Transcranial Stimulation Treatments (rTMS & tDCS & tACS)

This guy actually committed suicide (see page 2) because rTMS worsened his tinnitus, so yeah...

Suicidal Because Noise from rTMS (140 dB!) Massively Worsened My Tinnitus and Caused Hearing Loss

 

@Aussie Lea, I'm following tDCS more than rTMS.

 

I did visit Brai3n last year and I was due to have tDCS (I didn't as other medical issues took hold).

They knew of my hyperacusis (sound sensitivity) but did assure me the procedures were quiet.

Perhaps though this was tDCS rather than rTMS (?)

 

Thanks for that. I wonder how reactive tinnitus would respond to electrical stimulation. A part of me fears it might excite it more, but that’s me going off of just thought.

 

@ErikaS, I don't think it would matter if it's reactive or not. It's a case of whether the stimulus would break up and disrupt the aberrant pattern.

 

When I spoke to Dr. De Ridder about the treatment, and I told him about my tinnitus being sound reactive and changing a lot, he did say he felt it could help stabilise it.

I took that to mean make less reactive.

Obviously this was my take on it.

He basically said he felt that the treatment would help 'stabilise it, soften it a bit and may take a tone or two away'.

I did though get the impression it would stabilise me more than reduce the tinnitus - or if tinnitus did reduce, it would be by a relatively small %.

 

Thanks for sharing, @DeanD... For me, my tinnitus is not loud at baseline, so if it could stabilize the reactivity, that would be life-changing. There is a tDCS specialist two states over from me (USA).

I just did a quick tDCS search in the USA and there is a place in Santa Barbara, California called NeuroField Neurotherapy and it appears tinnitus is listed under their tDCS treatments. Curious if anyone on Tinnitus Talk ventured there.

 

→ The Evaluation of Effects of Electrical Stimulation in Treatment of Patients with Chronic Tinnitus with Normal Hearing Sensitivity

 

“With normal hearing sensitivity” ... are we to assume that this means no hyperacusis and/or reactivity/sound sensitive tinnitus participants?

Just comparing, what we can, to the study you posted previously that targeted the auditory cortex and saw significant results. I wonder which one holds “better” results, and why these researchers chose to target dorsolateral prefrontal cortex over auditory cortex when they note that both are targeted tinnitus treatments.

 

Yes, that's how I interpreted it.

There is a good review paper here of the different positions and types of stimulation:

State of the art: non-invasive electrical stimulation for the treatment of chronic tinnitus

There must be enough evidence now to get some of these methods into a tinnitus clinic. The equipment already exists for other diseases.

Is your tinnitus bilateral?

 

Thanks for the link. Yes, bilateral. It started in right ear (inner ear damage only in right ear) but became bilateral within a month after I had a cold or two. Right ear is still “worse” in terms of reactivity and physically sensitive, but left ear is definitely affected and sensitive as well.

Does it matter if it is bilateral tinnitus with this treatment? I didn’t see anything in the literature mentioning unilateral tinnitus specifically.

I do think those with reactivity could still do this and possibly find benefit, like @DeanD shared, Dr. Dirk De Ridder said it could possibly help stabilize things overall.

 

→ Down-Regulation of Tinnitus Negative Valence via Concurrent HD-tDCS and PEI Technique: A Pilot Study

 

I have a call with a Dr. Nate Bergman next Friday. He is the head of a brain/cognitive wellness center located near Cleveland, Ohio called Kemper Cognitive Wellness. He is board certified in Internal Medicine with expertise in brain health and neurodegenerative diseases. Prior to coming to his current practice, he worked at Cleveland Clinic and co-developed their cognitive impairment program.

They complete brain mapping/qEEG and use nuerostimmulation including tDCS for many conditions. When I called and asked about tinnitus, they reported that they have had tinnitus patients and use tDCS, but results are not as consistent as he’d want them to be. So, he wants to hear my case. I appreciate the response and honesty. I can share his input regarding what he has seen with tinnitus and tDCS if anyone is interested after I speak with him.

 

We all appreciate his honesty. Many say tDCS doesn't decrease the loudness of tinnitus but can decrease the stress of it. About 20-30% seem to get a loudness reduction of around 10%. If you do, it's worth it with severe tinnitus. There also seems to be a lot of variation in how it's carried out; studies are being done to find this out. A personalised approach based on the patients qEEG seems best but even then I'm not overly confident on good results being obtained.

 

Thanks for the feedback. I will share what he has to say. I am chatting with him, and then I have an appointment made with a top neurologist who specializes in seizures and epilepsy to discuss my case and a drug like Keppra. I have talked with 2 friends who are pharmacists and they basically told me Keppra is worth trying. My reactivity is my debilitation factor and literally makes it sound like my ears have actual seizure activity with how my sounds sound and how they change from sound stimuli in my environment or just because. Just educating myself on all options as we wait for Dr. Shore’s device.

 

A little bit of an update from my Friday conversation with Dr. Bergman. Long story short, he referred me to a practice that is literally 5 miles away from my house. This practitioner, Christopher Rauhoff, has the latest equipment and is credentialed in reading EEG/qEEG as well as using the different neuromodulation equipment. I spoke wit this man, again very straight forward and spoke brain waves, neuroplasticity, and hyperexcitability in the brain like no other practitioner I have spoken with. He himself has tinnitus and has managed tinnitus cases as well as hyperacusis cases. He spoke about 2 separate young men who came to him after living in noise-cancelling headphones in the home and being homebound, and he was able to get them both out of the headphones and the house and interacting with the world again. He said "the one still wears earplugs on busy streets and when in louder environments because that still bothers him, but doing much better". Always nice to hear stories, but I need to see and hear the results myself.

I meet with him on Friday to do initial testing. He said in addition to the brain mapping, he also uses an auditory response test, which he says is very useful with cases like mine. I am not sure if it is an Auditory Brainstem Response test, I will confirm this with him when I speak to him again this week. I made it VERY clear that my goal is to calm reactivity and stabilize the tinnitus, then minimizing tinnitus (call it my wish list). He said he believes the reactivity will be "more straight forward" than the tinnitus. I found that comment interesting. I think my favorite part of the who "thing" is his partner, Tiffany Thompson. She is the CEO of her own big practice out in Santa Barbara, CA and is one of the "highest credentialed and experienced" neurotherapeutic practitioners in the US. She is also a brainstem specialist, and they treat tinnitus and hyperacusis patients at her practice as well. She will be analyzing my results with Chris and putting the protocol together with him. He shared that ever since he joined forces with her after attending conference in CA run by her, the results he gets with his patients has increased significantly.

Stay tuned, I guess?

 

I wonder if that's because he believes the reactivity is due in part to underlying hyperacusis (often cited as having more successful treatment outcomes than tinnitus?). I remember discussing reactivity with my audiologist who said she often hears accounts of hyperacusis "aggravating tinnitus" (her words).

Anyhow, thanks for the update, it sounds like you're in good hands.

 

I’m excited for you! Can’t wait for the update.

 

I wonder if you and him think the same thing when the term "reactivity" is used. Is he thinking reactivity in terms of an emotional response to the tinnitus, whilst you are quite rightly thinking of increased volume when exposed to sound?

I had pain and loudness hyperacusis after my worsening, with reactive tinnitus. Now the hyperacusis has gone but the reactive tinnitus remains.

I don't know why this is not a subset on tinnitus patients on their own. Would it be useful to do fMRI and qEEG on these subsets as you could establish a base level and check brain wave changes as sound is played to the patient's ear. The patient could then subjectively rate the loudness and the researcher look for correlates. This serves as a sort of control.

With regards to your treatment, I, like many, would be interested how you get on.

Is the practitioner using magnetic or electric modulation?

 

When I spoke about my reactivity, I specifically explained how my tinnitus responds/reacts/changes/becomes aggravated by sound stimuli in my environment. I then went on to explain to him how I tried Neurofeedback sessions a few months back, and the woman who ran that decided to break apart the protocol and target parasympathetic and sympathetic areas before just doing the tinnitus protocol, and I said “I’m going to be blunt. That did nothing for me or my reactivity, and by the time we got to the tinnitus protocol I was already so fed up I kind of just stopped going”. He said “I’m not surprised”. So I made sure to draw a line and say “Yes, my nervous system is shot, I can’t deny that. But that is not the primary cause of my reactivity. I had sudden hearing loss and nerve damage, and reactivity started before I even got worked up about all of this”.

He will definitely be using electrical stimulation modulation, what else may come up in discussion after my testing remains. He knows my hesitancy with magnetic and understood.

 

I will tell you what. I am blessed enough to have lower level tinnitus as far as volume goes. But my reactivity makes up for it. It’s awful, and it sends my sounds oscillating with electricity components and so so intrusive. So if I only got reactivity under control through this and my tinnitus just stabilized, I would cry happy tears and consider myself 70% cured. Not sure if that is even possible, but damnit I will at least try.

 

New technique to help the brain ‘unlearn’ phantom perceptions to be discussed at tinnitus conference (06/06/2023)

Hosted by the Trinity College Institute of Neuroscience, the conference will also feature a public event aimed at people living with tinnitus.

A new technique which could help tinnitus patients ‘unlearn’ the phantom perceptions associated with the condition will be among cutting-edge discoveries discussed at a conference in Trinity College Dublin this week.

(...)

A gathering of world-leading researchers, technicians, patient support advocates and people living with tinnitus will take place this week in Trinity College Dublin. By bridging the gap between academia, industry, medicine and society, the conference aims to capitalise on ground-breaking new research in tinnitus, some of which is being carried out in Ireland, to open new avenues of clinical practice and patient-engagement strategies.

The conference, ‘Engineering the future of tinnitus: Bridging Academia, Industry, Medicine & Society’, will take place on June 6th – 9th, 2023. It is being hosted by the Trinity College Institute of Neuroscience – home to the Clinical & Integrative Neuroscience lab (Lab CLINT) which is conducting breakthrough research on chronic tinnitus.

By demonstrating that tinnitus is the consequence of altered neural activity in specific brain networks rather than an ear problem, discoveries at Lab CLINT have contributed to a paradigm shift in how we understand the ‘phantom perceptions’ associated with tinnitus and chronic pain.

These breakthroughs are leading to the development of new clinical approaches to treatment including a new method which could be used to unlearn the phantom perceptions experienced by pain and tinnitus patients. Members of Lab CLINT will discuss this research at the conference (more information below).

(...)

The Clinical & Integrative Neuroscience (lab CLINT) in Trinity’s School of Psychology and the Trinity College Institute of Neuroscience is undertaking ground-breaking research on chronic tinnitus and chronic pain. Led by Sven Vanneste, Professor of Neuroscience at the School of Psychology, the lab is advancing fundamental knowledge of human brain function to develop new clinical application and treatment approaches. In particular, the lab is working to further our understanding of brain function, including the ‘phantom perceptions’ associated with tinnitus and chronic pain.

By demonstrating that tinnitus is the consequence of altered neural activity in specific brain networks rather than an ear problem, the lab has contributed to a paradigm shift in how we understand tinnitus. Researchers at the lab demonstrated that tinnitus has different subtypes related to hearing loss. They have also illustrated that similar neural mechanisms play a role in different subtypes, which is also valid for chronic pain such as fibromyalgia and neuropathic pain.

These findings have led to new treatment approaches such as invasive and non-invasive brain stimulation techniques that are used in clinics and hospitals all over the world. A new method currently under development in the lab to activate specific brain circuits could be used to unlearn the phantom percept present in pain and tinnitus patients.

 

I take some issue with this. See the HCN2 thread. Origin of signal? Yes, it spreads through the brain, but origin?

 

Obviously vague about the actual method, hopefully @Hazel catches this and can fill us in.

 

Since Dr. Sven Vanneste is involved in this project, I asked the Brai3n clinic about this 'new' technique. Their answer: it's about... Lenire.

Sigh, sorry for placing this misleading article, fellow Tinnitus Talkers. I really got my hopes up, but this news is such a downer.

 

Hmmmm... it's strange indeed. However, I'm not surprised that the social media team of Brai3n miscommunicated about recent or new developments in the research field of tinnitus, as I've heard from several people that they've experienced similar things.

Anyway, thanks for sending hope to us with this news! I'm looking forward to your post about Dr. Vanneste's device in the TRI thread.

 

Hey all,

So I just got back a little bit ago from my follow up with my neuromodulation practitioner, Chris, following my brain mapping this past Friday. It was close to a 2-hour follow up, so I obviously can't share every detail nor would I want to bore anyone, but for the first time in a long time, I feel SEEN and HEARD, and dare I say, a little hopeful?

As I said, my testing was completed this past Friday. Chris analyzed the data himself, then met with a virtual "round table" of practitioners that are mainly across the USA but he said there were some from the UK on the call as well. They gather every so often to discuss case studies, analyze brain mapping data, provide opinion on treatment protocol, etc. I should say this is not tinnitus focused group, it is an array of neuro conditions but tinnitus and sound sensitivity cases have been brought up and discussed. On the call was Dr. Nicholas Dogris, CEO and co-founder of Neurofield Neurotherapy Clinic located in Santa Barbara, CA. This is apparently one of the leading neuromodulation clinics in the USA. They create and sell "top of the line" neuromodulation equipment, which is the equipment my practitioner uses. Their equipment is also used by top universities in California for research and across the states in other clinics, so I feel good knowing that.

I feel very fortunate because not only was my brain mapping analyzed by Chris, but it was discussed with this group including Dr. Dogris. Furthermore, I feel very fortunate that my brain mapping results speak for my condition. I was told that this is not always the case, meaning they aren't always able to look at results and see "wow, it's right there". Fortunately, my brain mapping is very telling.

If you know what brought me to this tinnitus world, it was an ear infection in my right ear that went into the inner ear and caused never damage. I wasn't treated with any steroids, so that inflammation and damage just sat in there. On my brain mapping, right in my right temporal and parietal lobe area above my right ear, I have a huge Gamma presence that is "not normal at all" per Chris' explanation. He said "we only see something like this in different parts of the brain that indicate things from brilliance to schizophrenia". He said for me, this indicated physical trauma, damage, etc. This large presence of Gamma is hyperexcited waves with high energy. This, to him and the others, was the visual confirmation that something big happened here and is now a Gamma mess.

Other notable takeaways:

• My frontal cortex area is working double overtime.
• There is a right posterior area that is directly related to trauma experiences, sense and safety of self, sense of self in the world, etc. He said this area is showing just as significant dysregulation as the above Gamma area is. This makes sense if you were to read my support thread about trying to become a mom and the amount of trauma I have endured over the past 1-4 years.
• My brain thinks it is in constant danger and acts as such.
• My left auditory cortex seems to be trying to compensate for my right.
• There is a breakdown along what they call the "motor strip" that is networked in with sensory input.
• Due to areas of dysregulation, they are affecting specific networks across the brain, all trying to compensate for what was lost, but obviously not successfully.

Something that was interesting, while they were going over my results and saw this huge Gamma presence in the right temporal and parietal lobe area not only during the EEG but in an auditory task, Dr. Dogris, who has seen and analyzed so many of these, had never before seen what I was showing.

So for treatment, with keeping in mind that I am most debilitated by my sound reactivity, followed by the tinnitus, Chris said 90% of the time, they start with the areas of trauma, emotions, etc. to calm down the brain and work from there to the "bear". But given my case and mapping, Dr. Dogris said "Honestly, go right for the bear.". Meaning, we are going first start with attempting to untangle and calm that Gamma mess at ground zero, then go from there. He will be using an array of neuromodulation techniques, mainly electric currents. I will be more specific with what exactly as I move forward. Also, I am doing one more evaluation on Thursday with a partner of his that is a brainstem specialist with expertise in areas of sensory and motor. He feels her findings will only help assist our intervention plan moving forward.

As of now, I will do 10-15 sessions, then retest. Last but not least, he said that he likes how variable and responsive my tinnitus is, even though that's what drives me crazy about it. Be he feels this variability and how it can change may be to our advantage. I know the proof will be in the treatment, but I couldn't have asked for a more comprehensive review of findings and just that validation that something's gone very awry, and I found someone who seems reliable and eager to try help improve it.

 

I start my treatment on Monday. It appears we will be starting with transcranial random noise stimulation (tRNS) approach. On the NeuroField Neurotherapy webpage, they state that this is currently their most effective treatment for the condition. I found their below write up about it interesting...

I just wanted to share this information as I go about this. Although I seem to be a good candidate for this as I happen to show a crazy excess of gamma near my right auditory cortex, with my reactivity component, I always get nervous when I see that an area of my brain will be "stimulated" as my mind goes to being heightened, so I am going to ask questions with this in mind as I do this.

Just a reminder, I am not going to the actual NeuroField Clinic that is in CA, I am working with a local practitioner who has been trained by them and uses their equipment.