Multitarget Surgical Neuromodulation: Combined C2 and Auditory Cortex Implantation for Tinnitus

Abstract
Tinnitus, as a phantom sound can express itself as a pure tone and as a noise-like sound. It is notoriously difficult to treat, and in medically, psychologically and audiologically intractable, tinnitus patients sometimes intracranial electrodes overlying the auditory cortex are implanted. In this case report, we describe a patient who had a complete resolution of the pure tone component of his tinnitus by an auditory cortex implant, without any beneficial effect on the noise-like aspect of his tinnitus, even after changing the stimulation design to burst stimulation, which is known to treat noise-like tinnitus better than tonic stimulation. After an initial successful treatment of his noise-like component with transcutaneus electrical nerve stimulation, a wire electrode is inserted subcutaneously and connected to his internal pulse generator. With the dual stimulation his pure tone tinnitus remains abolished after 5 years of stimulation and his noise-like tinnitus is improved by 50%, from 8/10 to 4/10. This case report suggests that multi-target stimulation might be better than single target implantation in selected cases.

http://www.ncbi.nlm.nih.gov/pubmed/25703225

 

This study was a breakthrough. And it should lead to more experimentation with multiple implants and target sites. What brain implants have done for Parkinson's patients is quite impressive. DeRidder is trying to do the same for tinnitus sufferers. Because tinnitus affects so many brain regions, moreover, selecting multiple implant areas makes sense. Of course, implants will be the last resort for those with very loud, intractable tinnitus. But, for the right patient, the implants will be miraculous.

Here is just one of many positive articles on implants for Parkinson's:

http://www.nydailynews.com/life-sty...ry-helps-parkinson-patients-article-1.2172694​

 

The way I see it, if that is of any importance to anyone, is that a universal solution for tinnitus will need to be something directly involved with the auditory cortex - therefore studies like these are encouraging. There are too many causes originating in different areas (hairs, nerves, neck, jaw, etc.) that make it unrealistic to believe there will be the emergence of one drug or treatment directly to the ear to cure it all. The auditory cortex is the last stop. Please challenge me if I'm incorrect or being a jerk about this.

 

You just destroyed all my hope for a cure

Just kidding

 

That would be the most direct way of treating all forms of tinnitus, but it would be hard to imagine for me how exactly it would work, even in that case. Like somehow they would target the auditory cortex with something, and suppress the information causing the tinnitus, even in this case, it may have to be individually tailored, to the individual frequencies a person is hearing their tinnitus at. And even in that case, it would still be somewhat less than ideal, because it would actually be inducing a form of hearing loss,(or even brain damage?) since it is filtering out/suppressing your auditory information at the frequencies where the tinnitus is (of course people with tinnitus would still welcome this). And how would such a solution work for tinnitus that changes pitch? And all the different extreme/bizarre forms of "tinnitus" people can have like "whooshing" or "chimes" etc.

I guess such a treatment, like you say, would be the most direct way of treating tinnitus, but it would not treat the CAUSE of the tinnitus. It wouldn't treat hearing loss, hearing damage, TMJ, brain injury, or neck/back injury, etc.

Ideally I'd really like to see cures that restore hearing function, which would likely include restoring hair cells, neurons, and the connection between them. The end result would be repaired hearing RESULTING in the symptom of tinnitus leaving, in those that have tinnitus for this reason. But of course, it would not likely treat tinnitus originating from TMJ, high blood pressure, etc. (However those kinds of tinnitus already do have better treatments than people with hearing damage/loss).

In a way tinnitus is a symptom, not the disease itself. However, unfortunately, it is such a horrible symptom, that it is often worse than the disorder/disease causing it.

 

DBS (Deep Brain Stimulation) is obviously a hot item these days. Dr. Stokroos (ENT) and Dr. Temel (Neuro surgeon) @ Maastricht University The Netherlands have published a recent paper about it:

Link to: The impact of deep brain stimulation on tinnitus.

Interesting read for academics. Let's hope this is the start of a countdown for a solid solution

 

Good find, I also found this one. Looks like there are multiple efforts headed in that direction.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765244/

I also realize this would just be a bandaid but it would help a lot people feel better in the meantime while they find solutions for their underlying cause.

 

I'm concerned that even when there becomes very sufficient evidence showing that procedures like this are effective for tinnitus sufferers, the more difficult part will be having such procedures become readily obtainable to sufferers. On the Wikipedia for DBS, it talks about several severe conditions for which DBS is very effective at treating/managing, but to my knowledge, it still isn't readily available to people in my country, even with conditions like parkinson's.

 

I know, I hear you. It may be about who you know and where you live.

 

Trust me,if you want something bad enough you can make it happen.

The only thing that limits you is you and that's it.

If this would cure me of tinnitus and hyperacusis, I'd move heaven and earth to get it done no matter what.

Speaking of hyperacusis, is there any info regarding this being effective for hyperacusis?

 

That's a good question. I do feel like they are both reactive in similar ways and connected, hence why a lot of people get them together. I'm going to contact the people from that study and sacrifice myself to them. Today has been a horrible day hence why I'm on this site AGAIN on Christmas.

 

Is this something similar?
http://hyperacusisfocus.org/2015/04...uces-neurological-activity-in-auditory-brain/

 

Is this some form of brain implant?Or is it a neuro modulation device?

 

I have just skimmed the abstract and it said:
"Neuromodulation is an increasingly accepted treatment for neurological and psychiatric disorders but is limited by its invasiveness or its inability to target deep brain structures using noninvasive techniques. We propose a new concept called Multimodal Synchronization Therapy (mSync) for achieving targeted activation of the brain via noninvasive and precisely timed activation of auditory, visual, somatosensory, motor, cognitive, and limbic pathways."

So noninvasive, which means not an implant? I'm not an expert on these things, I just thought it looked like some of the stuff discussed in this thread.

 

In the paper I posted above there is an answer to why they aren't obtainable for most sufferers.

"Neuromodulation is rapidly growing as a treatment option for various brain disorders1 . Clinical outcomes for invasive approaches, including deep brain or cortical stimulation, have been encouraging for some neurological conditions such as Parkinson’s tremors and tinnitus2–5. However, they are used only in a limited patient population due to their surgical risks, high cost, and need for extensive fitting in specialized clinics"

 

This is odd because it says that it is non-invasive which basically means non-surgical but then mentions it's not readily available due to its surgical risk. It think it's just for very very special people... I will email them.

 

Yeah non invasive means not an implant,invasive would be putting electrodes deep wisthin the brain I'm guessing.

My guess is that they are talking about stimulating the skin,auditory brain and other parts at the same times in order to calm down the hyperactivity by maybe placing electrodes on the skin whilst playing different tones or something to that effect,basically VNS is what comes to mind.

What I find interesting is their mention of skin,my H causes my skin to go prickly and stingy so if I hear a noise or sounds that are too much my whole body stings and prickles as a result,this is also a symptom of neuropathy but I found it interesting regardless.

 

Hmm, well come to think about it, the Silverstein round and oval window surgery for hyperacusis is also called "noninvasive" but it's still a surgery so I don't think noninvasive have to mean nonsurgical.

 

Okay, I emailed these guys regarding the study mentioned above - The impact of deep brain stimulation on tinnitus.

My question:
I am a strong believer that a universal treatment lies in stimulation vs pill form for example. Would this also impact all types of tinnitus including ototoxic induced or even drug withdrawal induced?

Their answer:
Tinnitus is indeed a disorder that is associated with a high burden. We think that tinnitus is generated in the central auditory network following hearing loss, e.g. due to ototoxicity, and can also indirectly affect brain stuctures that code for emotion, fear etc. Thus we aim to find a treatment that specifically interacts with this pathologic activity in the central auditory network. Therapies like deep brain stimulation could be a promising treatment also for ototoxic-induced tinnitus.

I like what they are saying and I told them to keep me updated (not sure if they will but I figured it was worth a shot).

 

My personal feeling, not based into anything much scientific, is that a cure to T or H would be more in line with a drug that synthesises very powerful amounts of vitamins and nutrients, and that should be administered shortly after loud noises. There have been tests in the past to measure recovery from NIHL administering prednisone and piracetam after a loud noise, but the results were not much promising, and the effect of these drugs was not very significant. It seems also hard to isolate the effect of a certain drug or treatment from the effect of the mere passing of time, so researchers cannot really say cathegorically "these sample patients improved from taking this drug". Maybe there is just a natural effect of recovery (rebound in hearing thresholds) or improvement from inflammation caused after loud noise by the time elapsed until they measure results.

Personally, unless my T or H were completely unbearable (and I had pretty extreme H), I would not be willing to undergo surgery related to the brain. Surgery on the brain cortex or inner ear, hearing nerve etc could probably have a lot of risks that could outweigh the benefits sought. Just imagine that the surgery does not help with T or H and on top of that creates a new nasty problem, like some problem related to balance or dizziness.

 

Should pick up this thread with what we know about the DCN today.