DALLAS (Ivanhoe Newswire) – Music is Terry Price’s livelihood and passion. As a church choir director, he has performed all over the world.
“I just feel like have the greatest job in the world. I do what I love,” he told Ivanhoe.
But one day the music he loved so much became painful.
“All of a sudden the higher pitches, instead of sounding like single notes, sounded like clusters of screeches, and it was unimaginably bad. It was terrible,” Price said.
Price had tinnitus: a constant high-pitched ringing in the ears. He had to give up music and even contemplated retiring.
“[Patients] generally classify it as annoying, hard to concentrate, it keeps them up at night, it’s driving them crazy,” Shawna Jackson, AuD, Audiologist at the University of Texas at Dallas, told Ivanhoe.
Now researchers are planning a clinical trial to test Vagus nerve stimulation. A small device is placed directly on the Vagus nerve, and electrical pulses stimulate the nerve while patients listen to certain sounds. The idea is to retrain the brain.
“You tell the brain all the sounds are important except the tinnitus,” Sven Vanneste, PhD, Associate Professor at the University of Texas at Dallas, told Ivanhoe.
In a European trial, 10 patients had the treatment. Half of them experienced significant decreases in symptoms.
As part of this new clinical trial, patients will have treatments for two and a half hours, five days a week from home. The Vagus nerve stimulator is also used to treat other conditions such as epilepsy and depression.
Price hopes to be part of the U.S. trial. But sound therapy has helped him control his symptoms.
“It’s dramatically better,” he said.
BACKGROUND: Tinnitus is defined as the perception of sound in one or both ears or in the head when no external sound is present. It is often called "ringing in the ears," although some people hear hissing, roaring, whistling, chirping, or clicking. Though statistics vary, according to the American Tinnitus Association, more than 50 million Americans experience tinnitus to some degree. Of these, about 12 million people have tinnitus severe enough to seek medical attention. About 2 million people are so debilitated by the noise that they can't function on a day-to-day basis. (Source: http://www.ata.org/for-patients/faqs)
WHAT CAUSES IT? According to the American Academy of Otolaryngology, Head and Neck Surgery, most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. In older people with tinnitus, the tinnitus could result from hearing nerve impairment that often comes with advancing age. In younger people, the leading cause of tinnitus is exposure to loud noise. In some cases, allergy, high or low blood pressure, a tumor, diabetes, thyroid problems, or injury to the head or neck could be behind the tinnitus. Medications such as anti-inflammatories, antibiotics, sedatives, antidepressants and aspirin might also cause it. The first step toward quieting the noise is to make an appointment with a specialist called an otolaryngologist. (Source: http://www.entnet.org/HealthInformation/ tinnitus.cfm)
NEW TECHNOLOGY: Researchers at the University of Texas at Dallas are now testing nerve stimulation to treat tinnitus. Specifically they are looking at the vagus nerve, which runs down both sides of your body from your brainstem through to your neck and abdomen. Vagus nerve stimulation is already used to treat things like epilepsy and depression, as it can induce changes in the way the brain responds to stimuli. But with tinnitus, researchers are hoping that by stimulating the vagus nerve they can essentially retrain the brain to not respond to the tinnitus tone. A stimulator is put into place in surgery, and will be left in for 12 weeks during the current trial, during which they receive about two hours of treatment for five days a week. Each treatment session is about 300 stimuli each. In a pilot study performed in Belgium, five of the ten participants saw a response, and four of the five had a 44 percent suppression, which is very good compared to current procedures. (Source: Mayo Clinic, Dr. Sven Vanneste)
Dr. Sven Vanneste, Associate Professor at UTD, talks about a new surgery that is stopping tinnitus in its tracks.
So, how does vagus nerve stimulus work?
Dr. Vanneste: Well, based on animal research, when you stimulate the vagal nerve you can actually induce changes in the brain and we know in tinnitus patients that there is a hyperactivity and hypersynchrony in a specific brain area, which is called the primary auditory cortex. Basically what you do is tell the brain all the sounds that you’re hearing are important, but because you do not present the tinnitus tone you tell the brain all the sounds are important except the tinnitus tone. That’s the basic idea behind it.
But how do you do that with simple electricity?
Dr. Vanneste: Well, what we know is when you stimulate the vagal nerve, you actually activate some neurotransmitters that are really important. And because you do vagal nerve stimulation, paired with sound therapy, you really can have an effect where you want it to be. So in this case, it is in the primary auditory cortex. Maybe, there are also other regions that might be involved and that we change, but that’s something that we still have to do research on.
Can you explain exactly how you do it, where you implant it, and how it works?
Dr. Vanneste: The surgeon is making an incision around the neck close to the throat and there is the vagal nerve and it’s an electrode that surrounds what you can actually see it over here, that surrounds the vagal nerve. The lead connects to what we call an IPG, an implantable pulse generator, it’s basically a battery. And, we can communicate with that specific device via computer. So, each time that we present a tone, we can also send a trigger to the IPG that the vagal nerve needs to be stimulated, so that’s basically how we do it.
Do you leave the stimulator in and for how long?
Dr. Vanneste: For the clinical trial, we will leave the IPG in there for at least 12 weeks and after 12 weeks, the patient can decide.
How many times during the day would a patient get a treatment?
Dr. Vanneste: So, the treatment is 2-1/2 hours a day for 5 days a week and they receive about 300 stimuli each session. They can also decide when to do it; they can do it in the morning, afternoon, night, it doesn’t matter.
Do you have to be in the clinic to get?
Dr. Vanneste: No, so when we did the first trial in Belgium, they had to come to the clinic because we didn’t have the internal pulse generator yet. So it was a big device. But now, a company made specific IPG that is implantable. So the patient can do the treatment at home.
Does it hook to their computer or what?
Dr. Vanneste: Well, it’s wireless so and they just have to turn on the device to see if it connects with computer and just run the program.
So in Belgium, what have your studies shown there?
Dr. Vanneste: So in Belgium, we had promising results. It was just a pilot study. We implanted it in 10 patients and 5 patients had a response. Five patients didn’t have a response, but interesting thing was that those patients took certain medication that probably blocked the effect, but because it was a pilot study, our idea was we were going to include all types of tinnitus patients just to get more knowledge.
Of the five that it helped, was it a 10% help? Was it a 90% help?
Dr. Vanneste: No, four of them had a very good response, they had a 44% suppression rate which is really a very good response compared to other treatments that we already tried. That’s just for the mood component. So, in tinnitus, you have two components, you have just the sound as it is, but also some people are really stressed by their tones, so for the mood component, we had a 44% suppression rate and then for the loudness, well, we noticed that it was 26 DB, decibels improvement.
So, what you’re doing here could really give some people a chance at a normal life, correct?
Dr. Vanneste: That is our hope. So I have to say a lot of patients with tinnitus can live with it. They say, “I hear the tinnitus, but it’s doable.” But some patients are really desperate because of their tinnitus. It really affects their daily life, so for those patients this could be really helpful, absolutely.