Treatment Prospects: Vagus Nerve Stimulation

Have you heard back from MicroTransponder yet? I sure hope you are accepted.

 

This sounds like it's got a lot of potential. The only drawback is that it requires implantation of the device through surgery. Shouldn't someone being doing a trial using CerboMed's VNS stimulator, which doesn't require surgery???

 

Nice find! I've never heard of t-VNS. But here's information on their proof-of-concept trial for epilepsy. I wonder if this technology could be adapted for tinnitus?

http://www.ncbi.nlm.nih.gov/pubmed/22554199

http://www.fiercebiotech.com/press-...ive-intermediate-results-epilepsy-pilot-study

 

Here's by the way the manual of the VNS device I tried. Costs about 300-400€ and the local Tinnitus clinic in Helsinki sells these: http://www.tinnitus.fi/fi/Tinnitusklinikka/ETUSIVU/

 

The only good surgery is invasive surgery, IMO.

 

The National Institute of Deafness and other Communicable Disorders ( NIDCD) recently granted funding for a clinical trial that will seek to find a therapeutic cure for Tinnitus, which causes a persistent buzzing sound in the ear. The grant (U44DC010084) from the National Institutes of Health (NIH) will support new research, which is being conducted with the help of a co-operative agreement with Dallas-based medical device company MicroTransponder, and will seek to test new methods in treating the condition.

Tinnitus is a condition which affects around 24 million Americans, with 10% of the patient population presenting with a persistent ringing sound that lasts for 5 minutes or more, and about 10 million patients who are afflicted enough to seek medical treatment. It is a condition which develops with aging, and is the leading cause of disability in veterans returning from Iraq and Afghanistan.

In recent years, scientists have worked to better understand the what causes tinnitus. Hearing impairment occurs when the sensory cells of the inner ear get damaged and hence they cannot transmit nerve impulses to the brain. A monotonic map, which traces the auditory pathway from the ears to the brain, has been created part of ongoing research into the condition. This pathway (which is currently just a concept) consists of nerves (neurons) transmitting sound waves of various frequencies to the brain in the form of signals. Due to hearing impairment, certain frequencies are not processed by these neurons, and hence the brain does not receive them. This condition corresponds to the distortion patterns of neurons in the auditory cortex. The brain then tries to regain these frequencies by amplifying the signals of the neighboring neurons, which in turn results in them responding more strongly leading to persistent ringing or the wheezing sounds.

The technique used in this regard is the Vagus Nerve Stimulation (VNS) technique — a technique confirmed as safe and effective by UT Dallas researchers previously — with the help of the “Serenity System.” Here, patients are given headphones with a series of single frequency waves being fed in, paired with stimulation to the vagus nerve (extending from the head to the abdomen). These signals encourage the release of neurotransmitters (acetylcholine, norepinephrine, etc.) that encourage neuroplasticity, which are then processed by the brain.

 

UT Dallas study: Initial success for new tinnitus treatment
Posted on January 11, 2014by vnstherapy
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UT Dallas study: Initial success for new tinnitus treatment
by PressRelease • January 10, 2014 • 0 Comments
UT Dallas researchers have demonstrated that treating tinnitus, or ringing in the ears, using vagus nerve stimulation-tone therapy is safe and brought significant improvement to some of the participants in a small clinical trial.

Drs. Sven Vanneste and Michael Kilgard of the School of Behavioral and Brain Sciences used a new method pairing vagus nerve stimulation (VNS) with auditory tones to alleviate the symptoms of chronic tinnitus. Their results were published in the journalNeuromodulation: Technology at the Neural Interface.

VNS is an FDA-approved method for treating various illnesses, including depression and epilepsy. It involves sending a mild electric pulse through the vagus nerve, which relays information about the state of the body to the brain.

“The primary goal of the study was to evaluate safety of VNS-tone therapy in tinnitus patients,” Vanneste said. “VNS-tone therapy was expected to be safe because it requires less than 1 percent of the VNS approved by the FDA for the treatment of intractable epilepsy and depression. There were no significant adverse events in our study.”

According to Vanneste, more than 12 million Americans have tinnitus severe enough to seek medical attention, of which 2 million are so disabled that they cannot function normally. He said there has been no consistently effective treatment.

The study, which took place in Antwerp, Belgium, involved implanting 10 tinnitus sufferers with a stimulation electrode directly on the vagus nerve. They received two and a half hours of daily treatment for 20 days. The participants had lived with tinnitus for at least a year prior to participating in the study, and showed no benefit from previous audiological, drug or neuromodulation treatments. Electrical pulses were generated from an external device for this study, but future work could involve using implanted generators eliminating the need for clinical visits.

Half of the participants demonstrated large decreases in their tinnitus symptoms, with three of them showing a 44-percent reduction in the impact of tinnitus on their daily lives. Four people demonstrated clinically meaningful reductions in the perceived loudness of their tinnitus by 26 decibels.

Five participants, all of whom were on medications for other problems, did not show significant changes. However, the four participants who benefited from the therapy were not using any medications. The report attributes drug interactions as blocking the effects of the VNS-tone therapy.

“In all, four of the ten patients showed relevant decreases on tinnitus questionaires and audiological measures,” Vanneste said. “The observation that these improvements were stable for more than two months after the end of the one month therapy is encouraging.”

Researchers at the University Hospital Antwerp, Belgium, and MicroTransponder Inc. also contributed to the study.

A larger study involving four different centers will soon begin in the United States.

 

Long term, I'm not sure the benefits of vagus nerve stimulation will outweigh its risks. I know, for example, that they remove the device implanted in your chest after you've attained--or fail to attain--relief. But I also read that they keep the clip attached to your vagus nerve. Apparently, researchers believe that to remove the clip might cause more damage than leaving it alone.

Does anyone have information on this?

 

Does anyone know why they only accept people with tonal tinnitus and not with hissing? Is it just more simple to research like that or smth?
It sounds pretty invasive though so I suppose it would an option for people with severely intrusive tinnitus only.

 

There's a general consensus--from what I've read--that tonal tinnitus is easier to treat than mixed or narrow band (e.g., hissing) tinnitus. It's interesting that some researchers consider hissing a type of tonal tinnitus; the hissing sound involves more frequencies (and hence damage?) than a single tone. That said, most researchers will distinguish between pure tone and noise-like tinnitus. There are some differences regarding brain areas that are activated between the two tinnitus types, according to one 2010 study:

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0013618

The Differences in Brain Activity between Narrow Band Noise and Pure Tone Tinnitus

Abstract
Background
Tinnitus is an auditory sensation characterized by the perception of sound or noise in the absence of any external sound source. Based on neurobiological research, it is generally accepted that most forms of tinnitus are attributable to maladaptive plasticity due to damage to auditory system. Changes have been observed in auditory structures such as the inferior colliculus, the thalamus and the auditory cortex as well as in non-auditory brain areas. However, the observed changes show great variability, hence lacking a conclusive picture. One of the reasons might be the selection of inhomogeneous groups in data analysis.

Methodology
The aim of the present study was to delineate the differences between the neural networks involved in narrow band noise and pure tone tinnitus conducting LORETA based source analysis of resting state EEG.

Conclusions
Results demonstrated that narrow band noise tinnitus patients differ from pure tone tinnitus patients in the lateral frontopolar (BA 10), PCC and the parahippocampal area for delta, beta and gamma frequency bands, respectively. The parahippocampal-PCC current density differences might be load dependent, as noise-like tinnitus constitutes multiple frequencies in contrast to pure tone tinnitus. The lateral frontopolar differences might be related to pitch specific memory retrieval.

I believe that such distinctions, like between tonal and noise-like tinnitus, will result in the development of more effective therapeutics.

 

There seems to be more and more positive evidence of VNS together with audio stimulation. Since we have our own DIY Acoustic CR Neuromodulation approach which seems to give instant relief to some of us, what would happen if we pair VNS treatment to that? I have to seriously think about buying that external VNS device I tried quickly in the past and give it another try...

 

I found another t-VNS device: http://www.cerbomed.com

 

Ugh. I'm scheduled to go to UT Dallas this summer and they told me I'm not eligible for their trial until I waste my money on TRT. God damn it.

 

Why do they want you to do that? To only get the people who can't be helped any other way?

 

Yeah they want the severely ones that didnt find any relief from trt or counseling

 

hmm. guess it would work to say that you're suicidal and that TRT is not an option

 

I think anyone that has t and is bothered should at least try trt if not counseling or neuromonics then at least you can say you tryed it and if it doesnt help then you know it wont help you.

 

She says that she used a unique approach and it has shown high effectiveness in actually altering the perception of tinnitus. She's associated with the Microtransponder initiative so she's not without credibility. Still, it's a lot of money to spend for something in still highly apprehensive towards.

 

But it's nonsense. If I haven't habituated in five excruciating years, it's not gonna happen. I'm not even going to humor them at this point. Especially when we know more than the councilors. All they can do is tell you it's just a noise in your head and you'll be alright. No really, that's all they can do is patronize us.

 

Yeah five years is along time.. Im sorry :-/

 

it's normal, their policies state this : the applicant failed at least one tinnitus therapy (such as a counseling or sound therapy).

you can say that you failed CBT , shrink etc etc

 

Just curious guys as I cant find any info but does anyone know how this concept works really??How does stimulateing the vagus nerve stop the noise.Does it calm down electrical activity in the brain somehow??Also I read somewhere theyre not accepting people with H any ideas why??Sorry if this has been answered already

 

Somebody nicknamed @bluethundr on Twitter has been accepted to the Microtransponder trial. At the time of writing this, it is his/her most recent tweet. Just thought I would put that information here in case others also wanted to follow along.

 

In a nutshell, the technique attempts to make use of the brain's own natural ability to plastically adapt to new stimulus. In theory, each time your brain is learning something or adapting to changing conditions in a new way, there is plastic reorganization taking place at some level. Researchers have known for a while that the Vagus nerve is highly involved in that. Stimulating the vagus nerve releases chemicals in the brain that tell the brain to "remember" something, or make it a higher priority to. The idea is that if you stimulate the vagus nerve at the same time you play tones above (or above and below concurrently) the frequency at which the tinnitus rests, you can lessen the tinnitus percept. This has to be done over and over for a good deal of time for the brain to basically say to itself "these new tones are more important, I'll devote resources to these new tones". In theory, the tinnitus then lessens, and the symptom is alleviated to a good degree. The phase I study was not geared to show efficacy, just safety. Selection of quality end points has always been an issue in clinical trials for tinnitus, so I wish them the best of luck. This does look promising, and is based on a lot of what has been learned in neuroscience in the last couple of decades.

Incidentally, the reason they don't want anyone who is taking psychiatric medication is that they believe these drugs that decrease or enhance naturally occuring neurotransmitters actually block the ability of the brain to plastically reorganize to a degree.

 

Five years? Buddy, we have the rest of our God given lives.

The ride never ends!

 

You can think that.. But not to
Me.. Maybe 40 years ago yeah but not these days!

 

Thanks for your response Hudson really appreciate it but is there any info regarding possible use for H??I believe my H to be brain related so was curious if this could help.

 

I am scheduled officially to meet the lead audiologist involved with TE project. Shawna Jackson. She was a very nice woman who explained the finer points of how this works and after trying another route she will consider me for the study.

 

Good luck.