Dr Mel Siff Blog

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

Some of you, through personal experience or that of family or friends, may
be very familiar with the fairly common disorder known as Tinnitus, a
persistent type of periodic or sustained ringing in the ears that can make
life a real misery. The most common opinion is that little can be done to
assist the sufferer, but some therapists have found thatTinnitus Retraining
Therapy (TRT) may be of definite value.

WEB INFORMATION

The following sites give a huge amount of research and clinical material on
the nature and treatment of tinnitus:

http://www.ucl.ac.uk/~rmjg101/tinnitus1.html
http://www.earaces.com/TRT.htm
http://www.tinnitus-hyperacusis.com/About/Tinnitus/tinnitus.html
http://www.sonus.com/tinnitus/faqs.htm

SCIENTIFIC ARTICLES

If you have not had need to consult Medline, here is a suitable page to help
find medical articles: Key phrases or words such “tinnitus” or “treatment of
tinnitus” yield numerous references.

http://www.ncbi.nlm.nih.gov/PubMed

One simply has to subscribe free to use this service.

Here is a selection on abstracts on the causes and treatment of tinnitus:

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Jastreboff PJ, Jastreboff MM Tinnitus Retraining Therapy (TRT) as a method
for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol 2000
Mar;11(3):162-77

Tinnitus and Hyperacusis Center, Department of Otolaryngology, Emory
University School of Medicine, Atlanta, Georgia 30322, USA.

The aim of this paper is to provide information about the neurophysiologic
model of tinnitus and Tinnitus Retraining Therapy (TRT). With this overview
of the model and therapy, professionals may discern with this basic
foundation of knowledge whether they wish to pursue learning and subsequently
implement TRT in their practice. This paper provides an overview only and is
insufficient for the implementation of TRT.

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Brand H Neural therapy in tinnitus Wien Med Wochenschr 1983 Nov
15;133(21):545-7 [Article in German]

After the examination by ENT-specialists in 96 cases of tinnitus a
conventional medical therapy with vasodilators and vitamin A has been tried.
This therapy showed unsatisfactory results. Then neural therapy as defined by
segmental therapy with a preparation containing lidocaine (Xyloneural) has
been applied. The results have been so encouraging, that this method can be
advised as basical therapy in tinnitus.

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Marion MS, Cevette MJ Tinnitus. Mayo Clin Proc 1991 Jun;66(6):614-20

Tinnitus, a common complaint, reportedly affects more than 37 million
Americans. Most often, it is associated with a sensorineural hearing loss in
the high-frequency range. Tinnitus, however, is a symptom and not a disease.
Complacency about this symptom complex may cause physicians to overlook a
severe underlying pathologic process. Patients with unilateral tinnitus,
pulsatile tinnitus, fluctuating tinnitus, or tinnitus associated with vertigo
should undergo thorough assessment, including elicitation of a complete
history, physical examination, and audiologic analysis. In many instances,
treatment is effective. Masking of tinnitus, medical therapy, and biofeedback
and counseling are some measures that have been used in the management of
tinnitus.

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Muhlnickel W, Elbert T, Taub E, Flor H Reorganization of auditory cortex
in tinnitus.
Proc Natl Acad Sci U S A 1998 Aug 18;95(17):10340-3

Dept of Psychology, Clinical Psychology and Behavioral Neuroscience, Humboldt
University, Hausvogteiplatz 5-7, D-10117 Berlin, Germany.

Magnetic source imaging was used to determine whether tonotopy in auditory
cortex of individuals with tinnitus diverges from normative functional
organization. Ten tinnitus subjects and 15 healthy controls were exposed to
four sets of tones while magnetoencephalographic recordings were obtained
from the two cortical hemispheres in sequence. A marked shift of the cortical
representation of the tinnitus frequency into an area adjacent to the
expected tonotopic location was observed. The Euclidean distance of the
tinnitus frequency from the trajectory of the tonotopic map was 5.3 mm
compared with a distance of 2.5 mm of a corresponding frequency in the
healthy controls (t = 3.13). In addition, a strong positive correlation was
found between the subjective strength of the tinnitus and the amount of
cortical reorganization (r = 0.82). These results demonstrate that tinnitus
is related to plastic alterations in auditory cortex. Similarities between
these data and the previous demonstrations that phantom limb pain is highly
correlated with cortical reorganization suggest that tinnitus may be an
auditory phantom phenomenon.