Systematic Review on Intra- and Extracochlear Electrical Stimulation for Tinnitus

Assouly, Kelly K. S.; Dullaart, Max J.; Stokroos, Robert J.; Dijk, Bas van; Stegeman, Inge; Smit, A.L.

doi:10.3390/brainsci11111394

Cited by 10 publications

(9 citation statements)

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“…Increasing evidence indicates that electrical current is a promising treatment itself, independently of auditory stimulation (Shepherd and Javel, 1999;Konopka et al, 2001;Rubinstein et al, 2003;Steenerson and Cronin, 2003;Aydemir et al, 2006;De Ridder et al, 2006;Seidman et al, 2008;Di Nardo et al, 2009;Noreña et al, 2015;Paciello et al, 2018). To define which stimulation patterns should be optimized for tinnitus relief, a deeper understanding of the mechanisms involved in tinnitus suppression is needed (Assouly et al, 2021). CI represents the main tool to investigate the effects of intracochlear electric current in patients with chronic tinnitus.…”

Section: Discussionmentioning

confidence: 99%

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The Effectiveness of Targeted Electrical Stimulation via Cochlear Implant on Tinnitus-Perceived Loudness

et al. 2022

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IntroductionThe cause of tinnitus improvement in cochlear implant (CI) users is not understood. On the basis that a spatially limited dysfunction in the auditory pathway could cause tinnitus, we used single-channel stimulation to evaluate any variation of tinnitus-perceived loudness and identify the cochlear regions involved.Materials and MethodsIt was an observational prospective case-crossover study. After the first mapping, 21 adults with unilateral CI and chronic tinnitus expressed their tinnitus loudness based on the Visual Analog Scale (VAS) score (0–10) at baseline (L0), during a 10 s single-channel stimulation with C-level of electric current (L1) and 30 min after CI activation (L2). Tinnitus reduction [RT = (L0 – L1) × 100/L0] > 50% was considered significant. VAS outcomes were compared between baseline (L0) and (each) single-channel stimulation (L1) to find the channel with the greatest RT (suppressive channel-SC), whose frequency range revealed the cochlear region involved. Seven patients with asymmetric hearing loss underwent the pitch-matching test to identify the actual frequency evoked by the SC. We compared selective (L1) and non-selective (L2) intracochlear stimulation using paired t-test. Preoperative Tinnitus Handicap Inventory (THI) score was compared with those at 1, 6, and 12 months with paired t-tests to evaluate long-term tinnitus perception.ResultsWe observed a significant reduction of tinnitus loudness during the experimental procedure [L0 (6.4 ± 2.4) vs. L1 (1.7 ± 2.7), p = 0.003]. A total of 15/21 patients (71.4%) had a significant (RT > 50%) and selective improvement, reporting a mean L1 of 0.4 ± 2.0 (p = 0.0001). In 10/15 (66.6%) patients, the SC was in the apical turn, within 1,000 Hz; in 5/15 patients (33.4%) within 4,000 Hz. The cochlear region 125–313 Hz was the most affected by tinnitus improvement (p = 0.0074). Targeted stimulation was more effective than non-selective stimulation [L1 vs. L2 (4.3 ± 2.5), p = 0.0022]. In 3/7 patients, the perceived pitch did not fall within the SC frequency ranges. All patients with selective attenuation described tinnitus as monotone. Patients with non-selective attenuation had polyphonic tinnitus and better THI results after 1 year.ConclusionTargeted intracochlear electrical stimulation improved chronic tinnitus perception, especially in monotone tinnitus, and the apical region was mainly involved. Our results provide new insights into the pathophysiological mechanisms of tinnitus and targets for innovative therapeutic strategies.

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Section: Discussionmentioning

confidence: 99%

“…Nowadays, the different methods used and the uncertainty of clinical efficacy have made it impossible to guide technological development toward a real therapy (Assouly et al, 2021). Considering this scenario, the intracochlear electrical stimulation via CI could represent a putative approach to tinnitus treatment.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Targeted Electrical Stimulation via Cochlear Implant on Tinnitus-Perceived Loudness

et al. 2022

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“…This view is also confirmed by recent studies. Thus, it has been shown that intra-and extracochlear electrical stimulation can contribute to the suppression of non-pulsatile tinnitus [35][36][37]. Therefore, the effect of lidocaine does not seem to provide the only possible explanation.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the effect of lidocaine does not seem to provide the only possible explanation. However, a recent systematic review did not find an answer as to which stimulation pattern is most effective for suppression [ 35 ]. In this analysis, we could not find any correlation between higher current and better effect, which, therefore, requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

The effect of lidocaine iontophoresis for the treatment of tinnitus: a systematic review

Bülow

Best

Brugger

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Tinnitus is a common symptom with multiple causes and treatment options. Previous studies have investigated the effect of lidocaine iontophoresis. The aim of this review is to systematically present the effects on tinnitus and to derive possible effects. Methods In accordance to the PRISMA statement, the search and analysis were performed. An abstract in German or English and a performed intervention with lidocaine iontophoresis for the treatment of tinnitus, independent of the study design, were considered as inclusion criteria. Due to the heterogeneity of the studies, only a narrative synthesis was performed. Results The search yielded 179 studies of which 170 were excluded. Six full-texts and three abstracts were included. In total, 957 patients were treated with lidocaine iontophoresis. The percent improvement in symptoms after lidocaine iontophoresis ranged from 4% to 62%. The qualitative assessment of the studies resulted in an overall “weak” rating for all of them. Conclusions Due to the heterogeneity and the limited quality of the studies found, no clear statement can be made about the efficacy. The number of those who benefited from therapy varied widely. In addition, it cannot be ruled out that the effect was merely due to electrical stimulation of the cochlea.

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“…Some studies reported cases of tinnitus worsening after cochlear implantation 11 14. The variability of tinnitus outcomes following cochlear implantation might be associated with patient characteristics, hearing characteristics, tinnitus characteristics prior to surgery, trauma provoked by the implantation procedure or different electrical stimulation strategies 15–19. Moreover, it is still unclear what the effect of electrical stimulation with a CI will be when patients do receive an implant primarily for tinnitus and not for hearing loss.…”

Section: Introductionmentioning

confidence: 99%

Effect of electrical stimulation with a cochlear implant on tinnitus impact: protocol of an individual patient data meta-analysis

2022

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IntroductionTinnitus is the perception of sound without an external stimulus, often experienced as a ringing, buzzing sound. While several studies have shown a reduction in tinnitus distress following cochlear implantation, others showed an increase or no change after implantation. At this stage, clinicians have little certainty when counselling their patients prior to implantation regarding tinnitus post-implantation. To help clinicians to counsel cochlear implant (CI) candidates on the risk of developing or improving tinnitus after implantation, we aim to assess the effect of electrical stimulation with a CI on tinnitus impact for individual adult patients with tinnitus. We will also apply prediction models to individual patient data (IPD) of clinical trials to find predictive factors of the effect of electrical stimulation on tinnitus impact.Method and analysisThe IPD meta-analysis is a follow-up project of the systematic review on cochlear implantation in patients with tinnitus as a primary complaint. First, the systematic searches will be updated to date. Methodological quality of eligible studies will be assessed using the Risk of Bias In Non-randomised Studies of Intervention tool (ROBINS-I). Based on a data-sharing agreement, authors of the eligible studies will be invited to share their deidentified and complete IPD. The primary outcome is the effect of electrical stimulation with a CI on tinnitus impact 1 month or more post-implantation. IPD meta-analysis will be used to assess the primary outcome, while differentiating the tinnitus impact questionnaires. Second, linear regression analyses will be used to model the effect of electrical stimulation on tinnitus impact based on relevant predictors.Ethics and disseminationThe Medical Research Involving Human Subject Act does not apply, and ethical approval is not required. The study results will be made accessible to the public in a peer-review open access journal.PROSPERO registration numberCRD42022319367, review ongoing.

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Systematic Review on Intra- and Extracochlear Electrical Stimulation for Tinnitus

Cited by 10 publications

References 71 publications

The Effectiveness of Targeted Electrical Stimulation via Cochlear Implant on Tinnitus-Perceived Loudness

The Effectiveness of Targeted Electrical Stimulation via Cochlear Implant on Tinnitus-Perceived Loudness

The effect of lidocaine iontophoresis for the treatment of tinnitus: a systematic review

Effect of electrical stimulation with a cochlear implant on tinnitus impact: protocol of an individual patient data meta-analysis

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