ARC 2011
Current Trends in the Evaluation and Treatment of Tinnitus
Abstracts & Learner Objectives

Overview of the Pathophysiology of Tinnitus

James Kaltenbach, PhD, Cleveland Clinic

This presentation willexamine current theories concerning the neurobiological basis of tinnitus. Thepresentation will begin with a review of the main causes and characteristics of tinnitus in human subjects and an overview of currently availabletreatments. This will lead into an examination of current theories concerning the neural underpinnings of tinnitus. The focus will be on localization of the neural generators and the cellular defects and abnormal patterns of activity leading to tinnitus. Emphasis will be placed on the concept of neural plasticity as a key element in the induction of tinnitus. The presentation will end with a perspective of the impactthat knowledge oftinnitus mechanisms is having on the therapeutic treatment of tinnitus.

After this session, participants will be able to:

Describe the contemporary concepts of tinnitus
identify where in the auditory system tinnitus related changes occur and what mechanisms are involved
cite how treatments for tinnitus are being reshaped by knowledge of underlying mechanisms

Human Brain Imaging and Animal Models of Tinnitus

Richard Salvi, PhD, University at Buffalo

I will review some of our PET brain imaging studies with patients who could modulate the loudness of their tinnitus. These studies identified sites in the auditory pathway and limbic regions involved with tinnitus. I will also discuss how animal models have been used to study the neural correlates of tinnitus and test new drugs to suppress tinnitus. Modern brain imaging techniques and novel animal models have given researchers powerful new tools to investigate tinnitus.

After this session, participants will be able to:

describe techniques to image the neural activity associated with tinnitus
identify methods to assess tinnitus in animal mode
describe the neural correlates of salicylate induced tinnitus

Imaging Brain Function in People with Tinnitus

Jennifer Melcher, PhD, Massachusetts Eye & Ear Infirmary, Harvard Medical School

Our experiments using functional magnetic resonance imaging (fMRI) to compare tinnitus patients with closely-matched non-tinnitus controls demonstrate:

abnormally elevated responses to sound in central auditory centers that reflect the hyperacusis often accompanying tinnitus;
elevated cortical responses related specifically to tinnitus and possibly reflecting over-attention to the auditory domain;
abnormal networks of brain activity that may underlie the emotional and attentional aspects of tinnitus. These and other recent findings will be presented.

After this session, participants will be able to:

describe the basic elements of fMRI studies of tinnitus
discern important aspects of a well-controlled imaging study of tinnitus
describe brain centers for which there is evidence of involvement in tinnitus and hyperacusis

Hyperacusis

Craig Formby, PhD, University of Alabama

Over the past decade we have conducted a series of studies to garner a better understanding of hyperacusis and its treatment within the context of a TRT-based intervention program. My presentation will review our research efforts and highlight new evidence that sound therapy can be implemented successfully with counseling to improve sound tolerance, enhance speech understanding, and augment hearing aid benefit for individuals who, before treatment, had reduced sound tolerance and aided benefit.

After this session, participants will be able to:

Recognize and distinguish hyperacusis from other commonly confused sound tolerance complaints, related conditions, and supra-threshold symptoms such as loudness recruitment, phonophobia, and misophonia
Contrast treatment options for hyperacusis in terms of the effects of sound-attenuating versus sound-enhancing interventions
Grasp the concept that an adaptive and plastic central auditory gain control process may play a critical role in the hyperacusis phenomenon

Tinnitus: Psychological Distress and Treatment

Laurence McKenna, PhD, Royal NationalThroat, Nose and Ear Hospital,London, England

The psychological impact of tinnitus will be described in terms of changes in thinking, behaviour mood and stress arousal. A cognitive behaviour therapy (CBT) framework for understanding this distress will be outlined. The development of psychological therapy will be traced and current perspectives will be highlighted; the main focus will be on CBT. The data supporting this approach will be presented. Future directions will be discussed with a focus on Mindfulness Based Meditation; an approach for which an evidence base is emerging.

After this session, participants will be able to:

describe the main psychological impacts of tinnitus
describe how this distress comes about
explain the role of psychological therapy in the care of the tinnitus patient

Sound Therapies: Basis, Implementation and Outcomes

Grant Searchfield, PhD, University of Auckland, New Zealand

Sound has been used to manage tinnitus for centuries and is now amongst the most widely used tinnitus treatment tools. Sound, or “acoustic”, therapy can be implemented using different instruments (e.g. hearing aids, sound generators, MP3 players) with many aims (e.g. partial masking, habituation, relaxation, attention diversion). The sounds recommended for tinnitus management vary in their temporal, spectral and emotion-evoking characteristics. However our understanding of the mechanisms explaining their effect on tinnitus perception are limited. Although tinnitus is perceived as sound, in psychoacoustic experiments it does not behave in a manner consistent with externally generated sound. Persistent increased input to the central auditory system, through sound, likely results in plastic changes within the auditory pathways, leading to changes in processing, which may interfere or reverse the representation of tinnitus in the auditory pathways. In this presentation the theoretical, experimental and clinical evidence for the use of sounds therapy in tinnitus management are discussed. The aims of the presentation are to

introduce the basis for sound therapy
review the spectral and temporal characteristics of stimuli commonly advocated for tinnitus relief
to review electroacoustical characteristics of common sound presentation technologies and
report sufferers’ perception of treatment effectiveness.

After this session, participants will be able to:

Describe the underlying basis of several sound therapy types
Identify the different psycho-acoustical features of sound reported as being beneficial for sound therapy
Identify ways in which an individual’s listening preferences and hearing can influence the choice of sound therapy

Tinnitus Therapies: From Bedside to Bench and Back Again

Carol Bauer, MD, Southern Illinois University School of Medicine

Treatments aimed at elimination of tinnitus have been available for centuries. Most early tinnitus treatments were based on empiricism and anecdotal evidence. Advances in neuroscience, availability of tools for assessing neural correlates of tinnitus and the development of models for testing tinnitus theories have led to theory-driven clinical studies. An overview of the theoretical basis of current tinnitus treatments will be presented and promising areas for translating basic science to clinical treatments will be suggested.

After this session, participants will be able to:

contrast tinnitus treatments based on anecdotal evidence with treatments based on theoretical mechanisms
describe knowledge gaps in designing effective tinnitus treatments
identify areas of clinical practice for application of current knowledge about tinnitus