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Implant for Tinnitus?

Robert L. Folmer, PhD

October 13, 2003


Question

I have heard that there is an implant which will effectively mask or eliminate the constant ringing of tinnitus. I have had this condition for 38 years. It would be nice to have some silence, finally. Any ideas other than supplements. Thanks.

Answer

You might be referring to a cochlear implant -- a device designed for people with severe to profound hearing loss in both ears. A cochlear implant consists of an electrode array that is surgically inserted into the inner ear, a small microphone, and a speech processor.

The goal of cochlear implantation is to restore hearing to people who are functionally deaf. Tinnitus is a common perception among deaf people. If a cochlear implant is successful and allows the patient to hear some external sounds, this usually reduces the perception of tinnitus, especially on the implanted side. Numerous studies reported that cochlear implants reduced or suppressed tinnitus for a majority of patients who experienced tinnitus prior to implantation (Brackmann, 1981; Tyler & Kelsay, 1990; McKerrow et al, 1991; Souliere et al, 1992; Ito, 1997; Dauman, 2000; Ruckenstein et al, 2001).

Other types of implants to restore hearing include:

  • The auditory brainstem implant, a device designed for
    patients without a functional cochlea or auditory nerves (Toh & Luxford, 2002).


  • An implant that stimulates the auditory nerve directly with a 3-dimensional array of electrodes is being developed by a group of researchers at the University of Utah (Badi et al, 2003).


  • A variety of middle ear implants.
Most cases of tinnitus are associated with some degree of hearing loss. If any amount of hearing can be restored, the patient's perception of tinnitus usually decreases. The devices described above can reduce the patient's perception of tinnitus by increasing their perception of external sounds. However, only a small percentage of tinnitus patients are candidates for any of these implants.

Do not despair. The good news is that many tinnitus patients benefit from more conventional in-the-ear devices such as hearing aids, sound generators, or combination instruments (hearing aid + sound generator in one unit). Even if the tinnitus does not disappear completely while these devices are in use, most patients can obtain significant relief from the symptom. For maximum effect, acoustic therapy should be used within the framework of a comprehensive tinnitus management program.

Additional information is provided in the article ''A Patient's Guide to Tinnitus.''

http://www.healthyhearing.com/healthyhearing/newroot/articles/arc_disp.asp?article_id=182&catid=615

One other type of implant has been proposed to relieve tinnitus. Shi & Martin (1999) hypothesized that tinnitus generation and maintenance shares mechanisms with other neurological symptoms such as chronic pain and movement disorders including Parkinson's Disease. A procedure called deep brain stimulation (DBS) is sometimes used to treat patients with Parkinson's Disease or chronic pain who do not receive sufficient relief from medications. DBS involves brain surgery: a small hole is drilled in the patient's skull and a thin electrode is advanced slowly through the hole to a particular location within the brain.





A small amount of electrical current is turned on and conducted through the electrode to surrounding neural tissue. If the electrode placement is accurate, patients experience immediate relief from their symptoms. A battery-powered stimulus generator is connected to the electrode and implanted under the skin near the patient's collar bone. The patient can then control the current delivered to the electrode.

Martin et al (1999) conducted a study of seven patients who experienced tinnitus and also had deep brain stimulators implanted for movement disorders. All of the patients experienced hearing loss and tinnitus prior to DBS implantation. Three of the patients reported a reduction in tinnitus when their stimulator was turned on compared to when it was off. This result led Shi & Martin (1999) to suggest that a stimulating electrode implanted in a particular auditory region of the brain might be even more effective for reducing the perception of tinnitus. To date, DBS surgery has not been performed for tinnitus. Before DBS surgery for tinnitus is attempted, many questions need to be answered, including:

1) Exactly where in the brain should a stimulating electrode be placed to maximize tinnitus relief?

2) Which tinnitus patients, if any, should be considered candidates for this procedure?

3) Do potential benefits from the procedure outweigh its inherent risks?

Fortunately, the vast majority of tinnitus patients can obtain relief from the symptom without resorting to any type of surgical implantation. Even though a true ''cure'' for most cases of chronic tinnitus is not yet available, effective tinnitus management tools and strategies are available to help patients now (Folmer, 2002).

References

Badi AN, Kertesz TR, Gurgel RK Shelton C, Normann RA. Development of a novel eighth-nerve intraneural auditory neuroprosthesis. Laryngoscope 2003;113(5):833-842.

Brackmann DE. Reduction of tinnitus in cochlear-implant patients. J Laryngol Otol 1981;Suppl 4:163-165.

Dauman R. Electrical stimulation for tinnitus suppression. In Tyler RS (ed), Tinnitus Handbook San Diego: Singular, 2000;377-398.

Folmer R. Long-term reductions in tinnitus severity. BMC Ear Nose and Throat Disorders 2002;2:3.
http://www.biomedcentral.com/1472-'6815/2/3

Ito J. Tinnitus suppression in cochlear implant patients. Otolaryngol Head and Neck Surg 1997;117(6):701-703.

Martin WH, Shi YB, Burchiel KJ, Anderson VC. Deep brain stimulation effects on hearing function and tinnitus. In Hazell J (ed): Proceedings of the Sixth International Tinnitus Seminar. London: The Tinnitus and Hyperacusis
Centre 1999;68-72.

McKerrow WS, Schreiner CE, Snyder RL, Merzenich MM, Toner JG. Tinnitus suppression by cochlear implants. Ann Otol Rhinol Laryngol 1991;100:552-558.

Ruckenstein MJ, Hedgepeth C, Rafter KO, Montes ML, Bigelow DC. Tinnitus suppression in patients with cochlear implants. Otol Neurotol 2001;22:200-204.

Shi YB, Martin WH. Deep brain stimulation -- a new treatment for tinnitus? In Hazell J (ed): Proceedings of the Sixth International Tinnitus Seminar. London: The Tinnitus and Hyperacusis Centre 1999;578-580.

Souliere CR, Kileny PR, Zwolan TA, Kemink JL. Tinnitus suppression following cochlear implantation: a multifactorial investigation. Arch Otolaryngol Head and Neck Surg 1992;118(12):1291-1297.

Sterkers O, Boucarra D, Labassi S, et al. A middle ear implant, the Symphonix Vibrant Soundbridge: retrospective study of the first 125 patients implanted in France. Otol Neurotol 2003;24:427-436.

Toh EH, Luxford WM. Cochlear and brainstem implantation. Otolaryngol Clin N Amer 2002;35(2):325-342.

Tyler RS, Kelsay D. Advantages and disadvantages reported by some of the better cochlear-implant patients. Am J Otol 1990;11(4):282-289.


Robert L. Folmer, Ph.D.

OHSU Tinnitus Clinic
Mail Code NRC04
Oregon Health & Science University
3181 SW Sam Jackson Park Road
Portland, OR 97239
telephone: (503) 494-7954
email: ohrc@ohsu.edu
web: http://www.ohsu.edu/ohrc/tinnitusclinic


robert l folmer

Robert L. Folmer, PhD

Robert Folmer earned B.A. and M.A. degrees in biology from San Francisco State University.  He received his Ph.D. in Speech and Hearing Science from the University of California, San Francisco.  In 1997 he joined the staff of the OHSU Tinnitus Clinic in Portland where he currently serves as Clinical Neurophysiologist and Assistant Professor of Otolaryngology.  In addition to his duties evaluating and treating patients in the Tinnitus Clinic, Dr. Folmer also provides intraoperative neural monitoring during surgeries that involve the spinal cord or cranial nerves.


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