BF: Some people hear that tinnitus is in the brain and conclude that it is somehow not a real medical condition… that it is an imaginary, mental or psy- chological issue. That’s not the case, right?
FH: Of course not! Just because the tinnitus signal is generated in the brain, doesn’t mean it is ‘made up.’ Tinnitus is no less ‘real’ than other medical con- ditions, like epilepsy, that stem from neurological hyperactivity.
BF: Can we reverse the changes in our brain that generate the perception of tinnitus?
FH: It’s less a question of ‘reversing the changes’ than it is of encouraging compensatory neuroplastic changes. Newer changes may be sufficient to stop the continued generation of tinnitus. At the moment, scientists around the world are exploring options for affecting positive neuroplastic changes that can quiet tinnitus. Some of these experimental treatments include vagus nerve stimulation, cortical stimulation, and the development of potential pharmacological agents. At the moment, these are all in the experi- mental phase.
Right now, there are well-established behavioral treatments that can help patients deal with tinnitus and its associated neuroplastic changes. Cognitive therapy, which combines education with counseling, is a type of ‘brain retraining’ that helps patients navigate around the negative neural, emotional, and behavioral patterns that exacerbate tinnitus.
BF: So cognitive behavioral therapy can be a part of effective tinnitus management?
FH: Certainly! Randomized controlled trials have shown that cognitive behavioral therapies are effec- tive in reducing the perceived burden of tinnitus, at least for a majority of patients. I believe counseling (my umbrella term for an array of different cognitive therapies) is currently an underappreciated and underutilized part of tinnitus management.
BF: From a neurological perspective, how does counseling help with what’s going on in the brain?
FH: We know from research into depression and anxiety that counseling has a distinct and measur- able effect on the brain. We can extrapolate from this to tinnitus, although we do not have brain imaging studies of counseling as an intervention in tinnitus.
BF: What about sound therapy? Can listening to “notched” music, or other sounds modified to your specific tinnitus perception, create corrective neuroplastic changes?
FH: There is short-term relief when you listen to soothing sounds or broad-band noises or sounds that help mask your tinnitus. When you have a low-level of surrounding or external noise, the contrast with your internal noise is reduced, and therefore you are better able to ignore it. But in terms of long-term relief or evidence about changes in neuroplasticity, we do not yet have conclusive data.
BF: There has been a lot of talk and research about repetitive transcranial magnetic stimulation (rTMS) and other varieties of electrical stimulation as a treatment for tinnitus. How and why do these treatments work?
FH: These therapies work by using electromagnetic currents to temporarily disrupt the aberrant activity in the brain’s neurons. Some of the neuroplastic changes associated with tinnitus include neuron hyperactivity in the auditory cortices and altered functional connections between frontal and posterior (or auditory) cortices. rTMS, and other similar treat- ments attempt to reduce this hyperactivity through the application of an electrical or magnetic current in the affected brain areas. This treatment has been used successfully to treat other disorders, such as intractable depression, and it is a promising area of research. However, as of yet, there is no unequivocal evidence to say that such stimulation helps alleviate tinnitus loudness or distress associated with tinnitus for a majority of patients.
BF: Are there any external factors or stimuli that impact the brain’s generation of tinnitus? Are there foods, activities, or behaviors that impact brain function as it relates to tinnitus?
FH: Patients tell us, anecdotally, that caffeine, nico- tine, alcohol, and foods containing vitamin B, may help or hurt their tinnitus. However, when these inputs have been scientifically tested, the results do not indicate a strong effect on tinnitus.
With respect to behavioral changes, I would suggest that patients adopt habits or activities that increase a sense of control and enhance their self-efficacy. Reaction to tinnitus is both physiological and psy- chological, so every tool in our toolbox should be adopted. The specific behaviors that are empower- ing may be unique to each individual, so a degree of introspection may be necessary by patients to see what works for them.
20 Tinnitus Today | Summer 2014
anxiety that counseling has a distinct and measur- able effect on the brain. We can extrapolate from this to tinnitus, although we do not have brain imaging studies of counseling as an intervention in tinnitus.
FH: We know from research into depression and
BF: From a neurological perspective, how does counseling help with what’s going on in the brain?
shown that cognitive behavioral therapies are effec- tive in reducing the perceived burden of tinnitus, at least for a majority of patients. I believe counseling (my umbrella term for an array of different cogni- tive therapies) is currently an underappreciated and underutilized part of tinnitus management.
FH: Certainly! Randomized controlled trials have
BF: So cognitive behavioral therapy can be a part of effective tinnitus management?
Right now, there are well-established behavioral treatments that can help patients deal with tinnitus and its associated neuroplastic changes. Cognitive therapy, which combines education with counseling, is a type of ‘brain retraining’ that helps patients navigate around the negative neural, emotional, and behavioral patterns that exacerbate tinnitus.
than it is of encouraging compensatory neuroplastic changes. Newer changes may be sufficient to stop the continued generation of tinnitus. At the moment, scientists around the world are exploring options for affecting positive neuroplastic changes that can quiet tinnitus. Some of these experimental treatments include vagus nerve stimulation, cortical stimulation, and the development of potential pharmacological agents. At the moment, these are all in the experi- mental phase.
FH: It’s less a question of ‘reversing the changes’
BF: Can we reverse the changes in our brain that generate the perception of tinnitus?
is generated in the brain, doesn’t mean it is ‘made up.’ Tinnitus is no less ‘real’ than other medical con- ditions, like epilepsy, that stem from neurological hyperactivity.
FH: Of course not! Just because the tinnitus signal
BF: Some people hear that tinnitus is in the brain and conclude that it is somehow not a real medical condition… that it is an imaginary, mental or psy- chological issue. That’s not the case, right?
With respect to behavioral changes, I would suggest that patients adopt habits or activities that increase a sense of control and enhance their self-efficacy. Reaction to tinnitus is both physiological and psy- chological, so every tool in our toolbox should be adopted. The specific behaviors that are empower- ing may be unique to each individual, so a degree of introspection may be necessary by patients to see what works for them.
tine, alcohol, and foods containing vitamin B, may help or hurt their tinnitus. However, when these inputs have been scientifically tested, the results do not indicate a strong effect on tinnitus.
FH: Patients tell us, anecdotally, that caffeine, nico-
BF: Are there any external factors or stimuli that impact the brain’s generation of tinnitus? Are there foods, activities, or behaviors that impact brain function as it relates to tinnitus?
FH: These therapies work by using electromagnetic currents to temporarily disrupt the aberrant activity in the brain’s neurons. Some of the neuroplastic changes associated with tinnitus include neuron hyperactivity in the auditory cortices and altered functional connections between frontal and posterior (or auditory) cortices. rTMS, and other similar treat- ments attempt to reduce this hyperactivity through the application of an electrical or magnetic current in the affected brain areas. This treatment has been used successfully to treat other disorders, such as intractable depression, and it is a promising area of research. However, as of yet, there is no unequivocal evidence to say that such stimulation helps alleviate tinnitus loudness or distress associated with tinnitus for a majority of patients.
BF: There has been a lot of talk and research about repetitive transcranial magnetic stimulation (rTMS) and other varieties of electrical stimulation as a treatment for tinnitus. How and why do these treat- ments work?
soothing sounds or broad-band noises or sounds that help mask your tinnitus. When you have a low-level of surrounding or external noise, the contrast with your internal noise is reduced, and therefore you are better able to ignore it. But in terms of long-term relief or evidence about changes in neuroplasticity, we do not yet have conclusive data.
FH: There is short-term relief when you listen to
BF: What about sound therapy? Can listening to “notched” music, or other sounds modified to your specific tinnitus perception, create corrective neuro- plastic changes?
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32