OK, I'm back as promised with a longer report on the conference.
My Key Takeaways
In no particular order, here are some interesting new things I learned during the conference. Keep in mind that there were many parallel sessions, so one had to pick and choose what to attend; hence, this does not represent the whole program per se.
Research Presentations:
Arnaud Norena's work on KCC2 – I like him generally as a researcher because he approaches the problem of tinnitus from many different angles. KCC2 is a potassium chloride transporter that influences GABA, a neurotransmitter that inhibits nerve signals, i.e., calms down brain activity. GABA inhibition has long been hypothesized to be associated with tinnitus. He did some work on animals indicating a chain reaction from noise-induced hearing loss through this KCC2 chemical, leading to less GABA and thus overexciting the auditory nerves, creating a tinnitus signal. One must always be careful to realize that this is just an animal study so far, and the theory has yet to be validated in humans. Still, it's a potential new avenue for cure-focused research.
Dirk de Ridder's "War on Tinnitus" talk – The title of his talk raised some concerns from the audience over its perceived controversial nature. But I liked it because some controversy might be precisely what these kinds of conferences need to create a sense of purpose and urgency. We recorded his talk in full, to be published later, but summarizing briefly: He talked about how tinnitus should be approached at the overall system level, using a combination of different treatments that target different brain areas to break up the 'network of tinnitus.'
Hyperacusis & misophonia – It's really good to see the increased attention on these topics. I already wrote up a summary in my previous post. See above.
Emilie Cardon – I think she is a very promising young neuroscientist. She delivered two presentations: One on a potential tinnitus biomarker and one on tinnitus's effects on cognition in cochlear implant users. I've attached both presentations here; she was kind enough to share them.
Hamid Djalilian's work on migraine and tinnitus – I only knew Dr. Djalilian from his work on electrical stimulation of the inner ear to resolve tinnitus, which I interviewed him about for the Tinnitus Talk Podcast. While that work has apparently moved into human trials, which is promising, he has also been working on the link between tinnitus and migraine. His theory is that tinnitus worsening could be caused by migraine. He stressed that migraine does not always come with a headache, but rather it's a 'central hypersensitivity disorder' that can make the ringing louder. He's had some success lowering tinnitus in his clinic through migraine treatments and reducing lifestyle triggers.
Robin Guillard's work on tinnitus and dreams – We co-authored a paper with Robin that was based on data we gathered (publication pending) that looked into the relationship between tinnitus and naps. Here, he presented on tinnitus and dreams. See the attached presentation. This might seem like a somewhat 'fluffy' topic, but as you can see in his presentation, there is a hypothesized link between lucid dreaming and a tinnitus on/off switch.
Tinnitus Hub Milestone: Organizing Our Own Symposium!
I co-organized an entire symposium, a huge landmark for Tinnitus Hub. At the last TRI in Dublin, we were on stage for the first time, and now we are organizing a symposium. We recorded the whole thing, which will soon be published, and I will also share all the slides in the next post. But I can already say that it was very well received. It really made some researchers stop and think about the patient experience when it comes to measuring treatment success.
A personal highlight for me was that at the final conference session, where
Berthold Langguth summarized key learnings from the conference, he showed not just one but three of my slides – and he did not do this for any other presenter! So, here's a big thank you to Berthold for taking patient participation seriously.
Organizational/Corporate Presentations:
ATA expanding its grants program – The American Tinnitus Association had a lot more news to share than ever seen before. There's definitely a renewed sense of purpose under their fresh new CEO
Patrick Lynch. Of particular interest is the fact that they're planning to expand their grants program. See picture below. However, when I asked what the research focus of their grants program would be, they didn't really have an answer.
Revitalization of the TRI? – The Tinnitus Research Initiative (TRI) used to provide funding that led to many of the earliest insights on tinnitus. These days, it's more of a network organization that, in my view, has been quite dormant. But a presentation by two TRI board members –
Sven Vanneste and
Berthold Langguth – announced some potentially exciting new plans, including relaunching their working groups and newsletter, and the upcoming launch of a central tinnitus database.
Neuromod/Lenire was VERY present at the conference. They had a booth, and several sessions were dedicated to clinicians/audiologists speaking about 'real world' evidence from their clinics. This evidence was all so positive that I could barely believe it. I suspect there's some self-selection mechanism going on whereby only the most motivated/receptive patients end up starting AND finishing the treatment, and those results get reported. Neuromod also organized a small pre-conference dinner to which I was invited for some unfathomable reason.
Two interesting takeaways from Hubert Lim's presentation at this dinner:
- He spoke of Lenire 2.0, which will be much more personalized. Specifically, it will include 'notched' sound therapy—hardly a novel idea, but it's good that they're looking at personalization. I was a bit confused, though, because they've spoken in the past about the treatment being customized, but I suppose that was only customization to one's hearing threshold, not to one's tinnitus.
- In response to a question about why they did not report on minimum masking levels to prove whether loudness reduction was occurring, apart from the answer that we've heard before about how difficult this is to measure, I heard a new answer this time, namely: "Lenire is just distraction for the brain." I hope I'm not misquoting here, but I recall Hubert Lim saying this.
Areas for Improvement
Academic conferences can be tedious, longwinded, overly technical, and navel-gazing affairs. The TRI conference is no different, especially when you're attending as a layperson. The relevance of certain findings for us tinnitus sufferers often remains unclear or has not been sufficiently considered. Some specific areas for improvement I would highlight are:
- There is a lack of central coordination from the TRI board. I have spoken to them about this in the past. Each conference tends to be quite different depending on the local organizing committee. I have yet to see a strong centralized research agenda. But maybe their new direction (see above) will bring this.
- Having Pawel Jastreboff opening the conference hardly speaks to a spirit of innovation and fresh energy. His presentation was nearly 60 slides long, and while I think he ended with some genuinely good recommendations (e.g., about publishing negative results and sharing data), my view remains – also from talking to many neuroscientists about this – that his neurophysiological model of tinnitus has not been validated, and TRT has rather underwhelming outcomes and can at best be considered just one of many similarly underwhelming tools in a clinician's toolbox.
- There were a lot of topics that I recall from previous conferences (TRI but particularly also ARO) that were missing here, where it would have been interesting to hear about updates or progress. For instance, regarding tinnitus potentially being caused by an inflammatory response and the role of metabolomics and genetics in causing tinnitus.
- There were many 'same old' presentations that gave me a sense of déjà vu. For instance, two sessions on the heterogeneity of tinnitus, a few sessions on sound therapy and counseling, and 'new' trial results from neuromodulation approaches like rTMS and tDCS, where it seems they still haven't found the magic bullet.
- There was also some potentially interesting stuff but with a "so what?" aspect, e.g., categorizations of hyperacusis that seem more like a semantic discussion than anything else or studies linking tinnitus to cognitive impairments or stress without any sense of the mechanism behind it, or the finding that there is a 'spatial perception' to. The added value or benefit to patients is either unclear or limited.
- As in previous years, there was very little representation from the industry, apart from the usual suspects like Neuromod and Neosensory. Of course, it's not entirely the organizers' fault, considering how little interest the industry has in tinnitus. However, it would be good to see some efforts made, even by inviting speakers from other fields, to translate academia into commercial investment.
Networking
Above all, I fear that my critique sounds very doom and gloom, as if it were all a giant waste of time. I will tell you that nothing is further from the truth, though. Inspiration is always found in new research insights, clinicians' persistence in doing their best for their patients, hearing about new research ideas, and simply connecting on a human level. I can definitely corroborate what
@JD mentioned above about dedicated and hard-working individuals from all around the globe.
You will usually learn the most interesting things during the informal networking around the conference. This includes:
- Hearing an ENT doctor say that the Lenire 'real world' results were not legit because both the company and the audiologists have a vested interest in selling the device to as many people as possible, whereas it's probably only helpful for a subset of patients.
- Hearing people critique each other's work. For instance, I spoke to Will Sedley, a neuroscientist whom I greatly respect, who was somewhat skeptical Dr. Djalilian's migraine theory, and indeed, it seems much of it is (as of yet) unsubstantiated but still an interesting avenue of investigation for a specific subgroup of patients. I also discussed with Hamid the possibility of doing a large-scale survey through Tinnitus Talk to substantiate (or disprove) the association between migraine and tinnitus.
- Similarly, I discussed with Robin Guillard the idea of significantly expanding the sample size of his dreams study, as this kind of data (i.e., "do you hear tinnitus in your dreams?" and related questions) is easy to collect online. So, it might be interesting to help him collect larger survey data. What do you guys think?
- Hearing of new research ideas. Emilie Cardon, for instance, shared a new research idea with me that sounded interesting: To look at cochlear implant users whose tinnitus disappears when they turn the device on, and try to measure the difference between the 'tinnitus on' versus 'tinnitus off' state – I didn't have the chance to ask what she wanted to measure, but it seems to me such a study could yield important clues about where we should intervene to silence tinnitus.
But there's one experience in particular that I would like to highlight. They did not formally present anything at the conference, but the
Rainwater Foundation was present with several people. Why is this interesting? They have been funding brain degradation conditions like Alzheimer's for years. However, since Todd Rainwater developed tinnitus himself, they are now funding a large consortium study to find a tinnitus biomarker. A fresh new player in the field; that's always good to see!
Finally, Vancouver is a gorgeous city, and I felt blessed to spend a week there representing all of you guys. Thank you to everyone who donated to make this happen! Here's a picture of the conference venue: