say my t was pretty much back to normal.

3 Today I did another session with DIY ACRN at 8kHz. After this my tones definitely dissipated into a hiss and the low pitched whirring was less noticeable than last night, but still more prominent than usual. T overall was louder than usual. Over about fifteen minutes the hiss seemed to recede and a tone became dominant, but not one I've been aware of having before. It was definitely lower in pitch than what I am usually aware of being dominant, although my t is usually quite a complex cacophony. Two hours after the session ended, this was still how it was, although it seems now (about three hours after) to be turning back into more like the t I had before the session, if a bit louder.

Observations:

- My t is not stable at the moment (recent spike) so take these results with a pinch of salt.

- ACRN did not have much effect on me when I tried it previously, even using it 4-6 hours a day as advised. Using it for one hour along with tVNS has shown a very significant effect on my tinnitus.

- My t is not at this point improved in any way, but it is definitely affected in quite a powerful and complex way.

- On the official ACRN trial I was advised that if ACRN was working then it was expected that the pitch would drift downwards, and also that it might get louder at first. That description seems not incompatible with what I have experienced today in a compressed time frame.

- My t is composed of many sounds and so is probably not best suited to neuromodulating sound therapies. I am not confident about identifying any one frequecy accurately, and even if I did much of my t would probably be at quite different frequencies, suggesting that neuromodulating sound therapies are risky for me (I might make one part of my t better and another part worse).

- I used the tVNS device on a higher setting than advised in the instructions. I seem, however to have got more sensitive to the effect and can now feel the stimulation when it is set at 8. Previously I needed it set higher before I could feel it. Information I found online suggested setting it so that you can feel it clearly but it is not painful. This is what I have done rather than following the guideline of 5-8 in the instructions.

- My gut feeling at this point is that tVNS combined with ACRN seem a potentially very powerful intervention. If anybody else (perhaps with a more suitable t than mine) feels like giving it a try then I would be extremely interested to hear.

 

@Steve I downloaded your neuromodulation files. Could I ask about the construction of them? Are they intended to target any particular frequencies? I analysed one in Audacity and all frequencies seemed to be represented. Is there any particular characteristic of t that you are targeting?

They are very calming anyway. Made me think of a lovely album I used to enjoy:

௵ mileece - formations

 

They are a scattergun approach, really aimed for people who can't identify a tone but they seem to have helped people with all sorts of tinnitus. The idea is to stimulate all over between roughly 100Hz and 10KHZ though I may have gone slightly higher with those files.

I am working on a new synth that I'm testing out on myself at the moment. I have two tones I think I can identify that are the most annoying so I've got two sequences running and am seeing what effect it has.

I'm coming to the idea of only listening for 20 minutes maximum however as any more than that and my ears feel worse afterwards. Maybe it's a personal thing or maybe just getting the same kind of noise repeated for that length of time is about enough for the ears / brain. I'm using six tones either side of the tinnitus tone for each sequence.

I can make a sequence for you to try (or anyone for that matter), bearing in mind that it is experimental. I've sub-divided each octave by 20 so I can make a sequence for any frequency up to just over 10KHz. Using the same principle as the notched music I'm taking around an octave out, centred around the tinnitus frequency.

 

That's me I think. I keep trying, but I don't feel confident. Maybe tVNS is not gonna be helpful for me, but I was feeling I had to try something after the way my t has been the last few weeks.

Thanks for the offer of making a sequence for me. I really don't know what I want at this stage, but might accept your offer soon. My t currently (now about 6 hours since the end of my earlier session) sounds a bit louder than it was before the session, but roughly back to what it was in character. I'm gonna leave it alone for tonight now - I don't want to push my luck after the strong response I had earlier. I think I'll try one of your files that I downloaded tomorrow maybe with the tVNS. I really was not expecting anything so strong to happen so suddenly, and still not quite sure how to think about it.

 

It is not stated anywhere in docs explicitly NOT TO, but it does say to use the device for 1-2 hours a day. By the sound of it, you have used it a lot more often. Have you asked the guys at the tinnitustreatmentcentre.com if thats a good idea?

Although I have used the device only two times (180 minutes in total), my tinnitus got a lot worse. Someone in the thread mentioned that a fluctuating tinnitus is part of the healing process. I remember reading a variation of that earlier too. I hope thats true.

Where can I download this audio?

 

I keep hearing this about tinnitus getting worse during the healing process, what healing process?
Who are these people getting healed that can verify this tinnitus myth?
Makes no sense to me ..heheh

 

I guess it's a sure fire way of covering all there bases . If the T flares up then it's the healing process, if not then who cares? I don't know honestly. If they ship to the USA I will rent this but I don't think they do.

 

Here: https://www.tinnitustalk.com/threads/neuromodulation.7700/

 

I read the study they are referring on that page and they had neither control group nor placebo group.

Additionally they write: "Pilottitutkimukset ovat kuitenkin osoittaneet, että tVNS näyttää olevan hyödyllinen hoitomuoto tinnitukseen ja etenkin tinnitukseen liittyvään stressiin."

Which means that "Pilot studies have shown that tVNS seems to be useful treatment form for T and especially for T related stress."

So in my book this goes to snake oil / placebo section for the moment. I bet that the same effect can be achieved by putting a person to massage chair and put a relaxing masking track on and after this conclude that persons T related stress has decreased. So nothing permanent on tinnitus volume decrease.

General PS. Oh my god it's hard to type foreign language in Trobalt high. I had to look half of the words from dictionary to get this message right...

PPS. At Helsinki Ear Institute who is offering this service is somewhat unwilling to answer to questions related to study or the effectiveness of this device. I even asked that could I test the device for a week or two and if it works, Ill pay the full bill - no answer

 

Folks, can you use this technology if your tinnitus is more "noise" than tonal? I think my noise is between 4 and 6K, would that be enough? Or can you hurt your efforts somehow if you're off the mark?

 

Hi, so far I used the device for three sessions of an hour each over two days. So that part of what I did was in line with TTC advice. I deviated though in applying it with higher 'intensity'. I turned it up to 16 and 20 (take that Spinal Tap!) based on reading (I think in a study) to set it so you can feel it easily but it is not painful.

I also deviated in using DIY ACRN as sound therapy rather than notched music. My suspicion is that this caused the strong response, although I cannot be certain until I try something else. However...

If your t has also got worse as a result of using the device for the same total length of time as me then maybe the device caused my changes rather than the ACRN/tVNS combination as I suspect. Am I correct that you are not currently using sound therapy?

I'm nearly back to what I was before in terms of overall volume if that is reassuring to you. I'm hoping/assuming that any changes we observe will return to baseline provided we don't repeat the process that caused them too many times.

 

Well, it has definitely had an effect on my tinnitus, albeit not an effect that is yet helpful. The study Markku found compared tVNS with a placebo ('sham') group and concluded that tVNS was an effective substitute for VNS:

The effects of tVNS parameters on autonomic function in 48 healthy
participants were investigated using heart rate variability (HRV) and
microneurography. tVNS was performed using a transcutaneous electrical nerve
stimulation (TENS) machine and modified surface electrodes. Participants visited the
laboratory once and received either active (200 μs, 30Hz; n = 34) or sham (n = 14)
stimulation.
...
Conclusion
: tVNS can increase HRV and reduce sympathetic nerve outflow, which
is desirable in conditions characterised by enhanced sympathetic nerve activity, such
as heart failure. tVNS can therefore influence human physiology and provide a
simple and inexpensive alternative to invasive VNS.
http://www.researchgate.net/publica...thy_Humans_Reduces_Sympathetic_Nerve_Activity

And there are reputable looking links between VNS and neural plasticity. Neural plasticity is desirable to reverse or reduce the maladaptive plasticity that causes tinnitus.
http://www.ncbi.nlm.nih.gov/pubmed/24309259
http://www.ncbi.nlm.nih.gov/pubmed/25278857
http://www.utdallas.edu/txbdc/targeted-plasticity/

I don't think this could yet be called a proven treatment, but there is some interesting evidence and reason to be hopeful.

 

That is the question on my mind. I think at this stage it will be harder to treat our type of tinnitus than purely tonal tinnitus. I am hopeful we can find a way. Getting it wrong could make t worse (long term in theory, short term from my recent experience).

You could try using notched music/sound with a notch to remove all sound between 4-6k, maybe a little more on either side. There are no guarantees so it is up to you to weigh up how keen you are to try something that may or may not help.

 

I'm not sure why you quote study which compares VNS and tVNS techniques. After all - even the proof of VNS working on T is yet to be found.

But like I said, I'll put tVNS treatment to snake oil/placebo category only for the moment - right next to laser and acoustic neuromodulation treatments.

 

I didn't mean to start an argument. I only said:

I'm not trying to sell this to anyone, but having looked into it a bit before spending my own money I thought it was worth a try. There is some scientific backing, both theoretically and empirically:

www.nature.com/nature/journal/v470/n7332/full/nature09656.html%3FWT.ec_id%3DNATURE-20110203
http://www.utd.edu/~kilgard/vagus.htm
http://www.utd.edu/~kilgard/EngineerKilgardNature2011.pdf

(And based on what we established earlier in the thread, anyone interested can try this for the price of a cheap TENS machine and an earclip electrode.)

 

I have this TENS device, which costs about ~60-80€ and which has simply one electrode replaced with an ear clip for tVNS. I have just tried it once or twice, so can't really say if it works or not for my tinnitus. I do believe it can help combined with sound stimulation. My problem is also that I can't locate my tinnitus frequency. The Helsinki Ear Clinic sells these kind of tVNS devices.

http://www.mettlerelectronics.com/tens-210/

 

From what I read above, I understand that there is hope? Is that what you understand also?