Novel Tinnitus Therapy Helps Patients Cope With Phantom Noise

Discussion in 'Research News' started by exodus, Oct 30, 2014.

    1. exodus

      exodus Member

      Tinnitus Since:

      here is the article:

      Patients with tinnitus hear phantom noise and are sometimes so bothered by the perceived ringing in their ears, they have difficulty concentrating. A new therapy does not lessen perception of the noise but appears to help patients cope better with it in their daily lives, according to new research.

      A pilot study at Washington University School of Medicine in St. Louis showed that patients participating in computer-based cognitive training and taking a drug called d-cycloserine reported greater improvements in the ability to go about their daily lives than patients who did the same cognitive training but took a placebo. The researchers note that the study was small, involving 30 patients.

      The study appears Oct. 30 in JAMA Otolaryngology-Head & Neck Surgery.

      "We suspect that both the problems and the solutions concerning tinnitus are in the brain," said senior author Jay F. Piccirillo, MD, professor of otolaryngology. "We don't know what causes the ringing. Many people with tinnitus have had ear trauma or hearing loss but not all. And at the same time, a lot of people with ear injuries or hearing loss don't have tinnitus."

      Both groups performed the same cognitive training, which involved computer-based exercises focused on improving processing of sound, speech and memory. Piccirillo and his colleagues were interested in whether the drug could help patients experience the potential benefits of the cognitive training more quickly than a placebo. D-cycloserine has been shown to encourage neuroplasticity, a state in which the brain is more amenable to change, whether in resolving irrational fears or in improving concentration, attention and executive function, a set of mental processes that govern tasks like planning, organizing, problem solving and decision making.

      D-cycloserine originally was developed as an antibiotic and is still prescribed for drug-resistant tuberculosis. More recently, it has been used in psychiatric care to help treat phobias and as an anti-anxiety medication. The idea is that perhaps the drug can boost the effectiveness of brain training to help patients ignore tinnitus, even if the ringing or phantom noise persist.

      "In people unable to ignore tinnitus, there is evidence that some brain networks, including areas of attention, executive function and emotion, are not working properly," said Piccirillo. "We think the cognitive therapy helps our patients change the wiring in the brain, which may help them direct attention away from the tinnitus."

      Therefore, Piccirillo and his colleagues asked whether a drug that primes the brain for remodeling could help patients experience the benefits of cognitive training more quickly.

      "To change the brain, you've got to challenge it," Piccirillo said. "If the challenge is too hard, you give up. But if it's too easy, you get bored. With these cognitive-training exercises, the program is designed to adjust the difficulty so that patients respond correctly about 80 percent of the time. It gets harder as they make progress, but they're always at about the 80 percent mark. The idea is that with d-cycloserine, patients will move more efficiently through the training program."

      Piccirillo likens it to encouraging people to go to the gym. If patients notice a benefit from the training more quickly, they may be more likely to stick with exercising.

      In the new study, the researchers saw a greater improvement in self-reported measures of brain function in the group that got the drug. In questionnaires, patients who got the drug reported fewer instances of forgetfulness and attention difficulties, though they did not perform measurably better on tests of cognitive ability.

      While the results were modest, Piccirillo pointed out the small sample size and the fact that they only asked patients to do the brain training two days per week rather than five. The researchers were concerned that if patients did training five days a week, each patient's performance would improve so much that it would not be possible to see any differences between groups.

      "There is a lot of evidence that d-cycloserine can help people train their brains," Piccirillo said. "It facilitates neuroplasticity and is known to be effective in fear extinction, obsessive-compulsive disorder and anxiety disorders. And now we have evidence that it has some benefit in tinnitus.

      "We would like to perform a larger study with the same brain-fitness program and d-cycloserine, to see if what we saw in this pilot study can be confirmed with more participants," he said.
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    2. Robb
      Question it

      Robb Member Benefactor

      Tinnitus Since:
      Yes I believe them BUT

      Very vague study no numbers etc. of course this medicament helped a bit more than the placebo.
      We need more better indicators that there is a significant reduction in volume
    3. rtwombly

      rtwombly Member

      Southeast USA
      Tinnitus Since:
      Cause of Tinnitus:
      There is a disturbing trend to insist CBT works when the scientific papers - such as the one I just read concerning combining d-cycloserine with CBT for anxiety disorder - suggest it has a spotty record at best. It seems like the scientific community is split between those who think the brain should be changeable by psychotherapy and those who favor drug-induced changes. Maybe it's just hard to quantify the psychotherapy benefits, but it does have the whiff of desperation.

      On the other hand, maybe d-cycloserine would be effective as an adjunct to potassium channel modulation by chemical means.
    4. Sound Wave

      Sound Wave Member Benefactor

      Tinnitus Since:
      Cause of Tinnitus:
      Probably headphones
      Thanks for sharing. VERY interesting. I believe my challenges to focus on things and paying attention in general are linked with my T.
      • Agree Agree x 1
    5. Asian

      Asian Member

      Tinnitus Since:
      4 weeks
      The drug D-cycloserine (DCS), when used with a computer-based cognitive training program, may help in the management of tinnitus, a new study suggests.

      The drug is suggested to act as a partial agonist at the N-methyl-D-aspartate (NMDA) receptor in the brain, enhancing long-term potentiation and thus strengthening new synaptic connections. Previous studies have suggested that it may encourage neuroplasticity of the brain, rendering it more amenable to changes, such as resolving irrational fears or in improving concentration, attention, and executive function.

      In the current study, published online October 30 in JAMA Otolaryngology-Head & Neck Surgery, patients who received DCS did not show a significant reduction in tinnitus bother but did report an improvement in cognitive difficulties associated with tinnitus. The authors say this finding "may be important given the particularly high rate of concerns about cognitive difficulties associated with tinnitus."

      They note that 70% of patients with tinnitus report concentration difficulties and that in a model constructed to predict quality of life in patients with severe tinnitus, no audiologic or psychological variable contributed more to a decreased quality of life than self-reported impairments in concentration.

      Huge Public Health Problem

      Talking in a JAMA podcast, senior author Jay F. Piccirillo, MD, Washington University School of Medicine, St Louis, Missouri, says, "Tinnitus is a huge public health problem affecting more than 60 million people in the US, about 20% seriously interfering with sleep, cognition and causing emotional problems."

      "We think DCS helps people to learn and extinguish fears and other anxiety related complaints. When linked with the computer training program which exploits the brain's ability to remodel itself, the drug seems to help the brain train itself not to focus on the tinnitus."

      The current study involved 34 patients aged 35 to 65 years with subjective, unilateral or bilateral, nonpulsatile tinnitus of at least 6 months' duration. They underwent 5 weeks of twice-weekly computer-based cognitive training with 250 mg of DCT or placebo taken orally before each computer session.

      Results showed that compared with placebo recipients, the patients taking DCS showed a significant reduction from baseline in median score on the tinnitus functional index (TFI; change in score, –5.8 vs –1.0). Although this difference was statistically significant, it did not achieve the value of 13, which is the minimally clinically significant difference. In addition, statistical significance was lost after adjustment for age and duration of tinnitus.

      Reduces Concerns About Cognition?

      However, the drug was also associated with improvements in self-reported cognitive deficits on the Cognitive Failures Questionnaire (CFQ; change in score, –4.5 vs –2.0), which remained significant after adjustment for other factors.

      In attempting to explain why DCS was associated with a statistically significant improvement in self-reported cognitive difficulties yet did not affect objectively assessed cognitive performance or more strongly reduce tinnitus bother, the authors suggest that as the study was so small an effect may have been observed only in the most strongly affected outcome.

      Noting that DCS most clearly augments learning related to reduced fear, they also suggest that in this study the drug may have helped reduce concerns about cognitive performance, rather than learning reflected in scores on objective neurocognitive testing.

      They add that if this is the case, DCS might be more likely to reduce tinnitus bother if the intervention clearly involves exposure to tinnitus-related fears, which was not the case in this study.

      They conclude that future research is needed to replicate these findings, preferably in a larger sample that might allow detection of additional effects.

      This research was supported by a grant from the Doris Duke Clinical Research Foundation, as well as support from the Stanford University Medical Scholars Fellowship. Posit Science provided access to the Brain Fitness Program for all participants. A coauthor reported receiving support from Roche and Lundbeck to conduct research unrelated to that described in this article. The authors have disclosed no other relevant financial relationships.
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    6. cullenbohannon

      cullenbohannon Member Benefactor

      Tinnitus Since:
    7. Robb
      Question it

      Robb Member Benefactor

      Tinnitus Since:
    8. gary

      gary Member Benefactor

      Macomb, MI. USA
      Tinnitus Since:
      Cause of Tinnitus:
      Who Knows
      What I got out of that article was that the d-cycloserine treatments help mostly those who have problems with mental abilities, not tinnitus. Interesting read though.
    9. cullenbohannon

      cullenbohannon Member Benefactor

      Tinnitus Since:
      Hey robb I dont know a whole about the drug but its not suppose to help quiet T, but it seems like it can help one to concentrate and focus better with tinnitus.

      This is from wikipedia. If it could do what it says here then it could contribute greatly in habitation to tinnitus it might be able to help people break the cycle we get into with t which could be a big help in habitation. If you wanted to try it you could talk to your doctor, and give it a shot.

      Psychiatric uses[edit]
      The dextrorotary form of cycloserine has been investigated in numerous studies focusing on fear extinction and addictions in the human and animal model systems.

      Implications in fear conditioning, memory consolidation, and extinction[edit]
      D-Cycloserine, when used in conjunction with exposure-based cognitive behavior therapy, helps with fear extinction in an array of anxiety- and stress-inducing disorders.[8][9] These disorders and phobias are a result of and get perpetuated through pathological fear memory.[8][9] Pavlovianfear conditioning is a notable animal model to induce this form of conditioning in the laboratory and provides an avenue to examine mechanisms of learning and memory.[8][9] In this conditioning model, a neutral and nonaversive stimulus such as light or tone (termed as the conditioned stimulus, CS) is paired with an aversive stimulus, such as an electrical shock to the foot (termed as the unconditioned stimulus, US).[8][9] After these two stimuli are presented together a few times, the animals quickly learn to associate these stimuli together, and elicit a learned response, such as freezing or sweaty fingers (termed as the conditioned response, CR).[8][9]

      The process of extinction (associative learning) entails unlearning this association between the CS and US, and results in a decrease in the frequency of the CR being elicited.[8][9] This occurs by repeatedly presenting the CS without the US.[8][9] By repeating this numerous times, the animals learn to not associate the stimuli together, which can be examined by the decrease in frequency of the CR being elicited.[8][9] Similar to fear conditioning, extinction can be broken down into several categories, such as acquisition (training), consolidation, and retrieval of extinction memory.[8][9] Understanding the circuitry and mechanisms of extinction has strong implications for development of novel therapeutics to be used in conjunction with exposure-based cognitive behavioral therapy for patients suffering from anxiety and stress inducing disorders.[8][9] Another reason for development of pharmacological therapeutics is due to the fact that a decrease in exhibition of the CR may not always be permanent since episodes of renewal can also result.[8][9] Relapse of CR can also occur gradually with time, in lieu of other aversive events or with reinstatement (re-presentation) of the US.[8][9] Likewise, with exposure-based cognitive therapies, an impending limitation is the high rates of relapse.[8][9] For all of these reasons, there is considerable interest in the creation of pharmacological treatments to enhance extinction and reduce relapse rates.[8][9]

      Many studies have shown the extinction process is dependent upon N-methyl-D-aspartate (NMDA) receptors in the basolateral amygdala(BLA).[8][9] D-Cycloserine (DCS) is a partial agonist of the NMDA receptor, where it increases excitatory NMDA neurotransmission by binding to the glycine-binding sites.[8][9] DCS has been shown to enhance extinction retention in rats.[8][9] It enhances fear extinction during within-sessions which suggests that DCS facilitates the learning aspect of extinction.[8][9] Though DCS has been shown to reduce some occurrences of relapse and reinstatement in humans and rats, it does not seem to prevent renewal.[8][9] Nevertheless, considerable interest exists in employing DCS as a treatment for psychiatric disorders, due to its beneficial therapeutic effects in several studies which have employed DCS for anxiety disorders, acrophobia, post-traumatic stress disorder, obsessive-compulsive disorder, and panic disorders.[8][9]
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