Member- Apr 18, 2013
- 1,633
- Tinnitus Since
- 2003
- Cause of Tinnitus
- Flu, Noise-induced, Jaw trauma
Updated post with a summary of the conference - it's a bit long, sorry. Also sorry to any of the presenters there who I haven't featured. Notes were a frenzy of typing:
I apologise in advance for misquoting any research, though I'm hoping I haven't. Happy to be corrected anywhere.
Summary of the Conference
The main focus of the conference was sub-typing tinnitus. The thing that really struck home for me, over and over, was the need to identify what the patient will respond to before undertaking treatment.
In reality this doesn't happen. You go to a specialist who delivers a narrow range of options, generally based on the same theory. In this case the effect is generally on a 30/30/30 split of improvement, no change and getting worse.
I got a really hopeful feeling from the conference, they are making advances in understanding tinnitus and the TRI are right at the front of that. Germany beats any other country in the number of tinnitus research projects being carried out.
There were over 300 people registered to the conference, a real diversity of specialists involved with tinnitus. It filled me with hope that they are all interested in the search for a cure and developing effective treatments.
I couldn't go to every talk so I've summarised briefly what I can here, I veered more towards epidemiology.
EU COST Action: TINNET
There is a COST action for EU researchers, which from April 2014-April 2018 covers all travel and expenses for researchers at conferences and events. Great thing, really facilitates a lot of the connections and pushes people to work together.
The TRI Database
The TRI database has over 4,000 patients. All protected, anonymous data. They are encouraging centres to become involved and share their patient information. The more data they have the more insight into patients and sub-typing can be done. Already a pretty impressive feat and a very well designed database by Rüdiger Pryss, this guy seriously knows his stuff.
David Baguley's Talk on Hyperacusis
David Baguley gave an excellent talk on hyperacusis. Pitched it perfectly so that all the audience got it. The research is slightly scattered in the terminology used and the meanings behind it. It needs to be agreed so that all are comparative and the data can be properly understood. It is confusing and unhelpful when people discussing hyperacusis can actually be talking about other conditions.
There is a theory that it is psychologically reinforced, auditory gain is turned up. A bit like having a noisy neighbour, their noise may really annoy you but to another wouldn't seem that bad. Because you have a stress reaction to it it seems louder and more irritating to you. This doesn't cover every case of course, pathology can differ between patients.
Migraines and Tinnitus
Touching on a few talks, there does seem to be an association between migraines and tinnitus. Brain imaging does show some of the same areas affected, though migraine affects a larger number of areas.
Anxiety and Tinnitus
No surprises but the level of anxiety has been shown to correlate with the perceived loudness of the tinnitus. The more the patient reinforces the tinnitus with a negative pattern of thought and speech the more distress and higher volume. Lucy Handscomb has some developing findings that look to be proving the NeuroPhysiological model, which for me stresses the importance of getting intervention early and breaking the anxiety reaction. It's something we say a lot but the more you obsess over the negative, worry over worsening etc then then the worse you perceive it to be.
Hearing Aids in Tinnitus Therapy
Quite a few presentations dealt with hearing aids in tinnitus therapy - none were delivered by hearing aid companies. In general it was shown that where there is a certain amount of hearing loss then hearing aids improved the outcome of tinnitus treatments.
When Is a Treatment Considered Effective?
Something I'm quite big on is measuring when a treatment works, how do we know that studies are reliable? Erwin George measured an improvement of 9.6 points from intervention alone on the Tinnitus Questionnaire (TQ). Kathryn Facknell has some good work validating the tinnitus questionnaires; because of natural variations she recommended that a difference of 18 points in the TFI (also THQ and THI) could be the mark where a treatment is considered effective. Her work is incredibly useful and will hopefully be taken up as a standard.
Cochlear Implants for Patients with Single-Sided Deafness
Cochlear Implants showed good benefits for patients with single-sided deafness.
Internet-Based Treatments
Gerhard Andersson gave an excellent talk on internet based treatments. To summarise briefly, which is hard as he has been doing this since 1998 and cited a lot of work, there is evidence to show efficacy can be as good as clinical delivery for certain treatments (CBT and suchlike). This was for mild and moderate cases. There are no predictors for who will respond though.
A Loss of Grey Matter in the Frontal Cortex in Tinnitus Patients
Josef Rauschecker's work was pretty intriguing, he showed some brain images that identify a loss of grey matter in the frontal cortex in tinnitus patients. The region is active in discerning sounds that are pleasant or unpleasant. Many other studies are finding structural changes in the frontal region. The larger the loss of volume the greater the loudness is perceived by the patient. It isn't clear if this loss is pre or post tinnitus.
Tinnitus seems to be kept at bay if the pre-frontal cortex is able to see the tinnitus as a sound not wanted and switch off the awareness, suppress the sound - are we all running around with tinnitus in our brains but the gating system in the brain turns it off in a healthy patient? I could write volumes about his talk, best to check out his research if you're interested.
Susan Shore, Responses to Sound in a Damaged Cortex and Somatic Tinnitus
Susan Shore also looked at the brain, really interesting work on responses to sound in a damaged cortex. Low level tones seem to fire across the tonotopic map, kind of like harmonics in sound. Her team are also looking at a treatment for somatic tinnitus. Again could write a lot here.
BTA's NICE Model: It's Cost Effective to Treat Tinnitus
The BTA work on the pathway of the patient through the NHS was really good. It's country specific but they can make a real difference with their findings. Within the NICE model, they have shown that it is cost effective to treat tinnitus. If the NHS can be pushed on this then it can make a big difference to a lot of people.
Music Therapy, Auditory Training and Tinnitus
Heike Argstater featured some work on music therapy improving tinnitus, as well as the use of hearing aids in hearing loss patients improving the outcome. Patients, even musically trained ones, struggled to sing a tone when it was in the region of their tinnitus. Their training improves this and many patients experience a lowering of their tinnitus pitch with music therapy. There was also related work from Dean Thompson to show that auditory training in moderate hearing loss patients improved their speech in noise recognition
Mindfulness and Tinnitus
Laurence McKenna's work on Mindfulness was impressive. They tested it against relaxation therapy, which is a known treatment. Gave exactly the same treatment time and face to face time to patients and found that their tinnitus mindfulness gave a significantly better benefit.
Deeper Hearing Damage & The Synaptic Loss
The final keynote, Charles Liberman, looked at deeper hearing damage. The evidence shows that even where there is a mild hearing cell damage from noise exposure there could be a larger damage that goes unnoticed to the synaptic connections. We lose around 30% of the synaptic connections naturally over the course of our lives, it takes a loss of 90% before they have a significant impact on an audiogram.
When exposed to a loud noise - say a concert - the hair cells may go back to normal but the synaptic loss doesn't. Regardless of the level of hearing damage the synapses are vulnerable. The audiogram may not change but the level of information going to the Central Nervous System is reduced.
Neurotrophins can restore the synapses, this is where his research is heading next. It's unclear how the use of steroids could affect the synapses when treating a hearing loss, highlighted this as an area for research.
Tinnitus Hub Survey
We were able to talk to a number of people about our recent survey. Hopefully we can make an announcement once we've talked again to people, for now it seems that our data is going to be very helpful. The group that responded who were in the acute phase appears to be the largest ever sample collected.
We will be collaborating with professionals to analyse the results in full. A lot of people at the conference were impressed by just how many people took part. It shows that we have a group voice and that we can become so much more involved in the world of research as patients.
Prof. Deborah Hall & The Team Were Amazing
Lastly, Deborah Hall and her team were pretty amazing all through the conference. It was excellent and they did an amazing job. The whole Nottingham team were brilliant.
The official conference website can be accessed here: https://tri2016.ihr.mrc.ac.uk/
Steve
I apologise in advance for misquoting any research, though I'm hoping I haven't. Happy to be corrected anywhere.
Summary of the Conference
The main focus of the conference was sub-typing tinnitus. The thing that really struck home for me, over and over, was the need to identify what the patient will respond to before undertaking treatment.
In reality this doesn't happen. You go to a specialist who delivers a narrow range of options, generally based on the same theory. In this case the effect is generally on a 30/30/30 split of improvement, no change and getting worse.
I got a really hopeful feeling from the conference, they are making advances in understanding tinnitus and the TRI are right at the front of that. Germany beats any other country in the number of tinnitus research projects being carried out.
There were over 300 people registered to the conference, a real diversity of specialists involved with tinnitus. It filled me with hope that they are all interested in the search for a cure and developing effective treatments.
I couldn't go to every talk so I've summarised briefly what I can here, I veered more towards epidemiology.
EU COST Action: TINNET
There is a COST action for EU researchers, which from April 2014-April 2018 covers all travel and expenses for researchers at conferences and events. Great thing, really facilitates a lot of the connections and pushes people to work together.
The TRI Database
The TRI database has over 4,000 patients. All protected, anonymous data. They are encouraging centres to become involved and share their patient information. The more data they have the more insight into patients and sub-typing can be done. Already a pretty impressive feat and a very well designed database by Rüdiger Pryss, this guy seriously knows his stuff.
David Baguley's Talk on Hyperacusis
David Baguley gave an excellent talk on hyperacusis. Pitched it perfectly so that all the audience got it. The research is slightly scattered in the terminology used and the meanings behind it. It needs to be agreed so that all are comparative and the data can be properly understood. It is confusing and unhelpful when people discussing hyperacusis can actually be talking about other conditions.
There is a theory that it is psychologically reinforced, auditory gain is turned up. A bit like having a noisy neighbour, their noise may really annoy you but to another wouldn't seem that bad. Because you have a stress reaction to it it seems louder and more irritating to you. This doesn't cover every case of course, pathology can differ between patients.
Migraines and Tinnitus
Touching on a few talks, there does seem to be an association between migraines and tinnitus. Brain imaging does show some of the same areas affected, though migraine affects a larger number of areas.
Anxiety and Tinnitus
No surprises but the level of anxiety has been shown to correlate with the perceived loudness of the tinnitus. The more the patient reinforces the tinnitus with a negative pattern of thought and speech the more distress and higher volume. Lucy Handscomb has some developing findings that look to be proving the NeuroPhysiological model, which for me stresses the importance of getting intervention early and breaking the anxiety reaction. It's something we say a lot but the more you obsess over the negative, worry over worsening etc then then the worse you perceive it to be.
Hearing Aids in Tinnitus Therapy
Quite a few presentations dealt with hearing aids in tinnitus therapy - none were delivered by hearing aid companies. In general it was shown that where there is a certain amount of hearing loss then hearing aids improved the outcome of tinnitus treatments.
When Is a Treatment Considered Effective?
Something I'm quite big on is measuring when a treatment works, how do we know that studies are reliable? Erwin George measured an improvement of 9.6 points from intervention alone on the Tinnitus Questionnaire (TQ). Kathryn Facknell has some good work validating the tinnitus questionnaires; because of natural variations she recommended that a difference of 18 points in the TFI (also THQ and THI) could be the mark where a treatment is considered effective. Her work is incredibly useful and will hopefully be taken up as a standard.
Cochlear Implants for Patients with Single-Sided Deafness
Cochlear Implants showed good benefits for patients with single-sided deafness.
Internet-Based Treatments
Gerhard Andersson gave an excellent talk on internet based treatments. To summarise briefly, which is hard as he has been doing this since 1998 and cited a lot of work, there is evidence to show efficacy can be as good as clinical delivery for certain treatments (CBT and suchlike). This was for mild and moderate cases. There are no predictors for who will respond though.
A Loss of Grey Matter in the Frontal Cortex in Tinnitus Patients
Josef Rauschecker's work was pretty intriguing, he showed some brain images that identify a loss of grey matter in the frontal cortex in tinnitus patients. The region is active in discerning sounds that are pleasant or unpleasant. Many other studies are finding structural changes in the frontal region. The larger the loss of volume the greater the loudness is perceived by the patient. It isn't clear if this loss is pre or post tinnitus.
Tinnitus seems to be kept at bay if the pre-frontal cortex is able to see the tinnitus as a sound not wanted and switch off the awareness, suppress the sound - are we all running around with tinnitus in our brains but the gating system in the brain turns it off in a healthy patient? I could write volumes about his talk, best to check out his research if you're interested.
Susan Shore, Responses to Sound in a Damaged Cortex and Somatic Tinnitus
Susan Shore also looked at the brain, really interesting work on responses to sound in a damaged cortex. Low level tones seem to fire across the tonotopic map, kind of like harmonics in sound. Her team are also looking at a treatment for somatic tinnitus. Again could write a lot here.
BTA's NICE Model: It's Cost Effective to Treat Tinnitus
The BTA work on the pathway of the patient through the NHS was really good. It's country specific but they can make a real difference with their findings. Within the NICE model, they have shown that it is cost effective to treat tinnitus. If the NHS can be pushed on this then it can make a big difference to a lot of people.
Music Therapy, Auditory Training and Tinnitus
Heike Argstater featured some work on music therapy improving tinnitus, as well as the use of hearing aids in hearing loss patients improving the outcome. Patients, even musically trained ones, struggled to sing a tone when it was in the region of their tinnitus. Their training improves this and many patients experience a lowering of their tinnitus pitch with music therapy. There was also related work from Dean Thompson to show that auditory training in moderate hearing loss patients improved their speech in noise recognition
Mindfulness and Tinnitus
Laurence McKenna's work on Mindfulness was impressive. They tested it against relaxation therapy, which is a known treatment. Gave exactly the same treatment time and face to face time to patients and found that their tinnitus mindfulness gave a significantly better benefit.
Deeper Hearing Damage & The Synaptic Loss
The final keynote, Charles Liberman, looked at deeper hearing damage. The evidence shows that even where there is a mild hearing cell damage from noise exposure there could be a larger damage that goes unnoticed to the synaptic connections. We lose around 30% of the synaptic connections naturally over the course of our lives, it takes a loss of 90% before they have a significant impact on an audiogram.
When exposed to a loud noise - say a concert - the hair cells may go back to normal but the synaptic loss doesn't. Regardless of the level of hearing damage the synapses are vulnerable. The audiogram may not change but the level of information going to the Central Nervous System is reduced.
Neurotrophins can restore the synapses, this is where his research is heading next. It's unclear how the use of steroids could affect the synapses when treating a hearing loss, highlighted this as an area for research.
Tinnitus Hub Survey
We were able to talk to a number of people about our recent survey. Hopefully we can make an announcement once we've talked again to people, for now it seems that our data is going to be very helpful. The group that responded who were in the acute phase appears to be the largest ever sample collected.
We will be collaborating with professionals to analyse the results in full. A lot of people at the conference were impressed by just how many people took part. It shows that we have a group voice and that we can become so much more involved in the world of research as patients.
Prof. Deborah Hall & The Team Were Amazing
Lastly, Deborah Hall and her team were pretty amazing all through the conference. It was excellent and they did an amazing job. The whole Nottingham team were brilliant.
The official conference website can be accessed here: https://tri2016.ihr.mrc.ac.uk/
Steve
