UCI — Acoustic and Electrical Stimulation for the Treatment of Tinnitus

Aren’t they recruiting for it?

 

It’s a trial. Not approved yet.

 

They are still working on it - trying to develop a device that can be used on ongoing basis. The results from the trans-tympanic stimulation are just transitory as others have said. Once the current stops, the tinnitus comes back.

Like Gb3 noted it was a trial. Not an approved therapy. Free to participate in the trial of course (in fact you get paid $15-20 per hour), but the primary goal is to collect data rather than treatment.

Interesting experience though if you have the time and resources to participate.

 

@Hope, I think it's too expensive for health insurance. The chances of success are similar to those of CI implants - the electrical stimulation will eliminate / improve the tinnitus in most cases. The CI operation is not approved / paid for because of tinnitus - only in the case of deafness.

 

Does anyone have an update from the UCI trial? I’m trying to find a contact to email for status. If anyone has an update before I attempt to do that it would be great.

 

Contact: Hamid Djalilian, MD, tinnitus@uci.edu
Contact: Sahara George, BA, tinnitus@uci.edu

 

Please let us know what you hear back. This seems like it could be a great stepping stone (or even long-term solution) as science advances.

 

Hey @bobthebuilder, if you happen to see this, I was wondering if the trial you were in was in the Northeast and where? I’m in the greater Philadelphia area.

 

Hey - the electrical stimulation trial was at UC Irvine. I had to fly out there. Same with the Nortriptyline / Topiramate trial. But I've done two trials in the northeast (IV Ketamine - at Columbia in NYC; IV Lidocaine - at Mass Eye and Ear in Boston). These were investigational trials, for their own research purposes though, not for treatment.

Check this out for the latest trials.

 

Thanks so much @bobthebuilder.

How did the Lidocaine trial go?

 

No real effect for me. But a good diagnostic tool. If it silences your tinnitus while you’re on it (which it has done for others), you know it’s likely of acoustic trauma / cochlear origin.

If it doesn’t do anything for your tinnitus, and you don’t have measurable hearing loss, you know the tinnitus is likely from within your brain.

If it has some positive effect but doesn’t silence it completely, it’s probably a mix of the two.

In any case, good to support their research if you are able to! The fMRI imaging will hopefully reveal the real mechanism of tinnitus.

 

Could you tell me what's the fMRI imaging?

 

Basically a real time MRI that lets them see which parts of the brain are more/less active over a period of time. So if your tinnitus fades away as the Lidocaine takes effect, they can see where in the brain the activity levels are changing.

Wikipedia: Functional Magnetic Resonance Imaging

 

I was under the impression that "tinnitus in the brain" doesn't really exist, but that the anomalous brain activity is a result of the brain trying to compensate for damage to other parts of the hearing cycle (cochlea, nerve damage, acoustic neuroma, pressure in the middle ear, contraction of jaw muscles).

Is there documentation that points to tinnitus that solely originates from brain activity? And what causes such brain activity if no physical defect is linked to it?

I know spontaneous brain activity is a cause for many ailments and diseases: Epilepsy, Migraine, Cluster Headaches. But all these things seem to be "periodic": An attack lasts hours or days, but is not continuous for long periods of time.

It would be interesting to read about tinnitus that does not relate to a physical defect. It may shed light on a lot of things for other people on the forum who cannot pinpoint a cause or possible causes for their tinnitus.

 

Great question. I used to be under the same impression that auditory system damage is a prerequisite, and this still seems to be a common view among doctors. However, there are a couple papers that have changed my mind recently, as well as anecdotal evidence / experiences that point to the contrary. Still an open question, though.

The anecdotal evidence is myself (loud constant tinnitus) and many others who don't have any measurable hearing loss or any other ear abnormalities. The triggers seem to be varied and unrelated to ear damage - mine was probably Amitriptyline + stress, while I have a couple friends who've gotten chronic tinnitus from 1) benzo withdrawal, 2) cervical instability.

The experience is that I've experienced a few days of relief from psychedelics (unsure whether it was 5-MeO-DMT or Ibogaine that did it, since I did them back to back) while others on the board have gotten complete (and lasting) relief from Psilocybin and regular DMT. The fact that this is possible with psychedelics seems to suggest to me that at least some people have tinnitus only in the brain that can be cured within the brain.

The research evidence of brain-only tinnitus is from mice studies on the dorsal cochlear nucleus:

• Serotonin causes dysfunction (mixes up signals between somatic and auditory inputs) in dorsal cochlear nucleus in mice - Link
• Serotonin causes hyperactivity in dorsal cochlear nucleus in mice - Link
• Dorsal cochlear nucleus hyperactivity as a marker of tinnitus in mice - Link
• Dorsal cochlear nucleus abnormal post-stimulus plasticity as a marker of tinnitus in guinea pigs - Link
• High frequency stimulation of dorsal cochlear nucleus suppresses tinnitus in rats - Link

The first paper seems to suggest that if your serotonin levels get dysregulated enough, you can get tinnitus, because it causes your dorsal cochlear nucleus (which is the first-layer gatekeeper for auditory nerve signals, as well as some somatic nerve signals) to malfunction. Pretty sure this is what happened to me (thanks to Amitriptyline) and explains why I have somatic tinnitus (which I can modulate a bit by moving on my jaw / pushing on my face) without any acoustic trauma or measurable hearing loss.

Unclear what the mechanism is, but my experience with IV Lidocaine (no effect on my tinnitus) vs. others (who get complete silence) leads me to believe that it can actually be used as a diagnostic tool to determine whether your tinnitus is of cochlear origin or brain origin. If the Lidocaine gives you a moderate benefit, you probably have a mix of both. I remember reading in another paper (which I can't seem to find right now) that the same people who get silence from tinnitus while on IV Lidocaine also typically get relief from anti-convulsants such as Carbamazepine / Oxcarbazepine and typically have measurable hearing loss with a history of acoustic trauma.

If this model turns out to be accurate, there will probably end up being two different types of treatment for these two types of tinnitus (e.g. Susan Shore's device for the brain origin tinnitus, vs. OTO-313 and other regenerative therapies for the cochlear origin tinnitus). Though I think it is likely that the brain targeting treatments will be able to help both types, while the ear targeting treatments will only help those with the latter.

 

Thank you very much for the detailed explanation! Tinnitus is a really fascinating beast. If I had the mental capacity to do it, I would love to do a very deep dive into the neurological and physical aspects of tinnitus. I feel like there is so much to discover and analyse but just not enough people doing it.

My worldview may be naïve however, there are probably many very capable people who have spent a lifetime of research in the field of the auditory system and have not even come a step closer to understanding what is going on with tinnitus.

 

Don’t need to fully understand it. Few medical conditions are fully understood. Just need real efficacious treatments, and stat.

 

I agree, furthermore, even the mechanism of action of some treatments aren't yet fully understood but they are used. For example, VNS (vagus nerve stimulation) is used for treatment of refractory epilepsy, but how it specifically works, is not understood either. Some antifungals (can't remember the names) have unknown mechanism of action. So treatments can work without fully understanding the mechanism.

 

Botox around my jaw did nothing for me. No measurable hearing loss, even with official high frequency test. I don't have a problem with hearing in noisy places (sign of hidden hearing loss). Most likely meds gave me mine. So I support your hypothesis of it being my dumb old brain. Desensitized Dopamine, Serotonin or GABA issues.

Guessing they don't speak to you about your fMRI results, as they usually don't during a clinical trial.

 

Did you find something that works for you? Is your tinnitus in the ears or in the brain?

 

I have found nothing. It is highly somatic, so I am working on my neck right now. It has been stiff for years. Some days the range of motion is so limited, because it starts hurting.

It was either Prozac or withdrawal from benzos or Anafranil. I jumped back on both when the tinnitus started. So I honestly don't know if I ever gave my brain chemistry time to heal. I have been withdrawing again from benzos, then the Anafranil (clomipramine) pooped out. I have had horrible side effects from most ADs. Benzos aren't long term solutions. So I am going to have to face the music of tinnitus without drugs some day. Honestly the drugs helped me keep moving, but changed who I was as a person. Much more introverted, don't make much jokes, limited emotions. It wasn't the tinnitus that did that.

I will say that my tinnitus is not as bad on antidepressants. I just have bad coping mechanisms in place. You would think if it sounds less intrusive, less often, I should be happier. But my brain is not wired that way. I am a negative person by default, who has always had a hard time dealing with trauma, feelings, etc... Antidepressants only helped in that they took away my feelings, except anger.

 

God that gave me so much hope right there. Thank you for saying that man.

 

Same boat as you (somatic tinnitus, no high frequency hearing loss). Pretty sure mine was triggered by 5 days of taking 10 mg Amitriptyline, which the doctor assured had no side effects. I stopped the medication as soon as tinnitus started but it never went away. Very frustrating that this isn't a better known side effect given its potential severity. Excess serotonin is now known to screw up the somatic/auditory circuits in the dorsal cochlear nucleus.

And yep they wouldn't share fMRI results or any early findings / theories from the study, other than letting me know I didn't have any visible structural abnormalities or brain tumors.

Same experience as you with an SSRI (also with a similar personality type).

Zoloft made me feel "depersonalized" after a month, didn't do anything for the tinnitus loudness but made it easier to move past it. Made me feel like a robot in a way - more able to get through the routine each day without getting hung up on the tinnitus. Decided to stop taking it as I didn't want to develop a dependence and wasn't working full-time to need it.

Hang in there brother.

 

Any news about this trial?

Completion date was July 2022 according to ClinicalTrials.gov.

 

There is a video podcast on this research. In it they discuss the timeline to completion being another 3-5 years (assuming the studies go well I'd think within 7 years is reasonable to be brought to market and available to the public). They are developing the chip now, then will proceed to human trials. The timeline is discouraging, but the research is VERY encouraging. This will alleviate a lot of people's suffering assuming it can be safely and routinely administered.

 

Do they mention trying to treat hyperacusis too or is it just tinnitus?

 

I do not remember them mentioning hyperacusis, but if you're interested in tinnitus as well, it's definitely worth a listen.

 

How does injected Lidocaine help detect the origin of tinnitus in the brain, using a real time MRI, as I'm thinking you can't inject Lidocaine in the brain, can you?

 

Intravenous Lidocaine (dripped in through an IV, rather than locally injected) silences tinnitus for some people... not sure exactly how/why, though from what I've read it does cross the blood brain barrier so it is probably floating around in your brain as well as your ear.

You're awake during this, so you can tell them subjectively if your tinnitus has disappeared or not. If it has, they can look at your baseline vs. experimental fMRI to see if there's any difference in activity in the auditory processing areas where they think tinnitus activity might reside in the brain... if multiple people who report their tinnitus going silent have brain activity decrease in a particular area, I assume they can use that data to confirm where the tinnitus actually is.

 

I have heard about people doing Lidocaine injections around ears to calm tinnitus. But I assume this has to be done periodically as after the Lidocaine wears off, the tinnitus will come back the same?