The Search for a Cure (Responses from Dr. Roland Schaette)

Responses from Dr Roland Schaette, British Tinnitus Association’s Senior Research Associate at the UCL Ear Institute in London

How close are we to finding a cure for tinnitus?
At the moment, we are closer than ever to finding a cure for tinnitus. In the past decade, tinnitus research has made tremendous progress, and we have learned a lot about the mechanisms that are involved in the development of tinnitus. A very significant part of the progress has come from a switch of perspective: although tinnitus can be triggered in the ear, the processes that keep it going and make it a problem are in the brain.,so tinnitus can be approached from a neuroscience perspective. This broadened scope has attracted the interest of brain researchers towards tinnitus, and today more research groups than ever before are involved in tinnitus research. The picture of the mechanisms that lead to the development of tinnitus has become much clearer. I thus expect that the puzzle of how tinnitus arises will be solved within the next decade, and that this will lead to true targeted tinnitus treatments.

Why has clinical research so far failed to identify a cure?
In the past, the major obstacle blocking the way towards a cure was that our understanding of how tinnitus arises had been quite limited. Especially, it was unknown which mechanisms in the brain lead to the persistent, aberrant nerve cell activity that underlies the perception of the phantom sound. Without a thorough understanding of these issues, the potential targets for tinnitus treatments were unclear. However, a clearer picture of the mechanisms of tinnitus development has been emerging in the last decade, and this could form the basis for new targeted approaches towards tinnitus treatment in the not too distant future.

What do we know and what don't we know about tinnitus?
It is now well established that tinnitus is generated in the brain and not in the ear. Moreover, we have learned from animal studies that tinnitus might be linked to increased spontaneous activity of nerve cells in the brain. The development of this pathological hyperactivity can be triggered for example by hearing loss. What we do not know yet is how this happens exactly, i.e. which functional mechanisms in the brain are responsible for the observed changes. However, several candidate mechanisms have been identified recently, and we have also come closer to understanding where exactly in the auditory system these changes take place.

What research is currently being done at UCL?
At the UCL Ear Institute, we pursue an integrated approach to tinnitus research that comprises data collection from tinnitus patients, animal experiments to study in detail the mechanisms of tinnitus development, and computer modeling to derive a comprehensive theory of tinnitus development. We believe that all these building blocks are necessary to gain a thorough understanding of tinnitus, as they form a closed loop: the data we collect from humans and animals is used to advance our computer model of tinnitus, and the predictions from the model inspire new experiments. A recent success of this strategy has been that we could validate a specific prediction of the computer model, when we found physiological evidence for cochlear damage even in tinnitus patients with a normal audiogram.

To what extent is the British Tinnitus Association funding/contributing to finding a cure?
Even though the in the UK alone there are more than a million tinnitus sufferers, it is difficult to obtain funding for tinnitus research, and the number of research groups that focus on understanding this condition has therefore remained relatively small. Funding from a dedicated charity like the BTA thus makes a huge difference. The BTA has funded a post for a Senior Research Associates research at the UCL Ear Institute, where this position has acted as a “condensation nucleus” for dedicated tinnitus research, and thus the BTA has helped to establish a whole new program of research into how tinnitus arises and how it might be cured. Since the post was established two years ago, we have managed to provide new evidence for a common mechanism for the development of tinnitus with and without apparent hearing loss, providing an important piece to the puzzle of the genesis of tinnitus.

What has been discovered in the last 12 months, and how has this improved understanding about tinnitus?
In most cases, tinnitus is associated with hearing loss, and how damage to the inner ear might trigger the development of tinnitus has been studied in great detail. However, a substantial fraction of tinnitus patients has a normal audiogram, and it has been an open question whether tinnitus is caused by the same mechanism in that case, or whether we are dealing with different pathologies that just give rise to the same symptom. We could now provide physiological evidence that also tinnitus patients with a normal audiogram have a certain kind of damage to structures of the inner ear, and our computer model predicts that this kind of damage could act as a trigger for tinnitus. Moreover, our data also indicate that plastic changes that might be involved in the generation of tinnitus already take place in the early processing stages of the auditory system. We have thus come a lot closer to identifying and localising the processes that lead to tinnitus.

What further research would you like to undertake in this area?
In the next year, we firstly plan to continue our data collection from tinnitus patients. Secondly, we want to study the mechanisms of tinnitus development in more detail in animal experiments, and we will specifically tailor the experiments to match the characteristics of our human data. In that way, we can observe directly in the brain how the nerve cell activity changes in a situation that resembles human tinnitus as closely as possible. Finally, we will use our computer model to simulate different treatment approaches to cure tinnitus “in silico”, which will help us identify new approaches to tinnitus treatment. We hope that this integrated approach, spanning all the levels from basic to clinical research, will significantly speed up the search for a cure for tinnitus.

About Dr Roland Schaette
Roland studied Biophysics in Berlin and Zurich. He then returned to Berlin where he did a PhD on Tinnitus and continued working there as a postdoc before starting work at the Ear Institute.

 

if he says 10 years that meens he knows the road map we have to pass/ if he knows the rout let us see it and force some steps to shotten the time

 

No, they just stretch out research time for more funding.

 

From what I hear they have been saying that we are 5-10 years away from a cure for the past 3 decades but now it does seem much more likely that if a cure is going to happen, it may happen this time.

 

dr. Roland ucl. institute London say"today more researchgroups than ever are involved in in t research".
Who are these Groups and what are they doing, does anybody know.They could give us a rapport or a breafing.
We could make 2014 the year of breakthrough, with 3-5 different treatments.

 

To Eik,

In past 3 decades they said we are 5-10 years away from a cure but the predict was wrong all the time because they dind't understand mechanisms that are involved in the development of tinnitus. Now the mechanisms are clear since 2011 when Researchers in the University of Leicester's Department of Cell Physiology and Pharmacology have identified a cellular mechanism that could underlie the development of tinnitus following exposure to loud noises. The discovery could lead to novel tinnitus treatments, and investigations into potential drugs to prevent tinnitus are currently underway.

And in maj 2013 Scientists in the University of Pittsburgh Found Mechanism That Causes Noise-Induced Tinnitus and Drug That Can Prevent It . using epilepsy drug called retigabine,

When researchers now say "we are closer than ever to finding a cure for tinnitus " i believe they mean it and not just predict it because when Mechanisms of the condition is already known so the half way of finding a treatment is already crossed

Now anytime drug can be found and i think is matter of months or max 2 years


To Jes,

Researchers groups are many now, you can take a look at this link

http://www.tinnitus.org.uk/tri-conference-report-2011
Only in this meeting over hundred scientist are engaged to find a cure
http://www.tinnitus.org.uk/tri-conference-report-2011

 

Sorry i mean 200 Researchers from 26 countries,

http://www.tinnitus.org.uk/tri-conference-report-2011

 

(these are only my opinions on what I know about T)

@Dani good post and you make some great points. While it is true that researchers have identified some key mechanisms, there still is much work to be done. Most of the mechanisms they have identified are key to preventing noise induced tinnitus only, not so much in treating those who already have it. Where does that leave the rest of us?

It is great that researchers at the TRI finally agreed this year that T is not really a hearing problem but a neuro/brain issue but I think many of us with T figured that out some time ago. Hearing loss may be a trigger for T in some but that's only a small part of the big picture. Many people I know with T have no measurable hearing loss.

Researchers have been searching for an existing drug to treat tinnitus since the 90s with very little result, this includes several different epilepsy/anti seizure type drugs. Retigabaine does look promising for T, but as of yet has only been tested on mice and only for the prevention of T, not for those who already have it. Clinicals on people would take several years.

For new drugs to treat T, if they have to be researched, produced in a lab, go thru pre-clinicals, clinicals via IND, government approval and bring to market new drugs that takes upwards of 12 years on average. Of new drugs only 1 in 5000 ever makes it to market.

If they can find an existing drug such as Retigabine that proves to work for tinnitus then getting this approved for use for T maybe reduce by 5-6 years if everything goes right.

I am not trying to dash any hopes of a treatment or even a cure. I am not sure how close we are to a cure. They throw the word "cure" around for all kinds of conditions but there are few cures for anything. We can't even cure the common cold. However, a viable treatment for T is a definite possibility sooner than later. Now that researchers agree, they can focus energies and target the areas of the brain they think are responsible for tinnitus and discover those treatments.

We have to be realistic that these things take a long time and tinnitus is woefully underfunded. When the top Tinnitus organization in the world gets a little more than $1 million a year in funding, that is not going to go very far. That is why it is great that private companies such as Auris Medical and Microtransponder can get private funding for Tinnitus research to develop treatments. If a cure is going to be discovered it will most likely be by a company such as these. Stem cells look promising for a number of conditions including T. It is still early but much funding is being pumped into stem cell research.

We didn't choose to have T, but if we have to have this dreaded T, there is no better time in history than now.

I do have hope, in the meantime while I wait, I will do good things with my life.

 

the cure for T will not be prior to ability to control and reprogram brain/ will it be ever?

 

I believe the cure is in the pipeline, we are not being told of it yet. But soon we will be told. I give it 12-18 months and we will have a over the counter pill that will make it stop all together.

 

I am afraid living with a pill for T can lead some of us join another health support pages because of the side effects. On the other hand, waiting for a miracle cure for restoring inner ear means waiting for a revolutionary breakthrough in mediacal science, which we are too far away from.. I think the best cure for most is masking with white noise(did not work in my case) which is first mentioned and suggested by Hippocrates 2500 years earlier.. This is my conclusion from all researches i have looked over.

 

after reading several research papers, I think that tinnitus is the inequation between inhibition and activation. A stressful event might lead to loss of inhibition of tinnitus, while a special type of hearing loss can trigger a special type of disfunction in the inner hair cells. You might still have no detectable hearing loss. but in order to hear no tinnitus you need the hair cells to be sending completely random spikes in silence. but one of the hair cells is sending spikes not in the right timing or randomality then you will hear a sound. Besides, the moment you hear tinnitus you have a small hearing loss - since you won't be able to hear extremely very faint sounds of the same tinnitus tone - the tinnitus will mask those sounds to a small degree.. that's what I believe although many ENTs will tell you that hearing the tinnitus tone does not change the hearing test results.
This is why some people with hearing loss have no tinnitus and vice versa. this is a special type of inner ear cells dysfunction.
Tinnitus probably isn't a true or false phenomena. it is undetectable when there is more inhibition than excitation. if a guy without tinnitus will take klonopin and the moment he stops taking the klonopin he receives a tinnitus (and such withdrawl effects have occurred), then it means that he had tinnitus in daily life - just undetectable - due to natural inhibition.

 

Excellent point. Which is why benzo induced tinnitus is very likely to resolve itself in most cases within 1 year (as the inhibition/excitation balance is restored).

 

I believe this is the case. Stretched funding. The longer these people have jobs.

 

I tell you what If Tinnitus was a symptom of aids it would have been sorted by now.

Right on!!!!!!!!!!!!!

 

i will continue to pray for a cure for all of us, that a cure will come soon and it would be even better if all we needed
to do was take one pill ??? wow..

 

I will be curious once they find a cure. How will they be able to cure all of us with T? That line will too long to measure. How quickly will it be distributed? Will it be too expensive for some of us? Will insurance cover it?

 

so much to look forward too , but cant wait for that day...

 

Thank you for this video!

I'm always a little disappointed to see how basic the level of understanding seems to be, even amongst the 'experts' in the field. When hearing such people discuss the cutting edge of medical knowledge I would normally hope to hear complicated theories that required years of specialised education to understand, instead I hear a few cude models and the word 'maybe' used a lot

What I found interesting, and worrying, in your video was the idea of generating 'phantom sounds' thought the use earplugs in test subjects. I was rather concerned that once the sounds had been 'recognised' the subjects might not be able to forget them (I have the impression that my own tinnitus is my 'consciousness' recognising a sound that was possibly always there).

Happily it sounds like once the earplugs were removed, the test subjects went back to no longer hearing tinnitus sounds. This suggests to me:

1. The cure for tinnitus is a repair to our dammaged innner ears. Make the signal from them normal again and the tinnitus will stop!

2. The suggestion we are hearing that 'tinnitus is in the brain' is wrong. What it sounds like is that the brain is just reacting rationally to a reduced signal that it is receiving from our ears... as also indicated by the hyperacusis which often accompanies it (the volume is stuck on '11').

Attempts to 'regulate the brain' sound to me rather like trying to quieten your HiFi by stuffing socks in the loudspeakers rather than adjusting the amplifier control - surely fiddling with the signal after it has left the ears and once it is in the brain stem will stand the risk of degrading or destroying the good part of the signal (ie. our hearing) as well, but at a 'brain level' rather than at an 'ear level' (shudder... no hearing aid or cochlear implant could fix that)?

I am therefore concerned that the effort being put into 'brain retraining' may prove to be a disappointing dead-end and that the energies/money diverted into this would be better employed developing cochlear imaging techniques so that we can actually see what is happening in the inner ear and regeneration techniques so that we can fix the underlying problems causing these noises.

 

Some useful research but I agree that we shouldn't expect any results soon. One of the big problems is how much research money is diverted into either yet more sound therapy treatments - each claiming to do something new - or into so-called psychology treatments, which actually brand tinnitus sufferers as people suffering mental health problems (just look at the tinnitus wiki entry which scapegoats sufferers as having "neuroticism, anxiety sensitivity, and catastrophic thinking" (I'm not making it up!).

If we could stop all the money going to the psychologists and the sound therapists then we might be able to fund some research which is actually productive.

 

Tinnitus affects one in ten, but only a small percentage of that are bothered enough to commit the cash and effort to treat this condition.

 

There is a "cure" for tinnitus and it would involve using stereotactic radiosurgery such as GammaKnife or Cyberknife to lesion the primary auditory cortices of the brain. The primary auditory cortices are tonotopically organized such that specific regions respond to certain frequencies. Radiosurgery could be used to selectively lesion the specific areas corresponding to an individual's tinnitus frequency range. My tinnitus currently is around 11 khz and I would have that region specifically targeted if it ever got to the point where I could not bear it any longer. For me, spending 10-15k to have this procedure performed somewhere overseas would be well worth it despite the limited loss of hearing to give me quality of life back.

I would be using this type of approach if my tinnitus ever got to the point where I was considering suicide or my quality of life became unacceptably bad. I would recommend exploring this option for anyone in that position now. You would need to convince a radiosurgery team to perform such a procedure but I believe that a high probability of a successful outcome is likely with the proper team and preparation.

I even suspect that full destruction of those specific areas of the auditory cortices wouldn't be necessary, I think that with increasing ionizing radiation exposure, the mechanisms generating the tinnitus tones would decrease in a near linear fashion. Cyberknife was specifically developed to deliver incremental doses of ionizing radiation to target areas and would be an excellent system to deliver this type of therapy.

 

I know that many would trade some or even all of their hearing to be free of tinnitus. There are options now if you are willing to think slightly outside of the box.

 

Per Wikipedia:

As with other primary sensory cortical areas, auditory sensations reachperception only if received and processed by a cortical area. Evidence for this comes from lesion studies in human patients who have sustained damage to cortical areas through tumors or strokes,[4] or from animal experiments in which cortical areas were deactivated by surgical lesions or other methods.[5] Damage to the Primary Auditory Cortex in humans leads to a loss of any awareness of sound, but an ability to react reflexively to sounds remains as there is a great deal of subcortical processing in the auditory brainstem and midbrain.

 

Interesting update on tinnitus research from the past 12 months by Dr Roland Schaette.

"It is difficult to predict when exactly these approaches will make the transition from basic science to clinical studies and beyond, since the devil might be in the detail and more research is still needed, but I am optimistic that it will be in the not too distant future". Someone should ask Dr Schaette what he means by not too distant !


Last updated on 19 March 2014
Roland Schaette on tinnitus research from the past 12 months
What progress has there been in the understanding of tinnitus in the past year?

In the past year, several important studies have been published that have advanced our understanding of the mechanisms of tinnitus. For example, several detailed studies on animal models of tinnitus have managed to show that the occurrence of tinnitus could be due to specific changes in the activity of nerve cells in the brain.
It was observed that in animals with tinnitus, nerve cells in the auditory brainstem (i.e. the first processing stages of the auditory pathway) showed increased activity even when there was no sound present (Dehmel et al., 2012; Li et al., 2013). One of the studies also demonstrated that acute noise-induced tinnitus could be prevented from developing into chronic tinnitus when a drug was administered shortly after noise exposure (Li et al., 2013), suggesting new ways for the treatment of acute tinnitus through timely interventions. (...)

www.tinnitus.org.uk/this-years-progress

 

but which drug?

 

When is a cure for tinnitus likely to be developed?

I believe that we are getting closer to developing a cure for tinnitus, since intensive research efforts during the past decade have laid a solid foundation upon which translational research can now start to build up. We are really beginning to understand what happens in the brain when tinnitus develops, and the latest animal studies have highlighted potential targets that might be amenable to specific interventions. It now looks like it will be possible to develop a pill for tinnitus, or to alleviate tinnitus through specific acoustic and electric stimulation paradigms with longlasting effects. It is difficult to predict when exactly these approaches will make the transition from basic science to clinical studies and beyond, since the devil might be in the detail and more research is still needed, but I am optimistic that it will be in the not too distant future.



nice

 

Retigabine. -G

 

ok, didn't know that... is this drug available?