From: Exp Brain Res. 2010 May 28. [Epub ahead of print]
Somatic tinnitus has been defined as tinnitus temporally associated to a somatic disorder involving the head and neck. Several studies have demonstrated the interactions between the somatosensory and auditory system at the dorsal cochlear nucleus, inferior colliculus, and parietal association areas. The objective is to verify the effect of transcutaneous electrical nerve stimulation of the upper cervical nerve (C2) in the treatment of somatic tinnitus. As electrical stimulation of C2 increases activation of the dorsal cochlear nucleus through the somatosensory pathway and enlarges the inhibitory role of the dorsal cochlear nucleus on the central nervous system, C2 TENS can be considered for tinnitus modulation. A total of 240 patients in whom tinnitus is modulated by somatosensory events (e.g., tinnitus change with rotation, retro- and antiflexion of neck) or modulated by pressure on head or face were included in this study. Both a real and a sham TENS treatment were applied for 30 min (10 min of 6 Hz, followed by 10 min of 40 Hz and 10 min of sham). Significant tinnitus suppression was found. Only 17.9% (N = 43) of the patients with tinnitus responded to C2 TENS. They had an improvement of 42.92%, and six patients had a reduction of 100%.
From: Prog Brain Res. 2007;166:389-94. Trans-electrical nerve stimulation (TENS) for somatic tinnitus.
The somatic tinnitus syndrome includes those forms of tinnitus that are associated with a somatic disorder involving the head and upper neck. It has been suggested that physiological mechanisms where interactions occur between the somatosensory and auditory systems are the etiology for that kind of tinnitus. Trans-electrical nerve stimulation (TENS) of areas of skin close to the ear increases the activation of the dorsal cochlear nucleus through the somatosensory pathway and may augment the inhibitory role of this nucleus on the CNS and thereby ameliorate tinnitus. In a prospective descriptive study of 26 patients with the probable diagnosis of somatic tinnitus we found that TENS could improve the tinnitus in 46% of the participants (23% did not hear it anymore, and in 23% its intensity was reduced). VAS scores improved from 6.5 to 6.0 after 2 weeks of treatment. Patients used TENS at home for 2h, once per day during 2 weeks (alternating ramped burst, 150 pps, with pulse duration of 100 micro s, amplitude 0-60 mA; average TENS intensity was 27 mA). Intermittent “typewriter” type of tinnitus was the most responsive. Somatic tinnitus without otologic disease had better response than tinnitus associated to otological causes.
From: J Laryngol Otol. 2006 Jun;120(6):442-5. Epub 2006 Mar 24. Treatment of tinnitus with transcutaneous electrical nerve stimulation improves patients’ quality of life.
Tinnitus can adversely affect patients’ quality of life. Transcutaneous electrical nerve stimulation (TENS) may be effective in the management of tinnitus. No study has investigated the efficacy of TENS for the management of tinnitus by means of quality of life measures. In this study, we evaluated the efficacy of TENS for the management of tinnitus symptoms by using the visual analogue scale (VAS), tinnitus handicap inventory test, Nottingham health profile (NHP) and short form-36 (SF-36) questionnaires. Twenty-two patients were included in this study (male/female, 16/6; mean age, 48.04 +/- 15.57 years). Nine patients had unilateral and 13 patients had bilateral tinnitus. After TENS, improvement measured by VAS was only marginally significant. However, after TENS, there were statistically significant improvements regarding tinnitus severity scores, tinnitus handicap inventory scores, NHP fatigue, social isolation and emotional problems scores, and many parameters measured by the SF-36 (physical functioning, general health, vitality, social functioning, role limitations due to emotional problems, and mental health). Transcutaneous electrical nerve stimulation is a useful method to improve the quality of life of patients with tinnitus.
From: Otolaryngol Pol. 2008;62(5):601-5. Electrical stimulation as an alternative method of tinnitus treatment.
The aim of the study was to evaluate the influence of the selective electrical stimulation of the hearing organ on tinnitus in people with sensorineural hearing loss. The study comprised 248 tinnitus patients treated by using electrical stimulation. The material was divided into two groups, regarding the method of stimulation. In group I–168 people, transtympanal electrical stimulation of the promontory was applied, whereas in group II–80 people, hydrotransmissive technique was used. ENT examination, audiological and radiological diagnostics, as well as the evaluation of the audiometric parameters of tinnitus was performed. The patients were asked to fill in the questionnaire concerning tinnitus. In 80 patients hydrotransmissive electrical stimulation was conducted using the own prototype device, in 168 patients–transtympanal stimulation, after local anaesthesia with Xylocain gel. RESULTS: On the whole, in group of 248 patients, subjective improvement (decrease in the severity of tinnitus) was noticed in 130 people (52.4%), comprising 32 cases (13%) of total relief. In 93 patients (37.5%) tinnitus remained unchanged, and in 25 (10.1%) the deterioration was observed. The comparison of the results of two electrical stimulation methods, showed the superiority of hydrotransmissive one (improvement in 58.75% of patients), however, the number of cases of total relief was greater in the case of transtympanal method (15.5%). Considering subjective evaluation, as well as audiometric (the intensity and the frequency parameters, MML) the hydrotransmissive method appeared to be more effective (improvement in 53.75%) comparing to transtympanal stimulation (improvement in 44.6%). On the basis of studies conducted in the Clinic and the long history of the electrical stimulation administration in tinnitus treatment, it can be stated that this method may by applied in cases, in which other therapeutical methods failed.
From: Acta Otolaryngol Suppl. 2006 Dec;(556):20-6. Summary of evidence pointing to a role of the dorsal cochlear nucleus in the etiology of tinnitus.
Evidence has accumulated in the last decade that the dorsal cochlear nucleus may be an important site in the etiology of tinnitus. This evidence comes from a combination of studies conducted in animals and humans. This paper will review the key findings, as follows. 1) Direct electrical stimulation of the dorsal cochlear nucleus leads to changes in the loudness of tinnitus. This suggests that the loudness of tinnitus may be linked to changes in the level of neural activity in the dorsal cochlear nucleus. 2) Exposure to tinnitus inducers, such as intense sound or cisplatin, causes neural activity in the dorsal cochlear nucleus to become chronically elevated, a condition known as neuronal hyperactivity. 3) This hyperactivity is very similar to the activity that is evoked in the dorsal cochlear nucleus by sound stimulation, suggesting that the hyperactivity represents a code that signals the presence of sound, even when there is no longer any sound stimulus. 4) Noise-induced hyperactivity in the dorsal cochlear nucleus is correlated with tinnitus. Behavioral studies have demonstrated that animals exposed to the same intense sound that causes hyperactivity in the dorsal cochlear nucleus develop tinnitus-like percepts. The correlation between the level of hyperactivity and the behavioral index of tinnitus was found to be statistically significant. 5) The dorsal cochlear nucleus is a polysensory integration center, and electrophysiological studies have shown that both spontaneous activity and hyperactivity of neurons in the dorsal cochlear nucleus can be modulated by stimulation of certain ipsilateral cranial nerves, such as the sensory branch of the trigeminal nerve. This ipsilateral modulation of dorsal cochlear nucleus activity offers a plausible explanation of how tinnitus, when perceived on one side, can be modulated by certain manipulations of the head and neck on the side ipsilateral to the tinnitus, but rarely on the contralateral side. 6) The dorsal cochlear nucleus exhibits various forms of neuronal plasticity that parallel the various forms of plasticity that characterize tinnitus. These findings collectively strengthen the view that the dorsal cochlear nucleus may be a key structure that should be included as a target of anti-tinnitus treatment.
