PILOT: Vote on Your Favourite Research Paper!

As a whiplash sufferer, the auditory radiation findings make me absolutely sick. Although my specifically unilateral tinnitus & hyperacusis make me feel better that it’s more likely direct auditory damage...

 

I wish I had the time to read them all

EDIT: Stupid me. I'll try to read all the abstracts. But to be fair, it's hard to judge a paper by its abstract.

 

I'll look at these more closely this coming week, but from scanning the titles none of these seem to fit with any of the reasons, raised by BTA, for why there is no cure for tinnitus.

TC

 

Can’t see: Finally a cure for tinnitus!
That one I will read

 

Voted for: Abnormal Spontaneous Neural Activity of the Central Auditory System Changes the Functional Connectivity in the Tinnitus Brain: A Resting-State Functional MRI Study

Not sure if that was the best choice but I want research to focus on treatments that can actually reduce tinnitus loudness, understanding the mechanisms behind tinnitus would be an important first step.

I'm genuinely surprised by how many voted for the paper on reduced tinnitus-anxiety.

 

This, for that reason.

 

Below are my remarks on the publications (I am interested in the bolded ones: 2,5,6,7,8,9,13,14). Since we have to chose just one study, I chose n°8.

1) In which parts of the body is this arterial stiffness measured? All over the body? Is the stiffness the same all over the body? We need the full article to know.

2) How did they measure the quality of sleep of patients before the occurrence of tinnitus? a questionnaire asked afterwards is not reliable. Ideally, polysomnography should have been done before and after the onset of tinnitus. "suggesting that the sleep quality of the past may have an impact on tinnitus occurrence" seems interesting but needs further investigation like "can sleep apnea cause tinnitus?", since some people awake with tinnitus (one more subtype of tinnitus).

3) It's about mice (animal model reliable?), and just salicylate induced tinnitus (a particular cause of tinnitus, which may cause a particular damage in the inner ear). The compound is given prior to the salicylate (in order to prevent, not to cure). The outcome is anxiety-behavior, not loudness. Though salicylate is the most used drug in the world, I have not found any member in this forum, who has "aspirin" as the cause of his/her tinnitus.

4) An umpteenth review of CBT versus no intervention or other therapies. The conclusion sentence "CBT may be effective in reducing the negative impact that tinnitus can have on quality of life" is contrary to the results and even is contrary to another conclusion sentence "Overall, there is limited evidence for CBT for tinnitus improving anxiety, health-related quality of life or negatively biased interpretations of tinnitus". It proves that CBT must be definitely abandoned.

5) It concerns this : https://www.tinnitustalk.com/threads/take-part-in-the-comitid-study.21572/. So if I understood correctly, the next step is "to identify and evaluate suitable measurement instruments". So process still in progress...

6) This area of research can be interesting for those who appreciate to have a sound masking their tinnitus (or divert attention) and/or have a long residual inhibition timeset. Though so far, researchers admit it is a temporary relief (will there be one day a permanent therapeutic effect?)

7) Is fibromyalgia the cause of tinnitus? (74.3% of the patients), it is not specifically written. If it is the case, it would be interesting to know the mechanism of action of this disease on the inner ear/brain (one more subtype of tinnitus). Prevalence of fibromyalgia is 2 to 8% among the population.

8) This is exactly the kind of study that needs to be led. We use an imaging tool (in this case RS-fMRI) to screen a difference between a group of tinnitus sufferers and a control group, before and after a drug or acoustic intervention (in this case an acoustic intervention). However we need to read the full article since tinnitus loudness, THI... before and after treatment are not mentioned.

9) It is a case report for someone who needed a Auditory Brainstem Implant (so a rare subtype of hearing loss, much more than CI). I am impressed by this sentence: "Comparing the ABI OFF and ABI ON conditions, significant increase in regional cerebral blood flow (rCBF) was observed in brain areas involved in the salience network showing already suppression of tinnitus only by electrical stimulation in the absence of auditory stimuli". Does it mean that whatever the cause of tinnitus, an ABI can switch off tinnitus? It means a lot and needs further investigation.

10) It is a case report. So we can see that a part of the brain named auditory radiation has been injured, may be the cause of the onset of tinnitus. And so, can we treat this part of the brain? We need the full article.

11) This time, it is a Auditory Brainstem Response study about unilateral tinnitus (difference between tinnitus ears and non tinnitus ears) with no significant results. From what I know (https://www.tinnitustalk.com/search/3875428/?q=auditory+brainstem+response&o=relevance&c[node]=4) ABR is not a relevant tool to measure tinnitus.

12) It is a protocol. Anyway, it is about Ginkgo Biloba: at the very least, this will be for tinnitus patients who have vascular issues. FYI, Systematic rewiew already done several times:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157487/
http://www.tinnitusjournal.com/arti...of-tinnitus-an-updated-literature-review.html
https://www.cochrane.org/CD003852/ENT_ginkgo-biloba-for-tinnitus

13) Like n°8, We use an imaging tool (in this case RS-fMRI) to screen a difference between a group of tinnitus sufferers and a control group, though both share the same issue (SSD). "These findings... suggest tinnitus biomarkers to monitor treatment response and to target specific brain areas for innovative neuromodulation therapies.". Though no treatment has been tested.

14) Like n°8 and 13. Relevant study. RS-fMRI seems to be a good tool to investigate tinnitus. Though no treatment has been tested.

15) Like n°3, it's about mice (animal model reliable?), and just salicylate induced tinnitus (a particular cause of tinnitus, which may cause a particular damage in the inner ear). However, they find a factor (VGLUT3) which may be responsible for tinnitus.

16) Well, nothing we don't already know. All this data, a priori collected by a tinnitus clinic, could be included in a large database (biobank).

 

I went with
"Is there an association between the parameters of arterial stiffness and tinnitus"

I am a believer that my tinnitus is inducted my "something" in the neck - jaw and also I've had hypertension. So that is what made me go for that. (I did not have the time time read all the papers - abstracts).

 

I mean yeah, from the look of the votes people just go by the titles of the studies. I think the DMT one would never be as high if people saw it was only tested on mice.

Thank you for the post, I began to do one like it but you beat me to it . I have more or less the same choices of studies i.e. one looking for biomarkers or testing treatments in humans. Chose number 8 because from my understanding it does both.

I don't know if it could be implemented, but having multiple choices up to 3-5 would maybe be more meaningful. I chose number 8 but it was a close tie with number 14 and I saw maybe one or two more interesting one.

 

Research needs to focus on hard science.

Tinnitus researchers need to do deep physiological, biological, otological and neurological research and so on, but this obviously depends heavily on research into technological advancements as well (imaging techniques for example). These fields need to be heavily funded.

Tinnitus researchers need to collaborate and avoid doing the same studies. Research that has been done already should be highly discouraged. Confirming previous findings is a must, but continuing pointless research over and over again is really frustrating.

Since there is a lack of funding in general, imo all research which doesn’t go in the direction of the main problem(s) should be abandoned. All studies who look at edge cases preferably also.

Dr. Shore, Dr. Rauschecker and others should have an abundance of resources, yet money is wasted on yet another study on CBT, ginkgo and so on.

It seems that everybody researches what they want, in their corner. There’s a complete lack of overarching organisation into tinnitus research.

1. Specific case that can be treated already. Anything related arteries and blood pressure has treatment options, including just living healthier.
2. Circumstantial causes of tinnitus are not very interesting and hard to prove. It’s like studying if noise could be a cause. We need to focus on the exact pathology of all tinnitus subtypes and see how it can be resolved once it’s present.
3. Anxiety research needs to be abandoned. Comorbidity research is a waste of time as it does not address the main problem. Drugging up is not the answer and creates new problems. It is a very slippery road to take when trying to treat severe problems with hallucinogens. I would warn people to not take them as they can cause Hallucinogenic Persistent Perception Disorder (HPPD) which is very similar to VSS and this is way worse than just having tinnitus. It destroys your life. You can go on r/HPPD and see how hallucinogens have affected people. This research is dangerous imo. The same goes for ketamine research to treat depression which seems to be on the rise. Disassociation is not the answer. It will permanently change who you are.
4. Anything psychology related should not receive any funding. It contributes little to nothing and in fact stands in the way of progress by consuming the little resources tinnitus funding gets. CBT research should be entirely abandoned. I cannot believe this continues to get funding while for example this study itself states that it may help, but there is little evidence. Is that science? This completely blows my mind and more studies of this kind will continue to receive funding. There is an obvious major bias there by CBT researchers who want to be sure that they don’t impact their own business. There is no evidence it may help, but they will state that it may help?! Statements like “it may help” have no business in a scientific research paper.
5. You can measure and define tinnitus characteristics any way you want. It’s still going to be subjective. Research needs to move forward towards objective measuring of tinnitus and keep subjective measurements secondary. There can be some value, but I find it hard to accept that it takes so much research (decades) to get to a uniform classification model. It shows how disorganised tinnitus research is. >>> I would love to see a global patient database being built with all possible data that could be useful for research. We shouldn’t wait for researchers, they will simply waste 10 years of research on defining a model. At that time there will still be no data collected. It would be so awesome if such global patient database could be built in or around Tinnitus Talk. Researchers would be able to readily access Tinnitus Talk to have contact with specific tinnitus patients or perform analysis on the broad set of data.
6. All forms of sound therapy or acoustic stimulation research are likely not (that) valuable. The solution for tinnitus will never come from external sounds imo. Residual inhibition is very short term and even if you can find a way to achieve a continuum, you will still need to stimulate your hearing continuously with another sound.
7. At first glance it seemed interesting, as I’m interested in the correlation between fybro and tinnitus, but this will probably not be addressed. The abstract is too short to get an idea on it. Critical remarks could be however the usage of THI to assess efficacy and that pregabalin may actually be a cause of tinnitus as well, so a study of one month may lead to wrong conclusions. Pharmaceuticals that influence GABA receptors are probably best to avoid in the long term.
8. This refers to an interesting finding (altered functional connectivity in the thalamus) and I would rather learn more about this finding itself. It states that sound therapy desensitizes tinnitus, which is again not focussing on the real underlying cause, but reaction or feeling in regards to tinnitus.
9. Very interesting case study. Bit confused though if we’re actually talking about tinnitus reduction or masking as they introduce 70dB white noise to the ABI.
10. More proof that tinnitus can originate in the brain itself without any cochlear damage, but this was already known. An interesting case to be added to the data.
11. Would be good to have a better understanding of the following statement: “Our result that ABR changes were not found between tinnitus and non-tinnitus ears implies that tinnitus does not simply originate from the defect of the peripheral auditory system. It conforms to the contemporary theory that a higher level of the brain is involved in the generation of tinnitus.” and “Our result may support the non-auditory gating theory, but further studies of functional evaluation is required.” This is what I’m also afraid of. The theory of cochlear damage directly leading to tinnitus is too simple. This probably refers to Dr. Rauschecker’s work. It is also aligned with the hypothesis on visual snow syndrome (failing filtering mechanism at the level of the thalamus).
12. Ginkgo is a blood thinner and may help some tinnitus patients with tinnitus related to blood pressure. I don’t see what the value is of further studies in this regard. Ginkgo does nothing for 99% of tinnitus patients and the BTA has a page where it states it might even make tinnitus worse. If Ginkgo worked we would all know it. How many times has this been studied and how many more times are we going to study Ginkgo in the future. The section regarding tinnitus pathology however is a very interesting summary on potential tinnitus causes.
13. “These findings support a striatal gating model of tinnitus and suggest tinnitus biomarkers to monitor treatment response and to target specific brain areas for innovative neuromodulation therapies.” Finding objective biomarkers is very valuable, especially if they could lead to neuromodulation treatments.
14. Neurological research is very valuable to determine the involved brain networks.
15. No immediate comment. Could be an interesting finding.
16. “We found a statistically significant correlation between tinnitus and comorbidities like anxiety, depression, TMJ disorders, dysthyroidism, headache and levothyroxine and PPI intake.” I wonder how many times researchers have analysed the correlation between tinnitus and anxiety and depression. Something that is obvious. All patients know this. Anyone with a logical mindset knows this.

So I would say the best research is 9, 10, 11, 13, 14 and 15. Without going into deep detail all of this seems valuable to some degree, all the rest seems to be questionable to some or large degree.

9 and 10 are case studies. 9 seems very interesting, but needs some more clarification imo.

11 is interesting, but it doesn’t really provide anything new?

13 and 14 is deeper neurological research and is probably the most valuable.

Since I only have one choice, I’ve chosen 14.

 

I want to second Hazel's thanks for taking a deeper look into this.

I've got to be honest, I skimmed over the docs but it's all very dry reading to me and I just don't have the predisposition for digesting this kind of stuff. Nevertheless, I also believe 13 and 14 are the best finalists to choose from. @Frédéric's post recently about the new high powered MRI machine was brilliant. Hopefully a machine like this is going to bring us one step closer to what I think at this point will be the Holy Grail, which is for doctors to be able to "see" tinnitus. Absent this ability in the present, I'll choose research number 13 because I believe a model of - biomarkers to monitor treatment response and to target specific brain areas for innovative neuromodulation therapies - is going to offer us the best potential for relief within the short to medium term.

 

It was a very difficult choice between 13 and 14. Research #13 is definitely a great choice as well.

 

About the study, I see, that is a very important viewpoint and not something I’ve heard before and clearly misunderstood that this was the intention of the study. Let’s hope this becomes more common. As you say it’s usually the other way around. So that is a good point indeed.

About the data collection:
Happy to hear that Tinnitus Hub considers this a good idea and that in fact you’ve already been thinking about this. I feel it could be invaluable. I fully understand that it takes resources (time, money and skills), but it’s great to hear that we agree on the value this could bring. I also know that it’s easier said than done. Long term project for sure. There’s certainly a lot of complexity involved.

This site has 30,000 members though. Surely there must be some skilled data model designers and programmers on the site? Maybe some people would like to volunteer and work out a proof of concept? I don’t know of course, maybe I’m dreaming.

 

Welcome to the winning team.

 

I voted for number 14 and it turned out to be in the lead.

 

I choose that one as well and happy to see it is the winner.

 

None of them.

The papers talking about inner ear implants that seem to (successfully, if I recall) suppress tinnitus via electrical stimulation of deafferentated neurons (for which there is, inexplicably, no follow up or current research that I have noticed) is where all energy should be aimed, besides for Frequency Therapeutics' ideas, etc.

I don't know why the aforementioned isn't a research priority. It seems well within reach.

I.e., this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591848/

 

This is the first I hear about this.

 

I as well, before I found it.
Anyone know why more research isn't being done into this area?