Science of Tinnitus Treatment Part 2 by Dr Mel Siff

31 Mar

Science of Tinnitus Treatment Part 2 by Dr Mel Siff

Author: Dr Mel Siff Blog // Category: Dr Siff on Injuries/Disease

Simpson JJ, Davies WE A review of evidence in support of a role for 5-HT in
the perception of tinnitus. Hear Res 2000 Jul;145(1-2):1-7

Tinnitus is a debilitating condition from which some 0.5-1% of the
population of the Western world suffer sufficiently badly as to interfere
with their normal working and leisure life. There is no satisfactory
treatment at the present time and the uncertainty surrounding the mechanism
of its generation makes it difficult to devise an effective cure. After much
debate, the consensus of opinion amongst researchers regarding its site of
origin is that it is primarily a central nervous system pathology although
there certainly exists a class of patients whose tinnitus is peripherally
based. In this paper, we provide some speculative ideas on how an initial
auditory insult can be translated into central neurological substrates that
represent tinnitus. Plastic changes arising from sensory deprivation trigger
a change in synaptology and neurotransmission with a consequent change in
receptor configuration.

From neuroanatomical considerations and analogies with other clinical
conditions, we postulate the involvement of serotonin (5-HT) in these plastic
changes and consider the evidence available from the use of serotonergic
drugs in different conditions. A possible relationship between 5-HT and
lidocaine is also discussed.

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Lockwood AH, et al Neuroanatomy of tinnitus. Scand Audiol Suppl
1999;51:47-52

We tested the hypothesis that tinnitus was due to excessive spontaneous
activity in the central auditory system by seeking cerebral blood flow (CBF)
changes that paralleled changes in the loudness of tinnitus in patients able
to alter the loudness of their tinnitus. We found CBF changes in the left
temporal lobe in patients with right ear tinnitus, in contrast to bilateral
temporal lobe activity associated with stimulation of the right ear. The
tones activated more extensive portions of the brain in patients than
controls. We conclude that tinnitus is not cochlear in origin and associated
with plastic transformations of the central auditory system. We suggest that
tinnitus arises as a consequence of these aberrant new pathways and may be
the auditory system analog to phantom limb sensations in amputees.

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Park J, White AR, Ernst E: Efficacy of acupuncture as a treatment for
tinnitus: a systematic review. Arch Otolaryngol Head Neck Surg 2000
Apr;126(4):489-92

BACKGROUND: Tinnitus is a prevalent condition for which patients may seek
treatment with acupuncture since no conventional treatment has been shown to
be effective. OBJECTIVE: To summarize and critically review all randomized
controlled trials on the efficacy of acupuncture as a treatment for tinnitus
. . . . inconsistent acupoints. Three studies scored 3 points or more on the
Jadad scale. MAIN OUTCOME MEASURES: Outcome measurements were visual analog
scale scores for loudness, annoyance, and awareness of tinnitus; subjective
severity scale scores for tinnitus; or Nottingham Health Profile scores.
RESULTS: Two unblinded studies showed a positive result, whereas 4 blinded
studies showed no significant effect of acupuncture. CONCLUSION: Acupuncture
has not been demonstrated to be effective as a treatment for tinnitus on the
evidence of rigorous randomized controlled trials.

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Erlandsson SI, Hallberg LR Prediction of quality of life in patients with
tinnitus. Br J Audiol 2000 Feb;34(1):11-20

According to epidemiological studies of tinnitus prevalence, 0.5-1% of
respondents report that tinnitus severely affects their ability to lead a
normal life. In the present investigation quality of life and its association
with tinnitus-related factors: psychological, psychosomatic and audiological,
was studied based on a sample of 122 patients, who attended the hearing
clinic for distress due to tinnitus. A stepwise regression analysis was
performed with quality of life as a dependent variable. Six of 13 variables
included in the model proved to be significant regressors and to explain 65%
of the variance. The six predictor variables were: impaired concentration,
feeling depressed, perceived negative attitudes, hypersensitivity to sounds,
average hearing level (best ear) and tinnitus duration (the shorter the
duration of tinnitus the more negative impact on quality of life). The three
most significant predictors were directly related to perceived psychological
distress and explained most of the variance in quality of life in tinnitus
patients included in this study.

An unexpected finding was that fluctuations in tinnitus, vertigo, headache or
perceived social support did not prove to belong to the significant
regressors. The results are discussed in view of the construct of quality of
life, depressive cognitions and social support in general, as well as in
tinnitus-specific life circumstances

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